bluuebunny/crossref_metadata_2025 huggingface dataset:
Large variability in feeding behavior among crossbred growing cattle
Authors: Kelly David N , Sleator Roy D , Murphy Craig P , Conroy Stephen B , Judge Michelle M , Berry Donagh P
Published: July 2020

The purpose of this study was to define an extensive suite of feeding behavior traits in growing crossbred cattle and to investigate their phenotypic inter-relationships as well as relationships with other performance and efficiency traits. Time-series feeding behavior data, as well as feed intake and liveweight records, were available for 624 growing crossbred cattle, of which 445 were steers and 179 were heifers. Feeding behavior repeatability estimates were calculated using linear mixed models. Additionally, partial Spearman correlations were estimated among 14 feeding behavior traits, as well as between feeding behavior with both performance and feed efficiency traits, using residuals retained from linear mixed models. The marginal contribution of several feeding behavior traits to the variability in metabolizable energy intake (MEI) was also determined. Repeatability estimates of 0.57, 0.36, and 0.48 were calculated for the number of feed events per day, the total time spent feeding per day, and the feeding rate, respectively. Cattle that ate more frequently each day, ate at a faster rate and consumed less energy in each visit to the feed bunk. More efficient cattle fed less often per day and fed for a shorter duration per day; they also had a slower feeding rate and fed for longer in each visit to the feed bunk. Moreover, heavier cattle fed for a longer duration per day had a faster feeding rate, but fed less often per day; heavier animals also fed first in the pen after the fresh feed was offered. The number of feed events per day and feeding time per day together explained an additional 13.4 percentage points of the variability in MEI above that already explained by all of growth rate, liveweight, and backfat depth. The results from the present study suggest that several repeatable time-series-related feeding behavior traits, that are less resource intensive to measure, may have a role as useful predictor traits of important but relatively difficult to record traits, such as feed intake and efficiency.
Excessive heating of 00-rapeseed meal reduces not only amino acid digestibility but also metabolizable energy when fed to growing pigs
Authors: Oliveira Maryane S F , Wiltafsky-Martin Markus K , Stein Hans H
Published: July 2020

Two experiments were conducted to test the hypothesis that both the degree of heating and the time that heat is applied will affect the concentration of DE and ME, and the apparent ileal digestibility (AID) and the standardized ileal digestibility (SID) of amino acids (AA) in 00-rapeseed meal (00-RSM) fed to growing pigs. The nine treatments were prepared using a conventional 00-RSM that was either not autoclaved or autoclaved at 110 °C for 15 or 30 min or at 150 °C for 3, 6, 9, 12, 15, or 18 min. In experiment 1, 20 growing barrows with an average initial BW of 21.2 ± 1.2 kg were randomly allotted to the 10 diets in a replicated 10 × 4 Youden square with 10 diets and four periods in each square. A corn-based basal diet and nine diets containing corn and each source of 00-RSM were formulated. Urine and fecal samples were collected for 5 d after 7 d of adaptation. In experiment 2, nine diets contained one of the nine sources of 00-RSM as the sole source of AA, and an N-free diet that was used to measure basal endogenous losses of AA and CP was formulated. Twenty growing barrows with an initial BW of 69.8 ± 5.7 kg had a T-cannula installed in the distal ileum and were allotted to a 10 × 7 Youden square design with 10 diets and 7 periods. Ileal digesta were collected on days 6 and 7 of each 7-d period. Results from the experiments indicated that there were no effects of autoclaving at 110 °C on DE and ME or on AID and SID of AA in 00-RSM, but DE and ME, and AID and SID of AA were less (P < 0.01) if 00-RSM was autoclaved at 150 °C compared with 110 °C. At 150 °C, there were decreases (quadratic, P < 0.05) in DE and ME, and in AID and SID of AA as heating time increased. In conclusion, autoclaving at 110 °C did not affect ME or SID of AA in 00-RSM, but autoclaving at 150 °C had negative effects on ME and SID of AA and the negative effects increased as heating time increased.
Toxic Metal-Containing Particles in Aerosols from Pod-Type Electronic Cigarettes
Authors: Pappas R Steven , Gray Naudia , Halstead Mary , Valentin-Blasini Liza , Watson Clifford
Published: July 2020

The popularity of electronic cigarettes (electronic nicotine delivery systems or ENDS) has grown rapidly over the past decade. With the continued evolution of ENDS, and the arrival of newer replaceable pod devices on the market, it is prudent to examine their emissions to help determine potential health risks to the user. Metal-containing particles were examined in aerosol from several pod-based devices from three manufacturers that offer flavored liquids in their respective products. Previous ENDS metal emissions studies focused on the total toxic metal concentrations in aerosols and have suggested that the principal sources are oxidized internal metal components that are in contact with the liquid. Most metal oxides have limited solubility, and it is likely that some metal content in ENDS aerosol may present as particles rather than dissolved forms. Examining the composition and number of particles in the ENDS aerosols is important because inhaled metal oxide particles cause pulmonary inflammation. Chronic inhalation of ENDS aerosol may lead to inflammatory cell activation in the lungs. Therefore, this study was designed to measure metal oxide particle concentrations and sizes in ENDS aerosols from select pod-based systems. Aerosol samples were generated with pod liquids (tobacco, mint or menthol) from devices produced by three manufacturers using CORESTA Recommended Method 81 parameters with a high-purity fluoropolymer aerosol trap. Particle sizes for chromium, iron, nickel, copper, zinc, tin and lead oxides were measured in triplicate using single particle inductively coupled plasma–mass spectrometry and dynamic light scattering. A novel aspect of these measurements included using dual element particle analysis to infer particle source component material. Particle concentrations in aerosols from the devices were variable between devices and from pod to pod, ranging from no detectable chromium- and zinc-containing particles in aerosol from some pods to 222,000 lead containing particles per 10 puffs from individual pods.
LncRNA PCAT18/miR-301a/TP53INP1 axis is involved in gastric cancer cell viability, migration and invasion
Authors: Dou Jin , Tu Daoyuan , Zhao Haijian , Zhang Xiaoyu
Published: July 2020

MiR-301a is as an oncogene involved in the regulation of gastric cancer (GC) progression, but the underlying mechanism is unclear. This study was to explore the lncRNA PCAT18/miR-301a/TP53INP1 axis in regulating the GC cell proliferation and metastasis. In the present study, GC tissues and cell lines were collected for the detection of PCAT18 expression. Herein, we found that PCAT18 is significantly decreases in human GC tissues and five GC cell lines. Overexpression of PCAT18 inhibits cell viability, invasion and migration of GC cells and tumour growth of GC xenograft tumours. PCAT18 negatively regulates the expression level of miR-301a. The interaction between PCAT18 and miR-301a is confirmed by RIP and RNA pull down. MiR-301a mimic increases cell viability and promotes cell migration and invasion and reverses the inhibitory action of PCAT18. TP53INP1 expression is negatively regulated by miR-301a and TP53INP1/miR-301a is involved in GC viability, migration and invasion. The promoting of PCAT18 on TP53INP1 expression is abolished by miR-301a overexpression. In conclusion, lncRNA PCAT18 acts as a tumour suppressor for GC and lncRNA PCAT18, miR-301a and TP53INP1 comprise a signal axis in regulating GC cell proliferation, migration and invasion.
Depth and productivity as predictive parameters for the widespread invasion of Arctodiaptomus dorsalis (Marsh, 1907) (Copepoda: Calanoida) in tropical lakes in the Philippines
Authors: de Leon Justine R , Guinto Shea K P , Tordesillas Dino T , Papa Rey D S
Published: July 2020

A massive invasion of the Neotropical calanoid copepod Arctodiaptomus dorsalis (Marsh, 1907) has been taking place in the Philippines since at least 1993. This copepod’s fecundity is known to depend on food concentration, increasing temperature appears to have detrimental effects on its hatching success and survivorship, but parameters that are truly predictive of the successful integration and propagation of this species in particular bodies of water have not yet been identified. We conducted a spatial analysis of morphometric features and reproductive capacity, the latter proxied by clutch size (CS), of different populations of A. dorsalis inhabiting 11 tropical lakes in the Philippines. Correlations between either morphometry or CS and selected water quality parameters were investigated based on collections and measurements made from December 2018 to April 2019. Means of morphometric measurements differed significantly (P < 0.001) among the populations of A. dorsalis in all lakes. Total length (TL) of adult males, TL of non-ovigerous adult females, and CS of ovigerous females all showed significant (P < 0.001) inverse correlations with lake depth, accounting for about 30% of the observed variability among lakes (r = –0.55, –0.55, and –0.58, respectively). Shallow lakes, which are more homogenous in terms of nutrient distribution throughout the water column, thus provide a more suitable habitat than deep lakes for A. dorsalis and provides a partial explanation of the widespread occurrence and abundance of the species in the shallower, more eutrophic lakes in the Philippines.
Exploring Black Girls’ Recommendations for Healthy Lifestyle Interventions to Address Obesity
Authors: Jernigan Maryam M
Published: July 2020

Objective This mixed-methods study investigated Black girls’ (N = 15) definitions of health and reports on socio-ecological factors that influenced health attitudes, beliefs, and behaviors. Participants were surveyed about their emotional health, body image, experiences of discrimination, and eating patterns. Methods Directed content analysis was used to identify themes, categories, and capture the depth of information conveyed. The study also used the Nominal Group Technique to elicit recommendations about intervention content, structure, and facilitation of a healthy lifestyle program targeting Black girls. Participants represented various ethnic backgrounds, ranged in age from 14 to 17 years (M = 16), and were in the ninth and 10th grades. Participants also represented a specific sample of Black adolescent girls who are medically categorized as obese. Results Findings indicated that Black girls use an intersectional (race–gender) lens to frame their definitions of health and inform health-related behaviors. Recommendations for obesity interventions targeting Black girls include leveraging time during school to deliver services, intentional selection of program facilitators to include race–gender similarities, and professionals trained to work with adolescents. Additionally, considerations for provider–patient interactions include the use of nonstigmatizing language and direct communication. Conclusion Findings serve to address the paucity of culturally responsive interventions targeting Black girls’ health. Implications include enhancement of program retention and sustained engagement to facilitate effective treatment outcomes and address the disparity in the prevalence of obesity. In doing so, there is a potential to reduce health disparities associated with increased weight as Black girls’ transition into adulthood.
SNR G39.2−0.3, an hadronic cosmic rays accelerator
Authors: de Oña Wilhelmi Emma , Sushch Iurii , Brose Robert , Mestre Enrique , Su Yang , Zanin Roberta
Published: July 2020

Recent results obtained with gamma-ray satellites have established supernova remnants as accelerators of GeV hadronic cosmic rays. In such processes, CRs accelerated in SNR shocks interact with particles from gas clouds in their surrounding. In particular, the rich medium in which core-collapse SNRs explode provides a large target density to boost hadronic gamma-rays. SNR G39.2–0.3 is one of the brightest SNR in infrared wavelengths, and its broad multiwavelength coverage allows a detailed modelling of its radiation from radio to high energies. We reanalysed the Fermi-LAT data on this region and compare it with new radio observations from the MWISP survey. The modelling of the spectral energy distribution from radio to GeV energies favours a hadronic origin of the gamma-ray emission and constrains the SNR magnetic field to be at least ∼100 µG. Despite the large magnetic field, the present acceleration of protons seems to be limited to ∼10 GeV, which points to a drastic slow down of the shock velocity due to the dense wall traced by the CO observations, surrounding the remnant. Further investigation of the gamma-ray spectral shape points to a dynamically old remnant subjected to severe escape of CRs and a decrease of acceleration efficiency. The low-energy peak of the gamma-ray spectrum also suggests that that the composition of accelerated particles might be enriched by heavy nuclei which is certainly expected for a core-collapse SNR. Alternatively, the contribution of the compressed pre-existing Galactic cosmic rays is discussed, which is, however, found to not likely be the dominant process for gamma-ray production.
Global analysis of the TRAPPIST Ultra-Cool Dwarf Transit Survey
Authors: Lienhard F , Queloz D , Gillon M , Burdanov A , Delrez L , Ducrot E , Handley W , Jehin E , Murray C A , Triaud A H M J , Gillen E , Mortier A , Rackham B V
Published: July 2020

We conducted a global analysis of the TRAPPIST Ultra-Cool Dwarf Transit Survey – a prototype of the SPECULOOS transit search conducted with the TRAPPIST-South robotic telescope in Chile from 2011 to 2017 – to estimate the occurrence rate of close-in planets such as TRAPPIST-1b orbiting ultra-cool dwarfs. For this purpose, the photometric data of 40 nearby ultra-cool dwarfs were reanalysed in a self-consistent and fully automated manner starting from the raw images. The pipeline developed specifically for this task generates differential light curves, removes non-planetary photometric features and stellar variability, and searches for transits. It identifies the transits of TRAPPIST-1b and TRAPPIST-1c without any human intervention. To test the pipeline and the potential output of similar surveys, we injected planetary transits into the light curves on a star-by-star basis and tested whether the pipeline is able to detect them. The achieved photometric precision enables us to identify Earth-sized planets orbiting ultra-cool dwarfs as validated by the injection tests. Our planet-injection simulation further suggests a lower limit of 10 per cent on the occurrence rate of planets similar to TRAPPIST-1b with a radius between 1 and 1.3 R⊕ and the orbital period between 1.4 and 1.8 d.
SPIDERS: overview of the X-ray galaxy cluster follow-up and the final spectroscopic data release
Authors: Clerc N , Kirkpatrick C C , Finoguenov A , Capasso R , Comparat J , Damsted S , Furnell K , Kukkola A E , Ider Chitham J , Merloni A , Salvato M , Gueguen A , Dwelly T , Collins C , Saro A , Erfanianfar G , Schneider D P , Brownstein J , Mamon G A , Padilla N , Jullo E , Bizyaev D
Published: July 2020

SPIDERS (The SPectroscopic IDentification of eROSITA Sources) is a large spectroscopic programme for X-ray selected galaxy clusters as part of the Sloan Digital Sky Survey-IV (SDSS-IV). We describe the final data set in the context of SDSS Data Release 16 (DR16): the survey overall characteristics, final targeting strategies, achieved completeness, and spectral quality, with special emphasis on its use as a galaxy cluster sample for cosmology applications. SPIDERS now consists of about 27 000 new optical spectra of galaxies selected within 4000 photometric red sequences, each associated with an X-ray source. The excellent spectrograph efficiency and a robust analysis pipeline yield a spectroscopic redshift measurement success rate exceeding 98 per cent, with a median velocity accuracy of 20 km s−1 (at z = 0.2). Using the catalogue of 2740 X-ray galaxy clusters confirmed with DR16 spectroscopy, we reveal the 3D map of the galaxy cluster distribution in the observable Universe up to z ∼ 0.6. We highlight the homogeneity of the member galaxy spectra among distinct regions of the galaxy cluster phase space. Aided by accurate spectroscopic redshifts and by a model of the sample selection effects, we compute the galaxy cluster X-ray luminosity function and we present its lack of evolution up to z = 0.6. Finally we discuss the prospects of forthcoming large multiplexed spectroscopic programmes dedicated to follow up the next generation of all-sky X-ray source catalogues.
The first broad-band X-ray view of the narrow-line Seyfert 1 Ton S180
Authors: Matzeu G A , Nardini E , Parker M L , Reeves J N , Braito V , Porquet D , Middei R , Kammoun E , Lusso E , Alston W N , Giustini M , Lobban A P , Joyce A M , Igo Z , Ebrero J , Ballo L , Santos-Lleó M , Schartel N
Published: July 2020

We present joint XMM–Newton and NuSTAR observations of the ‘bare’ narrow-line Seyfert 1 Ton S180 (z = 0.062), carried out in 2016 and providing the first hard X-ray view of this luminous galaxy. We find that the 0.4–30 keV band cannot be self-consistently reproduced by relativistic reflection models, which fail to account simultaneously for the soft and hard X-ray emission. The smooth soft excess prefers extreme blurring parameters, confirmed by the nearly featureless nature of the Reflection Grating Spectrometer (RGS) spectrum, while the moderately broad Fe K line and the modest hard excess above 10 keV appear to arise in a milder gravity regime. By allowing a different origin of the soft excess, the broad-band X-ray spectrum and overall spectral energy distribution (SED) are well explained by a combination of (a) direct thermal emission from the accretion disc, dominating from the optical to the far/extreme UV; (b) Comptonization of seed disc photons by a warm (kTe ∼ 0.3 keV) and optically thick (τ ∼ 10) corona, mostly contributing to the soft X-rays; (c) Comptonization by a standard hot ($kT_{\rm \mathrm{ e}}\gtrsim 100$ keV) and optically thin (τ < 0.5) corona, responsible for the primary X-ray continuum; and (d) reflection from the mid/outer part of the disc. The two coronae are suggested to be rather compact, with $R_{\rm hot}\lesssim R_{\rm warm}\lesssim 10\, r_{\rm g}$. Our SED analysis implies that Ton S180 accretes at super-Eddington rates. This is a key condition for the launch of a wind, marginal (i.e. 3.1σ significance) evidence of which is indeed found in the RGS spectrum.
Prion protein lowering is a disease-modifying therapy across prion disease stages, strains and endpoints
Authors: Minikel Eric Vallabh , Zhao Hien T , Le Jason , O’Moore Jill , Pitstick Rose , Graffam Samantha , Carlson George A , Kavanaugh Michael P , Kriz Jasna , Kim Jae Beom , Ma Jiyan , Wille Holger , Aiken Judd , McKenzie Deborah , Doh-ura Katsumi , Beck Matthew , O’Keefe Rhonda , Stathopoulos Jacquelyn , Caron Tyler , Schreiber Stuart L , Carroll Jeffrey B , Kordasiewicz Holly B , Cabin Deborah E , Vallabh Sonia M
Published: July 2020

Lowering of prion protein (PrP) expression in the brain is a genetically validated therapeutic hypothesis in prion disease. We recently showed that antisense oligonucleotide (ASO)-mediated PrP suppression extends survival and delays disease onset in intracerebrally prion-infected mice in both prophylactic and delayed dosing paradigms. Here, we examine the efficacy of this therapeutic approach across diverse paradigms, varying the dose and dosing regimen, prion strain, treatment timepoint, and examining symptomatic, survival, and biomarker readouts. We recapitulate our previous findings with additional PrP-targeting ASOs, and demonstrate therapeutic benefit against four additional prion strains. We demonstrate that <25% PrP suppression is sufficient to extend survival and delay symptoms in a prophylactic paradigm. Rise in both neuroinflammation and neuronal injury markers can be reversed by a single dose of PrP-lowering ASO administered after the detection of pathological change. Chronic ASO-mediated suppression of PrP beginning at any time up to early signs of neuropathology confers benefit similar to constitutive heterozygous PrP knockout. Remarkably, even after emergence of frank symptoms including weight loss, a single treatment prolongs survival by months in a subset of animals. These results support ASO-mediated PrP lowering, and PrP-lowering therapeutics in general, as a promising path forward against prion disease.
Evidence That ‘Candidatus Liberibacter asiaticus’ Moves Predominantly Toward New Tissue Growth in Citrus Plants
Authors: Raiol-Junior Laudecir L. , Cifuentes-Arenas Juan C. , de Carvalho Everton V. , Girardi Eduardo A. , Lopes Silvio A.
Published: July 2020

‘Candidatus Liberibacter asiaticus’ (Las) is an unculturable, phloem-limited, insect-transmitted bacterium associated with the Asiatic form of huanglongbing (HLB), the most destructive citrus disease. In Asia and the Americas, it is transmitted by the Asian citrus psyllid (Diaphorina citri Kuwavama). Despite considerable research, little is known about the processes involved in plant infection and colonization by Las. This study was conducted to determine whether the basal portion (below girdling) of the plant is an important route for Las to move laterally from a point of inoculation on a branch to pathogen-free branches elsewhere in the canopy, and to quantify the influence of actively growing tissues on vertical upward (acropetally) or downward (basipetally) movement of Las. Nongirdled and fully or partially girdled stems of potted plants of ‘Pera’ sweet orange, graft-inoculated above or below girdling, were sampled in distinct regions and assessed by qPCR, 6 months postinoculation. Las invaded all regions of partially and nongirdled plants but remained restricted to the inoculated regions of fully girdled plants, evidence that in planta bacterium movement is limited to the phloem. In fully girdled plants, starch accumulated above the girdling site, probably because of changes in flow of phloem sap. To study the influence of actively growing tissues, inoculated ‘Valencia’ sweet orange plants were kept intact or were top- or root-pruned to force production of new tissues, and sampled at 15-day intervals. Las migrated rapidly and most predominantly toward newly developing root and leaf tissues. The rapid and predominant movement of Las to newly developed shoots and roots would explain failures of canopy heat treatments and pruning to cure HLB-affected trees, and reinforces the need to protect rapidly growing new shoots from feeding by D. citri in order to minimize transmission and spread of the pathogen by the vector within and between orchards.
Genome Resource of Sphingomonas carotinifaciens L9-754T, an Endophyte Isolated From Leaf Tissues of Jatropha curcas
Authors: Li Gengmi , Qin Jian , Zhang Tao , Yang Li , Yang Qianhua , Cao Yingjiang , Tang Bin , Li Zhaoxiang , Luo Jing , You Shumei , Wan Xianqi , Liu Ying , Guo Longbiao , Jiang Kaifeng , Zheng Jiakui
Published: July 2020

Sphingomonas carotinifaciens strain L9-754T (DSM 27347) is a gram-negative, chemoheterotrophic, and rod-shaped endophyte isolated from the stem tissues of Jatropha curcas L. This strain has putative in vitro antagonistic ability against the plant pathogenic fungus Magnaporthe grisea. A draft genome of L9-754T was obtained using the PacBio SMRT cell platform. By analyzing the genome of strain L9-754T, a gene cluster (GQR91_18700 - GQR91_18715) related to an antioxidant enzyme was identified in the obtained draft genome. The information obtained from the draft genome is expected to reveal the putative properties helpful in biocontrol applications.
Faculty Survey on the Status of Lymphology Education in Professional Doctor of Physical Therapy Programs
Authors: Doubblestein David A. , Yorke Amy M. , Larson Cathy A.
Published: July 2020

Background and Purpose:

The lymphatic system is vital for fluid homeostasis, waste removal, immunity, and tissue healing. It can be impacted by multiple diseases and traumatic processes seen by physical therapists across practice settings; hence, lymphology education in professional (entry-level) doctor of physical therapy (DPT) programs is needed. Studies to obtain information about professional DPT lymphology education have not been conducted for 20 years. The purposes of this study were to (1) describe current, typical lymphology content within professional DPT programs; and (2) identify whether lymphology content is perceived as entry-level material amongst professional DPT faculty who were responsible for teaching lymphology content (TL) and professional DPT faculty who did not teach lymphology content (NTL).

Subjects:

Professional DPT faculty (N = 43) in the United States who taught or did not teach lymphology curriculum.

Methods:

Cross-sectional online survey research design. Descriptive data were gathered on lymphology content, hours, and curriculum standings. The χ2 test assessed relationships between faculty status and entry-level lymphology curriculum status. The Spearman rank correlation coefficient assessed relationships between teaching hours and entry-level status.

Results:

Variability exists across curricula in range of hours devoted to didactic (0.4-14.1 hours) and laboratory (0-10 hours) instruction pertaining to lymphology. Individual curriculum contents were predominantly considered entry-level material.

Limitations:

Response rate was limited.

Conclusion:

Consistent lymphology curriculum content and format are lacking within the professional DPT programs that participated in the survey, indicating opportunities for advancements in entry-level lymphology education and investigation into best educational practices for teaching this content.
Radiographic Predictors of Difficult McGrath MAC Videolaryngoscopy in Patient Undergoing Cervical Spine Surgery
Authors: Yoon Sehee , Oh Hyongmin , Yoon Hyun-Kyu , Lee Hyung-Chul , Park Hee-Pyoung
Published: July 2020

Background:

McGrath MAC videolaryngoscopy is a useful technique for successful intubation in cervical spine-injured patients with manual in-line stabilization of the neck during intubation. We aimed to identify radiographic predictors of difficult McGrath MAC videolaryngoscopy in patient undergoing cervical spine surgery.

Methods:

Patients undergoing cervical spine surgery who were intubated with a McGrath MAC videolaryngoscope under manual in-line stabilization of the neck between June 2016 and August 2018 were included in this study. Data on airway-related variables and radiographic indices obtained from preoperative lateral cervical spine x-ray, magnetic resonance imaging, and computed tomography (CT) scans were retrospectively collected. Patients were divided into difficult and easy McGrath MAC videolaryngoscopic intubation groups on the basis of intubation time and the number of intubation attempts.

Results:

In total, 183 patients were included in the study of which 33 (18%) showed difficult videolaryngoscopic intubation. In multivariate logistic regression analysis, atlanto-occipital distance (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.62-0.89; P=0.001) on lateral cervical spine x-ray, incisor-C1-C6 angle in neck extension on lateral cervical spine x-ray (OR, 1.12; 95% CI, 1.02-1.22; P=0.015), tongue area/oral cavity area ratio in the mid-sagittal plane of cervical magnetic resonance imaging or computed tomography (OR, 1.12; 95% CI, 1.05-1.19; P<0.001), and interincisor gap (OR, 0.92; 95% CI, 0.86-0.98; P=0.015) were independent risk factors for difficult videolaryngoscopic intubation.

Conclusions:

Radiographic variables indicating enlarged tongue relative to the oral cavity and limited neck extension were associated with difficult McGrath MAC videolaryngoscopy in patients undergoing cervical spine surgery with manual in-line cervical stabilization during intubation.
The Effects of Anesthetics on Glioma Progression: A Narrative Review
Authors: Gray Kristen , Avitsian Rafi , Kakumanu Saranya , Venkatraghavan Lashmi , Chowdhury Tumul
Published: July 2020

There are many established factors that influence glioma progression, including patient age, grade of tumor, genetic mutations, extent of surgical resection, and chemoradiotherapy. Although the exposure time to anesthetics during glioma resection surgery is relatively brief, the hemodynamic changes involved and medications used, as well as the stress response throughout the perioperative period, may also influence postoperative outcomes in glioma patients. There are numerous studies that have demonstrated that choice of anesthesia influences non-brain cancer outcomes; of particular interest are those describing that the use of total intravenous anesthesia may yield superior outcomes compared with volatile agents in in vitro and human studies. Much remains to be discovered on the topic of anesthesia’s effect on glioma progression.
A Case Report of Donnai-Barrow Syndrome
Authors: Robinson Melissa K. , Coe Kristi , Bradshaw Wanda T.
Published: July 2020

Background:

A genetic disorder should be considered when an infant presents with multiple congenital anomalies. Because of the acute presentation of an infant with multiple life-threatening defects, a genetic diagnosis of a rare disorder took weeks to delineate.

Clinical Findings:

This case describes a late preterm infant who presented at birth with congenital diaphragmatic hernia, tetralogy of Fallot, cleft lip, low-set ears, and hypertelorism.

Primary Diagnosis:

Donnai-Barrow syndrome was the final diagnosis confirmed by a defect observed on the LRP2 (2q31.1) gene using sequence analysis. This is a rare disorder that presents with a variety of phenotypic features in infants.

Interventions:

Initial neonatal resuscitation in the delivery room included intubation, positive pressure ventilation, and oxygen supplementation. Extracorporeal membrane oxygenation therapy was initiated from day of life 3 to 15. Initial surgery included correction of the congenital diaphragmatic hernia, and further surgical procedures included tracheostomy, gastrostomy tube, circumcision, ventricular septal defect repair, and cleft lip repair. Physical, occupational, and speech therapies were also initiated.

Outcomes:

The infant was transported to a pediatric rehabilitation facility at 6 months of life for further management of his chronic lung disease requiring tracheostomy with ventilator dependence.

Practice Recommendations:

Early recognition and diagnosis of genetic syndromes can improve family education and guide treatment interventions. An underlying syndrome should be suspected when an infant presents with multiple congenital defects. Infants with Donnai-Barrow syndrome should have thorough cardiac, neurologic, ophthalmologic, audiologic, and renal examinations due to the gene mutation effects on those systems.
Factors Associated With the Need for Pharmacological Management of Neonatal Opioid Withdrawal Syndrome
Authors: Scott Lisa Fath , Guilfoy Veronica , Duwve Joan M. , Rawl Susan M.
Published: July 2020

Background:

Neonatal opioid withdrawal syndrome (NOWS) is a significant and growing health problem that affects more than 23,000 infants annually, with an estimated hospital cost of more than $720 million.

Purpose:

The purpose of this study was to examine factors associated with the need to initiate medication for the treatment of NOWS.

Methods:

A retrospective review of medical records was conducted of 204 infants born to mothers who used opioids during pregnancy from April 2011 to September 2017. Associations between maternal, infant, and environmental factors and the need for neonatal pharmacological management were examined using χ2,ttests, and regression analysis.

Results:

Of 204 neonates exposed to opioids prenatally, 121 (59%) developed symptoms of NOWS, requiring treatment with morphine. Neonates requiring morphine had significantly higher gestational ages (37.7 weeks vs 36.4 weeks;P< .001), and mothers were present at the neonate's bedside for a lower proportion of their total hospital stay (57% vs 74% of days;P< .001). Maternal factors associated with the need for neonatal medication treatment included the mother's reason for opioid use (P= .014), primary type of opioid used (P< .001), tobacco use (P= .023), and use of benzodiazepines (P= .003).

Implications for Practice:

This research provides information regarding the proportion of infants exposed to opioids prenatally who develop NOWS that requires treatment, as well as maternal, infant, and environmental factors associated with the need for neonatal medication use.

Implications for Research:

Future research is needed to examine these relationships prospectively in a larger and more diverse sample.
Tackling global challenges in pediatric rheumatology
Authors: Lewandowski Laura B.
Published: July 2020

Purpose of the review

To highlight the current challenges in diagnosis and clinical care of pediatric rheumatic disease and barriers to research and education of pediatric rheumatologists worldwide.

Recent findings

Recent studies and reports demonstrate a paucity of studies on epidemiology, outcomes, and management guidelines from many regions of the world. There have been noteworthy efforts to bridge the gap in under resourced areas. An analysis of the global burden of rheumatic disease has demonstrated that while understudied, musculoskeletal diseases are prevalent and increasingly contribute to loss of years of healthy life. In juvenile idiopathic arthritis, two milestone publications in global pediatric rheumatology have recently been published. An international study evaluated the epidemiology, treatment, and outcomes of juvenile idiopathic arthritis and demonstrated global diversity in both clinical manifestations and outcomes. Notably, the first guidelines for managing pediatric rheumatic disease in a less resourced setting have been published for juvenile idiopathic arthritis. This document offers the first publication targeted to address challenges faced by pediatric rheumatology caregivers in low-resourced settings. These documents serve as exemplars for international collaboration in pediatric rheumatology and can be used as models for other pediatric rheumatic disease research. Other efforts are making progress in various arenas towards increasing access to care, education, and training in pediatric rheumatology.

The global burden of rheumatic disease in the pediatric population is poorly understood but unrecognized disease greatly impacts the overall morbidity and mortality in this population. More studies in lesser resourced regions are needed to prioritize access to pediatric rheumatology care and prioritize a further increase in research capacity and education moving forward.
Optimal Technical Factors During Operative Management of Low-Energy Femoral Neck Fractures
Authors: Schottel Patrick C. , Blankstein Michael , Sprague Sheila , Swiontkowski Marc , Bzovsky Sofia , Bhandari Mohit , Schemitsch Emil H. ,   on behalf of the FAITH Investigators
Published: July 2020

Objective:

To determine if cancellous screw (CS) and sliding hip screw (SHS) technical factors during low-energy femoral neck fracture fixation affects a 24-month revision surgery rate and health-related quality of life (HRQL).

Design:

Prospective randomized controlled study.

Setting:

International, multicenter.

Patients:

Eight hundred ninety-eight femoral neck fracture patients age 50 years and older.

Intervention:

Patients were randomized to fracture stabilization with either CSs or a SHS device as part of the Fixation Using Alternative Implants for the Treatment of Hip Fractures (FAITH) trial. CS technical factors analyzed included screw diameter, short versus long screw threads, screw number and formation, screw orientation, and washer use. SHS technical factors studied were side plate length, supplemental screw use, lag screw position, and tip–apex distance.

Main Outcome Measurements:

Revision surgeries within 24 months to promote fracture healing, relieve pain, treat infection, or improve function. In addition, HRQL measures were collected, including the SF-12 Physical Component Score and Western Ontario and McMaster Universities Osteoarthritis Index.

Results:

The 3-screw inverted triangle pattern had a significantly lower revision surgery rate than a 3-screw triangle formation (P = 0.004). No other CS or SHS technical factors were predictive of revision surgery or affected a patient's HRQL (P > 0.05).

Conclusions:

A 3-screw inverted triangle pattern was superior to a 3-screw triangle formation. However, injury and patient factors such as fracture displacement, age, smoking status and sex play a more significant role in clinical outcomes for low-energy femoral neck fracture treatment.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Why Make the Cut? Trochanteric Slide Osteotomy Can Improve Exposure to the Anterosuperior Acetabulum
Authors: Phelps Kevin D. , Crickard Colin V. , Li Katherine , Harmer Luke S. , Andrews McArthur Erica , Sample Robinson Katherine , Sims Stephen H. , Hsu Joseph R.
Published: July 2020

Objective:

To define relative increases in visual bony surface area and access to critical landmarks with the addition of a trochanteric slide osteotomy to a Kocher–Langenbeck approach.

Methods:

A Kocher–Langenbeck approach followed by a trochanteric slide osteotomy was sequentially performed on 10, fresh-frozen, hemipelvectomy cadaveric specimens. Visual and palpable access to relevant surgical landmarks was recorded. Calibrated digital photographs were taken of each approach and analyzed using Image J.

Results:

The acetabular surface area exposed was 27.66 (±6.67) cm2 for a Kocher–Langenbeck approach. This increased to and 41.82 (±7.97) cm2 with the addition of a trochanteric osteotomy. The exposed surface area was increased by 51.2% for the trochanteric osteotomy (P < 0.001). The superior margin of the acetabulum could be visualized and palpably accessed in both exposures. Access to the more anterosuperior portions of the acetabulum was consistently possible in the trochanteric osteotomy but not with the Kocher–Langenbeck approach.

Conclusions:

A trochanteric osteotomy may visually improve access to the most anterosuperior acetabulum but does not significantly improve surgical access to relevant portions of the superior acetabulum when compared with a Kocher–Langenbeck approach.
Therapeutic Facet Joint Interventions in the Lumbar Spine
Authors: Mazmudar Aditya , Nayak Rusheel , Patel Alpesh A.
Published: July 2020

Objective:

In this narrative review, the current literature on therapeutic interventions for low back pain of facet joint etiology is assessed from an economic value perspective.

Summary of Background Data:

The efficacy and economics of facet joint interventions in the treatment of lumbar back pain is a controversial topic. Trends show that facet joint interventions are becoming increasingly used, perhaps as physicians become more averse to treating chronic low back pain with opioids. With the emphasis on value-based spine care and changing reimbursement models, the perspective of rigorously evaluating the outcomes these interventions provide and the costs they incur is particularly relevant.

Discussion:

Although the evidence is noted to be limited, most systematic reviews fail to demonstrate the therapeutic utility of intra-articular facet joint injections in low back pain because of high study heterogeneity. A few good quality studies and systematic reviews describe moderate evidence for the utilization of therapeutic medial branch blocks and radiofrequency neurotomies in alleviating facet joint pain.

Conclusion:

Consequently, there is a need for high-quality cost-effectiveness studies for facet joint interventions so that evidence-based and economically viable solutions can be used to optimize patient care at a societally affordable price.
Patient Outcomes Following Short-segment Lumbar Fusion Are Not Affected by PI-LL Mismatch
Authors: Divi Srikanth N. , Kepler Christopher K. , Hilibrand Alan S. , Goyal Dhruv K.C. , Mujica Victor E. , Radcliff Kristen E. , Anderson David Greg , Kurd Mark F. , Rihn Jeffrey A. , Kaye Ian D. , Woods Barrett R. , Vaccaro Alexander R. , Schroeder Gregory D.
Published: July 2020

Study Design:

This is a retrospective cohort study.

Objective:

The objective of this study was to further elucidate the relationship between pelvic incidence-lumbar lordosis (PI-LL) mismatch and surgical outcomes in patients undergoing short segment lumbar fusions for degenerative lumbar disease.

Summary of Background Data:

There are few studies examining the relationship between spinopelvic parameters and patient reported outcome measurements (PROMs) in short segment lumbar degenerative disease.

Materials and Methods:

A retrospective review was conducted at single academic institution. Patients undergoing 1- or 2-level lumbar fusion were retrospectively identified and separated into 2 groups based on postoperative PI-LL mismatch ≤10 degrees (NM) or PI-LL mismatch >10 degrees (M). Outcomes including the Physical Component Score (PCS)-12, Mental Component Score (MCS)-12, Oswestry Disability Index (ODI), Visual Analog Scale (VAS) back and leg scores were analyzed. Absolute PROM scores, the recovery ratio and the percentage of patients achieving minimum clinically important difference between groups were compared and a multiple linear regression analysis was performed.

Results:

A total of 306 patients were included, with 59 patients in the NM group and 247 patients in the M group. Patients in the M group started with a higher degree of PI-LL mismatch compared with the NM group (22.2 vs. 7.6 degrees, P<0.001) and this difference increased postoperatively (24.7 vs. 2.5 degrees, P<0.001). There were no differences between the 2 groups in terms of baseline, postoperative, or Δ outcome scores (P>0.05). In addition, having a PI-LL mismatch was not found to be an independent predictor of any PROM on multivariate analysis (P>0.05).

Conclusion:

The findings in this study show that even though patients in the M group had a higher degree of mismatch preoperatively and postoperatively, there was no difference in PROMs.

Level of Evidence:

Level III.
New targets and technologies for CAR-T cells
Authors: Freitag Fabian , Maucher Marius , Riester Zeno , Hudecek Michael
Published: July 2020

Purpose of review

Immunotherapy with gene-engineered chimeric antigen receptor (CAR)-T cells has curative potential in advanced malignancies and undergoes a surging preclinical and clinical development. Here, we present a selection of new targets and technologies that illustrate the progress that is being made with the aspiration to make CAR-T cell therapy a universally applicable and effective treatment in cancer medicine.

Recent findings

There is a rich pipeline of new target antigens for CAR-T cells in hematology and oncology that are rated based on uniformity but also stability of expression on tumor cells under therapeutic pressure. New technologies in CAR-T cell engineering are directed at neutralizing inhibitory ligands and factors in the tumor microenvironment, preventing CAR-T cell exhaustion and enhancing selectivity for tumor cells with ‘smart’ CAR designs. The manufacture of CAR-T cells using virus-free protocols is anticipated to reduce supply-chain complexity and to improve patient access.

CD19 CAR-T cell therapy is an approved treatment for B-cell leukemia and -lymphoma and considering the current ‘target and technology’ pipeline, we anticipate that additional CAR-T cell products will accomplish their ‘breakthrough’ and clinical proof-of-concept in other indications in hematology and in oncology. Technologies to enhance therapeutic index and facilitate manufacturing will be key for assuring availability and accessibility of CAR-T cell products and their implementation into routine clinical practice.
Toxicity of combined targeted therapy and concurrent radiotherapy in metastatic melanoma patients: a single-center retrospective analysis
Authors: Ziegler Johanna S. , Kroeze Stephanie , Hilbers Marie-Luise , Imhof Laurence , Guckenberger Matthias , Levesque Mitchell P. , Dummer Reinhard , Cheng Phil , Mangana Joanna
Published: July 2020

The Eastern Cooperative Oncology Group consensus guidelines from 2016 recommend interruption of targeted therapy with BRAF- and MEK-inhibitors during radiotherapy with data being based mostly on BRAF monotherapy. The aim of this study is to provide data on the safety of concurrent radiotherapy and combination targeted therapy with BRAF- and MEK-inhibitors. A total of 32 patients with 51 sessions of radiotherapy from one center receiving concurrent radiotherapy and BRAF- and MEK- inhibitors were included. Radiotherapy-associated toxicities were retrospectively collected. Incidence was compared between three groups: (A) targeted therapy during radiotherapy with and, (B) without interruption, and (C) radiotherapy before the start of targeted therapy. Survival and local disease control were examined. Targeted therapy was interrupted during radiotherapy in 16, not interrupted in 14, and only started after radiotherapy in 21 sessions. Stereotactic radiotherapy was applied in 28 sessions, conventionally fractionated radiotherapy in 23. The brain was the most common site of irradiation (n = 36). Radiotherapy-associated toxicities occurred in 41.2% (n = 21) of sessions and did not differ significantly among the groups. Overall survival was 11.7 months and progression-free survival was 8.4 months. No increase in radiotherapy-associated toxicity was seen where combination targeted therapy was not interrupted during radiotherapy. Prospective clinical trials are warranted to support our findings.
Meta-analysis of Proportions Using Generalized Linear Mixed Models
Authors: Lin Lifeng , Chu Haitao
Published: July 2020

Epidemiologic research often involves meta-analyses of proportions. Conventional two-step methods first transform each study’s proportion and subsequently perform a meta-analysis on the transformed scale. They suffer from several important limitations: the log and logit transformations impractically treat within-study variances as fixed, known values and require ad hoc corrections for zero counts; the results from arcsine-based transformations may lack interpretability. Generalized linear mixed models (GLMMs) have been recommended in meta-analyses as a one-step approach to fully accounting for within-study uncertainties. However, they are seldom used in current practice to synthesize proportions. This article summarizes various methods for meta-analyses of proportions, illustrates their implementations, and explores their performance using real and simulated datasets. In general, GLMMs led to smaller biases and mean squared errors and higher coverage probabilities than two-step methods. Many software programs are readily available to implement these methods.