bluuebunny/crossref_metadata_2025 huggingface dataset:
Transdiaphragmatic Chest Wall Herniation
Authors: Meader Anna G. , Ciraulo David L. , Rappold Joseph F. , Sawhney Jaswin S.
Published: December 2020

Background

The combination of traumatic simultaneous diaphragmatic rupture and chest wall herniation remains rare, with 42 cases of traumatic transdiaphragmatic intercostal hernia (TDIH) reported in the literature since 1946. An accurate count of cases is difficult to obtain, as TDIH nomenclature has been variable. 1 - 5 Risk factors for traumatic TDIH are not well established. As these injuries are uncommon, best management techniques have yet to be established. Reported repair techniques include primary closure, closure with mesh, and implantation of prosthetic or autologous material. We present our single-center series of 7 patients, the largest reported to our knowledge, and discuss the challenges of repairing these difficult injuries.

Methods

After obtaining institutional review board approval, data were abstracted from the electronic medical record on all adults who underwent evaluation and treatment for traumatic TDIH between July 2014 and January 2019.

Results

Of the 7 cases of traumatic TDIH, 6 patients developed TDIH secondary to cough; the seventh patient presented with chronic chest wall pain after an episode of heavy lifting. All patients were obese or overweight. Pain and a “popping sensation” were the most common presenting symptoms. All patients underwent operative intervention with primary repair of the diaphragm and suture approximation of the ribs. 3 patients had onlay mesh repair of the chest wall and/or abdominal wall. 1 patient had plating of his rib fracture. 3 patients had a recurrence of the intercostal portion of the hernia No patients have undergone reoperation thus far.

Discussion

While previously thought to more commonly occur on the left side due to the protective effects of the diaphragm, 2 the majority in this series had right-sided injuries. Herniation through the ninth-10th interspace remains the most common location. 4 Computed tomography imaging should be used for diagnosis and operative planning. It is best to manage these hernias acutely to re-establish normal anatomy. Mesh may be required in delayed reconstructions of if the chest wall cannot be re-approximated. Rib plating should be considered in cases of instability or flail. High rates of complications are not unexpected given the complicated and rare nature of the injury. Given the high rate of intercostal hernia recurrence, it is likely that mesh repair or should be more often used in the treatment of this injury.
Debility Risk Model as a Predictor for Postsurgical Outcomes
Authors: Hanna Yousif , Nandra Kulvir , Kustera Christopher , Smith Jessica , Metzinger Matthew , Patel Kamini , Cowan Scott
Published: December 2020

Background

Decreased patient functional status is associated with higher rates of postoperative morbidity and mortality. The Vizient program recently implemented a debility risk model to identify patients with impaired functional status. We examined the relationship between this novel model and inpatient postsurgical outcomes in a large urban tertiary care center.

Methods

The Vizient database was accessed to compare surgical outcomes between patients coded with debility and patients without debility between January 2017 and December 2018. Data for each surgical specialty were obtained, and a chi-squared analysis was used to detect differences in readmission rates, mortality, and postoperative complications (defined by Vizient). These complications include pneumonia, postoperative infection, anesthesia complications, and shock.

Results

We found patients with debility have a higher mortality rate (3%) than patients without debility (2%) across all surgical specialties ( P = .0103). Patients with debility have a higher 30-day readmission rate (16%) than those without debility (8%) across all specialties ( P < .0001). Patients with debility had a higher rate of inpatient complications for neurosurgery (12.11% vs. 8%, P = .008), trauma surgery (11.9% vs. 6%, P =.025), general surgery (17.67% vs. 7%, P = .013), and cardiac surgery (47.06% vs. 18%, P =.0025).

Conclusions

Our study supports the use of the Vizient debility code to predict postsurgical outcomes and risk stratify patients. By extension, functional status assessments in preoperative evaluation of patients remain important. Further, studies can build upon this data to measure the impact of preoperative, outpatient debility assessments in surgical patients.
From Ancient Texts to Digital Imagery: A Brief History on the Evolution of Anatomic Illustrations
Authors: Rubalcava Nathan S. , Gadepalli Samir K.
Published: December 2020

In a time when social isolation heavily relies on the use of digital representation, photography, and e-books, it is easy to take for granted the impact imagery has on our society and the pedagogical purposes of illustration, particularly in the teaching of surgery. Illustrations after all are the basis of all anatomical atlases and are quintessential tools that allow for an expedient and thorough understanding of concepts underlying the fabric of the human body. Yet, surgery has not always been taught with an atlas. Illustrations, much like surgery, have seen an incredible transformative process spanning across the ages to achieve their status in modern medicine. Through this brief review, we will not only glean an understanding of the evolution of anatomical illustrations but also the social context in which surgery has also evolved throughout history.
US Rural Surgeons Leading During COVID-19: Where Are They Now?
Authors: Sarap Michael , Conyers Julie , Cunningham Crystal , Deutchman Adam , Levine Glenn , Long Sue , Molt Patrick , Rossi Matt , Welsh David , Hughes Dorothy
Published: December 2020

Rural surgeons from disparate areas of the United States report on the effects of the COVID-19 pandemic in their communities as the virus has spread across the country. The pandemic has brought significant changes to the professional, economic, and social lives of the individual surgeons and their communities.
Tracheostomy in Patients on Venovenous Extracorporeal Membrane Oxygenation: Is It Safe?
Authors: Kelley Katherine M. , Galvagno Samuel M. , Wallis Marianne , Mazzeffi Michael A. , Deatrick Kristopher , Betzold Richard , Scalea Thomas , Menaker Jay
Published: December 2020

Background

The anticoagulation and coagulopathy associated with venovenous extracorporeal membrane oxygenation (VV-ECMO) lead to concern for increased risks of tracheostomy. The purpose of this study is to evaluate the safety of tracheostomy in patients on VV-ECMO.

Methods

Patients admitted between November 2015 and January 2019 to a dedicated intensive care unit for VV-ECMO were reviewed retrospectively.

Results

96 patients underwent tracheostomy. Tracheostomy was performed percutaneously in 51 patients, open in 24, and hybrid in 21. 28 patients had postprocedure bleeding which was from the tracheostomy site in 13, the airway in 13, and both in 2. 6 patients had major tracheostomy site bleeding and 3 patients had major airway bleeding. 7 patients had minor tracheostomy site bleeding, 10 patients had minor airway bleeding, and 2 patients had minor bleeding at both. Bleeding complications were more common following percutaneous tracheostomy. Being on anticoagulation prior to tracheostomy was protective.

Discussion

Bleeding following tracheostomy in VV-ECMO is common with higher bleeding rates observed for those done percutaneously. Most complications were minor. Tracheostomy in patients on VV-ECMO appears safe
Evidence Supporting the Value of Surgical Procedures: Can We Do Better?
Authors: Darrow Jonathan J. , Robertson Christopher T. , Kasoff Willard S.
Published: December 2020

There is an acknowledged need for higher-quality evidence to quantify the benefit of surgical procedures, yet not enough has been done to improve the evidence base. This lack of evidence can prevent fully informed decision-making, lead to unnecessary or even harmful treatment, and contribute to wasteful expenditures of scare health care resources. Barriers to evidence generation include not only the long-recognized technical difficulties and ethical challenges of conducting randomized surgical trials, but also legal challenges that limit incentives to conduct surgical research as well as market-based challenges that make it difficult for those funding surgical research to recoup investment costs. These legal and market dynamics differ substantially from those surrounding new drug or device development. Nevertheless, obstacles could be overcome and overall expenditures could be reduced if a share of federal health care agency budgets were reallocated to generating randomized trial data, standardizing outcome measures, and conducting observational studies analogous to those that have been facilitated for drugs via the Food and Drug Administration’s Sentinel Initiative. Until better quality evidence is available, ethical principles require adequate disclosure of the limited evidence base supporting current surgical procedures.
On the Impact of Case and Prosody on Thematic Role Disambiguation: An Eye-Tracking Study on Hungarian
Authors: Müller Gábor , Bodnár Emese , Skopeteas Stavros , Kröger Julia Marina
Published: December 2020

Thematic-role assignment is influenced by several classes of cues during sentence comprehension, ranging from morphological exponents of syntactic relation such as case and agreement to probabilistic cues such as prosody. The effect of these cues cross-linguistically varies, presumably reflecting their language-specific robustness in signaling thematic roles. However, language-specific frequencies are not mapped onto the cue strength in a one-to-one fashion. The present article reports two eye-tracking studies on Hungarian examining the interaction of case and prosody during the processing of case-unambiguous (Experiment 1) and case-ambiguous (Experiment 2) clauses. Eye fixations reveal that case is a strong cue for thematic role assignment, but stress only enhances the effect of case in case-unambiguous clauses. This result differs from findings reported for Italian and German in which case initial stress reduces the expectation for subject-first clauses. Furthermore, the sentence comprehension facts are not explained by corpus frequencies in Hungarian. After considering an array of hypotheses about the roots of cross-linguistic variation, we conclude that the crucial difference lies in the high reliability/availability of case cues in Hungarian in contrast to the further languages examined within this experimental paradigm.
Protocol of a Multi-centric Randomized Controlled Trial to Evaluate Efficacy of Telephone-Based Psychosocial Interventions on Future Suicide Risk in Suicide Attempters
Authors: Beniwal Ram Pratap , Sreedaran Priya , Chari Uttara , Ashok MV  , Bhatia Triptish
Published: December 2020

Background:

Persons with previous history of a suicide attempt are at increased future risk of death by suicide. These vulnerable individuals, however, do not seek receive or seek help from mental health services. Telephone-based psychosocial interventions are potential strategies in augmenting mental health care in such persons.

Methods:

We aim to compare the efficacy of telephone-based psychosocial interventions (TBPI) with routine telephone reminders in persons with recent suicide attempts using a multi-site, parallel group, rater-blind, two-arm randomized controlled trial design in 362 participants. In the first group, participants will receive three sessions of TBPI comprising of brief supportive interventions, problem-solving strategies, and reminders for adherence to prescribed mental health treatment at weekly intervals. In the second group, participants will receive three telephone reminders for adherence to prescribed mental health treatment at weekly intervals. We will follow up participants for 6 months. Primary outcomes are suicidal ideation scores on Beck’s Scale for Suicide Ideation and number of repeat suicide attempts. Secondary outcomes are scores on Beck’s Hopelessness Scale, Beck’s Depression Inventory, Connor–Davidson Resilience Scale and Visual Analogue Rating Scales for acceptability of interventions. Outcomes will be assessed at 1, 3, and 6 months after receiving telephone interventions or reminders.

Results:

The trial is currently underway after prospective registration under Clinical Trials Registry of India and has recruited 260 participants till August 15, 2020.

Conclusion:

This study has potential to generate evidence on additional strategies for use along with standard mental health treatments in management of high-risk suicide behaviors.
Challenges of Building, Deploying, and Using AI-Enabled Telepsychiatry Platforms for Clinical Practice Among Urban Indians: A Qualitative Study
Authors: Thenral M  , Annamalai Arunkumar
Published: December 2020

Background:

Published literature shows the overall challenges associated with artificial intelligence (AI)-enabled medicine and telepsychiatry more from the western perspective, with no specific mention from the perspective of individual stakeholders or Indians. This study was conceptualized to understand the perceived challenges of building, deploying, and using AI-enabled telepsychiatry for clinical practice from the perspectives of psychiatrist, patients, and the technology experts (who build such services) in urban India.

Methods:

Between February 2020 and April 2020, a semistructured topic guide was drafted for qualitative exploratory study among psychiatrists ( n = 14), their patients ( n = 14), technology experts ( n = 13), and Chief Executive Officers (CEOs) ( n = 5) of health technology incubation centers. Interviews were conducted over the phone, recorded, and analyzed using the grounded theory approach.

Results:

Almost all respondents cited ethical, legal, accountability, and regulatory implications as challenges. The major issues stated by patients were privacy/confidentiality, ethical violations, security/ hacking, and data ownership. Psychiatrists cited lack of clinical validation, lack of established studies or trials, iatrogenic risk, and healthcare infrastructure issues as the main challenges. Technology experts stated data-related issues as the major challenge. The CEOs quoted the lack of interdisciplinary experts as one of the main challenges in building deployable AI-enabled telepsychiatry in India.

Conclusions:

There are challenges to deploy an AI-enabled telepsychiatry platform in India. There is a need to constitute an interdisciplinary team to systematically address these challenges. Deployment of AI-enabled telepsychiatry is not possible without clinical validation and addressing current challenges.
Effectiveness and implementation of palliative care interventions for patients with chronic obstructive pulmonary disease: A systematic review
Authors: Broese Johanna MC , de Heij Albert H , Janssen Daisy JA , Skora Julia A , Kerstjens Huib AM , Chavannes Niels H , Engels Yvonne , van der Kleij Rianne MJJ
Published: December 2020

Background:

Although guidelines recommend palliative care for patients with chronic obstructive pulmonary disease, there is little evidence for the effectiveness of palliative care interventions for this patient group specifically.

Aim:

To describe the characteristics of palliative care interventions for patients with COPD and their informal caregivers and review the available evidence on effectiveness and implementation outcomes.

Design:

Systematic review and narrative synthesis (PROSPERO CRD42017079962).

Data sources:

Seven databases were searched for articles reporting on multi-component palliative care interventions for study populations containing ⩾30% patients with COPD. Quantitative as well as qualitative and mixed-method studies were included. Intervention characteristics, effect outcomes, implementation outcomes and barriers and facilitators for successful implementation were extracted and synthesized qualitatively.

Results:

Thirty-one articles reporting on twenty unique interventions were included. Only four interventions (20%) were evaluated in an adequately powered controlled trial. Most interventions comprised of longitudinal palliative care, including care coordination and comprehensive needs assessments. Results on effectiveness were mixed and inconclusive. The feasibility level varied and was context-dependent. Acceptability of the interventions was high; having someone to call for support and education about breathlessness were most valued characteristics. Most frequently named barriers were uncertainty about the timing of referral due to the unpredictable disease trajectory (referrers), time availability (providers) and accessibility (patients).

Conclusion:

Little high-quality evidence is yet available on the effectiveness and implementation of palliative care interventions for patients with COPD. There is a need for well-conducted effectiveness studies and adequate process evaluations using standardized methodologies to create higher-level evidence and inform successful implementation.
Transient visual blurring during a sexual intercourse in a young woman with surgically corrected myopia and unrecognized pigmentary glaucoma: A rare case report
Authors: Cozzupoli G. M. , Salgarello T. , Giudiceandrea A. , Rizzo S.
Published: December 2020

Purpose:

To present a rare case of unilateral visual loss episodes occurred during sexual intercourse in a young patient affected by unrecognized pigmentary glaucoma and previously undergone myopic refractive surgery.

Case description:

The patient presented surgically flattened corneas and markedly asymmetric pigmentary glaucoma.

Conclusions:

Previous refractive surgery, sexual intercourse, and athletic lifestyle might be risk factors for acute pigment dispersion and chronic progression of pigmentary glaucoma in young myopic patients. During their ophthalmic examination prior to refractive surgery, greater attention should be paid to detect early signs of pigmentary dispersion, and awareness of these dangerous situations should be raised in affected patients.
Intraocular lens power calculation formula accuracy: Comparison of 12 formulas for a trifocal hydrophilic intraocular lens
Authors: Rocha-de-Lossada Carlos , Colmenero-Reina Elvira , Flikier David , Castro-Alonso Francisco-Javier , Rodriguez-Raton Alvaro , García-Madrona Jose-Luis , Peraza-Nieves Jorge , Sánchez-González José-María
Published: December 2020

Purpose:

To evaluate the accuracy of 12 intraocular lens (IOL) power formulas; Barrett Universal II, Emmetropia Verifying Optical (EVO), Haigis, Hill-Radial Basis Function (RBF), Hoffer Q, Holladay I, Kane, Ladas Super Formula, Olsen Lenstar, Panacea, Pearl-DGS, Sanders-Retzlaff-Kraff/theoretical (SRK/T). In addition, an analysis of the efficacy as a function of the axial length was performed.

Methods:

About 171 from 93 patients: 68 male eyes and 103 female eyes. Twelve IOL power formula calculations were studied with one IOL platform (trifocal hydrophilic IOL, FineVision Micro F), one biometer (Lenstar LS 900), one topographer (CSO Sirius Topographer), one surgeon, and one optometrist. Optimization were determined to be zeroed mean refractive prediction error. Mean error (ME), mean absolute error (MAE), median absolute error (MedAE) and refractive accuracy within ±1.00 D was calculated. Axial length was split in short and medium eyes.

Results:

One hundred and seventy eyes were included. Formulas were ranked by percentage within ±0.50 diopters and MAE (D). Among all eyes, Olsen 86.55% (0.273 D) and Barrett Universal II 86.55% (0.285D). For short eyes (<22.5 mm), Olsen 90.70% (0.273 D) and Kane 90.70% (0.225 D). For medium eyes, Barrett 89.34% (0.237 D) and Pearl 86.89% (0.263 D).

Conclusion:

Olsen and Barrett formula obtained excellent accuracy for overall eyes. Kane and Olsen formula obtained the best results in short eyes. For medium axial length Barrett formula achieved the best accuracy results.
Nonlinear dynamic characteristics and control of planar linear array deployable structures consisting of scissor-like elements with revolute clearance joint
Authors: Li Bo , Wang San-Min , Gantes Charis J , Tan U-Xuan
Published: December 2020

This paper comprehensively deals with the parametric effects of the joint clearance and friction coefficient on the dynamics of planar deployable structures consisting of scissor-like elements (SLEs). The dynamic model for scissor deployable structure is based on a comprehensive consideration of the symmetry and array characteristics of this mechanism and on a Lagrange method, which represents the motion equations. A modified nonlinear contact-force model is employed to evaluate the intrajoint contact force, and the incorporation of the friction effect between the inter-connecting bodies is included in this study. The total impact forces produced in the real mechanical joint are embedded into the dynamics and the differential equations of motion are solved numerically based on a set of initial conditions. The clearance size, angle velocity, and friction coefficient are analyzed and discussed separately. Using Poincaré map, the regular and irregular responses of the deployable mulitibody systems are observed. Next, a control scheme is evaluated to maintain a more stable behavior and continuous contact between the clearance joints. The controlled results are compared with those without control, concluding that some undesired effects caused by the clearance joints can be prevented or reduced, resulting in continuous contact at the clearance joint.
Feasibility and flexural behavior of RC beams prestressed with straight unbonded aluminum alloy tendons
Authors: Chang Zhaoqun , Xing Guohua , Zhao Jiahua , Huang Jiao
Published: December 2020

This paper investigates the feasibility and flexural behavior of reinforced concrete beams internally prestressed with straight unbonded aluminum alloy tendons by testing five partially prestressed beams and one reference beam. For each beam specimen, load-deflection curves, failure modes and cracking behavior, the relationship between load and strains in steel and prestressing aluminum alloy tendons were examined and analyzed. In particular, the effects of effective prestress, combined reinforcement index (CRI), and partial prestressing ratio (PPR) on flexure of concrete beams were discussed. The test results indicated that the spacing and width of concrete cracks of prestressed beams containing the same amount of bonded longitudinal steel reinforcement decreased with the increase of effective prestress, and the combined reinforcement index governs flexural behavior of the prestressed beams. The flexural crack width and displacement ductility exhibited a reduction with the increase of CRI. In addition, an analytical model was established to calculate the flexural strength and corresponding deflection at midspan of the concrete beams internally prestressed with unbonded aluminum alloy tendons by suggesting a new simplified curvature distribution, which is more accordant with the original curvature distribution. The proposed model provides a relatively good estimation of the flexural capacity and midspan deflection of the prestressed beams.
The interplay between leisure, friendship, and dementia
Authors: Fortune Darla , Whyte Colleen , Genoe Rebecca
Published: December 2020

The ways in which friends behave can greatly influence the experience of living with dementia. For example, previous research has highlighted the negative implications that dwindling friendships have on one’s leisure engagement after a diagnosis of dementia. In this study, we share findings from a study that highlights the interplay between leisure, friendship, and dementia to demonstrate the complementary relationship that can exist. Specifically, we describe ways friendship can be a bridge to maintaining leisure engagement and how leisure can, in turn, support the maintenance of friendships for individuals with dementia. Data were gathered through individual, dyad, and group interviews conducted with individuals with dementia and their friends and family. Our findings have implications for friends of individuals with dementia who may be searching for ways to support the continuation of mutually enjoyable leisure experiences. Findings also have implications for the ways leisure providers can more fully attend to the relational needs of individuals with dementia in order to help support their continued friendships.
Agitation Techniques to Enhance Drainage of Retained Hemothorax
Authors: Makey Ian A. , Das Nitin A. , Jacob Samuel , El-Sayed Ahmed Magdy M. , Makey Colleen M. , Johnson Scott B. , Thomas Mathew
Published: December 2020

Background. Retained hemothorax (RH) is a common problem in cardiothoracic and trauma surgery. We aimed to determine the optimum agitation technique to enhance thrombus dissolution and drainage and to apply the technique to a porcine-retained hemothorax. Methods. Three agitation techniques were tested: flush irrigation, ultrasound, and vibration. We used the techniques in a benchtop model with tissue plasminogen activator (tPA) and pig hemothorax with tPA. We used the most promising technique vibration in a pig hemothorax without tPA. Statistics. We used 2-sample t tests for each comparison and Cohen d tests to calculate effect size (ES). Results. In the benchtop model, mean drainages in the agitation group and control group and the ES were flush irrigation, 42%, 28%, and 2.91 ( P = .10); ultrasound, 35%, 27%, and .76 ( P = .30); and vibration, 28%, 19%, and 1.14 ( P = .04). In the pig hemothorax with tPA, mean drainages and the ES of each agitation technique compared with control (58%) were flush irrigation, 80% and 1.14 ( P = .37); ultrasound, 80% and 2.11 ( P = .17); and vibration, 95% and 3.98 ( P = .06). In the pig hemothorax model without tPA, mean drainages of the vibration technique and control group were 50% and 43% (ES = .29; P = .65). Discussion. In vitro studies suggested flush irrigation had the greatest effect, whereas only vibration was significantly different vs the respective controls. In vivo with tPA, vibration showed promising but not statistically significant results. Results of in vivo experiments without tPA were negative. Conclusion. Agitation techniques, in combination with tPA, may enhance drainage of hemothorax.
Cubital tunnel syndrome with small occult ganglion: A case report of bike rider
Authors: Kuboi Takuro , Tajika Tsuyoshi , Endo Fumitaka , Hatori Yuhei , Saida Ryuta , Chikuda Hirotaka
Published: December 2020

Cubital tunnel syndrome, the second-most common peripheral compression neuropathy, is associated with dynamic pressure in the cubital tunnel with the elbow flexion position. Medial elbow ganglion originated from the ulnohumeral joint causing cubital tunnel syndrome has been reported. This report describes the case of a 48-year-old man who developed numbness in his left ring and little finger after prolonged motorbike touring. He gradually showed decreased hand grip strength with medial elbow joint pain. Ultrasonography and magnetic resonance images revealed small occult ganglion at the medial side of elbow joint. Surgical resection of ganglion and ulnar nerve decompression relieved the ulnar neuropathy symptom. Prolonged motorbike riding while maintaining the elbow flexion position might exacerbate the symptom of cubital tunnel syndrome in patients with even a small space-occupying lesion such as the small occult ganglion.
How Do Partisans Consume News on Social Media? A Comparison of Self-Reports With Digital Trace Measures Among Twitter Users
Authors: Shin Jieun
Published: December 2020

There are growing concerns that social media exacerbates the selective exposure of audience members to content that supports their political views. However, despite the hype, the existing literature does not fully address the extent to which social media users selectively consume like-minded news stories, in part due to different methodologies. In an attempt to move toward a common framework, this study examined the partisan selective exposure of a representative sample of Twitter users by combining survey data with digital trace data. Specifically, the study linked survey responses ( n = 558) from Twitter users with their media following and exposure to news via their friends. The study found that selectivity bias was present in all types of data, including self-reported media consumption (survey), media following (Twitter), and indirect exposure to media (Twitter). However, the study found some differences between self-reports and digital measures such that the overlaps in media diets between partisan groups were much larger based on the digital trace data than the self-reported data. In addition, the study observed an asymmetric pattern of selective exposure between conservatives and liberals in the digital trace data, but not in the self-reported data. The implications of these findings are discussed with reference to the contemporary news environment, hostile media effects, and normative assumptions of selective exposure.
Biomagnification of ionizable organic compounds in rainbow trout Oncorhynchus mykiss
Authors: Mueller Carolin , Trapp Stefan , Polesel Fabio , Kuehr Sebastian , Schlechtriem Christian
Published: December 2020

Background

The assessment of persistence, bioaccumulation and toxicity (PBT) is part of the regulation process of ionic organic compounds (IOCs) and a major challenge, as a commonly acknowledged approach for the estimation of the bioaccumulation potential of IOCs is still missing. The goal of the present study was, therefore, to experimentally determine the bioaccumulation of fully ionized compounds and to identify screening parameters that can indicate high bioaccumulation potential of IOCs. Three feeding studies with rainbow trout (Oncorhynchus mykiss) were carried out according to OECD TG 305. Separation of liver, gastrointestinal tract (GIT) and carcass allowed to further elucidate the tissue distribution of the individual test substances. The chemicals chosen had characteristics that made them suspect for high bioaccumulation, and included two cations (tetrabutylphosphonium bromide (TBP), trimethyloctadecyl ammonium chloride (TMOA)) and four anions (benzotriazole, tecloftalam, pentachlorophenol (PCP), MEE-phosphonate). Data on the dietary biomagnification of IOCs (strong acids) were also collected from published literature.

Results

The highest distribution factors were found for the GIT, followed by liver. However, none of the tested IOCs showed a distinct biomagnification potential, as kinetic biomagnification factors (BMFk) ranged between 0.001 and 0.05 g/g (median 0.009 g/g). Cations showed lower assimilation efficiency (α) than anions, except for tecloftalam. In contrast, anions showed a considerably faster depuration rate (half-life less than 0.5 days) compared to cations (half-life of around 5 days). Sixteen potential screening parameters for BMF were calculated with a chemical property estimation tool (ACD/i-Lab) and correlated with the BMF data from this study and from literature. The number of hydrogen bond donors (nHBD) showed the highest correlation to measured BMF, but the prediction is only based on two values (one or two nHBD), while the other descriptors were insignificantly correlated.

Conclusion

The suspected dietary bioaccumulation potential of the six IOCs could not be confirmed in the feeding studies with rainbow trout. The more than twenty screening parameters showed no particularly high correlation neither with the test results nor with the BMF values collected from literature. The results corroborate earlier findings that ionization lowers the tendency of a chemical for dietary bioaccumulation, compared to non-ionized chemicals. In addition to the lipophobicity of ionic molecule moieties, fast depuration seems to be a major reason for the observed low dietary bioaccumulation of ionic compounds, in particular anions. Fast depuration may happen due to rapid metabolism of charged compounds, and future studies should test this hypothesis.
Heterologous expression of the atypical tetracycline chelocardin reveals the full set of genes required for its biosynthesis
Authors: Lukežič Tadeja , Pikl Špela , Zaburannyi Nestor , Remškar Maja , Petković Hrvoje , Müller Rolf
Published: December 2020

Background

Chelocardin (CHD) exhibits a broad-spectrum antibiotic activity and showed promising results in a small phase II clinical study conducted on patients with urinary tract infections. Importantly, CHD was shown to be active also against tetracycline-resistant Gram-negative pathogens, which is gaining even more importance in today’s antibiotic crisis. We have demonstrated that modifications of CHD through genetic engineering of its producer, the actinomycete Amycolatopsis sulphurea, are not only possible but yielded even more potent antibiotics than CHD itself, like 2-carboxamido-2-deacetyl-chelocardin (CD-CHD), which is currently in preclinical evaluation. A. sulphurea is difficult to genetically manipulate and therefore manipulation of the chd biosynthetic gene cluster in a genetically amenable heterologous host would be of high importance for further drug-discovery efforts.

Results

We report heterologous expression of the CHD biosynthetic gene cluster in the model organism Streptomyces albus del14 strain. Unexpectedly, we found that the originally defined CHD gene cluster fails to provide all genes required for CHD formation, including an additional cyclase and two regulatory genes. Overexpression of the putative pathway-specific streptomyces antibiotic regulatory protein chdB in A. sulphurea resulted in an increase of both, CHD and CD-CHD production. Applying a metabolic-engineering approach, it was also possible to generate the potent CHD analogue, CD-CHD in S. albus. Finally, an additional yield increase was achieved in S. albus del14 by in-trans overexpression of the chdR exporter gene, which provides resistance to CHD and CDCHD.

Conclusions

We identified previously unknown genes in the CHD cluster, which were shown to be essential for chelocardin biosynthesis by expression of the full biosynthetic gene cluster in S. albus as heterologous host. When comparing to oxytetracycline biosynthesis, we observed that the CHD gene cluster contains additional enzymes not found in gene clusters encoding the biosynthesis of typical tetracyclines (such as oxytetracycline). This finding probably explains the different chemistries and modes of action, which make CHD/CD-CHD valuable lead structures for clinical candidates. Even though the CHD genes are derived from a rare actinomycete A. sulphurea, the yield of CHD in the heterologous host was very good. The corrected nucleotide sequence of the CHD gene cluster now contains all gene products required for the production of CHD in a genetically amenable heterologous host, thus opening new possibilities towards production of novel and potent tetracycline analogues with a new mode of action.
Correction to: Inducible expression of heat shock protein 20 protects airway epithelial cells against oxidative injury involving the Nrf2-NQO-1 pathway
Authors: Bao Aihua , Ma Aying , Zhang Hui , Qiao Lihua , Ben Suqin , Zhou Xin , Zhang Min
Published: December 2020

An amendment to this paper has been published and can be accessed via the original article.
The reversal of human phylogeny: Homo left Africa as erectus, came back as sapiens sapiens
Authors: Árnason Úlfur , Hallström Björn
Published: December 2020

Background

The molecular out of Africa hypothesis, OOAH, has been considered as an established fact amid population geneticists for some 25–30 years despite the early concern with it among phylogeneticists with experience beyond that ofHomo. The palaeontological support for the hypothesis is also questionable, a circumstance that in the light of expanding Eurasian palaeontological knowledge has become accentuated through the last decades.

Results

The direction of evolution in the phylogenetic tree of modern humans (Homo sapiens sapiens,Hss) was established inter alia by applying progressive phylogenetic analysis to an mtDNA sampling that included a Eurasian, Lund, and the African Mbuti, San and Yoruba. The examination identified the African populations as paraphyletic, thereby compromising the OOAH. The finding, which was consistent with the out of Eurasia hypothesis, OOEH, was corroborated by the mtDNA introgression fromHssintoHsnn(Neanderthals) that demonstrated the temporal and physical Eurasian coexistence of the two lineages. The results are consistent with the palaeontologically established presence ofH. erectusin Eurasia, a Eurasian divergence betweenH. sapiensandH. antecessor≈ 850,000 YBP, anHsdivergence betweenHssandHsn(Neanderthals + Denisovans) ≈ 800,000 YBP, an mtDNA introgression fromHssintoHsnn* ≈ 500,000 YBP and an Eurasian divergence among the ancestors of extantHss≈ 250,000 YBP at the exodus of Mbuti/San into Africa.

Conclusions

The present study showed that Eurasia was not the receiver but the donor inHssevolution. The findings thatHomoleft Africa aserectusand returned assapiens sapiensconstitute a change in the understanding ofHsevolution to one that conforms to the extensive Eurasian record ofHspalaeontology and archaeology.
Rapid Sequence Induction With a Standard Intubation Dose of Rocuronium After Magnesium Pretreatment Compared With Succinylcholine: A Randomized Clinical Trial
Authors: Czarnetzki Christoph , Albrecht Eric , Masouyé Philippe , Baeriswyl Moira , Poncet Antoine , Robin Matthias , Kern Christian , Tramèr Martin R.
Published: December 2020

BACKGROUND:

Succinylcholine remains the muscle relaxant of choice for rapid sequence induction (RSI) but has many adverse effects. High-dose rocuronium bromide may be an alternative to succinylcholine for RSI but recovery times are nearly doubled compared with a standard intubating dose of rocuronium. Magnesium sulfate significantly shortens the onset time of a standard intubating dose of rocuronium. We set out to investigate whether intravenous (IV) pretreatment with MgSO4 followed by a standard intubating dose of rocuronium achieved superior intubation conditions compared with succinylcholine.

METHODS:

Adults were randomized to receive a 15-minute IV infusion of MgSO4 (60 mg·kg–1) immediately before RSI with propofol 2 mg·kg–1, sufentanil 0.2 μg·kg–
1 and rocuronium 0.6 mg·kg–1, or a matching 15-minute IV infusion of saline immediately before an identical RSI, but with succinylcholine 1 mg·kg–1. Primary end point was the rate of excellent intubating conditions 60 seconds after administration of the neuromuscular blocking agent and compared between groups using multivariable log-binomial regression model. Secondary end points were blood pressure and heart rate before induction, before and after intubation, and adverse events up to 24 hours postoperatively.

RESULTS:

Among 280 randomized patients, intubating conditions could be analyzed in 259 (133 MgSO4-rocuronium and 126 saline-succinylcholine). The rate of excellent intubating conditions was 46% with MgSO4-rocuronium and 45% with saline-succinylcholine. The analysis adjusted for gender and center showed no superiority of MgSO4-rocuronium compared with saline-succinylcholine (relative risk [RR] 1.06, 95% confidence interval [CI], 0.81-1.39, P = .659). The rate of excellent intubating conditions was higher in women (54% [70 of 130]) compared with men (37% [48 of 129]; adjusted RR 1.42, 95% CI, 1.07-1.91, P = .017). No significant difference between groups was observed for systolic and diastolic blood pressures. Mean heart rate was significantly higher in the MgSO4-rocuronium group. The percentage of patients with at least 1 adverse event was lower with MgSO4-rocuronium (11%) compared with saline-succinylcholine (28%) (RR 0.38, 95% CI, 0.22-0.66, P < .001). With saline-succinylcholine, adverse events consisted mainly of postoperative muscle pain (n = 26 [19%]) and signs of histamine release (n = 13 [9%]). With MgSO4-rocuronium, few patients had pain on injection, nausea and vomiting, or skin rash during the MgSO4-infusion (n = 5 [4%]).

CONCLUSIONS:

IV pretreatment with MgSO4 followed by a standard intubating dose of rocuronium did not provide superior intubation conditions to succinylcholine but had fewer adverse effects.
Intraoperative Focused Cardiac Ultrasound for Assessment of Hypotension: A Systematic Review
Authors: Navas-Blanco Jose R. , Louro Jack , Reynolds John , Epstein Richard H. , Dudaryk Roman
Published: December 2020

Focused cardiac ultrasound (FoCUS) has become a valuable tool to assess unexplained hypotension in critically ill patients. Due to increasing availability of transthoracic echocardiography (TTE) equipment in the operating room, there is a widespread interest in its usefulness for intraoperative diagnosis of hypotension as an alternative to transesophageal echocardiography (TEE). The objective of this systematic review is to evaluate the utility of intraoperative FoCUS to assess patients experiencing unexplained hypotension while undergoing noncardiac surgery. We performed a systematic literature search of multiple publication databases for studies that evaluated the utility of intraoperative FoCUS for assessment and management of unexplained hypotension in patients undergoing noncardiac surgery, including retro- and prospective clinical studies. A summary of the study findings, study quality, and assessment of level of evidence is presented. We identified 2227 unique articles from the literature search, of which 27 were potentially relevant, and 9 were included in this review. The number of patients pooled from these studies was 255, of whom 228 had intraoperative diagnoses with the aid of intraoperative FoCUS. The level of evidence of all studies included was very low according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines. This systematic review has demonstrated that FoCUS may be a useful, noninvasive method to differentiate causes of intraoperative hypotension and guide correcting interventions, although the quality of evidence is very low. Further prospective high-quality studies are needed to investigate whether intraoperative FoCUS has a diagnostic utility that is associated with improved outcomes.
Comparison of confocal and non-confocal split-detection cone photoreceptor imaging
Authors: Sredar Nripun , Razeen Moataz , Kowalski Bartlomiej , Carroll Joseph , Dubra Alfredo
Published: December 2020

Quadrant reflectance confocal and non-confocal scanning light ophthalmoscope images of the photoreceptor mosaic were recorded in a subject with congenital achromatopsia (ACHM) and a normal control. These images, captured with various circular and annular apertures, were used to calculate split-detection images, revealing two cone photoreceptor contrast mechanisms. The first contrast mechanism, maximal in the non-confocal 5.5-10 Airy disk diameter annular region, is unrelated to the cone reflectivity in confocal or flood illumination imaging. The second mechanism, maximal for confocal split-detection, is related to the cone reflectivity in confocal or flood illumination imaging that originates from the ellipsoid zone and/or inner-outer segment junction. Seeking to maximize image contrast, split-detection images were generated using various quadrant detector combinations, with opposite (diagonal) quadrant detectors producing the highest contrast. Split-detection generated with the addition of adjacent quadrant detector pairs, shows lower contrast, while azimuthal split-detection images, calculated from adjacent quadrant detectors, showed the lowest contrast. Finally, the integration of image pairs with orthogonal split directions was used to produce images in which the photoreceptor contrast does not change with direction.
Measurement of the permanent electric dipole moment of ultracold ground state 85Rb133Cs molecules by microwave coherent spectroscopy
Authors: Gong Ting , Ji Zhonghua , Du Jiaqi , Zhao Yanting , Xiao Liantuan , Jia Suotang
Published: December 2020

We demonstrate measurement of the permanent electric dipole moment (EDM) of 85Rb133Cs molecules in the absolute vibrational ground state by microwave (MW) coherent spectroscopy. The rotational states of the considered molecules, which are formed from short-range photoassociation of mixed cold atoms, are nondegenerated under external electric field. To measure the EDM based on electric-field-induced shifts of the sublevels of X1Σ+(v = 0, J = 1) rotational state, we utilized a MW coherent spectroscopy, which has a higher resolution than depletion spectroscopy and one-photon MW spectroscopy and can also eliminate the influence from Stark shift of the excited state existing in both spectroscopies above. In order to acquire accurate electric intensity, electromagnetic induced transparency spectroscopy of 85Rb Rydberg atoms is used to implement the calibration. The permanent EDM of 85Rb133Cs molecules is finally determined to be 1.266(15) D, which agrees with the theoretical calculations and is comparable with the value of its isotopic molecule.
Hydrogen isotopic analysis of nuclear reactor materials using ultrafast laser-induced breakdown spectroscopy
Authors: Kautz E. J. , Devaraj A. , Senor D. J. , Harilal S. S.
Published: December 2020

Laser-induced breakdown spectroscopy is a promising method for rapidly measuring hydrogen and its isotopes, critical to a wide range of disciplines (e.g. nuclear energy, hydrogen storage). However, line broadening can hinder the ability to detect finely spaced isotopic shifts. Here, the effects of varying plasma generation conditions (nanosecond versus femtosecond laser ablation) and ambient environments (argon versus helium gas) on spectral features generated from Zircaloy-4 targets with varying hydrogen isotopic compositions were studied. Time-resolved 2D spectral imaging was employed to detail the spatial distribution of species throughout plasma evolution. Results highlight that hydrogen and deuterium isotopic shifts can be measured with minimal spectral broadening in a ∼ 10 Torr helium gas environment using ultrafast laser-produced plasmas.
RESPONSABILIDADE CIVIL DO ESTADO EM TEMPOS DE COVID-19: BREVES CONSIDERAÇÕES A LUZ DAS RECOMENDAÇÕES DA ORGANIZAÇÃO MUNDIAL DA SAÚDE E SOB A ÓTICA CONSTITUCIONAL MODERNA DOS DIREITOS E GARANTIAS FUNDAMENTAIS
Authors: De Souza Junior Jarbas Paula
Published: December 2020

A presente pesquisa tem como objeto de estudo o atual cenário de calamidade global instaurado pela Pandemia Covid-19, especialmente no que condiz a possibilidade de responsabilização civil do Estado brasileiro por omissão, em decorrência da relativização das recomendações da Organização Mundial da Saúde (OMS). Partindo-se de premissas gerais, sem a intenção de exaurir-se o assunto, serão analisadas e identificadas as características constitutivas básicas da Organização Mundial da Saúde, suas atribuições, bem como a força vinculante de subordinação às suas orientações. Além do mais, examinar-se-á a responsabilidade civil do Estado sob a ótica constitucional da eficácia direta e imediata dos direitos fundamentais, em suas obrigações negativas e em suas dimensões prestacionais, vez tratar-se à saúde de uma prestação constitucionalmente indispensável à proteção do ser humano, restando desautorizados excessos e omissões.PALAVRAS-CHAVE: Covid-19; OMS; Dever de proteção; Responsabilidade civil estatal.
O TRANSCONSTITUCIONALISMO COMO UMA ALTERNATIVA PARA A PROBLEMÁTICA AMBIENTAL NAS SOCIEDADES MODERNAS
Authors: Dallacort Luis Ângelo , Faverzani da Luz Ariane , Pilau Sobrinho Liton Lanes
Published: December 2020

O presente estudo tem como objetivo analisar o fenômeno do transconstitucionalismo como forma de solução de demandas ambientais. Para isso, a pesquisa aborda conceitos sobre globalização e sociedades modernas. Também, abarca a questão ambiental no tocante à utilização de recursos naturais de maneira descontrolada e como essas ações comprometem o futuro da humanidade. Por fim, trata sobre o transconstitucionalismo como solução das problemáticas ambientais. Assim, utilizando-se do escopo teórico-bibliográfico e do método hipotético-dedutivo, os resultados obtidos indicaram a importância do diálogo entre distintos âmbitos jurídicos para a efetivação da conscientização universal em busca de uma sociedade mais equilibrada e sustentável.PALAVRAS-CHAVE: Globalização; Meio Ambiente; Sustentatiblidade; Transconstitucionalismo.