bluuebunny/crossref_metadata_2025 huggingface dataset:
Opportunities for advancing ecosystem-based management in a rapidly changing, high latitude ecosystem
Authors: Skern-Mauritzen Mette , Olsen Erik , Huse Geir
Published: October 2018

Unprecedented and rapid changes are ongoing in northern high latitude, marine ecosystems, due to climate warming. Species distributions and abundances are changing, altering both ecosystem structure and dynamics. At the same time, human impacts are increasing. Less sea ice opens for the opportunity of more petroleum-related activities, shipping and tourism. Fisheries are moving into previously unfished habitats, targeting more species across more trophic levels. There is a need for ecosystem-based fisheries management (EBFM) and ecosystem-based management (EBM) to take the rapid, climate driven changes into account. Recently, there has been much development in qualitative, semi-quantitative, and quantitative scientific approaches to support EBFM and EBM. Here, we present some of these approaches, and discuss how they provide opportunities for advancing EBFM and EBM in one high-latitude system, namely the Barents Sea. We propose that advancing EBFM and EBM is more about adding tools to the toolbox than replacing tools, and to use the tools in coordinated efforts to tackle the increasing complexities in scientific support to management. Collaborative and participatory processes among stakeholders and scientists are pivotal for both scoping and prioritizing, and for efficient knowledge exchange. Finally, we argue that increasing uncertainty with increasing complexity is fundamental to decision making in EBFM and EBM and needs to be handled, rather than being a reason for inaction or irrelevance.
Arbitral Institutions and the Enforcement of Climate Change Obligations for the Benefit of all Stakeholders: The Role of ICSID
Authors: Miles Wendy , Lawry-White Merryl
Published: September 2018

In 2015, States concluded the landmark Paris Agreement, which committed to a long-term goal of “holding the increase in the global average temperature to well below 2°C above pre-industrial levels and pursuing efforts to limit the temperature increase to 1.5°C above pre-industrial levels”. The Paris Agreement galvanises all signatory nations in a common cause — combating climate change and adapting to and investigating its effects, and with enhanced support to assist developing countries to do so. As such, it charts a new course in the global climate effort.

The goals of the Paris Agreement will only be achieved through massive investment in pursuit of a common objective. According to the International Finance Corporation, an estimated US$90 trillion investment is required to implement the Paris Agreement. The current regime of international investment agreements (IIAs) provides an invaluable opportunity to promote the investment required to achieve the Paris Agreement objectives, including mitigation, adaptation and transition from fossil fuels. However, users must take care to ensure that investment is, in fact, protected and encouraged, and to maintain critical progress in promoting international climate change policy.

ICSID is one of the five arms of the World Bank Group, which recognises that “[c]limate change is a threat to the core mission of the World Bank Group”. The ICSID Convention is also designed to promote international private investment. As such, ICSID sits at an important nexus in this discussion.

This article: (i) provides an overview of several influential arbitration decisions relating to international environmental disputes, and the way in which the existing climate change regime uses arbitration as a dispute resolution mechanism; (ii) examines the evolution of investment treaties, prior decisions, especially in the field of renewable energy, and the tools available within IIAs for tribunals to promote the Paris Agreement objectives; (iii) discusses what arbitral institutions have done to date, in terms of tools, procedures, rules and other mechanisms, to promote climate change expertise and facilitate the resolution of disputes in a way that is consistent with climate change concerns; and (iv) considers ICSID's position as an arm of the World Bank, particularly in light of the WBG Climate Change Action Plan commitment to scaling up climate action and aligning internal processes with intentionally agreed climate change goals.
The loud and the quiet: searching for radio counterparts of two radio-weak BL Lac candidates with VLBI
Authors: Cao Hong-Min , Frey Sándor , Gabányi Krisztina É , Yang Jun , Cui Lang , Hong Xiao-Yu , An Tao
Published: October 2018

BL Lac objects are known to have compact jets inclined to our line of sight at a small angle, showing prominent radio emission. Two radio-weak BL Lac candidates with no counterparts in current radio surveys were recently reported by Massaro et al. Both sources were selected as candidate low-energy counterparts of unassociated Fermi γ-ray sources. We carried out very long baseline interferometry (VLBI) observations with the European VLBI Network (EVN) at 5 GHz to explore their radio properties at the milliarcsecond (mas) scale. One target, J1410+7405, is clearly detected with the EVN. Its measured 5-GHz flux density, 2.4 mJy, is consistent with recent interferometric measurements with the Karl G. Jansky Very Large Array, suggesting that the radio emission is confined to the inner ${\lesssim}10$-mas region. J1410+7405 is therefore identified as a radio-loud jetted active galactic nucleus, and its brightness temperature exceeds ∼109 K. Its properties are similar to those of other γ-ray-detected BL Lac objects. On the other hand, the second target, J0644+6031, remains undetected with the EVN with a 6σ brightness upper limit of 0.12 mJy beam−1. This source is thus radio-quiet, confirming its peculiarity, or possibly questioning its BL Lac nature.
Impacts of the new carbon fusion cross-sections on type Ia supernovae
Authors: Mori Kanji , Famiano Michael A , Kajino Toshitaka , Kusakabe Motohiko , Tang Xiaodong
Published: October 2018

Type Ia supernovae (SNe Ia) are thought to be thermonuclear explosion of white dwarfs (WDs). Their progenitors are not well understood. One popular scenario is the double-degenerate (DD) scenario, which attributes SNe Ia to WD–WD binary mergers. The fates of the WD mergers depend on the rate of 12C + 12C reaction. Recently, the 12C + 12C cross-sections have been measured and the analysis of the data using the Trojan Horse Method suggested that the astrophysical reaction rate is larger than conventional rates at astrophysical temperatures due to possible resonances. The resonance contribution results in a decrease of the carbon burning ignition temperature. Therefore, accretion-induced collapse occurs more easily and increases the birth rate of Galactic neutron stars with the contribution of the DD scenario to the SNe Ia rate becoming even smaller.
Optimization of Movement: A Dynamical Systems Approach to Movement Systems as Emergent Phenomena
Authors: Guccione Andrew A , Neville Brian T , George Steven Z
Published: October 2018

The term “movement system” has been defined as “represent(ing) the collection of systems (cardiovascular, pulmonary, endocrine, integumentary, nervous, and musculoskeletal) that interact to move the body or its component parts.”5 Although we do not dispute the advantage of defining the “movement system” as a physiological system, we contend that how the profession is identified with a monolithic “movement system” is imprudent. We contend that our scientific expertise regarding “movement optimization” should move forward by reconsidering how movement is produced (and potentially optimized) as a behavioral phenomenon in itself and abandon further attempts to promote “the movement system” with a purportedly unique and static label. We believe that reframing diagnosis is possible if there is a move away from an exclusive emphasis on classification of anatomical and physiological deviations from “normal” based on organismic constraints when such data yield, at best, an incomplete insight into functional performance that includes environmental and task constraints. The recent application of complex systems approaches to disciplines as diverse as medicine, biology, economics, and meteorology warrants thoughtful consideration of the potential benefits of incorporating similar advances in conceptualization of the central questions in physical therapy.
Improving Physical Activity Through Adjunct Telerehabilitation Following Total Knee Arthroplasty: Randomized Controlled Trial Protocol
Authors: Kline Paul W , Melanson Edward L , Sullivan William J , Blatchford Patrick J , Miller Matthew J , Stevens-Lapsley Jennifer E , Christiansen Cory L
Published: October 2018

Background

Physical activity remains low and nearly unchanged from preoperative levels following total knee arthroplasty (TKA), and this is thought to underlie long-term functional limitations, secondary health problems, and higher health care costs after TKA.

Objective

Our objective is to determine whether a telehealth-based intervention could improve physical activity and functional outcomes after TKA.

Design

The design is a 2-arm, parallel, assessor-blinded, randomized controlled trial with baseline, midintervention, postintervention, and 6-month follow-up assessments.

Setting

The setting is one academic medical center and one Veterans Affairs health care system.

Participants

One hundred US military veterans (aged 50–85 years) scheduled for unilateral TKA will participate in this study.

Intervention

The telehealth-based intervention to change physical activity behavior will be delivered through 10 sessions each of 30 minutes over a 12-week period. Participants will be provided with a wearable physical activity monitor to receive feedback on step count and guide goal-setting. Control participants will receive telehealth-based education on nonbehavioral aspects of health for the same frequency and duration as the intervention group. For both groups, telehealth sessions will occur concurrently with standardized outpatient rehabilitation.

Measurements

The primary outcome will be change in physical activity, assessed as daily step counts measured using an accelerometer-based sensor. Secondary outcomes will be measured using the Life-Space Assessment questionnaire and change in physical function (30-Second Chair-Stand Test, Timed “Up & Go” Test, Six-Minute Walk Test, Western Ontario and McMaster Universities Osteoarthritis Index, and Veterans RAND 12-Item Health Survey).

Limitations

Participant and interventionist blinding is not possible.

Conclusions

This trial will assess the efficacy of a novel behavior-change intervention to improve physical activity and physical function in patients after TKA. Effective physical activity behavior change could provide clinicians with a technique to augment current practice and resolve poor physical activity outcomes, long-term health problems, and high costs following TKA.
Oxygen deprivation influences the survival of Listeria monocytogenes in gerbils1
Authors: Harris Jillian , Paul Oindrila , Park Si Hong , White Sally J , Budachetri Khemraj , McClung Daniel M , Wilson Jessica G , Olivier Alicia K , Thornton Justin A , Broadway Paul R , Ricke Steven C , Donaldson Janet R
Published: October 2018

Listeria monocytogenes is a facultative anaerobic foodborne pathogen capable of surviving harsh environments. Recent work has indicated that anaerobic conditions increase the resistance capability of certain strains to environmental stressors. The goal of the study was to conduct a preliminary study to determine whether exposure to anaerobic conditions prior to infection increases the ability to survive in vivo. Gerbils were inoculated with one of five doses of the L. monocytogenes strain F2365 by oral gavage: phosphate-buffered saline (control), 5 × 106 colony forming units aerobic culture (low aerobic), 5 × 108 aerobic culture (high aerobic), 5 × 106 anaerobic culture (low anaerobic), or 5 × 108 anaerobic culture (high anaerobic) dose of F2365. Gerbils inoculated with a high aerobic or anaerobic dose exhibited significant weight loss. Gerbils administered either the low or high anaerobic dose had at least 3 log10 of L. monocytogenes present in fecal samples, which contrasted with gerbils that received the low aerobic dose. Animals that received the high anaerobic dose had a significant increase in bacterial loads within the liver. Histologic examination of the L. monocytogenes positive livers exhibited locally extensive areas of hepatocellular necrosis, though the extent of this damage differed between treatment groups. Microbial community analysis of the cecum from gerbils infected with L. monocytogenes indicated that the abundance of Bacteroidales and Clostridiales increased and there was a decrease in the abundance of Spirochaetales. This study suggests that anaerobic conditions alter the localization pattern of L. monocytogenes within the gastrointestinal tract. These findings could relate to how different populations are more susceptible to listeriosis, as oxygen availability may differ within the gastrointestinal tract.
Teen issues, part two
Authors: Espelin Jill
Published: October 2018

The good news? Teenagers are drinking, smoking, and taking drugs less than they used to. The bad news? The latest fads are easier to conceal and readily available.
Pediatric Candidemia Epidemiology and Morbidities
Authors: Lausch Karen Rokkedal , Schultz Dungu Kia Hee , Callesen Michael Thude , Schrøder Henrik , Rosthøj Steen , Poulsen Anja , Østergaard Lars , Mortensen Klaus Leth , Storgaard Merete , Schønheyder Henrik Carl , Søgaard Mette , Arendrup Maiken Cavling
Published: October 2018

Background:

Candidemia is the most frequent pediatric fungal infection, but incompletely elucidated in population-based settings. We performed a nationwide cohort study including all pediatric patients with candidemia in Denmark from 2004 to 2014 to determine age, incidence, species distribution, underlying diseases, patient management and outcomes.

Methods:

All candidemia episodes were identified through the active nationwide fungemia surveillance program. Susceptibility testing followed the EUCAST E.Def 7 (European Committee on Antifungal Susceptibility Testing, Edition Definitive) reference method. χ2 test, Fisher exact test and Venn diagrams were used for statistical analyses.

Results:

One hundred fifty-three pediatric patients (≤ 15 years) with 158 candidemia episodes were identified. The overall annual incidence rate was 1.3/100,000 population, higher for neonates (5.7/100,000 live births) and low birth weight neonates (103.8/100,000 live births). From 2004 to 2009 to 2010 to 2014, the proportion of Candida albicans decreased from 74.4% to 64.7%, whereas fluconazole resistance increased from 7.8% to 17.7%. Virtually all patients had at least 1 underlying disease (98.6%) and multimorbidity was common (43.5%, ≥2 underlying diseases). Underlying diseases differed by age with heart malformations and gastrointestinal disease prevalent in children younger than 3 years. The overall 30-days mortality was 10.2% and highest for neonates (17.1%). Mortality increased from 2004 to 2010 to 2014, driven by an increase among older children.

Conclusion:

This first nationwide epidemiologic study of pediatric candidemia confirmed a high incidence among neonates and a substantial burden of comorbidities. Moreover, an increasing proportion of fluconazole resistant nonalbicans species was observed. Our findings underline the importance of choosing correct treatment and continuous surveillance of pediatric candidemia.
A Staged Procedure in the Treatment of Primary Lacrimal Sac Epithelial Malignancy: A Retrospective Cases Analysis
Authors: Zhang Rui , Qian Jiang , Meng Fengxi , Yuan Yifei , Bai Mengying , Bi Yingwen , Xu Binbin , Yuan Yiqun , Hong Rujian
Published: October 2018

Purpose:

To determine the effect of a staged procedure in the treatment of primary lacrimal sac epithelial malignancy.

Methods:

This is a retrospective case series of 18 consecutive patients with primary lacrimal sac epithelial malignancy treated at an orbital tumor referral center between 2002 and 2017. Study was conducted in compliance with the Declaration of Helsinki. All patients underwent biopsy of the mass to confirm the diagnosis pathologically. Chemotherapy concurrent with radiotherapy was delivered to the patients to reduce and concrete the tumor prior to surgery. En bloc resection of the lacrimal sac malignancy and nasolacrimal duct was followed.

Results:

Eleven patients were male and 7 patients were female. The median follow-up time was 72.2 months. Nine patients had squamous cell carcinoma, 7 poorly differentiated carcinoma, 1 transitional cell carcinoma, and 1 adenoid cystic carcinoma. After chemotherapy and radiotherapy, the tumor volume was reduced significantly (p < 0.0001). En bloc resection of the lacrimal sac malignancy was performed in all patients with concurrent partial ethmoidectomy in 8 patients and medial maxillectomy in 5 patients. One patient (5.6%) suffered from adenoid cystic carcinoma died of metastatic disease. Two patients (11.1%) with local recurrence received reoperation, and 1 patient (5.6%) with pulmonary metastasis received gamma knife radiosurgery. These patients are alive with no evidence of tumor. Other patients are alive without evidence of disease at last follow up. No patient had new onset of lymph node enlargement during and after the treatment.

Conclusions:

The staged procedure is a promising method for the treatment of primary lacrimal sac epithelial malignancy with no postoperative lymph node metastasis.
The Role of Inferior Turbinate Fracture in the Management of Congenital Nasolacrimal Duct Obstruction
Authors: Rajabi Mohammad Taher , Inanloo Bahman , Salabati Mirataollah , Rafizadeh Mohsen , Tabatabaie Seyed Ziaeddin , Bayat Reza , Mahmoudzadeh Raziyeh
Published: October 2018

Purpose:

To evaluate the effect of inferior turbinate fracture in the treatment of congenital nasolacrimal obstruction combined with first attempt probing in children younger than 36 months.

Methods:

This prospective case–control study was conducted on 230 eyes from 176 children aged 12 to 36 months with congenital nasolacrimal duct obstruction. All patients underwent simple probing under general anesthesia. Inferior turbinate fracture was performed in case group combined with first probing. Patients were followed up 1, 3, and 6 months after surgery.

Results:

Total success rate was 91.2% for patients with turbinate fracture and 86.4% for patients without turbinate fracture. The difference between success rates was not statistically significant (p = 0.269). The authors did not find significant difference between cases and controls in age subgroups. Success rate in combined case and control groups in patients younger than 24 months (success rate: 91.7%) was significantly higher than those older than 24 months (success rate: 71.9%; p = 0.001). In univariate logistic regression analysis, age ≥24 months showed a negative association with the success rate (odds ratio = 0.232; 95% confidence interval: 0.91–0.59; p = 0.002). Other factors like sex, bilaterality of nasolacrimal duct obstruction, method of probing were not significantly associated with response to treatment.

Conclusions:

Inferior turbinate fracture does not improve the outcomes of simple probing and is not recommended during the first attempt in treatment of congenital nasolacrimal duct obstruction. Late probing (after 24 months of age) may have a higher failure rate, and increased age is the important factor that predicts failure in probing simple congenital nasolacrimal duct obstruction.
A Study on the Performance and Safety Test of Infant Incubator Devices
Authors: Tavakoli Golpaygani Ali , Hassani Kamra , Reza Marzieh
Published: October 2018

Nowadays, most neonatal or newborn babies are put in infant incubators to overcome distress during the postnatal care. These incubators can be defined as an optimal cabin environment with electronic equipment that enables premature babies with health problems to be able to continue their vital functions and grow. Despite the support of incubators, many newborn deaths are reported within the neonatal period. Similar to any other electromedical equipment, an infant incubator must be calibrated periodically because its malfunction may cause serious damage to the newborn's health or even lead to the newborn's death. So, the reliability of infant incubator is a matter of importance, and the performance and safety of these devices must be regularly verified, at least annually, using adequate analyzer via expert persons.
Eleven Years of Clozapine Experience in Autism Spectrum Disorder
Authors: Rothärmel Maud , Szymoniak Fanny , Pollet Charlotte , Beherec Laurène , Quesada Pierre , Leclerc Sophie , Belhaine Amina , Rosier Antoine , Guillin Olivier
Published: October 2018

Background

Autism spectrum disorders (ASDs) are neurodevelopmental disorders that comprise wide graduated clinical expressions but similar core symptoms (repetitive, stereotyped behavior, and social communication disabilities). Many patients with ASD have disruptive behaviors like aggressiveness, temper tantrums, or self-injury that interfere with their socializations, their learning abilities, and their quality of life. These behaviors represent a common target for pharmacology. Beherec et al (J Clin Psychopharmacol. 2011;31:341–344) (first cohort), showed the efficacy of clozapine on disruptive behaviors in 6 patients with autism who were older than 16 years. The aim of this study was to assess the efficacy and tolerance of clozapine in a new cohort and the long-term effect in our first cohort.

Procedures

Concerning the replication study, we conducted a retrospective study of the changes of aggressive behaviors for all patients with ASD who were treated with clozapine from 2011 to 2017. Disruptive behaviors were monitored from 1 to 6 months before and after the initiation of the clozapine.

Results

All the patients of the first cohort were still on clozapine after an average of 11 + 2.6 years, with the same efficacy and no serious adverse effect was noted. For the replication study, 13 patients were included. Clozapine resulted in a significant decrease in the number of the days with aggression (65.2% + 32.6%). Once again, no serious adverse effect was notified. All the patients had a better quality of life.

Conclusions

Our study confirms that clozapine could be an efficacious and well-tolerated treatment for ASD patients with disruptive behaviors who do not respond to other antipsychotics on the long term.
A Tiered Approach to Trauma Education in the Emergency Department
Authors: Lee Donna B. , Battle Deb
Published: October 2018

Although trauma centers are required to provide trauma education to nurses caring for trauma patients, there are no clearly defined standards for this education. In an effort to improve emergency department (ED) trauma nursing care, a tiered approach to ED trauma education (basic, intermediate, and advanced) was developed to provide specialized trauma education to a larger number of ED nurses at a Level II trauma center in Georgia. This tiered approach to ED trauma nurse education has resulted in the ability to quickly activate multiple trauma teams that work together competently and efficiently, leading to improved patient care and development of competent ED trauma nurses.
Efficacy and safety of dupilumab for the treatment of moderate-to-severe atopic dermatitis in adults: A pooled analysis of two phase 2 clinical trials
Authors: Tofte Susan J. , Papp Kim , Sadick Neil , Bohnert Krista , Simpson Eric , Thaçi Diamant , Bieber Thomas , Blauvelt Andrew , Sofen Howard , Gooderham Melinda , Chen Zhen , Gadkari Abhijit , Eckert Laurent , Graham Neil M. H. , Pirozzi Gianluca , Ardeleanu Marius
Published: October 2018

Background and purpose:

There is a need for new treatment options for moderate-to-severe atopic dermatitis (AD) in adults. Dupilumab, a fully human anti-interleukin-4 receptor α monoclonal antibody, has recently been approved for this indication.

Methods:

A pooled analysis of a phase 2a (NCT01548404) and a phase 2b (NCT01859988) study and a subanalysis of the 2b study evaluated the efficacy and safety of subcutaneous dupilumab 300 mg once weekly (qw) and every 2 weeks (q2w) in adults with moderate-to-severe AD.

Results:

Dupilumab significantly improved clinical outcomes in both analyses at week 12. Itch was significantly improved in the pooled analysis as measured by peak pruritus Numerical Rating Scale, 5-dimension pruritus scale, and SCORing Atopic Dermatitis (SCORAD) Visual Analog Scale (VAS) pruritus scores (all p < .0001 vs. placebo at week 12). Sleep loss was significantly improved (SCORAD VAS sleep loss score; p < .0001 vs. placebo at week 12); similar results were shown for the q2w dose. Dupilumab had an acceptable safety profile.

Conclusions:

Consistent with previous studies, dupilumab qw and q2w significantly improved signs and symptoms of AD at week 12, including improvements in itch and sleep loss.

Implications for practice:

Subcutaneous dupilumab is an effective new treatment option for adults with moderate-to-severe AD.
Environmental Sound Awareness in Experienced Cochlear Implant Users and Cochlear Implant Candidates
Authors: McMahon Kevin R. , Moberly Aaron C. , Shafiro Valeriy , Harris Michael S.
Published: October 2018

Objective:

To determine if postlingually deaf adult cochlear implant (CI) users have better environmental sound awareness (ESA) compared with adult patients eligible for CIs who have not yet undergone implantation.

Study Design:

Cross-sectional cohort study.

Setting:

Tertiary referral center.

Patients:

A group of 39 postlingually deaf adult patients who are experienced CI users (ECI), and a group of 20 postlingually deaf adult patients who are cochlear implant candidates (CIC) awaiting implantation.

Intervention:

Cochlear implantation.

Main Outcome Measure:

Environmental sound awareness as measured by accuracy (percent correct) using the computerized, Familiar Environmental Sounds Test—Identification (FEST-I).

Results:

There was no significant difference between ESA in our sample of ECI users versus CIC patients. The ECI users scored an average FEST-I accuracy of 59.9% (SD 14.3). In comparison, the CICs had an average FEST-I accuracy of 54.7% (SD 26.4). This difference was not statistically significant.

Conclusions:

Our findings suggest that, despite the commonly held notion that improved ESA may be a benefit of cochlear implantation, our sample of ECI users did not demonstrate superior performance compared with CICs.
Associations of TCF7L2 gene polymorphisms with the risk of diabetic nephropathy
Authors: Zhuang Yan , Niu Fukun , Liu Defeng , Sun Juanjuan , Zhang Xiaowei , Zhang Jian , Guo Shuxia
Published: October 2018

The aim of the study was to explore the correlation between rs7903146 and rs290487 polymorphisms in transcription factor 7-like 2 (TCF7L2) gene and diabetic nephropathy (DN) in Chinese Han population.

Polymerase chain reaction–restriction fragment length polymorphism was used to determine genotypes of TCF7L2 polymorphisms in 90 patients with DN and 96 diabetes patients without DN. The linkage disequilibrium (LD) and haplotype analysis were performed with haploview software. Hardy–Weinberg equilibrium was assessed in the control group based on the genotype distributions of TCF7L2 polymorphisms. The genotype, allele, and haplotype distribution differences between the case and control groups were analyzed by chi-squared test, and odds ratio (OR) and 95% confidence interval (CI) were used to indicate the relative risk of DN.

People carrying TT genotype of rs7903146 were more easily to be attacked by DN than CC genotype carriers (P = .02, OR = 4.26, 95% CI = 1.12–16.24). Meanwhile, T allele also showed 1.85 times risk to suffer from DN compared with C allele (OR = 1.85, 95% CI = 1.02–3.10). However, there was no significant difference in genotypes and alleles frequencies of rs290487 between 2 groups. The strong LD existed between the 2 single nucleotide polymorphisms and haplotype T–T (rs7903146–rs290487) increased the susceptibility to DN (OR = 2.63, 95% CI = 1.31–5.25).

TCF7L2 rs7903146 polymorphism may be associated with the susceptibility to DN in Chinese Han population, but rs290487 is not. Additionally, haplotype is also a risk factor for DN.
Prognostic value of transcranial facial nerve motor-evoked potentials in predicting facial nerve function following cerebellopontine angle tumorectomy
Authors: Song Hongmei , Ma Chengyuan , Xu Dahai , Yu Mingxin , Feng Jiachun , Sun Lichao
Published: October 2018

Facial nerve paralysis is a common complication following cerebellopontine angle (CPA) surgery. This study investigated the prognostic value of facial nerve motor-evoked potentials (FNMEPs) elicited by transcranial electrical stimulation for facial nerve outcome after CPA tumorectomy.

A total of 95 patients were enrolled in this study between January 2014 and January 2016. All these patients underwent CPA tumorectomy (unilateral, n = 95; bilateral, n = 1). Intraoperative FNMEP elicited by transcranial electrical stimulation was recorded. The short- and long-term postoperative facial nerve functions were evaluated according to the House–Brackmann (HB) scale. The correlation between perioperative changes in the FNMEP stimulus threshold (delta FNMEP = postoperative stimulus threshold level–preoperative stimulus threshold level) and postoperative facial nerve functions were analyzed.

On the first day postoperatively, the facial nerve function was HB grade I in 67, grade II in 17, grade III in 7, and grade IV in 5 facial nerves. One year postoperatively, the facial nerve function was grade I in 80, grade II in 11, grade III in 3, and grade IV in 2 facial nerves. The delta FNMEP was significantly correlated with the short- and long-term facial nerve function; receiver operating characteristic (ROC) curves yielded a cut-off delta FNMEP value of 30 V (sensitivity, 91.3%; specificity, 98.6%) and 75 V (sensitivity, 100%; specificity, 98.8%) for predicting short- and long-term facial nerve function damage, respectively.

FNMEP elicited by transcranial electrical stimulation is an effective and safe approach for predicting facial nerve function in CPA tumorectomy. A high delta FNMEP is a potential indicator for the prediction of postoperative facial nerve damage.
Bidirectionality of the dentato-rubro-thalamo-cortical tract allows concurrent hypoperfusion in ipsilateral cerebellum and contralateral cerebral hemisphere
Authors: He Hsin-Chen , Hsu Ming-Chun , Hsu Chun-Sheng , Cheng Yuan-Yang , Chang Shin-Tsu
Published: October 2018

Rationale

The brain circulation of the dentato-rubro-thalamo-cortical tract (DRTT) has been reported for decade, but is rarely observed using nuclear medicine imaging tools, to analyze a patient with midbrain hemiatrophy syndrome. We present a case that revealed notable interruption in the middle of the DRTT. Finding out whether the superior cerebellar peduncle of the midbrain was injured was a decisive element for developing bidirectional effect of DRTT.

Patient concerns

A 34-year-old right-handed female presented with progressive weakness and bradykinesia in the left-sided limbs for about 6 months. She had difficulty with hand dexterity for activities of daily life and general tasks. She reported poor balance during walking and sitting. Muscle strength was 3 in the left hand and 4 in the foot due to atrophy of left limbs. The circumference of 10 cm proximally/distally from the lateral epicondyle of the humerus was 25.7/23.8 cm at right and 24.2/20.8 cm at left in the upper limbs, and 15 cm proximally/distally from the lateral joint space was 42.1/35.0 cm at right and 43/30.8 cm at left in the lower limbs. The brain magnetic resonance imaging study revealed a small-sized right midbrain.

Diagnosis

Based on the distinct features of limbs atrophy and the locations of the lesions on the magnetic resonance (MR) imaging, the patient was diagnosed with midbrain hemiatrophy syndrome.

Interventions

The patient was only willing to accept physical and occupational training programs at our outpatient clinic.

Outcomes

We utilized serial anatomic and functional neuroimaging of the brain to survey the neurologic deficit. Brain perfusion single-photon emission computed tomography (SPECT) showed hypoperfusion over the left fronto-parietal regions, left anterior temporal region, and left occipital region, and also the left striatum and right cerebellum. Symptoms were gradually recovered with rehabilitation, and he was transferred to a rehabilitation facility on hospital day 40.

Lessons

This is the first report to demonstrate concurrent hypoperfusion of ipsilateral cerebellum and contralateral cerebral hemisphere observed on SPECT images in a case of midbrain hemiatrophy syndrome. In our case, with midbrain hemiatrophy syndrome could be explained as mutual direction effect of DRTT.
Lethal neonatal mitochondrial phenotype caused by a novel polymerase subunit gamma mutation
Authors: AlJabri Mohamed F. , Kamal Naglaa M. , Halabi Abdulrahman , Korbi Haifa , Alsayyali Mashhour M.A. , Alzahrani Yahea A.
Published: October 2018

Rationale:

Polymerase subunit gamma (POLG) is a gene that codes for the catalytic subunit of the mitochondrial DNA polymerase, which is involved in the replication of mitochondrial DNA. Mutations in these genes are associated with a range of clinical syndromes characterized by secondary mtDNA defect including mtDNA mutation and mtDNA depletion which may culminate in complete failure of energy production (respiratory changes complex 1 defect) as in this case.

Patient concerns:

We herein report a full term Saudi female neonate born to consanguineous parents, who was noticed immediately after birth to have severe hypotonia, poor respiratory effort, and dysmorphic features. She had 3 siblings who died with same clinical scenario in neonatal period.

Diagnoses:

Molecular genetic testing revealed a novel compound heterozygous mutation of POLG gene c.680G>A (p.Arg227Gin) and c.3098C>T (p.Ala1033Val).

Interventions:

The patient remained in neonatal intensive care unit with multidisciplinary team management and was ventilator dependent until she passed away.

Outcomes:

The detected mutation had led to complete failure of energy production (respiratory changes complex 1 defect) until she died at the age of 5 months.

Lessons:

Mitochondrial respiratory chain defect should be considered in patients with severe neonatal hypotonia,encephalopathy, and respiratory failure especially in highly consanguineous population.
Magnetic resonance imaging of the fetal brain at 3 Tesla
Authors: da Silva Nivaldo Adolfo , Vassallo José , Sarian Luis Otávio , Cognard Christophe , Sevely Annick
Published: October 2018

To report our preliminary experience with cerebral fetal magnetic resonance imaging (MRI) with a 3 Tesla (3T) scanner. We assessed feasibility, time of acquisition, and possibility to establish a diagnosis.

Fifty-nine pregnant women had fetal MRI performed during the third trimester of pregnancy due to clinical or sonography concern of a central nervous system anomaly. No fetal or maternal sedation was used. The MRI protocol consisted of T2 turbo-spin-echo images in 3 planes of space. No T1-weighted images were performed. All images were analyzed by 2 pediatric neuroradiologists, who evaluated spatial resolution, artifacts, time of acquisition, and possibility to establish a diagnosis suspected by sonography.

Examinations were performed safely for all patients. The images required longer time of acquisition (approximately 75 seconds for each plane in the space). The specific absorption rate was not exceeded in any fetus. Cerebral fetal MRI was normal in 22 cases. The spectrum of diagnostics included isolated ventriculomegaly, posterior fossa malformation, corpus callosum malformation, gyration anomalies, craniosynostosis, tuberous sclerosis, microcephaly, external hydrocephaly, midline arachnoid cyst, cerebral lesions, and persistent hyperplastic primitive vitreous.

In our series, 3 T MRI of fetal brain was feasible and able to establish a diagnosis but required longer time of acquisition.
An observational study of the epidermal growth factor receptor-tyrosine kinase inhibitor resistance mechanism in epidermal growth factor receptor gene mutation-positive non-small cell lung cancer
Authors: Yoshimura Akihiro , Uchino Junji , Tanimura Keiko , Chihara Yusuke , Tamiya Nobuyo , Kaneko Yoshiko , Takeda Takayuki , Hiranuma Osamu , Hasegawa Isao , Kubota Yutaka , Shiotsu Shinsuke , Takumi Chieko , Hiraoka Noriya , Yamada Tadaaki , Takayama Koichi
Published: October 2018

Non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutation show a high response to EGFR-tyrosine kinase inhibitor (EGFR-TKI). Clinically, EGFR-positive NSCLC acquires several resistance mechanisms during EGFR-TKI treatment, such as the emergence of a secondary mutation (T790M), MET gene amplification, and transformation to small cell lung cancer. However, the mechanism of resistance to afatinib, a second-generation EGFR-TKI, remains unclear. In this study, we prospectively investigate the mechanism of resistance to afatinib using proteomic analyses.

In total, 35 EGFR-positive NSCLC patients of both sexes and ≥20 years old will be included. NSCLC patients with major obstacles in major organs, such as bone marrow, heart, lung, liver, and kidney, will be excluded. Eligible patients will be administered afatinib or gefitinib until disease progression and proteomic analysis will be performed with biopsy samples before treatment and at disease progression.

The primary outcome is to detect the potential predictive anomalies in proteins that can be candidates for the resistance factor of afatinib. The secondary outcome is to detect gene and protein abnormalities affecting progression-free survival, response rate, and rate of disease control in afatinib therapy.

The protocol was approved by the institutional review boards of Kyoto Prefectural University of Medicine and all the participating hospitals. Written informed consent was obtained from all patients before registration, in accordance with the Declaration of Helsinki. The results of the study will be disseminated via publications in peer-reviewed journals.

Trial registration number is UMIN000031013.
Primary total knee arthroplasty for complex supracondylar femoral fractures in patients with knee arthritis
Authors: Wang Wei , Yang Kun , Yang Pei , Song Dandan , Wang Chunsheng , Song Jinhui , Li Xiaohui , Wang Kunzheng
Published: October 2018

When elder arthritis patients suffered from complex supracondylar femoral fractures, their joints condition and general health condition elevate the difficulties in operation and post-surgical recovery.

Here, we aimed to simplify the operation procedure by using one-step Total Knee Arthroplasty (TKA) with a stemmed femoral implant. We also investigated if this method could improve the patients’ experience after the operation. The surgery including femoral osteotomy and implantation was performed on all fourteen patients by the same orthopedic specialist. The patients’ hospitalization time was recorded. The recovery of knee function and patient satisfaction was evaluated by a systematic follow-up with average time 38 months, up to 5 5 years, using Hospital for Special Surgery (HSS) knee scores, the range of motion (ROM), anteroposterior and lateral radiography, and Visual Analog Scale (VAS) scores. The average of hospitalization days was 16 days. No angular deformity, malunion, or shortening were found at radiography.

The average ROM was 105.2° at the end of the follow-up period. The knees in all the patients show adequate stability. All patients had returned to their former daily activities. Seventeen out of 24 patients were satisfied with the outcome of the surgery.

The usage of TKA with a stemmed femoral implant is a reasonable method for elderly patients suffering from supracondylar femoral fractures and concomitant knee arthritis.
Short bowel syndrome caused by laparoscopic loop enterostomy of the jejunum in an adult with undiagnosed intestinal malrotation
Authors: Hsu Yin-Chen , Hsu Li-Sheng , Huang Wen-Shih , Weng Jun-Cheng , Chen Chien-Wei
Published: October 2018

Rationale:

Failure to recognize intestinal malrotation in adults can cause complications during surgeries, especially those with a limited operative field. We report a case of short bowel syndrome caused by mistaken creation of a loop enterostomy in the jejunum due to undiagnosed intestinal malrotation.

Patient concerns:

A 72-year-old man underwent a laparoscopic right hemicolectomy and ileocolostomy because of complicated diverticulitis. Six days after the surgery, he received laparoscopic exploration because of anastomotic leak, and a laparoscopic loop ileostomy was also performed as a protective diversion stoma. One month after surgery, he complained of severe diarrhea from the enterostomy after food and water intake. An upper gastrointestinal and small bowel series revealed that the duodenojejunal junction (DJJ) did not cross the midline and there was a short distance between the DJJ and the enterostomy in the right lower quadrant.

Diagnoses:

Short bowel syndrome caused by mistaken creation of a loop enterostomy in the jejunum due to undiagnosed intestinal malrotation.

Interventions:

Total parental nutrition was used and the loop enterostomy was closed 3 months after the initial surgery.

Outcomes:

The patient was discharged uneventfully 2 weeks after the loop enterostomy.

Lessons:

Intestinal malrotation in adults is often encountered during routine radiological examinations. However, it may cause complications during surgery if ignored. Radiologists should keep in mind that complications may occur if a complete presurgical evaluation of intestinal malrotation is not performed, and surgeons should take caution when performing surgeries, especially those with a limited operative field.
Investigation of rare earth elements in urine and drinking water of children in mining area
Authors: Liang Qingqing , Yin Haijing , Li Jianting , Zhang Liping , Hou Ruili , Wang Suhua
Published: October 2018

To compare the contents of rare earth elements in urine and drinking water of children in the mining and control areas and evaluate the health risk of children in the mining area.

Urine and drinking water of 128 children in the mining area and 125 children in the control area were collected from June to July 2015. The contents of rare earth elements were determined using inductively coupled plasma mass spectrometry.

The detection rates of rare earth elements, including yttrium (Y), lanthanum (La), cerium (Ce), praseodymium (Pr), neodymium (Nd), and samarium (Sm), in the urine of children in the exposed group were all 100%, except for samarium (98%); the rates in the control group were 85.7%, 100%, 100%, 98%, 98%, and 59.2%, respectively, and the remaining elements were not detectable. The concentrations of Y, La, Ce, Pr, Nd, and Sm in the urine of children in the exposed group were significantly higher than that in the control group (P < .01). In addition, the composition ratio of lanthanum was higher than that in the control group. The detection rates of lanthanum and Ce in the drinking water of children in the exposed group were 1.44% and 0.72%, respectively. The others were not detectable; the rates in the control group were all 0%.

The pollution caused by the presence of Y, La, Ce, Pr, Nd, and Sm in the mining area might affect the health of children in the area, but drinking water might not be the cause.
Drug dependence in patients with chronic pain
Authors: Tetsunaga Tomoko , Tetsunaga Tomonori , Nishida Keiichiro , Kanzaki Hirotaka , Misawa Haruo , Takigawa Tomoyuki , Shiozaki Yasuyuki , Ozaki Toshifumi
Published: October 2018

Drug dependence, which can exist concurrently with chronic pain, is seen as one of the major causes of rapidly increasing medical expenses. However, drug dependence in patients with chronic pain has not been evaluated. The aim of this study was to identify the risk factors for drug dependence in patients with chronic noncancer pain.

This retrospective study included 151 patients with chronic noncancer pain (43 males, 108 females; mean age, 72 years). Low back pain (LBP) occurred in 96 patients, whereas 22 had shoulder pain, 8 had hip pain, and 77 had knee pain. Patients were divided into drug dependence and nondrug dependence groups based on the Severity of Dependence Scale (SDS) scores. Patients with SDS scores ≥5 and <5 were classified into drug dependence and nondrug dependence groups, respectively. All patients completed self-report questionnaires. Factors that predict drug dependence were identified by performing univariate and multivariate analyses.

Sixty (40%) of the 151 patients met the SDS criteria for drug dependence. Significant differences were found between patients with and without drug dependence for the LBP, hip pain, number of medications, and for the Numerical Rating Scale, Pain Disability Assessment Scale (PDAS), Hospital Anxiety and Depression Scale, and Pain Catastrophizing Scale (PCS) scores. Multiple regression analysis identified LBP, hip pain, PCS, and PDAS scores as factors related to drug dependence in patients with chronic noncancer pain.

Drug dependence tends to differ in patients based on the location of their chronic pain. Pain catastrophizing and disability indicated a greater tendency for drug dependence. Thus, PCS and PDAS scores are useful screening tools for predicting drug dependence in patients with chronic pain.
Use of Postpartum Magnetic Resonance Imaging for Diagnosis and Classification of Retained Placenta Tissue
Authors: Zhang Shui-Hua , Zhang Jia-Yun , Zhang Jing , Chen Wen-Li , Zhou Quan
Published: October 2018

Objective

To study the potential application of magnetic resonance imaging (MRI) for classification of retained placental tissue (RPT) in the uterus postnatally.

Methods

Twenty-two patients with clinically or pathologically proven RPT were studied.

Results

The thickness ratio (D1/D2) of invaded (D1) to normal (D2) myometrium could be categorized into 3 groups (>0.6, 0.1–0.6, and <0.1) correlating with the 3 types of RPT: accreta vera (RPA), increta (RPI), and percreta (RPP) (r = −0.861, P < 0.01). After uterine arterial embolization, the RPT showed lower signal intensity than the myometrium without flow voids on T2-weighted images. Two cases of RPP showed gradual enhancement, except 1 case of infection and 2 cases that did not involve enhancement examinations, whereas 17 cases of RPA and RPI showed early enhancement.

Conclusions

Magnetic resonance imaging can facilitate diagnosis of RPT severity. Dynamic contrast enhancement can indicate RPT activity and blood supply, thereby ensuring appropriate clinical decision making.
Are We Overdiagnosing Pulmonary Embolism? Yes!
Authors: Tan Stephanie , Haramati Linda B.
Published: October 2018

Pulmonary embolism (PE) is a relatively common and potentially fatal pathology. Fear of missing the diagnosis is pervasive for physicians, including radiologists. However, as computed tomography pulmonary angiography technology and utilization have evolved over the years, we have gained an understanding that not all PEs are equal. As such, our interpretations of PE imaging studies must be enriched by this understanding and adapted to patient circumstances. Herein, we shine the light on overdiagnosis of PE, exploring the evidence, impact, costs, and consequences of overdiagnosis on the care of our patients.