bluuebunny/crossref_metadata_2025 huggingface dataset:
Gravity and the non-linear growth of structure in the Carnegie-Spitzer-IMACS Redshift Survey
Authors: Kelson Daniel D , Abramson Louis E , Benson Andrew J , Patel Shannon G , Shectman Stephen A , Dressler Alan , McCarthy Patrick J , Mulchaey John S , Williams Rik J
Published: January 2020

A key obstacle to developing a satisfying theory of galaxy evolution is the difficulty in extending analytic descriptions of early structure formation into full non-linearity, the regime in which galaxy growth occurs. Extant techniques, though powerful, are based on approximate numerical methods whose Monte Carlo-like nature hinders intuition building. Here, we develop a new solution to this problem and its empirical validation. We first derive closed-form analytic expectations for the evolution of fixed percentiles in the real-space cosmic density distribution, averaged over representative volumes observers can track cross-sectionally. Using the Lagrangian forms of the fluid equations, we show that percentiles in δ – the density relative to the median – should grow as $\delta (t)\propto \delta _{0}^{\alpha }\, t^{\beta }$, where α ≡ 2 and β ≡ 2 for Newtonian gravity at epochs after the overdensities transitioned to non-linear growth. We then use 9.5 square degress of Carnegie-Spitzer-IMACS Redshift Survey data to map galaxy environmental densities over 0.2 < z < 1.5 (∼7 Gyr) and infer α = 1.98 ± 0.04 and β = 2.01 ± 0.11 – consistent with our analytic prediction. These findings – enabled by swapping the Eulerian domain of most work on density growth for a Lagrangian approach to real-space volumetric averages – provide some of the strongest evidence that a lognormal distribution of early density fluctuations indeed decoupled from cosmic expansion to grow through gravitational accretion. They also comprise the first exact, analytic description of the non-linear growth of structure extensible to (arbitrarily) low redshift. We hope these results open the door to new modelling of, and insight-building into, galaxy growth and its diversity in cosmological contexts.
Berkeley supernova Ia program: data release of 637 spectra from 247 Type Ia supernovae
Authors: Stahl Benjamin E , Zheng WeiKang , de Jaeger Thomas , Brink Thomas G , Filippenko Alexei V , Silverman Jeffrey M , Cenko S Bradley , Clubb Kelsey I , Graham Melissa L , Halevi Goni , Kelly Patrick L , Kleiser Io , Shivvers Isaac , Yuk Heechan , Cobb Bethany E , Fox Ori D , Kandrashoff Michael T , Kong Jason J , Mauerhan Jon C , Wang Xianggao , Wang Xiaofeng
Published: January 2020

We present 637 low-redshift optical spectra collected by the Berkeley Supernova Ia Program (BSNIP) between 2009 and 2018, almost entirely with the Kast double spectrograph on the Shane 3 m telescope at Lick Observatory. We describe our automated spectral classification scheme and arrive at a final set of 626 spectra (of 242 objects) that are unambiguously classified as belonging to Type Ia supernovae (SNe Ia). Of these, 70 spectra of 30 objects are classified as spectroscopically peculiar (i.e. not matching the spectral signatures of ‘normal’ SNe Ia) and 79 SNe Ia (covered by 328 spectra) have complementary photometric coverage. The median SN in our final set has one epoch of spectroscopy, has a redshift of 0.0208 (with a low of 0.0007 and high of 0.1921), and is first observed spectroscopically 1.1 d after maximum light. The constituent spectra are of high quality, with a median signal-to-noise ratio of 31.8 pixel−1, and have broad wavelength coverage, with $\sim\! 95{{\ \rm per\ cent}}$ covering at least 3700–9800 Å. We analyse our data set, focusing on quantitative measurements (e.g. velocities, pseudo-equivalent widths) of the evolution of prominent spectral features in the available early-time and late-time spectra. The data are available to the community, and we encourage future studies to incorporate our spectra in their analyses.
The Swift Bulge Survey: optical and near-IR follow-up featuring a likely symbiotic X-ray binary and a focused wind CV
Authors: Shaw A W , Heinke C O , Maccarone T J , Sivakoff G R , Strader J , Bahramian A , Degenaar N , Kennea J A , Kuulkers E , Rau A , Rivera Sandoval L E , Shishkovsky L , Swihart S J , Tetarenko A J , Wijnands R , in ’t Zand J J M
Published: January 2020

The nature of very faint X-ray transients (VFXTs) – transient X-ray sources that peak at luminosities $L_X\lesssim 10^{36} {\rm \, erg \, s^{-1}}$ – is poorly understood. The faint and often short-lived outbursts make characterizing VFXTs and their multiwavelength counterparts difficult. In 2017 April we initiated the Swift Bulge Survey, a shallow X-ray survey of ∼16 square degrees around the Galactic centre with the Neil Gehrels Swift Observatory. The survey has been designed to detect new and known VFXTs, with follow-up programmes arranged to study their multiwavelength counterparts. Here we detail the optical and near-infrared follow-up of four sources detected in the first year of the Swift Bulge Survey. The known neutron star binary IGR J17445-2747 has a K4III donor, indicating a potential symbiotic X-ray binary nature and the first such source to show X-ray bursts. We also find one nearby M-dwarf (1SXPS J174215.0-291453) and one system without a clear near-IR counterpart (Swift J175233.9-290952). Finally, 3XMM J174417.2-293944 has a subgiant donor, an 8.7 d orbital period, and a likely white dwarf accretor; we argue that this is the first detection of a white dwarf accreting from a gravitationally focused wind. A key finding of our follow-up campaign is that binaries containing (sub)giant stars may make a substantial contribution to the VFXT population.
Microfluidics in male reproduction: is ex vivo culture of primate testis tissue a future strategy for ART or toxicology research?
Authors: Sharma Swati , Venzac Bastien , Burgers Thomas , Le Gac Séverine , Schlatt Stefan
Published: January 2020

The significant rise in male infertility disorders over the years has led to extensive research efforts to recapitulate the process of male gametogenesis in vitro and to identify essential mechanisms involved in spermatogenesis, notably for clinical applications. A promising technology to bridge this research gap is organ-on-chip (OoC) technology, which has gradually transformed the research landscape in ART and offers new opportunities to develop advanced in vitro culture systems. With exquisite control on a cell or tissue microenvironment, customized organ-specific structures can be fabricated in in vitro OoC platforms, which can also simulate the effect of in vivo vascularization. Dynamic cultures using microfluidic devices enable us to create stimulatory effect and non-stimulatory culture conditions. Noteworthy is that recent studies demonstrated the potential of continuous perfusion in OoC systems using ex vivo mouse testis tissues. Here we review the existing literature and potential applications of such OoC systems for male reproduction in combination with novel bio-engineering and analytical tools. We first introduce OoC technology and highlight the opportunities offered in reproductive biology in general. In the subsequent section, we discuss the complex structural and functional organization of the testis and the role of the vasculature-associated testicular niche and fluid dynamics in modulating testis function. Next, we review significant technological breakthroughs in achieving in vitro spermatogenesis in various species and discuss the evidence from microfluidics-based testes culture studies in mouse. Lastly, we discuss a roadmap for the potential applications of the proposed testis-on-chip culture system in the field of primate male infertility, ART and reproductive toxicology.
The Role of Smoking in Country Differences in Life Expectancy Across Europe, 1985–2014
Authors: Janssen Fanny
Published: January 2020

Introduction

Smoking contributes substantially to mortality levels and trends. Its role in country differences in mortality has, however, hardly been quantified. The current study formally assesses the—so far unknown—changing contribution of smoking to country differences in life expectancy at birth (e0) across Europe.

Methods

Using all-cause mortality data and indirectly estimated smoking-attributable mortality rates by age and sex for 30 European countries from 1985 to 2014, the differences in e0 between each individual European country and the weighted average were decomposed into a smoking- and a nonsmoking-related part.

Results

In 2014, e0 ranged from 70.8 years in Russia to 83.1 years in Switzerland. Men exhibited larger country differences than women (variance of 21.9 and 7.0 years, respectively). Country differences in e0 increased up to 2005 and declined thereafter. Among men, the average contribution of smoking to the country differences in e0 was highest around 1990 (47%) and declined to 35% in 2014. Among women, the average relative contribution of smoking declined from 1991 to 2011, and smoking resulted in smaller differences with the average e0 level in the majority of European countries. For both sexes combined, the contribution of smoking to country differences in e0 was higher than 20% throughout the period.

Conclusions

Smoking contributed substantially to the country differences in e0 in Europe, their increases up to 1991, and their decreases since 2005, especially among men. Policies that discourage smoking can help to reduce inequalities in mortality levels across Europe in the long run.

Implications

Smoking contributes substantially to country differences in life expectancy at birth (e0) in Europe, particularly among men, for whom the contribution was highest around 1990 (47%) and declined to 35% in 2014. In line with the anticipated progression of the smoking epidemic, the differences between European countries in e0 due to smoking are expected to further decline among men, but to increase among women. The role of smoking in mortality convergence since 2005 illustrates that smoking policies can help to reduce inequalities in life expectancy levels across Europe, particularly when they target smoking in countries with low e0.
The importance of temperature and lipid accumulation for initiation and duration of Calanus hyperboreus spawning
Authors: Schultz Mads , Nielsen Torkel Gissel , Møller Eva Friis
Published: January 2020

Large, lipid-storing copepods play a central role in marine Arctic ecosystems. Knowledge of the mechanisms that control their oogenesis is important for understanding their phenology and population dynamics. We investigated the impact of female lipid content on the timing and cumulative egg production (EP) of Calanus hyperboreus at 0, 3 and 6°C. The lipid content of females in early autumn was a good predictor of their EP potential. However, we saw no indication of a threshold in lipid content for initiation of spawning. Higher temperature resulted in 17 and 24 days earlier spawning at 3 and 6°C compared with 0°C, and the mean spawning duration was 8 and 30 days shorter, respectively. This illustrates that temperature affects the phenology of C. hyperboreus. When EP began, lipid metabolism increased 2–4 times. The females allocated 1.3 μg lipid per egg independent of temperature. However, the basic metabolism increased with increasing temperature; consequently, a smaller fraction of lipid was allocated for EP when the temperature increased.
Ultrasound-Guided Intercostal Peripheral Nerve Stimulator Implantation: Technique Report and Feasibility Study in a Cadaver
Authors: Gupta Sahil , Clendenen Steven , Ferreira-Dos-Santos Guilherme , Hurdle Mark Friedrich
Published: January 2020

Objective

This study aimed to describe and validate a novel ultrasound-guided intercostal peripheral nerve stimulator implantation technique.

Methods

The fifth to tenth ribs on both sides of an unembalmed cadaveric specimen were localized using a 15–6-MHz linear array transducer, counting distally from T-1 bilaterally. A single interventionist then implanted 12 peripheral nerve stimulators on the fifth through tenth ribs, six MicroLeads on the left side and six StimRouters on the right side, using an in-plane lateral to medial approach to the inferior border of the corresponding rib. After all the stimulators were implanted, their location was confirmed using fluoroscopy. Gross anatomic dissection was later performed for each of the stimulators placed, and the distance of the lead from the intercostal nerve and pleura was noted.

Results

All leads were noted in an accurate position in the plane between the inner and innermost intercostal muscle, without any intrapleural placement. The distance of the leads from the intercostal nerves was on average 2.3 mm and 1.1 mm for MicroLead and StimRouter, respectively.

Conclusions

To our knowledge, this study is the first to determine the feasibility of ultrasound-guided peripheral nerve stimulator placement in close proximity to the pleura. All the stimulator leads were accurately placed using our ultrasound-guided technique and were within 0.5–3 mm from the intercostal nerve. Although this technique might prove technically challenging, the use of ultrasound for intercostal peripheral nerve stimulator implantation appears feasible and warrants further investigation to establish this as an acceptable technique for patients.
Functional analysis of chimeric TrCel6A enzymes with different carbohydrate binding modules
Authors: Christensen Stefan Jarl , Badino Silke Flindt , Cavaleiro Ana Mafalda , Borch Kim , Westh Peter
Published: January 2020

The glycoside hydrolase (GH) family 6 is an important group of enzymes that constitute an essential part of industrial enzyme cocktails used to convert lignocellulose into fermentable sugars. In nature, enzymes from this family often have a carbohydrate binding module (CBM) from the CBM family 1. These modules are known to promote adsorption to the cellulose surface and influence enzymatic activity. Here, we have investigated the functional diversity of CBMs found within the GH6 family. This was done by constructing five chimeric enzymes based on the model enzyme, TrCel6A, from the soft-rot fungus Trichoderma reesei. The natural CBM of this enzyme was exchanged with CBMs from other GH6 enzymes originating from different cellulose degrading fungi. The chimeric enzymes were expressed in the same host and investigated in adsorption and quasi-steady-state kinetic experiments. Our results quantified functional differences of these phylogenetically distant binding modules. Thus, the partitioning coefficient for substrate binding varied 4-fold, while the maximal turnover (kcat) showed a 2-fold difference. The wild-type enzyme showed the highest cellulose affinity on all tested substrates and the highest catalytic turnover. The CBM from Serendipita indica strongly promoted the enzyme’s ability to form productive complexes with sites on the substrate surface but showed lower turnover of the complex. We conclude that the CBM plays an important role for the functional differences between GH6 wild-type enzymes.
SOIL–SOYBEAN TRANSFER FACTOR OF NATURAL RADIONUCLIDES IN DIFFERENT SOIL TEXTURES AND THE ASSESSMENT OF COMMITTED EFFECTIVE DOSE
Authors: Uosif M A M , Alrowaili Z A , Elsaman Reda , Mostafa A M A
Published: January 2020

From three different soil textures (clay, silt and sand), 36 soil and soybeans samples were accumulated from the agricultural area of EL-Mynia governorate in Upper Egypt, between (27°36′19.44″N; 30°30′14.14″ E) and (28°48′28.45″ N; 31°00′32.27″ E). Soil textures were prepared by particle size distribution through a pipette method. Its radioactivity measurements were performed with a NaI (Tl) and 3 × 3 inch crystal. The transfer factor (TF) of natural radionuclides from soil to soybeans was calculated. The value of the TF for 226Ra in clay soil ranges from 0.27 ± 0.03 to 0.42 ± 0.05, in sandy soil it ranges from 0.21 ± 0.02 to 0.57 ± 0.07 and in silt soil it ranges from 0.25 ± 0.03 to 0.53 ± 0.06. The TF for 232Th in clay soil ranges from 0.22 ± 0.03 to 0.90 ± 0.12, in sandy soil it ranges from 0.21 ± 0.03 to 1.00 ± 0.13, while in silt soil it ranges from 0.25 ± 0.03 to 0.88 ± 0.12. The TF for 40K in clay soil ranges from 0.95 ± 0.13 to 2.05 ± 0.29, in sandy soil it ranges from 1.21 ± 0.17 to 2.52 ± 0.35 and in silt soil it ranges and from 1.01 ± 0.14 to 1.46 ± 0.26.The results show that the committed effective dose from soybean consumption is between 54.5 and 103.4 μSv y−1 assuming consumption of 20 kg y−1.
Mathematical routines in transition: facilitating students’ defining and proving of sequence convergence
Authors: Schüler-Meyer Alexander
Published: January 2020

The transition to tertiary mathematics requires students to use definitions of mathematical objects instead of intuitions. However, routines of defining and of proving with definitions are difficult to engage in, as they are not familiar to students who come from secondary school mathematics. Defining is highly complex because of its underlying rules, which demand that a definition has to be minimal, formal, deductively ordered, operationalized and so forth. While students can learn these rules by the teacher making them explicit during defining, this paper illustrates a trajectory that aims to systematically build on students’ familiar secondary school routines of classifying, describing, symbolizing and proving as resources for learning defining and proving with definitions. This trajectory is informed by a five-session teaching–learning intervention in which upper-secondary students in Germany are engaged in defining and proving with definitions and which specifically focuses on systematically building on students’ prior experiences in secondary school mathematics.
Albumin Use in Brain-injured and Neurosurgical Patients: Concepts, Indications, and Controversies
Authors: Ma Heung Kan , Bebawy John F.
Published: January 2020

Human albumin has been used extensively for decades as a nonwhole blood plasma replacement fluid in the perioperative and critical care setting. Its potential advantages as a highly effective volume expander must be weighed, however, against its potential harm for patients in the context of various neurological states and for various neurosurgical interventions. This narrative review explores the physiological considerations of intravenous human albumin as a replacement fluid and examines the extant clinical evidence for and against its use within the various facets of modern neuroanesthesia and neurocritical care practice.
Early Definitive Care Is as Effective as Staged Treatment Protocols for Open Ankle Fractures Caused by Rotational Mechanisms: A Retrospective Case–Control Study
Authors: Peterson Daniel L. , Schuurman Meg , Geamanu Andreea , Padela Muhammad T. , Kennedy Christopher J. , Wilkinson Joseph , Vaidya Rahul
Published: January 2020

Objectives:

To compare immediate internal fixation with primary wound closure to temporary fixation/stabilization with delayed fixation and wound closure protocols for management of open ankle fractures.

Design:

Retrospective case–control study.

Setting:

Level 1 trauma center.

Patients:

Eighty-eight consecutive patients who presented with a Gustilo–Anderson type I, II, or IIIa open ankle fracture to a single center.

Intervention:

Patients were divided into 2 cohorts: either immediate internal fixation with primary wound closure (EARLY) or temporary fixation/stabilization with delayed fixation and wound closure (STAGED) due to practice differences of the attending surgeons.

Main Outcome Measures:

Infection, length of stay, number and type of operations, and clinical measures. We also assessed the 2 groups with regard to demographics and radiographic classification.

Results:

Overall, incidence of infection was 6 (6.8%) with no significant difference between patients treated with EARLY versus STAGED protocols. The EARLY cohort had a significantly shorter length of hospital stay, fewer number of reoperations but similar clinical outcomes for pain, ambulation, and radiographic evidence of osteoarthritis for patients followed for >12 months.

Conclusion:

Our study showed that early definitive treatment compared with a staged protocol for Gustilo–Anderson type I, II, and IIIa open ankle fractures has similar rates of infection, shorter hospital stay, fewer surgical interventions, and similar clinical outcomes.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Improved Outcomes After Regional Implementation of Sepsis Alert: A Novel Triage Model*
Authors: Rosenqvist Mari , Bengtsson-Toni Maria , Tham Johan , Lanbeck Peter , Melander Olle , Åkesson Per
Published: January 2020

Objectives:

To assess whether the triage model Sepsis Alert for Emergency Departments results in improved initial care of patients with severe infections.

Design:

Interventional study comparing patient care before and after the start of a new triage model, including 90-day follow-up.

Setting:

Eight emergency departments in Skåne County, Sweden.

Subjects:

Patients with suspected severe infection.

Interventions:

Patients with severely deviating vital signs and suspected infection were triaged into a designated sepsis line called Sepsis Alert, for rapid evaluation supported by an infectious disease specialist. Also, all emergency department staff participated in a designated sepsis education before the model was introduced.

Measurements and Main Results:

Medical records were evaluated for a 3-month period 1 year before the triage system was started in 2016 and for a 3-month period 1 year after. Of 195,607 patients admitted to these emergency departments during two 3-month periods, a total of 5,321 patients presented severely abnormal vital signs. Of these, 1,066 patients who presented with fever greater thanor equal to 38°C or history of fever/chills were considered to be patients at risk of having severe sepsis. Among patients triaged according to Sepsis Alert, 89.3% received antibiotic treatment within 1 hour after arrival to the emergency department (median time to antibiotics, 26 min), which was significantly better than before the start of the new triage: 67.9% (median time to antibiotics, 37 min) (p < 0.001). Additionally, sepsis treatment quality markers were significantly improved after the introduction of Sepsis Alert, including number of blood cultures and lactate measurements taken, percentage of patients receiving IV fluids, and appropriate initial antibiotic treatment. There were no differences in 28- or 90-day mortality rates.

Conclusions:

The implementation of the new triage model Sepsis Alert with special attention to severe sepsis patients led to faster and more accurate antibiotic treatment and improved diagnostic procedures and supportive care.
A Task-Analytic Framework Comparing Preoperative Electronic Health Record–Mediated Nursing Workflow in Different Settings
Authors: Zheng Lu , Kaufman David R. , Duncan Benjamin J. , Furniss Stephanie K. , Grando Adela , Poterack Karl A. , Miksch Timothy A. , Helmers Richard A. , Doebbeling Bradley N.
Published: January 2020

Preoperative care is a critical, yet complex, time-sensitive process. Optimization of workflow is challenging for many reasons, including a lack of standard workflow analysis methods. We sought to comprehensively characterize electronic health record–mediated preoperative nursing workflow. We employed a structured methodological framework to investigate and explain variations in the workflow. Video recording software captured 10 preoperative cases at Arizona and Florida regional referral centers. We compared the distribution of work for electronic health record tasks and off-screen tasks through quantitative analysis. Suboptimal patterns and reasons for variation were explored through qualitative analysis. Although both settings used the same electronic health record system, electronic health record tasks and off-screen tasks time distribution and patterns were notably different across two sites. Arizona nurses spent a longer time completing preoperative assessment. Electronic health record tasks occupied a higher proportion of time in Arizona, while off-screen tasks occupied a higher proportion in Florida. The contextual analysis helped to identify the variation associated with the documentation workload, preparation of the patient, and regional differences. These findings should seed hypotheses for future optimization efforts and research supporting standardization and harmonization of workflow across settings, post–electronic health record conversion.
Homocysteine and IgA nephropathy: observational and Mendelian randomization analyses
Authors: Zhang Yue-Miao , Zhou Xu-Jie , Shi Su-Fang , Liu Li-Jun , Lyu Ji-Cheng , Zhang Hong
Published: January 2020

Background:

High levels of plasma homocysteine occur almost uniformly in patients with end-stage renal disease (ESRD). IgA nephropathy (IgAN) is the most common form of primary glomerulonephritis and a common cause of ESRD in young adults. Here, we aimed to detect whether homocysteine was elevated and associated with clinical-pathologic manifestations of IgAN patients and tested its causal effects using a two-sample Mendelian randomization (MR) approach.

Methods:

For observational analysis, 108 IgAN patients, 30 lupus nephritis (LN) patients, 50 minimal change disease (MCD) patients, and 206 healthy controls were recruited from April 2014 to April 2015. Their plasma homocysteine was measured and clinical-pathologic manifestations were collected from medical records. For MR analysis, we further included 1686 IgAN patients. The missense variant methylenetetrahydrofolate reductase C677T (rs1801133) was selected as an instrument, which was genotyped by TaqMan allele discrimination assays.

Results:

Majority of IgAN patients (93.52%, 101/108) showed elevated levels of plasma homocysteine (>10 μmol/L). Plasma homocysteine in IgAN patients was significantly higher than that in MCD patients (median: 18.32vs.11.15 μmol/L,Z = −5.29,P < 0.01) and in healthy controls (median: 18.32vs.10.00 μmol/L,Z = −8.76,P < 0.01), but comparable with those in LN patients (median: 18.32 Lvs.14.50 μmol/L,Z = −1.32,P = 0.19). Significant differences were observed in sub-groups of IgAN patients according to quartiles of plasma homocysteine for male ratio (22.22%vs.51.85%vs.70.37%vs.70.37%,χ2 = 14.29,P < 0.01), serum creatinine (median: 77.00vs.100.00vs.129.00vs.150.00 μmol/L,χ2 = 34.06,P < 0.01), estimated glomerular filtration rate (median: 100.52vs.74.23vs.52.68vs.42.67 mL·min−1·1.73 m−2,χ2 = 21.75,P < 0.01), systolic blood pressure (median: 120.00vs.120.00vs.125.00vs.130.00 mmHg,χ2 = 2.97,P = 0.05), diastolic blood pressure (median 80.00vs.75.00vs.80.00vs.81.00 mmHg,χ2 = 11.47,P < 0.01), and pathologic tubular atrophy and interstitial fibrosis (T) (T0/T1/T2: 62.96%/33.33%/3.70%vs.29.63%/40.74%/29.63%vs.24.00%/48.00%/28.00%vs.14.81%/37.04%/48.15%,χ2 = 17.66,P < 0.01). The coefficient of each rs1801133-T allele on homocysteine levels after controlling age and sex was 7.12 (P < 0.01). MR estimates showed causal positive effects of homocysteine on serum creatine (β = 0.76,P = 0.02), systolic blood pressure (β = 0.26,P = 0.02), diastolic blood pressure (β = 0.20,P = 0.01), and pathologic T lesion (β = 0.01,P = 0.01) in IgAN.

Conclusions:

By observational and MR analyses, consistent results were observed for associations of plasma homocysteine with serum creatinine, blood pressures, and pathologic T lesion in IgAN patients.
Long non-coding RNA HOTAIRM1 promotes proliferation and inhibits apoptosis of glioma cells by regulating the miR-873-5p/ZEB2 axis
Authors: Lin Yi-Hai , Guo Liang , Yan Feng , Dou Zhang-Qi , Yu Qian , Chen Gao
Published: January 2020

Background

Glioblastoma is one of the most common malignant brain tumors. Conventional clinical treatment of glioblastoma is not sufficient, and the molecular mechanism underlying the initiation and development of this disease remains unclear. Our study aimed to explore the expression and function of miR-873a-5p in glioblastoma and related molecular mechanism.

Methods

We analyzed the most dysregulated microRNAs from the Gene Expression Omnibus (GEO) database and examined the expression of miR-873-5p in 20 glioblastoma tissues compared with ten normal brain tissues collected in the Zhejiang Tongde Hospital. We then overexpressed or inhibited miR-873-5p expression in U87 glioblastoma cell lines and analyzed the phenotype using the cell counting kit-8 assay, wound healing assay, and apoptosis. In addition, we predicted upstream and downstream genes of miR-873-5p in glioblastoma using bioinformatics analysis and tested our hypothesis in U87 cells using the luciferase reporter gene assay and Western blotting assay. The differences between two groups were analyzed by Student's t test. The Kruskal-Wallis test was used for the comparison of multiple groups. A P < 0.05 was considered to be significant.

Results

The miR-873-5p was downregulated in glioblastoma tissues compared with that in normal brain tissues (normal vs. tumor, 0.762 ± 0.231 vs. 0.378 ± 0.114, t = 4.540, P < 0.01). Overexpression of miR-873-5p inhibited cell growth (t = 6.095, P < 0.01) and migration (t = 3.142, P < 0.01) and promoted cell apoptosis (t = 4.861, P < 0.01), while inhibition of miR-873-5p had the opposite effect. Mechanistically, the long non-coding RNA HOTAIRM1 was found to act as a sponge of miR-873-5p to activate ZEB2 expression in U87 cells.

Conclusions

We uncovered a novel HOTAIRM1/miR-873-5p/ZEB2 axis in glioblastoma cells, providing new insight into glioblastoma progression and a theoretical basis for the treatment of glioblastoma.
Artificial intelligence in gastrointestinal endoscopy: general overview
Authors: El Hajjar Ahmad , Rey Jean-François
Published: January 2020

Artificial intelligence (AI) is now a trendy subject in clinical medicine and especially in gastrointestinal (GI) endoscopy. AI has the potential to improve the quality of GI endoscopy at all levels. It will compensate for humans’ errors and limited capabilities by bringing more accuracy, consistency, and higher speed, making endoscopic procedures more efficient and of higher quality. AI showed great results in diagnostic and therapeutic endoscopy in all parts of the GI tract. More studies are still needed before the introduction of this new technology in our daily practice and clinical guidelines. Furthermore, ethical clearance and new legislations might be needed. In conclusion, the introduction of AI will be a big breakthrough in the field of GI endoscopy in the upcoming years. It has the potential to bring major improvements to GI endoscopy at all levels.
Use of Extranasal Bilobed Transposition Flaps in Cutaneous Reconstructive Surgery at 2 Institutions
Authors: Steele Robert B. , Jellinek Nathaniel J. , Foy Amanda , Lee Kachiu , Vij Alok , Knackstedt Thomas J.
Published: January 2020

BACKGROUND

Bilobed transposition flaps are versatile random pattern flaps used in nasal and extranasal reconstruction as they preserve free margins, access distal tissue reservoirs, and reliably repair dynamic defects.

OBJECTIVE

We highlight the utility of extranasal bilobed flaps to encourage surgeons to consider these flaps for Mohs micrographic surgery defects.

METHODS

A two-institution retrospective chart review of patients reconstructed using an extranasal bilobed flap after Mohs micrographic surgery was performed. A validated scar scale was applied to postoperative photographs. Statistical analyses of the patient and surgery characteristics including patient co-morbidities, anatomic distribution, flap dimensions, and postprocedural events, including revisions, were conducted.

RESULTS

Forty-eight patients were identified. Site-specific flap dimensions were obtained with the cheek/lower eyelid requiring greater tissue mobilization with a higher final to primary defect ratio when compared with other sites. Postoperative events (complications, erythema, flap fullness, dehiscence, infection, etc.) were minimal. No major complications were noted. Nine cases of flap fullness or swelling were identified. Neither flap fullness nor dehiscence compromised flap integrity or cosmetic outcome. Independent flap cosmetic outcome review was good using a validated photographic scar scale.

CONCLUSION

Bilobed transposition flaps are versatile repairs for extranasal reconstruction with a favorable safety and outcome profile.
Performance and Impact of a CLIA-waived, Point-of-care Respiratory PCR Panel in a Pediatric Clinic
Authors: Beal Stacy G. , Posa Molly , Gaffar Maira , Reppucci Jennifer , Mack Jasmine A. , Gurka Matthew J. , Rand Kenneth , Houck Herbert , Kelly Maria N.
Published: January 2020

Background:

Laboratory-based respiratory polymerase chain reaction (PCR) panels are rarely used in outpatient pediatric practice due to prolonged turn-around times and cost of medical equipment. The BioFire FilmArray Respiratory Panel EZ (RP EZ) is a Clinical Laboratory Improvement Amendments–waived respiratory pathogen PCR panel which rapidly tests for 14 common respiratory organisms. The aim of this study was to identify the distribution of organisms seen in pediatric clinics and to determine if utilization of this point-of-care test improved disease management, while exploring impact on clinic workflow.

Methods:

From January 2018 through January 2019, when clinically appropriate, patients were tested by the RP EZ and/or antigen tests (Clinic A) or antigen test only (Clinic B). Residual samples from Clinic B antigen tests were frozen and later tested on the RP EZ for definitive pathogen identification. Patient data and prescription records were extracted from the electronic health record.

Results:

A total of 430 patients had RP EZ tests performed, and at least 1 organism was detected in 70.4% of patients. The most common organisms identified were human rhinovirus/enterovirus, influenza, and respiratory syncytial virus. Appropriate treatment occurred for 93.6% of patients when the RP EZ was performed (Clinic A) versus 87.9% of patients who had only antigen tests performed (Clinic B, P = 0.0445). Utilization of RP EZ testing also significantly reduced appointment duration time (48.0 versus 54.9 minutes, P = 0.0009). Three false-positive influenza B results were identified by antigen testing.

Conclusions:

A point-of-care PCR panel improved patient care by providing an accurate diagnosis and shortened appointment duration.
Obstructive Sleep Apnea in Psychiatric Inpatients
Authors: Tanielian Maria , Doghramji Karl , Certa Kenneth
Published: January 2020

The aim of this study was to identify the prevalence of heightened risk for obstructive sleep apnea (OSA) and its clinical predictors in a heterogeneous diagnostic group of hospitalized psychiatric patients. Ninety-one consecutive psychiatric inpatients were administered the STOP-BANG and Epworth Sleepiness Scale (ESS) inventories. Medical and demographic information was gathered from inpatient clinical charts. Predictors of high OSA risk score were analyzed by a multivariate regression model. A total of 58.2% (53 patients) were determined to have a high risk for OSA. The predictors of high OSA risk were use of mood stabilizers, use of CNS depressants, use of CNS stimulants, and excessive daytime sleepiness measured by ESS. The risk of OSA was high in psychiatric inpatients, and particularly elevated in older patients and those taking commonly utilized psychiatric medications.
Anterior Tricuspid Leaflet Cleft in an Adult Male
Authors: Yamasaki Gentaro , Kondo Takeshi , Kuse Azumi , Sugimoto Marie , Takahashi Motonori , Morichika Mai , Nakagawa Kanako , Sakurada Makoto , Asano Migiwa , Ueno Yasuhiro
Published: January 2020

The deceased was a 44-year-old male who was treated for a suspected Ebstein's anomaly observed using transthoracic echocardiogram. He was found dead in his bed at home. Autopsy revealed that the septal tricuspid leaflet was intact; however, a large anterior tricuspid leaflet cleft and right atrioventricular cavity dilation were observed. Pathological examination revealed a normal tricuspid valve, except for the presence of a cleft with local fibrosis of the left ventricle papillary muscle and hemosiderin-containing macrophages at both lungs. There were no other abnormalities that may have led to death. It was concluded that he died a cardiac death based on the right heart overload associated with the anterior tricuspid leaflet cleft. This case indicates the possibility that the anterior tricuspid leaflet cleft can cause death and also highlights the necessity of a detailed autopsy to accurately diagnose the cause of death.
Emergency Physician–Administered Sedation for Thoracostomy in Children With Pleuropneumonia
Authors: Tel-Dan Shira Fajnerman , Shavit Danielle , Nates Ron , Samuel Nir , Shavit Itai
Published: January 2020

Background

Thoracostomy drainage is sometimes required in children with pleuropneumonia who have large parapneumonic effusion. This procedure is usually performed under sedation. The aim was to report sedation adverse events (SAEs) in pneumonia patients sedated for thoracostomy by pediatric emergency physicians.

Methods

A retrospective cohort study was conducted. The medical records of all emergency department patients who underwent thoracostomy between January 1, 2012, and December 31, 2018, were extracted. Study outcomes were SAEs that required intervention.

Results

Pigtail catheters were placed by chest surgeons in 28 children with a median age of 2 years (interquartile range [IQR], 1–5 years). All the thoracostomies were successfully performed under sedation performed by 11 pediatric emergency physicians. The median amount of fluid drained after catheter insertion was 200 mL (IQR, 100–500 mL). The median pleural fluid PH was 7.0 (IQR, 6.9–7.3), and the median white blood cell count was 34,600 per mm3 (IQR, 11,800–109,000 per mm3). Thirteen patients (46.4%) were sedated with a total median dose of 3 mg/kg of ketamine (IQR, 2–4 mg/kg) and 0.2 mg/kg of midazolam (IQR, 0.2–0.3 mg/kg); 11 patients (39.3%) were treated with 1 mg/kg of ketamine (IQR, 0.5–2 mg/kg) and 3 mg/kg of propofol (IQR, 2–4 mg/kg). Four patients (14.3%) were treated exclusively with 4 mg/kg of ketamine (IQR, 3–5 mg/kg). Nine oxygen desaturations required intervention; 1 was associated with laryngospasm and 1 with apnea. All the SAEs were successfully managed. No cases of hypotension, bradycardia, airway obstruction, or pulmonary aspiration were recorded.

Conclusions

The first series of pneumonia patients sedated for thoracostomy by pediatric emergency physicians is reported. Sedation was safely performed in this cohort.
Emergency Department Visits for Behavioral Health Concerns After Sexual Assault
Authors: Robinson Elizabeth , Ketterer Tara , Molnar Jennifer , DiGirolamo Sara , Rockey Alison , Brennan Brian , Lavelle Jane , Mollen Cynthia
Published: January 2020

The mental health issues that can follow sexual assault are well described. Mental health service (MHS) referrals can be beneficial but can be challenging to obtain. Absence of MHS can exacerbate mental health issues and lead to subsequent emergency visits. Sexual assault victims may therefore have an increased risk of returning to the emergency department (ED).

Objectives

The primary purpose of this study was to identify the prevalence of patients who are victims of sexual assault who subsequently return to the ED with behavioral health (BH) concerns. The secondary purpose of this study was to explore potential factors that may affect whether a patient returns to the ED.

Methods

Using a retrospective design, we examined electronic medical records and a quality improvement database of patients aged 12 to 15 years (inclusive) who sought care in a large, urban, freestanding, tertiary care children's hospital ED after an acute sexual assault.

Results

Our primary finding was that of 192 included patients, 24.5% (95% confidence interval, 18.6%–31.2%) subsequently returned to the ED with BH concerns. Of these, 14 (7.3%) returned within 6 months. Secondary aim results included observed trust and mistrust in providers as documented in ED provider notes among patients with previous experience in the MHS system.

Conclusions

A substantial proportion of patients who are victims of sexual assault return to the ED for BH concerns at some point. Further investigation is needed to determine factors affecting a return visit to the ED, which can lead to improved services when caring for sexual assault victims.
The Use of PECARN and CATCH Rules in Children With Minor Head Trauma Presenting to Emergency Department 24 Hours After Injury
Authors: Sert Ekrem Taha , Mutlu Hüseyin , Kokulu Kamil
Published: January 2020

Objective

Major studies (PECARN [Pediatric Emergency Care Applied Research Network], CATCH [Canadian Assessment of Childhood Head Injury]) that regulate the use of computed tomography (CT) algorithms in children with minor head trauma (MHT) have been conducted among children presenting in 24 hours after injury. In this study, we aimed to compare use and results of PECARN and CATCH rules in children presenting in and after 24 hours following injury.

Methods

Records of children who were admitted to emergency department and underwent CT imaging because of MHT during a 5-year period were retrospectively reviewed. Efficacy of PECARN and CATCH rules was investigated for predicting traumatic CT findings in patients presenting in and after 24 hours. Logistic regression was performed to evaluate whether presenting after 24 hours affected the ability of guidelines in predicting traumatic CT findings.

Results

This study included 2490 patients who met the criteria. Of these patients, 6.7% (168/2490) presented after 24 hours following injury. Traumatic CT findings were found in 6.7% (168/2490) of patients. This rate was 6.9% (161/2322) in those presenting in 24 hours and 4.2% (7/168) in those presenting after 24 hours, and there was no significant difference in the incidence of traumatic CT findings between the 2 groups (P = 0.17). Among children presenting in 24 hours, the sensitivity of PECARN was 96.3% (95% confidence interval [CI], 91.7%–98.5%), whereas the sensitivity of CATCH was 91.9% (95% CI, 86.3%–95.4%) in detecting traumatic intracranial injury. The sensitivity of both PECARN and CATCH was 85.7% (95% CI, 42.0%–99.2%) among children presenting after 24 hours. Presence of CT scan indication according to PECARN statistically predicted intracranial damage, and this was not affected by the admission time.

Conclusions

Patients with MHT presenting after 24 hours following injury constitute a clinically important population. Regardless of the admission time, current guidelines predict traumatic CT abnormalities.
Incidence of Complications following Volar Locking Plate Fixation of Distal Radius Fractures: An Analysis of 647 Cases
Authors: DeGeorge Brent R. , Brogan David M. , Becker Hillary A. , Shin Alexander Y.
Published: January 2020

Background:

This study assessed the risk and factors of complications after volar locking plate fixation of distal radius fractures.

Methods:

A single-institution retrospective review of patients undergoing volar locking plate fixation of distal radius fractures between May of 2000 and May of 2015 was undertaken. Demographic data, major complications, minor complications, and radiographic parameters were evaluated.

Results:

Six hundred forty-seven distal radius fractures managed with volar plate fixation in 636 patients were reviewed. Mean follow-up was 9.1 months. Mean age was 56.5 years. Mean body mass index was 28.0, and 14.6 percent of patients had a body mass index greater than 35. Fractures were classified as Arbeitsgemeinschaft für Osteosynthesefragen class 23-C (67.2 percent), 23-A (26.6 percent), and 23-B (6.2 percent). The incidence of major and minor complications was 13.8 percent and 17.5 percent, respectively. The most common complication was transient paresthesia (9.7 percent). The incidence of tendon rupture or irritation was 0.5 percent or 2.5 percent, respectively. Hardware removal for painful/symptomatic hardware occurred in 6.2 percent at an average of 427.8 days after surgery. Major complications and minor complications were increased 2.2- and 1.9-fold, respectively, in patients with a body mass index greater than 35. Major complications were also increased 3.19 times in patients with residual intraarticular step-off. Hardware removal was 3.3 times more likely in patients with Soong grade 2 plate prominence and 2.9 times more likely in patients with a history of diabetes mellitus.

Conclusions:

Volar plate osteosynthesis of distal radius fractures is associated with an overall low complication rate. Patient factors, including diabetes mellitus and obesity, and intraoperative factors, including intraarticular fracture alignment and plate prominence, were associated with a higher rate of complications or revision surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Diffusion Magnetic Resonance Imaging Predicts Peripheral Nerve Recovery in a Rat Sciatic Nerve Injury Model
Authors: Farinas Angel F. , Manzanera Esteve Isaac V. , Pollins Alonda C. , Cardwell Nancy L. , Kaoutzanis Christodoulos , Nussenbaum Marlieke E. , Does Mark D. , Dortch Richard D. , Perdikis Galen , Thayer Wesley P.
Published: January 2020

Background:

Nerve regeneration after an injury should occur in a timely fashion for function to be restored. Current methods cannot monitor regeneration prior to muscle reinnervation. Diffusion tensor imaging has been previously shown to provide quantitative indices after nerve recovery. The goal of this study was to validate the use of this technology following nerve injury via a series of rat sciatic nerve injury/repair studies.

Methods:

Sprague-Dawley rats were prospectively divided by procedure (sham, crush, or cut/repair) and time points (1, 2, 4, and 12 weeks after surgery). At the appropriate time point, each animal was euthanized and the sciatic nerve was harvested and fixed. Data were obtained using a 7-Tesla magnetic resonance imaging system. For validation, findings were compared to behavioral testing (foot fault asymmetry and sciatic function index) and cross-sectional axonal counting of toluidine blue–stained sections examined under light microscopy.

Results:

Sixty-three rats were divided into three treatment groups (sham, n = 21; crush, n = 23; and cut/repair, n = 19). Fractional anisotropy was able to differentiate between recovery following sham, crush, and cut/repair injuries as early as 2 weeks (p < 0.05), with more accurate differentiation thereafter. More importantly, the difference in anisotropy between distal and proximal regions recognized animals with successful and failed recoveries according to behavioral analysis, especially at 12 weeks. In addition, diffusion tension imaging–based tractography provided a visual representation of nerve continuity in all treatment groups.

Conclusions:

Diffuse tensor imaging is an objective and noninvasive tool for monitoring nerve regeneration. Its use could facilitate earlier detection of failed repairs to potentially help improve outcomes.