bluuebunny/crossref_metadata_2025 huggingface dataset:
APOGEE detection of N-rich stars in the tidal tails of Palomar 5
Authors: Phillips Siân G , Schiavon Ricardo P , Mackereth J Ted , Allende Prieto Carlos , Anguiano Borja , Beaton Rachael L , Cohen Roger E , García-Hernández D A , Geisler Douglas , Horta Danny , Jönsson Henrik , Kisku Shobhit , Lane Richard R , Majewski Steven R , Mason Andrew , Minniti Dante , Schultheis Mathias , Taylor Dominic
Published: December 2021

Recent results from chemical tagging studies using Apache Point Observatory Galactic Evolution Experiment data suggest a strong link between the chemical abundance patterns of stars found within globular clusters (GC), and chemically peculiar populations in the Galactic halo field. In this paper, we analyse the chemical compositions of stars within the cluster body and tidal streams of Palomar 5, a GC that is being tidally disrupted by interaction with the Galactic gravitational potential. We report the identification of nitrogen-rich (N-rich) stars both within and beyond the tidal radius of Palomar 5, with the latter being clearly aligned with the cluster tidal streams; this acts as confirmation that N-rich stars are lost to the Galactic halo from GCs, and provides support to the hypothesis that field N-rich stars identified by various groups have a GC origin.
Accurate flux calibration of GW170817: is the X-ray counterpart on the rise?
Authors: Troja E , O’Connor B , Ryan G , Piro L , Ricci R , Zhang B , Piran T , Bruni G , Cenko S B , van Eerten H
Published: December 2021

X-ray emission from the gravitational wave transient GW170817 is well described as non-thermal afterglow radiation produced by a structured relativistic jet viewed off-axis. We show that the X-ray counterpart continues to be detected at 3.3 years after the merger. Such long-lasting signal is not a prediction of the earlier jet models characterized by a narrow jet core and a viewing angle ≈20 deg, and is spurring a renewed interest in the origin of the X-ray emission. We present a comprehensive analysis of the X-ray dataset aimed at clarifying existing discrepancies in the literature, and in particular the presence of an X-ray rebrightening at late times. Our analysis does not find evidence for an increase in the X-ray flux, but confirms a growing tension between the observations and the jet model. Further observations at radio and X-ray wavelengths would be critical to break the degeneracy between models.
Enhanced phase mixing of torsional Alfvén waves in stratified and divergent solar coronal structures – Paper I. Linear solutions
Authors: Boocock C , Tsiklauri D
Published: December 2021

We derive a corrected analytical solution for the propagation and enhanced phase mixing of torsional Alfvén waves, in a potential magnetic field with exponentially divergent field lines, embedded in a stratified solar corona. Further we develop a code named TAWAS that calculates the analytic solution describing torsional Alfvén waves using idl software language. We then use TAWAS to demonstrate that both our correction to the analytic solution and the inclusion of wave reflection have a significant impact on Alfvén wave damping. We continue to utilize TAWAS by performing a parameter study in order to identify the conditions under which enhanced phase mixing is strongest. We find that phase mixing is the strongest for high frequency Alfvén waves in magnetic fields with highly divergent field lines and without density stratification. We then present a finite difference solver, Wigglewave, which solves the linearized evolution equations for the system directly. Comparing solutions from TAWAS and Wigglewave we see that our analytical solution is accurate within the limits of the WKB approximation but under-reports the wave damping, caused by enhanced phase mixing, beyond the WKB limit. Both TAWAS and Wigglewave solve the linearized governing equations and not the complete non-linear magnetohydrodynamics (MHD) equations. Paper II will consider simulations that solve the full MHD equations including important non-linear effects.
Reproducing NGC 3109 association in numerical simulations
Authors: Micic M , Beslic I , Martinovic N
Published: December 2021

We investigate the origins of the uniquely elongated (1067 kpc in length and 97 kpc in width) association of galaxies known as NGC 3109, positioned at ∼ 1 Mpc from the Local Group (LG). To understand its likely origins, we have conducted a series of numerical simulations where the NGC 3109 association is represented as a regular, gravitationally bound N-body system of five galaxies, stripped from most of their dark matter due to previous tidal effects. The association evolves for 10 Gyr in an analytical potential representing the influence of the LG. We find that a loosely gravitationally bound system of five galaxies in a hyperbolic orbit toward the LG evolves into a tidally elongated structure similar to recent observations of NGC 3109. In this proof of concept model, the N-body simulations can reproduce the observations of the NGC 3109 association, such as its dimensions, as well as the radial velocity and distance from the LG.
The telomeric 5′ end nucleotide is regulated in the budding yeast Naumovozyma castellii
Authors: Itriago Humberto , Jaiswal Rishi K , Philipp Susanne , Cohn Marita
Published: December 2021

The junction between the double-stranded and single-stranded telomeric DNA (ds–ss junction) is fundamental in the maintenance of the telomeric chromatin, as it directs the assembly of the telomere binding proteins. In budding yeast, multiple Rap1 proteins bind the telomeric dsDNA, while ssDNA repeats are bound by the Cdc13 protein. Here, we aimed to determine, for the first time, the telomeric 5′ end nucleotide in a budding yeast. To this end, we developed a permutation-specific PCR-based method directed towards the regular 8-mer telomeric repeats in Naumovozyma castellii. We find that, in logarithmically growing cells, the 320 ± 30 bp long telomeres mainly terminate in either of two specific 5′ end permutations of the repeat, both corresponding to a terminal adenine nucleotide. Strikingly, two permutations are completely absent at the 5′ end, indicating that not all ds-ss junction structures would allow the establishment of the protective telomere chromatin cap structure. Using in vitro DNA end protection assays, we determined that binding of Rap1 and Cdc13 around the most abundant ds–ss junction ensures the protection of both 5′ ends and 3′ overhangs from exonucleolytic degradation. Our results provide mechanistic insights into telomere protection, and reveal that Rap1 and Cdc13 have complementary roles.
The positive feedback regulatory loop of miR160-Auxin Response Factor 17-HYPONASTIC LEAVES 1 mediates drought tolerance in apple trees
Authors: Shen Xiaoxia , He Jieqiang , Ping Yikun , Guo Junxing , Hou Nan , Cao Fuguo , Li Xuewei , Geng Dali , Wang Shicong , Chen Pengxiang , Qin Gege , Ma Fengwang , Guan Qingmei
Published: December 2021

Drought stress tolerance is a complex trait regulated by multiple factors. Here, we demonstrate that the miRNA160–Auxin Response Factor 17 (ARF17)–HYPONASTIC LEAVES 1 module is crucial for apple (Malus domestica) drought tolerance. Using stable transgenic plants, we found that drought tolerance was improved by higher levels of Mdm-miR160 or MdHYL1 and by decreased levels of MdARF17, whereas reductions in MdHYL1 or increases in MdARF17 led to greater drought sensitivity. Further study revealed that modulation of drought tolerance was achieved through regulation of drought-responsive miRNA levels by MdARF17 and MdHYL1; MdARF17 interacted with MdHYL1 and bound to the promoter of MdHYL1. Genetic analysis further suggested that MdHYL1 is a direct downstream target of MdARF17. Importantly, MdARF17 and MdHYL1 regulated the abundance of Mdm-miR160. In addition, the Mdm-miR160-MdARF17–MdHYL1 module regulated adventitious root development. We also found that Mdm-miR160 can move from the scion to the rootstock in apple and tomato (Solanum lycopersicum), thereby improving root development and drought tolerance of the rootstock. Our study revealed the mechanisms by which the positive feedback loop of Mdm-miR160-MdARF17-MdHYL1 influences apple drought tolerance.
Fear of Movement and Reinjury in Sports Medicine: Relevance for Rehabilitation and Return to Sport
Authors: Kvist Joanna , Silbernagel Karin Grävare
Published: December 2021

Athletes are defined by their ability to move and are often accustomed to pain as it relates to their sports and exercise regime. The forced movement restriction and pain associated with an acute or overuse injury has a profound effect not only on their physical abilities but also on their psychological well-being and social context. With the goal of returning to sport, the rehabilitation focus historically has been on recovery of physical attributes, but more recent research is addressing the psychological factors. This Perspective proposes that—according to the current evidence in sports medicine—the fear that affects choice of treatment, rehabilitation, and return to sports is intertwined with physical capacity and recovery of function. Past injury is also 1 of the main risk factors for a sports injury; therefore, fear of reinjury is not irrational. For an athlete, the fear related to a sports injury encompasses the fear of reinjury along with fear of not being able to return to the sport at their highest performance level—and the fear of having lifelong debilitating pain and symptoms. This Perspective reviews the evidence for the influence of fear of movement and reinjury on choice of treatment, rehabilitation, and return to sport and provides suggestions on how to address this fear during the continuum of treatment and return to sports.
Assessment of disability in idiopathic inflammatory myopathy: a call for linearity
Authors: Min Minoesch , Walter Anne W , Lim Johan , Eftimov Filip , Verhamme Camiel , de Visser Marianne , van Schaik Ivo N , Aggarwal Rohit , de Haan Rob J , van der Kooi Anneke J , Raaphorst Joost ,   the Dutch Myositis Network, Saris Christiaan G J , Brusse Esther , Hoogendijk Jessica E
Published: December 2021

Objectives

To evaluate the clinimetric properties of the Academic Medical Centre Disability Score (ALDS) in patients with idiopathic inflammatory myopathy (IIM).

Methods

We used prospectively collected data of IIM patients who completed a phase-2 study with first-line IVIG monotherapy. The ALDS is a patient-reported questionnaire which contains 25 items relevant for disability in myositis. ALDS and all core set measures (CSMs) for myositis [including HAQ-Disability Index (HAQ-DI)] were evaluated at baseline and 9 weeks follow-up. In addition, the 2016 ACR/EULAR myositis response criteria outcome called Total Improvement Score (TIS) was evaluated at 9 weeks. We examined floor/ceiling effects, reliability and construct validity of the ALDS. To examine known-group validity, ALDS change scores over time were compared with TIS and physician impression of clinical response.

Results

Nineteen patients with IIM [median age 59 years, 12 (63%) female] were enrolled. At baseline, ALDS showed a median score of 65.4 (IQR 58.2–73.5), good Cronbach’s alpha (α = 0.84) and a small ceiling effect (11%). Construct validity was confirmed by moderate to strong correlations between ALDS and HAQ-DI [rs = −0.57 (baseline); −0.86 (follow-up)]. ALDS change score correlated with TIS (rs = 0.70), discriminated between responders and non-responders (TIS ≥ 40; P = 0.001), between groups based on physician impression of clinical response (P = 0.03), and detected deterioration.

Conclusion

The ALDS showed promising clinimetric properties and detected relevant changes in disability in patients with myositis. These results warrant further investigations.
Interplay between genetics and lifestyle on pain susceptibility in women with fibromyalgia: the al-Ándalus project
Authors: Estévez-López Fernando , Guerrero-González Juan M , Salazar-Tortosa Diego , Camiletti-Moirón Daniel , Gavilán-Carrera Blanca , Aparicio Virginia A , Acosta-Manzano Pedro , Álvarez-Gallardo Inmaculada C , Segura-Jiménez Víctor , Soriano-Maldonado Alberto , Geenen Rinie , Delgado-Fernández Manuel , Martínez-González Luis J , Ruiz Jonatan R , Álvarez-Cubero María J
Published: December 2021

Objectives

It is widely acknowledged that the experience of pain is promoted by both genetic susceptibility and environmental factors such as engaging in physical activity (PA), and that pain-related cognitions are also important. Thus, the purpose of the present study was to test the association of 64 polymorphisms (34 candidate genes) and the gene–gene, gene–PA and gene–sedentary behaviour interactions with pain and pain-related cognitions in women with FM.

Methods

Saliva samples from 274 women with FM [mean (s.d.) age 51.7 (7.7) years] were collected for extracting DNA. We measured PA and sedentary behaviour by accelerometers for a week, pain with algometry and questionnaires, and pain-related cognitions with questionnaires. To assess the robustness of the results, a meta-analysis was also performed.

Results

The rs6311 and rs6313 polymorphisms (5-hydroxytryptamine receptor 2A, HTR2A) were individually related to algometer scores. The interaction of rs4818 (catechol-O-methyltransferase, COMT) and rs1799971 (opioid receptor μ gene, OPRM1) was related to pain catastrophizing. Five gene–behaviour interactions were significant: the interactions of sedentary behaviour with rs1383914 (adrenoceptor alpha 1A, ADRA1A), rs6860 (charged multivesicular body protein 1A, CHMP1A), rs4680 (COMT), rs165599 (COMT) and rs12994338 (SCN9A) on bodily pain subscale of the Short Form 36. Furthermore, the meta-analysis showed an association between rs4680 (COMT) and severity of FM symptoms (codominant model, P-value 0.032).

Conclusion

The HTR2A gene (individually), COMT and OPRM1 gene–gene interaction, and the interactions of sedentary behaviour with ADRA1A, CHMP1A, COMT and SCN9A genes were associated with pain-related outcomes. Collectively, findings from the present study indicate a modest contribution of genetics and gene–sedentary behaviour interaction to pain and pain catastrophizing in women with FM. Future research should examine whether reducing sedentary behaviour is particularly beneficial for reducing pain in women with genetic susceptibility to pain.
Reward Processing in Children With Psychotic-Like Experiences
Authors: Harju-Seppänen Jasmine , Irizar Haritz , Bramon Elvira , Blakemore Sarah-Jayne , Mason Liam , Bell Vaughan
Published: December 2021

Alterations to striatal reward pathways have been identified in individuals with psychosis. They are hypothesized to be a key mechanism that generate psychotic symptoms through the production of aberrant attribution of motivational salience and are proposed to result from accumulated childhood adversity and genetic risk, making the striatal system hyper-responsive to stress. However, few studies have examined whether children with psychotic-like experiences (PLEs) also exhibit these alterations, limiting our understanding of how differences in reward processing relate to hallucinations and delusional ideation in childhood. Consequently, we examined whether PLEs and PLE-related distress were associated with reward-related activation in the nucleus accumbens (NAcc). The sample consisted of children (N = 6718) from the Adolescent Brain Cognitive Development (ABCD) study aged 9–10 years who had participated in the Monetary Incentive Delay (MID) task in functional MRI. We used robust mixed-effects linear regression models to investigate the relationship between PLEs and NAcc activation during the reward anticipation and reward outcome stages of the MID task. Analyses were adjusted for gender, household income, ethnicity, depressive symptoms, movement in the scanner, pubertal development, scanner ID, subject and family ID. There was no reliable association between PLEs and alterations to anticipation- or outcome-related striatal reward processing. We discuss the implications for developmental models of psychosis and suggest a developmental delay model of how PLEs may arise at this stage of development.
N-Cycling Microbiome Recruitment Differences Between Modern and Wild Zea mays
Authors: Favela Alonso , Bohn Martin , Kent Angela
Published: December 2021

Rewilding modern agricultural cultivars by reintroducing beneficial ancestral traits is a proposed approach to improve sustainability of modern agricultural systems. In this study, we compared recruitment of the rhizosphere microbiome among modern inbred maize and wild teosinte to assess whether potentially beneficial plant microbiome traits have been lost through maize domestication and modern breeding. To do this, we surveyed the bacterial and fungal communities along with nitrogen (N)-cycling functional groups in the rhizosphere of six modern domesticated maize genotypes and ancestral wild teosinte genotypes, while controlling for environmental conditions and starting soil inoculum. Using a combination of high-throughput sequencing and quantitative PCR, we found that the rhizosphere microbiomes of modern inbred and wild teosinte differed substantially in taxonomic composition, species richness, and abundance of N-cycling functional genes. Furthermore, the modern versus wild designation explained 27% of the variation in the prokaryotic microbiome, 62% of the variation in N-cycling gene richness, and 66% of N-cycling gene abundance. Surprisingly, we found that modern inbred genotypes hosted microbial communities with higher taxonomic and functional gene diversity within their microbiomes compared with ancestral genotypes. These results imply that modern maize and wild maize differ in their interaction with N-cycling microorganisms in the rhizosphere and that genetic variation exists within genus Zea to potentially “rewild” microbiome-associated traits (i.e., exudation, root phenotypes, and so on).
Identity and Pathogenicity of Fungi Associated with Root, Crown, and Vascular Symptoms Related to Winter Squash Yield Decline
Authors: Rivedal Hannah M. , Tabima Javier F. , Stone Alexandra G. , Johnson Kenneth B.
Published: December 2021

Winter squash (Cucurbita maxima cultivar Golden Delicious) produced in Oregon’s Willamette Valley for edible seed production has experienced significant yield losses because of a soilborne disease. The symptoms associated with this disease problem include root rot, crown rot, and vascular discoloration in the stems, leading to a severe late season wilt and plant collapse. Through field surveys, Fusarium oxysporum, F. solani, F. culmorum-like fungi, Plectosphaerella cucumerina, and Setophoma terrestris were identified to be associated with diseased tissues, and each produced symptoms of root rot, crown rot, or stem discoloration in preliminary pathogenicity trials. In this study, 219 isolates of these species were characterized by molecular identity analyses using BLAST of the internal transcribed spacer and translation elongation factor 1 alpha genomic regions and by pathogenicity testing in outdoor, large-container trials. Molecular identity analyses confirmed the identity of isolates at 99 to 100% similarity to reference isolates in the database. In pathogenicity experiments, F. solani produced the most severe symptoms, followed by F. culmorum-like fungi, F. oxysporum, P. cucumerina, and S. terrestris. Some treatments of mixed-species inoculum produced symptom severity greater than what was expected from individual species. In particular, the mixture of F. culmorum-like fungi, F. oxysporum, and P. cucumerina and the mixture of F. culmorum-like fungi, F. solani, and S. terrestris had symptom ratings as high as that of F. solani by itself. Results indicate that this soilborne disease is caused primarily by Fusarium solani, but interactions between the complex of F. solani, F. culmorum-like fungi, F. oxysporum, and P. cucumerina can exacerbate disease severity.
Evaluation of Albumin Kinetics in Critically Ill Patients With Coronavirus Disease 2019 Compared to Those With Sepsis-Induced Acute Respiratory Distress Syndrome
Authors: Su Chang , Hoffman Katherine L. , Xu Zhenxing , Sanchez Elizabeth , Siempos Ilias I. , Harrington John S. , Racanelli Alexandra C. , Plataki Maria , Wang Fei , Schenck Edward J.
Published: December 2021

OBJECTIVES:

This report aims to characterize the kinetics of serum albumin in critically ill patients with coronavirus disease 2019 compared with critically ill patients with sepsis-induced acute respiratory distress syndrome.

DESIGN:

Retrospective analysis.

SETTING:

We analyzed two critically ill cohorts, one with coronavirus disease 2019 and another with sepsis-induced acute respiratory distress syndrome, treated in the New York Presbyterian Hospital-Weill Cornell Medical Center.

PATIENTS:

Adult patients in the coronavirus disease 2019 cohort, diagnosed through reverse transcriptase-polymerase chain reaction assays performed on nasopharyngeal swabs, were admitted from March 3, 2020, to July 10, 2020. Adult patients in the sepsis-induced acute respiratory distress syndrome cohort, defined by Sepsis III criteria receipt of invasive mechanical ventilation and a Pao
2/Fio
2 ratio less than 300 were admitted from December 12, 2006, to February 26, 2019.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We evaluated serial serum albumin levels within 30 days after ICU admission in each cohort. We then examined the albumin progression trajectories, aligned at ICU admission time to test the relationship at a similar point in disease progression, in survivors and nonsurvivors. Albumin trajectory in all critically ill coronavirus disease 2019 patients show two distinct phases: phase I (deterioration) showing rapid albumin loss and phase II (recovery) showing albumin stabilization or improvement. Meanwhile, albumin recovery predicted clinical improvement in critical coronavirus disease 2019. In addition, we found a deterioration and recovery trends in survivors in the sepsis-induced acute respiratory distress syndrome cohort but did not find such two-phase trend in nonsurvivors.

CONCLUSIONS:

The changes in albumin associated with coronavirus disease 2019 associated respiratory failure are transient compared with sepsis-associated acute respiratory distress syndrome and highlight the potential for recovery following a protracted course of severe coronavirus disease 2019.
Non-alcoholic steatohepatitis and risk of hepatocellular carcinoma
Authors: Rios Rafael S. , Zheng Kenneth I. , Zheng Ming-Hua
Published: December 2021

The emergence of non-alcoholic fatty liver disease (NAFLD) as the leading chronic liver disease worldwide raises some concerns. In particular, NAFLD is closely tied to sedentary lifestyle habits and associated with other metabolic diseases, such as obesity and diabetes. At the end of the disease spectrum, non-alcoholic steatohepatitis (NASH) may progress to cirrhosis and hepatocellular carcinoma (HCC), representing a serious health problem to modern society. Recently, an increasing number of HCC cases originating from this progressive disease spectrum have been identified, with different levels of severity and complications. Updating the current guidelines by placing a bigger focus on this emerging cause and highlighting some of its unique features is necessary. Since, the drivers of the disease are complex and multifactorial, in order to improve future outcomes, having a better understanding of NASH progression into HCC may be helpful. The risks that can promote disease progression and currently available management strategies employed to monitor and treat NASH-related HCC make up the bulk of this review.
Estimation of Burden of Kidney Dysfunction in HIV-Infected Pediatrics and Adolescents by Use of Urinary Neutrophil Gelatinase-Associated Lipocalin: A Single Center Experience in Kenya
Authors: Lomole Anne P. , Macharia William M. , Limbe Mary S. , Kinuthia Doris W. , Kabinga Samuel K.
Published: December 2021

Background:

About 75% of patients infected with human immunodeficiency virus (HIV) live in sub-Saharan Africa. In Kenya, about 1.5 million Kenyans are living with HIV, of whom almost 100,000 are children and adolescents. Highly active antiretroviral therapy (HAART) has converted HIV infection to a chronic illness with its attendant complications. Kidney disease is a common complication of HIV infection and its treatment. Kidney disease in HIV-infected persons can be asymptomatic, insidious onset and may lack specific clinical features. It can only be detected on active screening. The urine albumin-to-creatinine ratio and estimated glomerular filtration rate (eGFR) using serum creatinine are not sensitive in identification of early kidney injury. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) has been used as marker of early kidney injury.

Methods:

This cross-sectional study used uNGAL and serum creatinine to determine the prevalence of kidney dysfunction in HIV-infected children and adolescents with HAART at Gertrude's Children's Hospital, Nairobi, Kenya, from March 2016 to February 2017. Urine samples were assayed for uNGAL using the Bio Porto® enzyme-linked immunosorbent assay. Serum creatinine was assayed using the Jaffe reaction in the Cobas® 6000 biochemistry analyzer and eGFR calculated using the Schwartz formula. Scatter plot of eGFR against log uNGAL levles was performed by Statistical Package for Social Sciences and Pearson correlation coefficeint between log uNGAL levles and eGFR was analyzed.

Results:

Ninety-three patients were recruited. Their mean age was 11.8 ± 3.6 years and the median duration on HAART was 72.6 months. Males were 47 (50.5%). The prevalence of kidney dysfunction using uNGAL was 15.1% (95% CI 7.6%–22.5%) and 5.4% (95% CI 1.8%–12.1%) by eGFR. The mean eGFR was 131 ± 25 mL·min−1·1.73 m−2 and median uNGAL was 10 ng/mL. For every one ng/mL increase in uNGAL value above the normal value, eGFR decreases by 4.8 mL·min−1·1.73 m−2 (P = 0.038). Patients with elevated uNGAL were older when compared with those with normal uNGAL (13.5 vs. 11.5 years).

Conclusion:

Urinary NGAL picked up to three times more patients with kidney dysfunction than eGFR derived from serum creatinine. All the patients were asymptomatic. Older children and adolescents were more likely to manifest with kidney dysfunction. Further studies are necessary to evaluate if uNGAL can be utilized routinely to evaluate for early kidney disease in HIV-infected patients.
Safety of 3 Tesla Magnetic Resonance Imaging in Patients With Auditory Brainstem Implants
Authors: Wichova Helena , Peng Kevin , Ledbetter Luke , Slattery William , Brackmann Derald , Lekovic Gregory
Published: December 2021

Objective:

To evaluate the safety of 3 Tesla (T) magnetic resonance imaging (MRI) in patients with auditory brainstem implants (ABI) with the magnet removed at implantation and report incidence of complications.

Study Design:

Retrospective chart review.

Setting:

Tertiary neurotology ambulatory practice.

Patients:

Patients with diagnosis of Neurofibromatosis, type 2 (NF2) with functional ABIs.

Intervention(s):

Observational recordings.

Main Outcome Measure(s):

Of the 89 patients meeting inclusion criteria, 7 patients underwent 3T MRI, with a total of 39 scans done. Three patients had 1 scan each, one patient had 4 scans, one patient had 5 scans, one patient had 6 scans, and one patient had 21 scans. The mean time between ABI placement and first 3 T scan was 118 ± 73 months. The most common indication for imaging was surveillance of NF2 lesions. The most frequent scans were MRI brain (25.6%), followed by MRI of cervical (15%), thoracic (15%) and lumbar (15%) spine, and MRI IAC (8%). There were no reported complications for any of the scans. No scans were interrupted due to patient discomfort. There were no device malfunctions.

Conclusions:

3 T MRIs are safe in patients with ABIs as long as the magnet is removed. It is recommended that the magnet be removed at the time of implantation in all NF2 patients, who require frequent surveillance.
Optimal Light Source Intensity Setting in Endoscopic Ear Surgery
Authors: Vachutka Jaromir , Trneckova Marketa , Salzman Richard , Kolarova Hana , Belakova Petra
Published: December 2021

Hypothesis:

Higher light intensity settings do not yield improved image quality in endoscopic ear surgery.

Background:

Light intensity is a parameter with major impact on the quality of digital images. For ear surgery, light produces heat associated with a thermal risk to ear structures and the light source setting should be accordingly optimized.

Methods:

Several series of still images were acquired during live middle ear surgery, using cadaveric and plastic temporal bone models and with three-dimensional printed models. Images obtained under varying light intensities were compared with the image acquired at maximum intensity of a light emitting diode light source. We analyzed digital image brightness and noise using quantitative methods.

Results:

Our measurements revealed significantly decreased image brightness with light intensities set below 20% with an increase in noise at light intensities lower than 30%.

Conclusion:

The optimal light source setting corresponded to 30% intensity in our experimental set-up. Special attention should be given to those cases where faster image quality degradation is expected (dark or bloody scenes or larger cavities). The results were strongly dependent on the equipment used. The methods described in this study can serve as a general guide for determining the optimal light source setting in any specific set-up.
Early Outcomes of a New Active Transcutaneous Bone Conduction Implant in Pediatric Patients
Authors: You Peng , Choi Alexander , Drob Jennifer , Hunsaker Sabrina Marciante , Liu Yi-Chun Carol , Silva Rodrigo
Published: December 2021

Objective:

To describe the early surgical and audiometric outcomes in pediatric patients implanted with a new active transcutaneous bone conduction implant system.

Study Design:

Retrospective case review.

Setting:

Tertiary pediatric hospital.

Patients:

Pediatric patients (18 or younger) with conductive or mixed hearing loss that completed postoperative aided testing following implantation with the Cochlear Osia system from December 2019 to December 2020.

Intervention:

Rehabilitative.

Main Outcome Measure:

Preoperative air conduction (AC), preoperative bone conduction (BC), and postoperative aided thresholds were compared. Pure-tone averages (PTA), air-bone gap (ABG), and functional gain were calculated. Surgical complications and patient satisfaction were summarized from the chart review.

Results:

Sixteen patients (20 implants) met the inclusion criteria. The average age at the time of implantation was 12.9 ± 2.4 years. The preoperative AC and BC thresholds were 64.4 dB (±11.9 dB) and 7.9 dB (±4.90 dB), respectively, with an average ABG of 56.5 dB (±12.8 dB). The average postoperative aided threshold was 21.2 dB (± 4.25 dB) with a mean functional gain of 43.1 dB (±10.2 dB). One patient developed seroma postoperatively, which was treated conservatively. No other complications were reported over a mean follow-up time of 7.1 ± 4 months. For 13 patients with previous passive bone conduction implants or devices, the Osia system was universally favored.

Conclusions:

The new active transcutaneous bone conduction system showed favorable early clinical and audiometric outcomes. Repeated processor connectivity issues represent a potential area for future device development. This is the largest pediatric case series to date.

Level of Evidence: Level 4—Retrospective Review.
Outcomes of Stapedotomy in Patients With Concomitant Otosclerosis and Superior Semicircular Canal Dehiscence: Should a Radiographic Third-Window Be a Contraindication to Stapes Surgery?
Authors: Sioshansi Pedrom C. , Drury Emily E. , Tu Nathan C. , Babu Seilesh C. , Schutt Christopher A.
Published: December 2021

Objective:

Review surgical outcomes of stapedotomy in patients with concomitant otosclerosis and superior semicircular canal dehiscence.

Study design:

Retrospective case review.

Setting:

Tertiary referral center.

Patients:

Patients with otosclerosis and radiographic superior semicircular canal dehiscence undergoing stapedotomy between 2008 and 2020.

Intervention:

Stapedotomy.

Main outcome measures:

Pre- and postoperative hearing and unmasking of third-window symptoms. Hearing was measured by air conduction (AC) and bone conduction (BC) pure-tone averages (PTA), air-bone gap (ABG), and word recognition scores (WRS). Third-window symptoms included hyperacusis, autophony, sound- or pressure-induced vertigo, imbalance, or oscillopsia.

Results:

Twenty patients with otosclerosis and radiographic superior semicircular canal dehiscence underwent stapedotomy, 13 primary and 7 revision. Mean AC PTA was 49.3 dB preoperatively and 35.6 dB postoperatively (p = 0.0077), while the ABG improved on average from 23.9 to 9.68 dB (p < 0.0001). The ABG improved to ≤10 dB in 12/20 patients (60%), and ≤20 dB in 18/20 patients (90%). There was no significant difference in BC PTA or WRS postoperatively. Two patients (10%) experienced potential transient unmasking of third-window symptoms—hyperacusis and prolonged imbalance—which both resolved. There were no other complications. There was no significant difference in audiologic outcomes or unmasking of third window symptoms between primary or revision cases.

Conclusions:

Persistent conductive hearing loss is common following stapedotomy for otosclerosis in patients with concomitant superior semicircular canal dehiscence. However, a majority of patients can achieve excellent hearing outcomes, while unmasking of third window symptoms appears to be rare. Radiographic superior semicircular canal dehiscence may not be an absolute contraindication to stapes surgery for otosclerosis.
Door to Needle Count Down
Authors: El Nahas Nevine M. , Shokri Hossam M. , Roushdy Tamer M. , Dawood Noha L. , Abushady Eman M. , Georgy Shady S. , Zaki Amr S. , Bedros Rady Y. , Aref Hany M.
Published: December 2021

Background:

The purpose of this study is to share our experience in changing hospital strategies to achieve rapid thrombolysis in acute ischemic stroke (AIS) patients in 2 university stroke centers. Rapid reperfusion by shortening door to needle time (DTN) reduces morbidity and mortality for patients with AIS. Our aim is to evaluate the effect of applying certain logistic strategies to reduce DTN for thrombolysis and its impact on clinical outcome.

Methods:

In this retrospective registry-based observational study from the SITS-ISTR Dataset, we studied AIS patients admitted to 2 stroke centers in Ain Shams University over 3 successive years from 2016 till 2018. We analyzed change of DTN and outcome at 3 months by modified Rankin scale over these 3 years.

Results:

By the end of the 3 year period there was a 6.1% increase in number of patients receiving thrombolysis. There was a significant decrease of median DTN by 41%, and increase in percentage of patients receiving recombinant tissue plasminogen activator within a shorter DTN. Also, the number of patients with a favorable outcome (modified Rankin scale≤2) increased by 23.3%. There was insignificant difference regarding mortality rate.

Conclusion:

Applying a goal-directed corrective strategy to improve quality of service can, in a short time, reduce DTN and improve patient outcome.
Community-Based Rehabilitation Promotes the Functional Recovery of Patients After Intracerebral Hemorrhage
Authors: Qian Hong , Chen Shuangxi , Chen Yarui , Chang Yunqian , Li Yihui , Dou Shiying , Chen Qianlan , Wang Gang , Xie Ming
Published: December 2021

Background:

Intracerebral hemorrhage (ICH), a severe disorder with the high death rate, high recurrence rate and high disability rate, affected the quality of human life. Community-based rehabilitation (CBR) helps disabled people at both community and family levels. However, the effect of CBR on the recovery of people after ICH remains unclear.

Methods:

Patients were treated with the CBR training program, subsequently, medication compliance test, clinical neural impairment measurements, functional comprehensive assessments, improved Barthel index score, and life qualities assessments were to performed at 3-month or 6-month intervention of CBR to evaluate the influence of CBR on the medication compliance, physical function and life quality of patients after ICH.

Results:

After the treatment of CBR, we observed that, the rate of medication compliance, motor function, functional comprehensive rating scale score, modified Barthel index score, and generic quality of life inventory-74 in the CBR-treated group were significantly higher than that in the control group; the neural impairment measure score in the CBR-treated group was significantly decreased in comparison to the control group.

Conclusion:

CBR increased the medication compliance, promoted the recovery of the neurological function and improved the life qualities of ICH patients.
Translating Phenomenology of Psychogenic Nonepileptic Seizures Into Nosology
Authors: Janocko Nicholas J. , Morton Matthew L. , Groover Olivia , Teagarden Diane L. , Villarreal Hannah K. , Merchant Shanaz , Ahuruonye Ndubuisi , Rodriguez-Ruiz Andres A. , Drane Daniel L. , Karakis Ioannis
Published: December 2021

Background:

Patients with psychogenic nonepileptic seizures (PNES) can be semiologically dichotomized into those with hyperkinetic and those with paucikinetic events. The objective of this study was to compare characteristics of patients with diverse phenomenology and their caregivers to evaluate for differences that could inform about disease nosology.

Methods:

Patients and caregivers monitored at the Epilepsy Monitoring Unit completed surveys about sociodemographic and disease characteristics, treatment and health care utilization, physical and psychosocial impact, and epilepsy knowledge. Patients were classified into hyperkinetic versus paucikinetic based on their recorded events. Comparison of the 2 populations was performed using Student t test for continuous variables and Fischer exact test for categorical variables.

Results:

Forty-three patients with Epilepsy Monitoring Unit confirmed PNES and 28 caregivers were enrolled. Patients with hyperkinetic events were more commonly non-White patients and necessitated greater caregiving time. Otherwise, no statistically significant differences were seen between the 2 semiologically diverse groups of patients and caregivers in their sociodemographic (age, sex, employment, income, marital, and education) and disease (age of onset, duration, seizures frequency) characteristics, treatment (number of antiseizure medications before diagnosis, side effects) and health care utilization (emergency room visits, hospitalizations, clinic visits), physical (injuries) and psychosocial (depression, anxiety, quality of life, stigma, burden) characteristics, nor in their knowledge about seizures.

Conclusions:

Hyperkinetic events were more frequently encountered in non-White patients and required more caregiving time. Further research is required to elucidate if phenomenological dichotomy of PNES can inform about their nosological basis, and if it can guide treatment and define prognosis.
Management of Chronic Subdural Hematoma in Patients Requiring Therapeutic Anticoagulation
Authors: Neth Bryan J. , Ighodaro Eseosa T. , Brinjikji Waleed , Cloft Harry , Scharf Eugene L.
Published: December 2021

Introduction:

A common risk factor of chronic, nontraumatic subdural hematoma (SDH) is anticoagulation therapy. Anticoagulation is generally held in patients who develop SDH, but this can lead to thromboembolic events. While prior studies have reported the clinical outcomes of patients with anticoagulation-related SDH, there remains little evidence regarding ongoing anticoagulation treatment.

Case Report:

We report the management of 2 patients who developed anticoagulation-related SDH and underwent middle meningeal artery (MMA) embolization and successful reinitiation of anticoagulation therapy. In both patients, we conservatively managed anticoagulation with heparin and/or enoxaparin as a bridge to warfarin after MMA embolization. Follow-up computed tomography head revealed interval decrease of SDH and stable neurological status.

Conclusions:

These cases provide anecdotal evidence of a challenging clinical scenario where there is a necessary indication for therapeutic anticoagulation (ie, venous sinus thrombosis or atrial appendage thrombus) and comorbid SDH. Endovascular MMA embolization may be an effective adjunct therapy for clinical scenarios in patients with SDH and an urgent indication for anticoagulation. Longer follow-up, prospective series, and future randomized clinical trials are needed to objectively assess outcomes in this clinically challenging patient population.
Diaphragmatic Mesothelial Cyst: Radiological Appearance and Follow-Up Results During Childhood
Authors: Akdulum Ismail , Öztürk Mehmet , Karatoprak Sinan , Akyüz Melih , Sığırcı Ahmet , Boyunaga Öznur Leman
Published: December 2021

To identify radiological findings of diaphragmatic mesothelial cysts (DMC) in the pediatric age group and to assess follow-up outcomes.

In this study, 27 pediatric age group patients were evaluated with ultrasonography (US), computed tomography (CT), or magnetic resonance imaging due to various clinical indications and diagnosed with DMC from May 2014 to September 2018. Age, sex, imaging indications and DMC localization, volumes in the first diagnosis, and follow-ups were retrospectively evaluated. Descriptive statistics were used for age, sex, imaging indications, and volume are presented as numbers and percentages.

Ages range from 5 months to 13 years. Nine girls and 18 boys included in this study. The most common imaging indications were abdominal pain, diarrhea, and obesity. The mean volume of DMC was at first 2.62 and 2.45 mL during the follow-ups. There was volume reduction in 24 cases, and no change in 3 cases. Mean follow-up duration was 22.4 months. The US imaging findings were similar for all cases, bilobular cystic lesion with fat indentation between the cyst and liver parenchyma.

The typical localization and lateral fat sign are useful in differential diagnosis of DMC from cystic lesions of liver. The US is a very effective and beneficial radiological method for diagnosis and follow-up. Routine clinical and sonographic follow-ups may be sufficient for asymptomatic patients with stable cyst volume.
Interobserver Variability of Ultrasound Features Based on American College of Radiology Thyroid Imaging Reporting and Data System Lexicon in American College of Radiology Thyroid Imaging Reporting and Data System System
Authors: Özel Alper , Türkyılmaz Mut Deniz , Ağrıdağ Üçpınar Burçin , Özdal Sayer Ayşe , Yanç Uğur , von Bodelschwingh Bade , Gemalmaz Ali
Published: December 2021

The aim of this study is to evaluate the variability of selecting the ultrasound features used in American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) and in assigning the ACR-TIRADS level in a single center among radiologists and radiology residents. The study cohort consisted of 108 thyroid nodules in 102 patients who had definite cytology results after thyroid fine needle aspiration biopsy (Bethesda category II, VI) or surgery. Seven observers including 3 radiologists and 4 radiology residents evaluated the nodules according to 5 ultrasound feature categories. The evaluation process was performed after a joint meeting session, in which the “white papers” of the ACR-TIRADS committee were discussed regarding the thyroid ultrasound reporting lexicon, and final TIRADS system. Variability of ultrasound features and assigning ACR-TIRADS level was measured using Fleiss kappa statistics. Agreement for ultrasound features was “substantial” to “almost perfect” among all observers, with composition (κ = 0.86), macrocalcification (κ = 0.89) and peripheral calcification (κ = 0.92) at the highest level of agreement. The level of agreement for large comet tail artifacts and punctate echogenic foci was “moderate” in residents, whereas in radiologists, that level was “substantial.” The agreement for assigning ACR-TIRADS level was moderate in resident as well as in radiologist subgroup. Agreement of thyroid ultrasound features was “substantial to almost perfect” among all observers. Although the level of agreement among resident group decreased to “moderate” level, ACR-TIRADS is a useful system in thyroid nodule management.
Reconstruction of Complete Bilateral Maxillary Defects With Free Flaps
Authors: Yu Sen , Zhang Wen-Bo , Wang Yang , Mao Chi , Guo Chuan-Bin , Peng Xin
Published: December 2021

Reconstruction of complete bilateral maxillary defects (CBMDs) can be challenging due to the extensive loss of bone and soft tissues. This is a retrospective case series of 46 consecutive patients with CBMDs that were reconstructed with different micro-vascular free flaps. The authors aimed to evaluate the surgical outcomes and discuss the different reconstruction options in this case series. Thirty-six patients underwent reconstruction following ablation surgery for malignant tumors, 6 for benign tumors, 3 patients were treated for osteomyelitis, and 1 patient underwent free flap reconstruction for posttraumatic defects. Free fibula flap (n = 26) is the most commonly used reconstruction method in this case series, which was used in all defect types. This is followed by anterolateral thigh flap (n = 10), 5 rectus abdominis myocutaneous free flap, 3 radial forearm free flaps, and 2 composite free flaps. In this series, 44 free flaps survived, whereas only 2 flaps were lost. All patients could resume a soft diet postoperatively. Reconstruction of CBMDs with vascularized free flaps is a safe and reliable procedure.
The Effect of Cryotherapy Application on Postoperative Pain
Authors: Muaddi Hala , Lillie Erin , Silva Stephanie , Cross Jori-Lee , Ladha Karim , Choi Stephen , Mocon Aaron , Karanicolas Paul
Published: December 2021

Objective:

To systematically review and meta-analyze whether the application of cryotherapy on closed incisions reduces postoperative pain and opioid consumption.

Background:

Reduction of acute pain and opioid use is important in the postoperative phase of patient care. ‘‘Cryotherapy’’ refers to the use of low temperatures for therapeutic purposes.

Methods:

MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Online registries of clinical trial were search until October 2019. RCT that examined postoperative application of cryotherapy over surgical incisions in adults compared to no cryotherapy were eligible. Selection, extraction, and risk of bias appraisal were completed in duplicate. Data were synthesized using random effects meta-analyses. The outcomes of interest were postoperative pain, opioid use, hospital length of stay (LOS) and surgical site infection (SSI).

Results:

Fifty-one RCTs (N = 3425 patients) were included. With moderate certainty evidence, patients treated with cryotherapy experienced a reduction in pain on postoperative day 1 (standardized mean differences −0.50, 95% CI −0.71 to −0.29, l
2

= 74%) and day 2 (standardized mean differences −0.63, 95% CI −0.91 to −0.35, I
2
= 83%) relative to without cryotherapy application. With moderate certainty of evidence, cryotherapy reduces opioid consumption in morphine milliequivalents and morphine milliequivalents/kg, (mean differences –7.43, 95% CI –12.42, –2.44, I
2
= 96%) and (mean differences −0.89, 95% CI −1.45, −0.33, I2= 99%), respectively. With low certainty evidence, cryotherapy does not affect hospital LOS or rate of SSI.

Conclusion:

Cryotherapy is a pragmatic, noncostly intervention that reduces postoperative pain and opioid consumption with no effect on SSI rate or hospital LOS.