bluuebunny/crossref_metadata_2025 huggingface dataset:
Multicentre experience with the frozen elephant trunk technique to treat penetrating aortic ulcers involving the aortic arch
Authors: Kreibich Maximilian , Kremer Jamila , Vötsch Andreas , Berger Tim , Farag Mina , Winkler Andreas , Siepe Matthias , Karck Matthias , Beyersdorf Friedhelm , Rylski Bartosz , Czerny Martin , Gottardi Roman
Published: December 2020

OBJECTIVES

Our goal was to evaluate the use of the frozen elephant trunk (FET) technique for the treatment of penetrating aortic ulcers involving the aortic arch.

METHODS

Between January 2008 and January 2020, a total of 34 patients had the FET technique at 3 aortic centres. The indication for the FET technique was unsuitability for thoracic endovascular aortic repair due to the lack of a sufficient proximal landing zone even after supra-aortic rerouting (subclavian transposition, double transposition), ectasia of the ascending aorta/aortic arch (>40 mm) and/or a shaggy proximal thoracic aorta.

RESULTS

Additional cardiac procedures were performed in 14 patients (41%), and the beating heart technique was used in 7 patients (21%). Perioperative mortality was 18% (n = 6); 3 of these patients had a major stroke (9%). No case of spinal cord ischaemia was observed, and 2 patients (6%) developed a non-disabling stroke. After a median follow-up of 7 (first quartile: 1; third quartile 29) months, 2 patients (6%) died (1 of malignant disease and 1 of an unclear cause); 10 additional aortic interventions in all aortic segments (29%; endovascular: n = 8 [24%] and conventional surgical: n = 2 [6%]) were performed in 8 patients.

CONCLUSIONS

The FET technique is a good treatment option for patients with penetrating aortic ulcers involving the aortic arch unsuitable for thoracic endovascular aortic repair. However, the high obliterative atherosclerotic load in these patients is accompanied by an un-neglectable risk of perioperative neurological injury. Concomitant cardiac surgical procedures are frequently needed. Patients commonly require secondary aortic procedures in all aortic segments, emphasizing the need for thorough primary conceptual planning and stringent follow-up.
Promoting written employment contracts: evidence from a randomised awareness campaign
Authors: Jäckering Lisa , Meemken Eva-Marie , Sellare Jorge , Qaim Matin
Published: December 2020

Written employment contracts may improve the conditions of agricultural workers in developing countries, but farmers as employers often prefer less formal oral arrangements. We evaluate whether farmers’ preferences, which are deeply rooted in traditional norms, can be influenced through a group awareness campaign. In a randomised experiment in Côte d’Ivoire, we show that such a campaign increases farmers’ preferences for written contracts and for contract features involving social benefits for workers. The campaign also increases farmers’ likelihood to initiate concrete steps towards signing a contract with their workers. We conclude that group-based interventions can change farmers’ traditional views about employment relations.
Stress-associated neurobiological activity is linked with acute plaque instability via enhanced macrophage activity: a prospective serial 18F-FDG-PET/CT imaging assessment
Authors: Kang Dong Oh , Eo Jae Seon , Park Eun Jin , Nam Hyeong Soo , Song Joon Woo , Park Ye Hee , Park So Yeon , Na Jin Oh , Choi Cheol Ung , Kim Eung Ju , Rha Seung-Woon , Park Chang Gyu , Seo Hong Seog , Kim Chi Kyung , Yoo Hongki , Kim Jin Won
Published: December 2020

Aims

Emotional stress is associated with future cardiovascular events. However, the mechanistic linkage of brain emotional neural activity with acute plaque instability is not fully elucidated. We aimed to prospectively estimate the relationship between brain amygdalar activity (AmygA), arterial inflammation (AI), and macrophage haematopoiesis (HEMA) in acute myocardial infarction (AMI) as compared with controls.

Methods and results

18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) imaging was performed within 45 days of the index episode in 62 patients (45 with AMI, mean 60.0 years, 84.4% male; 17 controls, mean 59.6 years, 76.4% male). In 10 patients of the AMI group, serial 18F-FDG-PET/CT imaging was performed after 6 months to estimate the temporal changes. The signals were compared using a customized 3D-rendered PET reconstruction. AmygA [target-to-background ratio (TBR), mean ± standard deviation: 0.65 ± 0.05 vs. 0.60 ± 0.05; P = 0.004], carotid AI (TBR: 2.04 ± 0.39 vs. 1.81 ± 0.25; P = 0.026), and HEMA (TBR: 2.60 ± 0.38 vs. 2.22 ± 0.28; P < 0.001) were significantly higher in AMI patients compared with controls. AmygA correlated significantly with those of the carotid artery (r = 0.350; P = 0.005), aorta (r = 0.471; P < 0.001), and bone marrow (r = 0.356; P = 0.005). Psychological stress scales (PHQ-9 and PSS-10) and AmygA assessed by PET/CT imaging correlated well (P < 0.001). Six-month after AMI, AmygA, carotid AI, and HEMA decreased to a level comparable with the controls.

Conclusion

AmygA, AI, and HEMA were concordantly enhanced in patients with AMI, showing concurrent dynamic changes over time. These results raise the possibility that stress-associated neurobiological activity is linked with acute plaque instability via augmented macrophage activity and could be a potential therapeutic target for plaque inflammation in AMI.
SARS-CoV-2 Serologic Assays in Control and Unknown Populations Demonstrate the Necessity of Virus Neutralization Testing
Authors: Rathe Jennifer A , Hemann Emily A , Eggenberger Julie , Li Zhaoqi , Knoll Megan L , Stokes Caleb , Hsiang Tien-Ying , Netland Jason , Takehara Kennidy K , Pepper Marion , Gale Michael
Published: December 2020

Background

To determine how serologic antibody testing outcome links with virus neutralization of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), we evaluated individuals for SARS-CoV-2 antibody level and viral neutralization.

Methods

We compared serum Ig levels across platforms of viral antigens and antibodies with 15 positive and 30 negative SARS-CoV-2 controls followed by viral neutralization assessment. We then applied these platforms to a clinically relevant cohort of 114 individuals with unknown histories of SARS-CoV-2 infection.

Results

In controls, the best-performing virus-specific antibody detection platforms were SARS-CoV-2 receptor binding domain (RBD) IgG (sensitivity 87%, specificity 100%, positive predictive value [PPV] 100%, negative predictive value [NPV] 94%), spike IgG3 (sensitivity 93%, specificity 97%, PPV 93%, NPV 97%), and nucleocapsid protein (NP) IgG (sensitivity 93%, specificity 97%, PPV 93%, NPV 97%). Neutralization of positive and negative control sera showed 100% agreement. Twenty individuals with unknown history had detectable SARS-CoV-2 antibodies with 16 demonstrating virus neutralization. Spike IgG3 provided the highest accuracy for predicting serologically positive individuals with virus neutralization activity (misidentified 1/20 unknowns compared to 2/20 for RBD and NP IgG).

Conclusions

The coupling of virus neutralization analysis to a spike IgG3 antibody test is optimal to categorize patients for correlates of SARS-CoV-2 immune protection status.
Evaluating the Role of Government Collaboration in the Perceived Performance of Community-Based Nonprofits: Three Propositions
Authors: Nederhand José
Published: December 2020

The topic of government–nonprofit collaboration continues to be much-discussed in the literature. However, there has been little consensus on whether and how collaborating with government is beneficial for the performance of community-based nonprofits. This article examines three dominant theoretical interpretations of the relationship between collaboration and performance: collaboration is necessary for the performance of nonprofits; the absence of collaboration is necessary for the performance of nonprofits; and the effect of collaboration is contingent on the nonprofits’ bridging and bonding network ties. Building on the ideas of governance, nonprofit, and social capital in their respective literature, this article uses set-theoretic methods (fsQCA) to conceptualize and test their relationship. Results show the pivotal role of the nonprofit’s network ties in mitigating the effects of either collaborating or abstaining from collaborating with government. Particularly, the political network ties of nonprofits are crucial to explaining the relationship between collaboration and performance. The evidence demonstrates the value of studying collaboration processes in context.
Infrared analysis of Glycine dissociation by MeV ions and keV electrons
Authors: da Costa C A P , Souza-Corrêa J A , da Silveira E F
Published: December 2020

Knowledge on amino acid’s dissociation rates by solar wind is relevant for the study of biomaterial resistance in space. The radiolysis and sputtering of glycine by 1 keV electron beam and by 1.8 MeV H+, 1.5 MeV He+, and 1.5 MeV N+ ion beams are studied in laboratory at room temperature. Infrared spectroscopy is used to determine column density decrease rates and destruction cross-sections. Present results stand in good agreement with those found in the literature and show that over five orders of magnitude, apparent destruction cross-sections (which includes sputtering), σdap, are approximately proportional to the electronic stopping power, Se, that is σdap ≈ aSe, where 1/a ≈ 120 eV nm−3. This value corresponds to the mean absorbed energy density necessary to dissociate (and/or eject) glycine; if it is taken as the minimum energy for molecular destruction, than the stopping power threshold is 23 keV μm−1. Assuming σdap = aSe for electron and ion projectiles, the half-life of pure α-glycine is estimated for the solar wind processing at 1 au: about 10 D for protons or electrons and 40 D for He ions.
A two-component Comptonization model for the type-B QPO in MAXI J1348−630
Authors: García Federico , Méndez Mariano , Karpouzas Konstantinos , Belloni Tomaso , Zhang Liang , Altamirano Diego
Published: December 2020

Spectral-timing analysis of the fast variability observed in X-rays is a powerful tool to study the physical and geometrical properties of the accretion/ejection flows in black hole (BH) binaries. The origin of type-B quasi-periodic oscillations (QPO), predominantly observed in BH candidates in the soft-intermediate state, has been linked to emission arising from the relativistic jet. In this state, the X-ray spectrum is characterized by a soft-thermal blackbody-like emission due to the accretion disc, an iron emission line (in the 6–7 keV range), and a power-law-like hard component due to inverse-Compton scattering of the soft-photon source by hot electrons in a corona or the relativistic jet itself. The spectral-timing properties of MAXI J1348−630 have been recently studied using observations obtained with the NICER observatory. The data show a strong type-B QPO at ∼4.5 Hz with increasing fractional rms amplitude with energy and positive lags with respect to a reference band at 2–2.5 keV. We use a variable-Comptonization model that assumes a sinusoidal coherent oscillation of the Comptonized X-ray flux and the physical parameters of the corona at the QPO frequency, to fit simultaneously the energy-dependent fractional rms amplitude and phase lags of this QPO. We show that two physically connected Comptonization regions can successfully explain the radiative properties of the QPO in the full 0.8–10 keV energy range.
Identification of new classical Ae stars in the Galaxy using LAMOST DR5
Authors: Anusha R , Mathew Blesson , Shridharan B , Arun R , Nidhi S , Banerjee Gourav , Kartha Sreeja S , Paul K T , Bhattacharyya Suman
Published: December 2020

We report the first systematic study to identify and characterize a sample of classical Ae stars in the Galaxy. The spectra of these stars were retrieved from the A-star catalogue using the Large sky Area Multi-Object fibre Spectroscopic Telescope (LAMOST) survey. We identified the emission-line stars in this catalogue from which 159 are confirmed as classical Ae stars. This increases the sample of known classical Ae stars by about nine times from the previously identified 21 stars. The evolutionary phase of classical Ae stars in this study is confirmed from the relatively small mid- and far-infrared excess and from their location in the optical colour–magnitude diagram. We estimated the spectral type using MILES spectral templates and identified classical Ae stars beyond A3, for the first time. The prominent emission lines in the spectra within the wavelength range 3700–9000 Å are identified and compared with the features present in classical Be stars. The H α emission strength of the stars in our sample show a steady decrease from late-B type to Ae stars, suggesting that the disc size may be dependent on the spectral type. Interestingly, we noticed emission lines of Fe ii, O i, and Paschen series in the spectrum of some classical Ae stars. These lines are supposed to fade out by late B-type and should not be present in Ae stars. Further studies, including spectra with better resolution, is needed to correlate these results with the rotation rates of classical Ae stars.
HH 175: a giant Herbig–Haro flow emanating from a multiple protostar
Authors: Reipurth Bo , Friberg Per
Published: December 2020

HH 175 is an isolated Herbig–Haro object seen towards the B35 cloud in the λ Ori region. We use deep Subaru 8 m interference filter images and Spitzer images to show that HH 175 is a terminal shock in a large collimated outflow from the nearby embedded source IRAS 05417+0907. The body of the eastern outflow lobe is hidden by a dense ridge of gas. The western outflow breaks out of the front of the cometary-shaped B35 cloud, carrying cloud fragments along, which are optically visible due to photoionization by the massive λ Ori stars. The total extent of the bipolar outflow is 13.7 arcmin, which at the adopted distance of 415 pc corresponds to a projected dimension of 1.65 pc. The embedded source IRAS 05417+0907 is located on the flow axis approximately midway between the two lobes, and near-infrared images show it to be a multiple system of six sources, with a total luminosity of 31 L⊙. Millimeter maps in CO, 13CO, and C18O show that the B35 cloud is highly structured with multiple cores, of which the one that spawned IRAS 05417+0907 is located at the apex of B35. It is likely that the embedded source is the result of compression by an ionization-shock front driven by the λ Ori OB stars.
A study of Si ii and S ii features in spectra of Type Ia supernovae
Authors: Zhao Xulin , Maeda Keiichi , Wang Xiaofeng , Sai Hanna
Published: December 2020

We studied the spectral features of Si ii λλ4130, 5972, 6355 and the S ii W-trough for a large sample of Type Ia supernovae (SNe Ia). We found that in the NV (normal-velocity) subclass of SNe Ia, these features tend to reach a maximum line strength near maximum light, except for Si ii λ5972. Spectral features with higher excitation energy, such as the S ii W-trough, are relatively weak and have a relatively low velocity. SNe Ia with larger Δm15(B) tend to have lower velocities, especially at phases after maximum light. NV SNe show a trend of increasing line strength with increasing Δm15(B), while 91T/99aa-like SNe show an opposite trend. Near maximum light, the absorption depth of Si ii λ5972 shows the strongest correlation with Δm15(B), while at early times the sum of the depths of Si ii λλ4130 and 5972 shows the strongest correlation with Δm15(B). The overall correlation between velocity and line strength is positive, but within NV SNe the correlation is negative or unrelated, depending on the phase. In normal SNe Ia (including the high-velocity SNe), the velocity difference and depth ratio of a longer-wavelength feature to a shorter-wavelength feature tend to increase with increasing Δm15(B). These results are mostly well explained with atomic physics, but some puzzles remain, possibly related to the effects of saturation, line competition or other factors.
A multi-epoch study of radio continuum emission from massive protostars
Authors: Obonyo W O , Lumsden S L , Hoare M G , Kurtz S E , Purser S J D
Published: December 2020

We report the results of the Jansky Very Large Array (JVLA) observation of five massive protostars at 6 and 22.2 GHz. The aim of the study was to compare their current fluxes and positions with previous observations to search for evidence of variability. Most of the observed sources present the morphologies of a thermal core, hosting the protostar and exhibiting no proper motion, and associated non-thermal radio lobes that are characterized by proper motions and located away from the thermal core. Some of the protostars drive jets whose lobes have dissimilar displacement vectors, implying precession of the jets or the presence of multiple jet drivers. The jets of the protostars were found to have proper motions that lie in the range of 170 ≤ v ≤ 650 km s−1, and precessions of periods of 40 ≤ p ≤ 50 yr and angles of 2 ≤ α ≤ 10°, assuming that their velocities v = 500 km s−1. The core of one of the sources, S255 NIRS3, which was in outburst at the time of our observations, showed a significant change in flux compared to the other sources. Its spectral index decreased during the outburst, consistent with the model of an expanding gas bubble. Modelling the emission of the outburst as that of a new non-thermal lobe that is emerging from a thermal core whose emission enshrouds that of the lobe also has the potential to account for the increase in flux and a decrease in the spectral index of the source’s outburst.
Physical conditions and redshift evolution of optically thin C iii absorbers: low-z sample
Authors: Mohapatra Abhisek , Srianand R , Pradhan Ananta C
Published: December 2020

We present a detailed analysis of 99 optically thin C iii absorption systems at redshift 0.2 ≤ z ≤ 0.9 associated with neutral hydrogen column densities in the range 15 ≤ log $N({\rm{H\,{\small I}}})$ (cm−2) ≤ 16.2. Using photoionization models, we infer the number density (nH), C-abundance ([C/H]), and line-of-sight thickness (L) of these systems in the ranges −3.4 ≤ log nH (cm−3) ≤ −1.6, −1.6 ≤ [C/H] ≤ 0.4, and 1.3 pc ≤ L ≤ 10 kpc, respectively, with most of the systems having sub-kpc scale thickness. We combine the low-z and previously reported high-z (2.1 ≤ z ≤ 3.3) optically thin C iii systems to study the redshift evolution and various correlations between the derived physical parameters. We see a significant redshift evolution in nH, [C/H], and L. We compare the redshift evolution of metallicity in C iii systems with those of various types of absorption systems. We find that the slope of [C/H] versus z for C iii absorbers is steeper compared to the redshift evolution of cosmic metallicity of the damped Ly α sample (DLA) but consistent with that of sub-DLAs. We find the existence of strong anticorrelation between L and [C/H] for the combined sample with a significance level of 8.39σ. We see evidence of two distinct [C/H] branch C iii populations (low-[C/H] branch, $[\mathrm{ C/H}]\, \le -1.2$, and high-[C/H] branch, $[\mathrm{ C/H}]\, \gt -1.2$) in the combined C iii sample when divided appropriately in the L versus $N({\rm{C\,{\small III}}})$ plane. Further studies of C iii absorbers in the redshift range 1.0 ≤ z ≤ 2.0 are important to map the redshift evolution of these absorbers and gain insights into the time evolution physical conditions of the circumgalactic medium.
Capabilities of selenoneine to cross thein vitroblood–brain barrier model
Authors: Drobyshev Evgenii , Raschke Stefanie , Glabonjat Ronald A , Bornhorst Julia , Ebert Franziska , Kuehnelt Doris , Schwerdtle Tanja
Published: December 2020

The naturally occurring selenoneine (SeN), the selenium analogue of the sulfur-containing antioxidant ergothioneine, can be found in high abundance in several marine fish species. However, data on biological properties of SeN and its relevance for human health are still scarce. This study aims to investigate the transfer and presystemic metabolism of SeN in a well-established in vitro model of the blood–brain barrier (BBB). Therefore, SeN and the reference Se species selenite and Se-methylselenocysteine (MeSeCys) were applied to primary porcine brain capillary endothelial cells (PBCECs). Se content of culture media and cell lysates was measured via ICP-MS/MS. Speciation analysis was conducted by HPLC–ICP-MS. Barrier integrity was shown to be unaffected during transfer experiments. SeN demonstrated the lowest transfer rates and permeability coefficient (6.7 × 10−7 cm s−1) in comparison to selenite and MeSeCys. No side-directed accumulation was observed after both-sided application of SeN. However, concentration-dependent transfer of SeN indicated possible presence of transporters on both sides of the barrier. Speciation analysis demonstrated no methylation of SeN by the PBCECs. Several derivatives of SeN detected in the media of the BBB model were also found in cell-free media containing SeN and hence not considered to be true metabolites of the PBCECs. In concluding, SeN is likely to have a slow transfer rate to the brain and not being metabolized by the brain endothelial cells. Since this study demonstrates that SeN may reach the brain tissue, further studies are needed to investigate possible health-promoting effects of SeN in humans.
Long-Term Outcomes of Intra-Arterial Chemotherapy for Progressive or Unresectable Pilocytic Astrocytomas: Case Studies
Authors: Uluc Kutluay , Siler Dominic A , Lopez Ricardo , Varallyay Csanad , Netto Joao Prola , Firkins Jenny , Lacy Cindy , Huddleston Amy , Ambady Prakash , Neuwelt Edward A
Published: December 2020

BACKGROUND

Progressive and/or unresectable pilocytic astrocytomas (PAs) carry a poor prognosis compared to typical PA. Early radiotherapy (RT) may have severe long-term neurocognitive side effects in this patient population. Intra-arterial (IA) chemotherapy is a viable alternative or addition to intravenous (IV) chemotherapy, which may be beneficial in avoidance of early RT.

OBJECTIVE

To evaluate the safety and efficacy of IA chemotherapy in this subset of patients.

METHODS

This is a retrospective review of medical records of PA patients who are treated with IA chemotherapy at Oregon Health & Science University from 1997 until 2019. Response to treatment was categorized as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD). Progression free survival (PFS) and overall survival (OS) are also reported.

RESULTS

Twelve patients were identified. All patients experienced progression prior to initiation of IA chemotherapy. The most common grade 3 or 4 toxicities related to chemotherapy were thrombocytopenia (66%), neutropenia (66%), leukopenia (50%), anemia (33%), and lymphopenia (16%). Responses achieved were CR in 1, PR in 3, SD in 7, and PD in 1. Median PFS and median OS were 16.5 and 83.5 mo, respectively. A total of 112 procedures (IA injections) were performed and 250 arteries were catheterized. There were 3 minor and no major complications attributable to procedures.

CONCLUSION

This study demonstrates that IA chemotherapy can be safely used in patients with unresectable or progressive PA.
Electronic Cigarette Product Placement and Imagery in Popular Music Videos
Authors: Escobedo Patricia , Rosenthal Erica L , Saucier Camille J , Unger Jennifer B , Cruz Tess B , Kirkpatrick Matt , Allem Jon-Patrick
Published: December 2020

Introduction

Given the increasing use of electronic cigarettes (e-cigarettes) among young adults, it is crucial to identify possible sources of e-cigarette marketing exposure in media popular among young adults. However few studies document e-cigarette product placement (eg, visible logo, branded merchandise or gear such as a branded hat or shirt) in music videos. The objective of this study was to determine the extent of e-cigarette product placement and imagery in popular music videos.

Methods

Songs on the Billboard Hot 100 list during the weeks of June 16 through September 22, 2018 with official music videos were identified (n = 180) and coded for e-cigarette product placement and imagery (including aerosol clouds), visible brand names, number of views (as of October 25, 2018), music genre, video themes, and combustible tobacco content.

Results

E-cigarette product placement and imagery appeared in 7 (3.8%) music videos which were viewed over a billion times, providing billions of e-cigarette impressions. Among music videos with e-cigarette product placement and imagery, the most prevalent theme was Image/Lifestyle/Sociability (eg, ostentatious lifestyle, partying) and the most prevalent genre was Hip Hop. The e-cigarette companies KandyPens and Mig Vapor were identified.

Conclusion

While e-cigarette product placement or imagery appeared in a relatively low number of music videos in this study, these videos received views in the billions. Music videos should be considered when assessing e-cigarette marketing exposure among priority populations. Future research should examine how viewing e-cigarette product placement and imagery in music videos influences susceptibility to use such products among young adults.

Implications

While e-cigarette product placement (eg, scenes with visible branding, a visible logo, branded merchandise or gear such as a branded hat or shirt) or imagery appeared in a relatively low number of popular music videos in this study, these videos received views in the billions on YouTube. KandyPens and Mig Vapor were the companies responsible for the majority of the product placement identified in this study. The predominant music genre of videos featuring any e-cigarette product placement or imagery was Hip Hop, while the predominant theme of videos was Image/Lifestyle/Sociability. Music videos appear to be a potential source of exposure to e-cigarette products. Future research should examine how viewing e-cigarette product placement and imagery in music videos influences susceptibility to use such products among priority populations.
Progressive Changes in Glutamate Concentration in Early Stages of Schizophrenia: A Longitudinal 7-Tesla MRS Study
Authors: Jeon Peter , Limongi Roberto , Ford Sabrina D , Mackinley Michael , Dempster Kara , Théberge Jean , Palaniyappan Lena
Published: December 2020

Progressive reduction in glutamatergic transmission has been proposed as an important component of the illness trajectory of schizophrenia. Despite its popularity, to date, this notion has not been convincingly tested in patients in early stages of schizophrenia. In a longitudinal 7T magnetic resonance spectroscopy (1H-MRS), we quantified glutamate at the dorsal anterior cingulate cortex in 21 participants with a median lifetime antipsychotic exposure of less than 3 days and followed them up after 6 months of treatment. Ten healthy controls were also scanned at 2 time points. While patients had significantly lower overall glutamate levels than healthy controls (F(1,27) = 5.23, P = .03), we did not observe a progressive change of glutamate concentration in patients (F(1,18) = 0.47, P = .50), and the group by time interaction was not significant (F(1,27) = 0.86, P = .36). On average, patients with early psychosis receiving treatment showed a 0.02 mM/y increase, while healthy controls showed a 0.06 mM/y reduction of MRS glutamate levels. Bayesian analysis of our observations does not support early, post-onset glutamate loss in schizophrenia. Interestingly, it provides evidence in favor of a lack of progressive glutamate change in our schizophrenia sample—indicating that the glutamate level at the onset of illness was the best predictor of the levels 6 months after treatment. A more nuanced view of glutamatergic physiology, linked to early cortical maturation, may be required to understand glutamate-mediated dynamics in schizophrenia.
Spatial analysis of congenital syphilis in a federative unit in northeastern Brazil
Authors: Graepp Fontoura Iolanda , Lima Valckinara Carreiro , Fontoura Volmar Morais , Santos Floriacy Stabnow , de Jesus Costa Ana Cristina Pereira , de Oliveira Francisca Jacinta Feitoza , de Oliveira Feitosa Marcela , de Almeida Tavares Hanari Santos , Lima Lilian Natália Ferreira , Falcão Arissane de Sousa , Silva Roberta de Araújo e , Dias Ismália Cassandra Costa Maia , dos Santos Leonardo Hunaldo , Bezerra Janaina Miranda , Fonseca Sheila Cristina Teixeira , Santos Neto Marcelino
Published: December 2020

Background

Congenital syphilis is an infectious disease that affects 1 million children a year worldwide.

Methods

The objective of this study was to describe a spatial analysis of the epidemiological characteristics of congenital syphilis in the state of Maranhão, Brazil from 2007 to 2018. This was an ecological study using data obtained in May 2020 from three Brazilian information systems. The spatial correlation was analyzed according to local and global Moran indexes.

Results

During the 12-y period, 1 426 177 children were born. Of these children, 3684 acquired congenital syphilis (0.26%; mean annual rate of 2.62/1000 live births) and 70 died (1.90%; mean annual rate 0.05). The clusters were statistically significant according to the global Moran index of 0.40 (p=0.01). Spearman's correlation coefficient between the rate of detection of syphilis in pregnant women and family health strategy teams was strong, positive and significant (ρ=0.73; p<0.00). Most of the variables studied showed a trend of annual increase (p<0.05).

Conclusions

The use of spatial analysis tools have made it possible to detect areas with both a greater and a lesser need for intervention, and to more effectively improve and monitor those areas to change the epidemiological profile of the disease.
Two Unique Prophages of ‘CandidatusLiberibacter asiaticus’ Strains from Pakistan
Authors: Cui Xuejin , Liu Kehong , Atta Sagheer , Zeng Chunhua , Zhou Changyong , Wang Xuefeng
Published: December 2020

‘Candidatus Liberibacter asiaticus’ (CLas) is a pathogen causing Huanglongbing (HLB, yellow shoot disease), which is highly destructive to citrus production. The CLas strains harbor prophages. We identified two unique prophages, designated as P-PA19-1 and P-PA19-2, in CLas strain PA19 from Pakistan using next-generation sequencing analysis. P-PA19-1 prophage has high sequence similarity (identity: 78.23%) at the early-gene region of prophage SC1 (Type 1), but it is significantly divergent in the late-gene region (identity: 62.03%). P-PA19-2 was highly similar to SC2 (Type 2) in the late gene region (identity: 97.96%), and also in the early gene region except for a deletion of a 7,179-bp nucleotide sequence that contains a CRISPR/cas system in SC2. Both P-PA19-1 and P-PA19-2 had circular plasmid forms, and only P-PA19-2 was found integrated in the PA19 chromosome. The two new prophages were only found in Pakistani samples. Identification of prophages enhances our understanding of CLas genomic diversity and also the biology and evolution of CLas prophages.
Gastroesophageal reflux and asthma: when, how, and why
Authors: Paoletti Giovanni , Melone Giulio , Ferri Sebastian , Puggioni Francesca , Baiardini Ilaria , Racca Francesca , Canonica Giorgio W. , Heffler Enrico , Malipiero Giacomo
Published: December 2020

Purpose of review

Gastro-esophageal reflux is a possible cause of uncontrolled symptoms of asthma and should be actively investigated and treated before severe asthma is diagnosed and biological therapy started.

Recent findings

Recent investigations on esophageal function and tissue biomarkers in patients with asthma and associated GERD have established a relevant role for esophageal motility and neuronal sensory abnormalities in linking the two diseases. Characterization of the underpinning inflammatory substrate has showed mixed results as both neutrophilic and eosinophilic type 2 inflammatory changes have been described.

New findings regarding inflammatory mechanisms in GERD-associated asthma as well as new diagnostic tools to investigate functional esophageal abnormalities and characterize asthma endotype have identified potential treatable traits that may improve the clinical management and outcome of asthmatic patients with GERD.
Allergen immunotherapy and biologics in respiratory allergy: friends or foes?
Authors: Malipiero Giacomo , Melone Giulio , Puggioni Francesca , Pawankar Ruby , Heffler Enrico , Paoletti Giovanni
Published: December 2020

Purpose of review

Allergen-specific immunotherapy has established as an indispensable disease-modifying treatment in allergy practice but its safety and efficacy might be furtherly improved by combining it with other drugs or therapeutic intervention that co-modulate immune type 2 immune networks

Recent findings

In the past two decades, clinical research focused on AIT and omalizumab co-treatment to improve both safety and long-term efficacy of allergic disease treatment. Recently, combination of AIT with other biologicals targeting different mediators of type 2 inflammation has been set up with interesting preliminary results. Moreover, AIT current contraindication might be overcome by contemporarily controlling underlying type 2 inflammation in severe atopic patients.

AIT--biological combination treatment can realize a complex multitargeted treatment strategy allowing for consistently improving disease control and sparing steroid administration.
Coronavirus Disease 2019 (COVID-19) Vaccines and Pregnancy
Authors: Rasmussen Sonja A. , Kelley Colleen F. , Horton John P. , Jamieson Denise J.
Published: December 2020

Coronavirus disease 2019 (COVID-19) vaccines have begun to be distributed across the United States and to be offered initially to priority groups including health care personnel and persons living in long-term care facilities. Guidance regarding whether pregnant persons should receive a COVID-19 vaccine is needed. Because pregnant persons were excluded from the initial phase 3 clinical trials of COVID-19 vaccines, limited data are available on their efficacy and safety during pregnancy. After developmental and reproductive toxicology studies are completed, some companies are expected to conduct clinical trials in pregnant persons. Until then, pregnant persons and their obstetricians will need to use available data to weigh the benefits and risks of COVID-19 vaccines. Issues to be considered when counseling pregnant persons include data from animal studies and inadvertently exposed pregnancies during vaccine clinical trials when available, potential risks to pregnancy of vaccine reactogenicity, timing of vaccination during pregnancy, evidence for safety of other vaccines during pregnancy, risk of COVID-19 complications due to pregnancy and the pregnant person's underlying conditions, and risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and potential for risk mitigation. The Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine have each issued guidance supportive of offering COVID-19 vaccine to pregnant persons. As additional information from clinical trials and from data collected on vaccinated pregnant persons becomes available, it will be critical for obstetricians to keep up to date with this information.
Atelectrauma Versus Volutrauma: A Tale of Two Time-Constants
Authors: Bates Jason H. T. , Gaver Donald P. , Habashi Nader M. , Nieman Gary F.
Published: December 2020

Objectives:

Elucidate how the degree of ventilator-induced lung injury due to atelectrauma that is produced in the injured lung during mechanical ventilation is determined by both the timing and magnitude of the airway pressure profile.

Design:

A computational model of the injured lung provides a platform for exploring how mechanical ventilation parameters potentially modulate atelectrauma and volutrauma. This model incorporates the time dependence of lung recruitment and derecruitment, and the time-constant of lung emptying during expiration as determined by overall compliance and resistance of the respiratory system.

Setting:

Computational model.

Subjects:

Simulated scenarios representing patients with both normal and acutely injured lungs.

Measurements and Main Results:

Protective low-tidal volume ventilation (Low-Vt) of the simulated injured lung avoided atelectrauma through the elevation of positive end-expiratory pressure while maintaining fixed tidal volume and driving pressure. In contrast, airway pressure release ventilation avoided atelectrauma by incorporating a very brief expiratory duration (

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) that both prevents enough time for derecruitment and limits the minimum alveolar pressure prior to inspiration. Model simulations demonstrated that

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has an effective threshold value below which airway pressure release ventilation is safe from atelectrauma while maintaining a tidal volume and driving pressure comparable with those of Low-Vt. This threshold is strongly influenced by the time-constant of lung-emptying.

Conclusions:

Low-Vt and airway pressure release ventilation represent markedly different strategies for the avoidance of ventilator-induced lung injury, primarily involving the manipulation of positive end-expiratory pressure and

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, respectively.

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can be based on exhalation flow values, which may provide a patient-specific approach to protective ventilation.
Gastrocolic fistula: a case report
Authors: Frisone Daniele , Gobin Niels , Renard Philippe , Malekzadeh Sonaz , Constantin Christophe , Barberini Luc E.
Published: December 2020

Introduction:

Gastrocolic fistula (GCF) is a rarely reported complication of numerous diseases. When associated with malignancies, the prognosis is usually poor. The classic presentation includes diarrhea, feculent vomiting, and weight loss.

Presentation of Case:

We hereby report the case of a patient who presented with weight loss and dyspepsia for 2 months, in the absence of diarrhea. Diagnosis of a GCF was made by performing a gastroscopy and a computed tomography scan. The biopsy taken during gastroscopy showed a lower tract gastrointestinal cancer, and the patient underwent surgical treatment by “en bloc” resection. After an anastomosis leak, he recovered well and underwent adjuvant chemotherapy. After a 3-year follow-up, the patient is alive and disease free.

Discussion:

This case presentation, together with a literature review, underlines that variable symptoms and signs that can be associated to this rare condition. The role of new imaging techniques such as computed tomography scan, compared with barium enema, should also be evaluated in this setting. The absence of lymph-node involvement may predict a good prognosis.

Conclusion:

GCF is a rare presentation of malignant diseases. In order to diagnose this rare condition a high grade of suspicion is needed, as symptoms are variable and most diagnostic tools are not sensitive enough to recognize it.
“You Helped Create This, Help Me Now”: A Qualitative Analysis of Patients’ Concerns about Breast Implants and a Proposed Strategy for Moving Forward
Authors: Steve Anna K. , Temple-Oberle Claire , Yeung Justin K. , Lafreniere Ann-Sophie , Harrop A. Robertson
Published: December 2020

Background:

Some women with breast implants express concern about the safety of implants, fearing the possibility of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and breast implant-related illness.

Methods:

A qualitative analysis was performed to examine the perceived challenges, barriers, and worries experienced by these women. Convenience sampling was used to elicit responses from members of Canadian BIA-ALCL Facebook advocacy groups. Three independent coders read and reread the transcripts, using thematic analysis to identify emerging themes.

Results:

Sixty-four women answered questions posed by the president of the Canadian Society of Plastic Surgeons regarding concerns about their breast implants. Five themes were identified: informing, listening, acknowledging, clarifying, and moving forward. Patients desire improved communication about possible risks before implantation and as new information becomes available (informing), sincere listening to their concerns (listening), acknowledgement that these disease entities may be real and have psychosocial/physical impact on patients (acknowledging), clarification of implant-related problems and their treatment (clarifying), and improved processes for monitoring and treatment of patients with identified problems (moving forward). Consideration of these themes in the context of the five domains of trust theory (i.e., fidelity, competence, honesty, confidentiality, and global trust) suggests significant breakdown in the doctor-patient relationship for a subset of concerned women.

Conclusions:

Concerns related to BIA-ALCL and breast implant-related illnesses have undermined some women’s trust in plastic surgeons. Consideration of these five themes and their impact on the five domains of trust can guide strategies for reestablishing patients’ trust in the plastic surgery community.
Superselective Arterial Hyaluronidase Thrombolysis Is Not an Effective Treatment for Hyaluronic Acid–Induced Retinal Artery Occlusion: Study in a Rabbit Model
Authors: Chen Jiabao , Ruan Jiyin , Wang Wei , Chen Zaizhong , Huang Qinying , Yang Yatong , Li Jinying
Published: December 2020

Background:

Worldwide application of hyaluronic acid has brought about severe complications, including central retinal arterial occlusion, which leads to a deleterious effect on vision. The current study explored the efficacy of superselective arterial hyaluronidase thrombolysis in rabbit retinal artery occlusion induced by hyaluronic acid.

Methods:

Occlusion of the internal/external ophthalmic artery in New Zealand White rabbits was induced with superselective injection of hyaluronic acid. Superselective subtraction angiography and fundus examination were conducted to confirm and evaluate the artery embolism. After 30 minutes of embolism, hyaluronidase was injected in the occluded artery through superselective arterial intubation.

Results:

Compared with preoperative and contralateral eyes, the postoperative eyes showed the symptoms of central retinal arterial occlusion and embolization, confirmed by digital subtraction angiography. After intraarterial hyaluronidase thrombolysis, the embolization failed to dissolve as shown on funduscopic and angiographic examinations.

Conclusions:

Superselective ophthalmic artery intervention could accurately and successfully establish the animal models of retinal artery occlusion induced by hyaluronic acid. The precise occlusion site of the retinal artery and complete embolism were confirmed by ophthalmologic examinations. Intraarterial hyaluronidase thrombolysis might not be an effective method to treat retinal artery occlusion induced by hyaluronic acid.
Muscle Fascia Changes in Patients with Occipital Neuralgia, Headache, or Migraine
Authors: Gfrerer Lisa , Hansdorfer Marek A. , Amador Ricardo O. , Chartier Christian , Nealon Kassandra P. , Austen William G.
Published: December 2020

In an ongoing effort to understand the pathogenesis of occipital neuralgia/headache/migraine, it is critical to describe the anatomical/tissue changes encountered during surgery. Greater occipital nerve anatomical studies mainly focus on the greater occipital nerve course through muscle/fascial planes and interaction with the occipital vessels. However, structural soft-tissue changes have not been described in detail. Anecdotally, trapezius fascia is thickened at the greater occipital nerve trigger site. This study further investigates this observation. Patients undergoing greater occipital nerve decompression surgery were enrolled prospectively in this observational study (n = 92). Tissue changes were recorded intraoperatively. The resulting data were examined. Trapezius fascia was more than 3 mm thick and appeared fibrotic in 86 patients (94 percent), whereas semispinalis muscle appeared normal in all subjects. The greater occipital nerve was macroscopically abnormal, defined as edematous, flattened, and discolored in 29 cases (32 percent). The occipital artery interacted significantly with the greater occipital nerve in 88 percent of cases. The authors conclude that the tissue structure is abnormal in patients undergoing greater occipital nerve decompression surgery. This is the first study that describes the prevalence of thickened and fibrotic appearing trapezius fascia at the occipital trigger site, a phenomenon encountered in the vast majority of patients (94 percent). This structural anomaly has a resemblance to thickened fascial tissues seen in other nerve compression syndromes, and could be related to microtrauma/overuse or actual trauma in the head and neck region.
Evolution of Cranioorbital Shape in Nonsyndromic, Muenke, and Saethre-Chotzen Bilateral Coronal Synostosis: A Case-Control Study of 2-Year Outcomes
Authors: Adidharma Widya , Mercan Ezgi , Purnell Chad , Birgfeld Craig B. , Lee Amy , Ellenbogen Richard G. , Hopper Richard A.
Published: December 2020

Background:

The purpose of this study was to quantify change in cranioorbital morphology from presentation, after fronto-orbital advancement, and at 2-year follow-up.

Methods:

Volumetric, linear, and angular analyses were performed on computed tomographic scans of consecutive bilateral coronal synostosis patients. Comparisons were made across three time points, between syndromic and nonsyndromic cases, and against normal controls. Significance was set at p < 0.05.

Results:

Twenty-five patients were included: 11 were nonsyndromic, eight had Saethre-Chotzen syndrome, and six had Muenke syndrome. Total cranial volume was comparable to normal, age-matched control subjects before and 2 years after surgery despite an expansion during surgery. Axial and sagittal vector analyses showed advancement and widening of the lower forehead beyond control values with surgery and comparable anterior position, but increased width compared to controls at 2 years. Frontal bossing decreased with a drop in anterior cranial height and advanced lower forehead position. Middle vault height was not normalized and turricephaly persisted at follow-up. Posterior fossa volume remained lower at all three time points compared to control subjects. Supraorbital retrusion relative to anterior corneal position was overcorrected by surgery, with values comparable to those of control subjects at 2 years because of differential growth. There was no difference at 2 years between syndromic and nonsyndromic groups.

Conclusions:

Open fronto-orbital advancement successfully remodels the anterior forehead but requires overcorrection to be comparable to normal at 2 years. Although there are differences in syndromic cases at presentation, they do not result in significant morphometric differences on follow-up. Posterior fossa volume remains lower at all time points.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Powered Rhinoplasty: A Simple Step-by-Step Approach
Authors: Racy Emmanuel , Fanous Amanda , Benmoussa Nadia
Published: December 2020

Reduction of a nasal hump and nasal base narrowing are very common steps during a primary rhinoplasty procedure. The greatest difficulty is to obtain stable fracture lines, a natural appearance, beautiful dorsal aesthetic lines, and the absence of palpable or visible irregularities, especially in the long term. The surgeon strives for a reproducible technique, which seems to be more feasible with mechanical osteotomies (powered or piezoelectric) than with traditional manual osteotomies. The aim of this article is to describe powered osteotomy in a step-by-step fashion to provide a clear guideline for rhinoplasty surgeons.