bluuebunny/crossref_metadata_2025 huggingface dataset:
Differentiating Neuromyelitis Optica–Related and Multiple Sclerosis–Related Acute Optic Neuritis Using Conventional Magnetic Resonance Imaging Combined With Readout-Segmented Echo-Planar Diffusion-Weighted Imaging
Authors: Lu Ping , Tian Guohong , Liu Xilan , Wang Feng , Zhang Zhongshuai , Sha Yan
Published: May 2018

Purpose

In clinical practice, acute optic neuritis (ON) associated with the development of neuromyelitis optica (NMO) after the first attack is often indistinguishable from that associated with multiple sclerosis (MS). We aimed to determine the optimal combination of features derived from conventional magnetic resonance imaging (MRI) and diffusion-weighted imaging using readout-segmented echo-planar imaging (RESOLVE-DWI) for the differentiation of these conditions.

Materials and Methods

Orbital conventional MRI and RESOLVE-DWI were performed using a 3.0-T scanner on 54 patients with acute ON (26 NMO-related and 28 MS-related). The features detected by conventional MRI (including laterality, the enhancement pattern, and the extent and position of involvement) and the apparent diffusion coefficient (ADC) measurements were retrospectively compared between the NMO-related and MS-related groups. A multivariate logistic regression analysis was used to identify the most significant variables, and receiver operating characteristic curve analyses were performed to determine the ability of a combined diagnostic model based on the qualitative and quantitative characteristics identified in this study to differentiate the 2 conditions.

Results

The multivariate logistic regression analyses indicated that the presence of chiasm involvement and lower ADC values were significantly associated with NMO-related acute ON compared with MS-related acute ON (P = 0.037 and 0.008, respectively). The diagnostic criterion of chiasm involvement or “ADC < 791 × 10−6 mm2/s and chiasm involvement” had the highest specificity (96.9%), and “ADC < 791 × 10−6 mm2/s or chiasm involvement” showed the optimal sensitivity (77.8%) for differentiating NMO-related from MS-related acute ON.

Conclusions

Conventional MRI RESOLVE-DWI is helpful for differentiating NMO-related acute ON from MS-related acute ON. The combination of the ADC value chiasm involvement appears to be effective for discriminating these 2 types of acute ON.
Quantitative Comparison of Virtual Monochromatic Images of Dual Energy Computed Tomography Systems: Beam Hardening Artifact Correction and Variance in Computed Tomography Numbers: A Phantom Study
Authors: Wu Rongli , Watanabe Yoshiyuki , Satoh Kazuhiko , Liao Yen-Peng , Takahashi Hiroto , Tanaka Hisashi , Tomiyama Noriyuki
Published: May 2018

Objective

The aim of this study was to quantitatively compare the reduction in beam hardening artifact (BHA) and variance in computed tomography (CT) numbers of virtual monochromatic energy (VME) images obtained with 3 dual-energy computed tomography (DECT) systems at a given radiation dose.

Methods

Five different iodine concentrations were scanned using dual-energy and single-energy (120 kVp) modes. The BHA and CT number variance were evaluated.

Results

For higher iodine concentrations, 40 and 80 mgI/mL, BHA on VME imaging was significantly decreased when the energy was higher than 50 keV (P = 0.003) and 60 keV (P < 0.001) for GE, higher than 80 keV (P < 0.001) and 70 keV (P = 0.002) for Siemens, and higher than 40 keV (P < 0.001) and 60 keV (P < 0.001) for Toshiba, compared with single-energy CT imaging.

Conclusions

Virtual monochromatic energy imaging can decrease BHA and improve CT number accuracy in different dual-energy computed tomography systems, depending on energy levels and iodine concentrations.
The Value of Modified Renal Rim Grade in Predicting Acute Kidney Injury Following Severe Acute Pancreatitis
Authors: Wang Yi , Cao Li-kun , Wei Yi , Song Bin
Published: May 2018

Objective

To retrospectively determine the value of modified renal rim grade (MRRG) in predicting acute kidney injury (AKI) in the early phase of severe acute pancreatitis (SAP).

Methods

This institutional review board–approved retrospective study included patients with SAP who underwent abdominal contrast-enhanced computed tomography (CT) within 48 hours after disease onset. Modified renal rim grade, renal rim grade, CT severity index, modified CT severity index, extrapancreatic inflammation on CT scores, and posterior pararenal (PPR) space involvement were assessed. Clinical data, including bedside index of severity in acute pancreatitis and New Japanese Severity Scoring system scores, were collected. Primary end points were AKI and mortality. Scores were evaluated by receiver operating characteristic curve analysis. Correlational analyses between MRRG scores and the other scores were performed with Spearman analysis.

Result

One hundred five consecutive patients were enrolled in our study. The areas under the curve (AUCs) of MRRG in predicting AKI (0.90) and mortality (0.83) were comparable to extrapancreatic inflammation on CT (0.89 and 0.85, P > 0.05) and were higher than those of the other CT scores (P < 0.05). Modified renal rim grade score of greater than 4 yielded sensitivities and specificities of 81% and 89% for predicting AKI and 88% and 66% for mortality. Modified renal rim grade correlated moderately with bedside index of severity in acute pancreatitis (Spearman r = 0.47) and New Japanese Severity Scoring system (r = 0.43) scores. Besides, the prevalence of PPR space involvement in nonrecovery AKI patients was higher than that in recovery patients (94% vs 36%, P < 0.05).

Conclusions

Modified renal rim grade is well correlated with the occurrence of AKI and mortality in SAP. The PPR space involvement is a promising prognostic factor for nonrecovery of AKI in SAP patients.
Evaluation of the Communication Between Arachnoid Cysts and Neighboring Cerebrospinal Fluid Spaces by T2W 3D-SPACE With Variant Flip-Angle Technique at 3 T
Authors: Algin Oktay
Published: May 2018

Purpose

Phase-contrast cine magnetic resonance imaging (PC-MRI) is a widely used technique for determination of possible communication of arachnoid cysts (ACs). Three-dimensional (3D) sampling perfection with application-optimized contrasts using different flip-angle evolutions (3D-SPACE) technique is a relatively new method for 3D isotropic scanning of the entire cranium within a short time. In this research, the usage of the 3D-SPACE technique in differentiation of communicating or noncommunicating type ACs was evaluated.

Materials and Methods

Thirty-five ACs in 34 patients were retrospectively examined. The 3D-SPACE, PC-MRI, and contrast material–enhanced cisternography (if present) images of the patients were analyzed. Each cyst was described according to cyst size/location, third ventricle diameter, Evans index, and presence of hydrocephalus. Communication was defined as absent (score 0), suspected (score 1), or present (score 2) on each sequence. Results of PC-MRI or cisternography (if available) examinations were used as criterion standard techniques to categorize all cysts as communicating or noncommunicating type. The results of 3D-SPACE were compared with criterion standard techniques. The comparisons between groups were performed using Mann-Whitney and Fisher exact tests.

Results

For demonstration of communication status of the cysts, criterion standard test results and 3D-SPACE findings were almost in perfect harmony (κ[95% confidence interval: 0.94]; P < 0.001). When evaluating the communicative properties, 3D-SPACE findings correlated with other final results at a rate of 97%. There is a positive correlation with third ventricular diameters and Evans index for all patients (r = 0.77, P < 0.001). For other analyzed variables, there is no significant difference or correlation between the groups.

Conclusions

The 3D-SPACE technique is an easy, useful, and noninvasive alternative for the evaluation of morphology, topographical relationships, and communication status of ACs.
Increased Arterial Stiffness Adversely Affects Left Ventricular Mechanics in Patients With Pediatric Takayasu Arteritis From a Toronto Cohort
Authors: Grotenhuis Heynric B. , Aeschlimann Florence A. , Hui Wei , Slorach Cameron , Yeung Rae S. M. , Benseler Susanne M. , Bradley Timothy J. , Grosse-Wortmann Lars
Published: May 2018

Background/Objective

Takayasu arteritis (TA) is characterized by extensive aortic, large and midsize arterial wall inflammation. The aim of this study was to assess the morphological and elastic properties of the aorta and large arteries and the impact on left ventricular (LV) mechanics in children with TA.

Methods

Seven pediatric TA patients (6 female patients, 13.8 ± 3.2 years) were assessed with magnetic resonance imaging, vascular ultrasound, applanation tonometry, and echocardiography from February 2015 until July 2017 and compared with 7 age- and sex-matched controls. Takayasu arteritis disease activity was assessed clinically by the Pediatric Vasculitis Activity Score (PVAS).

Results

Pediatric TA patients showed increased carotid-to-radial artery pulse wave velocity (8.1 ± 1.8 vs. 6.4 ± 0.6 m/s, p = 0.03) and increased carotid-to-femoral artery pulse wave velocity (8.3 ± 1.9 vs. 5.1 ± 0.8 m/s, p < 0.01) when compared with controls. Patients demonstrated increased LV mass index (74.3 ± 18.8 vs. 56.3 ± 10.9 g/m2, p = 0.04), altered myocardial deformation with increased basal rotation (−9.8 ± 4.5 vs. −4.0 ± 2.0 degrees, p = 0.01) and torsion (19.9 ± 8.1 vs. 9.1 ± 3.1 degrees, p = 0.01), and impaired LV diastolic function with decreased mitral valve E/A ratio (1.45 ± 0.17 vs. 2.40 ± 0.84, p = 0.01), increased mitral valve E/E′ ratio (6.8 ± 1.4 vs. 4.9 ± 0.7, p < 0.01), and increased pulmonary vein A-wave velocity (26.7 ± 5.7 vs. 16.8 ± 3.3 cm/s, p = 0.03). Carotid-to-radial artery pulse wave velocity was associated with systolic (R = 0.94, p < 0.01), diastolic (R = 0.85, p = 0.02), and mean blood pressure (R = 0.91, p < 0.01), as well as disease activity by PVAS (R = 0.75, p = 0.05). The PVAS was associated with carotid-to-radial artery pulse wave velocity (R = 0.75, p = 0.05), as well as systolic (R = 0.84, p = 0.02), diastolic (R = 0.82, p = 0.03), and mean blood pressure (R = 0.84, p = 0.02).

Conclusions

Increased arterial stiffness is present in pediatric TA patients and associated with increased blood pressure and TA disease activity. Pediatric TA patients demonstrate altered LV mechanics, LV hypertrophy, and impaired diastolic function.
Novel Technique of Distal Roux-en-Y Gastric Bypass for Insufficient Weight Loss After Primary Procedure: Personal Experience and Primary Results at 12 Months
Authors: Thomopoulos Theodoros , Tomasi Vincent , Koliakos Evangelos , Thoma Maximilien , Navez Benoit
Published: May 2018

Purpose:

In the literature, up to 20% of patients present a failure of weight loss after primary Roux-en-Y gastric bypass (RYGBP) or other restrictive procedures. Our aim is to describe the midterm results of our novel technique of distal Roux-en-Y gastric bypass (DRYGBP) as a revisional procedure.

Materials and Methods:

We performed our DRYGBP in 21 patients. The length of the common channel was 100 cm, whereas the lengths of the alimentary and the biliopancreatic limbs were 2/3 and 1/3 of the remaining bowel, respectively. We created 2 subgroups, a “revisional” group after failed restrictive procedures and a “distalization” group after failed RYGBP.

Results:

The mean excess weight loss at 12 months in the “revisional” group (10 patients) was 67.8% and in the “distalization” group (11 patients) 57.1%. We did not experience any mortality nor severe morbidity rates.

Conclusions:

In our experience, our DRYGBP differentiated procedure seems to be effective at 12 months.
Stabilization of Single-incision Laparoscopic Cholecystectomy by Needle Puncture and Bendable Retractor
Authors: Takahashi Kodai , Kanehira Eiji , Kamei Aya , Tanida Takashi , Sasaki Kazunori
Published: May 2018

Background:

A recent meta-analysis and systematic review suggested that single-incision laparoscopic cholecystectomy (SILC) had a higher procedure failure rate with more blood loss and that it required a longer surgical time than conventional laparoscopic cholecystectomy. Herein, we introduce our experience with the needlescopic grasper-assisted and bendable retractor-assisted SILC technique and evaluate its safety and sustainability.

Methods:

The present retrospective cohort study included 407 Japanese patients who underwent needlescopic grasper-assisted and bendable retractor-assisted SILC between January 2012 and April 2017 at our institution.

Results:

In the present study, all patients successfully underwent needlescopic grasper-assisted and bendable retractor-assisted SILC without conversion to open surgery. Regarding surgical outcomes, mean surgical time was 58.2±23.2 minutes, and additional ports were required in 9 patients (2.2%). Postoperative morbidity developed in only 6 patients (1.4%).

Conclusions:

The surgical approaches defined herein were safe and sustainable with favorable surgical outcomes. Compared with conventional SILC, needlescopic grasper-assisted and bendable retractor-assisted SILC might become a mainstream procedure for minimally invasive surgery from the viewpoint of surgical difficulty.
Endoscopic Treatment of the Coloanal Anastomotic Dehiscence and Stricture: Stenting Via Rendezvous Technique
Authors: Oztas Erkin , Saygili Fatih , Ulas Murat , Disibeyaz Selcuk
Published: May 2018

An anastomotic leak is a serious complication of colorectal surgery. Leak management is often grueling, and a definitive stoma is often mandatory for rescue therapy. Herein, we present a patient who experienced coloanal anastomotic dehiscence and complete stricture at the proximal part of the anastomosis. This case was successfully treated with a fully covered self-expandable metallic stent placement via the combined endoscopic (per ileostomy) and manual (per anal channel) rendezvous technique.
A new weighted injury severity scoring system: Better predictive power for pediatric trauma mortality
Authors: Shi Junxin , Shen Jiabin , Caupp Sarah , Wang Angela , Nuss Kathryn E. , Kenney Brian , Wheeler Krista K. , Lu Bo , Xiang Henry
Published: May 2018

BACKGROUND

An accurate injury severity measurement is essential for the evaluation of pediatric trauma care and outcome research. The traditional Injury Severity Score (ISS) does not consider the differential risks of the Abbreviated Injury Scale (AIS) from different body regions nor is it pediatric specific. The objective of this study was to develop a weighted ISS (wISS) system for pediatric blunt trauma patients with better predictive power than ISS.

METHODS

Based on the association between mortality and AIS from each of the six ISS body regions, we generated different weights for the component AIS scores used in the calculation of ISS. The weights and wISS were generated using the National Trauma Data Bank. The Nationwide Emergency Department Sample (NEDS) was used to validate our main results. Pediatric blunt trauma patients younger than 16 years were included, and mortality was the outcome. Discrimination (areas under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, negative predictive value, concordance) and calibration (Hosmer-Lemeshow statistic) were compared between the wISS and ISS.

RESULTS

The areas under the receiver operating characteristic curves from the wISS and ISS are 0.88 versus 0.86 in ISS of 1 to 74 and 0.77 versus 0.64 in ISS of 25 to 74 (p < 0.0001). The wISS showed higher specificity, positive predictive value, negative predictive value, and concordance when they were compared at similar levels of sensitivity. The wISS had better calibration (smaller Hosmer-Lemeshow statistic) than the ISS (11.6 vs. 19.7 for ISS = 1–74 and 10.9 vs. 12.6 for ISS = 25–74). The wISS showed even better discrimination with the Nationwide Emergency Department Sample.

CONCLUSION

By weighting the AIS from different body regions, the wISS had significantly better predictive power for mortality than the ISS, especially in critically injured children.

LEVEL OF EVIDENCE AND STUDY TYPE

Prognostic/epidemiological, level IV.
Validation of predictive equations to assess energy expenditure in acute spinal cord injury
Authors: Ramirez Christine L. , Pelekhaty Stacy , Massetti Jennifer M. , Galvagno Samuel , Harmon Laura , Botwinick Isadora , Scalea Thomas M. , Stein Deborah M.
Published: May 2018

BACKGROUND

Acute spinal cord injury (SCI) is devastating with morbidities compounded by inadequate nutrition. The American Society for Parenteral and Enteral Nutrition recommends indirect calorimetry (IC) to evaluate energy needs in SCI because no predictive energy equations have been validated. We sought to determine the accuracy of predictive equations to predict measured energy expenditure (MEE).

METHODS

A retrospective review was performed over 2 years. Patients 18 years or older with cervical SCI who received IC were included. Height, weight, maximum temperature and minute ventilation on day of IC, plus MEE and VCO2 from IC were obtained. Predicted energy expenditure (PEE) was calculated using Harris–Benedict (HB), Penn State (PS), Mifflin St. Jeor (MSJ), Weir, Ireton–Jones (IJ), and 25 kcal/kg formulas. MEE was then compared to the PEE of each method.

RESULTS

Thirty-nine IC studies were completed for 20 patients. Weir had the strongest correlation to MEE (r = 0.98), followed by PS (r = 0.82). Correlations were similar among HB (r = 0.78), MSJ (r = 0.75), and IJ (r = 0.73), and weakest with 24 kcal/kg (r = 0.55). All had a p value <0.001. Deming regression confirmed strong correlations between Weir and PS to MEE, with coefficients of 1.03 and 1.515 (p < 0.001), respectively. Other formulas had comparatively higher coefficients and standard errors. Bland–Altman analysis confirmed Weir had the narrowest range of difference, with a mean difference of 25.5 kcal/day, followed by PS (−336.1 kcal/day).

CONCLUSIONS

Weir is the best predictive energy equation, with all statistical tests demonstrating a strong correlation between MEE and Weir. The second best predictive equation is the Penn State formula, which predicts actual MEE measured by IC with high accuracy.

LEVEL OF EVIDENCE

Diagnostic study, level III
A subset of five human mitochondrial formyl peptides mimics bacterial peptides and functionally deactivates human neutrophils
Authors: Kaczmarek Elzbieta , Hauser Carl J. , Kwon Woon Yong , Riça Ingred , Chen Li , Sandler Nicola , Otterbein Leo E. , Campbell Yan , Cook Charles H. , Yaffe Michael B. , Marusich Michael F. , Itagaki Kiyoshi
Published: May 2018

BACKGROUND

Trauma causes inflammation by releasing mitochondria that act as Danger-Associated Molecular Patterns (DAMPs). Trauma also increases susceptibility to infection. Human mitochondria contain 13 N-formyl peptides (mtFPs). We studied whether mtFPs released into plasma by clinical injury induce neutrophil (PMN) inflammatory responses, whether their potency reflects their similarity to bacterial FPs and how their presence at clinically relevant concentration affects PMN function.

METHODS

N-terminal sequences of the 13 mtFPs were synthesized. Changes in human PMN cytosolic Ca2+ concentration ([Ca2+]i) and chemotactic responses to mtFPs were studied. Sequence similarity of mtFPs to the canonical bacterial peptide f-Met-Leu-Phe (fMLF/fMLP) was studied using the BLOcks SUbstitution Matrix 62 (BLOSUM 62) system. The presence of mtFPs in plasma of trauma patients was assayed by Enzyme-linked immunosorbent assay (ELISA). The effects of the most potent mtFP (ND6) on PMN signaling and function were then studied at ambient clinical concentrations by serial exposure of native PMN to ND6, chemokines and leukotrienes.

RESULTS

Five mtFPs (ND6, ND3, ND4, ND5, and Cox 1) induced [Ca2+]i flux and chemotaxis in descending order of potency. Evolutionary similarity to fMLF predicted [Ca2+]i flux and chemotactic potency linearly (R
2 = 0.97, R
2 = 0.95). Chemoattractant potency was also linearly related to [Ca2+]i flux induction (R2 = 0.92). Active mtFPs appear to circulate in significant amounts immediately after trauma and persist through the first week. The most active mtFP, ND6, suppresses responses to physiologic alveolar chemoattractants (CXCL-1, leukotriene B4) as well as to fMLF where CXCL-1 and leukotriene B4 do not suppress N-formyl peptide receptor (FPR)-1 responses to mtFPs. Prior FPR-1 inhibition rescues PMN from heterologous suppression of CXCR-1 and BLT-1 by mtFPs.

CONCLUSION

The data suggest mtFPs released by injured tissue may attract PMN to trauma sites while suppressing PMN responses to other chemoattractants. Inhibition of mtFP-FPR1 interactions might increase PMN recruitment to lung bacterial inoculation after trauma. These findings suggest new paradigms for preventing infections after trauma.

LEVEL OF EVIDENCE

Therapeutic, Level IV.
Implementation of a CT scan practice guideline for pediatric trauma patients reduces unnecessary scans without impacting outcomes
Authors: McGrew Patrick R. , Chestovich Paul J. , Fisher Jay D. , Kuhls Deborah A. , Fraser Douglas R. , Patel Purvi P. , Katona Chad W. , Saquib Syed , Fildes John J.
Published: May 2018

INTRODUCTION

Computed tomography (CT) scans are useful in the evaluation of trauma patients, but are costly and pose risks from ionizing radiation in children. Recent literature has demonstrated the use of CT scan guidelines in the management of pediatric trauma. The study objective is to review our treatment of pediatric blunt trauma patients and evaluate CT use before and after CT-guideline implementation.

METHODS

Our Pediatric Level 2 Trauma Center (TC) implemented a CT scan practice guideline for pediatric trauma patients in March 2014. The guideline recommended for or against CT of the head and abdomen/pelvis using published criteria from the Pediatric Emergency Care and Research Network. There was no chest CT guideline. We reviewed all pediatric trauma patients for CT scans obtained during initial evaluation before and after guideline implementation, excluding inpatient scans. The Trauma Registry Database was queried to include all pediatric (age < 15) trauma patients seen in our TC from 2010 to 2016, excluding penetrating mechanism and deaths in the TC. Scans were considered positive if organ injury was detected. Primary outcome was the proportion of patients undergoing CT and percent positive CTs. Secondary outcomes were hospital length of stay, readmissions, and mortality. Categorical and continuous variables were analyzed with χ
2 and Wilcoxon rank-sum tests, respectively. p < 0.05 was considered significant.

RESULTS

We identified 1,934 patients: 1,106 pre- and 828 post-guideline. Absolute reductions in head, chest, and abdomen/pelvis CT scans were 17.7%, 11.5%, and 18.8%, respectively (p < 0.001). Percent positive head CTs were equivalent, but percent positive chest and abdomen CT increased after implementation. Secondary outcomes were unchanged.

CONCLUSIONS

Implementation of a pediatric CT guideline significantly decreases CT use, reducing the radiation exposure without a difference in outcome. Trauma centers treating pediatric patients should adopt similar guidelines to decrease unnecessary CT scans in children.

LEVEL OF EVIDENCE

Therapeutic study, level IV.
Can acute care surgeons perform while fatigued? An EAST multicenter study
Authors: Schuster Kevin M. , Hazelton Joshua P. , Rattigan Deviney , Nguyen Linh , Kim Dennis , Spence Lara H. , Turay David , Luo-Owen Xian , Perez Javier Martin , Dayal Saraswati , Blatt Melissa , Hill Casey , Bhattacharya Bishwajit
Published: May 2018

BACKGROUND

Fatigued surgeon performance has only been assessed in simulated sessions or retrospectively after a night on call. We hypothesized that objectively assessed fatigue of acute care surgeons affects patient outcome.

METHODS

Five acute care surgery services prospectively identified emergency cases over 27 months. Emergency cases were defined by the surgeon identifying the patient as requiring immediate operation upon consultation or admission. Within 48 hours, surgeons reported sleep time accumulated before operation, if nonclinical delays to operation occurred, and patient volume during the shift. To maximize differences, fatigued surgeons were defined as performing a case after midnight without having slept in the prior 18 hours. Rested surgeons performed cases at or before 8 pm or after at least 3 hours of sleep before operation. A four-level ordinal scale was used to assign case complexity. Hierarchical logistic regression models were constructed to assess the impact of fatigue on mortality and major morbidity while controlling for center and patient level factors.

RESULTS

Of 882 cases collected, 611 met criteria for fatigue or rested. Of these cases, 370 were performed at night and 182 by a fatigued surgeon. Rested surgeons were more likely to be operating on an older or female patient; other characteristics were similar. Mortality and major morbidity were similar between fatigued and rested surgeons (12.1% vs 12.1% and 46.9% vs 48.9%), respectively. After controlling for center and patient factors, surgeon fatigue did not affect mortality or major morbidity. Mortality variance was 6.30% and morbidity variance was 7.02% among centers.

CONCLUSION

Acute care surgeons have similar outcomes in a fatigued or rested state. Work schedules for acute care surgeons should not be adjusted to shifts less than 24 hours for the sole purpose of improving patient outcomes.

LEVEL OF EVIDENCE

Prognostic study, level IV.
Trauma patients are safe to fly 72 hours after tube thoracostomy removal
Authors: Zonies David , Elterman Joel , Burns Christopher , Paul Vincent , Oh John , Cannon Jeremy
Published: May 2018

BACKGROUND

Current recommendations for safe air travel following traumatic pneumothorax are 2 to 3 weeks after radiographic resolution. These recommendations are based on several small observational studies and expert consensus, which cite a theoretical risk of recurrence and hypoxia because of decreased oxygen tension at altitude. We sought to systematically study the timing of chest drain removal after traumatic pneumothorax and risk of recurrence in relation to air travel.

METHODS

A retrospective cohort study of consecutively admitted patients who sustained a traumatic chest injury treated with tube thoracostomy over a 5-year period was undertaken. Adult patients with a postremoval expiratory chest x-ray demonstrating absence of pneumothorax and at least a 24-hour observation period before flight were eligible for study. All patients were transferred to a participating medical center for continued care. In-flight medical monitoring was available for all patients. Baseline patient characteristics, interval period from drain removal to flight, in-flight medical records, and incidence of radiographic or clinical recurrence of pneumothorax at the destination facility were recorded.

RESULTS

Seventy-three patients who met the inclusion criteria were studied. All were male with a median age of 24 years (interquartile range [IQR], 22–26 years), injury severity score of 30 (IQR, 24–38), and chest abbreviated injury scale value of 3 (IQR, 2–4). The majority of patients sustained a penetrating injury (74%). The median duration of tube thoracostomy was 4 days (IQR, 3–6 days). The median period between thoracostomy tube removal and flight was 2.5 days (IQR, 1.5–4 days). Twenty-nine patients (40%) remained mechanically ventilated during transport. There were no reported in-flight medical emergencies for the entire cohort. There were no reported postflight radiographic or clinical recurrences during the subsequent 30 days.

CONCLUSIONS

After a 72-hour period of observation, air travel after tube thoracostomy removal appears safe for both mechanically ventilated and nonventilated patients.

LEVEL OF EVIDENCE

Therapeutic, level IV.
Blunt traumatic scapular fractures are associated with great vessel injuries in children
Authors: Abd el-shafy Ibrahim , Rosen Lisa M. , Prince Jose M. , Letton Robert W. , Rosen Nelson G.
Published: May 2018

BACKGROUND

Patients with stable blunt great vessel injury (GVI) can have poor outcomes if the injury is not identified early. With current pediatric trauma radiation reduction efforts, these injuries may be missed. As a known association between scapular fracture and GVI exists in adult blunt trauma patients, we examined whether that same association existed in pediatric blunt trauma patients.

METHODS

Bluntly injured patients younger than 18 years old were identified from 2012 to 2014 in the National Trauma Data Bank. Great vessel injury included all major thoracic vessels and carotid/jugular. Demographics of patients with and without scapular fracture were compared with descriptive statistics. The χ2 test was used to examine this association using SAS Version 9.4 (SAS Institute, Inc, Cary, NC).

RESULTS

We found a significant association between pediatric scapular fracture and GVI. Of 291,632 children identified, 1,960 had scapular fractures. Children with scapular fracture were 10 times more likely to have GVI (1.2%) compared to those without (0.12%, p < 0.0001). Most common GVI seen were carotid artery, thoracic aorta, and brachiocephalic or subclavian artery or vein. Children with both scapular fracture and GVI were most commonly injured by motor vehicles (57% collision, 26% struck).

CONCLUSIONS

Injured children with blunt scapular fracture have a 10-fold greater risk of having a GVI when compared to children without scapular fracture. Presence of blunt traumatic scapular fracture should have appropriate index of suspicion for a significant GVI in pediatric trauma patients.

LEVEL OF EVIDENCE

Epidemiologic and prognostic study, level III; Therapeutic, level IV.
Survival and Metabolic Function of Syngeneic Mouse Islet Grafts Transplanted Into the Hepatic Sinus Tract
Authors: Li Feng , Jiao Ao , Li Xiaohang , Zhang Chengshuo , Sun Ning , Zhang Jialin
Published: May 2018

Background

Islet grafts are transplanted into the liver via a portal vein in 90% of the clinical islet transplantations. However, the portal vein is far from being the ideal infusion site due to its unique drawbacks. These issues necessitated the exploration of an alternatively optimized site for clinical islet transplantation. With the widespread clinical application of percutaneous transhepatic puncture technique, we envisioned the possibility of islet transplantation into the hepatic sinus tract (HST).

Methods

The HST was created by temporarily placing a medically approved material into the hepatic parenchyma of C57BL/6 mice. The syngeneic islets were transplanted into the HST, after which, the nonfasting blood glucose, intraperitoneal glucose tolerance, and morphology were evaluated.

Results

A collagen-lined HST was formed by the 28-day implantation of a cylindrical nylon rod. Transplantation of ~300 syngeneic islets into the HST routinely reversed the hyperglycemia of the recipient mice and maintained normoglycemia for longer than 100 days until the graft was removed. The islet grafts within the HST stained positively for insulin, glucagon, and abundant microvessels and achieved comparable results to the islet grafts under the kidney capsule with respect to glycemic control and glucose tolerance.

Conclusions

These results suggested that an HST can be constructed for islet transplantation by temporarily placing a nylon material in the liver parenchyma. The HST is a promising site for clinical islet transplantation, thereby providing a satisfactory environment for the survival and metabolic function of islet grafts.
Acoustic Calibration in an Echoic Environment
Authors: Kazakov Alexander , Israel Nelken
Published: May 2018

Background: The sound fed to a loudspeaker may significantly differ from that reaching the ear of the listener. The transformation from one to the other consists of spectral distortions with strong dependence on the relative locations of the speaker and the listener as well as on the geometry of the environment. With the increased importance of research in awake, freely-moving animals in large arenas, it becomes important to understand how animal location influences the corresponding spectral distortions.

New Method: We describe a full calibration pipeline that includes spatial sampling and estimation of the spectral distortions. We estimated the impulse responses of the environment using Golay complementary sequences.

Using those sequences, we also describe an acoustic 3D localization method for freely moving animals.

Results: In our arena, the impulse responses are dominated by a small number of strong reflections. We use this understanding to provide guidelines for designing the geometry of the environment as well as the presented sounds, in order to provide more uniform sound levels throughout the environment. Our 3D localization method achieves a 1 cm precision through the utilization of sound cues only.

Comparison with Existing Methods: To our knowledge, this is the first description of a large-scale acoustic calibration pipeline with acoustic localization for neuroscience studies.

Conclusions: Principled sampling of large arena allows for better design and control of the acoustic information provided to freely-moving animals.
DAF-16/Foxo suppresses the transgenerational sterility ofprg-1piRNA mutants via a systemic small RNA pathway
Authors: Simon Matt , Spichal Maya , Heestand Bree , Frenk Stephen , Hedges Ashley , Godwin Malik , Wellman Alicia S. , Sakaguchi Aisa , Ahmed Shawn
Published: May 2018

Mutation of thedaf-2insulin/IGF-1 receptor activates the DAF-16/Foxo transcription factor to suppress the transgenerational sterility phenotype ofprg-1/piRNA mutants that are deficient for piRNA-mediated genome silencing. As with PRG-1/piRNAs, mutations in the nuclear RNA interference genenrde-1compromised germ cell immortality, but deficiency fordaf-2did not suppress the transgenerational sterility ofnrde-1ornrde-4single mutants or ofprg-1; nrde-4orprg-1; hrde-1double mutants. NRDE-1 and NRDE-4 promote transcriptional silencing in somatic cells via the nuclear Argonaute protein NRDE-3, which was dispensable for germ cell immortality. However,daf-2deficiency failed to promote germ cell immortality inprg-1; nrde-3mutants. Consistently, we found that DAF-16 activity in somatic cells suppressed the transgenerational sterility ofprg-1mutants via the SID-1 dsRNA transmembrane channel that promotes systemic RNAi as well as Dicer, the dsRNA binding protein RDE-4 and the RDRP RRF-3. We conclude that DAF-16 activates a cell-non-autonomous systemic RNAi pathway that promotes small RNA-mediated genome silencing in germ cells to suppress loss of the genomic immune surveillance factor Piwi/PRG-1.

Author Summary

Small RNAs can promote genome silencing. The Argonaute protein Piwi interacts with thousands of small RNAs termed piRNAs in germ cells to suppress expression of transposons and foreign genetic elements. However, the Piwi silencing system may be commonly targeted by viral or transposon genomic parasites that seek to suppress the endogenous defences against their expression and replication. Activation of the DAF-16 stress response pathway promotes adult longevity and can also abolish the transgenerational sterility ofC. elegansPiwi mutants. We found that DAF-16 accomplishes this by activating a somatic small RNA pathway where small RNAs are initially produced in the soma and are then transported into the germline to suppress expression of a toxic genetic locus in Piwi mutants. Thus, the DAF-16 stress response pathway activates a systemic small RNA cascade to suppress defects in the Piwi/piRNA genome silencing system.
The interplay between demography and neutral evolution at the expansion front of a widespread conifer,Picea sitchensis
Authors: Elleouet Joane S. , Aitken Sally N.
Published: May 2018

Tree species in the northern hemisphere have advanced and retreated with interglacial and glacial periods, and are currently subject to rapid anthropogenic climate change. These observations prompt questions about the mechanisms allowing tree populations to respond quickly to selection pressures when establishing into new areas. Focusing on the northern expanding range edge ofPicea sitchensis, a widespread conifer of western North America, we ask how genetic structure and diversity develop during colonization, and assess the role of demographic history in shaping the evolutionary trajectory of a colonizing population. By combining nearly 500 years of tree-ring and genetic data at the expansion front on the Kodiak Archipelago, we show that allelic richness - but not expected heterozygosity - increased rapidly during early stages of establishment in the 1600s, while genetic differentiation from populations further from the front decreased. This trend ended in the 1700s, after an increase in population growth rate. These findings highlight the major role of long-distance pollen dispersal in the recovery of genetic diversity during initial stages of colonization, and suggest that demographic dynamics including an initial lag in population growth are likely limiting factors in the adaptation of tree populations tracking their niche in a changing climate.
Autophagy Decreases Alveolar Epithelial Cell Injury by Suppressing the NF-κB Signaling Pathway and Regulating the Release of Inflammatory Mediators
Authors: Fan Tao , Yang Shuo , Huang Zhixin , Wang Wei , Pan Shize , Xu Yao , Zhang Boyou , Mao Zhangfan , Fang Yifan , Guo Xiaobo , Hu Hao , Geng Qing
Published: May 2018

To research the impact of autophagy on alveolar epithelial cell inflammation and its possible mechanism in early stages of hypoxia, we established a cell hypoxia-reoxygenation model and orthotopic left lung ischemia-reperfusion model. Rat alveolar epithelial cells stably expressing GFP-LC3 were treated with an autophagy inhibitor (3-methyladenine, 3-MA) or autophagy promoter (rapamycin), followed by hypoxia-reoxygenation treatment at 2, 4 and 6h in vitro. In vivo, twenty-four male Sprague-Dawley rats were randomly divided into four groups (model group: no blocking of hilum in the left lung; control group: blocking of hilum in the left lung for 1h with DMSO lavage; 3-MA group: blocking of hilum in the left lung for 1h with 100ml/kg of 3-MA (5μmol/L) solution lavage; rapamycin group: blocking of hilum in the left lung for 1h with 100ml/kg of rapamycin (250nmol/L) solution lavage) to establish an orthotopic left lung ischemia model. This study demonstrated that rapamycin significantly suppressed the NF-κB signaling pathway, restrained the expression of pro-inflammatory factors. A contrary result was confirmed by 3-MA pretreatment. These findings indicate that autophagy reduces ischemia-reperfusion injury by repressing inflammatory signaling pathways in the early stage of hypoxia in vitro and in vivo. This could be a new protective method for lung ischemia-reperfusion injury.
Genetic compensation is triggered by mutant mRNA degradation
Authors: El-Brolosy Mohamed A. , Rossi Andrea , Kontarakis Zacharias , Kuenne Carsten , Günther Stefan , Fukuda Nana , Takacs Carter , Lai Shih-Lei , Fukuda Ryuichi , Gerri Claudia , Kikhi Khrievono , Giraldez Antonio J. , Stainier Didier Y.R.
Published: May 2018

Genetic compensation by transcriptional modulation of related gene(s) (also known as transcriptional adaptation) has been reported in numerous systems1–3; however, whether and how such a response can be activated in the absence of protein feedback loops is unknown. Here, we develop and analyze several models of transcriptional adaptation in zebrafish and mouse that we show are not caused by loss of protein function. We find that the increase in transcript levels is due to enhanced transcription, and observe a correlation between the levels of mutant mRNA decay and transcriptional upregulation of related genes. To assess the role of mutant mRNA degradation in triggering transcriptional adaptation, we use genetic and pharmacological approaches and find that mRNA degradation is indeed required for this process. Notably, uncapped RNAs, themselves subjected to rapid degradation, can also induce transcriptional adaptation. Next, we generate alleles that fail to transcribe the mutated gene and find that they do not show transcriptional adaptation, and exhibit more severe phenotypes than those observed in alleles displaying mutant mRNA decay. Transcriptome analysis of these different alleles reveals the upregulation of hundreds of genes with enrichment for those showing sequence similarity with the mutated gene’s mRNA, suggesting a model whereby mRNA degradation products induce the response via sequence similarity. These results expand the role of the mRNA surveillance machinery in buffering against mutations by triggering the transcriptional upregulation of related genes. Besides implications for our understanding of disease-causing mutations, our findings will help design mutant alleles with minimal transcriptional adaptation-derived compensation.
Ade novoperoxidase is also a promiscuous yet stereoselective carbene transferase
Authors: Stenner Richard , Steventon Jack W. , Seddon Annela , Anderson J. L. Ross
Published: May 2018

By constructing anin vivoassembled, catalytically proficient peroxidase, C45, we have recently demonstrated the catalytic potential of simple,de novo-designed heme proteins. Here we show that C45’s enzymatic activity extends to the efficient and stereoselective intermolecular transfer of carbenes to olefins, heterocycles, aldehydes and amines. Not only is this the first report of carbene transferase activity in a completelyde novoprotein, but also of enzyme-catalyzed ring expansion of aromatic heterocyclesviacarbene transfer by any enzyme.
An amplitude code increases the efficiency of information transmission across a visual synapse
Authors: James Ben , Darnet Léa , Moya-Díaz José , Seibel Sofie-Helene , Lagnado Leon
Published: May 2018

Most neurons in the brain transmit information digitally using sequences of spikes that trigger release of synaptic vesicles of fixed size. The first stages of vision and hearing are distinct in operating with analogue signals, but it is unclear how these are recoded for synaptic transmission. By imaging the release of glutamate in live zebrafish, we demonstrate how ribbon synapses of retinal bipolar cells transmit analogue visual signals by changes in both the rate and amplitude of synaptic events. Higher contrasts released glutamate packets composed of more vesicles and coding by amplitude often continued after rate coding had saturated. Glutamate packets equivalent to five vesicles transmitted four times as many bits of information per vesicle compared to independent release events. By discretizing analogue signals into sequences of numbers ranging up to eleven, ribbon synapses increase the dynamic range, temporal precision and efficiency with which visual information is transmitted.
Pink ShrimpFarfantepenaeus duorarumSpatiotemporal Abundance Trends Along an Urban, Subtropical Shoreline Slated for Restoration
Authors: Zink Ian C. , Browder Joan A. , Lirman Diego , Serafy Joseph E.
Published: May 2018

The Biscayne Bay Coastal Wetlands (BBCW) project of the Comprehensive Everglades Restoration Plan (CERP) aims to reduce point-source freshwater discharges and spread freshwater flow along the mainland shoreline of southern Biscayne Bay to approximate conditions in the coastal wetlands and bay that existed prior to construction of canals and water control structures. An increase in pink shrimp (Farfantepenaeus duorarum) density to ≥ 2 individuals m−2during the wet season (i.e., August-October) along the mainland shoreline was previously proposed as an indicator of BBCW success. This study examined pre-BBCW baseline densities and compared them with the proposed target. Densities were monitored by seasonal (wet, dry) throw-trapping (1 m2replicated in triplicate) at 47 sites along ~22 km of the southwestern Biscayne Bay coastline over 10 years (2007-2016). Densities varied across years and were most often higher in dry seasons. Quantile regression revealed density limitation by four habitat attributes: water temperature (°C), depth (m), salinity (ppt), and submerged aquatic vegetation (SAV: % cover). Procrustean analyses that tested for congruence between shrimp densities and habitat metrics found that water temperature, water depth, and salinity explained ~ 28%, 28%, and 22% of density variability, respectively. No significant relationship with SAV was observed. Hierarchical clustering was used to identify spatially and temporally similar groupings of pink shrimp densities by sites or season-years. Significant groupings were later investigated with respect to potentially limiting habitat attributes. Six site and four year-season clusters were identified. Although habitat attributes significantly differed among spatial clusters, within-cluster median pink shrimp densities did not correlate with within-cluster minima, maxima, medians, or standard deviations of habitat attributes. Pink shrimp densities corresponded significantly with salinity and appeared limited by it. Salinity is an environmental attribute that will be directly influenced by CERP implementation.
Prevalence of antibodies against Borna disease virus proteins in Japanese children with autism spectrum disorder
Authors: Honda Tomoyuki , Sofuku Kozue , Matsunaga Hidenori , Tachibana Masaya , Mohri Ikuko , Taniike Masako , Tomonaga Keizo
Published: May 2018

Bornavirus infection occurs in many animals, including humans. However, the epidemiology of bornavirus in humans, especially children, is as yet unclear. Here, antibodies against bornaviruses in Japanese children with autism spectrum disorder (ASD) were evaluated using immunofluorescence analysis, western blotting and radio ligand assay. The prevalence of antibodies against bornavirus‐specific speckles, nucleoprotein and phosphoprotein were 22%, 48%, and 33%, respectively, in children with ASD. According to our criteria, the prevalence of antibodies against bornaviruses was 7.4% in children with ASD. This is the first report of the serological prevalence of bornavirus in Japanese children. Our results provide valuable baseline‐data for future studies regarding bornavirus epidemiology in children.
Amniotic fluid lactic acid and matrix metalloproteinase‐8 levels at the time of fetal surgery for a spine defect: association with subsequent preterm prelabour rupture of membranes
Authors: Moron AF , Athanasiou A , Barbosa M , Milani HJ , Sarmento SG , Cavalheiro S , Witkin SS
Published: May 2018

Objective

In utero fetal surgery to correct incomplete closure of the spinal cord lessens the extent of permanent damage but is associated with preterm prelabour rupture of membranes (PPROM). We determined whether compounds in amniotic fluid collected at the time of surgery predicted subsequent development of PPROM.

Design

Prospective study.

Setting

Hospitals in Sao Paulo, Brazil.

Population

Twenty‐four consecutive pregnant women at 24–26 weeks of gestation seen between February and October 2017 with a singleton pregnancy underwent in utero surgery to correct an open spinal defect in their fetus.

Methods

Amniotic fluid was tested for lactic acid, matrix metalloproteinase 2 (MMP‐2), MMP‐8, MMP‐9 and interleukin‐6 (IL‐6) by enzyme‐linked immunosorbent assay. Clinical data were collected after completion of all laboratory studies.

Main outcome measure

Amniotic fluid concentration of compounds in women with or without PPROM.

Results

Preterm prelabour rupture of membranes occurred in seven (29.2%) women. There were no differences in maternal age, gravidity, parity, race, history of caesarean sections or fetal gender between women with or without PPROM. Length of surgery, days of wound healing and length of hospital stay were also indistinguishable. The median concentrations of MMP‐8 (1.7 versus 0.6 ng/ml; P = 0.0041) and lactic acid (7.1 versus 5.9 mm; P = 0.0181) were higher in women with PPROM. The amniotic fluid MMP‐8 level was also negatively correlated with gestational age at delivery (Spearman r = −0.4217, P = 0.0319).

Conclusion

Differences in susceptibility to develop PPROM are present before fetal surgery. An increase in anaerobic glycolysis, evidenced by the intra‐amniotic lactic acid level, may enhance MMP‐8 production and weaken maternal and fetal membranes.

Tweetable abstract

Matrix metalloproteinase‐8 and lactic acid in amniotic fluid predict preterm prelabour rupture of membranes.