bluuebunny/crossref_metadata_2025 huggingface dataset:
An Evaluation of a Novel Medical Device Versus Standard Interventions in the Treatment of Tension Pneumothorax in a Swine Model (Sus scrofa)
Authors: Sheldon Rowan R , Do Woo S , Forte Dominic M , Weiss Jessica B , Derickson Michael J , Eckert Matthew J , Martin Matthew J
Published: June 2019

Introduction

Tension pneumothorax is a common cause of preventable death in trauma. Needle decompression is the traditional first-line intervention but has high failure rates. We sought to evaluate the effectiveness and expedience of needle thoracostomy, surgical tube thoracostomy, and Reactor™ thoracostomy – a novel spring-loaded trocar insertion device.

Materials and Methods

Yorkshire swine underwent controlled thoracic insufflation to create tension pneumothorax physiology for device comparison. Additional experiments were performed by increasing insufflation pressures to achieve pulseless electrical activity. Intervention was randomized to needle thoracostomy (14 gauge), tube thoracostomy (32Fr), or Reactor™ thoracostomy (36Fr). Air leak was simulated throughout intervention with 40–80 mL/kg/min insufflation. Intrathoracic pressure monitoring and hemodynamic parameters were obtained at 1 and 5 minutes.

Results

Tension physiology and tension-induced pulseless electrical activity were created in all iterations. Needle thoracostomy (n = 28) was faster at 7.04 ± 3.04 seconds than both Reactor thoracostomy (n = 32), 11.63 ± 5.30 (p < 0.05) and tube thoracostomy (n = 32), 27.06 ± 10.73 (p < 0.01); however, Reactor™ thoracostomy was faster than tube thoracostomy (p < 0.001). Physiological decompression was achieved in all patients treated with Reactor™ and tube thoracostomy, but only 14% of needle thoracostomy. Cardiac recovery to complete physiologic baseline occurred in only 21% (6/28) of those treated with needle thoracostomy whereas Reactor™ or tube thoracostomy demonstrated 88% (28/32) and 94% (30/32) response rates. When combined, needle thoracostomy successfully treated tension pneumothorax in only 4% (1/28) of subjects as compared to 88% (28/32) with Reactor™ thoracostomy and 94% (30/32) with tube thoracostomy (p < 0.01).

Conclusions

Needle thoracostomy provides a rapid intervention for tension pneumothorax, but is associated with unacceptably high failure rates. Reactor™ thoracostomy was effective, expedient, and may provide a useful and technically simpler first-line treatment for tension pneumothorax or tension-induced pulseless electrical activity.
J-PAS: forecasts on interacting dark energy from baryon acoustic oscillations and redshift-space distortions
Authors: Costa A A , Marcondes R J F , Landim R G , Abdalla E , Abramo L R , Xavier H S , Orsi A A , Devi N Chandrachani , Cenarro A J , Cristóbal-Hornillos D , Dupke R A , Ederoclite A , Marín-Franch A , Oliveira C M , Vázquez Ramió H , Taylor K , Varela J
Published: June 2019

We estimate the constraining power of Javalambre-Physics of the Accelerated Universe Astrophysical Survey (J-PAS) for parameters of an interacting dark energy (DE) cosmology. The survey is expected to map several millions of luminous red galaxies, emission line galaxies, and quasars in an area of thousands of square degrees in the northern sky with precise photometric redshift measurements. Forecasts for the DESI and Euclid surveys are also evaluated and compared to J-PAS. Using the Fisher matrix approach, we find that J-PAS can place constraints on the interaction parameter comparable to those from DESI, with an absolute uncertainty of about 0.02, when the interaction term is proportional to the dark matter energy density, and almost as good, of about 0.01, when the interaction is proportional to the DE density. For the equation of state of DE, the constraints from J-PAS are slightly better in the two cases (uncertainties 0.04–0.05 against 0.05–0.07 around the fiducial value −1). Both surveys stay behind Euclid but follow it closely, imposing comparable constraints in all specific cases considered.
Quantifying the AGN-driven outflows in ULIRGs (QUADROS) IV: HST/STIS spectroscopy of the sub-kpc warm outflow in F14394+5332
Authors: Tadhunter C , Holden L , Ramos Almeida C , Batcheldor D
Published: June 2019

Considerable uncertainties remain about the nature of warm, AGN-driven outflows and their impact on the evolution of galaxies. This is because the outflows are often unresolved in ground-based observations. As part of a project to study the AGN outflows in some of the most rapidly evolving galaxies in the local Universe, here we present Hubble Space Telescope (HST)/Space Telescope Imaging Spectrograph (STIS) observations of F14394+5332E that resolve the sub-kpc warm outflow for the first time in an ultra-luminous infrared galaxy. The observations reveal a compact, high-ionization outflow region (rmax ∼ 0.9 kpc) set in a more extensive (rmax ∼ 1.4 kpc) halo that is kinematically quiescent and has a lower ionization state. A large line width (600 < FWHM < 1500 km s−1) is measured throughout the outflow region, and the outflowing gas shows a steep velocity gradient with radius, with the magnitude of the blueshifted velocities increasing from ∼500 to 1800 km s−1 from the inner to the outer part of the outflow. We interpret the observations in terms of the local acceleration, and hydrodynamic destruction, of dense clouds as they are swept up in a hot, low-density wind driven by the AGN. We discuss the implications for measuring the mass outflow rates and kinetic powers for the AGN-driven outflows in such objects.
Inflowing gas in the central parsec of M81
Authors: Devereux Nick
Published: June 2019

Spectroscopic observations of the Seyfert 1/Liner nucleus of M81, obtained recently with the Space Telescope Imaging Spectrograph aboard the Hubble Space Telescope(HST), have revealed an ultraviolet (UV)–visible spectrum rich with emission lines of a variety of widths, ionization potentials, and critical densities, including several in the UV that have not previously been reported. Even at the highest angular resolution currently achievable with HST, the broad-line region of M81 cannot be uniquely defined on the basis of commonly used observables such as the full width at half-maximum of the emission lines, or ratios of various emission lines. Numerous broad forbidden lines complicate interpretation of the spectra. At least three separate line-emitting components are inferred. Firstly, a large, highly ionized, low-density, low-metallicity H+ region producing the broad Balmer lines. Located within the H+ region are smaller condensations spanning a wide range in density, and the source of forbidden line emission through collisional excitation of the respective ions. Intermingled with the H+ region and the condensations is a curious extended source of time-variable C iv λ1548 emission. Collectively, these observations can be qualitatively understood in the context of a shock-excited jet cavity within a large H+ region that is photoionized by the central UV–X-ray source. The H+ region contains ∼500 M⊙ of low-metallicity gas that is dynamically unstable to inflow. At the current rate, the available H+ gas can sustain the advection-dominated accretion flow that powers the central UV–X-ray source for 105 yr.
Global analysis of luminosity- and colour-dependent galaxy clustering in the Sloan Digital Sky Survey
Authors: Paul Niladri , Pahwa Isha , Paranjape Aseem
Published: June 2019

We present a halo occupation distribution (HOD) analysis of the luminosity- and colour-dependent galaxy clustering in the Sloan Digital Sky Survey. A novelty of our technique is that it uses a combination of clustering measurements in luminosity bins to perform a global likelihood analysis, simultaneously constraining the HOD parameters for a range of luminosity thresholds. We present simple, smooth fitting functions which accurately describe the resulting luminosity dependence of the best-fitting HOD parameters. To minimize systematic halo modelling effects, we use theoretical halo 2-point correlation functions directly measured and tabulated from a suite of N-body simulations spanning a large enough dynamic range in halo mass and spatial separation. Thus, our modelling correctly accounts for non-linear and scale-dependent halo bias as well as any departure of halo profiles from universality, and we additionally account for halo exclusion using the hard sphere approximation. Using colour-dependent clustering information, we constrain the satellite galaxy red fraction in a model-independent manner which does not rely on any group-finding algorithm. We find that the resulting luminosity dependence of the satellite red fraction is significantly shallower than corresponding measurements from galaxy group catalogues, and we provide a simple fitting function to describe this dependence. Our fitting functions are readily usable in generating low-redshift mock galaxy catalogues, and we discuss some potentially interesting applications as well as possible extensions of our technique.
The angular scale of homogeneity in the local Universe with the SDSS blue galaxies
Authors: Avila F , Novaes C P , Bernui A , de Carvalho E , Nogueira-Cavalcante J P
Published: June 2019

We probe the angular scale of homogeneity in the local Universe using blue galaxies from the SDSS survey as a cosmological tracer. Through the scaled counts in spherical caps, $\mathcal {N}(\lt \theta)$, and the fractal correlation dimension, $\mathcal {D}_{2}(\theta)$, we find an angular scale of transition to homogeneity for this sample of θH = 22.19° ± 1.02°. A comparison of this measurement with another obtained using a different cosmic tracer at a similar redshift range (z < 0.06), namely, the H i extragalactic sources from the ALFALFA catalogue, confirms that both results are in excellent agreement (taking into account the corresponding bias correction). We also perform tests to assess the robustness of our results. For instance, we test if the size of the surveyed area is large enough to identify the transition scale we search for, and also we investigate a reduced sample of blue galaxies, obtaining in both cases a similar angular scale for the transition to homogeneity. Our results, besides confirming the existence of an angular scale of transition to homogeneity in different cosmic tracers present in the local Universe, show that the observed angular scale θH agrees well with what is expected in the ΛCDM scenario. Although we cannot prove spatial homogeneity within the approach followed, our results provide one more evidence of it, strengthening the validity of the Cosmological Principle.
Calibration of the virial factor f in supermassive black hole masses of reverberation-mapped AGNs
Authors: Yu Li-Ming , Bian Wei-Hao , Wang Chan , Zhao Bi-Xuan , Ge Xue
Published: June 2019

Using a compiled sample of 34 broad-line active galactic nuclei (AGNs) with measured H β time lags from the reverberation mapping (RM) method and measured bulge stellar velocity dispersions σ*, we calculate the virial factor f by assuming that the RM AGNs intrinsically obey the same MBH−σ* relation as quiescent galaxies, where MBH is the mass of the supermassive black hole (SMBH). Considering four tracers of the velocity of the broad-line regions (BLRs), i.e. the H β line width or line dispersion from the mean or rms spectrum, there are four kinds of the factor f. Using the H β full width at half-maximum (FWHM) to trace the BLRs velocity, we find significant correlations between the factor f and some observational parameters, e.g. FWHM, the line dispersion. Using the line dispersion to trace the BLRs velocity, these relations disappear or become weaker. It implies the effect of inclination in BLRs geometry. It also suggests that the variable f in MBH estimated from luminosity and FWHM in a single-epoch spectrum is not negligible. Using a simple model of thick-disc BLRs, we also find that, as the tracer of the BLRs velocity, H β FWHM has some dependence on the inclination, while the line dispersion σH β is insensitive to the inclination. Considering the calibrated FWHM-based factor f from the mean spectrum, the scatter of the SMBH mass is 0.39 dex for our sample of 34 low-redshift RM AGNs. For a high-redshift sample of 30 Sloan Digital Sky Survey RM AGNs with measured stellar velocity dispersions, we find that the SMBH mass scatter is larger than that for our sample of 34 low-redshift RM AGNs. It implies the possibility of evolution of the MBH−σ* relation from high-redshift to low-redshift AGNs.
Evidence for two early accretion events that built the Milky Way stellar halo
Authors: Myeong G C , Vasiliev E , Iorio G , Evans N W , Belokurov V
Published: June 2019

The Gaia Sausage is the major accretion event that built the stellar halo of the Milky Way galaxy. Here, we provide dynamical and chemical evidence for a second substantial accretion episode, distinct from the Gaia Sausage. The Sequoia Event provided the bulk of the high-energy retrograde stars in the stellar halo, as well as the recently discovered globular cluster FSR 1758. There are up to six further globular clusters, including ω Centauri, as well as many of the retrograde substructures in Myeong et al., associated with the progenitor dwarf galaxy, named the Sequoia. The stellar mass in the Sequoia galaxy is ∼5 × 10  M⊙ , whilst the total mass is ∼1010 M⊙ , as judged from abundance matching or from the total sum of the globular cluster mass. Although clearly less massive than the Sausage, the Sequoia has a distinct chemodynamical signature. The strongly retrograde Sequoia stars have a typical eccentricity of ∼0.6, whereas the Sausage stars have no clear net rotation and move on predominantly radial orbits. On average, the Sequoia stars have lower metallicity by ∼0.3 dex and higher abundance ratios as compared to the Sausage. We conjecture that the Sausage and the Sequoia galaxies may have been associated and accreted at a comparable epoch.
The X-ray coronae of two massive galaxies in the core of the perseus cluster
Authors: Arakawa N , Fabian A C , Walker S A
Published: June 2019

We study the X-ray properties of two elliptical galaxies, NGC 1270 and NGC 1272, in the core of the Perseus cluster with deep Chandra observations. Both galaxies have central supermassive black holes, the mass of which is 6.0 × 109 and 2.0 × 109 $\rm{M}_\odot$, respectively. Our aim is to examine relatively cool soft X-ray-emitting gas within the central region of these massive early-type galaxies. Such gas, referred to as a Minicorona in previous studies is common in the core of large elliptical cluster galaxies. It has not been completely stripped or evaporated by the surrounding hot intracluster medium and nor fully accreted on to the central black hole. With thermal emission from the minicorona dominating over any power-law radiation components, we find that both NGC 1270 and NGC 1272 encompass minicoronae, the temperature and radius of which are 0.99 and 0.63 keV; 1.4 and 1.2 kpc, respectively. For NGC 1272, the thermal coronal component dominates the core emission by a factor of over 10. We show that the depletion time-scale of minicoronal gas via viscous stripping is shorter by a factor of 100 than the replenishment time-scale due to stellar mass-loss. Magnetic fields are presumably responsible for suppression of the transport processes. Finally, we show that both objects have to meet a balance between cooling and heating as well as that among mass replenishment, stripping, and accretion.
Multifractal detrended moving average analysis of Kepler stars with surface differential rotation traces
Authors: de Freitas D B , Nepomuceno M M F , Cordeiro J G , Das Chagas M L , De Medeiros J R
Published: June 2019

A multifractal formalism is employed to analyse high-precision time-series data of Kepler stars with surface differential rotation (DR) traces. The multifractal detrended moving average (MFDMA) algorithm has been explored to characterize the multiscale behaviour of the observed time series from a sample of 662 stars selected with parameters close to those of the Sun (e.g. effective temperature, mass, effective gravity and rotation period). Among these stars, 141 have surface DR traces, whereas 521 have no detected DR signatures. In our sample, we also include the Sun in its active phase. Our results can be summarized in two points. First, our work suggests that star-spots for time series with and without DR have distinct dynamics. Secondly, the magnetic fields of active stars are apparently governed by two mechanisms with different levels of complexity for fluctuations. Throughout the course of the study, we identified an overall trend whereby the DR is distributed in two H regimes segregated by the degree of asymmetry A, where H-index denotes the global Hurst exponent that is used as a measure of long-term memory of time series. As a result, we show that the degree of asymmetry can be considered a segregation factor that distinguishes the DR behaviour when related to the effect of the rotational modulation on the time series. In summary, the multifractality signals in our sample are the result of magnetic activity control mechanisms leading to activity-related long-term persistent signatures.
Accretion and outflow in V404 Cyg
Authors: Casares J , Muñoz-Darias T , Mata Sánchez D , Charles P A , Torres M A P , Armas Padilla M , Fender R P , García-Rojas J
Published: June 2019

We study the optical evolution of the 2015 outburst in V404 Cyg, with emphasis on the peculiar nebular phase and subsequent decay to quiescence. From the decay time-scale of the Balmer emission associated with the nebula, we measure an outflow mass Mwind ≃ 4 × 10−6 M⊙. Remarkably, this is ∼100 times larger than the accreted mass and ∼10 per cent of the total mass stored in the disc. The wind efficiency must therefore be significantly larger than previous estimates for black hole transients, suggesting that radiation pressure (in addition to other mechanisms such as Compton-heating) plays a key role in V404 Cyg. In addition, we compare the evolution of the 2015 and 1989 outbursts and find not only clear similarities (namely a large luminosity drop ∼10 d after the X-ray trigger, followed by a brief nebular phase) but also remarkable differences in decay time-scales and long-term evolution of the H α profile. In particular, we see evidence for a rapid disc contraction in 2015, consistent with a burst of mass transfer. This could be driven by the response of the companion to hard X-ray illumination, most notably during the last gigantic (super-Eddington) flare on 2015 June 25. We argue that irradiation and consequential disc wind are key factors to understand the different outburst histories in 1989 and 2015. In the latter case, radiation pressure may be responsible for the abrupt end of the outburst through depleting inner parts of the disc, thus quenching accretion and X-ray irradiation. We also present a refined orbital period and updated ephemeris.
Fly-by encounters between two planetary systems I: Solar system analogues
Authors: Li Daohai , Mustill Alexander J , Davies Melvyn B
Published: June 2019

Stars formed in clusters can encounter other stars at close distances. In typical open clusters in the Solar neighbourhood containing hundreds or thousands of member stars, 10–20 per cent of Solar-mass member stars are expected to encounter another star at distances closer than 100 au. These close encounters strongly perturb the planetary systems, directly causing ejection of planets or their capture by the intruding star, as well as exciting the orbits. Using extensive N-body simulations, we study such fly-by encounters between two Solar system analogues, each with four giant planets from Jupiter to Neptune. We quantify the rates of loss and capture immediately after the encounter, e.g. the Neptune analogue is lost in one in four encounters within 100 au, and captured by the flying-by star in 1 in 12 encounters. We then perform long-term (up to 1 Gyr) simulations investigating the ensuing post-encounter evolution. We show that large numbers of planets are removed from systems due to planet–planet interactions and that captured planets further enhance the system instability. While encounters can initially leave a planetary system containing more planets by inserting additional ones, the long-term instability causes a net reduction in planet number. A captured planet ends up on a retrograde orbit in half of the runs in which it survives for 1Gyr; also, a planet bound to its original host star but flipped during the encounter may survive. Thus, encounters between planetary systems are a channel to create counter-rotating planets, This would happen in around 1 per cent of systems, and such planets are potentially detectable through astrometry or direct imaging.
Machine-learning identification of asteroid groups
Authors: Carruba V , Aljbaae S , Lucchini A
Published: June 2019

Asteroid families are groups of asteroids that share a common origin. They can be the outcome of a collision or be the result of the rotational failure of a parent body or its satellites. Collisional asteroid families have been identified for several decades using hierarchical clustering methods (HCMs) in proper elements domains. In this method, the distance of an asteroid from a reference body is computed, and, if it is less than a critical value, the asteroid is added to the family list. The process is then repeated with the new object as a reference, until no new family members are found. Recently, new machine-learning clustering algorithms have been introduced for the purpose of cluster classification. Here, we apply supervised-learning hierarchical clustering algorithms for the purpose of asteroid families identification. The accuracy, precision, and recall values of results obtained with the new method, when compared with classical HCM, show that this approach is able to found family members with an accuracy above 89.5 per cent, and that all asteroid previously identified as family members by traditional methods are consistently retrieved. Values of the areas under the curve coefficients below Receiver Operating Characteristic curves are also optimal, with values consistently above 85 per cent. Overall, we identify 6 new families and 13 new clumps in regions where the method can be applied that appear to be consistent and homogeneous in terms of physical and taxonomic properties. Machine-learning clustering algorithms can, therefore, be very efficient and fast tools for the problem of asteroid family identification.
Behavioral Interventions for Smokeless Tobacco Cessation
Authors: Nethan Suzanne Tanya , Sinha Dhirendra Narain , Sharma Shashi , Mehrotra Ravi
Published: June 2019

Introduction

Consumption of smokeless tobacco (SLT) is on the rise (especially in the World Health Organization South-East Asian region) and has numerous repercussions over the consumer’s health. This article reviews studies performed for SLT cessation using behavioral interventions, worldwide till 2017.

Methods

A systematic review by PICO (Problem, intervention, comparison, outcome) of behavioral intervention-based SLT cessation studies with minimum 6 months’ follow-up, reporting outcomes in terms of risk ratios (RRs) and 95% confidence interval (CI), published between 1992 and 2017 was performed. This was followed by a meta-analysis of the outcomes of these studies by deriving the pooled estimates by the random effects model, for those on adults and youth, categorized according to the type of country where the study was performed, that is, in terms of developed or developing. Publication bias among the included studies was assessed by the Begg’s test.

Results

Nineteen eligible studies comprising 24 498 participants, from all over the world were included. Behavioral interventions showed overall efficacy in SLT cessation in adults (RR = 1.63, 95% CI = 1.32 to 1.94) both in the developed (RR = 1.39, 95% CI = 1.16 to 1.63) and developing (RR = 2.79, 95% CI = 2.32 to 3.25) countries. However, these interventions did not prove effective for SLT cessation among youth overall (RR = 1.07, 95% CI = 0.73 to 1.41), either in the developed (RR = 1.39, 95% CI = 0.58 to 2.21) or in the developing (RR = 0.87, 95% CI = 0.68 to 1.07) countries. Publication bias was noted in all the studies among adults (p = .22) and youth (p = .05).

Conclusion

Behavioral interventions as a single modality are effective in SLT cessation, both in the developed and developing countries. Health care providers should be sensitized to provide the same.

Implications

A recent literature survey by Cochrane reviewed studies on interventions for SLT, including behavioral interventions, which included only those from the developed countries. The current analysis provides a broader, global update on the same by including studies performed both in the developed and developing countries (specifically the South-East Asian region—the high burden countries of SLT products).
Blurred Molecular Epidemiological Lines Between the Two Dominant Methicillin-Resistant Staphylococcus aureus Clones
Authors: Dupper Amy C , Sullivan Mitchell J , Chacko Kieran I , Mishkin Aaron , Ciferri Brianne , Kumaresh Ajay , Berbel Caban Ana , Oussenko Irina , Beckford Colleen , Zeitouni Nathalie E , Sebra Robert , Hamula Camille , Smith Melissa , Kasarskis Andrew , Patel Gopi , McBride Russell B , van Bakel Harm , Altman Deena R
Published: June 2019

Background

Methicillin-resistant Staphylococcus aureus (MRSA) causes life-threatening infections in both community and hospital settings and is a leading cause of health care–associated infections (HAIs). We sought to describe the molecular epidemiological landscape of patients with MRSA bloodstream infections (BSIs) at an urban medical center by evaluating the clinical characteristics associated with the two dominant endemic clones.

Methods

Comprehensive clinical data from the electronic health records of 227 hospitalized patients ≥18 years old with MRSA BSI over a 33-month period in New York City were collected. The descriptive epidemiology and mortality associated with the two dominant clones were compared using logistic regression.

Results

Molecular analysis revealed that 91% of all single-patient MRSA BSIs were due to two equally represented genotypes, clonal complex (CC) 5 (n = 117) and CC8 (n = 110). MRSA BSIs were associated with a 90-day mortality rate of 27%. CC8 caused disease more frequently in younger age groups (56 ± 17 vs 67 ± 17 years old; P < .001) and in those of nonwhite race (odds ratio [OR], 3.45; 95% confidence interval [CI], 1.51–7.87; P = .003), with few other major distinguishing features. Morbidity and mortality also did not differ significantly between the two clones. CC8 caused BSIs more frequently in the setting of peripheral intravenous catheters (OR, 5.96; 95% CI, 1.51–23.50; P = .01).

Conclusions

The clinical features distinguishing dominant MRSA clones continue to converge. The association of CC8 with peripheral intravenous catheter infections underscores the importance of classical community clones causing hospital-onset infections. Ongoing monitoring and analysis of the dynamic epidemiology of this endemic pathogen are crucial to inform management and prevent disease.
Between distribution and allocation: growth models, sectoral coalitions and the politics of taxation revisited
Authors: Haffert Lukas , Mertens Daniel
Published: June 2019

Comparative political economists typically analyze taxation as a matter of distribution. This article, by contrast, develops an allocational explanation of tax policy choices: as taxes channel resources into some economic activities and restrain others, they become subject to the allocational concerns of different sectors of the economy. We argue that sectoral coalitions straddling the class divide substantially influence the development of tax systems, and that the power of these coalitions is associated with differences in growth models. Employing a mixed methods approach, we first demonstrate a systematic association between growth models and consumption taxation across advanced capitalist countries. Afterward, we study the German value-added tax increase in 2005 to illustrate the political dynamics behind this result. In this debate, an export sector coalition prevailed over a domestic sector coalition that strongly opposed the reform. We conclude by discussing the wider implications for the study of taxation and comparative capitalism.
Mai1 Protein Acts Between Host Recognition of Pathogen Effectors and Mitogen-Activated Protein Kinase Signaling
Authors: Roberts Robyn , Hind Sarah R. , Pedley Kerry F. , Diner Benjamin A. , Szarzanowicz Matthew J. , Luciano-Rosario Dianiris , Majhi Bharat B. , Popov Georgy , Sessa Guido , Oh Chang-Sik , Martin Gregory B.
Published: June 2019

The molecular mechanisms acting between host recognition of pathogen effectors by nucleotide-binding leucine-rich repeat receptor (NLR) proteins and mitogen-activated protein kinase (MAPK) signaling cascades are unknown. MAPKKKα (M3Kα) activates MAPK signaling leading to programmed cell death (PCD) associated with NLR-triggered immunity. We identified a tomato M3Kα-interacting protein, SlMai1, that has 80% amino acid identity with Arabidopsis brassinosteroid kinase 1 (AtBsk1). SlMai1 has a protein kinase domain and a C-terminal tetratricopeptide repeat domain that interacts with the kinase domain of M3Kα. Virus-induced gene silencing of Mai1 homologs in Nicotiana benthamiana increased susceptibility to Pseudomonas syringae and compromised PCD induced by four NLR proteins. PCD was restored by expression of a synthetic SlMai1 gene that resists silencing. Expression of AtBsk1 did not restore PCD in Mai1-silenced plants, suggesting SlMai1 is functionally divergent from AtBsk1. PCD caused by overexpression of M3Kα or MKK2 was unaffected by Mai1 silencing, suggesting Mai1 acts upstream of these proteins. Coexpression of Mai1 with M3Kα in leaves enhanced MAPK phosphorylation and accelerated PCD. These findings suggest Mai1 is a molecular link acting between host recognition of pathogens and MAPK signaling.
Impact of climate change on insect–human interactions
Authors: Vega Arantza , Castro Leopoldo
Published: June 2019

Purpose of review

To update the influence of the global climate change on Hymenoptera venom allergy.

Recent findings

Climate change facilitates biological invasions of hymenopteran species and plays a role in the impact of introduced species relevant for human health. It contributes to a rise in the incidence of sting injuries and allergy reactions across the world.

Global climate change has contributed to the expansion and the redistribution of allergenic insect species, increasing the number of allergy cases caused by stinging insects worldwide. Imported insects are trending species in systemic reactions for multiple stings or hymenopteran venom allergy. They represent a threat for humans and a challenge for the allergists.
Asthma and anaphylaxis
Authors: Tanno Luciana Kase , Gonzalez-Estrada Alexei , Olivieri Bianca , Caminati Marco
Published: June 2019

Purpose of review

Both asthma and anaphylaxis are recognized noncommunicable hypersensitivity conditions, which should be correctly diagnosed and treated/controlled in order to decrease avoidable deaths. Nevertheless, their association is not completely clear. We here propose to review the current and new evidence-based data of asthma and anaphylaxis in the view of the new knowledge in the field that can support the quality practice and empower allergists and health professionals in treating symptoms and preventing death.

Recent findings

Hypersensitivity life-threatening conditions, such as anaphylaxis and asthma can coexist, mimic or worse each other. Asthma itself is not a strong predictor of more severe anaphylaxis. However, poor asthma control associated with more severe anaphylaxis reactions in all ages. In children, asthma is associated with the severity and recurrences of anaphylactic reactions.

Although recent data point for the association between asthma and anaphylaxis, we still do not have harmonized evidence to confirm if we are dealing with two independent comorbidities one worsening each other. However, as far as this review is covering two relevant public health problems in the field of allergy, it is mandatory put in place decisions supporting recommendations to better manage the affected patients and reduce the risk.

General strategies should include regular notification of this association, optimization of the classification and coding for anaphylaxis and asthma (new ICD 11 allergy codes) in order to harmonize epidemiological stratified data, early diagnosis of asthma in childhood, regular investigation of asthma in cases of anaphylaxis and optimization of the asthma control and lung function for all patients with indication to provocation tests, desensitization or allergen immunotherapy regardless to the trigger. Implementation of these strategies will involve national and international support for ongoing efforts in relationship with networks of centres of excellence to provide personalized management for the most at-risk patients and prevent death.
A Prospective Randomized Trial Comparing Topical Intranasal Lidocaine and Levobupivacaine in Patients Undergoing Endoscopic Binostril Transnasal Transsphenoidal Resection of Pituitary Tumors
Authors: Konay Arun S. , Williams Aparna , Chacko Ari G. , Singh Georgene
Published: June 2019

Introduction:

Local anesthetic intranasal packing is used in transnasal surgery to reduce hemodynamic fluctuations. We hypothesized that the long acting local anesthetic levobupivacaine would provide superior hemodynamic stability and postoperative analgesia compared with lidocaine in endoscopic transnasal transsphenoidal (TNTS) surgery.

Materials and Methods:

In this prospective, randomized, double-blind trial, 48 patients undergoing TNTS surgery were allocated to the 2 groups to receive preoperative intranasal packing with 15 mL of 1.5% lidocaine or 0.5% levobupivacaine each mixed with 60 mg ephedrine. Heart rate and mean arterial blood pressure were recorded immediately before induction of anesthesia, at various time points throughout surgery, and at tracheal extubation. Bleeding in the surgical field, time to extubation, and postoperative pain were also assessed.

Results:

There was no significant difference in heart rate between the lidocaine and levobupivacaine groups at any point. Mean arterial pressure was also similar between the 2 groups during surgery, whereas at extubation blood pressure was lower in the lidocaine compared with levobupivacaine group (85±10 vs. 96±16 mm Hg; P=0.0010). There were no differences between the 2 groups in the other outcome variables.

Conclusions:

Preoperative intranasal packing with 1.5% lidocaine or 0.5% levobupivacaine provide similar hemodynamic stability throughout TNTS. Lidocaine packing may be more advantageous for hemodynamic stability during extubation.
Semiextended Tibial Nail Insertion Using an Extraarticular Lateral Parapatellar Approach: A 24-Month Follow-up Prospective Cohort Study
Authors: Stella Marco , Santolini Emmanuele , Felli Lamberto , Santolini Federico , Horwitz Daniel S.
Published: June 2019

Objective:

To analyze the outcomes of tibial shaft fractures treated with a lateral parapatellar approach in the semiextended position for intramedullary nail insertion.

Design:

Prospective cohort study.

Setting:

Level I trauma center.

Patients and Methods:

Seventy patients treated from March 2012 to July 2015 with intramedullary nailing (IMN) using an extraarticular lateral parapatellar approach in the semiextended position were reviewed. Patients were clinically and radiographically checked at a minimum follow-up of 24 months, and the following data were recorded: fracture healing, any residual deformity, nail–apex distance, range of motion of the treated knee together with the contralateral side, knee functional outcome, and residual knee pain.

Results:

Twenty-four months after surgery, all patients were clinically and radiographically healed, with 2 cases of malalignment (angular deformity <10 degrees). The average range of motion of the treated knee was 0–130.6 degrees (±8.6 degrees) compared with 0–131.1 degree (±7.9 degrees) of the contralateral. Lysholm knee score was excellent for 57 patients, good for 11, and fair for 2. The mean residual pain was 0.6 (±1.1) according to the visual analogue scale.

Conclusions:

The described technique represents an effective option for IMN of tibial fractures. It is suitable for all tibial fractures, including proximal and distal. The results of our series demonstrate the effectiveness of this technique with nearly complete recovery of knee function and negligible incidence of anterior knee pain at a minimum follow-up of 24 months.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Enablers and Barriers to Implementing ICU Follow-Up Clinics and Peer Support Groups Following Critical Illness: The Thrive Collaboratives*
Authors: Haines Kimberley J. , McPeake Joanne , Hibbert Elizabeth , Boehm Leanne M. , Aparanji Krishna , Bakhru Rita N. , Bastin Anthony J. , Beesley Sarah J. , Beveridge Lynne , Butcher Brad W. , Drumright Kelly , Eaton Tammy L. , Farley Thomas , Firshman Penelope , Fritschle Andrew , Holdsworth Clare , Hope Aluko A. , Johnson Annie , Kenes Michael T. , Khan Babar A. , Kloos Janet A. , Kross Erin K. , Mactavish Pamela , Meyer Joel , Montgomery-Yates Ashley , Quasim Tara , Saft Howard L. , Slack Andrew , Stollings Joanna , Weinhouse Gerald , Whitten Jessica , Netzer Giora , Hopkins Ramona O. , Mikkelsen Mark E. , Iwashyna Theodore J. , Sevin Carla M.
Published: June 2019

Objectives:

Data are lacking regarding implementation of novel strategies such as follow-up clinics and peer support groups, to reduce the burden of postintensive care syndrome. We sought to discover enablers that helped hospital-based clinicians establish post-ICU clinics and peer support programs, and identify barriers that challenged them.

Design:

Qualitative inquiry. The Consolidated Framework for Implementation Research was used to organize and analyze data.

Setting:

Two learning collaboratives (ICU follow-up clinics and peer support groups), representing 21 sites, across three continents.

Subjects:

Clinicians from 21 sites.

Measurement and Main Results:

Ten enablers and nine barriers to implementation of “ICU follow-up clinics” were described. A key enabler to generate support for clinics was providing insight into the human experience of survivorship, to obtain interest from hospital administrators. Significant barriers included patient and family lack of access to clinics and clinic funding. Nine enablers and five barriers to the implementation of “peer support groups” were identified. Key enablers included developing infrastructure to support successful operationalization of this complex intervention, flexibility about when peer support should be offered, belonging to the international learning collaborative. Significant barriers related to limited attendance by patients and families due to challenges in creating awareness, and uncertainty about who might be appropriate to attend and target in advertising.

Conclusions:

Several enablers and barriers to implementing ICU follow-up clinics and peer support groups should be taken into account and leveraged to improve ICU recovery. Among the most important enablers are motivated clinician leaders who persist to find a path forward despite obstacles.
Diagnosis and Treatment of Developmental Dyslexia and Specific Learning Disabilities: Primum Non Nocere
Authors: Cainelli Elisa , Bisiacchi Patrizia Silvia
Published: June 2019

Specific learning disabilities (SLDs) are increasingly being addressed by researchers, schools, and institutions, as shown by the increasing number of publications, guidelines, and incidence statistics. Although SLDs are becoming a major topic in education with the final goal of inclusive schools, consistent drawbacks may emerge, resulting in disadvantages instead of benefits for some children. Overdiagnosis and unnecessary interventions may harm children's neurodevelopment and families' quality of life more than previously thought. In this commentary, we discuss recent understandings, their practical and educational applications, and some considerations of the effects of these choices on children.
Reduction in N-Desmethylclozapine Level Is Determined by Daily Dose But Not Serum Concentration of Valproic Acid—Indications of a Presystemic Interaction Mechanism
Authors: Smith Robert L. , Kyllesø Lennart , Haslemo Tore , Andreassen Ole Andreas , Molden Espen
Published: June 2019

Background:

Valproic acid (VPA) is frequently used together with clozapine (CLZ) as mood-stabilizer or for the prevention of seizures in patients with psychotic disorders. VPA is known to reduce levels of the pharmacologically active CLZ-metabolite N-desmethylclozapine (N-DMC), but factors determining the degree of this interaction are unknown. Here, we investigated the relationship between VPA dose and serum concentration on N-DMC levels in a large patient population adjusting for sex, age, and smoking habits as covariates.

Methods:

A total of 763 patients with steady-state serum concentrations of CLZ and N-DMC concurrently using VPA (cases, n = 76) or no interacting drugs (controls, n = 687) were retrospectively included from a therapeutic drug monitoring service at Diakonhjemmet Hospital, Oslo, between March 2005 and December 2016. In addition to information about prescribed doses, age, sex, smoking habits, and use of other interacting drugs were obtained. The effects of VPA dose and serum concentration on dose-adjusted N-DMC levels were evaluated by univariate correlation and multivariate linear mixed-model analyses adjusting for covariates.

Results:

The dose-adjusted N-DMC levels were approximately 38% lower in VPA users (cases) versus nonusers (controls) (P < 0.001). Within the VPA cases, a negatively correlation between VPA dose and dose-adjusted N-DMC levels was observed with an estimated reduction of 1.42% per 100-mg VPA dose (P = 0.033) after adjusting for sex, age, and smoking. By contrast, there was no correlation between VPA serum concentration and dose-adjusted N-DMC levels (P = 0.873).

Conclusions:

The study shows that VPA dose, not concentration, is of relevance for the degree of reduction in N-DMC level in clozapine-treated patients. Presystemic induction of UGT enzymes or efflux transporters might underlie the reduction in N-DMC level during concurrent use of VPA. Our findings indicate that a VPA daily dose of 1500 mg or higher provides a further 21% reduction in N-DMC concentration. This is likely a relevant change in the exposure of this active metabolite where low levels are associated with implications of CLZ therapy.
Chinese Patients With Heart Valve Replacement Do Not Benefit From Warfarin Pharmacogenetic Testing on Anticoagulation Outcomes
Authors: Hao Yexia , Yang Jun , Zheng Xuan , Hu Yuanping , Yan Xinsheng , Zhang Litao
Published: June 2019

Background:

Genotype-guided warfarin dosing has been shown in some randomized trials to improve anticoagulation outcomes in individuals of European ancestry; yet, its utility in Chinese patients with heart valve replacement remains unresolved.

Methods:

A total of 2264 patients who underwent heart valve replacement at Wuhan Asia Heart Hospital were enrolled in this study. Patients were randomly divided into 2 groups, namely, a genotype-guided and a traditional clinically guided warfarin dosing group. In the genotype-guided group (n = 1134), genotyping for CYP2C9 and VKORC1 (−1639 G→A) was performed using TaqMan genotyping assay. Warfarin doses were predicted with the International Warfarin Pharmacogenetics Consortium algorithm. Patients in the control group (n = 1130) were clinically guided. The primary outcome was to compare the incidence of adverse events (major bleeding and thrombotic) during a 90-day follow-up period between 2 groups. Secondary objectives were to describe effects of the pharmacogenetic intervention on the first therapeutic-target-achieving time, the stable maintenance dose, and the hospitalization days.

Results:

A total of 2245 patients were included in the analysis. Forty-nine events occurred during follow-up. Genotype-guided dosing strategy did not result in a reduction in major bleeding (0.26% versus 0.63%; hazard ratio, 0.44; 95% confidence interval, 0.13–1.53; P = 0.20) and thrombotic events (0.89% versus 1.61%; hazard ratio, 0.56; 95% confidence interval, 0.27–1.17; P = 0.12) compared with clinical dosing group. Compared with traditional dosing, patients in the genotype-guided group reached their therapeutic international normalized ratio in a shorter time (3.8 ± 2.0 versus 4.4 ± 2.0 days, P < 0.001). There was no difference in hospitalization days (P = 0.28).

Conclusions:

Warfarin pharmacogenetic testing according to the International Warfarin Pharmacogenetics Consortium algorithm cannot improve anticoagulation outcomes in Chinese patients with heart valve replacement.
Breast Cancer and the Obstetrician-Gynecologist: A Focus on Screening, Risk Assessment and Treatment of Survivors With Genitourinary Syndrome of Menopause
Authors: JASRA BHARTI , SAMIIAN LAILA , KAUNITZ ANDREW M.
Published: June 2019

Because of conflicting guidelines, providing appropriate breast cancer screening recommendations to our patients has become challenging. Given the high prevalence of genitourinary syndrome of menopause (GSM) overall, and among breast cancer survivors, and the understandable reluctance of physicians to prescribe effective hormonal treatments to survivors with this condition, addressing the needs of breast cancer survivors with bothersome GSM is both a common and controversial issue. In this review, we detail current breast cancer screening recommendations, breast cancer risk assessment, and management of GSM in breast cancer survivors.
Ophthalmic Manifestations of Mycoplasma-Induced Rash and Mucositis
Authors: Shah Parth R. , Williams Andrew M. , Pihlblad Matthew S. , Nischal Ken K.
Published: June 2019

Purpose:

Mycoplasma pneumoniae is a common cause of pediatric respiratory infections, with a quarter having extrapulmonary complications, most commonly a mucocutaneous eruption involving the ocular surface. A detailed description of the ophthalmic manifestations in Mycoplasma-induced rash and mucositis (MIRM) is currently lacking in the scientific literature.

Methods:

This is a retrospective chart review of consecutive cases of MIRM at a tertiary referral children's hospital between October 1 and December 1, 2018, with up to 2 months of follow-up. Main outcomes and measures were demographic information, clinical examination findings including visual acuity, detailed anterior segment findings, and course of both ophthalmic and systemic disease.

Results:

Five patients were included. Age range was 8 to 17 years (mean age 11.9 years, median 11 years), with a strong male preponderance (4:1). All patients had inflammatory conjunctivitis. One patient had recurrent conjunctival pseudomembrane formation, whereas 2 patients had lid margin and conjunctival ulceration. No cases had corneal involvement and visual outcomes were excellent.

Conclusions:

MIRM is associated with ocular involvement in almost all cases. Although this is generally mild, conjunctival epithelial defects and pseudomembrane formation can occur. We recommend that pediatric ophthalmologists follow children who are hospitalized with MIRM as closely as they would those diagnosed with other mucocutaneous syndromes, such as Stevens–Johnson syndrome or toxic epidermal necrolysis.