bluuebunny/crossref_metadata_2025 huggingface dataset:
The maximum accretion rate of hot gas in dark matter haloes
Authors: Stern Jonathan , Fielding Drummond , Faucher-Giguère Claude-André , Quataert Eliot
Published: January 2020

We revisit the question of ‘hot mode’ versus ‘cold mode’ accretion on to galaxies using steady-state cooling flow solutions and idealized 3D hydrodynamic simulations. We demonstrate that for the hot accretion mode to exist, the cooling time is required to be longer than the free-fall time near the radius where the gas is rotationally supported, Rcirc, i.e. the existence of the hot mode depends on physical conditions at the galaxy scale rather than on physical conditions at the halo scale. When allowing for the depletion of the halo baryon fraction relative to the cosmic mean, the longer cooling times imply that a virialized gaseous halo may form in halo masses below the threshold of $\sim 10^{12}\, {\rm M_{\odot }}$ derived for baryon-complete haloes. We show that for any halo mass there is a maximum accretion rate for which the gas is virialized throughout the halo and can accrete via the hot mode of ${\dot{M}}_{\rm crit}\approx 0.7(v_{\rm c}/100\, \rm km\ s^{-1})^{5.4}(R_{\rm circ}/10\, {\rm kpc})(Z/\, {\rm Z_{\odot }})^{-0.9}\, {\rm M_{\odot }}\, {\rm yr}^{-1}$, where Z and vc are the metallicity and circular velocity measured at Rcirc. For accretion rates $\gtrsim {\dot{M}}_{\rm crit}$ the volume-filling gas phase can in principle be ‘transonic’ – virialized in the outer halo but cool and free-falling near the galaxy. We compare ${\dot{M}}_{\rm crit}$ to the average star formation rate (SFR) in haloes at 0 < z < 10 implied by the stellar-mass–halo-mass relation. For a plausible metallicity evolution with redshift, we find that ${\rm SFR}\lesssim {\dot{M}}_{\rm crit}$ at most masses and redshifts, suggesting that the SFR of galaxies could be primarily sustained by the hot mode in halo masses well below the classic threshold of $\sim 10^{12}\, {\rm M_{\odot }}$.
Wind collision and accretion simulations of the massive binary system HD 166734
Authors: Kashi Amit
Published: January 2020

I have run hydrodynamic simulations that follow the colliding wind structure of the massive binary system HD 166734 along its binary orbit. I show that close to periastron passage the secondary wind is suppressed and the secondary accretes mass from the primary wind. The system consists of two blue supergiants with masses of $M_1 \approx 39.5 ~\rm {M_{\odot }}$ and $M_2 \approx 30.5 ~\rm {M_{\odot }}$, on an orbit of $P \simeq 34.538\, {\rm d}$ with an eccentricity of e ≈ 0.618. This close O–O binary with high eccentricity is observed through its orbit in X-rays, where it shows an unusually long minimum close to periastron passage. I use advanced simulations with wind acceleration and a prescription treatment of accretion and I simulate the entire orbit at high resolution, which captures the instabilities in the winds. I find that the colliding wind structure is unstable even at apastron. As the stars approach periastron passage, the secondary wind is quenched by the primary wind and the accretion on to the secondary begins. The accretion phase lasts for ${\simeq}12 \,{\rm d}$, and the amount of accreted mass obtained per cycle is $M_{\rm {acc}} \simeq 1.3 \times 10^{-8} \,{\rm M}_{\odot }$. The accretion phase can account for the observed decline in X-ray emission from the system.
Percutaneous Cordotomy for Pain Palliation in Advanced Cancer: A Randomized Clinical Trial Study Protocol
Authors: Viswanathan Ashwin , Vedantam Aditya , Williams Loretta A , Koyyalagunta Dhanalakshmi , Abdi Salahadin , Dougherty Patrick M , Mendoza Tito , Bassett Roland L , Hou Ping , Bruera Eduardo
Published: January 2020

BACKGROUND

Cancer pain, one of the most common symptoms for patients with advanced cancer, is often refractory to maximal medical therapy. A controlled clinical trial is needed to provide definitive evidence to support the use of ablative procedures such as cordotomy for patients with medically refractory cancer pain.

OBJECTIVE

To assess the efficacy of cordotomy for patients with unilateral advanced cancer pain using a controlled clinical trial study design. The secondary objectives are to define the patient experience of cordotomy for medically refractory cancer pain as well as to determine the utility of magnetic resonance imaging as a non-invasive biomarker for successful cordotomy.

METHODS

We will undertake a single-institution, double-blind, sham-controlled clinical trial of cordotomy in patients with refractory cancer pain. Patients in the cordotomy arm will undergo a percutaneous computed tomography-guided cordotomy at C1-C2, while patients in the control arm will undergo a similar procedure where the needle will not penetrate the thecal sac. The primary endpoint will be the reduction in pain intensity, as measured by the Edmonton Symptoms Assessment Scale.

EXPECTED OUTCOMES

We expect that patients randomized to cordotomy will have a significantly greater reduction in pain intensity than those patients randomized to the control surgical intervention.

DISCUSSION

This randomized clinical trial comparing cordotomy with a control intervention will provide the level of evidence necessary to determine whether cordotomy should be the standard of care intervention for patients with advanced cancer pain.
Successful Treatment of Malassezia furfur Endocarditis
Authors: Granok Alexander B
Published: January 2020

The first reported case of Malassezia furfur endocarditis in an adult patient is presented. The unique microbiological aspects of this organism, as well as the difficulties inherent in its antifungal susceptibility testing, are discussed.
Peripherally acting μ-opioid receptor antagonists for treatment of opioid-induced constipation in children
Authors: Novak Chris , Hogg Amanda , Sue Kyle , Davies Dawn
Published: January 2020

Background and Objective

Opioid-induced constipation (OIC) is a common and important problem in paediatric palliative care, critical care, and postoperative settings. Treatment for OIC is often ineffective and limited by enteral intake. A new class of drugs called peripherally acting mu-opioid receptor antagonists (PAMORAs) have been shown to be effective treatments of OIC in adults, including the agents methylnaltrexone and naloxegol. Data in children are limited to several small case reports, mostly in the palliative care setting. The goal of this study was to evaluate the effectiveness and safety of methylnaltrexone and naloxegol in hospitalized children, including those with critical illness.

Methods

We conducted a retrospective study of all children admitted to the Stollery Children’s Hospital in Edmonton (Canada) who received either methylnaltrexone or naloxegol for OIC. The primary outcome was median time to first bowel movement (BM) after the first dose of PAMORA.

Results

A total of 27 patients were included in the study. Kaplan–Meier survival analysis showed the median time to the first BM after the first dose of PAMORA was 15.5 hours. Seventeen (63%) patients had laxation within 24 hours of first dose. No significant adverse events were observed.

Conclusion

This study is the largest to date to evaluate efficacy and safety of PAMORAs in children. Future studies should be prospective and include larger numbers of patients with critical illness and postoperative OIC as indications for treatment.
Cell Wall Composition and Ultrastructural Immunolocalization of Pectin and Arabinogalactan Protein during Olea europaea L. Fruit Abscission
Authors: Parra Ruben , Paredes Miguel A , Labrador Juana , Nunes Cláudia , Coimbra Manuel A , Fernandez-Garcia Nieves , Olmos Enrique , Gallardo Mercedes , Gomez-Jimenez Maria C
Published: January 2020

Cell wall modification is integral to many plant developmental processes where cells need to separate, such as abscission. However, changes in cell wall composition during natural fruit abscission are poorly understood. In olive (Olea europaea L.), some cultivars such as ‘Picual’ undergo massive natural fruit abscission after fruit ripening. This study investigates the differences in cell wall polysaccharide composition and the localization of pectins and arabinogalactan protein (AGP) in the abscission zone (AZ) during cell separation to understand fruit abscission control in ‘Picual’ olive. To this end, immunogold labeling employing a suite of monoclonal antibodies to cell wall components (JIM13, LM5, LM6, LM19 and LM20) was investigated in olive fruit AZ. Cell wall polysaccharide extraction revealed that the AZ cell separation is related to the de-esterification and degradation of pectic polysaccharides. Moreover, ultrastructural localization showed that both esterified and unesterified homogalacturonans (HGs) localize mainly in the AZ cell walls, including the middle lamella and tricellular junction zones. Our results indicate that unesterified HGs are likely to contribute to cell separation in the olive fruit AZ. Similarly, immunogold labeling demonstrated a decrease in both galactose-rich and arabinose-rich pectins in AZ cell walls during ripe fruit abscission. In addition, AGPs were localized in the cell wall, plasma membrane and cytoplasm of AZ cells with lower levels of AGPs during ripe fruit abscission. This detailed temporal profile of the cell wall polysaccharide composition, and the pectins and AGP immunolocalization in the olive fruit AZ, offers new insights into cell wall remodeling during ripe fruit abscission.
Antibody humanization—the Influence of the antibody framework on the CDR-H3 loop ensemble in solution
Authors: Fernández-Quintero Monica L , Heiss Martin C , Liedl Klaus R
Published: January 2020

Antibody engineering of non-human antibodies has focused on reducing immunogenicity by humanization, being a major limitation in developing monoclonal antibodies. We analyzed four series of antibody binding fragments (Fabs) and a variable fragment (Fv) with structural information in different stages of humanization to investigate the influence of the framework, point mutations and specificity on the complementarity determining region (CDR)-H3 loop dynamics. We also studied a Fv without structural information of the anti-idiotypic antibody Ab2/3H6, because it completely lost its binding affinity upon superhumanization, as an example of a failed humanization. Enhanced sampling techniques in combination with molecular dynamics simulations allow to access micro- to milli-second timescales of the CDR-H3 loop dynamics and reveal kinetic and thermodynamic changes involved in the process of humanization. In most cases, we observe a reduced conformational diversity of the CDR-H3 loop when grafted on a human framework and find a conformational shift of the dominant CDR-H3 loop conformation in solution. A shallow side minimum of the conformational CDR-H3 loop ensemble attached to the murine framework becomes the dominant conformation in solution influenced by the human framework. Additionally, we observe in the case of the failed humanization that the potentially binding competent murine CDR-H3 loop ensemble in solution shows nearly no kinetical or structural overlap with the superhumanized variant, thus explaining the loss of binding.
A Comparison of Ground-Based Air-Blast Sprayer and Aircraft Application of Fungicides to Manage Scab in Tall Pecan Trees
Authors: Bock Clive H. , Hotchkiss Michael W.
Published: January 2020

Pecan scab (caused by Venturia effusa) is a destructive disease of pecan in the southeastern United States. Susceptible cultivars must be sprayed with fungicide every 10 to 21 days to ensure yield and kernel quality. Fungicide is most often applied using large orchard air-blast sprayers. Pecan trees grow tall, and air-blast sprays result in a gradient in spray deposition and consequently of scab. Aerial fungicide application is also practiced. Disease distribution and spray deposition of the two methods have not been compared but will provide information aiding decisions on spray application methods. We compared air-blast, aerial, and air-blast + aerial applications for efficacy controlling scab at five heights in the canopy of 25-m cultivar Schley pecan trees. There was a negative relationship between scab severity and height in control trees, a positive linear relationship with height in air-blast treated trees, and a generally negative linear relationship between scab severity and height in aerially treated trees. Air-blast + aerial treatments resulted in low severity of scab at all heights. Spray deposition on water-sensitive cards indicated a declining gradient with height using an air-blast sprayer, whereas aerial applications resulted in a low deposition at all sample heights. Air-blast sprays tended to result in less good control at heights >12.5 m, and aerially treated trees at ≤7.5 m. The results provide insight into the efficacy and advantages of these methods for applying fungicide to control scab in tall pecan trees; further research is needed to better understand the impact of frequency and timing of these two methods.
Cortical fNIRS Responses Can Be Better Explained by Loudness Percept than Sound Intensity
Authors: Weder Stefan , Shoushtarian Mehrnaz , Olivares Virginia , Zhou Xin , Innes-Brown Hamish , McKay Colette
Published: January 2020

Objectives:

Functional near-infrared spectroscopy (fNIRS) is a brain imaging technique particularly suitable for hearing studies. However, the nature of fNIRS responses to auditory stimuli presented at different stimulus intensities is not well understood. In this study, we investigated whether fNIRS response amplitude was better predicted by stimulus properties (intensity) or individually perceived attributes (loudness).

Design:

Twenty-two young adults were included in this experimental study. Four different stimulus intensities of a broadband noise were used as stimuli. First, loudness estimates for each stimulus intensity were measured for each participant. Then, the 4 stimulation intensities were presented in counterbalanced order while recording hemoglobin saturation changes from cortical auditory brain areas. The fNIRS response was analyzed in a general linear model design, using 3 different regressors: a non-modulated, an intensity-modulated, and a loudness-modulated regressor.

Results:

Higher intensity stimuli resulted in higher amplitude fNIRS responses. The relationship between stimulus intensity and fNIRS response amplitude was better explained using a regressor based on individually estimated loudness estimates compared with a regressor modulated by stimulus intensity alone.

Conclusions:

Brain activation in response to different stimulus intensities is more reliant upon individual loudness sensation than physical stimulus properties. Therefore, in measurements using different auditory stimulus intensities or subjective hearing parameters, loudness estimates should be examined when interpreting results.
Application of Big Data to Support Evidence-Based Public Health Policy Decision-Making for Hearing
Authors: Saunders Gabrielle H. , Christensen Jeppe H. , Gutenberg Johanna , Pontoppidan Niels H. , Smith Andrew , Spanoudakis George , Bamiou Doris-Eva
Published: January 2020

Ideally, public health policies are formulated from scientific data; however, policy-specific data are often unavailable. Big data can generate ecologically-valid, high-quality scientific evidence, and therefore has the potential to change how public health policies are formulated. Here, we discuss the use of big data for developing evidence-based hearing health policies, using data collected and analyzed with a research prototype of a data repository known as EVOTION (EVidence-based management of hearing impairments: public health pOlicy-making based on fusing big data analytics and simulaTION), to illustrate our points. Data in the repository consist of audiometric clinical data, prospective real-world data collected from hearing aids and an app, and responses to questionnaires collected for research purposes. To date, we have used the platform and a synthetic dataset to model the estimated risk of noise-induced hearing loss and have shown novel evidence of ways in which external factors influence hearing aid usage patterns. We contend that this research prototype data repository illustrates the value of using big data for policy-making by providing high-quality evidence that could be used to formulate and evaluate the impact of hearing health care policies.
Comparison of T1-S1 Spine Height of Postoperative Rib-based Implant Patients With Age-matched Peers
Authors: Johnson Mitchell A. , Cahill Patrick J. , Qiu Catherine , Lott Carina , Mayer Oscar H. , Flynn John M. , Anari Jason B.
Published: January 2020

Background:

Severe early-onset scoliosis leads to deficient spine height, thoracic growth inhibition, and ultimately pulmonary compromise. Rib-based growing instrumentation seeks to correct thoracic deformities, in part by correcting the spinal deformity, adding height, increasing thoracic volume, and allowing for continual spinal growth until maturity. However, the amount of growth in these patients relative to their peers is unknown.

Methods:

Sixty patients who had undergone surgical intervention for the treatment of early-onset scoliosis were assessed via radiographic measurements of coronal T1-S1 height and major curve angle before implantation and again at most recent follow-up (minimum 2 years). T1-S1 measurements were then compared with age-matched peers to assess growth differences. Clinical information was examined for relevant parameters.

Results:

The average age of our cohort at initial surgery and most recent follow-up was 4.4±3.8 and 10.0±4.4 years old, respectively. In this patient set, there was an average increase in T1-S1 height of 13.1±11.1 mm per year, with the majority of growth occurring in the first 2 years following implantation, and improvement in a major curve from 68±8 to 53±7 degrees. Overall, 77% of patients saw improvement in the major curve at most recent follow-up. Furthermore, a statistically significant greater percent of expected growth was seen in congenital compared with neuromuscular scoliosis (P<0.001). In addition, a weak negative correlation was observed between a number of surgical lengthenings and T1-S1 growth.

Conclusions:

Rib-based implant intervention has been shown to improve the major curve, but only improves growth potential to around 80% of expected growth. Scoliosis diagnosis type also influences growth rate potential, with congenital scoliosis patients being surgically treated earlier in life and having a growth rate approaching that of a healthy individual.

Level of Evidence:

Level III—Case control.
Restrictive Transfusion Practice in Adults Receiving Venovenous Extracorporeal Membrane Oxygenation: A Single-Center Experience
Authors: Doyle Andrew J. , Richardson Carla , Sanderson Barnaby , Wong Katie , Wyncoll Duncan , Camporota Luigi , Barrett Nicholas A. , Hunt Beverley J. , Retter Andrew
Published: January 2020

Objectives:

Restrictive transfusion policies have been adopted in critical care, although these have not included patients receiving extracorporeal membrane oxygenation. We aimed to assess survival outcomes, adverse events related to RBC transfusion, and cost implications following a change from a “liberal” to a “restrictive” RBC transfusion practice in patients receiving extracorporeal membrane oxygenation.

Design:

Retrospective observational study.

Setting:

Single high-volume tertiary critical care department at a university hospital.

Patients:

Patients 16 years old or greater receiving venovenous extracorporeal membrane oxygenation between 2011 and 2017 for more than 24 hours.

Interventions:

None.

Measurements and Main Results:

Clinical diagnoses, complications, outcomes, median hemoglobin, and hematocrit levels were obtained from patients’ electronic records. All laboratory results for hemoglobin and hematocrit were included. RBC transfusions were obtained from prescription charts. We included 402 patients: 99 during a “liberal” transfusion practice (2011–2014)—when the target hemoglobin level was greater than 100 g/L; and 303 treated during a “restrictive” transfusion practice (2014–2017) when the target hemoglobin level was greater than 80 g/L. We found that survival outcomes did not change following the implementation of a “restrictive” transfusion policy. There was also a decrease in the extracorporeal blood flow rates with restrictive transfusion of 0.5 L/min. Nonsurvivors of venovenous extracorporeal membrane oxygenation had higher usage of RBC units following a change in transfusion practice. The restrictive strategy allowed a cost saving of £454 per patient.

Conclusions:

These results suggest that the adoption of a more restrictive approach to RBC transfusion during venovenous extracorporeal membrane oxygenation is more cost-effective and associated with similar survival outcomes, than when compared with a more liberal approach.
Special prognostic phenomenon for patients with mid-range ejection fraction heart failure: a systematic review and meta-analysis
Authors: Guo Pan , Dai Jian-Feng , Feng Chao , Chen Shu-Tao , Feng Jin-Ping
Published: January 2020

Background:

Clinical features and outcomes of heart failure (HF) with mid-range ejection fraction (HFmrEF) remain controversial. Thus, we systematically reviewed literatures of clinical research to assess and analyze characteristics and prognosis of patients with HFmrEF.

Methods:

PubMed, Embase, and Web of Science were searched for cohort studies up to April 23, 2019. Clinical features and multivariate adjusted hazard ratios (HRs) of endpoints of short-term all-cause mortality (SAM), long-term all-cause mortality (LAM), long-term cardiovascular death (LCD) and long-term HF rehospitalization (LHR) among patients with HFmrEF and HF with preserved ejection fraction (HFpEF), HF with reduced ejection fraction (HFrEF) were well addressed. The primary outcome was LAM.

Results:

Totally 19 studies were included in this study with 164,678 patients enrolled. The follow-up time of LAM was 3.6 ± 2.5 years. HRs of LAM, SAM, LCD, LHR indicated that the risks of patients with HFmrEF were higher than HFpEF patients but lower than HFrEF patients, as for LAM, HFmrEF:HFpEF (reference) HR: 1.07, 95% confidence interval (CI): 1.00–1.15 (I

2
 = 63%, P = 0.0005); HFmrEF:HFrEF (reference) HR: 0.80, 95% CI: 0.73–0.88 (I

2
 = 70%, P < 0.0001). However, HFmrEF patients had the lowest rate in LAM (30.94%), SAM (2.73%), LCD (17.45%), LHR (26.36%) compared with the other two groups.

Conclusions:

This systematic review and meta-analysis compared features and prognosis between patients with HFmrEF and HFpEF, HFrEF by HRs. There appeared a special “separation phenomenon” showing rates of endpoints were inconsistent with their hazards in patients with HFmrEF compared with HFpEF patients.
Results of the NRG Oncology/RTOG 0848 Adjuvant Chemotherapy Question—Erlotinib+Gemcitabine for Resected Cancer of the Pancreatic Head
Authors: Abrams Ross A. , Winter Kathryn A. , Safran Howard , Goodman Karyn A. , Regine William F. , Berger Adam C. , Gillin Michael T. , Philip Philip A. , Lowy Andrew M. , Wu Abraham , DiPetrillo Thomas A. , Corn Benjamin W. , Seaward Samantha A. , Haddock Michael G. , Song Suisui , Jiang Yixing , Fisher Barbara J. , Katz Alan W. , Mehta Sharmila , Willett Christopher G. , Crane Christopher H.
Published: January 2020

Purpose:

NRG/RTOG 0848 was designed to determine whether adjuvant radiation with fluoropyrimidine sensitization improved survival following gemcitabine-based adjuvant chemotherapy for patients with resected pancreatic head adenocarcinoma. In step 1 of this protocol, patients were randomized to adjuvant gemcitabine versus the combination of gemcitabine and erlotinib. This manuscript reports the final analysis of these step 1 data.

Methods:

Eligibility—within 10 weeks of curative intent pancreaticoduodenectomy with postoperative CA19-9<180. Gemcitabine arm—6 cycles of gemcitabine. Gemcitabine+erlotinib arm—gemcitabine and erlotinib 100 mg/d. Two hundred deaths provided 90% power (1-sided α=0.15) to detect the hypothesized OS signal (hazard ratio=0.72) in favor of the arm 2.

Results:

From November 17, 2009 to February 28, 2014, 163 patients were randomized and evaluable for arm 1 and 159 for arm 2. Median age was 63 (39 to 86) years. CA19-9 ≤90 in 93%. Arm 1: 32 patients (20%) grade 4 and 2 (1%) grade 5 adverse events; arm 2, 27 (17%) grade 4 and 3 (2%) grade 5. GI adverse events, arm 1: 22% grade ≥3 and arm 2: 28%, (P=0.22). The median follow-up (surviving patients) was 42.5 months (min-max: <1 to 75). With 203 deaths, the median and 3-year OS (95% confidence interval) are 29.9 months (21.7, 33.4) and 39% (30, 45) for arm 1 and 28.1 months (20.7, 30.9) and 39% (31, 47) for arm 2 (log-rankP=0.62). Hazard ratio (95% confidence interval) comparing OS of arm 2 to arm 1 is 1.04 (0.79, 1.38).

Conclusions:

The addition of adjuvant erlotinib to gemcitabine did not provide a signal for increased OS in this trial.
Restarting Oral Anticoagulation in Patients With Atrial Fibrillation After an Intracranial Hemorrhage
Authors: Nguyen Nhi Y. , Frishman William H.
Published: January 2020

Atrial fibrillation is the most common sustained cardiac arrhythmia in the general population. In western countries with aging populations, atrial fibrillation poses a significant health concern, as it is associated with a high risk of thromboembolism, stroke, congestive heart failure, and myocardial infarction. Thrombi are generated in the left atrial appendage, and subsequent embolism into the cerebral circulation is a major cause of ischemic stroke. Therefore, patients have a lifetime risk of stroke, and those at high risk, defined as a CHA2DS2-VASc2 (congestive heart failure, hypertension, age >75 years, diabetes mellitus, stroke/transient ischemic attack/thromboembolism, vascular disease, age 65-74 yrs, sex category) ≥2, are usually placed on oral anticoagulants. Unfortunately, long-term anticoagulation poses bleeding risks, of which intracranial hemorrhage (ICH) is the most feared and deadly complication.

In patients who survive an ICH, the question of oral anticoagulation resumption arises. It is a therapeutic dilemma in which clinicians must decide how to manage the risk of thromboembolism versus recurrent hemorrhage. Although there is a substantial amount of retrospective data on the topic of resumption of anticoagulation, there are, at this time, no randomized controlled trials addressing the issue. We therefore sought to address ICH risk and management, summarize high quality existing evidence on restarting oral anticoagulation, and suggest an approach to clinical decision-making.
Recommendations for the Use of Antibiotics in Primary and Secondary Esthetic Breast Surgery
Authors: Prantl Lukas , Momeni Arash , Brebant Vanessa , Kuehlmann Britta , Heine Norbert , Biermann Niklas , Brix Eva
Published: January 2020

The use of systemic prophylactic antibiotics to reduce surgical-site infection in esthetic breast surgery remains controversial, although the majority of surgeons prefer to utilize antibiotics to prevent infection. Nonetheless, postoperative acute and subclinical infection and capsular fibrosis are among the most common complications following implant-based breast reconstruction. After esthetic breast augmentation, up to 2.9% of women develop infection, with an incidence rate of 1.7% for acute infections and 0.8% for late infections. After postmastectomy reconstruction (secondary reconstruction), the rates are even higher. The microorganisms seen in acute infections are Gram-positive, whereas subclinical late infections involving microorganisms are typically Gram-negative and from normal skin flora with low virulence. In primary implantation, a weight-based dosing of cefazolin is adequate, an extra duration of antibiotic cover does not provide further reduction in superficial or periprosthetic infections. Clindamycin and vancomycin are recommended alternative for patients with β-lactam allergies. The spectrum of microorganism found in late infections varies (Gram-positive and Gram-negative), and the antibiotic prophylaxis (fluoroquinolones) should be extended by vancomycin and according to the antibiogram when replacing implants and in secondary breast reconstruction, to target microorganisms associated with capsular contracture. All preoperative antibiotics should be administered <60 minutes before incision to guarantee high serum levels during surgical procedure.
The Use of Hypochlorous Acid Lavage to Treat Infected Cavity Wounds
Authors: Wongkietkachorn Apinut , Surakunprapha Palakorn , Wittayapairoch Jakrapan , Wongkietkachorn Nuttapone , Wongkietkachorn Supawich
Published: January 2020

Managing cavity wounds that cannot be cleaned using standard irrigating solution is challenging. An immunocompromised patient with a horseshoe perianal abscess was selected to represent a heavy infection in cavity wounds. Diluted povidone-iodine was initially used to lavage the wounds, but the fever persisted and the irrigation was painful. Hypochlorous acid was then used to irrigate the wound. One day after administration of the hypochlorous acid, the fever began to subside, suggesting that this solution was able to adequately destroy the infecting microorganisms. The patient rated his pain during this procedure as 2/10. The infection had cleared within 2 weeks, and a swab culture found no microbial growth. The wound volume was reduced by more than 90% after 5 weeks, and final wound closure was achieved after 6 weeks. By comparison, another patient with a horseshoe perianal abscess who underwent traditional irrigation with diluted povidone-iodine and wet-to-dry dressing faced similar problems, but the fever in this case did not subside, and the wound became more complicated. He complained of pain during the irrigation with diluted povidone-iodine, giving the procedure a pain score of 10/10. Wound care was also difficult due to fecal contamination. As a result, the patient had to undergo colostomy to divert feces to the abdomen, thus preventing it from contaminating the wound. Time to final wound closure was 10 weeks. These cases illustrate the effectiveness of hypochlorous acid in dealing with infection in wound cavities.
The Use of Autologous Serum to Reverse Severe Contact Lens-induced Limbal Stem Cell Deficiency
Authors: Yeh Shu-I , Chu Ting-Wen , Cheng Huey-Chuan , Wu Chien-Hsiu , Tsao Yeou-Ping
Published: January 2020

Purpose:

To describe the efficacy of autologous serum (AS) eye drops to reverse severe contact lens (CL)-induced limbal stem cell (LSC) deficiency (LSCD).

Methods:

This is a prospective, uncontrolled, interventional case series that enrolled 20 eyes of 14 consecutive patients diagnosed with severe CL-induced LSCD at presentation, based on clinical examination, at a tertiary referral center for the period December 2016 to December 2018. All eyes underwent AS treatment for at least 2 weeks with a follow-up for at least 2 months. Demographic data and treatment outcomes were collected and analyzed.

Results:

The mean patient age at presentation was 30.5 years (range, 19–49 years). The mean duration of soft contact lens wear was 15.6 years (SD, 7.58 years; range, 5–31 years). All study eyes had pain and blurred vision at presentation. All eyes had recurrent or persistent corneal epithelial defect, stromal scarring and opacity, and superficial vascularization and peripheral pannus at presentation. Aggressive treatment with AS succeeded in all eyes. Signs and symptoms of LSCD stabilized in all eyes within 2 weeks and resolved in 6 eyes (30.0%) in 2 weeks, 9 eyes (45.0%) in 4 weeks, and 5 eyes (25.0%) in 8 weeks. The mean follow-up time was 9.45 ± 1.79 weeks (range, 8–24 weeks).

Conclusions:

Early identification and aggressive treatment of the ocular surface disease with AS can medically reverse severe CL-induced LSCD and prevent the need for surgical intervention.
Longitudinal Analysis of Infrared Meibography in Patients Undergoing Hematopoietic Stem Cell Transplantation
Authors: Bernabei Federico , Versura Piera , Pellegrini Marco , Moscardelli Fabiana , Bonifazi Francesca , Sessa Mariarosaria , Arpinati Mario , Scorcia Vincenzo , Giannaccare Giuseppe
Published: January 2020

Purpose:

To evaluate meibomian gland (MG) changes in patients undergoing hematopoietic stem cell transplantation (HSCT) by infrared meibography and to further investigate possible correlations with hematological characteristics.

Methods:

Thirty-three patients were included: infrared meibography of the lower eyelid, Schirmer test, tear break-up time, ocular surface staining, and Ocular Surface Disease Index questionnaire were conducted before (V0) and 4 months after HSCT (V1). A paired samples t test was used to compare parameters before and after HSCT. A mixed analysis of variance was used to assess the effect of hematological characteristics on changes of MG loss (MGL) after HSCT.

Results:

MGL and corneal staining significantly increased after HSCT (respectively, from 24.3% ± 10.1% to 32.2 ± 15.0 and from 1.2 ± 1.5 to 2.0 ± 1.7; always P < 0.011), whereas tear break-up time significantly decreased (from 6.6 ± 4.2 seconds to 3.2 ± 2.2; P < 0.001). At V1, 19 patients (57.6%) belonged to ocular graft-versus-host disease severity grade 0, 8 (24.2%) to grade I, and 6 (18.2%) to grade II. The percentage of MGL at V0 and the increase of MGL from V0 to V1 did not differ between patients who developed ocular graft-versus-host disease and those who did not (always P > 0.05). At V1, MGs' quality reduced in 16 patients (48.5%), remained unchanged in 14 (42.4%), and improved in 3 (9.1%). The increase of MGL after HSCT was higher in patients receiving myeloablative conditioning regimen (P = 0.005).

Conclusions:

MG function, loss, and quality significantly worsened after HSCT. Myeloablative conditioning regimen was associated with higher MGL.
Neural substrates for poststroke complex regional pain syndrome type I: a retrospective case–control study using voxel-based lesion symptom mapping analysis
Authors: Kim Jun Yup , Yoon Seo Yeon , Kim Jinna , Jeong Yong Hyu , Kim Yong Wook
Published: January 2020

Poststroke complex regional pain syndrome (CRPS) is characterized by swelling, pain, and changes in the skin that appear on the affected wrist and hand. In this retrospective study, we analyzed the relationship between poststroke CRPS and the location of stroke lesion. From all patients admitted to our hospital from 2009 to 2019, we recruited 80 patients affected by their first unilateral stroke who met the inclusion/exclusion criteria. Thirty-eight patients diagnosed with CRPS after stroke were assigned to the experimental group according to the “Budapest criteria” adopted by the International Association for the Study of Pain, and 42 patients without CRPS were included as controls. Regions of interest were manually drawn on T1-weighted magnetic resonance images, and data were normalized to a standard brain template. In the poststroke CRPS group, the relationship between the location of brain lesion and pain severity was analyzed using Freedman–Lane multivariable regression adjusting for Medication Quantification Scale rating, which was the only parameter to show a statistically significant correlation with pain intensity. A threshold of P < 0.01 was considered statistically significant for all voxel-based lesion symptom mapping tests, corrected for multiple comparisons with 5000 permutations. Analyses using voxel-wise subtraction and Liebermeister statistics indicated that the corticospinal tract (CST) was associated with the development of poststroke CRPS. Statistically significant correlations were found between pain intensity and the CST and the adjacent lentiform nucleus. Our results suggest that the CST may be a relevant neural structure for development of poststroke CRPS and the intensity of pain caused by the syndrome.
Insight Into Differences in Dietary Sodium Adherence Between Men and Women With Heart Failure
Authors: Lennie Terry A. , Moser Debra K. , Chung Misook L.
Published: January 2020

Background

Men with heart failure are reported to be less adherent to low-sodium diets than women are. One potential reason may be that men consume more food and, consequently, more sodium than women do.

Objectives

The aims of this study were to compare dietary sodium intake, urine sodium excretion, and sodium density of diet consumed between men and women with heart failure and to determine whether sex moderated the relationship of kilocalories (kcals) consumed with dietary and urine sodium.

Methods

A total of 223 patients with heart failure (mean age, 62 ± 12 years; 70% men, 46% New York Heart Association class III–IV) completed detailed 4-day food diaries and provided 24-hour urine sodium samples. To account for sodium density of food, dietary sodium and urine sodium were referenced to sodium per 1000 kcal.

Results

On an absolute basis, men consumed 23% more kcals and 28% more sodium than women did; 24-hour sodium excretion was 16% higher in men than in women. There were no differences between men and women when dietary sodium and urinary sodium were referenced to 1000 kcal, indicating they consumed foods with similar sodium density. However, both moderation analyses showed that the dietary sodium intake of men and women with lower kcal intake was similar, whereas men with higher kcal intake consumed more sodium-dense foods than women did.

Conclusion

The results suggest that the men with higher sodium intake than women had 2 reasons for nonadherence. They consumed more food and foods with higher sodium density than women did.
The Diagnostic Accuracy and Sensitivity for Malignancy of Radial-Endobronchial Ultrasound and Electromagnetic Navigation Bronchoscopy for Sampling of Peripheral Pulmonary Lesions
Authors: McGuire Anna L. , Myers Renelle , Grant Kyle , Lam Stephen , Yee John
Published: January 2020

Background:

Lung cancer screening with computed tomography chest is identifying peripheral pulmonary lesions (PPLs) suspicious for early-stage lung cancer at increasing rates. Radial-endobronchial ultrasound (R-EBUS) and electromagnetic navigation bronchoscopy (ENB) are 2 methods to sample PPLs to diagnose and treat early lung cancer. ENB has a higher operating financial cost, however, the rationale for its use is possible higher diagnostic accuracy versus R-EBUS.

Objective:

The objective of this study was to determine the comparative diagnostic accuracy, sensitivity, and negative predictive value for R-EBUS and ENB in sampling PPLs.

Methods:

A systematic review and meta-analysis were conducted. The Ovid Medline database was queried for original research reporting a diagnostic yield of R-EBUS or ENB for PPLs identified on computed tomography chest suspicious for malignancy. The I
2 statistic assessed study heterogeneity. Random effects models produced pooled estimates of diagnostic accuracy and sensitivity for malignancy. Reasons for heterogeneity were explored with meta-regression. Publication bias and small study effects were assessed.

Results:

A total of 41 studies involved 2988 lung nodules (R-EBUS 2102, ENB 886) in 3204 patients (R-EBUS 2097, ENB 1107). Overall sensitivity to detect cancer was 70.7% [95% confidence interval (CI): 67.2-74.0]; R-EBUS 70.5% (95% CI: 66.1-74.8), ENB 70.7% (95% CI: 64.7-76.8). Pooled overall diagnostic accuracy was 74.2% (95% CI: 71.0-77.3); R-EBUS 72.4% (95% CI: 68.7-76.1), ENB 76.4% (95% CI: 70.8-82.0). The localization modalities had comparative safety profiles of <2% complications.

Conclusion:

Both technologies have a high proportion of successful PPL localization with similar sensitivity for malignancy and accuracy. As such, both reasonable options for health care authorities to employ diagnostic algorithms.
How Much Cochlea Do You Need for Cochlear Implantation?
Authors: Plontke Stefan K. , Fröhlich Laura , Wagner Luise , Kösling Sabrina , Götze Gerrit , Siebolts Udo , Liebau Arne , Rahne Torsten
Published: January 2020

Objective:

To assess the efficacy of cochlear implantation (CI) after surgical removal of sporadic intracochlear or intravestibulocochlear schwannomas.

Study Design:

Nonconcurrent cohort study.

Setting:

Monocentric study at a tertiary referral center.

Patients:

Patients with tumor resection and CI between 2011 and 2018 and a historic control group of CI patients matched by age, CI electrode type, and follow-up.

Interventions:

Partial or subtotal cochleoectomy for tumor removal and single-stage CI.

Outcome Measures:

Main outcome measure: word recognition score for monosyllables in quiet at 65 dB SPL.

Results:

Sixteen patients with tumor removal and CI (6 female, 10 male; mean age 55 ± 14 years) and 16 control patients (6 female, 10 male; mean age 55 ± 15 years) were identified. In the tumor group, surprisingly good word recognition scores were reached even after substantial structural defects in the cochlear capsule. While 12 months after cochlear implantation mean word recognition score for monosyllables in quiet was 58% (SD: 26) and 41% (SD: 26) in the control groups, it was 75% (SD: 19%) in the tumor group.

Conclusions:

In patients with intracochlear schwannomas, despite substantial structural damage to the cochlear capsule by partial or subtotal cochleoectomy, a tendency toward better performance with respect to word recognition with CI was observed as compared with other CI patients. The surprisingly good functional results despite substantial cochlear trauma may change clinical thinking with respect to cochlear implantation also beyond this special indication.
Manometric Esophageal Length to Height (MELH) Ratio Predicts Hiatal Hernia Recurrence
Authors: Lal Pooja , Tang Andrew , Sarvepalli Shashank , Raja Siva , Thota Prashanthi , Lopez Rocio , Murthy Sudish , Ray Monica , Gabbard Scott
Published: January 2020

Introduction:

The shortened esophagus is poorly defined and is determined intraoperatively, as there exists no objective test to identify a shortened esophagus before surgical hiatal hernia repair. We devised a unique manometric esophageal length to height (MELH) ratio to define the presence of a shortened esophagus and examined the role of esophageal length in hiatal hernia recurrence.

Patients and Methods:

A retrospective review identified 254 patients with hiatal hernia who underwent preoperative esophageal manometry and either an open hernia repair with Collis gastroplasty and fundoplication (with Collis) or laparoscopic repair and fundoplication without Collis gastroplasty (without Collis) from 2005-2016. The MELH ratio was calculated by measuring the upper to lower esophageal sphincter distance divided by the patient’s height.

Results:

Of 245 patients, 157 underwent repair with Collis, while 97 underwent repair without Collis. The Collis group had a shorter manometric esophageal length (20.2 vs. 22.4 cm, P<0.001) and lower MELH (0.12 vs. 0.13, P<0.001). The Collis group had fewer hernia recurrences (18% vs. 55%, log-rank P<0.001) and fewer reoperations for recurrence (0% vs. 10%, log-rank P<0.001) at 5 years. A 33% decrease in risk of hernia recurrence was seen for every 0.01 U increment in MELH ratio (hazard ratio: 0.67; 95% confidence interval: 0.55-0.83, P<0.001) while repair without Collis (hazard ratio: 6.1; 95% confidence interval: 3.2-11.7, P<0.001) was associated with increased risk of hernia recurrence.

Conclusion:

MELH ratio is an objective predictor of a shortened esophagus preoperatively. Lower MELH is associated with increased risk of recurrence and the risk associated with shortened esophagus can be mitigated with an esophageal lengthening procedure such as Collis gastroplasty.
Adequacy of Prescription Drug Coverage in Long-term Care
Authors: Briesacher Becky , Oliveri-Mui Brianne , Chhabra Bhavika , Koethe Benjamin
Published: January 2020

Research Objective:

Affordable access to medications is important to Medicare enrollees in long-term care (LTC), yet, it is unknown if prescription drug coverage is universal and adequate to meet their high medication needs.

Study Design:

We assessed enrollment in prescription drug coverage, out-of-pocket (OOP) payments and medication use in a nationwide LTC database of prescription-level, resident-level, and facility-level data for the period 2011–2013. Inadequate drug coverage was defined as ≥50% medications paid for OOP. Risk-adjusted generalized estimation equations models were estimated to identify predictors of inadequate drug coverage and total prescription fills.

Population Studied:

A nationwide sample of 332,087 Medicare enrollees observed >100 days in LTC.

Principal Findings:

We found Medicare Part D was the main source of drug coverage (82.4%), followed by private insurance (8.5%), and Veterans Administration (0.2%). No drug coverage could be detected for 8.9% (n=29,378) who paid for all of their medications OOP or received only temporary drug payment assistance. Inadequate drug coverage was identified in another 2721 persons. LTC Medicare enrollees without drug coverage or who had private insurance received significantly fewer prescriptions than if they had been enrolled in Medicare Part D.

Conclusion:

A substantial proportion of Medicare enrollees in LTC have inadequate or no drug coverage and are receiving less medication than indicated by their health needs.

Policy Implications:

Medicare Part D is an important policy for ensuring affordable access to medications in LTC. However, expansions are needed to increase enrollment and decrease inadequate drug coverage.
Brown Bowel Syndrome
Authors: Arnold Christina A. , Burke Allen P. , Calomeni Edward , Mayer Romana C. , Rishi Arvind , Singhi Aatur D. , Stashek Kristen , Voltaggio Lysandra , Tondon Rashmi
Published: January 2020

Brown bowel syndrome (BBS) is a rare condition associated with vitamin E deficiency and defined by prominent lipofuscin deposition in the muscularis propria. Eight unique cases of BBS were identified: 5 men and 3 women (mean age=58.6 y). Pertinent comorbidities included bariatric surgery=2, malnourishment=2, Crohn=2, cystic fibrosis=1, alcohol and cocaine abuse=1, and prior small bowel resections=1. Presenting symptoms included abdominal pain=3, bleeding=1, nausea and vomiting=1, and nonresponsiveness=1. Imaging studies were often abnormal: thickened bowel wall=3 (1 with a mass), small bowel obstruction=2, and edematous and dilated bowel wall=2. Most specimens were surgical resections (n=7, autopsy=1): extended right colectomy=2, small bowel only=5 (terminal ileum=3, jejunum=2). Two specimens were grossly described as mahogany, and 1 case contained a perforation. Histologic sections of all cases showed finely granular, brown cytoplasmic pigment in smooth muscle cells on hematoxylin and eosin. This pigment was most conspicuous in the muscularis propria (small bowel>colon), and it was not identified in the mucosa. The pigment was reactive with Fontana-Masson, carbol lipofuscin, Periodic acid-Schiff, and Periodic acid-Schiff with diastase, and electron microscopy was compatible with lipofuscin. The mean clinical follow-up was 208 weeks: 1 patient died of complications of encephalitis, the others were alive and well. BBS is important to recognize because it is linked with malnutrition, specifically vitamin E deficiency, and it can (rarely) clinically simulate malignancy. The diagnosis is based on the identification of the lipofuscin pigment in the cytoplasm of smooth muscle cells, which is most easily seen in the muscularis propria of the small bowel.