bluuebunny/crossref_metadata_2025 huggingface dataset:
BAT99-9 – a WC4 Wolf−Rayet star with nitrogen emission: evidence for binary evolution?
Authors: Hillier D John , Aadland Erin , Massey Philip , Morrell Nidia
Published: March 2021

An analysis of the Large Magellanic Cloud (LMC) WC4 star BAT99-9 (HD 32125, FD 4, Brey 7, WS 3) shows that the star still contains photospheric nitrogen. Three N emission features (N v λλ1238, 1242, N iv λ1719, and N iv λλ3479–3485) are unambiguously identified in the spectrum. cmfgen models of the star yield an N/C ratio of 0.004 ± 0.002 (by number) and a C/He ratio of $0.15_{-0.05}^{+0.10}$. Due to the similarity of BAT99-9 to other WC4 stars, and the good fit achieved by cmfgen to both the classic WC4 spectrum and the N lines, we argue that the N lines are intrinsic to BAT99-9. An examination of a limited set of rotating models for single-star evolution at LMC and Galactic metallicities shows that a model with a Galactic metallicity (z = 0.014) and a progenitor mass of around 50 M⊙ can have an N/C ratio similar to, or larger than, what we observe for a significant fraction of its lifetime. However, the LMC models (z = 0.006) are inconsistent with the observations. Both the single and binary BPASS models predict that many WC stars can have an N/C ratio similar to, or larger than, what we observe for a significant fraction of their lifetime. While the binary models cover a wider range of luminosities and provide a somewhat better match to BAT99-9, it is not currently possible to rule out BAT99-9 being formed through single-star evolution, given the uncertainties in mass-loss rates, and the treatment of convection and mixing processes.
A ring accelerator? Unusual jet dynamics in the IceCube candidate PKS 1502+106
Authors: Britzen S , Zajaček M , Popović L Č , Fendt C , Tramacere A , Pashchenko I N , Jaron F , Pánis R , Petrov L , Aller M F , Aller H D
Published: March 2021

On 2019/07/30.86853 ut, IceCube detected a high-energy astrophysical neutrino candidate. The Flat Spectrum Radio Quasar PKS 1502+106 is located within the 50 per cent uncertainty region of the event. Our analysis of 15 GHz Very Long Baseline Array (VLBA) and astrometric 8 GHz VLBA data, in a time span prior and after the IceCube event, reveals evidence for a radio ring structure that develops with time. Several arc-structures evolve perpendicular to the jet ridge line. We find evidence for precession of a curved jet based on kinematic modelling and a periodicity analysis. An outflowing broad line region (BLR) based on the C iv line emission (Sloan Digital Sky Survey) is found. We attribute the atypical ring to an interaction of the precessing jet with the outflowing material. We discuss our findings in the context of a spine-sheath scenario where the ring reveals the sheath and its interaction with the surroundings (narrow line region, NLR, clouds). We find that the radio emission is correlated with the γ-ray emission, with radio lagging the γ-rays. Based on the γ-ray variability time-scale, we constrain the γ-ray emission zone to the BLR (30–200 rg) and within the jet launching region. We discuss that the outflowing BLR provides the external radiation field for γ-ray production via external Compton scattering. The neutrino is most likely produced by proton–proton interaction in the blazar zone (beyond the BLR), enabled by episodic encounters of the jet with dense clouds, i.e. some molecular cloud in the NLR.
Unveiling the distinct formation pathways of the inner and outer discs of the Milky Way with Bayesian Machine Learning
Authors: Ciucă Ioana , Kawata Daisuke , Miglio Andrea , Davies Guy R , Grand Robert J J
Published: March 2021

We develop a Bayesian Machine Learning framework called BINGO (Bayesian INference for Galactic archaeOlogy) centred around a Bayesian neural network. After being trained on the Apache Point Observatory Galactic Evolution Experiment (APOGEE) and Kepler asteroseismic age data, BINGO is used to obtain precise relative stellar age estimates with uncertainties for the APOGEE stars. We carefully construct a training set to minimize bias and apply BINGO to a stellar population that is similar to our training set. We then select the 17 305 stars with ages from BINGO and reliable kinematic properties obtained from Gaia DR2. By combining the age and chemo-kinematical information, we dissect the Galactic disc stars into three components, namely the thick disc (old, high-[α/Fe], [α/Fe] ≳ 0.12), the thin disc (young, low-[α/Fe]), and the Bridge, which is a region between the thick and thin discs. Our results indicate that the thick disc formed at an early epoch only in the inner region, and the inner disc smoothly transforms to the thin disc. We found that the outer disc follows a different chemical evolution pathway from the inner disc. The outer metal-poor stars only start forming after the compact thick disc phase has completed and the star-forming gas disc extended outwardly with metal-poor gas accretion. We found that in the Bridge region the range of [Fe/H] becomes wider with decreasing age, which suggests that the Bridge region corresponds to the transition phase from the smaller chemically well-mixed thick to a larger thin disc with a metallicity gradient.
Time-scales to reach chemical equilibrium in ices at snowline distance around compact objects: the influence of accretion mass in the central object
Authors: Carvalho G A , Pilling S
Published: March 2021

In this work, we analyse soft X-ray emission due to mass accretion on to compact stars and its effects on the time-scale to reach chemical equilibrium of eventual surrounding astrophysical ices exposed to that radiation. Reaction time-scales due to soft X-ray in water-rich and pure ices of methanol, acetone, acetonitrile, formic acid, and acetic acid were determined. For accretion rates in the range $\dot{m}=10^{-12}\!-\!10^{-8}\,{\rm M}_\odot$ yr−1 and distances in the range 1–3 LY from the central compact objects, the time-scales lie in the range 10–108 yr, with shorter time-scales corresponding to higher accretion rates. Obtained time-scales for ices at snow-line distances can be small when compared to the lifetime (or age) of the compact stars, showing that chemical equilibrium could have been achieved. Time-scales for ices to reach chemical equilibrium depend on X-ray flux and, hence, on accretion rate, which indicates that systems with low accretion rates may not have reached chemical equilibrium.
Peeling off foregrounds with the constrained moment ILC method to unveil primordial CMB B modes
Authors: Remazeilles Mathieu , Rotti Aditya , Chluba Jens
Published: March 2021

Galactic foregrounds are the main obstacle to observations of the cosmic microwave background (CMB) B-mode polarization. In addition to obscuring the inflationary B-mode signal by several orders of magnitude, Galactic foregrounds have non-trivial spectral signatures that are partially unknown and distorted by averaging effects along the line of sight, within the pixel/beam window, and by various analysis choices (e.g. spherical harmonic transforms and filters). Statistical moment expansion methods provide a powerful tool for modelling the effective Galactic foreground emission resulting from these averaging effects in CMB observations, while blind component separation treatments can handle unknown foregrounds. In this work, we combine these two approaches to develop a new semiblind component separation method at the intersection of parametric and blind methods, called constrained moment ILC (cMILC). This method adds several constraints to the standard ILC method to deproject the main statistical moments of the Galactic foreground emission. Applications to maps are performed in needlet space and when compared to the NILC method, this helps in significantly reducing residual foreground contamination (bias, variance, and skewness) in the reconstructed CMB B-mode map, power spectrum, and tensor-to-scalar ratio. We consider sky simulations for experimental settings similar to those of LiteBIRD and PICO, illustrating which trade-offs between residual foreground biases and degradation of the constraint on r can be expected within the new cMILC framework. We also outline several directions that require more work in preparation for the coming analysis challenges.
What influences patients’ opinion of remission and low disease activity in psoriatic arthritis? Principal component analysis of an international study
Authors: Coates Laura C , Robinson Danielle E , Orbai Ana-Maria , Kiltz Uta , Leung Ying-Ying , Palominos Penelope , Cañete Juan D , Scrivo Rossana , Balanescu Andra , Dernis Emmanuelle , Meisalu Sandra , Ruyssen-Witrand Adeline , Eder Lihi , de Wit Maarten , Smolen Josef S , Lubrano Ennio , Gossec Laure
Published: March 2021

Objective

In PsA, the treatment objective is remission or low disease activity (LDA), but patients’ perception of remission is poorly studied. This analysis aimed to identify factors associated with patient-defined remission.

Methods

This analysis uses ReFlaP data, an international PsA study, with remission defined as ‘At this time, is your psoriatic arthritis in remission, if this means: you feel your disease is as good as gone?’. Variables associated with, first, patient-defined remission and, second, LDA were identified using multivariable logistic regression and principal component analysis (PCA) to explore correlated variables.

Results

Of 424 patients (50.2% male, mean age 52 years) with established disease, 94 (22.2%) reported themselves as being in remission and 191 (45.0%) as LDA alone. In multivariable analysis pain, psoriasis, impact of disease, physician opinion of symptoms from joint damage and Groll comorbidity index were independent predictors of remission. For LDA, results were similar. Using PCA, variance explained was 74% by five components for men and 80% by six components for women. The key component from PCA for remission was, for both sex, disease impact (Psoriatic Arthritis Impact of Disease, pain and HAQ) explaining 22.2–27.5% of variance. Other factors included musculoskeletal disease activity, chronicity/joint damage, psoriasis, enthesitis and CRP. For LDA, similar factors were identified but the variance explained was lower (64–68%).

Conclusion

Many factors impact on patients’ opinion of remission, dominated by disease impact. Disease activity in multiple domains, chronicity/age, comorbidities and symptoms due to other conditions contribute to a robust model highlighting that patient-defined remission is multifaceted.

Trials registration

Clinicaltrials.gov, http://clinicaltrials.gov, NCT 03119805.
Trends in Medical School Application and Matriculation Rates Across the United States From 2001 to 2015: Implications for Health Disparities
Authors: Zhang Donglan , Li Gang , Mu Lan , Thapa Janani , Li Yan , Chen Zhuo , Shi Lu , Su Dejun , Son Heejung , Pagan Jose A.
Published: March 2021

Purpose

Socioeconomic and geographic determinants of medical school application and matriculation may help explain the unequal distribution of physicians in the United States. This study describes trends in MD-granting medical school application and matriculation rates and explores the relationship between county median family income, proximity to a medical school, and medical school application and matriculation rates.

Method

Data were obtained from the Association of American Medical Colleges, including the age, gender, and Federal Information Processing Standards code for county of legal residence for each applicant and matriculant to U.S. MD-granting medical schools from 2001 through 2015. The application and matriculation rates in each county were calculated using the number of applicants and matriculants per 100,000 residents. Counties were classified into 4 groups according to the county median family income (high-income, middle-income, middle-low-income, low-income). The authors performed chi-square tests to assess trends across the study period and the association of county median family income with application and matriculation rates.

Results

There were 581,833 applicants and 262,730 (45.2%) matriculants to MD-granting medical schools between 2001 and 2015. The application rates per 100,000 residents during 2001–2005, 2006–2010, and 2011–2015 were 57.2, 62.7, and 69.0, respectively, and the corresponding matriculation rates were 27.5, 28.1, and 29.8. The ratios of the application rate in high-income counties to that in low-income counties during the 3 time periods were 1.9, 2.4, and 2.8, respectively.

Conclusions

The application and matriculation rates to MD-granting medical schools increased steadily from 2001 to 2015. Yet, applicants and matriculants disproportionately came from high-income counties. The differences in the application and matriculation rates between low-income and high-income counties grew during this period. Exploring these differences can lead to better understanding of the factors that drive geographic differences in physician access and the associated health disparities across the United States.
Agreement between continuous noninvasive finger cuff-derived and invasive arterial blood pressure measurements: Effect of data sampling and data processing
Authors: Flick Moritz , Matin Mehr Jasmin , Briesenick Luisa , Hoppe Phillip , Kouz Karim , Vokuhl Christina , Flotzinger Doris , Lerche Katja , Saugel Bernd
Published: March 2021

BACKGROUND

The effect of different methods for data sampling and data processing on the results of comparative statistical analyses in method comparison studies of continuous arterial blood pressure (AP) monitoring systems remains unknown.

OBJECTIVE

We sought to investigate the effect of different methods for data sampling and data processing on the results of statistical analyses in method comparison studies of continuous AP monitoring systems.

DESIGN

Prospective observational study.

SETTING

University Medical Center Hamburg-Eppendorf, Hamburg, Germany, from April to October 2019.

PATIENTS

49 patients scheduled for neurosurgery with AP measurement using a radial artery catheter.

MAIN OUTCOME MEASURES

We assessed the agreement between continuous noninvasive finger cuff-derived (CNAP Monitor 500; CNSystems Medizintechnik, Graz, Austria) and invasive AP measurements in a prospective method comparison study in patients having neurosurgery using all beat-to-beat AP measurements (Methodall), 10-s averages (Methodavg), one 30-min period of 10-s averages (Method30), Method30 with additional offset subtraction (Method30off), and 10 30-s periods without (Methodiso) or with (Methodiso-zero) application of the zero zone. The agreement was analysed using Bland-Altman and error grid analysis.

RESULTS

For mean AP, the mean of the differences (95% limits of agreement) was 9.0 (−12.9 to 30.9) mmHg for Methodall, 9.2 (−12.5 to 30.9) mmHg for Methodavg, 6.5 (−9.3 to 22.2) mmHg for Method30, 0.5 (−9.5 to 10.5) mmHg for Method30off, 4.9 (−6.0 to 15.7) mmHg for Methodiso, and 3.4 (−5.9 to 12.7) mmHg for Methodiso-zero. Similar trends were found for systolic and diastolic AP. Results of error grid analysis were also influenced by using different methods for data sampling and data processing.

CONCLUSION

Data sampling and data processing substantially impact the results of comparative statistics in method comparison studies of continuous AP monitoring systems. Depending on the method used for data sampling and data processing, the performance of an AP test method may be considered clinically acceptable or unacceptable.
Effects of two stepwise lung recruitment strategies on respiratory function and haemodynamics in anaesthetised pigs
Authors: Wittenstein Jakob , Huhle Robert , Scharffenberg Martin , Kiss Thomas , Herold Johannes , Vivona Luigi , Bergamaschi Alice , Schultz Marcus J. , Pelosi Paolo , Gama de Abreu Marcelo , Bluth Thomas
Published: March 2021

BACKGROUND

Lung recruitment manoeuvres and positive end-expiratory pressure (PEEP) can improve lung function during general anaesthesia. Different recruitment manoeuvre strategies have been described in large international trials: in the protective ventilation using high vs. low PEEP (PROVHILO) strategy, tidal volume (V

T
) was increased during volume-controlled ventilation; in the individualised peri-operative open-lung approach vs. standard protective ventilation in abdominal surgery (iPROVE) strategy, PEEP was increased during pressure-controlled ventilation.

OBJECTIVES

To compare the effects of the PROVHILO strategy and the iPROVE strategy on respiratory and haemodynamic variables.

DESIGN

Randomised crossover study.

SETTING

University hospital research facility.

ANIMALS

A total of 20 juvenile anaesthetised pigs.

INTERVENTIONS

Animals were assigned randomly to one of two sequences: PROVHILO strategy followed by iPROVE strategy or vice-versa (n = 10/sequence). In the PROVHILO strategy, V

T
was increased stepwise by 4 ml kg−1 at a fixed PEEP of 12 cmH2O until a plateau pressure of 30 to 35 cmH2O was reached. In the iPROVE strategy, at fixed driving pressure of 20 cmH2O, PEEP was increased up to 20 cmH2O followed by PEEP titration according to the lowest elastance of the respiratory system (ERS).

MAIN OUTCOME MEASURES

We assessed regional transpulmonary pressure (Ptrans), respiratory system mechanics, gas exchange and haemodynamics, as well as the centre of ventilation (CoV) by electrical impedance tomography.

RESULTS

During recruitment manoeuvres with the PROVHILO strategy compared with the iPROV strategy, dorsal Ptrans was lower at end-inspiration (16.3 ± 2.7 vs. 18.6 ± 3.1 cmH2O, P = 0.001) and end-expiration (4.8 ± 2.6 vs. 8.8 ± 3.4 cmH2O, P 
< 0.001), and mean arterial pressure (MAP) was higher (77 ± 11 vs. 60 ± 14 mmHg, P < 0.001). At 1 and 15 min after recruitment manoeuvres, ERS was higher in the PROVHILO strategy than the iPROVE strategy (24.6 ± 3.9 vs. 21.5 ± 3.4 and 26.7 ± 4.3 vs. 24.0 ± 3.8 cmH2O l−1; P 
< 0.001, respectively). At 1 min, PaO2 was lower in PROVHILO compared with iPROVE strategy (57.1 ± 6.1 vs. 59.3 ± 5.1 kPa, P = 0.013), but at 15 min, values did not differ. CoV did not differ between strategies.

CONCLUSION

In anaesthetised pigs, the iPROVE strategy compared with the PROVHILO strategy increased dorsal Ptrans at the cost of lower MAP during recruitment manoeuvres, and decreased ERS thereafter, without consistent improvement of oxygenation or shift of the CoV.

TRIAL REGISTRATION

This study was registered and approved by the Landesdirektion Dresden, Germany (DD24–5131/338/28).
Upregulation of miR-29a suppressed the migration and invasion of trophoblasts by directly targeting LOXL2 in preeclampsia
Authors: Xu Xiang-Hong , Tang Lin-Chen , Hao Fan , Jin Li-Ping
Published: March 2021

Objective:

Preeclampsia is a pregnancy-specific disorder that is a major cause of maternal and foetal morbidity and mortality, with a prevalence of 6–8% of pregnancies. Although the downregulation of lysyl oxidase (LOX) and LOX-like protein 2 (LOXL2), which leads to reduced trophoblast cell migration and invasion through activation of the TGF-β1/Smad3/collagen pathway, is relevant to preeclampsia, the mechanisms regulating differences in the gene expression of LOX and LOXL2 in placentas are not yet understood. This study aimed to investigate the mechanisms regulating differences in the gene expression of LOX and LOXL2 in placentas.

Methods:

The expression of miRNAs, LOX and LOXL2 in preeclamptic placentas and control placentas was analysed by qPCR. Localisation of miR29a and LOXL2 in preeclamptic placentas was performed by RNA-Fluorescence in-situ hybridization assay. The direct regulation of LOXL2 by miR-29a was assessed by dual-luciferase reporter assays in human extravillous trophoblast cells (HTR8/SVneo). Cell migration and invasion were evaluated by Transwell assays in HTR8/SVneo cells.

Results:

miR-29a expression was upregulated in preeclamptic placentas and negatively correlated with LOXL2 mRNA expression levels. RNA-Fluorescence in-situ hybridization assay revealed a clear overlap between miR-29a and LOXL2 in the placentas of preeclampic women. LOXL2 was a direct target gene of miR-29a, as confirmed by a dual-luciferase reporter assay in HTR8/SVneo trophoblast cells. miR-29a suppressed HTR8/SVneo trophoblast cell migration and invasion. LOXL2 overexpression reversed the inhibitory effects of miR-29a on HTR8/SVneo trophoblast cell migration and invasion.

Conclusion:

Our results suggest that the upregulation of miR-29a suppresses the migration and invasion of HTR8/SVneo trophoblast cells by directly targeting LOXL2 in preeclampsia.
Role of the sympathetic nervous system in cardiometabolic control: implications for targeted multiorgan neuromodulation approaches
Authors: Carnagarin Revathy , Kiuchi Marcio G. , Goh Gerard , Adams Leon , Cohen Neale , Kavnoudias Helen , Gan Seng K. , Van Schie Greg , Esler Murray D. , Matthews Vance B. , Schlaich Markus P.
Published: March 2021

Sympathetic overdrive plays a key role in the perturbation of cardiometabolic homeostasis. Diet-induced and exercise-induced weight loss remains a key strategy to combat metabolic disorders, but is often difficult to achieve. Current pharmacological approaches result in variable responses in different patient cohorts and long-term efficacy may be limited by medication intolerance and nonadherence. A clinical need exists for complementary therapies to curb the burden of cardiometabolic diseases. One such approach may include interventional sympathetic neuromodulation of organs relevant to cardiometabolic control. The experience from catheter-based renal denervation studies clearly demonstrates the feasibility, safety and efficacy of such an approach. In analogy, denervation of the common hepatic artery is now feasible in humans and may prove to be similarly useful in modulating sympathetic overdrive directed towards the liver, pancreas and duodenum. Such a targeted multiorgan neuromodulation strategy may beneficially influence multiple aspects of the cardiometabolic disease continuum offering a holistic approach.
A comprehensive review of regional anesthesia for head and neck surgery
Authors: Muse Iyabo O. , Straker Tracey
Published: March 2021

Head and neck surgery encompass a wide range of procedures from common tonsillectomy to major head and neck cancer resections requiring free flap reconstruction. Anesthetic management of these procedures relies predominately on general anesthesia; however, regional anesthetic techniques are available that can be used for both the primary anesthetic and analgesia, or in combination with general anesthesia. Traditionally most of these blocks were done blindly using anatomical structures, but with more availability of ultrasounds, these blocks are easier to perform, and with less complications. In this review, we will discuss the anatomical and ultrasound-guided approaches to regional anesthetic techniques that can be used in head and neck surgeries for primary intraoperative management, or in combination with general anesthesia for perioperative pain management. A discussion of outcomes studies of the different nerve blocks and potential complications associated with block placement will be highlighted.
Hepatectomy is associated with survival in intrahepatic cholangiocarcinoma
Authors: Chen Weili , Wu Zhaoping , Cao Lingling
Published: March 2021

Liver resection (LR) is a major treatment modality in select patients with stage I-III Intrahepatic cholangiocarcinoma (ICC), yet many studies demonstrated low rates of resection. The aim of the present study is to evaluate whether increasing resection rates would result in an increase in average survival in patients with stage I-III ICC.

Surveillance, Epidemiology, and End Results 18 registry database for 2004 through 2015 was retrieved for the present study. Propensity score matching was performed to eliminate possible bias. In addition, instrumental variable (IV) analysis was utilized to adjust for both measured and unmeasured confounders.

Among 2341 patients with clinical stage I-III ICC, we identified 1577 (67.4%) and 764 (32.6%) patients who received no treatment or LR, respectively. In the multivariable adjusted cohort, a clear prognostic advantage of LR was observed in overall survival (OS) (P < .001) and disease-specific survival (DSS) (P < .001) compared to patients who received no treatment. Estimates based on the IV analysis indicated that patients treated with LR had a significantly longer OS (P < .001) and DSS (P < .001) after adjusting confounding factors. In IV analyses stratified by American Joint Committee on Cancer tumor stage, we found that the better survival effects of LR on OS and DSS were consistent across all subgroups.

Our outcomes indicated that LR was associated with a survival benefit for marginal patients with stage I-III ICC.
Begelomab for severe refractory dermatomyositis
Authors: De Lorenzo Rebecca , Sciorati Clara , Monno Antonella , Cavalli Silvia , Bonomi Francesco , Tronci Stefano , Previtali Stefano , Rovere-Querini Patrizia
Published: March 2021

Rationale:

Severe refractory idiopathic inflammatory myopathy (IIM) represents a challenge for the clinician. The lack of efficacy of available tools reflects our incomplete insight into the molecular events sustaining the inflammatory tissue damage in these patients. We present the first case of refractory IIM treated with anti-dipeptidyl peptidase-4 (DPP-4)/cluster of differentiation 26 (CD26) monoclonal antibody.

Patient concerns:

A 55-year old man presented with proximal muscle weakness, diffuse erythematous skin lesions which rapidly evolved into ulcerations, dysphagia and dysphonia.

Diagnosis:

Increased serum creatine kinase levels and histological findings at muscle and skin biopsies were compatible with the diagnosis of dermatomyositis (DM). Several lines of treatment failed to control the disease including steroids, mycophenolate mofetil, tacrolimus, intravenous immunoglobulins and rituximab. Despite therapy, the patient also had recurrent intestinal vasculitis causing bowel perforation. Concurrently, DPP-4/CD26 expression in the patient's skin and skeletal muscle was observed.

Interventions:

The patient was treated with begelomab, a murine immunoglobulin G2b monoclonal antibody against DPP-4/CD26.

Outcomes:

Dysphagia, skin lesions and intestinal vasculitis resolved and the patient experienced a significant improvement of his quality of life.

Conclusion:

Blockade of DPP-4/CD26, which is expressed on T cells and mediates T cell activation and function, is safe and might be effective in patients with refractory DM.
Necrotizing retinitis in a patient with syphilis
Authors: Cheng Yan , Wang Chenguang , Su Guanfang
Published: March 2021

Rationale:

Ocular syphilis varies widely in presentation and should be considered in all patients with posterior uveitis. Necrotizing retinitis is a rare manifestation of ocular syphilis and mimics ARN.

Patient concerns:

We report a male patient who presented with bilateral dense vitritis obscuring fundus details similar to ARN, as a rare reported manifestation of syphilis, who was initially given intravitreal ganciclovir.

Diagnosis:

After the results for herpes viral PCR disclosed negative, the diagnosis of syphilitic necrotizing retinitis was made based on positive RPR.

Intervention and Outcomes:

With the clinical diagnosis of ocular syphilis, treatment with intravenous penicillin was promptly initiated. His visual acuity improved to 20/100 in the right eye and still light perception in the left. Pars plana vitrectomy with silicon oil tamponade was performed in his left eye.

Lessons:

Ocular syphilis varies widely in presentation and should be considered in all patients with posterior uveitis. However, whenever ARN is clinically suspected, empiric treatment against herpetic viruses should be promptly administered while awaiting further infectious disease study results. Recognition of syphilitic retinitis and prompt initiation of intravenous penicillin is of critical important for clinicians.
Acupuncture for chronic constipation in patients with diabetes mellitus
Authors: Cui Sufen , Yang Qiu , Xie Suhua , Liu Qian , Zhou Guangju
Published: March 2021

Background:

Assessing the effectiveness and safety of acupuncture for chronic constipation in patients with diabetes mellitus is the main purpose of this systematic review protocol.

Methods:

The following electronic databases will be searched from their respective inception dates to December 1st 2020: PubMed, the Cochrane Library, Embase, World Science Net, the Allied and Complementary Medicine Database, the Web of Science, China National Knowledge Infrastructure, the Chongqing VIP Chinese Science and Technology Periodical Database and the Wanfang Database. All published randomized controlled trials in English or Chinese related to acupuncture for constipation in patient with diabetes mellitus will be included. The Bristol stool scale, spontaneous complete bowel movements, and observing symptoms (yes/no) including defecation feeling, defecation weakness, feeling of incomplete evacuation, bloating, and flatulence were considered as primary measures. The treatment efficiency consideration according to Bristol stool scale was considered as secondary measure. Two reviewers will conduct the study selection, data extraction and assessment independently. The assessment of risk of bias and data synthesis will be conducted with Review Manager Software (RevMan) V.5.2.

Results:

The results will provide a high-quality synthesis of current evidence for researchers in this subject area.

Conclusion:

The conclusion of our study will provide an evidence to judge whether.

Acupuncture is an effective intervention for chronic constipation in patients with diabetes mellitus.

Ethics and dissemination:

Formal ethical approval is not necessary as the data cannot be individualized. The results of this protocol will be disseminated in a peer-reviewed journal or presented at relevant conferences.

PROSPERO registration number:

INPLASY202110079.
Symmetric and asymmetric activation of hematopoietic stem cells
Authors: Loeffler Dirk , Schroeder Timm
Published: March 2021

Purpose of review

Hematopoietic stem cells (HSCs) are in an inactive quiescent state for most of their life. To replenish the blood system in homeostasis and after injury, they activate and divide. HSC daughter cells must then decide whether to return to quiescence and metabolic inactivity or to activate further to proliferate and differentiate and replenish lost blood cells. Although the regulation of HSC activation is not well understood, recent discoveries shed new light on involved mechanisms including asymmetric cell division (ACD).

Recent findings

HSC metabolism has emerged as a regulator of cell fates. Recent evidence suggests that cellular organelles mediating anabolic and catabolic processes can be asymmetrically inherited during HSC divisions. These include autophagosomes, mitophagosomes, and lysosomes, which regulate HSC quiescence. Their asymmetric inheritance has been linked to future metabolic and translational activity in HSC daughters, showing that ACD can regulate the balance between HSC (in)activity.

We discuss recent insights and remaining questions in how HSCs balance activation and quiescence, with a focus on ACD.
Efficacy and Safety of Parenteral High-Dose Vitamin C Therapy in Pediatric Patients: A Scoping Review*
Authors: Yanase Fumitaka , Raman Sainath , Naorungroj Thummaporn , McCarthy Avril , Cree Michele , Schlapbach Luregn J. , Bellomo Rinaldo
Published: March 2021

OBJECTIVES:

Recently, several adult trials have investigated the potential benefit of high-dose vitamin C therapy in critically ill patients. In pediatric patients, little is known on the efficacy, safety, and risk of high-dose vitamin C therapy. We aimed to review the efficacy and potential harm associated with high-dose vitamin C treatment.

DATA SOURCES:

We searched MEDLINE, EMBASE, Cochrane Library, and National Institute of Health Clinical Trials Register.

STUDY SELECTION:

We included studies in neonatal and pediatric patients who received IV or intra-arterial high-dose vitamin C (ascorbic acid) defined as greater than or equal to 75 mg/kg/d.

Data Extraction:

Two independent investigators screened articles and extracted data.

DATA SYNTHESIS:

We found 1,364 articles, assessed 193 full texts for eligibility, and identified 12 eligible studies. These studies included 855 patients, with 194 receiving high-dose vitamin C. The age of patients who received high-dose vitamin C ranged from 2 hours after delivery to 8.4 years (median 2.4 yr), and the vitamin C dose ranged from 100 to 1,500 mg/kg/d (median 260.5 mg/kg/d). Four studies were double-blind randomized controlled trials, and no clinical efficacy outcome was reported in favor of or against vitamin C. Furthermore, no adverse event or signal of harm was reported with high-dose vitamin C.

CONCLUSIONS:

In 12 studies with 194 children treated with parenteral high-dose vitamin C, there was no evidence of clinical efficacy or inferior clinical outcomes in double-blind randomized controlled trials, and no reported harmful effects. These findings justify further investigations of this treatment in children.
A Call to Action for the Pediatric Critical Care Community
Authors: Conlon Thomas W. , Kantor David B. , Hirshberg Eliotte L. , Fraga Maria V. , Glau Christie L. , Horowitz Russ , Burzynski Jeffrey H. , Godshall Aaron J. , Nishisaki Akira
Published: March 2021

Healthcare regulatory bodies have escalated concerns regarding the use of point-of-care ultrasound by nonradiology and noncardiology physicians. A recently published PCCM
Perspective identified that data do not support many of these concerns and addressed common misconceptions associated with point-of-care ultrasound use in the critical care setting. Indeed, the global point-of-care ultrasound community and specifically the pediatric critical care community have the opportunity to be leaders in demonstrating how to translate new skills and technologies to the bedside in a safe and effective manner. We seek to extend the conversation and propose next steps in supporting integration of point-of-care ultrasound in pediatric critical care practice.
Trauma Exposure and Suicidality in a Pediatric Emergency Psychiatric Population
Authors: Marr Mollie C. , Gerson Ruth , Lee Mia , Storfer-Isser Amy , Horwitz Sarah M. , Havens Jennifer F.
Published: March 2021

Objectives

The increasing rates of depression and suicidality in children and adolescents are reflected in the increasing number of mental health–related visits to emergency departments. Despite the high rates of traumatic exposure experienced by high-acuity children and adolescents and a known link to suicidal ideation, the systematic review of trauma history is not a consistent part of emergency department assessments for suicide ideation or attempt. In the present study, we examined the prevalence of suicidality as well as traumatic exposures in children and adolescents presenting to a dedicated pediatric psychiatric emergency department.

Methods

Suicide ideation, suicide attempts, and trauma exposure history were identified through a retrospective chart review of youth (n = 861) who presented to a dedicated child psychiatric emergency department during a 1-year period. Bivariate analyses comparing demographic and trauma history for children with and without suicidality and a multivariable logistic regression were performed.

Results

Childhood adversity was common, with 52% of youth reporting at least one type of trauma exposure. Emotional abuse, physical abuse, and sexual abuse/assault were associated with suicidality. Any trauma exposure and the total number of different trauma exposures were associated with reported suicide attempt. After adjusting for sociodemographic characteristics, children who reported a history of emotional abuse had 3.2-fold increased odds of attempted suicide. Children who reported a history of being a victim of bullying had 1.9-fold increased odds of current suicidal ideation.

Conclusions

Traumatic experiences were common in youth presenting with suicidality. Traumatic experiences are frequently underrecognized in treatment settings because they are not part of routine evaluations and are often overlooked when trauma-related symptoms are not the presenting problem. Addressing traumatic experiences underlying depression and suicidal ideation is a necessary step in effective treatment. Emergency departments need to implement routine screening for traumatic exposures in children presenting with suicidal ideation or attempt.
The Expanding Role of Geometric Morphometrics in Craniofacial Surgery
Authors: Rutland John W. , Bellaire Christopher P. , Yao Amy , Arrighi-Allisan Annie , Napoli James G. , Delman Bradley N. , Taub Peter J.
Published: March 2021

Introduction:

Geometric morphometrics (GM) is an advanced landmark-based quantitative method used to study biological shape and form. Historically, GM has been limited to non-biomedical fields such as comparative biology; however, this technique confers advantages over traditional cephalometric methods, warranting a review of current applications of GM to human craniofacial disorders.

Methods:

The RISmed package was used to extract metadata associated with PubMed publications referencing GM analysis techniques in craniofacial and reconstructive surgery. PubMed search terms included “geometric AND morphometric AND craniofacial;” and “geometric AND morphometric AND reconstructive surgery.” Duplicate search results were eliminated.

Results:

Search yielded 139 studies between 2005 and 2020, of which 27 met inclusion criteria. Human craniofacial studies constituted 2% of all queried GM studies. Among these, cleft lip and palate were the most commonly studied craniofacial conditions (7 studies, 26%), followed by sagittal craniosynostosis (4 studies, 15%). Seventeen studies (63%) used GM to assess skeletal structures, seven studies (26%) examined both skeletal and soft tissues, and three studies (11%) analyzed soft tissues only. Eleven studies (40.1%) employed a GM approach to evaluate postoperative changes in craniofacial morphology. Two studies (7%) systematically compared GM analysis with conventional shape measurements.

Conclusion:

The ability to study shape while controlling for variability in structure size and imaging technique make GM a promising tool for understanding growth patterns in complex craniofacial diseases. Furthermore, GM overcomes many limitations of traditional cephalometric techniques, and hence may claim an expanded role in the study of human craniofacial disorders in clinical and research settings.
Quantifying Orthotic Correction of Trigonocephaly Using Optical Surface Scanning
Authors: Ramsey Jason A. , Stevens Phillip M. , Wurdeman Shane R. , Bonfield Christopher M.
Published: March 2021

Numerous publications describe techniques to measure trigonocephaly caused by metopic synostosis, but they are potentially hazardous for use in acquiring longitudinal data. Optical surface scanning technology can safely yield craniometrics but has not established a practical means for measuring objective morphological changes to trigonocephaly during the practical time constraints of a clinical visit. The purpose of this preliminary study was to evaluate a method for safely and repeatedly measuring frontal angle (FA) using technology available at multiple centers providing treatment with cranial remolding orthoses.

Optical scans of infants who underwent endoscopic-assisted minimally-invasive craniectomy for repair of metopic synostosis with cranial remolding were retrospectively analyzed. A novel FA measurement technique “FA30” was developed based on repeatable, geometrically-related surface landmarks approximating the glabella and frontotemporali. Results were compared to a control group and categories of non-synostotic deformity. Inter-rater reliability was assessed for pre- and post-treatment scan measurements among separate clinicians.

All trigonocephalic subjects (n = 5) had initial FA30 significantly lower than the control group and other cohorts (P < 0.001). During the course of orthotic cranial remolding following surgical release mean FA30 increased from 121.5° to 138.5° (P < 0.001), approaching the control group mean of 144.4°. Intraclass coefficient calculation showed high reliability (intraclass correlation coefficient: 0.993, 95% confidence interval: 0.957–0.998, P < 0.001), which was supported with Bland–Altman analyses of agreement.

Optical surface scanning may provide a safe, accurate, and repeatable means to measure FA. Increase in FA30 demonstrates correction of trigonocephaly. The method presented enables expeditious reporting of treatment progress to the infant's surgeon and parents, and has potential for use in optimizing treatment outcomes at multiple centers.
Postnatal Sagittal Craniosynostosis: A Novel Presentation and Considerations in Diagnosis and Management
Authors: Rao Vinay , Ali Rohaid , Roussel Lauren O. , Crozier Joseph W. , Svokos Konstantina , Woo Albert S.
Published: March 2021

Sagittal craniosynostosis results in scaphocephaly from abnormal fusion of the sagittal suture. Traditionally, craniosynostosis presents at birth and is diagnosed within the first year of life. The authors report a patient with development of sagittal craniosynostosis after birth, which we term postnatal sagittal craniosynostosis. This is a rare occurrence in which management considerations are critical but are not well discussed. A 3-year-old boy presented with concerns of a metopic ridge. Workup revealed metopic ridging and an open sagittal suture. The patient later developed signs of increased intracranial pressure and repeat computed tomography scan 14 months later identified a newly fused sagittal suture. The patient underwent open posterior cranial vault expansion, resulting in resolution of symptoms. Postnatal sagittal craniosynostosis is a rare condition and should be considered in otherwise unexplained increases in increased intracranial pressure among pediatric patients. Open posterior cranial vault expansion represents a safe and effective method to treat this condition.
A Competency-based Laparoscopic Cholecystectomy Curriculum Significantly Improves General Surgery Residents’ Operative Performance and Decreases Skill Variability
Authors: Huffman Elizabeth M. , Choi Jennifer N. , Martin John R. , Anton Nicholas E. , Nickel Brianne L. , Monfared Sara , Timsina Lava R. , Dunnington Gary L. , Stefanidis Dimitrios
Published: March 2021

Objective:

To demonstrate the feasibility of implementing a CBE curriculum within a general surgery residency program and to evaluate its effectiveness in improving resident skill.

Summary of Background Data:

Operative skill variability affects residents and practicing surgeons and directly impacts patient outcomes. CBE can decrease this variability by ensuring uniform skill acquisition. We implemented a CBE LC curriculum to improve resident performance and decrease skill variability.

Methods:

PGY-2 residents completed the curriculum during monthly rotations starting in July 2017. Once simulator proficiency was reached, residents performed elective LCs with a select group of faculty at 3 hospitals. Performance at curriculum completion was assessed using LC simulation metrics and intraoperative operative performance rating system scores and compared to both baseline and historical controls, comprised of rising PGY-3s, using a 2-sample Wilcoxon rank-sum test. PGY-2 group’s performance variability was compared with PGY-3s using Levene robust test of equality of variances; P < 0.05 was considered significant.

Results:

Twenty-one residents each performed 17.52 ± 4.15 consecutive LCs during the monthly rotation. Resident simulated and operative performance increased significantly with dedicated training and reached that of more experienced rising PGY-3s (n = 7) but with significantly decreased variability in performance (P = 0.04).

Conclusions:

Completion of a CBE rotation led to significant improvements in PGY-2 residents’ LC performance that reached that of PGY-3s and decreased performance variability. These results support wider implementation of CBE in resident training.
Characteristics and Donation Outcomes of Potential Organ Donors Perceived to Be at Increased Risk for Blood-borne Virus Transmission: An Australian Cohort Study 2010–2018
Authors: Waller Karen M.J. , De La Mata Nicole L. , Rosales Brenda M. , Hedley James A. , Kelly Patrick J. , Thomson Imogen K. , O’Leary Michael J. , Cavazzoni Elena , Ramachandran Vidiya , Rawlinson William D. , Wyburn Kate R. , Webster Angela C.
Published: March 2021

Background.

Safely increasing organ donation to meet need is a priority. Potential donors may be declined because of perceived blood-borne virus (BBV) transmission risk. With hepatitis C (HCV) curative therapy, more potential donors may now be suitable. We sought to describe potential deceased donors with increased BBV transmission risk.

Methods.

We conducted a cohort study of all potential organ donors referred in NSW, Australia, 2010–2018. We compared baseline risk potential donors to potential donors with increased BBV transmission risk, due to history of HIV, HCV or hepatitis B, and/or behavioral risk factors.

Results.

There were 624 of 5749 potential donors (10.9%) perceived to have increased BBV transmission risk. This included 298 of 5749 (5.2%) with HCV (including HBV coinfections) and 239 of 5749 (4.2%) with increased risk behaviors (no known BBV). Potential donors with HCV and those with increased risk behaviors were younger and had fewer comorbidities than baseline risk potential donors (P < 0.001). Many potential donors (82 with HCV, 38 with risk behaviors) were declined for donation purely because of perceived BBV transmission risk. Most were excluded before BBV testing. When potential donors with HCV did donate, they donated fewer organs than baseline risk donors (median 1 versus 3, P < 0.01), especially kidneys (odds ratio 0.08, P < 0.001) and lungs (odds ratio 0.11, P = 0.006).

Conclusions.

Many potential donors were not accepted because of perceived increased BBV transmission risk, without viral testing, and despite otherwise favorable characteristics. Transplantation could be increased from potential donors with HCV and/or increased risk behaviors.
Visual Hallucinations in a Patient With Moyamoya Disease: A Review and Case Report
Authors: Bodoano Sánchez Isabel , Fernández-Pérez María Dolores , Molera Manzano David , Gutiérrez-Rojas Luis , Romero-Fábrega Juan Carlos
Published: March 2021

Moyamoya disease (MMD) is characterized by the progressive development of stenosis in the distal carotid territory and an abnormal vascular network. It is a rare disease with a higher prevalence in Asian countries compared with other countries. The most common symptoms of MMD vary from stroke to epileptic seizure and headaches. However, individuals with MMD may also experience psychiatric symptoms such as depression, anxiety, and, in rare cases, psychosis. We report the case of a 34-year-old man with MMD who suffered from psychosis accompanied by visual hallucinations. The man was diagnosed with MMD and attends periodic follow-ups in our neurology outpatient clinic. After undergoing programmed neurosurgery, the man’s immediate postoperative follow-up neuroimaging showed an extensive right frontotemporal acute ischemic lesion for which he was treated and released. Almost a year later, he presented to an outpatient psychiatric clinic where he complained of visual hallucinations and delusions. This time, there was no change in neuroimaging. Treatment with olanzapine was successful, and the man’s symptoms were completely reversed. To our knowledge, this is the first reported case of visual hallucinations in an individual with MMD. This case is especially relevant because the visual hallucinations were not associated with an occipital ischemic lesion or with epileptic activity. We propose a topographic hypothesis to explain such findings.