bluuebunny/crossref_metadata_2025 huggingface dataset:
A scaling relationship for non-thermal radio emission from ordered magnetospheres: from the top of the main sequence to planets
Authors: Leto P , Trigilio C , Krtička J , Fossati L , Ignace R , Shultz M E , Buemi C S , Cerrigone L , Umana G , Ingallinera A , Bordiu C , Pillitteri I , Bufano F , Oskinova L M , Agliozzo C , Cavallaro F , Riggi S , Loru S , Todt H , Giarrusso M , Phillips N M , Robrade J , Leone F
Published: July 2021

In this paper, we present the analysis of incoherent non-thermal radio emission from a sample of hot magnetic stars, ranging from early-B to early-A spectral type. Spanning a wide range of stellar parameters and wind properties, these stars display a commonality in their radio emission which presents new challenges to the wind scenario as originally conceived. It was thought that relativistic electrons, responsible for the radio emission, originate in current sheets formed, where the wind opens the magnetic field lines. However, the true mass-loss rates from the cooler stars are too small to explain the observed non-thermal broad-band radio spectra. Instead, we suggest the existence of a radiation belt located inside the inner magnetosphere, similar to that of Jupiter. Such a structure explains the overall indifference of the broad-band radio emissions on wind mass-loss rates. Further, correlating the radio luminosities from a larger sample of magnetic stars with their stellar parameters, the combined roles of rotation and magnetic properties have been empirically determined. Finally, our sample of early-type magnetic stars suggests a scaling relationship between the non-thermal radio luminosity and the electric voltage induced by the magnetosphere’s co-rotation, which appears to hold for a broader range of stellar types with dipole-dominated magnetospheres (like the cases of the planet Jupiter and the ultracool dwarf stars and brown dwarfs). We conclude that well-ordered and stable rotating magnetospheres share a common physical mechanism for supporting the generation of non-thermal electrons.
Expression of the ISPpu9 transposase of Pseudomonas putida KT2440 is regulated by two small RNAs and the secondary structure of the mRNA 5′-untranslated region
Authors: Gómez-García Guillermo , Ruiz-Enamorado Angel , Yuste Luis , Rojo Fernando , Moreno Renata
Published: July 2021

Insertion sequences (ISs) are mobile genetic elements that only carry the information required for their own transposition. Pseudomonas putida KT2440, a model bacterium, has seven copies of an IS called ISPpu9 inserted into repetitive extragenic palindromic sequences. This work shows that the gene for ISPpu9 transposase, tnp, is regulated by two small RNAs (sRNAs) named Asr9 and Ssr9, which are encoded upstream and downstream of tnp, respectively. The tnp mRNA has a long 5′-untranslated region (5′-UTR) that can fold into a secondary structure that likely includes the ribosome-binding site (RBS). Mutations weakening this structure increased tnp mRNA translation. Asr9, an antisense sRNA complementary to the 5′-UTR, was shown to be very stable. Eliminating Asr9 considerably reduced tnp mRNA translation, suggesting that it helps to unfold this secondary structure, exposing the RBS. Ectopic overproduction of Asr9 increased the transposition frequency of a new ISPpu9 entering the cell by conjugation, suggesting improved tnp expression. Ssr9 has significant complementarity to Asr9 and annealed to it in vitro forming an RNA duplex; this would sequester it and possibly facilitate its degradation. Thus, the antisense Asr9 sRNA likely facilitates tnp expression, improving transposition, while Ssr9 might counteract Asr9, keeping tnp expression low.
The evolution of tax implicit value judgements in the UK: 1968–2018
Authors: van de Ven Justin , Hérault Nicolas
Published: July 2021

We develop an empirical approach for quantifying the value judgements implicit in the relative treatment of demographic subgroups by an entire tax and transfer system. The new approach can be applied to household survey data, allowing us to evaluate the evolution of these value judgements using UK data reported at annual intervals between 1968 and 2018. The results provide the first quantitative evaluations of widely cited substantial improvements in tax and transfer treatment enjoyed by some population subgroups—particularly families with children and age pensioners—relative to the wider population.
Plesiomonas shigelloides Septic Shock Following Ingestion of Dojo Nabe (Loach Hotpot)
Authors: Shinohara Takayuki , Okamoto Koh , Koyano Saho , Otani Amato , Yamashita Marie , Wakimoto Yuji , Jubishi Daisuke , Hashimoto Hideki , Ikeda Mahoko , Harada Sohei , Okugawa Shu , Moriya Kyoji
Published: July 2021

Plesiomonas shigelloides is a gram-negative bacillus that commonly causes self-limited diarrhea in humans. We present the case of P shigelloides bacteremia in a 49-year-old man with alcoholic cirrhosis who developed septic shock a day after eating Dojo nabe (loach hotpot), a Japanese traditional dish.
Supporting consulting paediatrics in rural, remote, or vulnerable communities in British Columbia: Time for national collaboration
Authors: Miller Kirsten , Benny Alexander , Retallack Jennifer
Published: July 2021

Rural consultant paediatricians in Canada are in short supply. Rural communities across the country could benefit from the implementation of strategies to ensure access to consistent, local consultant paediatric care. Compared to their urban counterparts, rural paediatricians face unique challenges, including significant call requirements, potential risk of burnout and difficulty in recruitment. In response to these challenges, a number of strategies to bolster the provision of paediatric care to rural, remote, and underserved communities have evolved in British Columbia, including virtual support, the development of a rural paediatric network, and new training opportunities. It is time for discussions about the vulnerability of consulting paediatric care in rural or underserved communities to occur at the national level. National engagement will foster collaboration, drive research, and facilitate workforce planning, with the goal of ensuring that all Canadian communities have access to consulting paediatric care.
Neutron star cooling in modified gravity theories
Authors: Dohi Akira , Kase Ryotaro , Kimura Rampei , Yamamoto Kazuhiro , Hashimoto Masa-aki
Published: July 2021

We study the thermal evolution of isolated neutron stars in scalar–tensor theories for the first time. Whether rapid cooling due to the direct Urca process occurs or not is an interesting question from the viewpoint of the temperature observation of isolated neutron stars. Moreover, investigation of the cooling effect of nucleon superfluidity also has large uncertainties, though it is important in modern cooling theory. The cooling effect is typically influenced by the proton fraction and the central density. If a fifth force is mediated due to a modification of gravity, the relation between the central density and mass of neutron stars differs from that in general relativity, and the cooling curve is also naively expected to vary. We find that an unscreened fifth force near the surface of neutron stars changes the mass–central density relation, and the direct Urca process can be triggered even for neutron stars with smaller mass. We also present cooling curves including nucleon superfluidity under the scalar–tensor theory. These results show that it might be useful to test gravitational theories with cooling observations of neutron stars.
Integrated Custom Composite Polyetheretherketone/Carbon fiber (PEEK/CF) Vertebral Body Replacement (VBR) in the Treatment of Bone Tumors of the Spine
Authors: Shen Francis H. , Gasbarrini Alessandro , Lui Darren F. , Reynolds Jeremy , Capua John , Boriani Stefano
Published: July 2021

Study Design.

Retrospective, multicenter chart, and radiologic review.

Objective.

To present the first case series of bone tumors of the spine surgically reconstructed with a new custom, fully radiolucent, polyetheretherketone/carbon fiber (PEEK/CF) vertebral body replacement (VBR) integrated system.

Summary of Background Data.

Surgical resections of spinal tumors result in large defects and local recurrence remains a concern. Current titanium-based implants adversely affects postoperative imaging, directly affects ability to identify tumor recurrence, and for delivery of radiotherapy treatments. PEEK/CF spinal implants allows for improved tumor surveillance, precise pre-radiation Computed Tomography planning, and reduces interference with post-reconstructive adjuvant radiotherapy.

Method.

Thirteen patients with spinal tumors underwent vertebral body resection and reconstruction with an integrated, fully radiolucent, custom PEEK/CF vertebral body replacement, and radiolucent posterior PEEK/CF screw-rod system and/or radiolucent anterior PEEK/CF plate system. Clinical and radiographic data were tabulated. Need for adjuvant radiotherapy determined based on final tissue histology and extent of surgical margins. Postoperative surveillance imaging were reviewed for local tumor recurrence.

Results.

The ability to integrate the PEEK/CF VBR connected to either the posterior screw-rod system, or anterior plate system provided immediate stability. The VBR was placed directly on cancellous vertebral body surface in 46.2% of cases. Loosening of the distal, or proximal, aspect of posterior system was seen in 15.4% of cases. There was no clinical or radiographic evidence of VBR migration and subsidence at latest follow up. Local recurrence occurred in one (7.7%) patient.

Conclusion.

This is the first series to describe the use of a fully-radiolucent, integrated, PEEK/CF implant system for spinal tumor reconstruction. The use of a PEEK/CF VBR system integrated to either the anterior plate, or posterior screw-rod system is feasible and allows for superior postoperative surveillance imaging and effective delivery of postoperative adjuvant radiotherapy.

Level of Evidence: 4
Mapping of Venous Sinus Anatomy and Occipital Bone Thickness for Safe Screw Placement in 100 Patients with 46,200 Standardized Measurements Using Computed Tomography Angiography
Authors: Reisener Marie-Jacqueline , Arzani Artine , Okano Ichiro , Salzmann Stephan N. , Rentenberger Colleen , Carrino John A. , Shue Jennifer , Pumberger Matthias , Sama Andrew A. , Cammisa Frank P. , Girardi Federico P. , Hughes Alexander P.
Published: July 2021

Study Design.

Retrospective descriptive study.

Objective.

The aim of this study was to create topographical maps of occipital bone thickness and venous sinus (VS) presence to assess the risks of screw insertion in four commercially available occipital plates.

Summary of Background Data.

Craniocervical junction instability and deformity are serious pathological conditions that require posterior fixation of the occipital bone to the cervical vertebrae. Insertion of occipital bone screws requires evaluation of both occipital bone thickness for effective internal fixation and intracranial VS presence for vascular injury prevention. Despite the surgical risks, there is a paucity of research on safe screw placement.

Methods.

We created a matrix of 231 standardized measurement points to analyze the occipital bone thickness and VS presence in cervical spine CT angiograms. These measurements were used to create topographical maps of occipital bone thickness and likelihood of VS presence, which we then compared to the screw hole configurations of four occipital plates.

Results.

Hundred patients were assessed. Maximum occipital bone thickness of 13.9 ± 3.3 mm was midline in the occipital bone, 45 mm from the foramen magnum, around the external occipital protuberance (EOP). Regions with thicknesses >8 mm were 2 cm lateral to the EOP at the level of the superior nuchal line and 2.5 cm inferior to the EOP. The area with the highest VS presence rate was around the EOP and the superior nuchal line. The right transverse VS was more prominent in both sexes.

Conclusion.

There is a limited area of the occipital bone with thicknesses for enough screw purchase. Previous studies have shown 8 mm as the minimum screw length to reduce the risk of implant failure. In our analysis, only “T”-shaped plates had configurations with thicknesses >8 mm for each screw hole. For every screw hole in the analyzed occipital plates, there was a possibility of VS presence ranging from 8% to 33%.

Level of Evidence: 5
Prevalence of Self-Reported Prescription Opioid Use and Illicit Drug Use Among U.S. Adults
Authors: Gu Ja K. , Allison Penelope , Grimes Trotter Alexis , Charles Luenda E. , Ma Claudia C. , Groenewold Matthew , Andrew Michael E. , Luckhaupt Sara E.
Published: July 2021

Objective:

To estimate the self-reported prevalence of prescription opioid use and illicit drug use in the United States.

Methods:

Self-reported prescription opioid use and illicit drug use (mostly nonopioid) were obtained for adults and adult workers (NHANES 2005–2016).

Results:

Prevalence (95% CI) of prescription opioid use was 6.5% (6.0–7.0) (adults) and 4.1% (3.7–4.5) (workers). Prevalence of illicit drug use was 9.5% (8.8–10.1) (adults) and 10.2% (9.4–11.1) (workers). Among occupations, prevalence of prescription opioid use was highest in personal care (6.5%; 4.1–10.4) and healthcare practitioners (5.9%; 3.8–9.0); for illicit drug use, construction/extraction (18.0%; 15.1–21.3) and food preparation (15.8%; 12.5–19.7).

Conclusion:

The prevalence of prescription opioid use was elevated among some occupations. Judicious prescription strategies and targeted interventions are both needed. The prevalence of illicit drug use among certain occupational groups suggests the need to ensure access to therapy.
Risk Factors for Complications Following Lateral Skull Base Surgery and the Utility of ICU Monitoring
Authors: Sioshansi Pedrom C. , Conway Robert M. , Anderson Brian , Minutello Katrina , Bojrab Dennis I. , Hong Robert S. , Sargent Eric W. , Schutt Christopher A. , Zappia John J. , Babu Seilesh C.
Published: July 2021

Objective:

To examine the role of intensive care unit (ICU) management following lateral skull base surgery for vestibular schwannoma and identify risk factors for complications warranting admission to the ICU.

Study Design:

Retrospective review.

Setting:

Tertiary referral center.

Patients:

Two hundred consecutive patients undergoing lateral skull base surgery for vestibular schwannomas.

Intervention:

Lateral skull base approach for resection of vestibular schwannoma and postoperative monitoring.

Main Outcome Measures:

Patients were grouped if they sustained an ICU complication, a non-ICU complication, or no complication. Analysis was performed to determine patient or treatment factors that may be associated with ICU complications. Multivariate and three-way analysis of variance compared groups, and multivariate logistic regression determined adjusted odds ratios (aOR) for analyzed factors.

Results:

Seventeen of 200 patients sustained ICU complications (8.5%), most commonly hypertensive urgency (n = 15). Forty-six (23%) sustained non-ICU complications, and 137 (68.5%) had no complications. When controlling for age, sex, obesity, and other comorbidities, only hypertension (aOR 5.43, 95% confidence interval (CI) 1.35–21.73, p = 0.017) and tumor volume (aOR 3.29, 95% CI 1.09–9.96, p = 0.035) were independently associated with increased risk of ICU complications.

Conclusions:

The necessity of intensive care following lateral skull base surgery is rare, with the primary ICU complication being hypertensive urgency. Preoperative hypertension and large tumor volume (>4500 mm3) were independently associated with increased risk for ICU complications. These findings may allow for risk stratification of patients appropriate for admission to stepdown units following resection of vestibular schwannomas. Further prospective, multi-center, randomized studies are necessary to validate these findings before systematic changes to current postoperative care practices.
Trends and Healthcare Use Following Different Cholesteatoma Surgery Types in a National Cohort, 2003–2019
Authors: Qian Zhen Jason , Tran Emma D. , Alyono Jennifer C. , Cheng Alan G. , Ahmad Iram N. , Chang Kay W.
Published: July 2021

Objective:

To describe national trends in cholesteatoma management.

Study Design and Setting:

Retrospective analysis Optum Clinformatics® Database from 2003 to 2019.

Patients:

16,179 unique adult and pediatric patients who received cholesteatoma surgery.

Interventions and Main Outcome Measures:

Patients were categorized into three groups by initial surgical modality: canal wall down (CWD), canal wall up (CWU), and tympanoplasty without mastoidectomy (TnoM). Three major comparisons between groups were performed: 1) temporal trends, 2) clinical and sociodemographic determinants, and 3) healthcare use in terms of total costs and incidence of postoperative imaging and subsequent surgery.

Results:

Overall, 23.2% received initial CWD surgery, 44.3% CWU, and 32.5% TnoM. 1) The incidence of initial CWD surgery decreased (odds ratios [OR] = 0.98, 95% confidence intervals [CI] [0.97,0.99]), while CWU increased (OR = 1.02, 95% CI [1.01,1.03]), and TnoM remained stable over the study period (OR = 0.99, 95% CI [0.98,1.00]). 2) Relative to CWU, TnoM surgery was less likely in adults, patients with prior complications, and non-White patients, while being more likely in patients with higher household income. CWD was more likely than CWU in adults, patients with prior complications, and non-White patients, while income had no effect. 3) Postoperative costs for CWU and CWD were similar. In 2 years following initial surgery, postoperative imaging and/or subsequent surgery was performed in 45.48% of CWD, 57.42% of CWU, and 41.62% of TnoM patients.

Conclusions:

Incidence of initial CWD surgery decreased and social disparities in cholesteatoma management were observed. Postoperative imaging or second-look surgery were performed in less than 60% of patients with initial CWU surgery and over 40% of patients with initial CWD.
Ectopic parathyroid adenoma with acute pancreatitis in a pediatric patient
Authors: Alghanmi Yasser Yahia , Sindi Haifa Hasan , Bader Doaa Emad , Alraddadi Sarah Mohammed
Published: July 2021

Introduction:

Hypercalcemia due to primary hyperparathyroidism (PHPT) is uncommon in children with an incidence of 2 to 5 in 100,000 children and adolescents. Primary hyperparathyroidism in children has a bimodal distribution that reflects different etiologies in very young and older children. PHPT is typically caused by a single parathyroid adenoma. Ectopic parathyroid adenomas account for 20% to 22% of primary hyperparathyroidism cases and are rare in children but should be considered in cases that present with hypercalcemia.

Patient concerns:

We report the case of a 13-year-old girl with PHPT who presented with an unusual presentation of acute pancreatitis and persistent hypercalcemia.

Diagnosis:

Tc-99m-sestamibi scanning and chest computed tomography scan with contrast showed an anterior mediastinal lesion at the midline embedded into the thymus and was diagnosed as an ectopic anterior mediastinal parathyroid adenoma.

Interventions:

The genetic test results of whole-exome sequencing were negative. After thoracoscopic and thymus excision, the patient's serum calcium level immediately normalized.

Outcomes:

Intact parathyroid hormone, serum calcium, and alkaline phosphatase levels returned to normal within two months.

Conclusion:

PHPT may present with acute pancreatitis, generalized fatigue, and muscle pain as presented in this patient and need a high index of suspicion for early diagnosis. Delayed diagnosis of PHPT can cause end-organ damage; timely diagnosis is especially critical to preserving bone and renal function.
Effectiveness and safety of herbal medicine on children with simple obesity
Authors: Shim Soo Bo , Lee Hyun Hee , Ahn Hye Li , Lee Ju Ah , Lee Hye Lim
Published: July 2021

Introduction:

Simple obesity is a type of obesity that does not involve other diseases or medical factors. Obesity is a serious public health problem in children and has become more serious because of the social distancing caused by the coronavirus disease 2019. This study aims to evaluate the effectiveness and safety of herbal medicine for the treatment of simple childhood obesity.

Methods and analysis:

We will search 11 international databases, namely Medline, the Cochrane Central Register of Controlled Trials, the Allied and Complementary Medicine Database, the Cumulative Index of Nursing and Allied Health Literature, Embase, the Oriental Medicine Advanced Searching Integrated System, the Research Information Service System, DataBase Periodical Information Academic, Wanfang, China National Knowledge Infrastructure, and the Chongqing VIP Chinese Science and Technology Journals Database. We will include randomised controlled trials on the application of herbal medicine on children with simple obesity. We will assess the quality of included studies using the Cochrane Handbook criteria version 5.2.0. We will synthesise and analyse the collected data using RevMan 5.3 software.

Ethics and dissemination:

Ethical approval is not required because there are no privacy concerns. The findings of this systematic review will be disseminated in a peer-reviewed journal.

OSF registration number:

DOI 10.17605/OSF.IO/KCNPX.
Renal function in patients following a low carbohydrate diet for type 2 diabetes: a review of the literature and analysis of routine clinical data from a primary care service over 7 years
Authors: Unwin David , Unwin Jen , Crocombe Dominic , Delon Christine , Guess Nicola , Wong Christopher
Published: July 2021

Purpose of review

People with T2 Diabetes (T2D) who follow a low carbohydrate diet (LCD) may increase their dietary protein intake. Dietary protein can modulate renal function so there is debate about its role in renal disease. There is concern that higher protein intakes may promote renal damage, and that LCDs themselves may impact on cardiovascular risk. We review the evidence around LCDs, renal and cardiovascular risk factors and compare to results obtained in a real-world, primary care setting.

Recent findings

Chronic kidney disease (CKD) is a well-recognised microvascular complication of T2D caused in part by; chronically increased glomerular pressure, hyperfiltration, increased blood pressure and advanced glycation end products. Hyperglycemia can be seen as central to all of these factors. A LCD is an effective first step in its correction as we demonstrate in our real-world cohort.

We found evidence that LCDs for people with T2D may improve many renal and cardiovascular risk factors. In our own LCD cohort of 143 patients with normal renal function or only mild CKD, over an average of 30 months the serum creatinine improved by a significant mean of 4.7 (14.9) μmol/L. What remains to be shown is the effect of the approach on people with T2D and moderate/severe CKD.
The Relationship Between Unemployment and Health Insurance Coverage
Authors: Benitez Joseph , Williams Timothy , Goldstein Evan , Seiber Eric E.
Published: July 2021

Objective:

The objective of this study was to determine whether the Affordable Care Act’s (ACA) major coverage expansions mitigated the impact of unemployment on health insurance coverage status.

Data Source:

A 2011−2019 versions of the American Community Survey developed by the University of Minnesota Integrated Public Use Microdata Series program.

Research Design:

We use difference-in-difference-in-differences (ie, triple difference) regressions to compare changes in the short-run impacts of local unemployment rates before and after the ACA.

Principal Findings:

Before the ACA, rises in local unemployment were associated with uninsurance due to losses in private coverage (ie, both nongroup and employer sponsored).

Following the ACA’s full implementation, the link between employment and coverage was attenuated by access to publicly subsidized qualified health plans on the ACA’s nongroup market, and enhanced access to Medicaid in states that expanded. Our findings suggest protections from unemployment-linked uninsured spells are largest in states that expanded Medicaid.

Conclusions:

Expanded access to coverage under the ACA could mitigate the adverse effects on insurance status and access to care historically linked to job loss. However, should the ACA be repealed, many households stand to lose their ability to turn to Medicaid or subsidized nongroup coverage as safety-net resources to offset the burdens of job loss.
LDL receptor-related protein 1 and its interacting partners in tissue homeostasis
Authors: Jaeschke Anja , Hui David Y.
Published: July 2021

Purpose of review

LDL receptor-related protein 1 (LRP1) is a multifunctional protein with endocytic and signal transduction properties due to its interaction with numerous extracellular ligands and intracellular proteins. This brief review highlights key developments in identifying novel functions of LRP1 in liver, lung, and the central nervous system in disease pathogenesis.

Recent findings

In hepatocytes, LRP1 complexes with phosphatidylinositol 4-phosphate 5-kinase-1 and its related protein to maintain intracellular levels of phosphatidylinositol (4,5) bisphosphate and preserve lysosome and mitochondria integrity. In contrast, in smooth muscle cells, macrophages, and endothelial cells, LRP1 interacts with various different extracellular ligands and intracellular proteins in a tissue-dependent and microenvironment-dependent manner to either enhance or suppress inflammation, disease progression or resolution. Similarly, LRP1 expression in astrocytes and oligodendrocyte progenitor cells regulates cell differentiation and maturation in a developmental-dependent manner to modulate neurogenesis, gliogenesis, and white matter repair after injury.

LRP1 modulates metabolic disease manifestation, inflammation, and differentiation in a cell-dependent, time-dependent, and tissue-dependent manner. Whether LRP1 expression is protective or pathogenic is dependent on its interaction with specific ligands and intracellular proteins, which in turn is dependent on the cell type and the microenvironment where these cells reside.
Bloodstream Infections in Children With Cancer: Pathogen Distribution and Antimicrobial Susceptibility Patterns Over a 10-Year Period
Authors: Maarbjerg Sabine F. , Kiefer Lotte V. , Albertsen Birgitte K. , Schrøder Henrik , Wang Mikala
Published: July 2021

Bloodstream infections (BSIs) adversely affect clinical outcome in children with cancer. Over 1 decade, this retrospective cohort study describes pathogen distribution in BSIs and antimicrobial susceptibility against empirical antibiotics frequently prescribed in children with cancer. The antibiotic efficacy was evaluated through the determination of minimal inhibitory concentrations for piperacillin-tazobactam and meropenem and by disk diffusion for remaining antibiotics. From 2004 to 2013, 398 BSIs occurred in 196 children with cancer (median age: 5.4 y), resulting in 457 bacteria. Overall, 266 (58.2%) were Gram-positive, and 191 (41.8%) were Gram-negative with a significant Gram-positive increase over time (P=0.032). Coagulase-negative staphylococci (74, 16.2%), viridans group streptococci (67, 14.7%), Escherichia coli (52, 11.4%), and Staphylococcus aureus (39, 8.5%) were the most common pathogens. Susceptibility to piperacillin-tazobactam (95.9%, P=0.419) and meropenem (98.9%, P=0.752) was stable over time, and resistance was observed among viridans group streptococci against piperacillin-tazobactam (18%) and meropenem (7%) and among Enterobacterales against piperacillin-tazobactam (3%). Vancomycin showed 98% Gram-positive activity, gentamicin 82% Gram-negative activity and ampicillin, cefotaxime, and cefuroxime were active in 50%, 72%, and 69% of pathogens, respectively, and BSI-related mortality was 0%. In conclusion, over 1 decade, we report an increase in Gram-positive BSIs, and stable, low-resistance rates against currently recommended empirical antibiotics, piperacillin-tazobactam and meropenem.
Psyllium
Authors: McRorie Johnson W. , Gibb Roger D. , Sloan Kyle J. , McKeown Nicola M.
Published: July 2021

Psyllium is a natural, predominantly soluble isolated fiber that forms a gel when hydrated. The psyllium gel is not fermented and transits the entire gastrointestinal tract intact. In the small intestine, the psyllium gel increases chyme viscosity, which slows the degradation and absorption of nutrients, which significantly improves fasting blood glucose and hemoglobin A1c levels in individuals with metabolic syndrome and type 2 diabetes mellitus (eg, −37 mg/dL). This delay in nutrient absorption prolongs satiety/delays hunger, leading to decreased energy intake and weight loss in overweight and obese patients. In the distal small intestine (terminal ileum), psyllium becomes more concentrated as water is absorbed, and the highly viscous gel interferes with the active reuptake of bile acids, which are captured in the gel and eliminated via stool. This decrease in the bile acid pool stimulates the liver to produce more bile. As cholesterol is a component of bile, the liver expresses low-density lipoprotein (LDL) cholesterol receptors to harvest LDL-cholesterol from the blood, thereby lowering both LDL-cholesterol (up to 24%) and total cholesterol (up to 20%) levels without affecting high-density lipoprotein cholesterol level. The cholesterol-lowering benefit of psyllium is also additive to the effects of statin drugs, with an effect equivalent to doubling the statin dose. In the large intestine, the nonfermented psyllium gel has a paradoxical “stool normalizing” effect: psyllium softens hard stool in constipation, firms loose/liquid stool in diarrhea, and normalizes stool form/reduces symptoms in irritable bowel syndrome. Psyllium is the only fiber recommended for treatment of constipation and irritable bowel syndrome by the American College of Gastroenterology. Taken together, psyllium is the only fiber supplement that provides 5 of the major health benefits identified by the Food and Drug Administration (cholesterol lowering, improved glycemic control, decreased energy intake/weight loss, decreased blood pressure secondary to weight loss, and laxation/regularity). Psyllium has also been shown clinically to be effective in disease states (eg, hypercholesterolemia, type 2 diabetes, obesity, chronic constipation, chronic diarrhea, hemorrhoids, ulcerative colitis, enteral nutrition–induced diarrhea, fecal incontinence, and irritable bowel syndrome). Taken together, the clinical data support the conclusion that “Fiber needs to gel to keep your patients well.”
Effectiveness of Syphilis Partner Notification After Adjusting for Treatment Dates, 7 Jurisdictions
Authors: Cope Anna Barry , Bernstein Kyle T. , Matthias James , Rahman Mohammad , Diesel Jill C. , Pugsley River A. , Schillinger Julia A. , Chew Ng Rilene A. , Klingler Ellen J. , Mobley Victoria L. , Samoff Erika , Peterman Thomas A.
Published: July 2021

Background

Disease intervention specialists (DIS) prevent syphilis by ensuring treatment for patients' sex partners through partner notification (PN). Different interpretations of how to measure partners treated due to DIS efforts complicates PN evaluation. We measured PN impact by counting partners treated for syphilis after DIS interviewed the patient.

Methods

We reviewed data from early syphilis cases reported during the 2015–2017 period in 7 jurisdictions. We compared infected partners brought to treatment using the following: (1) DIS-assigned disposition codes or (2) all infected partners treated 0 to 90 days after the patient's interview (adjusted treatment estimate). Stratified analyses assessed patient characteristics associated with the adjusted treatment estimate.

Results

Disease intervention specialists interviewed 23,613 patients who reported 20,890 partners with locating information. Many of the 3569 (17.1%) partners classified by DIS as brought to treatment were treated before the patient was interviewed. There were 2359 (11.3%) partners treated 0 to 90 days after the patient's interview. Treatment estimates were more consistent between programs when measured using our adjusted estimates (range, 6.1%–14.8% per patient interviewed) compared with DIS-assigned disposition (range, 6.1%–28.3%). Treatment for ≥1 partner occurred after 9.0% of interviews and was more likely if the patient was a woman (17.9%), younger than 25 years (12.6%), interviewed ≤7 days from diagnosis (13.9%), HIV negative (12.6%), or had no reported history of syphilis (9.8%).

Conclusions

Counting infected partners treated 0 to 90 days after interview reduced variability in reporting and facilitates quality assurance. Identifying programs and DIS who are particularly good at finding and treating partners could improve program impact.
Check It: A Community-Based Chlamydia Seek, Test, and Treat Program for Young Black Men Who Have Sex With Women in New Orleans, Louisiana
Authors: Schmidt Norine , Gomes Gérard , Scott Glenis , Wise Breon , Craig-Kuhn Megan Clare , Lederer Alyssa M. , Martin David H. , Kissinger Patricia J.
Published: July 2021

Background

Check It is a novel, bundled, community-based seek, test, and treat Chlamydia trachomatis (Ct) screening program for 15- to 24-year-old Black men in New Orleans who have sex with women. The program design addressed barriers and facilitators to Ct screening/treatment by enlisting trusted community partners, incorporating participant input, providing free index/partner expedited treatment, developing relatable marketing materials and an educational Web site, encouraging peer referral, and providing a modest monetary incentive.

Methods

Areas of high poverty were identified using census data; ethnographic/key informant interviews identified sites in those areas where the target population congregated. Black youth informed Web site design and social marketing. Content was inspirational/educational/amusing and endorsed recruitment and brand awareness. A community advisory board, participant interviews, community partner feedback, and recruitment staff involvement in the process evaluation helped refine the program in an ongoing manner.

Results

During formative stages, 41 key informant/community advisory board members informed program refinement. Community partners provided venue locations (n = 65) and participant referrals. Between May 22, 2017, and February 28, 2020, 1890 men were enrolled (acceptance rate, 96.0%) with Ct infection rate of 10.2%. Overall study treatment was provided to 86.1% (71.4%–90.9%) of participants who tested positive and 28.5% (14.5%–41.5%) of their partners. Findings from in-depth interviews with participants (n = 43) led to increased treatment uptake.

Conclusions

C. trachomatis community screening of young Black men was successful through collaboration with trusted community partners, by tailoring implements/marketing with participant input, reducing barriers to treatment, and providing modest monetary incentives. The Check It program can serve as a roadmap for reducing health disparities in this population.
SARS-CoV-2 and Placental Pathology
Authors: Glynn Shannon M. , Yang Yawei J. , Thomas Charlene , Friedlander Rachel L. , Cagino Kristen A. , Matthews Kathy C. , Riley Laura E. , Baergen Rebecca N. , Prabhu Malavika
Published: July 2021

The extent to which severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at different points in the pregnancy timeline may affect maternal and fetal outcomes remains unknown. We sought to characterize the impact of SARS-CoV-2 infection proximate and remote from delivery on placental pathology. We performed a secondary analysis of placental pathology from a prospective cohort of universally tested SARS-CoV-2 positive women >20 weeks gestation at 1 institution. Subjects were categorized as having acute or nonacute SARS-CoV-2 based on infection <14 or ≥14 days from delivery admission, respectively, determined by nasopharyngeal swab, symptom history, and serologies, when available. A subset of SARS-CoV-2 negative women represented negative controls. Placental pathology was available for 90/97 (92.8%) of SARS-CoV-2 positive women, of which 26 were from women with acute SARS-CoV-2 infection and 64 were from women with nonacute SARS-CoV-2. Fetal vascular malperfusion lesions were significantly more frequent among the acute SARS-CoV-2 group compared with the nonacute SARS-CoV-2 group (53.8% vs. 18.8%; P=0.002), while frequency of maternal vascular malperfusion lesions did not differ by timing of infection (30.8% vs. 29.7%; P>0.99). When including 188 SARS-CoV-2 negative placentas, significant differences in frequency of fetal vascular malperfusion lesions remained between acute, nonacute and control cases (53.8% vs. 18.8% vs. 13.2%, respectively; P<0.001). No differences were noted in obstetric or neonatal outcomes between acutely and nonacutely infected women. Our findings indicate timing of infection in relation to delivery may alter placental pathology, with potential clinical implications for risk of thromboembolic events and impact on fetal health.
Coronavirus Disease 2019 as a Possible Cause of Severe Orbital Cellulitis
Authors: Carvalho Vinicius Almeida , Vergínio Vinícius Eduardo de Oliveira , Brito Gabriel Conceição , Pereira-Stabile Cecilia Luiz , Stabile Glaykon Alex Vitti
Published: July 2021

Infection by severe respiratory syndrome coronavirus 2 (coronavirus disease 2019) has been the most important public health event of the last 100 years. The number of cases and deaths caused by this disease, its potential to rapidly spread and the search for a vaccine have been the center of discussion all over the world for over 1 year. In addition to the number of cases and all social, economic, and public health consequences of the pandemic, the variety of symptoms and clinical signs presented by infected patients has been subject of several studies and case reports. At the time of this writing, even with promising research, the clinical outcome of some patients is still unpredictable. The purpose of this article is to report an unusual case, the diagnostic process, and early treatment of this severe and atypical clinical picture. The patient is a young man diagnosed with coronavirus disease 2019 who sought our hospital in Southern Brazil reporting a history of pansinusitis progressing to a severe orbital cellulitis, requiring immediate surgical intervention.
The Use of the Free Iliac Bone Flap by Shaping Like Puzzle for a Wide Alveolar Defect in a Bilateral Cleft Lip and Palate with Rudimentary Premaxilla
Authors: Altuntaş Selman Hakkı , Aydın Mustafa Asım
Published: July 2021

Secondary alveolar bone grafting may not be feasible in a considerable number of patients who have cleft lip and palate, mainly because of the requirement for sizeable bony restitution and the insufficient amount of soft tissue for reliable coverage. Bone transport distraction and free vascularized bone transfers are the salvage techniques for treating these deformities and accomplishing successful bone grafting. This report presents a case of bilateral cleft lip and palate with a large palatoalveolar fistula and a rudimentary premaxilla after prior failed attempts at bone grafting. The authors used the free vascularized iliac bone flap with the osteotomies like puzzle for definitive restoration of the deformity.
Esophagectomy Complications Impact Long-term Survival
Authors: Sachidananda Sandeep , Timsina Lava , Namburi Niharika , Birdas Thomas J.
Published: July 2021

Objective:

To determine the effect of prolonged length of stay (LOS) after esophagectomy on long term survival.

Background:

Complications after esophagectomy have a significant impact in short-term survival. The specific effect of prolonged LOS after esophagectomy is unclear. We hypothesized that postoperative complications that occur after esophagectomy, resulting in prolonged LOS, have a detrimental effect on long term survival.

Methods:

All patients undergoing esophagectomy between 2004 and 2014 were identified in the National Cancer Database. To eliminate the confounding effect of short-term mortality, we included only patients who survived at least 90 days postoperatively. Demographics, disease characteristics, and perioperative outcomes were analyzed. Postoperative LOS was used as a surrogate for postoperative complications. The highest quintile of LOS was defined as excessive LOS (ELOS). Kaplan-Meier and Cox proportional hazards survival analyses were performed to examine survival.

Results:

A total of 20,719 patients were identified. Of those 3826 had ELOS, with median LOS 26days (range 18-168days). Their median survival was 30.6 months compared to 53.6 months in the entire non-ELOS group (P < 0.0001). After multivariate analysis ELOS (odds ratio 1.56, 95% confidence interval 1.46–1.67) was an independent predictor of overall mortality. Higher disease stage, higher age, male sex, higher Charlson/Deyo comorbidity score, and readmission after discharge were also significant negative predictors of long-term survival, whereas surgery in an academic institution, being at the highest income quartile and having private or Medicare insurance predicted longer survival (all P < 0.001).

Conclusions and Relevance:

Postoperative complications after esophagectomy, resulting in ELOS, predict lower long-term survival independent of other factors. Counseling patients about surgery should include the detrimental long-term effects of postoperative complications and ELOS. Avoiding ELOS (LOS exceeding 18 days) could be considered a quality metric after esophagectomy.
Improving Outcome of Superior Mediastinal Lymph Node Dissection During Esophagectomy
Authors: Wong Ian Y. H. , Zhang Rui Qi , Tsang Raymond K. Y. , Kwok Jeanette Y. Y. , Wong Claudia L. Y. , Chan Desmond K. K. , Chan Fion S. Y. , Law Simon Y. K.
Published: July 2021

Objective:

This study aimed at demonstrating the effects and learning curve of utilizing combined intermittent and continuous recurrent laryngeal nerve (RLN) monitoring for lymphadenectomy during esophagectomy.

Background:

RLN lymphadenectomy is oncologically important but is technically demanding. Vocal cord (VC) palsy as a result from RLN injury, carries significant morbidities.

Methods:

This is a retrospective study of consecutive esophageal squamous cell carcinoma (ESCC) patients who underwent transthoracic esophagectomy from 2010 to 2020. Combined nerve monitoring (CNM) included: CNM which involved a periodic stimulating left vagal electrode and intermittent nerve monitoring which utilized a stimulating probe to identify the RLNs. The integrity of the RLNs was assessed both intermittently and continuously. This technique was introduced in 2014. Patients were divided into “before CNM” and “CNM” groups. The primary outcome was the difference in number of RLN lymph nodes harvested and VC palsy rate. Learning curves were demonstrated by cumulative sum (CUSUM) analysis.

Results:

Two hundred and fifty-five patients were included with 157 patients in “CNM” group. The mean number of RLN lymph nodes harvested was significantly higher (4.31 vs 0.45, P < 0.0001) for the “CNM” group. VC palsy rates were significantly lower (17.8% vs 32.7%, P = 0.007). There was an initial increase in VC palsy rate, peaked at around 46 cases. The increase in lymph nodes harvested above the mean plateaued at around 96 cases.

Conclusions:

CNM helped improve bilateral RLN lymphadenectomy. Lymph node harvesting was increased with reduction of VC palsy after a learning curve.
Chitinilyticum piscinae sp. nov., isolated from aquaculture water
Authors: Pei Tao , Du Juan , Liu Yang , Deng Ming-Rong , Zhu Honghui
Published: July 2021

A novel Gram-stain-negative and rod-shaped bacterial strain, designated as 4Y14T, was isolated from aquaculture water and characterized by using a polyphasic taxonomic approach. Strain 4Y14T was found to grow at 10–40 °C (optimum, 28 °C), at pH 7.0–9.0 (optimum, 7.0–8.0) and with 0–2 % NaCl (optimum, 1 %, w/v). Phylogenetic analysis based on 16S rRNA gene sequences showed that strain 4Y14T belonged to the genus

Chitinilyticum

with high levels of similarity to

Chitinilyticum litopenaei

c1T (97.8 %) and

Chitinilyticum aquatile

c14T (97.2 %). Phylogenomic analysis indicated that strain 4Y14T formed an independent branch distinct from the two type strains above. Digital DNA–DNA hybridization (dDDH) and average nucleotide identity (ANI) values between strain 4Y14T and the two type strains were, respectively, 25.3 and 25.0 %, and 81.2 and 80.3 %, which were well below the thresholds of 70 % DDH and 95–96 % ANI for species definition, implying that strain 4Y14T should represent a novel genospecies. The predominant cellular fatty acids of strain 4Y14T were summed feature 3 (C16 : 1
ω7c and/or C16 : 1
ω6c) and iso-C16 : 0; the major polar lipids were diphosphatidylglycerol, phosphatidylcholine and phosphatidylethanolamine; and the sole respiratory quinone was Q-8. The genomic DNA G+C content was 60.1 mol%. Based on the phenotypic and genotypic analyses, strain 4Y14T is concluded to represent a novel species of the genus

Chitinilyticum

, for which the name Chitinilyticum piscinae sp. nov. is proposed. The type strain of the species is 4Y14T (=GDMCC 1.1934T=KACC 22080T).
Segmenting biological specimens from photos to understand the evolution of UV plumage in passerine birds
Authors: He Yichen , Cooney Christopher R. , Varley Zoë K. , Nouri Lara O. , Moody Christopher J. A. , Jardine Michael D. , Maddock Steve , Thomas Gavin H.
Published: July 2021

Ultraviolet (UV) colouration is thought to be an important signalling mechanism in many bird species, yet broad insights regarding the prevalence of UV plumage colouration and the factors promoting its evolution are currently lacking. Here, we develop a novel image segmentation pipeline based on deep learning that considerably outperforms classical (i.e. non-deep learning) segmentation methods, and use this to extract accurate information on whole-body plumage colouration from photographs of >24,000 museum specimens covering >4,500 species of passerine birds. Our results demonstrate that UV reflectance, particularly as a component of other colours, is widespread across the passerine radiation but is strongly phylogenetically conserved. We also find clear evidence in support of the role of light environment in promoting the evolution of UV plumage colouration, and a weak trend towards higher UV plumage reflectance among bird species with ultraviolet rather than violet-sensitive visual systems. Overall, our study provides important broad-scale insight into an enigmatic component of avian colouration, as well as demonstrating that deep learning has considerable promise for allowing new data to be bought to bear on long-standing questions in ecology and evolution.