bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of colistin heteroresistance in carbapenem-resistant Pseudomonas aeruginosa and association with clinical outcomes in patients: an observational study
Authors: Howard-Anderson Jessica , Davis Michelle , Page Alexander M , Bower Chris W , Smith Gillian , Jacob Jesse T , Andersson Dan I , Weiss David S , Satola Sarah W
Published: November 2021

Objectives

To describe the prevalence of colistin heteroresistance in carbapenem-resistant Pseudomonas aeruginosa (CRPA) and evaluate the association with clinical outcomes.

Methods

Colistin heteroresistance was evaluated in CRPA isolates collected from patients without cystic fibrosis in Atlanta, Georgia, USA using two definitions: HR1, growth at 4 and 8 mg/L of colistin at a frequency ≥1 × 10−6 the main population; and HR2, growth at a colistin concentration ≥8× the MIC of the main population at a frequency ≥1 × 10−7. A modified population analysis profile (mPAP) technique was compared with reference PAP for detecting heteroresistance. For adults hospitalized at the time of or within 1 week of CRPA culture, multivariable logistic regression estimated the association between heteroresistance and 90 day mortality.

Results

Of 143 colistin-susceptible CRPA isolates, 8 (6%) met the HR1 definition and 37 (26%) met the HR2 definition. Compared with the reference PAP, mPAP had a sensitivity and specificity of 50% and 100% for HR1 and 32% and 99% for HR2. Of 82 hospitalized patients, 45 (56%) were male and the median age was 63 years (IQR 49–73). Heteroresistance was not associated with 90 day mortality using HR1 (0% in heteroresistant versus 22% in non-heteroresistant group; P = 0.6) or HR2 (12% in heteroresistant versus 24% in non-heteroresistant group; P = 0.4; adjusted OR 0.8; 95% CI 0.2–3.4).

Conclusions

Colistin heteroresistance was identified in up to 26% of patients with CRPA in our sample, although the prevalence varied depending on the definition. We did not observe an apparent association between colistin heteroresistance and 90 day mortality.
A Coordinated Sampling and Identification Methodology for Larval Parasitoids of Spotted-Wing Drosophila
Authors: Abram Paul K , Wang Xingeng , Hueppelsheuser Tracy , Franklin Michelle T , Daane Kent M , Lee Jana C , Lue Chia-Hua , Girod Pierre , Carrillo Juli , Wong Warren H L , Kula Robert R , Gates Michael W , Hogg Brian N , Moffat Chandra E , Hoelmer Kim A , Sial Ashfaq A , Buffington Matthew L
Published: November 2021

We provide recommendations for sampling and identification of introduced larval parasitoids of spotted-wing drosophila, Drosophila suzukii (Matsumura) (Diptera: Drosophilidae). These parasitoids are either under consideration for importation (aka classical) biological control introductions, or their adventive (presumed to have been accidentally introduced) populations have recently been discovered in North America and Europe. Within the context of the ecology of D. suzukii and its parasitoids, we discuss advantages and disadvantages of estimating larval parasitism levels using different methods, including naturally collected fruit samples and sentinel baits. For most situations, we recommend repeated sampling of naturally occurring fruit rather than using sentinel baits to monitor seasonal dynamics of host plant–Drosophila–parasitoid associations. We describe how to separate Drosophilidae puparia from host fruit material in order to accurately estimate parasitism levels and establish host–parasitoid associations. We provide instructions for identification of emerging parasitoids and include a key to the common families of parasitoids of D. suzukii. We anticipate that the guidelines for methodology and interpretation of results that we provide here will form the basis for a large, multi-research team sampling effort in the coming years to characterize the biological control and nontarget impacts of accidentally and intentionally introduced larval parasitoids of D. suzukii in several regions of the world.
Effect of Irrigation on the Control of Red Imported Fire Ants (Hymenoptera: Formicidae) by Water-Resistant and Standard Fire Ant Baits
Authors: Oi David H , Atchison Rachel A , Chuzel Gerald , Chen Jian , Henke Jennifer A , Weeks Ronald D
Published: November 2021

The red imported fire ant, Solenopsis invicta (Buren), is an invasive pest of agricultural, urban, and natural areas. It is also considered a public health pest due to its painful stings. While it can be efficiently controlled by commercially available fire ant baits formulated with a corn-grit carrier, rain or irrigation is thought to degrade the carrier, compromising bait effectiveness. This study assessed the effect of irrigation on the efficacy of water-resistant and standard fire ant bait formulations, by comparing worker number, brood volume, and queen survivorship after access to water-soaked baits and to irrigated, bait-treated sod. In initial testing, wetted water-resistant and standard baits reduced fire ant colonies less than dry baits, both when baits were given to colonies directly and when colonies were given access to baits broadcasted (i.e., scattered) atop sod. Comparisons of the efficacy of piled versus broadcast applications of water-resistant and standard baits revealed reductions of >88% in adults and brood and no surviving queens for all bait treatments. This result was unexpected because piled baits were hypothesized to be better protected from irrigation than broadcast bait applications. In a field study, irrigated water-resistant and standard baits caused similar and significantly higher reductions in fire ant foraging activity relative to an untreated control. These results indicated that both the water-resistant and standard fire ant bait provided significant fire ant reductions even after irrigation.
Afferent System Overview
Authors: English Stephen W. , Benarroch Eduardo E.
Published: November 2021

The afferent, or sensory, systems include visual, auditory, somatosensory, and interoceptive (ie, pain, temperature, and visceral sensation) inputs to the central nervous system. This chapter briefly reviews principles of transduction, relay, and processing of sensory information. The dorsal column–medial lemniscal system is reviewed in more detail. However, pain, vision, olfaction, and hearing are reviewed in subsequent chapters. Sensory transduction refers to the transformation of a stimulus into an electric signal. This process involves several distinct families of cation channels and associated receptor types.
Basal Ganglia
Authors: Ali Farwa , Benarroch Eduardo E.
Published: November 2021

The basal ganglia are a group of nuclei that are involved in motor, cognitive, and behavioral circuits and are especially important in motor program selection and motor learning. The key components of the basal ganglia and their circuitry include the striatum (putamen, caudate nucleus, and nucleus accumbens), globus pallidus (GP), subthalamic nucleus (STN), substantia nigra, pedunculopontine nucleus (PPN), and parts of the thalamus and cortex. The basal ganglia have parallel motor, oculomotor, associative, and limbic circuits. This chapter reviews the anatomy and circuitry of the basal ganglia.
Neuropharmacology
Authors: Crepeau Amy Z.
Published: November 2021

Medications used in the treatment of nervous system disorders typically modulate neurotransmitter function or action potential propagation and alter neurologic function. This chapter reviews the principles of pharmacokinetics, the major targets for drug action to provide a basis for understanding how medications exert their action, and disease-specific treatments. An understanding of the pharmacokinetic principles of neurologic medications is important for prescribing and ordering medication. Multiple routes of administration, including intravenous, sublingual, intramuscular, subcutaneous, rectal, oral, and transdermal, are available for delivery of neurologic medications.
Evoked Potentials
Authors: Matt Hoffman E.
Published: November 2021

Evoked potentials provide a noninvasive, sensitive, and quantitative way to assess the functional integrity of the somatosensory, auditory, and visual pathways. The basic principle of evoked potentials is to apply a stimulus (sensory, auditory, or visual) in a controlled manner to create a volley of depolarization and repolarization. This stimulus volley ascends through the peripheral and central sensory, auditory, or visual pathways and can be recorded as the signals pass underneath recording electrodes. The generated evoked potential waveforms can represent either a traveling wave of depolarization in white matter or a stationary depolarization within gray matter. The use of somatosensory and brainstem auditory evoked potentials for outpatients has decreased in the past decades as the quality and availability of neuroimaging have improved; however, their use has had a resurgence in electrophysiologic monitoring and mapping of surgical cases involving the spine, posterior fossa, and supratentorial lesions, for which they are now a part of the standard of care.
Anxiety Disorders
Authors: Makhlouf Ahmed T.
Published: November 2021

Anxiety disorders are the most common psychiatric syndromes in the United States. About 29% of adults will receive a diagnosis of an anxiety disorder during their lifetime, and almost one-fifth of adults have symptoms of anxiety in any given year. Globally, anxiety disorders are responsible for 10% of the disability-adjusted life years for all psychiatric and neurologic disorders, second only to major depressive disorder.
Substance Use Disorders
Authors: Kolla Bhanuprakash , Hocker Sara E.
Published: November 2021

Substance use disorders are chronic, relapsing illnesses that are associated with serious medical, economic, and social consequences. Substance use disorders are associated with loss of control over the amount of substance used, continued use despite negative consequences, preoccupation with use, and dysphoria during abstinence. In heavy and long-term users, abrupt cessation or reduction in substance use results in substance-specific withdrawal syndrome. Risk of substance use disorders is influenced by genetic, psychosocial, and environmental factors.
Neurorehabilitation
Authors: Schultz Billie A.
Published: November 2021

Physical medicine and rehabilitation—physiatry—is the medical specialty focusing on the restoration of functional status of patients with musculoskeletal, nervous system, or congenital disorders. The World Health Organization defined disability and created the International Classification of Functioning, Disability, and Health. With this classification, a physiatrist addresses the 3 domains of disability: impairment, activity limitation, and restricted participation.
Status Epilepticus
Authors: Hawkes Maximiliano A. , Hocker Sara E.
Published: November 2021

Status epilepticus (SE) is a medical and neurologic emergency defined as persistent seizure activity lasting more than 5 minutes or recurrent seizures without recovery of consciousness in between. When seizures persist despite adequate doses of first- and second-line antiepileptic agents, the condition is called refractory SE. Super-refractory SE occurs when seizure activity continues or recurs 24 hours after the initiation of therapy with anesthetic agents.
Anoxic-Ischemic Encephalopathy
Authors: Chakraborty Tia , Fugate Jennifer E.
Published: November 2021

Anoxic-ischemic brain injury occurs when no blood is flowing to the brain. Neurologists commonly encounter this clinical state when evaluating comatose patients who have had a cardiac arrest and prolonged cardiopulmonary resuscitation attempts. Anoxic-ischemic injury may also occur in primary respiratory arrest or severe hypoxemia (eg, asphyxia, anaphylaxis, drug intoxication), but it is less well understood in these circumstances. This chapter reviews the pathophysiologic factors, clinical management, and prognostic factors in anoxic-ischemic brain injury.
Traumatic Brain Injury
Authors: Carlstrom Lucas P. , Wijdicks Eelco F. M.
Published: November 2021

Traumatic brain injury (TBI) continues to be a leading cause of long-term morbidity and death worldwide. Each year, an estimated 1.7 million persons in the United States sustain TBIs, leading to 275,000 hospitalizations and 52,000 deaths annually. In addition to high personal costs, the direct and indirect societal expenditures are estimated to be $60 billion per year. This chapter reviews the diagnostic approach to head trauma and prognosis in brain injury and addresses specific conditions, such as concussions and intracranial hemorrhages.
Pathologic Factors and Spectrum of Central Nervous System Inflammatory Demyelinating Diseases
Authors: Lucchinetti Claudia F. , Guo Yong
Published: November 2021

Multiple sclerosis (MS) is the most common cause of nontraumatic disability in young adults. It is a chronic inflammatory demyelinating disease of the central nervous system. Traditionally, MS has been considered an autoimmune disorder consisting of myelin autoreactive T cells that drive an inflammatory process, leading to secondary macrophage recruitment and subsequent myelin destruction. However, accumulating data based on increasing numbers of probes that can be effectively applied to MS tissue have indicated that the events involved in the immunopathogenesis of MS may be more complicated.
Mild Cognitive Impairment and Alzheimer Disease
Authors: Tipton Philip W. , Ertekin-Taner Nilüfer
Published: November 2021

Many patients who have Alzheimer disease (AD) present initially with mild cognitive impairment (MCI). This chapter reviews the clinical features of MCI and AD, the clinical evaluation of patients with these entities, and the approaches to management. MCI is defined by cognitive decline that is more than expected by aging alone but does not meet criteria for dementia because the person has the ability to perform activities of daily living. MCI is considered to be a prodrome to dementia, especially AD, given the increased risk of progression to dementia. MCI, which probably represents the earliest stages of dementia in many patients, requires clinical follow-up and is expected to become an important intervention point in future clinical trials of novel preventive therapies.
Acquired Muscle Disorders
Authors: Liewluck Teerin , Milone Margherita
Published: November 2021

Muscle diseases consist of various disorders that primarily affect skeletal muscle, but they can also affect cardiac or smooth muscle. The disorders may be inherited or acquired. The pathophysiology, clinical manifestations, diagnostic pathways, and treatment options will vary for each disorder. This chapter reviews common acquired muscle disorders. Inflammatory myopathies are characterized by muscle weakness and inflammatory reaction in muscle, and often, but not always, are accompanied by elevated creatine kinase values. They can occur with infections, systemic inflammatory diseases, or they may be idiopathic. On the basis of clinical, histologic, and immunopathologic criteria, idiopathic inflammatory myopathies can be distinguished as dermatomyositis, polymyositis, or inclusion body myositis. When dermatomyositis or polymyositis occurs in association with a connective tissue disease, the disorder is called overlap syndrome.
Neuro-ophthalmology: Visual Fields
Authors: Leavitt Jacqueline A.
Published: November 2021

Visual field testing is an important part of the assessment of the afferent visual system. This chapter reviews the clinical process of visual field evaluation and the localization of lesions that affect the visual system. The visual field can be thought of as an island with an outer edge beyond which one cannot see and with an elevated center. The normal extent of the peripheral field of vision from the center is 90° to 100° temporally, 75° inferiorly, and 60° nasally and superiorly. Visual fields are subjective and should be considered only 1 part of the examination of the visual pathways.
Neurologic Complications of Radiation Therapy and Chemotherapy
Authors: Schlosser Covell Gretchen E. , Sharma Akanksha , Porter Alyx B.
Published: November 2021

Separate from neurosurgery, radiation and chemotherapy have been used in the treatment of malignant and benign tumors of the brain and spinal cord. Although effective, the treatments can be associated with serious neurologic adverse effects. This chapter reviews the adverse effects of these treatments. External beam radiation therapy (RT) is a common mode of radiation and is most effective for high-grade glioma. Intensity-modulated RT and stereotactic radiosurgery are usually reserved for pituitary tumors, skull-base masses, metastatic disease, and primary parenchymal tumors.
Retroviral Infections of the Nervous System
Authors: Toledano Michel , Aksamit Jr Allen J.
Published: November 2021

Retroviruses are a family of RNA viruses that replicate by reverse transcription. The family includes HIV and human T-lymphotropic virus. This chapter reviews neurologic manifestations of these retroviruses. A retrovirus in the genus Lentivirus, HIV has 2 forms, HIV-1 and HIV-2. HIV-1 is associated with the global AIDS pandemic, whereas HIV-2 causes an AIDS-like illness primarily in West Africa, although pockets of infection exist globally.
Parasitic Infections of the Central Nervous System
Authors: Yost Micah D. , Toledano Michel
Published: November 2021

Parasitic infections make up a small but important subset of central nervous system (CNS) infections. Although necessary to be considered in the comprehensive differential diagnosis for patients presenting with suspected neurologic infections, these conditions are particularly important in regions where parasitic infections are endemic and for immunocompromised patients. Among the most common parasitic infections of the CNS are neurocysticercosis, echinococcosis (hydatid cyst), toxoplasmosis, amebic meningoencephalitis, and cerebral malaria.
Neurology and Pregnancy
Authors: Jackson Lauren M. , Nasr Deena M.
Published: November 2021

Pregnancy is a time of many physiologic and systemic changes that may predispose women to new neurologic diseases or alter the course of preexisting disease. Management of neurologic diseases during pregnancy is complicated by the risks and benefits to both mother and fetus that must be weighed when diagnostic tests and therapeutic options are selected.
Mayo Clinic Cases in Neuroimmunology
Authors: McKeon Andrew , Keegan B. Mark , Tobin W. Oliver
Published: November 2021

In the past 2 decades, diagnostics and therapeutics in neuroimmunology have rapidly evolved and increased in complexity. Diagnosis is assisted by various laboratory and advanced imaging techniques. Randomized clinical trials in multiple sclerosis and neuromyelitis optica, and smaller studies for rarer autoimmune diseases, have led to distinct immune molecule–targeted and mechanism-specific therapies. The fields of cerebrovascular medicine, neurooncology, and neuroinfectious diseases have not remained static either. All of these gains present a challenge, however, in that early and accurate neurologic diagnosis is more important than ever. In our experience, some diagnostic pitfalls lie in the interpretation of test results and images without reference to the nuances of the clinical history and examination. Although some things change (eg, technology), other things never change (eg, clinical common sense). The 83 case-based chapters focus on key components of the history, examination and test findings, and differential diagnosis, although we also reference treatment approaches extensively throughout. To bring some form to this extensive repertoire of cases, the book is divided into 3 sections covering central nervous system demyelinating disease, autoimmune neurologic disorders, and others. Illustrations include imaging and, where relevant, pathologic images and video material. Board review–style questions are also provided.
Variation in the stellar mass function along stellar streams
Authors: Webb Jeremy J , Bovy Jo
Published: November 2021

Stellar streams are the inevitable end product of star cluster evolution, with the properties of a given stream being related to its progenitor. We consider how the dynamical history of a progenitor cluster, as traced by the evolution of its stellar mass function, is reflected in the resultant stream. We generate model streams by evolving star clusters with a range of initial half-mass relaxation times and dissolution times via direct N-body simulations. Stellar streams that dissolve quickly show no variation in the stellar mass function along the stream. Variation is, however, observed along streams with progenitor clusters that dissolve after several relaxation times. The mass function at the edges of a stream is approximately primordial, as it is populated by the first stars to escape the cluster before segregation occurs. Moving inwards the mass function steepens as the intermediate parts of the stream consist of mostly low-mass stars that escaped the cluster after some segregation has occurred. The centre of the stream is then marked by a flatter mass function, as the region is dominated by high-mass stars that quickly segregated to the progenitor cluster’s centre and were the last stars to become unbound. We further find that the maximum slope of the mass function along the stream and the rate at which it decreases with distance from the dissolved progenitor serve as proxies for the dynamical state reached by the progenitor cluster before dissolution; this may be able to be applied to observed streams with near-future observations.
Multiwavelength optical and NIR variability analysis of the Blazar PKS 0027-426
Authors: Guise E , Hönig S F , Almeyda T , Horne K , Kishimoto M , Aguena M , Allam S , Andrade-Oliveira F , Asorey J , Banerji M , Bertin E , Boulderstone B , Brooks D , Burke D L , Carnero Rosell A , Carollo D , Carrasco Kind M , Carretero J , Costanzi M , da Costa L N , Davis T M , De Vicente J , Doel P , Everett S , Ferrero I , Flaugher B , Frieman J , Gandhi P , Goad M , Gruen D , Gruendl R A , Gschwend J , Gutierrez G , Hinton S R , Hollowood D L , Honscheid K , James D J , Johnson M A C , Kuehn K , Lewis G F , Lidman C , Lima M , Maia M A G , Malik U , Menanteau F , Miquel R , Morgan R , Ogando R L C , Palmese A , Paz-Chinchón F , Pereira M E S , Pieres A , Plazas Malagón A A , Sanchez E , Scarpine V , Serrano S , Sevilla-Noarbe I , Seymour N , Smith M , Soares-Santos M , Suchyta E , Swanson M E C , Tarle G , To C , Tucker B E
Published: November 2021

We present multiwavelength spectral and temporal variability analysis of PKS 0027-426 using optical griz observations from Dark Energy Survey between 2013 and 2018 and VEILS Optical Light curves of Extragalactic TransienT Events (VOILETTE) between 2018 and 2019 and near-infrared (NIR) JKs observations from Visible and Infrared Survey Telescope for Astronomy Extragalactic Infrared Legacy Survey (VEILS) between 2017 and 2019. Multiple methods of cross-correlation of each combination of light curve provides measurements of possible lags between optical–optical, optical–NIR, and NIR–NIR emission, for each observation season and for the entire observational period. Inter-band time lag measurements consistently suggest either simultaneous emission or delays between emission regions on time-scales smaller than the cadences of observations. The colour–magnitude relation between each combination of filters was also studied to determine the spectral behaviour of PKS 0027-426. Our results demonstrate complex colour behaviour that changes between bluer when brighter, stable when brighter, and redder when brighter trends over different time-scales and using different combinations of optical filters. Additional analysis of the optical spectra is performed to provide further understanding of this complex spectral behaviour.
Gemini NIFS survey of feeding and feedback in nearby active galaxies – V. Molecular and ionized gas kinematics
Authors: Bianchin M , Riffel R A , Storchi-Bergmann T , Riffel R , Ruschel-Dutra D , Harrison C M , Dahmer-Hahn L G , Mainieri V , Schönell A J , Dametto N Z
Published: November 2021

We study the gas distribution and kinematics of the inner kpc of six moderately luminous (43.43 ≤ log Lbol ≤ 44.83) nearby (0.004 ≤ z ≤ 0.014) Seyfert galaxies observed with the Near-infrared Integral Field Spectrograph (NIFS) in the J ($1.25\,\mu$m) and K ($2.2\,\mu$m) bands. We analyse the most intense emission lines detected on these spectral wavebands: [Fe ii] $1.2570\, \mu$m and Paβ, which trace the ionized gas in the partially and fully ionized regions, and $\mathrm{ H}_2 \ 2.1218\, \mu$m, which traces the hot (∼2000 K) molecular gas. The dominant kinematic component is rotation in the disc of the galaxies, except for the ionized gas in NGC 5899 that shows only weak signatures of a disc component. We find ionized gas outflow in four galaxies, while signatures of H2 outflows are seen in three galaxies. The ionized gas outflows display velocities of a few hundred km s−1, and their mass outflow rates are in the range 0.005–12.49 M⊙ yr−1. Their kinetic powers correspond to 0.005–0.7 per cent of the active galactic nuclei (AGN) bolometric luminosities. Besides rotation and outflows signatures in some cases, the H2 kinematics also reveals inflows in three galaxies. The inflow velocities are 50–80 km s−1 and the mass inflow rates are in the range 1–9 × 10−4 M⊙ yr−1 for hot molecular gas. These inflows might be only the hot skin of the total inflowing gas, which is expected to be dominated by colder gas. The mass inflow rates are lower than the current accretion rates to the AGN, and the ionized outflows are apparently disturbing the gas in the inner kpc.
The SAMI Galaxy Survey: trends in [α/Fe] as a function of morphology and environment
Authors: Watson Peter J , Davies Roger L , Brough Sarah , Croom Scott M , D’Eugenio Francesco , Glazebrook Karl , Groves Brent , López-Sánchez Ángel R , van de Sande Jesse , Scott Nicholas , Vaughan Sam P , Walcher Jakob , Bland-Hawthorn Joss , Bryant Julia J , Goodwin Michael , Lawrence Jon S , Lorente Nuria P F , Owers Matt S , Richards Samuel
Published: November 2021

We present a new set of index-based measurements of [α/Fe] for a sample of 2093 galaxies in the SAMI Galaxy Survey. Following earlier work, we fit a global relation between [α/Fe] and the galaxy velocity dispersion σ for red sequence galaxies, $[\alpha /\text{Fe}]=(0.378\pm 0.009)\rm {log}_{10}\left(\sigma /100\right)+(0.155\pm 0.003)$. We observe a correlation between the residuals and the local environmental surface density, whereas no such relation exists for blue cloud galaxies. In the full sample, we find that elliptical galaxies in high-density environments are α-enhanced by up to 0.057 ± 0.014 dex at velocity dispersions σ < 100 km s−1, compared with those in low-density environments. This α-enhancement is morphology-dependent, with the offset decreasing along the Hubble sequence towards spirals, which have an offset of 0.019 ± 0.014 dex. At low velocity dispersion and controlling for morphology, we estimate that star formation in high-density environments is truncated ∼1 Gyr earlier than in low-density environments. For elliptical galaxies only, we find support for a parabolic relationship between [α/Fe] and σ, with an environmental α-enhancement of at least 0.03 dex. This suggests strong contributions from both environment and mass-based quenching mechanisms. However, there is no evidence for this behaviour in later morphological types.
China’s Industrial Development Strategies and Policies
Authors: Lin Justin Yifu , Zhou Jianjun
Published: November 2021

China has adopted a transition strategy and industrial policies pragmatically according to its economic reality since the reform and opening up started in 1979. The organic combination of an effective market with a facilitating state was the main reason for the success of China’s economy in the past four decades. In the process of China’s economic development, industrial policies have played a crucial role in both industrial upgrading and technological progress. Relying on the comparative advantage—following strategy, China has fully utilized its latecomer advantage. Chinese enterprises learn advanced technologies from developed countries when the opportunities exist and do indigenous innovation when needed. Pragmatism and learning capacity has been the most important endowments and comparative advantages of the Chinese government and enterprises. With learning capacity, the government and enterprises can pragmatically explore the comparative advantage of the existing factor endowments and convert latent comparative advantages into competitive advantages to promote continuous transformation, upgrading, and sustainable development.
Concentration-Response Model of Immediate Release Oxycodone Drug Liking by Different Routes of Abuse
Authors: Nallani Srikanth C , Li Wenjing , Calderon Silvia N , Fields Ellen , Roca Rigoberto A , Xu Yun , Zhao Liang , Fang Lanyan , Sahajwalla Chandrahas G , Zineh Issam
Published: November 2021

Objective

To understand the correlation between oxycodone concentration and drug liking response for immediate-release formulations as they relate to different doses and different routes of administration following manipulation involved in opioid misuse and nontherapeutic use.

Methods

Concentration-response and noncompartmental analyses of drug liking and plasma oxycodone data from Category 3 human abuse potential studies (n = 15–29 per study) were conducted, using Phoenix 6.0 software. Time to onset of a set threshold of subjective effects (Tonset) and offset of subjective effects (Toffset) were estimated based on a baseline pharmacodynamic response set at 50 on a bipolar Drug Liking visual analog scale of 0–100 and the threshold for drug liking set at ≥65, based on study qualification criteria. Partial Area Under the Concentration (AUCTonset-Toffset) and Effect (AUETonset-Toffset) profiles were calculated and their correlation with individual partial AUE vs partial AUC was assessed.

Results

The oxycodone concentration-response (drug liking) was best described by a sigmoidal-effect Emax model (S-shaped). Using a defined threshold, drug liking was closely associated with the rate of rise in concentration and the onset of action for oxycodone administered via oral or intranasal route. Partial AUCTonset-Toffset and AUETonset-Toffset showed a strong linear correlation.

Conclusions

Results indicate that oxycodone concentration-response and duration of drug liking following manipulation via different routes of administration may be an approach for further exploring drug liking effects of opioids.
Gestational Trophoblastic Disease: Current Evaluation and Management
Authors: Soper J.T.
Published: November 2021

(Obstet Gynecol. 2021;137:355–370)

Gestational trophoblastic disease (GTD) refers to rare disease processes originating from the placenta that require timely and appropriate management. GTD includes partial or complete hydatidiform moles (HM), as well as severe gestational trophoblastic neoplasia (GTN) and related tumors. Obstetrician-gynecologists are more likely to be involved in the care of women with HM or who have unclear diagnosis related to human chorionic gonadotropin (hCG).
Postpartum Hemorrhage Requiring Transfusion and Risk of Cardiovascular Disease Later in Life: A Retrospective Cohort Study
Authors: Cho G.J. , Lee K.M. , Kim H.Y. , Han S.W. , Oh M.J. , Chiec L. , Chae Y.K.
Published: November 2021

(BJOG. 2021;128:738–744. doi: 10.1111/1471-0528.16515)

Roughly 20% of worldwide maternal deaths are due to postpartum hemorrhage (PPH). Currently occurring in 6% to 11% of births worldwide, the incidence of PPH is on the rise. PPH severely impacts maternal mortality and morbidity rates, leading to outcomes such as increased intensive care unit (ICU) admission, increased risk of stroke, and increased risk for heart disease. Most current research identifies risks immediately following childbirth or during the puerperium while long-term risks are relatively unstudied. This study aimed to identify whether PPH is associated with long-term cardiovascular disease (CVD) such as cerebrovascular disease (CV) and ischemic heart disease (IHD).
Spinal Epidural Hematoma and Abscess After Neuraxial Anesthesia: A Historical Cohort Study Using the Japanese Diagnosis Procedure Combination Database
Authors: Makito K. , Mouri H. , Matsui H. , Michihata N. , Fushimi K. , Yasunaga H.
Published: November 2021

(Can J Anesth/J Can Anesth. 2021;68:42–52)

Spinal epidural hematoma and spinal epidural abscess can lead to severe complications, including permanent paraplegia. Both occur rarely in neuraxial anesthesia, though the incidences are unclear. It is important to clearly understand and weigh the risks and benefits when making the decision to perform neuraxial anesthesia on a patient. This study aimed to identify risk factors and determine the incidences of spinal epidural hematoma and spinal epidural abscess following neuraxial anesthesia.
Association of First Trimester Prescription Opioid Use With Congenital Malformations in the Offspring: Population-based Cohort Study
Authors: Bateman B.T. , Hernandez-Diaz S. , Straub L. , Zhu Y. , Gray K.J. , Desai D.J. , Mogun H. , Gautam N. , Huybrechts K.F.
Published: November 2021

(BMJ. 2021;372:n102)

Opioids are commonly prescribed to treat pain during pregnancy, with ~5% of pregnant women in Europe, Canada, and Australia receiving opioids for pain. In the United States, ~22% women insured through Medicaid are prescribed opioids during pregnancy. Opioids may have a teratogenic effect, but evidence around this topic is limited and unclear. This study aimed to determine the association between prescription opioids in the first trimester and risk of congenital malformations while controlling for confounding factors.
Bradycardia-to-Delivery Interval and Fetal Outcomes in Umbilical Cord Prolapse
Authors: Wong L. , Tse W.T. , Lai C.Y. , Hui A.S.Y. , Chaemsaithong P. , Sahota D.S. , Poon L.C. , Leung T.Y.
Published: November 2021

(Acta Obstet Gynecol Scand. 2021;100:170–177)

Umbilical cord prolapse is an emergency with risk for significant complications, including prematurity and birth asphyxia. As cord compression and umbilical arterial vasospasm can lead to fetal hypoxia and birth asphyxia, rapid delivery is required to prevent fetal brain injury, cerebral palsy and death. However, studies have found improved Apgar scores associated with longer decision-to-delivery intervals in some cases of umbilical cord prolapse. Bradycardia-to-delivery interval may be a better predictor of perinatal outcomes because cord prolapse and onset of fetal hypoxia may occur before the decision to deliver. This study aimed to investigate the relationship between bradycardia-to-delivery interval or decision-to-delivery interval and adverse neonatal outcomes, specifically focusing on the range of fetal heart rate abnormalities in cases of umbilical cord prolapse.
Gestational Anemia and Severe Acute Maternal Morbidity: A Population-based Study
Authors: Guignard J. , Deneux-Tharaux D. , Seco A. , Beucher G. , Kayem G. , Bonnet M.P.
Published: November 2021

(Anaesthesia. 2021;76:61–71)

Gestational anemia (GA) has been associated with preterm birth, low birth weight, and maternal morbidity. However, the connection between maternal morbidity and GA is based on studies that focused on specific maternal complications, used interventions as proxies for complications, or lacked data about the timing of anemia and severe maternal complication. This prospective, population-based study aimed to investigate the association between GA and severe acute maternal morbidity (SMM).
Immediate “Kangaroo Mother Care” and Survival of Infants With Low Birth Weight
Authors: Arya S. , Naburi H. , Kawaza K. , Newton S. , Anyabolu C.H. , Bergman N. , Rao S.P.N. , Mittal P. , Assenga E. , Gadama L. , Larsen-Reindorf R. , Kuti O. , Linnér A. , Yoshida S. , Chopra N. , Ngarina M. , Msusa A.T. , Boakye-Yiadom A. , Kuti B.P. , Morgan B. , Minckas N. , Suri J. , Moshiro R. , Samuel . , Wireko-Brobby N. , Rettedal S. , Jaiswal H.V. , Sankar M.J. , Nyanor . , Tiwary H. , Anand P. , Manu A.A. , Nagpal K. , Ansong D. , Saini . , Aggarwal K.C. , Wadhwa N. , Bahl R. , Westrup B. , Adejuyigbe E.A. , Plange-Rhule G. , Dube Q. , Chellani H. , Massawe A.
Published: November 2021

(N Engl J Med. 2021;384:2028–2038. doi: 10.1056/NEJMoa2026486. PMID: 34038632; PMCID: PMC810848)

While preterm, low–birth-weight infants make up ~15% of neonates, they account for the vast majority of neonatal deaths (70%). “Kangaroo Mother Care,” where the mother or caregiver provides continuous skin-to-skin contact with the neonate, has been shown to decrease mortality in infants with a birth weight below 2.0 kg. This study aimed to determine when to initiate continuous kangaroo mother care and if it is safe.
Consensus Bundle on Postpartum Care Basics: From Birth to the Comprehensive Postpartum Visit
Authors: Stuebe A.M. , Kendig S. , Suplee P.D. , D’Oria R.
Published: November 2021

(Obstet Gynecol. 2021;137:33–40)

Postpartum care is an underutilized resource, with up to 23% of women forgoing a clinic visit in the weeks following delivery. Given the increased maternal morbidity and mortality postpartum, the Alliance of Innovation in Maternal Health developed a set of strategies to improve outcomes for postpartum women. This “consensus bundle” includes recommendations for Readiness, Recognition, Response and Reporting.
Birth Outcomes in Women With Body Mass Index of 40 kg/m2 or Greater Stratified by Planned and Actual Mode of Birth: A Systematic Review and Meta-Analysis
Authors: D’Souza R. , Horyn I. , Jacob C.-E. , Zaffar N. , Horn D. , Maxwell C.
Published: November 2021

(Acta Obstet Gynecol Scand. 2021;100:200–209)

Obese pregnant women are at increased risk of complications compared to those with normal body mass index (BMI). One systematic review found that pregnant women with BMI ≥40 kg/m2 were more likely to experience prepregnancy diabetes, gestational diabetes or hypertensive disorders during pregnancy compared with those with BMI ≤30 to 39.9 kg/m2. Among other factors, these conditions have been linked to higher rates of cesarean delivery (CD) and wound complications. Obesity in pregnancy has also been associated with increased risk of neonatal complications including Apgar scores <7 after 5 minutes and birth trauma. Vaginal delivery (VD) has generally been accepted as the preferred mode of delivery for this population. The aim of this study was to evaluate outcomes in obese pregnant women based on mode of delivery.
Association Between Neuraxial Labor Analgesia and Neonatal Morbidity After Operative Vaginal Delivery: A Retrospective Cross-sectional Study
Authors: Butwick A.J. , Wong C.A. , Lee H.C. , Blumenfeld Y.J. , Guo N.
Published: November 2021

(Anesthesiology. 2021;134:52–60)

Operative vaginal delivery can be used to avoid intrapartum delivery and the morbidities it carries, though operative vaginal delivery is associated with neonatal and maternal risks compared with spontaneous vaginal delivery. Adequate maternal analgesia is a requirement for operative vaginal delivery, and neuraxial analgesia is the most common choice. Neuraxial analgesia may cause pelvic muscle relaxation and reduce the likelihood of neonatal injury and morbidity. This study investigated the association of neuraxial analgesia with risk of neonatal morbidity in patients undergoing vaginal delivery.
Intraoperative Hypotension and Acute Kidney Injury after Noncardiac Surgery in Infants and Children: A Retrospective Cohort Analysis
Authors: Schacham Nadav Y. , Chhabada Surendrasingh , Efune Proshad N. , Pu Xuan , Liu Liu , Yang Dongsheng , Raza Praneeta C. , Szmuk Peter , Sessler Daniel I.
Published: November 2021

Background

Age- and sex-specific reference nomograms for intraoperative blood pressure have been published, but they do not identify harm thresholds. The authors therefore assessed the relationship between various absolute and relative characterizations of hypotension and acute kidney injury in children having noncardiac surgery.

Methods

The authors conducted a retrospective cohort study using electronic data from two tertiary care centers. They included inpatients 18 yr or younger who had noncardiac surgery with general anesthesia. Postoperative renal injury was defined using the Kidney Disease Improving Global Outcomes definitions, based on serum creatinine concentrations. The authors evaluated potential renal harm thresholds for absolute lowest intraoperative mean arterial pressure (MAP) or largest MAP reduction from baseline maintained for a cumulative period of 5 min. Separate analyses were performed in children aged 2 yr or younger, 2 to 6 yr, 6 to 12 yr, and 12 to 18 yr.

Results

Among 64,412 children who had noncardiac surgery, 4,506 had creatinine assessed preoperatively and postoperatively. The incidence of acute kidney injury in this population was 11% (499 of 4,506): 17% in children under 6 yr old, 11% in children 6 to 12 yr old, and 6% in adolescents, which is similar to the incidence reported in adults. There was no association between lowest cumulative MAP sustained for 5 min and postoperative kidney injury. Similarly, there was no association between largest cumulative percentage MAP reduction and postoperative kidney injury. The adjusted estimated odds for kidney injury was 0.99 (95% CI, 0.94 to 1.05) for each 5-mmHg decrease in lowest MAP and 1.00 (95% CI, 0.97 to 1.03) for each 5% decrease in largest MAP reduction from baseline.

Conclusions

In distinct contrast to adults, the authors did not find any association between intraoperative hypotension and postoperative renal injury. Avoiding short periods of hypotension should not be the clinician’s primary concern when trying to prevent intraoperative renal injury in pediatric patients.

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What We Already Know about This Topic

What This Article Tells Us That Is New
Colonoscopic Ultrasound-Guided Fine-Needle Aspiration Using a Curvilinear Array Transducer: A Single-Center Retrospective Cohort Study
Authors: Cheng Spencer , Matuguma Sergio E. , de Oliveira Guilherme H. P. , Silva Gustavo L.R. , Cheng Henrique , Sánchez-Luna Sergio A. , Minata Mauricio K
Published: November 2021

BACKGROUND:

Curvilinear array ultrasound transducers enable tissue sampling and have therapeutic capabilities. Nevertheless, colonic intubation and maneuvering with these transducers is technically challenging and is therefore typically limited to the rectosigmoid area. This retrospective cohort study aimed to evaluate the safety, feasibility, and diagnostic yield of colonoscopic ultrasound-guided fine-needle aspiration in deep colonic intubation.

IMPACT OF INNOVATION:

The impact of this innovation is to enable tissue sampling of colonic and extracolonic lesions guided by endoscopic ultrasound.

TECHNOLOGY, MATERIALS, AND METHODS:

Curvilinear array ultrasound is used in the evaluation of luminal and extraluminal colonic diseases. Thirteen patients underwent colonoscopic ultrasound with a curvilinear array ultrasound endoscope in a single center for subepithelial lesions, cancer staging, and extracolonic lesions from July 2015 to February 2021. Endosonography was performed using an Olympus EU-ME1 and GF-UCT 180 with a 5-12MHz curvilinear array transducer. The primary outcome was the percentage of patients who were successfully scanned with the endoscopic ultrasound. The secondary outcomes included the success rate of fine-needle aspiration, the diagnostic yield of the tissue samples, and the adverse events related to the procedure.

PRELIMINARY RESULTS:

A total of 13 female patients underwent colonoscopic ultrasound. All patients (100%, 13/13) were successfully scanned. Fine-needle aspiration was deemed necessary and successfully performed in 100% (5/5) of the patients. Tissue samples collected by fine-needle aspiration resulted in a diagnostic yield of 60%, and no adverse events resulted from this intervention.

CONCLUSIONS:

This study demonstrates the feasibility of performing colonoscopic ultrasound with a curvilinear array transducer. Fine-needle aspiration for subepithelial, colonic, and extracolonic lesions is feasible and safe in this setting with no adverse events reported in our study.

FUTURE DIRECTIONS:

Future research should be directed toward validating colonoscopic ultrasound with a curvilinear array transducer technique in prospective randomized trials. Studies evaluating the feasibility and safety of endoscopic ultrasound-guided interventions in the colon, such as abscess drainage and enteral anastomosis, should be considered.
Endothelium-Dependent Hyperpolarization: The Evolution of Myoendothelial Microdomains
Authors: Garland Christopher J. , Dora Kim A.
Published: November 2021

Endothelium-derived hyperpolarizing factor (EDHF) was envisaged as a chemical entity causing vasodilation by hyperpolarizing vascular smooth muscle (VSM) cells and distinct from nitric oxide (NO) ([aka endothelium-derived relaxing factor (EDRF)]) and prostacyclin. The search for an identity for EDHF unraveled the complexity of signaling within small arteries. Hyperpolarization originates within endothelial cells (ECs), spreading to the VSM by 2 branches, 1 chemical and 1 electrical, with the relative contribution varying with artery location, branch order, and prevailing profile of VSM activation. Chemical signals vary likewise and can involve potassium ion, lipid mediators, and hydrogen peroxide, whereas electrical signaling depends on physical contacts formed by homocellular and heterocellular (myoendothelial; MEJ) gap junctions, both able to conduct hyperpolarizing current. The discovery that chemical and electrical signals each arise within ECs resulted in an evolution of the single EDHF concept into the more inclusive, EDH signaling. Recognition of the importance of MEJs and particularly the fact they can support bidirectional signaling also informed the discovery that Ca2+ signals can pass from VSM to ECs during vasoconstriction. This signaling activates negative feedback mediated by NO and EDH forming a myoendothelial feedback circuit, which may also be responsible for basal or constitutive release of NO and EDH activity. The MEJs are housed in endothelial projections, and another spin-off from investigating EDH signaling was the discovery these fine structures contain clusters of signaling proteins to regulate both hyperpolarization and NO release. So, these tiny membrane bridges serve as a signaling superhighway or infobahn, which controls vasoreactivity by responding to signals flowing back and forth between the endothelium and VSM. By allowing bidirectional signaling, MEJs enable sinusoidal vasomotion, co-ordinated cycles of widespread vasoconstriction/vasodilation that optimize time-averaged blood flow. Cardiovascular disease disrupts EC signaling and as a result vasomotion changes to vasospasm.
Role of Circadian Rhythm and Impact of Circadian Rhythm Disturbance on the Metabolism and Disease
Authors: Han Hui , Dou Jinming , Hou Qingqing , Wang Huanjun
Published: November 2021

Molecular circadian clocks exist in almost all cells of the organism and operate for approximately 24 hours, maintain the normal physiological and behavioral body processes, and regulate metabolism of many cells related to a variety of disease states. Circadian rhythms regulate metabolism, mainly including neurotransmitters, hormones, amino acids, and lipids. Circadian misalignment is related to metabolic syndromes, such as obesity, diabetes, and hypertension, which have reached an alarming level in modern society. We reviewed the mechanism of the circadian clock and the interaction between circadian rhythm and metabolism, as well as circadian rhythm disturbance on the metabolism of hypertension, obesity, and diabetes. Finally, we discuss how to use the circadian rhythm to prevent diseases. Thus, this review is a micro-to-macro discussion from the perspective of circadian rhythm and aims to provide basic ideas for circadian rhythm research and disease therapies.