bluuebunny/crossref_metadata_2025 huggingface dataset:
Allopatric and Sympatric Drivers of Speciation inAlviniconchaHydrothermal Vent Snails
Authors: Breusing Corinna , Johnson Shannon B , Tunnicliffe Verena , Clague David A , Vrijenhoek Robert C , Beinart Roxanne A
Published: July 2020

Despite significant advances in our understanding of speciation in the marine environment, the mechanisms underlying evolutionary diversification in deep-sea habitats remain poorly investigated. Here, we used multigene molecular clocks and population genetic inferences to examine processes that led to the emergence of the six extant lineages of Alviniconcha snails, a key taxon inhabiting deep-sea hydrothermal vents in the Indo-Pacific Ocean. We show that both allopatric divergence through historical vicariance and ecological isolation due to niche segregation contributed to speciation in this genus. The split between the two major Alviniconcha clades (separating A. boucheti and A. marisindica from A. kojimai, A. hessleri, and A. strummeri) probably resulted from tectonic processes leading to geographic separation, whereas the splits between co-occurring species might have been influenced by ecological factors, such as the availability of specific chemosynthetic symbionts. Phylogenetic origin of the sixth species, Alviniconcha adamantis, remains uncertain, although its sister position to other extant Alviniconcha lineages indicates a possible ancestral relationship. This study lays a foundation for future genomic studies aimed at deciphering the roles of local adaptation, reproductive biology, and host–symbiont compatibility in speciation of these vent-restricted snails.
Unconventional Hall effect induced by Berry curvature
Authors: Ge Jun , Ma Da , Liu Yanzhao , Wang Huichao , Li Yanan , Luo Jiawei , Luo Tianchuang , Xing Ying , Yan Jiaqiang , Mandrus David , Liu Haiwen , Xie X C , Wang Jian
Published: July 2020

Berry phase and Berry curvature play a key role in the development of topology in physics and do contribute to the transport properties in solid state systems. In this paper, we report the finding of novel nonzero Hall effect in topological material ZrTe5 flakes when the in-plane magnetic field is parallel and perpendicular to the current. Surprisingly, both symmetric and antisymmetric components with respect to magnetic field are detected in the in-plane Hall resistivity. Further theoretical analysis suggests that the magnetotransport properties originate from the anomalous velocity induced by Berry curvature in a tilted Weyl semimetal. Our work not only enriches the Hall family but also provides new insights into the Berry phase effect in topological materials.
Property Systems and Economic Growth in Japan, 730–1874
Authors: NAKABAYASHI Masaki , FUKAO Kyoji , TAKASHIMA Masanori , NAKAMURA Naofumi
Published: July 2020

New estimates on the premodern economic growth of Japan, based on more concrete evidence, have been presented. We revise the estimates of Japan’s gross domestic product (GDP) from the mid-eighth century to the mid-19th century and its population in the 12th century and describe the institutional transformations that correspond to the output changes. The revision of output and population results in updated estimates of per capita GDP for the medieval period and extension of the growth estimates in the early modern period to the annual series for 1651–1841. This study employs the techniques of quantitative inference and descriptive interpretation of the estimated performance. The findings show that: (a) Both the GDP and population significantly declined towards the 12th century, stagnated and experienced recovery from the 13th century onwards, and then continued to grow through the 17th century; (b) GDP growth accelerated in the 18th and 19th centuries; and (c) per capita GDP growth began to rise in the 13th century after a sharp decline from the 10th to 12th centuries. It continued to rise through the 16th century but declined again in the mid-17th century and finally rose again from the late 17th century onwards.
Benefit and Risk Evaluation of Biased μ-Receptor Agonist Oliceridine versus Morphine
Authors: Dahan Albert , van Dam C. Jan , Niesters Marieke , van Velzen Monique , Fossler Michael J. , Demitrack Mark A. , Olofsen Erik
Published: July 2020

Background

To improve understanding of the respiratory behavior of oliceridine, a μ-opioid receptor agonist that selectively engages the G-protein–coupled signaling pathway with reduced activation of the β-arrestin pathway, the authors compared its utility function with that of morphine. It was hypothesized that at equianalgesia, oliceridine will produce less respiratory depression than morphine and that this is reflected in a superior utility.

Methods

Data from a previous trial that compared the respiratory and analgesic effects of oliceridine and morphine in healthy male volunteers (n = 30) were reanalyzed. A population pharmacokinetic–pharmacodynamic analysis was performed and served as basis for construction of utility functions, which are objective functions of probability of analgesia, P(analgesia), and probability of respiratory depression, P(respiratory depression). The utility function = P(analgesia ≥ 0.5) – P(respiratory depression ≥ 0.25), where analgesia ≥ 0.5 is the increase in hand withdrawal latency in the cold pressor test by at least 50%, and respiratory depression ≥ 0.25 is the decrease of the hypercapnic ventilatory response by at least 25%. Values are median ± standard error of the estimate.

Results

The two drugs were equianalgesic with similar potency values (oliceridine: 27.9 ± 4.9 ng/ml; morphine 34.3 ± 9.7 ng/ml; potency ratio, 0.81; 95% CI, 0.39 to 1.56). A 50% reduction of the hypercapnic ventilatory response by morphine occurred at an effect-site concentration of 33.7 ± 4.8 ng/ml, while a 25% reduction by oliceridine occurred at 27.4 ± 3.5 ng/ml (potency ratio, 2.48; 95% CI, 1.65 to 3.72; P < 0.01). Over the clinically relevant concentration range of 0 to 35 ng/ml, the oliceridine utility function was positive, indicating that the probability of analgesia exceeds the probability of respiratory depression. In contrast, the morphine function was negative, indicative of a greater probability of respiratory depression than analgesia.

Conclusions

These data indicate a favorable oliceridine safety profile over morphine when considering analgesia and respiratory depression over the clinical concentration range.

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Differential Ventilation Using Flow Control Valves as a Potential Bridge to Full Ventilatory Support during the COVID-19 Crisis
Authors: Levin Matthew A. , Shah Anjan , Shah Ronak , Kane Erica , Zhou George , Eisenkraft James B. , Chen Martin D. ,   for the Mount Sinai HELPS Innovate Group
Published: July 2020

Background

During the COVID-19 pandemic, ventilator sharing was suggested to increase availability of mechanical ventilation. The safety and feasibility of ventilator sharing is unknown.

Methods

A single ventilator in pressure control mode was used with flow control valves to simultaneously ventilate two patients with different lung compliances. The system was first evaluated using high-fidelity human patient simulator mannequins and then tested for 1 h in two pairs of COVID-19 patients with acute respiratory failure. Patients were matched on positive end-expiratory pressure, fractional inspired oxygen tension, and respiratory rate. Tidal volume and peak airway pressure (PMAX) were recorded from each patient using separate independent spirometers and arterial blood gas samples drawn at 0, 30, and 60 min. The authors assessed acid-base status, oxygenation, tidal volume, and PMAX for each patient. Stability was assessed by calculating the coefficient of variation.

Results

The valves performed as expected in simulation, providing a stable tidal volume of 400 ml each to two mannequins with compliance ratios varying from 20:20 to 20:90 ml/cm H2O. The system was then tested in two pairs of patients. Pair 1 was a 49-yr-old woman, ideal body weight 46 kg, and a 55-yr-old man, ideal body weight 64 kg, with lung compliance 27 ml/cm H2O versus 35 ml/cm H2O. The coefficient of variation for tidal volume was 0.2 to 1.7%, and for PMAX 0 to 1.1%. Pair 2 was a 32-yr-old man, ideal body weight 62 kg, and a 56-yr-old woman, ideal body weight 46 kg, with lung compliance 12 ml/cm H2O versus 21 ml/cm H2O. The coefficient of variation for tidal volume was 0.4 to 5.6%, and for PMAX 0 to 2.1%.

Conclusions

Differential ventilation using a single ventilator is feasible. Flow control valves enable delivery of stable tidal volume and PMAX similar to those provided by individual ventilators.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Is Immediate Weight-Bearing Safe After Single Implant Fixation of Elderly Distal Femur Fractures?
Authors: Lieder Charles M. , Gaski Greg E. , Virkus Walter W. , Kempton Laurence B.
Published: July 2020

Objectives:

To compare early complications in elderly patients with extra-articular distal femur fractures (DFFs) allowed to weight-bear as tolerated (WBAT) immediately versus patients prescribed initial touchdown weight-bearing (TDWB).

Design:

Retrospective cohort study.

Setting:

Level 1 academic trauma center.

Patients:

One hundred thirty-five patients 60 years or older who underwent surgical fixation of an extra-articular DFF, including the OTA/AO fracture classification of 33-A1-3, and periprosthetic fractures with a stable knee prosthesis (Lewis and Rorabeck type I or II) with at least 6 months follow-up.

Intervention:

Immediate WBAT or TDWB after surgical fixation of an extra-articular DFF with either an intramedullary nail or locked plate.

Main Outcome Measurements:

The primary outcome was a major adverse event within the first 6 months, defined as (1) early fixation failure or change in alignment leading to reoperation, (2) nonunion, or (3) deep infection. Secondary outcomes included postoperative inpatient length of stay, discharge disposition (secondary facility vs. home), malunion, mortality, and patient-reported outcomes.

Results:

The rate of early adverse events requiring reoperation was similar between the WBAT group (6, 10.7%) and the TDWB group (15, 19.0%; P = 0.23). There was no difference between groups with respect to length of stay, discharge disposition, malunion, and patient-reported outcomes.

Conclusions:

This study supports allowing carefully selected elderly patients, based on surgeon preference, to immediately weight-bear after operative fixation of an extra-articular DFF regardless of implant choice.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Predictive and prognostic value of magnesium serum level in FOLFIRI plus cetuximab or bevacizumab treated patients with stage IV colorectal cancer: results from the FIRE-3 (AIO KRK-0306) study
Authors: Schulz Christoph , Heinemann Volker , Heinrich Kathrin , Haas Michael , Holch Julian W. , Fraccaroli Alessia , Held Swantje , von Einem Jobst C. , Modest Dominik P. , Fischer von Weikersthal Ludwig , Kullmann Frank , Moehler Markus , Scheithauer Werner , Jung Andreas , Stintzing Sebastian
Published: July 2020

Magnesium wasting is a frequent side effect of epidermal growth factor receptor (EGFR)-antibody treatment as magnesium-absorption mechanisms are dependent on EGFR signaling. EGFR-inhibition results in decreased renal reabsorption. There is evidence that hypomagnesemia during cetuximab treatment correlates with response. The prognostic role of hypomagnesemia during bevacizumab treatment has not been studied yet. Here, we evaluate the prognostic value of hypomagnesemia in patients with metastatic colorectal cancer treated with FOLFIRI plus cetuximab or bevacizumab as first-line therapy. A total of 391 of 752 patients of the firstline irinotecan study population had magnesium levels measured at baseline and for the first three cycles (6 weeks) of treatment. Of those, 240 had Rat Sarkoma wildtype tumors. Overall hypomagnesemia was more common in the cetuximab compared to the bevacizumab arm (80 vs. 43%, P < 0.005). During therapy, magnesium showed a time-dependent decrease to 80% of baseline in the cetuximab and to 89% in the bevacizumab arm. Whereas magnesium continued to decrease over time in the cetuximab-treated patients, it remained stable in the bevacizumab-treated. Overall response rate (ORR) was associated with higher magnesium at week 6 (20.9 vs. 79.1%, P = 0.041). Bevacizumab-treated patients with magnesium levels below the median value at week 6 had a significantly longer progression-free survival (PFS; 11.7 vs. 9.9 months, P = 0.034; hazard ratio 0.73) and a trend towards longer overall survival (OS) (29.6 vs. 23.2 months, P = 0.089; hazard ratio 0.77). Hypomagnesemia at predefined time points and magnesium nadir had no significant effect on ORR, OS and PFS in the cetuximab arm. Our data show different magnesium kinetics in patients with metastatic colorectal cancer treated with cetuximab or bevacizumab. For patients treated with cetuximab, hypomagnesemia did not have an impact on response and survival. Hypomagnesemia might have a prognostic value in bevacizumab treatment.
Percutaneous Tracheostomy With Apnea During Coronavirus Disease 2019 Era: A Protocol and Brief Report of Cases
Authors: Niroula Abesh , Van Nostrand Keriann M. , Khullar Onkar V. , Force Seth , Jaber Wissam S. , Sardi Alejandro H. , Berkowitz David M.
Published: July 2020

Objective:

To assess feasibility of modified protocol during percutaneous tracheostomy in coronavirus disease 2019 pandemic era.

Design:

A retrospective review of cohort who underwent percutaneous tracheostomy with modified protocol.

Settings:

Medical, surgical, and neurologic ICUs.

Subjects:

Patients admitted in medical, surgical, and neurologic units with prolonged need of mechanical ventilation or inability to liberate from the ventilator.

Interventions:

A detailed protocol was written. Steps were defined to be performed before apnea and during apnea. A feasibility study of 28 patients was conducted. The key aerosol-generating portions of the procedure were performed with the ventilator switched to standby mode with the patient apneic.

Measurements and Main Results:

Data including patient demographics, primary diagnosis, age, body mass index, and duration of apnea time during the tracheostomy were collected. Average ventilator standby time (apnea) during the procedure was 238 seconds (3.96 min) with range 149 seconds (2.48 min) to 340 seconds (5.66 min). Single-use (disposable) bronchoscopes (Ambu A/S [Ballerup, Denmark] or Glidescope [Verathon, Inc., Bothell, WA]) were used during all procedures except in nine. No desaturation events occurred during any procedure.

Conclusions:

Percutaneous tracheostomy performed with apnea protocol may help minimize aerosolization, reducing risk of exposure of coronavirus disease 2019 to staff. It can be safely performed with portable bronchoscopes to limit staff and minimize the surfaces requiring disinfection post procedure.
Gut Microbiota and Cardiovascular Diseases
Authors: Anselmi Gaia , Gagliardi Lucilla , Egidi Gabriele , Leone Sabrina , Gasbarrini Antonio , Miggiano Giacinto Abele Donato , Galiuto Leonarda
Published: July 2020

The human intestine contains the largest and most diverse ecosystem of microbes. The main function of the intestinal bacterial flora is to limit the growth of potentially pathogenic microorganisms. However, the intestinal microbiota is increasingly emerging as a risk factor for the development of cardiovascular disease (CVD). The gut microbiota-derived metabolites, such as short-chain fatty acids, trimethylamine-N-oxide, bile acids, and polyphenols play a pivotal role in maintaining healthy cardiovascular function, and when dysregulated, can potentially lead to CVD. In particular, changes in the composition and diversity of gut microbiota, known as dysbiosis, have been associated with atherosclerosis, hypertension, and heart failure. Nonetheless, the underlying mechanisms remain yet to be fully understood. Therefore, the microbiota and its metabolites have become a new therapeutic target for the prevention and treatment of CVD. In addition to a varied and balanced diet, the use of prebiotic and probiotic treatments or selective trimethylamine-N-oxide inhibitors could play a pivotal role in the prevention of CVD, especially in patients with a high metabolic risk.
Association Between Outdoor Light-at-night Exposure and Colorectal Cancer in Spain
Authors: Garcia-Saenz Ariadna , de Miguel Alejandro Sánchez , Espinosa Ana , Costas Laura , Aragonés Nuria , Tonne Cathryn , Moreno Victor , Pérez-Gómez Beatriz , Valentin Antonia , Pollán Marina , Castaño-Vinyals Gemma , Aubé Martin , Kogevinas Manolis
Published: July 2020

Background:

Night-shift work, exposure to artificial light-at-night (ALAN) and particularly blue light spectrum, and the consequent circadian disruption may increase the risk of breast and prostate cancer. Colorectal cancer risk may also be increased among night-shift workers. We investigated the association between exposure to ALAN according to light spectrum and colorectal cancer among subjects who had never worked at night in a general population case–control study in Spain.

Methods:

We examined information on 661 incident histologically verified colorectal cancer cases and 1,322 controls from Barcelona and Madrid, 2007–2013. Outdoor ALAN exposure was based on images from the International Space Station (ISS) including data on remotely sensed upward light intensity. We derived adjusted odds ratio (OR) estimates and confidence intervals (CI) for visual light, blue light, and spectral sensitivities of the five human photopigments assigned to participant’s geocoded longest residence.

Results:

Exposure to blue light spectrum was positively associated with colorectal cancer (OR = 1.6; 95% CI: 1.2–2.2; highest vs. lowest tertile). ORs were similar (OR = 1.7; 95% CI: 1.3–2.3) when further adjusting for area socioeconomic status, diet patterns, smoking, sleep, and family history. We observed no association for outdoor visual light (full spectrum) (OR = 1.0; 95% CI, 0.7–1.2; highest vs. lowest tertile). Analysis of the five photopigments gave similar results with increased risks for shorter wavelengths overlapping with the blue spectrum and no association for longer wavelengths.

Conclusions:

Outdoor blue light spectrum exposure that is increasingly prevalent in recent years may be associated with colorectal cancer risk. See video abstract: http://links.lww.com/EDE/B708.
Validation of Assisted Reproductive Technology in the Medical Birth Registry of Norway Versus the Norwegian Prescription Database
Authors: Reigstad Marte Myhre , Storeng Ritsa , Furu Kari , Bakken Inger Johanne , Engeland Anders , Larsen Inger Kristin
Published: July 2020

Background:

Increasing attention has been given to the long-term effects of assisted reproductive technology (ART). This study assessed the validity and completeness of ART as registered in the Medical Birth Registry of Norway (MBRN) using drug prescription data from the Norwegian Prescription Database (NorPD) as reference.

Methods:

In this nationwide registry validation study, we included all pregnancies recorded in the MBRN between 2005 and 2017. We estimated sensitivity, specificity, and positive and negative predictive value (PPV and NPV) of the MBRN, using data from the NorPD as reference. We obtained the total percentage of ART pregnancies that could be identified (completeness) from both registries using the capture–recapture method. We analyzed subgroups by maternal age, gestational length, mode of ART treatment, health region, and mode of registration of ART (ART institution or birth notification form).

Results:

Twenty-three thousand seven hundred eighteen of a total 765,789 pregnancies were registered as ART pregnancies through the MBRN and 20,807 as ART pregnancies through the NorPD. The sensitivity of the MBRN was 85.1% (95% confidence interval [CI] = 84.7, 85.6) and the PPV was 74.7% (74.1–75.2). Sensitivity declined with increasing maternal age: 71.5% (69.4–73.7) in the age group 40–44 years, and 40.7% (22.2–59.3) in the ages above 45 years. Completeness when combining data was 96.2% (96.0–96.5).

Conclusions:

Our analysis shows that, when identifying women pregnant through ART, NorPD data complemented MBRN data to obtain a more complete count of all women giving birth after ART in Norway.
Mental Health Units in Correctional Facilities in the United States
Authors: Cohen Talia R. , Mujica Christin A. , Gardner Margaret E. , Hwang Melissa , Karmacharya Rakesh
Published: July 2020

Background

The prevalence of severe mental illness (SMI) in correctional settings is alarmingly high. Some correctional facilities have developed mental health units (MHUs) to treat incarcerated individuals with SMI.

Objective

To identify existing MHUs in the United States and collate information on these units.

Data Sources

A systematic review using Criminal Justice Abstracts, ERIC, PsycINFO, PubMed, and SocINDEX, plus an exploratory review using the Google search engine were conducted. MHUs were included if they were located within an adult correctional facility in the United States, specifically catered to SMI populations, and were in active operation as of June 2019.

Results

Eleven articles were identified through the peer-reviewed literature, but there were still major gaps in the information on MHUs. The Google search identified 317 MHUs. The majority of units were located within prisons (79.5%) and served only men (76%). The Google search found information indicating that 169 (53.3%) offered groups or programming to inmates; 104 (32.8%) offered individual therapy; and 89 (23%) offered both. One hundred sixty-six units (52.4%) had dedicated mental health staff, and 75 (23.7%) provided mental health training to correctional officers. Information on funding and outcomes of the MHUs is presented.

Limitations

Use of the Google search engine and sources that have not been peer reviewed limits the robustness of conclusions about the MHUs.

Conclusions

Standards for developing and implementing MHUs are not widespread. The shortcomings of current MHUs are discussed in the context of desired criteria for size, staffing, and programming.
Total Artificial Heart as Bridge to Cardiac Retransplantation
Authors: Zadikany Ronit H. , Cole Robert M. , Chang David H. , Patel Jignesh K. , Geft Dael R. , Czer Lawrence , Esmailian Fardad , Ramzy Danny , Moriguchi Jaime D. , Kobashigawa Jon A. , Kittleson Michelle M.
Published: July 2020

Mechanical circulatory support has been performed as a bridge to cardiac retransplantation in selected patients with graft failure. However, there is limited published experience on the use and potential benefit of the total artificial heart (TAH) as a bridge to cardiac retransplantation. We report on our institutional experience with 3 patients that received TAH as a bridge to retransplant, with 1 patient surviving post-retransplantation. This case series demonstrates the high-risk nature of this undertaking in cardiac retransplant candidates and highlights the issue of sensitization portending greater risk for poor outcomes after TAH as bridge to retransplantation.
Procedural outcomes of chronic total occlusion percutaneous coronary intervention in patients with dissection and reentry versus wire escalation techniques: a meta-analysis
Authors: Zhao Yejing , Peng Hongyu , Li Xiaonan , Liu Jinghua
Published: July 2020

Background

The procedural safety of dissection and reentry (DR) techniques in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains controversial, when compared with conventional wire escalation (WE) techniques. The meta-analysis was performed to evaluate the impact of DR techniques vs. WE techniques on periprocedural outcomes in patients with CTO undergoing PCI.

Methods

Studies were searched in electronic database from inception to December 2018. Results were pooled using random effects model and fixed effects model.

Results

The pooled analyses revealed that DR techniques increased risks of periprocedural complications in patients with CTO PCI, including higher coronary perforation rate [risk ratio (RR) = 2.10, 95% confidence interval (CI) 1.24–3.55], periprocedural myocardial infarction (RR = 1.85, 95% CI 1.23–2.78), branch occlusion (RR = 2.69; 95% CI 1.92–3.77) and coronary hematoma (RR = 3.06; 95% CI 2.45–3.82) detected by intravascular ultrasound, when compared to those with WE techniques. However, DR techniques were more applied in patients with higher complexity CTO lesions, which was evidenced by higher J-CTO score [standard mean differences (SMD) = 0.71, 95% CI 0.51–0.91] and longer fluoroscopy time (SMD = 0.93, 95% CI 0.70–1.16), that may explain the higher complications rates in the DR techniques group as compared with WE techniques.

Conclusion

The present meta-analysis suggests that the DR technique is relatively frequently used during contemporary CTO PCI, especially for challenging more complex CTO lesions. However, it is associated with higher, yet acceptable, rates of periprocedural adverse events as compared with a conventional WE strategy. Further refinement of DR techniques and evidence from large RCTs is needed to define the optimal role of DR in hybrid CTO PCI.
Dual-layer spectral detector computed tomography versus magnetic resonance cholangiopancreatography for biliary stones
Authors: Saito Hirokazu , Iwagoi Yuki , Noda Kana , Atsuji Shutaro , Takaoka Hiroko , Kajihara Hiroo , Shono Takashi , Nasu Jiro , Obara Hitoshi , Kakuma Tatsuyuki , Tada Shuji , Morishita Shoji , Matsushita Ikuo , Katahira Kazuhiro
Published: July 2020

Objective

Dual-layer spectral detector computed tomography (DLCT) can detect noncalcified biliary stones. The diagnostic ability of DLCT for detecting biliary stones may be comparable to that of magnetic resonance cholangiopancreatography (MRCP). This study seeks to compare the diagnostic ability for biliary stones between these two imaging modalities.

Methods

This retrospective study included 102 cases with a diagnosis of biliary stones including gallstones (n = 66) and common bile duct (CBD) stones (n = 25) or spontaneously passing CBD stones (n = 11). The reference standard used was operative findings, endoscopic retrograde cholangiopancreatography or follow-up over 6 months. In DLCT, 120-kVp images, 40-keV virtual monoenergetic images and material decomposition images were created. We compared the diagnostic ability of DLCT and MRCP for biliary stones using the McNemar’s test.

Results

The sensitivity and specificity of DLCT versus MRCP for biliary stones were 91.2% versus 95.6% and 90.9% versus 90.9%. Thus, the sensitivity and specificity were not significantly different (P = 0.25 and P = 1.0). Although in small stones (<9 mm) the sensitivity of calcified stones was not different between DLCT and MRCP (100% versus 92.5%), the sensitivity of noncalcified stones in DLCT was lower than that in MRCP (38.5% versus 100%).

Conclusion

The diagnostic ability of biliary stones in DLCT appears comparable to that of MRCP in overall cases. However, detecting noncalcified stones less than 9 mm in size is limited in DLCT.
Cholangitis in Patients With Biliary Atresia Receiving Hepatoportoenterostomy
Authors: Cheng Katherine , Molleston Jean P. , Bennett William E.
Published: July 2020

Introduction:

Biliary atresia (BA) is a progressive form of liver disease in the neonatal period usually requiring hepatoportoenterostomy (HPE). Cholangitis is a common sequelae of HPE but data about which patients are at risk for this complication are limited.

Objective:

The objective of the study was to determine risk factors associated with cholangitis in a large retrospective cohort after HPE.

Methods:

The Pediatric Health Information System (PHIS) was queried for BA (ICD‐9 975.61) and HPE (ICD‐9‐CM 51.37) admissions from 2004 to 2013. We performed univariate analysis and linear regression with dependent variables of ≥ 2 or ≥ 5 episodes of cholangitis, and independent variables of age at time of HPE, race, ethnicity, gender, insurance, ursodeoxycholic acid (UDCA) use, steroid use, presence of esophageal varices (EV), and portal hypertension (PH).

Results:

We identified 1112 subjects with a median age at HPE of 63 days and median number of cholangitis episodes of 2 within 2 years. On multiple regression analysis, black race (odds ratio (OR) 1.51, P = 0.044) and presence of PH (OR 2.24, P < 0.001) were associated with increased risk of ≥ 2 episodes of cholangitis, whereas HPE at >90 days was associated with less risk (OR 0.46, P = 0.001). Among those with ≥5 episodes, Asian race (OR 2.66, P = 0.038), public insurance (OR 1.72, P = 0.043), EV (OR 1.81, P = 0.017), and PH (OR 2.88, P < 0.001) were associated with higher risk.

Conclusions:

Complications, such as cholangitis remain a common problem for patients, after HPE, with median of 2 episodes within 2 years. Higher rates of cholangitis are associated with portal hypertension whereas lower rate is associated with age at HPE of >90 days. Asians, patients with public insurance, and those with portal hypertension are more likely to have recurrent cholangitis.
Distress in Infants and Young Children
Authors: Salvatore Silvia , Pagliarin Federica , Huysentruyt Koen , Bosco Annalisa , Fumagalli Letizia , Van De Maele Kristel , Agosti Massimo , Vandenplas Yvan
Published: July 2020

Objective:

The role of gastroesophageal reflux (GER) causing distress in infants is controversial but acid inhibitors are often empirically prescribed. We evaluated the relation between distress assessed by the Face, Legs, Activity, Cry, Consolability (FLACC) scale and GER in infants.

Methods:

We analyzed multiple intraluminal impedance‐pH (MII‐pH) monitoring tracings of infants with persistent unexplained fussiness or distress. Symptoms occurring during investigation were scored by parents using the FLACC scale and were grouped as “distress” episodes.

Results:

We recruited 62 children (ages 15 days to 23 months, median age 3.5 months). During MII‐pH, 452 episodes of distress were registered: 217 (48%) were temporally associated with GER and 235 (52%) were not, with no difference in the median value of FLACC between the 2 groups. Infants with abnormal acid exposure index had a significantly lower FLACC compared with the group with acid reflux index <7% (P < 0.001). When associated with symptoms, GER occurred significantly more often before than simultaneously or after an episode of distress (P = 0.001). Age, proximal extension, and duration of GER did not correlate with FLACC scores. Episodes of distress associated with nonacid reflux presented a significant higher FLACC compared with the ones with acid content (FLACC 6 vs 5, P = 0.011). In infants, episodes of distress do not significantly correlate with GER.

Conclusions:

No difference in infant distress was noted between proximal and distal GER. Non‐acid reflux is perceived at least as painful than acid GER. Our results stress that acid inhibitors should not be started in infants presenting distress unless a clear association with acid GER is demonstrated.
Associations Between Postoperative Management in the Critical Care Unit and Adolescent Developmental Outcomes Following Cardiac Surgery in Infancy: An Exploratory Study*
Authors: Shevell Allison H. , Sahakian Sossy K. , Nguyen Quynh , Fontela Patricia , Rohlicek Charles , Majnemer Annette
Published: July 2020

Objectives:

Children with congenital heart disease are at high risk for developmental sequelae. Most studies focus on preoperative and intraoperative predictors of developmental impairment, with less attention to the postoperative period. The relationship between patient-related factors specific to the postoperative course in the PICU following cardiac surgery with long-term neurodevelopmental outcomes in adolescence was examined.

Design:

Retrospective chart review of patients previously recruited to a study describing their developmental outcomes in adolescence.

Setting:

Single tertiary care pediatric hospital in Canada.

Patients:

Eighty adolescents, born between 1991 and 1999, with congenital heart disease who required open-heart surgery before 2 years old.

Measurements and Main Results:

Several variables related to acuity of illness and complexity of postoperative course in the PICU were collected. Outcome measures included the Movement-Assessment Battery for Children-2 (motor), Leiter Brief Intelligence Quotient (cognition), and Strength and Difficulties Questionnaire (behavior). Analyses examined associations between PICU variables and long-term outcomes. Longer mechanical ventilation (β= –0.49;p= 0.013) and dopamine use (β= –14.41;p= 0.012) were associated with lower motor scores. Dopamine use was associated with lower cognitive scores (β= –14.02;p= 0.027). Longer PICU stay (β= 0.18;p= 0.002), having an open chest postoperatively (β= 3.83;p= 0.017), longer mechanical ventilation (β= 0.20;p= 0.001), longer inotrope support (β= 0.27;p= 0.002), hours on dopamine (β= 0.01;p= 0.007), days to enteral feeding (β= 0.22;p= 0.012), lower hemoglobin (β= –0.11;p= 0.004), and higher creatinine (β= 0.05;p= 0.014) were all associated with behavioral difficulties.

Conclusions:

Several important developmental outcomes in adolescents were associated with factors related to their postoperative course in the PICU as infants. Findings may highlight those children at highest risk for neurodevelopmental sequelae and suggest new approaches to critical care management following open-heart surgery, with the aim of mitigating or preventing adverse long-term outcomes.
Clinical Features of Critical Coronavirus Disease 2019 in Children*
Authors: Bhumbra Samina , Malin Stefan , Kirkpatrick Lindsey , Khaitan Alka , John Chandy C. , Rowan Courtney M. , Enane Leslie A.
Published: July 2020

Objectives:

We sought to describe the presentation, course, and outcomes of hospitalized pediatric coronavirus disease 2019 patients, with detailed description of those requiring mechanical ventilation, and comparisons between critically ill and noncritical hospitalized pediatric patients.

Design:

Observational cohort study.

Setting:

Riley Hospital for Children at Indiana University Health in Indianapolis in the early weeks of the coronavirus disease 2019 pandemic.

Patients:

All hospitalized pediatric patients with confirmed coronavirus disease 2019 as of May 4, 2020, were included.

Interventions:

Patients received therapies including hydroxychloroquine, remdesivir, tocilizumab, and convalescent serum and were managed according to an institutional algorithm based on evidence available at the time of presentation.

Measurements and Main Results:

Of 407 children tested for severe acute respiratory syndrome-coronavirus 2 at our hospital, 24 were positive, and 19 required hospitalization. Seven (36.8%) were critically ill in ICU, and four (21%) required mechanical ventilation. Hospitalized children were predominantly male (14, 74%) and African-American or Hispanic (14, 74%), with a bimodal distribution of ages among young children less than or equal to 2 years old (8, 42%) and older adolescents ages 15–18 (6, 32%). Five of seven (71.4%) of critically ill patients were African-American (n = 3) or Hispanic (n = 2). Critical illness was associated with older age (p = 0.017), longer duration of symptoms (p = 0.036), and lower oxygen saturation on presentation (p = 0.016); with more thrombocytopenia (p = 0.015); higher C-reactive protein (p = 0.031); and lower WBC count (p = 0.039). Duration of mechanical ventilation averaged 14.1 days. One patient died.

Conclusions:

Severe, protracted coronavirus disease 2019 is seen in pediatric patients, including those without significant comorbidities. We observed a greater proportion of hospitalized children requiring mechanical ventilation than has been reported to date. Older children, African-American or Hispanic children, and males may be at risk for severe coronavirus disease 2019 requiring hospitalization. Hypoxia, thrombocytopenia, and elevated C-reactive protein may be useful markers of critical illness. Data regarding optimal management and therapies for pediatric coronavirus disease 2019 are urgently needed.
The Missing Link: The Business of Plastic Surgery
Authors: Reece Edward M. , Tanna Neil , Rohrich Rod J.
Published: July 2020

The practice of plastic surgery has become more complex. As plastic surgeons face the postgraduate realities of contracts, negotiations, and health system employment, they are frequently unprepared to effectively manage these challenges. Furthermore, many plastic surgery training programs do not emphasize real-world business and policy concerns in residency training. Plastic and Reconstructive Surgery endeavors to provide robust conceptual education and guidance in business and policy to help both private practice and academic plastic surgeons participate in, lead, and shape the future of health care.
“Quadripolar” Transcranial Electrical Stimulation for Motor Evoked Potentials
Authors: Schwartz Stephanie L. , Kale Emily B. , Madden Dennis , Husain Aatif M.
Published: July 2020

Purpose:

To determine if transcranial electrical stimulation (TES)–induced motor evoked potentials (MEPs) are of higher amplitude when using two electrodes as anodes and two as cathodes, known as “quadripolar stimulation.”

Methods:

Patients who underwent TES MEP monitoring in which control, bipolar stimulation and four variations of quadripolar stimulation were used were evaluated. The bipolar stimulation montage was C3-C4 (C3 was used as anode for stimulation first, then the polarity was switched to stimulate the contralateral side). Four quadripolar montages were used: C3/C1-C4/C2 (step 1), M3/M1-M4/M2 (step 2), C3/M1-C4/M2 (step 3), and M3/C1-M4/C2 (step 4). The area under the curve for the right foot TES MEP was compared for the various montages using descriptive statistics and Fisher exact test for proportions.

Results:

Sixteen patients were retrospectively evaluated. The mean age as 51.6 years, range 4 to 80 years; 11 were female. The transcranial electrical stimulation MEP area under the curve for the right foot MEP was highest in the bipolar montage in 1 of 16 patients (6.3%). Meanwhile, it was highest in step 4 (M3/C1-M4/C2) in 9 of 16 patients (56.3%; P = 0.027). The highest right foot MEP area under the curve with one of the quadripolar montages was seen in 15 of 16 patients (93.8%; P = 0.0001).

Conclusions:

Quadripolar stimulation resulted in higher area under the curve for right foot MEP compared with conventional bipolar stimulation.
Phenotypic selection through cell death: stochastic modelling of O-6-methylguanine-DNA methyltransferase dynamics
Authors: Lasri Ayoub , Juric Viktorija , Verreault Maité , Bielle Franck , Idbaih Ahmed , Kel Alexander , Murphy Brona , Sturrock Marc
Published: July 2020

Glioblastoma (GBM) is the most aggressive malignant primary brain tumour with a median overall survival of 15 months. To treat GBM, patients currently undergo a surgical resection followed by exposure to radiotherapy and concurrent and adjuvant temozolomide (TMZ) chemotherapy. However, this protocol often leads to treatment failure, with drug resistance being the main reason behind this. To date, many studies highlight the role of O-6-methylguanine-DNA methyltransferase (MGMT) in conferring drug resistance. The mechanism through which MGMT confers resistance is not well studied—particularly in terms of computational models. With only a few reasonable biological assumptions, we were able to show that even a minimal model of MGMT expression could robustly explain TMZ-mediated drug resistance. In particular, we showed that for a wide range of parameter values constrained by novel cell growth and viability assays, a model accounting for only stochastic gene expression of MGMT coupled with cell growth, division, partitioning and death was able to exhibit phenotypic selection of GBM cells expressing MGMT in response to TMZ. Furthermore, we found this selection allowed the cells to pass their acquired phenotypic resistance onto daughter cells in a stable manner (as long as TMZ is provided). This suggests that stochastic gene expression alone is enough to explain the development of chemotherapeutic resistance.
The preparation and characterization of uniform nanoporous structure on glass
Authors: Wang Lei , Li Likai , Liu Youbo , Wang Shuxian , Cai Hui , Jin Hao , Tang Qingwen , Sun Wei , Yang Deren
Published: July 2020

A novel fabrication method of uniform porous structures on the glass surface is proposed. The hydrofluoric acid fog formed by air-jet atomization etches the glass surface to fabricate nanoporous structure (NPS) on glass surface. This NPS shows the enhanced average light transmittance of approximately 92.9% and the superhydrophilic property with a contact angle less than 1° which presents an excellent anti-fog property. Passivated by fluorosilane, the NPS shows nearly the superhydrophobic property with a contact angle of 141.2°. This fabrication method has shown promising application prospects due to its simplicity, low cost and efficiency, which can be easily applied to large-scale industrial production.
Global relationships between tree-cavity excavators and forest bird richness
Authors: van der Hoek Yntze , Gaona Gabriel V. , Ciach Michał , Martin Kathy
Published: July 2020

Global monitoring of biodiversity and ecosystem change can be aided by the effective use of indicators. Tree-cavity excavators, the majority of which are woodpeckers (Picidae), are known to be useful indicators of the health or naturalness of forest ecosystems and the diversity of forest birds. They are indicators of the latter due to shared associations with particular forest elements and because of their role in facilitating the occurrence of other species through the provision of nesting cavities. Here, we investigated whether these positive correlations between excavators and other forest birds are also found at broad geographical scales. We used global distribution maps to extract richness estimates of tree-cavity nesting and forest-associated birds, which we grouped by zoogeographic regions. We then created generalized least-squares models to assess the relationships between these groups of birds. We show that richness of tree-cavity excavating birds correlates positively with that of secondary cavity nesters and other forest birds (generalists and specialists) at global scales, but with variation across zoogeographic regions. As many excavators are relatively easy to detect, play keystone roles at local scales and are effective management targets, we propose that excavators are useful for biodiversity monitoring across multiple spatial scales and geographical regions, especially in the tropics.
Potential for Zika virus transmission by mosquitoes in temperate climates
Authors: Blagrove Marcus S. C. , Caminade Cyril , Diggle Peter J. , Patterson Edward I. , Sherlock Ken , Chapman Gail E. , Hesson Jenny , Metelmann Soeren , McCall Philip J. , Lycett Gareth , Medlock Jolyon , Hughes Grant L. , della Torre Alessandra , Baylis Matthew
Published: July 2020

Mosquito-borne Zika virus (ZIKV) transmission has almost exclusively been detected in the tropics despite the distributions of its primary vectors extending farther into temperate regions. Therefore, it is unknown whether ZIKV's range has reached a temperature-dependent limit, or if it can spread into temperate climates. Using field-collected mosquitoes for biological relevance, we found that two common temperate mosquito species,
Aedes albopictus
and
Ochlerotatus detritus
, were competent for ZIKV. We orally exposed mosquitoes to ZIKV and held them at between 17 and 31°C, estimated the time required for mosquitoes to become infectious, and applied these data to a ZIKV spatial risk model. We identified a minimum temperature threshold for the transmission of ZIKV by mosquitoes between 17 and 19°C. Using these data, we generated standardized basic reproduction number
R
0
-based risk maps and we derived estimates for the length of the transmission season for recent and future climate conditions. Our standardized

R
0

-based risk maps show potential risk of ZIKV transmission beyond the current observed range in southern USA, southern China and southern European countries. Transmission risk is simulated to increase over southern and Eastern Europe, northern USA and temperate regions of Asia (northern China, southern Japan) in future climate scenarios.
Nutrients and warming interact to force mountain lakes into unprecedented ecological states
Authors: Oleksy Isabella A. , Baron Jill S. , Leavitt Peter R. , Spaulding Sarah A.
Published: July 2020

While deposition of reactive nitrogen (N) in the twentieth century has been strongly linked to changes in diatom assemblages in high-elevation lakes, pronounced and contemporaneous changes in other algal groups suggest additional drivers. We explored the origin and magnitude of changes in two mountain lakes from the end of the Little Ice Age at
ca
1850, to
ca
2010, using lake sediments. We found dramatic changes in algal community abundance and composition. While diatoms remain the most abundant photosynthetic organisms, concentrations of diatom pigments decreased while pigments representing chlorophytes increased 200–300% since
ca
1950 and total algal biomass more than doubled. Some algal changes began
ca
1900 but shifts in most sedimentary proxies accelerated
ca
1950 commensurate with many human-caused changes to the Earth System. In addition to N deposition, aeolian dust deposition may have contributed phosphorus. Strong increases in summer air and surface water temperatures since 1983 have direct and indirect consequences for high-elevation ecosystems. Such warming could have directly enhanced nutrient use and primary production. Indirect consequences of warming include enhanced leaching of nutrients from geologic and cryosphere sources, particularly as glaciers ablate. While we infer causal mechanisms, changes in primary producer communities appear to be without historical precedent and are commensurate with the post-1950 acceleration of global change.
Evolution of division of labour in mutualistic symbiosis
Authors: Uchiumi Yu , Sasaki Akira
Published: July 2020

Mutualistic symbiosis can be regarded as interspecific division of labour, which can improve the productivity of metabolites and services but deteriorate the ability to live without partners. Interestingly, even in environmentally acquired symbiosis, involved species often rely exclusively on the partners despite the lethal risk of missing partners. To examine this paradoxical evolution, we explored the coevolutionary dynamics in symbiotic species for the amount of investment in producing their essential metabolites, which symbiotic species can share. Our study has shown that, even if obtaining partners is difficult, ‘perfect division of labour’ (PDL) can be maintained evolutionarily, where each species perfectly specializes in producing one of the essential metabolites so that every member entirely depends on the others for survival, i.e. in exchange for losing the ability of living alone. Moreover, the coevolutionary dynamics shows multistability with other states including a state without any specialization. It can cause evolutionary hysteresis: once PDL has been achieved evolutionarily when obtaining partners was relatively easy, it is not reverted even if obtaining partners becomes difficult later. Our study suggests that obligate mutualism with a high degree of mutual specialization can evolve and be maintained easier than previously thought.