bluuebunny/crossref_metadata_2025 huggingface dataset:
Unique Phenotypic Characteristics and Clinical Course in Patients With Ulcerative Colitis and Primary Sclerosing Cholangitis: A Multicenter US Experience
Authors: Wang Ming-Hsi , Mousa Omar Y , Friton Jessica J , Raffals Laura E , Leighton Jonathan A , Pasha Shabana F , Picco Michael F , Cushing Kelly C , Monroe Kelly , Nix Billy D , Newberry Rodney D , Faubion William A
Published: October 2019

Introduction

Ulcerative colitis (UC) associated with primary sclerosing cholangitis (PSC) is a rare phenotype. We aimed to assess patients with UC-PSC or UC alone and describe differences in clinical and phenotypic characteristics, antitumor necrosis factor (TNF) therapy, and long-term clinical outcomes.

Methods

This retrospective multicenter cohort study included patients who received a diagnosis of UC from 1962 through 2015. We evaluated clinical factors associated with UC-PSC vs UC alone and assessed associations by using multivariable logistic regression models.

Results

Among 522 patients with UC, 56 (10.7%) had PSC. Compared with UC alone, patients with UC-PSC were younger (younger than 20 years) at diagnosis (odds ratios [OR], 2.35; adjusted P = 0.02) and had milder UC severity (adjusted P = 0.05), despite having pancolonic involvement (OR, 7.01; adjusted P < 0.001). In the biologics era (calendar year 2005 to 2015), patients with UC-PSC less commonly received anti-TNF therapy compared with patients with UC (OR, 0.38; adjusted P = 0.009), but their response rates were similar. Fewer patients with UC-PSC received corticosteroids (OR, 0.24; adjusted P = 0.005) or rectal 5-aminosalicyte acid (OR, 0.26; adjusted P < 0.001). Other differences were identified that were not statistically significant in a multivariable model: patients with UC-PSC more commonly were male, had lower rates of smoking, and had higher rates of colorectal cancer and colectomy.

Discussion

This study identified a unique phenotype of UC with concurrent PSC, which had different clinical behavior compared with UC only. These phenotypic characteristics can help identify high-risk patients with UC before PSC is diagnosed and guide different management and monitoring strategies.
Is Ulcerative Colitis Associated With Primary Sclerosing Cholangitis an Undertreated Condition?
Authors: Van Der Have Mike , Oldenburg Bas
Published: October 2019

Wang et al. report that ulcereative colitis–primary sclerosing cholangitis (UC-PSC) patients less commonly receive corticosteroids and anti-TNFα therapy, despite having more pancolonic involvement compared with UC. Whether UC-PSC is an undertreated condition will be discussed in this editorial.
Justifying the culture of justification
Authors: Möller Kai
Published: October 2019

The ideas of the culture of justification—according to which it is the role of the courts to ensure that every act of the state that affects a person is substantively justifiable—and the related right to justification—which claims that every person possesses a moral and, ideally, constitutional right to the justification that the culture of justification recommends—are intuitively powerful and widely discussed ideas in public law scholarship, but their moral foundation is not yet well understood. This article presents the moral case for these two concepts, which centers on the status of every person as a justificatory agent. It argues that under conditions of reasonable disagreement in politics, this status requires that any law or act be justified not only procedurally (e.g. in terms of a democratic vote) but also substantively, and it further demonstrates the necessity of the judicial protection of the right to justification as a matter of principle.
CHIRRUP: a practical algorithm for unsourced multiple access
Authors: Calderbank Robert , Thompson Andrew
Published: October 2019

Unsourced multiple access abstracts grantless simultaneous communication of a large number of devices (messages) each of which transmits (is transmitted) infrequently. It provides a model for machine-to-machine communication in the Internet of Things, including the special case of radio-frequency identification, as well as neighbour discovery in ad hoc wireless networks. This paper presents a fast algorithm for unsourced multiple access that scales to ${\mathscr{C}}=2^{100}$ (active or non-active) devices (arbitrary $100$ bit messages). The primary building block is multiuser detection of binary chirps, which are simply codewords in the second-order Reed–Muller code. The chirp detection algorithm originally presented by Howard et al. (2008, 42nd Annual Conference on Information Sciences and Systems) is enhanced and integrated into a peeling decoder designed for a patching and slotting framework. In terms of both energy per bit and number of active devices (number of transmitted messages), the proposed algorithm is within a factor of $2$ of state-of-the-art approaches. A significant advantage of our algorithm is its computational efficiency. We prove that the worst-case complexity of the basic chirp reconstruction algorithm is ${\mathscr{O}}[nK(\log _2^2 n + K)]$, where $n$ is the codeword length and $K$ is the number of active users. Crucially, the complexity is sublinear in ${\mathscr{C}}$, which makes the reconstruction computationally feasible—a claim we support by reporting computing times for our algorithm. Our performance and computing time results represent a benchmark against which other practical algorithms can be measured.
Protecting patient privacy in survival analyses
Authors: Bonomi Luca , Jiang Xiaoqian , Ohno-Machado Lucila
Published: October 2019

Objective

Survival analysis is the cornerstone of many healthcare applications in which the “survival” probability (eg, time free from a certain disease, time to death) of a group of patients is computed to guide clinical decisions. It is widely used in biomedical research and healthcare applications. However, frequent sharing of exact survival curves may reveal information about the individual patients, as an adversary may infer the presence of a person of interest as a participant of a study or of a particular group. Therefore, it is imperative to develop methods to protect patient privacy in survival analysis.

Materials and Methods

We develop a framework based on the formal model of differential privacy, which provides provable privacy protection against a knowledgeable adversary. We show the performance of privacy-protecting solutions for the widely used Kaplan-Meier nonparametric survival model.

Results

We empirically evaluated the usefulness of our privacy-protecting framework and the reduced privacy risk for a popular epidemiology dataset and a synthetic dataset. Results show that our methods significantly reduce the privacy risk when compared with their nonprivate counterparts, while retaining the utility of the survival curves.

Discussion

The proposed framework demonstrates the feasibility of conducting privacy-protecting survival analyses. We discuss future research directions to further enhance the usefulness of our proposed solutions in biomedical research applications.

Conclusion

The results suggest that our proposed privacy-protection methods provide strong privacy protections while preserving the usefulness of survival analyses.
Fútbol Club Barcelona v Commission: Foul Play—if in Doubt, the Commission to Question the Evidence Submitted by the Parties
Authors: Przerwa Jan , Polanec Jon
Published: October 2019

The General Court rules that the Commission should investigate beyond the evidence submitted by the parties if it is in possession of documents calling that evidence into question.
Efficacy of Emamectin Benzoate Trunk Injection Against the Asian Long-Horned Beetle [Anoplophora glabripennis (Coleoptera: Cerambycidae)]
Authors: Wang Jian-Hong , Che Shao-Chen , Qiu Lan-Fen , Li Guang , Shao Jin-Li , Zhong Li , Zhang Guo-Feng , Xu Hoss
Published: October 2019

The efficacy of tree injected with emamectin benzoate (EB) against the Asian long-horned beetle (ALB) was tested in a heavily infested willow forest in Beijing, China. In a 1.7-ha plot, 240 out of 310 trees were treated with two EB formulations at various rates. After fall application, the larval population decreased by 89% in the following spring and by >99% during the second year detected by monitoring new frass emission from marked holes. Consequently, the number of exit holes of emerging adults decreased to 0 in the second year. Re-infestation occurred in the third year after application. This high efficacy and lasting activity might be contributed to: a) a favorable translocation of EB in trees when injected into the sapwood; b) the high intrinsic activity against ALB larvae with LC50 of 20–30 ppb; and c) a reduced lifespan of ALB adults by over 60% when feeding on twigs of EB-treated trees. On untreated control trees, the larval population decreased during the first winter. In the second year after application, the larval population was wiped out during winter and a re-infestation started from border trees by adults flying in from outside the trial plot. This pattern indicates an eradication of the ALB population in the 1.7-ha plot can be expected 2 yr after EB treatment. The benefit of treating with EB on the surrounding population was observed in both the untreated trees and imidacloprid-treated trees, suggesting that treatment of EB benefits both the treated trees and the surrounding trees in the area.
GOPC-ROS1 Fusion Due to Microdeletion at 6q22 Is an Oncogenic Driver in a Subset of Pediatric Gliomas and Glioneuronal Tumors
Authors: Richardson Timothy E , Tang Karen , Vasudevaraja Varshini , Serrano Jonathan , William Christopher M , Mirchia Kanish , Pierson Christopher R , Leonard Jeffrey R , AbdelBaki Mohamed S , Schieffer Kathleen M , Cottrell Catherine E , Tovar-Spinoza Zulma , Comito Melanie A , Boué Daniel R , Jour George , Snuderl Matija
Published: October 2019

ROS1 is a transmembrane receptor tyrosine kinase proto-oncogene that has been shown to have rearrangements with several genes in glioblastoma and other neoplasms, including intrachromosomal fusion with GOPC due to microdeletions at 6q22.1. ROS1 fusion events are important findings in these tumors, as they are potentially targetable alterations with newer tyrosine kinase inhibitors; however, whether these tumors represent a distinct entity remains unknown. In this report, we identify 3 cases of unusual pediatric glioma with GOPC-ROS1 fusion. We reviewed the clinical history, radiologic and histologic features, performed methylation analysis, whole genome copy number profiling, and next generation sequencing analysis for the detection of oncogenic mutation and fusion events to fully characterize the genetic and epigenetic alterations present in these tumors. Two of 3 tumors showed pilocytic features with focal expression of synaptophysin staining and variable high-grade histologic features; the third tumor aligned best with glioblastoma and showed no evidence of neuronal differentiation. Copy number profiling revealed chromosome 6q22 microdeletions corresponding to the GOPC-ROS1 fusion in all 3 cases and methylation profiling showed that the tumors did not cluster together as a single entity or within known methylation classes by t-Distributed Stochastic Neighbor Embedding.
From forest to city: urbanization modulates relative abundance of anti-predator coloration
Authors: Anderson Nigel K , Gutierrez Stephanie O , Bernal Ximena E
Published: October 2019

Increased urbanization has resulted in community changes including alteration of predator communities. Little is known, however, about how such changes affect morphological anti-predator traits. Given the importance of coloration in predator avoidance, this trait in particular is expected to be susceptible to novel selective environments in urban areas. Here, we investigate the coloration pattern of a Neotropical anuran species, the túngara frog (Engystomops pustulosus), along an urbanization gradient. Túngara frogs have two distinct color patterns (unstriped and striped) which we found to occur at different frequencies along an urbanization gradient. Striped individuals increased in frequency with urbanization. To assess the strength of selection imposed by predators on the two color morphs, we deployed clay models of túngara frogs in forest and semi-urban populations. In addition, we examined microhabitat selection by individuals of the different morphs. We found higher predation rates associated with urbanization than forested areas. In particular, frogs from forested habitats had lower number of attacks by avian predators. Contrary to our predictions, however, predation rates were similar for both color morphs independent of urbanization. Also, coloration of the frogs did not affect their microhabitat preference. Overall, túngara frogs are more likely to have a striped coloration pattern in semi-urban areas where predation by birds is higher than in the forest. Our findings suggest that factors other than predation pressure shape the coloration pattern of urban frogs and emphasize the complex nature of effects that anthropogenic changes in habitat and predator communities may have on prey morphology.
Treeio: An R Package for Phylogenetic Tree Input and Output with Richly Annotated and Associated Data
Authors: Wang Li-Gen , Lam Tommy Tsan-Yuk , Xu Shuangbin , Dai Zehan , Zhou Lang , Feng Tingze , Guo Pingfan , Dunn Casey W , Jones Bradley R , Bradley Tyler , Zhu Huachen , Guan Yi , Jiang Yong , Yu Guangchuang
Published: October 2019

Phylogenetic trees and data are often stored in incompatible and inconsistent formats. The outputs of software tools that contain trees with analysis findings are often not compatible with each other, making it hard to integrate the results of different analyses in a comparative study. The treeio package is designed to connect phylogenetic tree input and output. It supports extracting phylogenetic trees as well as the outputs of commonly used analytical software. It can link external data to phylogenies and merge tree data obtained from different sources, enabling analyses of phylogeny-associated data from different disciplines in an evolutionary context. Treeio also supports export of a phylogenetic tree with heterogeneous-associated data to a single tree file, including BEAST compatible NEXUS and jtree formats; these facilitate data sharing as well as file format conversion for downstream analysis. The treeio package is designed to work with the tidytree and ggtree packages. Tree data can be processed using the tidy interface with tidytree and visualized by ggtree. The treeio package is released within the Bioconductor and rOpenSci projects. It is available at https://www.bioconductor.org/packages/treeio/.
ICOSLG-mediated regulatory T cell expansion and IL-10 production promote progression of glioblastoma
Authors: Iwata Ryoichi , Lee Joo Hyoung , Hayashi Mikio , Dianzani Umberto , Ofune Kohei , Maruyama Masato , Oe Souichi , Ito Tomoki , Hashiba Tetsuo , Yoshimura Kunikazu , Nonaka Masahiro , Nakano Yosuke , Norian Lyse , Nakano Ichiro , Asai Akio
Published: October 2019

Background

Targeting immune checkpoint proteins has recently gained substantial attention due to the dramatic success of this strategy in clinical trials for some cancers. Inducible T-cell co-stimulator ligand (ICOSLG) is a member of the B7 family of immune regulatory ligands, expression of which in cancer is implicated in disease progression due to regulation of anti-tumor adaptive immunity. Although aberrant ICOSLG expression has been reported in glioma cells, the underlying mechanisms that promote glioblastoma (GBM) progression remain elusive.

Methods

Here, we investigated a causal role for ICOSLG in GBM progression by analyzing ICOSLG expression in both human glioma tissues and patient-derived GBM sphere cells (GSCs). We further examined its immune modulatory effects and the underlying molecular mechanisms.

Results

Bioinformatics analysis and GBM tissue microarray showed that upregulation of ICOSLG expression was associated with poor prognosis in patients with GBM. ICOSLG expression was upregulated preferentially in mesenchymal GSCs but not in proneural GSCs in a tumor necrosis factor-α-/NF-ĸB-dependent manner. Furthermore, ICOSLG expression by mesenchymal GSCs promoted expansion of T cells that produced interleukin-10. Knockdown of the gene encoding ICOSLG markedly reduced GBM tumor growth in immune competent mice, with a concomitant downregulation of interleukin-10 levels in the tumor microenvironment.

Conclusions

Inhibition of the ICOSLG-ICOS axis in GBM may provide a promising immunotherapeutic approach for suppressing a subset of GBM with an elevated mesenchymal signature.
Characteristics of Upper Limb Impairment Related to Degenerative Cervical Myelopathy: Development of a Sensitive Hand Assessment (Graded Redefined Assessment of Strength, Sensibility, and Prehension Version Myelopathy)
Authors: Kalsi-Ryan Sukhvinder , Riehm Lauren E , Tetreault Lindsay , Martin Allan R , Teoderascu Florentina , Massicotte Eric , Curt Armin , Verrier Mary C , Velstra Inge-Marie , Fehlings Michael G
Published: October 2019

BACKGROUND

Degenerative cervical myelopathy (DCM) involves spinal cord compression, which causes neurological decline. Neurological impairment in DCM is variable and can involve complex upper limb dysfunction including loss of manual dexterity, hyperreflexia, focal weakness, and sensory impairment. The modified Japanese Orthopaedic Association (mJOA) score relies on the patients’ subjective perceptions, whereas existing objective measures such as strength and sensory testing do not capture subtle changes in dexterity and function.

OBJECTIVE

1) To characterize arm and hand function in DCM; and 2) To develop and validate Graded Redefined Assessment of Strength, Sensibility, and Prehension Version-Myelopathy (GRASSP-M), a clinical assessment that quantifies upper limb impairment.

METHODS

A total of 148 DCM patients (categorized into mild, moderate, and severe based on mJOA grade) and 21 healthy subjects were enrolled. A complete neurological exam, the mJOA, the QuickDASH, grip dynamometry, and the GRASSP-M were administered.

RESULTS

Strength, sensation, and manual dexterity significantly declined with increasing DCM severity (P ≤ .05). Impairment in hand dexterity showed better discrimination between mild, moderate, and severe DCM categories than strength or sensation. The GRASSP-M was found to be both a reliable (intraclass correlation coefficient >0.75 for intra- and inter-rater reliability) and valid (with both concurrent and construct validity) tool.

CONCLUSION

These results demonstrate that patients’ subjective reporting of functional status, especially in the mild DCM category, may underrepresent the extent of functional impairment. The GRASSP-M is an objective tool designed to characterize patients’ functional impairment related to the upper limb, which proves useful to diagnose and quantify mild dysfunction, monitor patients for deterioration, and help determine when patients should be treated surgically.
Skyrmion–electron interaction in the separated spin-up and spin-down quantum hydrodynamics approach
Authors: Trukhanova Mariya Iv
Published: October 2019

The Berry gauge field associated with adiabatic quantum evolution represents a very interesting area of research, especially for the description of non-relativistic fermions coupled to a skyrmion texture. We construct a quantum hydrodynamics model that describes the electron–skyrmion interactions, with separate descriptions of spin-up and spin-down electrons as two different fluids. The quantum effects, represented by the quantum Bohm potential, are taken into account. We investigate the electron gas moving in a smooth magnetic texture, where the magnetic moments adjust to the local magnetization direction of the skyrmion, and derive the equations of motion and evolution of spin density for two fluids of electrons in the emergent gauge fields. Applying the separated spin evolution quantum hydrodynamics to the 2D electron gas, traveling on the background of the Berry gauge field in plane samples, located in an external magnetic field, we predict a wave of a new kind in the electron gas. This novel wave appears as an influence of emergent fields and quantum effects.
Paradoxical association between blood modular interferon signatures and quality of life in patients with systemic lupus erythematosus
Authors: Seguier Julie , Jouve Elisabeth , Bobot Mickaël , Whalen Elisabeth , Dussol Bertrand , Gentile Stéphanie , Burtey Stéphane , Halfon Philippe , Retornaz Frédérique , Chaussabel Damien , Chiche Laurent , Jourde-Chiche Noémie
Published: October 2019

Objectives

Blood transcriptomic IFN signature is a hallmark of SLE. The impaired health-related quality of life (HRQOL) observed in SLE is poorly related to disease activity. The aim of this study was to test how IFN signatures were associated with HRQOL in SLE patients.

Methods

Among consecutive patients, blood transcriptomic profiles were analysed with a modular framework comprising 3 IFN modules: M1.2, M3.4 and M5.12. Disease activity was evaluated by the SLEDAI score, and HRQOL was assessed with the SF-36 questionnaire, which includes eight domains: physical function, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health (MH) and physical component summary and mental component summary scores.

Results

A total of 57 SLE patients were evaluated, among whom 27 (47%) were clinically quiescent, 30 (53%) were flaring, and 19 (33%) had active lupus nephritis. All SF-36 domains were altered in SLE patients compared with the general French population (P < 0.0001). In multivariate analysis, taking into account flares, age, ethnicity, smoking and renal severity, social functioning was independently associated with the IFN score (P = 0.027). Analyses restrained to quiescent patients (n = 27) yielded greater associations between social functioning and the three IFN modules, and between MH and M3.4. Considering all quiescent visits (n = 51), the IFN score was independently correlated with social functioning (P = 0.022) and MH (P = 0.038).

Conclusion

This unexpected paradoxical association between IFN signature and some specific HRQOL domains argues against a pivotal role of IFNs in the persistently altered HRQOL of SLE patients.
Phylogenomic Resolution of the Cetacean Tree of Life Using Target Sequence Capture
Authors: McGowen Michael R , Tsagkogeorga Georgia , Álvarez-Carretero Sandra , dos Reis Mario , Struebig Monika , Deaville Robert , Jepson Paul D , Jarman Simon , Polanowski Andrea , Morin Phillip A , Rossiter Stephen J
Published: October 2019

The evolution of cetaceans, from their early transition to an aquatic lifestyle to their subsequent diversification, has been the subject of numerous studies. However, although the higher-level relationships among cetacean families have been largely settled, several aspects of the systematics within these groups remain unresolved. Problematic clades include the oceanic dolphins (37 spp.), which have experienced a recent rapid radiation, and the beaked whales (22 spp.), which have not been investigated in detail using nuclear loci. The combined application of high-throughput sequencing with techniques that target specific genomic sequences provide a powerful means of rapidly generating large volumes of orthologous sequence data for use in phylogenomic studies. To elucidate the phylogenetic relationships within the Cetacea, we combined sequence capture with Illumina sequencing to generate data for $\sim $3200 protein-coding genes for 68 cetacean species and their close relatives including the pygmy hippopotamus. By combining data from $>$38,000 exons with existing sequences from 11 cetaceans and seven outgroup taxa, we produced the first comprehensive comparative genomic data set for cetaceans, spanning 6,527,596 aligned base pairs (bp) and 89 taxa. Phylogenetic trees reconstructed with maximum likelihood and Bayesian inference of concatenated loci, as well as with coalescence analyses of individual gene trees, produced mostly concordant and well-supported trees. Our results completely resolve the relationships among beaked whales as well as the contentious relationships among oceanic dolphins, especially the problematic subfamily Delphinidae. We carried out Bayesian estimation of species divergence times using MCMCTree and compared our complete data set to a subset of clocklike genes. Analyses using the complete data set consistently showed less variance in divergence times than the reduced data set. In addition, integration of new fossils (e.g., Mystacodon selenensis) indicates that the diversification of Crown Cetacea began before the Late Eocene and the divergence of Crown Delphinidae as early as the Middle Miocene. [Cetaceans; phylogenomics; Delphinidae; Ziphiidae; dolphins; whales.]
SNAPPy: A snakemake pipeline for scalable HIV-1 subtyping by phylogenetic pairing
Authors: Araújo Pedro M M , Martins Joana S , Osório Nuno S
Published: October 2019

Human immunodeficiency virus 1 (HIV-1) genome sequencing is routinely done for drug resistance monitoring in hospitals worldwide. Subtyping these extensive datasets of HIV-1 sequences is a critical first step in molecular epidemiology and evolution studies. The clinical relevance of HIV-1 subtypes is increasingly recognized. Several studies suggest subtype-related differences in disease progression, transmission route efficiency, immune evasion, and even therapeutic outcomes. HIV-1 subtyping is mainly done using web-servers. These tools have limitations in scalability and potential noncompliance with data protection legislation. Thus, the aim of this work was to develop an efficient method for large-scale local HIV-1 subtyping. We designed SNAPPy: a snakemake pipeline for scalable HIV-1 subtyping by phylogenetic pairing. It contains several tasks of phylogenetic inference and BLAST queries, which can be executed sequentially or in parallel, taking advantage of multiple-core processing units. Although it was built for subtyping, SNAPPy is also useful to perform extensive HIV-1 alignments. This tool facilitates large-scale sequence-based HIV-1 research by providing a local, resource efficient and scalable alternative for HIV-1 subtyping. It is capable of analyzing full-length genomes or partial HIV-1 genomic regions (GAG, POL, and ENV) and recognizes more than ninety circulating recombinant forms. SNAPPy is freely available at: https://github.com/PMMAraujo/snappy/releases.
The Incidence and Magnitude of Cerebral Desaturation in Traumatic Brain Injury: An Observational Cohort Study
Authors: Davie Sophie , Mutch W. Alan C. , Monterola Marita , Fidler Kelsi , Funk Duane J.
Published: October 2019

Background:

Cerebral ischemia in patients with traumatic brain injury (TBI) may propagate secondary neurological injury. Episodes of cerebral ischemia can be revealed through the use of cerebral oximetry monitoring. The objective of this study was to determine the incidence and severity of regional cerebral oxygen (rSO2) desaturation (rSO2<65%) in patients with severe TBI. Secondary outcomes included changes in other monitoring parameters associated with cerebral desaturation.

Materials and Methods:

In this single-center prospective observational cohort study, cerebral oximetry data were collected continuously for up to 72 hours in 18 adult patients with a diagnosis of severe nonpenetrating TBI who were being mechanically ventilated and undergoing intracranial pressure (ICP) monitoring an in intensive care unit in Canada. Mean arterial pressure (MAP), ICP, and cerebral perfusion pressure were collected at 5-minute intervals during the study period.

Results:

Twelve of 18 (67%) patients experienced an episode of cerebral desaturation. The median (interquartile range) nadir rSO2 was 57% (51% to 62%). The duration of desaturation was 265 (57 to 1277) minutes or 8.1% (2.6% to 26.0%) of recording time. In all patients, a linear regression analysis of the area under threshold of 65% for rSO2 was moderately correlated with the area above an ICP threshold of 20 mm Hg (R
2=0.52; P<0.01). Similarly, there was a modest correlation between rSO2 and MAP (R
2=0.41; P<0.01). These relationships also held true for those patients who experienced cerebral desaturation. Patients having episodes of ICP >20 mm Hg were 6 times more likely to have a cerebral desaturation (relative risk: 6.0; 95% confidence interval: 1.3-34.7).

Conclusions:

Cerebral desaturations occur frequently in patients with severe TBI, and their duration can be protracted. Episodes of desaturation were moderately correlated with increased ICP and decreased MAP.
Recording Obligatory Cortical Auditory Evoked Potentials in Infants: Quantitative Information on Feasibility and Parent Acceptability
Authors: Munro Kevin J. , Purdy Suzanne C. , Uus Kai , Visram Anisa , Ward Rachel , Bruce Iain A. , Marsden Antonia , Stone Michael A. , Van Dun Bram
Published: October 2019

Objectives:

With the advent of newborn hearing screening and early intervention, there is a growing interest in using supra-threshold obligatory cortical auditory evoked potentials (CAEPs) to complement established pediatric clinical test procedures. The aim of this study was to assess the feasibility, and parent acceptability, of recording infant CAEPs.

Design:

Typically developing infants (n = 104) who had passed newborn hearing screening and whose parents expressed no hearing concerns were recruited. Testing was not possible in 6 infants, leaving 98, age range 5 to 39 weeks (mean age = 21.9, SD = 9.4). Three short duration speech-like stimuli (/m/, /g/, /t/) were presented at 65 dB SPL via a loudspeaker at 0° azimuth. Three criteria were used to assess clinical feasibility: (i) median test duration <30 min, (ii) >90% completion rate in a single test session, and (iii) >90% response detection for each stimulus. We also recorded response amplitude, latency, and CAEP signal to noise ratio. Response amplitudes and residual noise levels were compared for Fpz (n = 56) and Cz (n = 42) noninverting electrode locations. Parental acceptability was based on an 8-item questionnaire (7-point scale, 1 being best). In addition, we explored the patient experience in semistructured telephone interviews with seven families.

Results:

The median time taken to complete 2 runs for 3 stimuli, including preparation, was 27 min (range 17 to 59 min). Of the 104 infants, 98 (94%) were in an appropriate behavioral state for testing. A further 7 became restless during testing and their results were classified as “inconclusive.” In the remaining 91 infants, CAEPs were detected in every case with normal bilateral tympanograms. Detection of CAEPs in response to /m/, /g/, and /t/ in these individuals was 86%, 100%, and 92%, respectively. Residual noise levels and CAEP amplitudes were higher for Cz electrode recordings. Mean scores on the acceptability questionnaire ranged from 1.1 to 2.6. Analysis of interviews indicated that parents found CAEP testing to be a positive experience and recognized the benefit of having an assessment procedure that uses conversational level speech stimuli.

Conclusions:

Test duration, completion rates, and response detection rates met (or were close to) our feasibility targets, and parent acceptability was high. CAEPs have the potential to supplement existing practice in 3- to 9-month olds.
Does Surgical Approach Influence the Risk of Postoperative Infection After Surgical Treatment of Tibial Pilon Fractures?
Authors: Esposito John G. , van der Vliet Quirine M. J. , Heng Marilyn , Potter Jeffrey , Cronin Patrick K. , Harris Mitchel B. , Weaver Michael J.
Published: October 2019

Objectives:

To determine whether a particular surgical approach or combination of approaches is a risk factor for infection.

Design:

Retrospective review.

Setting:

Two Level-1 trauma centers.

Patients/Participants:

Five hundred ninety pilon fractures in 581 patients (66% male) with a median age of 45 years were identified.

Intervention:

Open reduction internal fixation of pilon fractures.

Main Outcome Measures:

Postoperative deep surgical site infection and risk factors for postoperative deep infection.

Results:

The most common primary surgical approach was medial (54%), followed by anterolateral (25%), anteromedial (11%), posterolateral (8%), and posteromedial (2%). A dual approach to the distal tibia was used in 18% of the cases. The overall deep infection rate was 19%. There was no association between primary surgical approach and development of infection (P = 0.19–0.78). Independent risk factors for infection were smoking (hazard ratio, 2.1; P < 0.001) and need for soft tissue coverage (hazard ratio, 6.9; P < 0.001).

Conclusions:

Surgical approach does not appear to be a significant risk factor for postoperative infection after open reduction internal fixation of distal tibial pilon fractures. When treating tibial plafond fractures, surgeons should select the approach they feel best addresses the specific fracture pattern.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Simple Syndactyly Release With Dental Roll Dressing
Authors: Randall Rachel M. , Balch Samora Julie
Published: October 2019

The goal of surgical intervention to repair syndactyly is to improve cosmesis and allow for a fully functional hand with independent finger motion while preventing web creep, angular deformity of the involved digits, soft tissue contracture, or neurovascular injury. Because web creep is one of the most common complications of commissure reconstruction, it is important to create a good dorsal flap with a broad insertion proximal to the commissure. The authors describe a technique in which the placement of a “dental roll” between the newly separated digits helps not only with graft take and to seat the dorsal flap well into the web space, but also to prevent the newly separated digits from touching each other. The use of the dental roll in the web space is novel, can be used in place of standard bolter-type dressings, and, along with the creation of an appropriately sized dorsal commissure flap, has the potential to enhance healing and perhaps prevent web creep.
Overview: Value-based Care for Orthopedic Surgery
Authors: Attarian David E. , Seyler Thorsten M. , Bolognesi Michael P.
Published: October 2019

An overview of health care value definitions, the current health care paradigm and brief history of the origins of value-based care in orthopedics are presented. The 4 pillar strategic approach for achieving high-value musculoskeletal services includes (1) increasing revenue, (2) decreasing costs, (3) improving the patient experience, and (4) improving quality. The tactics for success in value-based orthopedic care are reviewed and discussed.
Short-Term Clinical and Quality Outcomes Have Inconsistent Changes From a Quality Improvement Initiative to Increase Access to Physical Therapy in the Cardiovascular and Surgical ICU
Authors: Tonna Joseph E. , Johnson Joshua , Presson Angela , Zhang Chong , Noren Chris , Lohse Bryan , Bento Haley , Barton Richard G. , Nirula Raminder , Mone Mary , Marcus Robin
Published: October 2019

Objectives:

Studies of mobility during critical illness have mostly examined transitions from immobility (passive activities) or limited mobility to active “early mobility.”

Design:

Observational analysis of a quality improvement initiative.

Setting:

Two ICUs (surgical ICU, cardiovascular ICU) at a tertiary academic medical center.

Patients:

Critically ill surgical and cardiovascular patients.

Interventions:

Doubling available physical therapy.

Measurements and Main Results:

We examined the outcomes of therapy time/patient/day, ICU and hospital length of stay, disposition location, and change in functional status. We adjusted for age, sex, illness severity, and number of surgeries. Among 1,515 patients (703 baseline, 812 quality improvement), total therapy time increased from 71,994 to 115,389 minutes and from 42,985 to 93,015 minutes, respectively, in each ICU. In the cardiovascular ICU per patient therapy increased 17% (95% CI, –4.9 to 43.9; p = 0.13), and in the surgical ICU, 26% (95% CI, –1 to 59.4; p = 0.06). In the cardiovascular ICU, there was a 27.4% decrease (95% CI, –52.5 to 10.3; p = 0.13) in ICU length of stay, and a 12.4% decrease (95% CI, –37.9 to 23.3; p = 0.45) in total length of stay, whereas in the surgical ICU, the adjusted ICU length of stay increased 19.9% (95% CI, –31.6 to 108.6; p = 0.52) and total length of stay increased 52.8% (95% CI, 1.0–130.2; p = 0.04). The odds of a lower level of care discharge did not change in either ICU (cardiovascular ICU: 2.6 [95% CI, 0.6–12.2; p = 0.22]); surgical ICU: 3.6 [95% CI, 0.9–15.4; p = 0.08]).

Conclusions:

Among diverse cardiothoracic and surgical patients, a quality improvement initiative doubling physical therapy shifts is associated with increased total administered therapy time, but when distributed among a greater number of patients during the quality improvement period, the increase is tempered. This was not associated with consistent changes in ICU length of stay or changes in disposition location.
Increasing Cardiovascular Data Sampling Frequency and Referencing It to Baseline Improve Hemorrhage Detection
Authors: Wertz Anthony , Holder Andre L. , Guillame-Bert Mathieu , Clermont Gilles , Dubrawski Artur , Pinsky Michael R.
Published: October 2019

Objectives:

We hypothesize that knowledge of a stable personalized baseline state and increased data sampling frequency would markedly improve the ability to detect progressive hypovolemia during hemorrhage earlier and with a lower false positive rate than when using less granular data.

Design:

Prospective temporal challenge.

Setting:

Large animal research laboratory, University Medical Center.

Subjects:

Fifty-one anesthetized Yorkshire pigs.

Interventions:

Pigs were instrumented with arterial, pulmonary arterial, and central venous catheters and allowed to stabilize for 30 minutes then bled at a constant rate of either 5 mL·min–1 (n = 13) or 20 (n = 38) until mean arterial pressure decreased to 40 or 30 mm Hg in the 5 and 20 mL·min–1 pigs, respectively.

Measurements and Main Results:

Data during the stabilization period served as baseline. Hemodynamic variables collected at 250 Hz were used to create predictive models of “bleeding” using featurized beat-to-beat and waveform data and compared with models using mean unfeaturized hemodynamic variables averaged over 1-minute as simple hemodynamic metrics using random forest classifiers to identify bleeding with or without baseline data. The robustness of the prediction was evaluated in a leave-one-pig-out cross-validation. Predictive performance of models was compared by their activity monitoring operating characteristic and receiver operating characteristic profiles. Primary hemodynamic threshold data poorly identified bleed onset unless very stable initial baseline reference data were available. When referenced to baseline, bleed detection at a false positive rates of 10–2 with time to detect 80% of pigs bleeding was similar for simple hemodynamic metrics, beat-to-beat, and waveform at about 3–4 minutes. Whereas when universally baselined, increasing sampling frequency reduced latency of bleed detection from 10 to 8 to 6 minutes, for simple hemodynamic metrics, beat-to-beat, and waveform, respectively. Some informative features differed between simple hemodynamic metrics, beat-to-beat, and waveform models.

Conclusions:

Knowledge of personal stable baseline data allows for early detection of new-onset bleeding, whereas if no personal baseline exists increasing sampling frequency of hemodynamic monitoring data improves bleeding detection earlier and with lower false positive rate.
Validation of Image Quality and Diagnostic Accuracy Using a Mobile Phone Camera Microscope Adaptor Compared With Glass Slide Review in Teledermatopathology
Authors: Laggis Caroline W. , Bailey Elizabeth E. , Novoa Roberto , Stewart Campbell L. , Stoff Benjamin , Wanat Karolyn A. , Barbieri John , Kovarik Carrie
Published: October 2019

New modalities of evaluating histopathology, such as whole-slide imaging, have been validated in the field of dermatopathology but are often unfeasible and unavailable in developing countries. Widely available across the globe, mobile phone camera technology represents a potential simple and inexpensive method of imaging histologic slides through the use of a mobile phone camera microscope adaptor. This study aims to validate the use of a commercially available adaptor in the diagnosis of inflammatory and infectious conditions in dermatopathology. Representative images were taken of slides for fifty-four cases using the adaptor and shared through a cloud-based platform with five dermatopathologists who rendered diagnoses and judged the quality of the images. After a washout period of 8 weeks, the same cases were assessed by the same dermatopathologists using the original glass slides. The intraobserver concordance rate was 93.3%, and the quality of the mobile phone images was rated as “excellent” or “diagnostic” in 94.4% of the cases. This study validates the use of this low-tech and low-cost adaptor as a reliable tool in teledermatopathology. Limitations of the study include those inherent to use of the adaptor and the limited panel of diagnoses. The primary value of this device may be in developing countries, but its practicality and ease of use lend itself to use in academic and consultative settings in the developed world as well.
Direct Oral Anticoagulant Use After Transcatheter Aortic Valve Replacement: A Case Series
Authors: Hendricks Abby K. , Nei Scott D. , Greason Kevin L. , Scott Rachael A.
Published: October 2019

Background:

Use of an anticoagulant after transcatheter aortic valve replacement (TAVR) has been increasing in practice after noted leaflet thrombosis on dual antiplatelet therapy. As the use of anticoagulation increases so does the number of poor warfarin candidates or warfarin intolerant patients. While direct oral anticoagulant (DOAC) use is increasing for other indications, there is a paucity of data for use after TAVR. The objective of this case series is to add to the available evidence for patients who may require a DOAC after TAVR.

Methods:

A single-center, retrospective observational case series was conducted including adults 18 years of age and older who received a DOAC after TAVR between November 2008 and June 2018 at Mayo Clinic Hospital—Rochester. All patients were identified as part of the Society of Thoracic Surgeons database.

Results:

Twenty-one patients were identified as having received a DOAC after TAVR. Median age was 83.5 years (interquartile range 77–87), with 71% males. Within this cohort, 20 patients (95.2%) had an alternative indication for anticoagulation of either atrial fibrillation or atrial flutter. Apixaban was prescribed in 66.7% of patients, followed by rivaroxaban (14.3%), dabigatran (9.5%), and edoxaban (4.8%). No thromboembolic events were reported. Three patients experienced a bleeding event, of which only 2 occurred in the 3 months immediately after TAVR.

Conclusions:

DOAC therapy after TAVR was generally safe and well tolerated. Taken in context of other retrospective studies, these data suggest that the presence of valvular heart disease, specifically TAVR in this case, should not preclude the use of DOACs.
Wise Pattern Direct Implant Breast Reconstruction: A Review and Improved Outcomes Using Dermal Matrix
Authors: Friedman Harold I. , Talebagha Sarah , Gilstrap Jarom , Mujadzic Mirsad , Chen Elliott
Published: October 2019

Background:

The inverted T (Wise pattern) mastectomy for patients with macromastia or significant breast ptosis has evolved along with generalized techniques for breast reconstruction. We present a review of Wise pattern breast reconstruction along with our technique for direct to implant reconstruction using dermal matrix.

Methods:

The literature was reviewed and an analysis of techniques and complications was performed. We present our series of patients incorporating dermal matrix and relatively large implants in direct to implant reconstruction.

Results:

Of 18 breasts reconstructed only 2 failed. One caused by flap necrosis secondary to smoking and one as a result of preoperative radiation.

Conclusion:

Wise pattern breast reconstruction using relatively large implants and dermal matrix in direct to implant reconstruction is a safe technique in selected patients with macromastia.
Addressing the Surgical Deficit: A Global Imperative for Plastic and Reconstructive Surgeons
Authors: Davis Rachel W. , Johnson Walter D. , Hollier Larry H.
Published: October 2019

Despite poor access to quality surgical and anesthesia care for the majority of the world’s people, with greatest impact on low- and middle-income countries, surgery has only recently begun to gain acceptance as a necessary component of global health. As a leader in global surgical funding, the field of Plastic and Reconstructive Surgery is uniquely positioned to influence change in global policy and financial support. For improvements in surgical access and outcomes worldwide, investment in surgical systems, commitment to national surgery, obstetric, and anesthesia planning, and continued evaluation and improvement of care delivery should be pursued.
Pathology of Rotavirus-driven Multiple Organ Failure in a 16-month-old Boy
Authors: Tarris Georges , Belliot Gaël , Callier Patrick , Huet Frédéric , Martin Laurent , de Rougemont Alexis
Published: October 2019

Autopsy investigation of a fatal case of rotavirus severe acute gastroenteritis and multiple organ failure in a 16-month boy with previous intrauterine growth retardation showed colocalization of nonstructural and structural rotavirus proteins within viroplasms in nephrons. This case brings new insights into extraintestinal rotavirus infection and new clues to its abilities to bind to human histo-blood group antigens.