bluuebunny/crossref_metadata_2025 huggingface dataset:
Nonhome Discharge as an Independent Risk Factor for Adverse Events and Readmission in Patients Undergoing Anterior Cervical Discectomy and Fusion
Authors: Neifert Sean Nakatani , Gal Jonathan S. , Chapman Emily K. , Caridi John M.
Published: February 2020

Study Design:

A retrospective study of a prospectively collected cohort.

Objective:

To characterize a cohort of patients who underwent anterior cervical discectomy and fusion (ACDF) and examine whether nonhome discharge (NHD) is associated with postdischarge adverse events (AEs) and readmission.

Summary of the Background Data:

Predictors of NHD have been elucidated in the spine surgery literature, and NHD has been tied to poor outcomes in the joint arthroplasty literature, but no such analysis exists for patients undergoing ACDF.

Materials and Methods:

All patients who underwent ACDF from 2012 to 2015 in the National Surgical Quality Improvement Program were identified. Those who underwent concomitant posterior cervical operations were excluded. Patients who were discharged to home were compared with those discharged to nonhome destinations on the basis of demographics and outcomes. Multivariable models were created to assess whether NHD was an independent risk factor for postdischarge AEs and readmission.

Results:

NHD patients were significantly older (63.96 vs. 53.57 y; P<0.0001), more functionally dependent (13.87% vs. 1.09%; P<0.0001), more likely to have body mass index >40 (9.38% vs. 7.51%; P=0.004), and more likely to have ASA Class >2 (77.89% vs. 39.57%; P<0.0001). Patients who underwent NHD were significantly more likely to suffer severe AEs (14.44% vs. 0.93%; P<0.0001), minor AEs (7.22% vs. 0.24%; P<0.0001), and infectious complications (3.58% vs. 0.13%; P<0.0001) before discharge. When examining AEs after discharge, patients who underwent NHD were more likely to suffer severe AEs (6.37% vs. 1.34%; P<0.0001), minor AEs (4.09% vs. 0.74%; P<0.0001), death (1.25% vs. 0.07%; P<0.0001), and unplanned readmission (10.12% vs. 3.06%; P<0.0001). In adjusted analysis, NHD was found to independently predict severe AEs after discharge (odds ratio, 2.40; 95% confidence interval, 1.87–3.07; P<0.0001) and readmission (odds ratio, 1.77; 95% confidence interval, 1.46–2.14; P<0.0001).

Conclusions:

NHD patients were significantly sicker than those discharged home. In addition, NHD is associated with higher rates of postdischarge complications.
Tafamidis
Authors: Nawarskas James J. , Shephard Emily A.
Published: February 2020

Transthyretin (TTR) amyloid cardiomyopathy is a life-threatening condition in which amyloid fibrils accumulate in the heart, eventually leading to cardiac symptomatology and death. To date, treatment of this condition has been directed at symptom relief due to a lack of effective treatment options which target the cause of the disease. The discovery that amyloid deposition was a result of dissociation of the TTR protein structure allowed for the development of tafamidis, which acts by stabilizing the TTR tetramer. Due to the rare nature of the disease, there is limited clinical trial data with tafamidis, with the largest clinical trial enrolling only 441 patients. Nonetheless, that trial demonstrated tafamidis to reduce all-cause mortality as well as cardiovascular hospitalizations compared to placebo with a comparable adverse effect profile, although not all subgroups of patients received benefit. The United States Food and Drug Administration subsequently granted Fast Track review status to tafamidis, leading to its approval in May 2019. Important questions still remain, however, such as which patient groups will receive the most benefit with this drug, how the exceptionally high cost of the drug will be handled by third-party payers, and how the therapeutic role of tafamidis will evolve as competing or perhaps complementary medications complete their ongoing clinical trials and move into the marketplace.
Interferential current: a new option for the treatment of sexual complaints in women with premature ovarian insufficiency using systemic hormone therapy: a randomized clinical trial
Authors: Benetti-Pinto Cristina L. , Giraldo Helena P. , Giraldo Andrea E. , Mira Ticiana A. , Yela Daniela A.
Published: February 2020

Objective:

The aim of the study was to evaluate the efficacy of interferential current (IC) in the sexual function of women with premature ovarian insufficiency (POI) using systemic hormone therapy (HT), compared to topical estriol.

Methods:

A randomized clinical trial with 40 women with POI using systemic HT, who were sexually active and referred for dyspareunia and reduction of lubrication. The women were divided into two treatment groups for 4 weeks: IC group (eight electrotherapy sessions twice a week); or E group (estriol vaginal cream, daily application, 0.5 mg/d). The Female Sexual Function Index was used to evaluate pre-/posttreatment sexual function.

Results:

Mean age was 37.13 ± 7.27 years and mean treatment time with HT was 8.20 ± 8.73 years, similar data for both groups. There was an improvement in global sexual function, lubrication, and pain domains for both treatments. The differences between the pre-/posttreatment lubrication scores were respectively 0.75 ± 3.31 (P = 0.014) for IC and 1.16 ± 1.22 (P < 0.001) for estriol, whereas for dyspareunia the differences were 1.00 ± 1.47 (P = 0.005) for IC, and 0.68 ± 1.30 (P = 0.006) for estriol. There was no pre-/posttreatment difference for the desire and arousal domains. Only in the IC group did orgasm (difference 0.90 ± 1.42, P = 0.010) and satisfaction improve (difference 0.70 ± 1.28, P = 0.021).

Conclusion:

The use of perineal IC seems to be a new option for women with POI using systemic HT and presenting with sexual complaints, leading to an improvement in pain, lubrication, satisfaction, and orgasm.
Early postoperative pain after laparoscopic donor nephrectomy predicts 30-day postoperative infectious complications: a pooled analysis of randomized controlled trials
Authors: Albers Kim I. , van Helden Esmee V. , Dahan Albert , Martini Chris H. , Bruintjes Moira H.D. , Scheffer Gert-Jan , Steegers Monique A.H. , Keijzer Christiaan , Warlé Michiel C.
Published: February 2020

Our research group recently published a positive association between early postoperative pain and 30-day postoperative complications in a broad surgical population. To investigate whether heterogeneity of the population and surgical procedures influenced these results, we explored this association in a homogenous surgical population. A secondary analysis of the LEOPARD-2 (clinicaltrials.gov NCT02146417) and RELAX-1 study (NCT02838134) in laparoscopic donor nephrectomy patients (n = 160) was performed. Pain scores on the postanesthesia care unit and postoperative day (POD) 1 and 2 were compared between patients with infectious, noninfectious, and no complications 30 days after surgery. Patients who developed infectious complications had significantly higher pain scores on POD1 and 2 (6.7 ± 2.1 and 6.4 ± 2.8) than patients without complications (4.9 ± 2.2 and 4.1 ± 1.9), respectively (P = 0.006 and P = 0.000). Unacceptable pain (numeric rating scale [NRS] ≥ 6) on POD1 was reported by 72% of patients who developed infectious complications, compared to 38% with noninfectious complications and 30% without complications (P = 0.018). This difference was still present on POD2 at 67% with infectious complications, 21% with noninfectious, and 40% without complications (P = 0.000). Multiple regression analysis identified unacceptable pain (numeric rating scale ≥6) on POD2 as a significant predictor for 30-day infectious complications (odds ratio 6.09, P = 0.001). Results confirm the association between early postoperative pain and 30-day infectious complications in a separate, homogenous surgical population. Further clinical trials should focus on finetuning of postoperative analgesia to elucidate the effects on the endocrine and immune response, preserve immune homeostasis, and prevent postoperative infectious complications.
Distribution of functional opioid receptors in human dorsal root ganglion neurons
Authors: Moy Jamie K. , Hartung Jane E. , Duque Melissa G. , Friedman Rob , Nagarajan Vidhya , Loeza-Alcocer Emanuel , Koerber H. Richard , Christoph Thomas , Schröder Wolfgang , Gold Michael S.
Published: February 2020

Preclinical evidence has highlighted the importance of the μ-opioid peptide (MOP) receptor on primary afferents for both the analgesic actions of MOP receptor agonists, as well as the development of tolerance, if not opioid-induced hyperalgesia. There is also growing interest in targeting other opioid peptide receptor subtypes (δ-opioid peptide [DOP], κ-opioid peptide [KOP], and nociceptin/orphanin-FQ opioid peptide [NOP]) on primary afferents, as alternatives to MOP receptors, which may not be associated with as many deleterious side effects. Nevertheless, results from several recent studies of human sensory neurons indicate that although there are many similarities between rodent and human sensory neurons, there may also be important differences. Thus, the purpose of this study was to assess the distribution of opioid receptor subtypes among human sensory neurons. A combination of pharmacology, patch-clamp electrophysiology, Ca2+ imaging, and single-cell semiquantitative polymerase chain reaction was used. Our results suggest that functional MOP-like receptors are present in approximately 50% of human dorsal root ganglion neurons. δ-opioid peptide-like receptors were detected in a subpopulation largely overlapping that with MOP-like receptors. Furthermore, KOP-like and NOP-like receptors are detected in a large proportion (44% and 40%, respectively) of human dorsal root ganglion neurons with KOP receptors also overlapping with MOP receptors at a high rate (83%). Our data confirm that all 4 opioid receptor subtypes are present and functional in human sensory neurons, where the overlap of DOP, KOP, and NOP receptors with MOP receptors suggests that activation of these other opioid receptor subtypes may also have analgesic efficacy.
TRPV1 antagonist BCTC inhibits pH 6.0-induced pain in human skin
Authors: Heber Stefan , Ciotu Cosmin I. , Hartner Gabriel , Gold-Binder Markus , Ninidze Nino , Gleiss Andreas , Kress Hans-Georg , Fischer Michael J.M.
Published: February 2020

Tissue acidosis due to ischemia occurs under several pathological conditions and is believed to contribute to pain in these circumstances. TRPV1, TRPA1, and ASICs are known to be sensitive to acidic pH. Addressing their possible role in acidosis perception, the respective antagonists BCTC, A-967079, and amiloride were injected in the volar forearm skin of 32 healthy volunteers. To investigate possible redundancies between channels, a full-factorial study design was used. Injections were performed in a prerandomized, double-blind, and balanced design. Each injection included a three-step pH protocol from pH 7.0 over pH 6.5 to pH 6.0 with a step duration of 90 seconds. Pain was reported by volunteers on a numerical scale every 10 seconds during injections. Confirming the primary hypothesis, the combination of all 3 antagonists reduced acid-induced pain at pH 6.0. Because of the full-factorial design, it could be concluded that BCTC alone, but not A-967079 or amiloride, or any combination thereof, was responsible for the observed effects, suggesting TRPV1 as primary sensor for pH 6.0-induced pain. Surprisingly, A-967079 even enhanced pain induced by pH 6.0. In cultured mouse dorsal root ganglion neurons, TPRV1 dependence of pH 6-induced calcium responses could be confirmed. Responses of hTRPV1 to acidic stimulation showed a maximum around pH6, providing an explanation for the pH-dependent inhibition by BCTC. A-967079 sensitizes pH responses is a TRPA1-responsive dorsal root ganglion neuron population, and a direct effect of A-967079 on hTRPA1 and hTRPV1 was excluded. In conclusion, inhibiting TRPV1-mediated acidosis-induced pain could be a symptomatic and potentially also a disease-modifying approach.
Combinatorial roles of mitochondria and cGMP/PKG pathway in the generation of neuronal free Zn2+ under the presence of nitric oxide
Authors: Yang De-Ming , Huang Chien-Chang , Chang Yu-Fen
Published: February 2020

Background:

Nitric oxide (NO), which possesses both protective and toxic properties, has been observed to have a complicated biphasic character within various types of tissues, including neuronal cells. NO was also found to cause the increase of another important signaling molecular Zn2+ (termed as NZR). The molecular mechanism of NZR has been extensively investigated, but the source of Zn2+ is present of a major candidate that is yet to be answered. The NO-protein kinase G (PKG) pathway, mitochondria, and metallothioneins (MTs), are all proposed to be the individual source of NZR. However, this hypothesis remains inconclusive. In this study, we examined the function of PKG signaling cascades, the mitochondria storage, and MT-1 during NZR of living PC12 cells.

Methods:

We applied live-cell imaging in combination with pharmacological inhibitors and activators as well as in vitro Zn2+ assay to dissect the functions of the above candidates in NZR.

Results:

Two mechanisms, namely, mitochondria as the only Zn2+ source and the opening of NO–PKG-dependent mitochondrial ATP-sensitive potassium channels (mKATP) as the key to releasing NO-induced increase in mitochondrial Zn2+, were proven to be the two critical paths of NZR in neuronal-related cells.

Conclusion:

This new finding provides a reasonable explanation to previously existing and contradictory conclusions regarding the function of mitochondria/mKATP and PKG signaling on the molecular mechanism of NZR.
Thermoablative Techniques for Excessive Central Airway Collapse
Authors: de Lima Andres , Vidal Barbara , Kheir Fayez , VanderLaan Paul A. , Mallur Pavan S. , Gangadharan Sidhu P. , Majid Adnan
Published: February 2020

Background:

Tracheobronchoplasty is the definitive treatment for patients with symptomatic excessive central airway collapse. This procedure is associated with high morbidity and mortality rates. Bronchoscopic techniques are an appealing alternative with less morbidity and the ability to apply it in nonsurgical patients. Although thermoablative methods have been proposed as treatment options to induce fibrosis of the posterior tracheobronchial wall, no studies have compared direct histologic effects of such methods. This study compared the effects of electrocautery, radiofrequency ablation, potassium titanyl phosphate laser, and argon plasma coagulation (APC) in the tracheobronchial tree in an ex vivo animal model.

Methods:

Four adult sheep cadavers were used for this study. Under flexible bronchoscopy, the posterior tracheal membrane was treated using different power settings on 4 devices. The airways were assessed for the presence of treatment-related histopathologic changes.

Results:

Histologic changes observed were that of acute thermal injury including: surface epithelium ablation, collagen fiber condensation, smooth muscle cytoplasm condensation, and chondrocyte pyknosis. No distinct histologic differences in the treated areas among different modalities and treatment effects were observed. APC at higher power settings was the only modality that produced consistent and homogenous thermal injury effects across all tissue layers with no evidence of complete erosion.

Conclusion:

Although electrocautery, radiofrequency ablation, potassium titanyl phosphate laser, and APC all induce thermal injury of the airway wall, only APC at high power settings achieves this effect without complete tissue erosion, favoring potential regeneration and fibrosis. Live animal studies are now plausible.
Is Additional Nebulized Lidocaine Helpful in Flexible Bronchoscopy?
Authors: Ho An Thi Nhat , Gandhiraj Deepthi , Jamkhana Zafar , Nayak Ravi , Patolia Setu
Published: February 2020

Background:

Conflicting evidence of nebulized lidocaine use in bronchoscopy still exist. This study will identify whether there is any difference in various patient-related, physician-related, or procedure-related outcomes with and without lidocaine nebulization before the procedure.

Method:

The authors performed a search in 4 electronic databases, including Pubmed, Scopus, Virtual Health Library, and Google Scholar from inception to August 2019. Data on patient-reported and physician-reported outcomes, doses of sedation, and lidocaine were extracted and pooled into standardized mean difference (SMD) and mean difference (MD) using the random-effect model.

Results:

Seven randomized controlled trials with 1366 patients were included. Cough was not different between the nebulized lidocaine group and no nebulized lidocaine group (SMD, −0.12; 95% confidence interval, −0.82 to 0.59; I
2, 95%; P=0.75), so as operator’s satisfaction score, ease of the procedure, patient’s discomfort, and unwillingness to repeat the procedure. Additional nebulized lidocaine group required higher lidocaine dose (MD, 81.93; 95% confidence interval, 17.14-146.71). Studies using only local anesthesia favored the “no additional lidocaine” group in improving cough, operator’s satisfaction score, and ease of the procedure. Subgroup analysis of studies using moderate sedation showed a decrease in midazolam dose and duration of the procedure in the “additional nebulized lidocaine group.”

Conclusion:

Additional administration of nebulized lidocaine increased the total dose of lidocaine used and did not improve cough symptoms, operator-satisfaction score, ease of the procedure, and willingness to repeat the procedure. Subgroup analysis of studies using moderate sedation showed a decrease in midazolam use and in procedure duration but the clinical significance of these findings is uncertain.
Strategies for prediction of drug-resistant pathogens and empiric antibiotic selection in community-acquired pneumonia
Authors: Gil Ryan , Webb Brandon J.
Published: February 2020

Purpose of review

Although most patients with community-acquired pneumonia (CAP) are appropriately treated with narrow-spectrum antibiotics, predicting which patients require coverage of drug-resistant pathogens (DRP) remains a challenge. The 2019 American Thoracic Society/Infectious Diseases Society of America CAP guidelines endorse using locally validated prediction models for DRP. Here we review risk factors for DRP and provide a summary of available risk prediction models.

Recent findings

Both inadequate initial empiric spectrum as well as unnecessary broad-spectrum antibiotic use are associated with poor outcomes in CAP. Multiple prediction models for DRP-based patient-level risk factors have been published, with some variation in included predictor variables and test performance characteristics. Seven models have been robustly externally validated, and implementation data have been published for two of these models. All models demonstrated better performance than the healthcare-associated pneumonia criteria, with most favoring sensitivity over specificity. We also report validation of the novel, risk factor-based treatment algorithm proposed in the American Thoracic Society/Infectious Diseases Society of America guidelines which strongly favors specificity over sensitivity, especially in nonsevere pneumonia.

Using patient-level risk factors to guide the decision whether to prescribe broad-spectrum antibiotics is a rational approach to treatment. Several viable candidate prediction models are available. Hospitals should evaluate the local performance of existing scores before implementing in routine clinical practice.
MicroRNAs: future biomarkers and targets of therapy in asthma?
Authors: Specjalski Krzysztof , Niedoszytko Marek
Published: February 2020

Purpose of review

MicroRNAs (miRNAs) are small noncoding RNA molecules that are considered one of the fundamental regulatory mechanisms of gene expression. They are involved in many biologic processes, such as signal transduction, cell proliferation and differentiation, apoptosis and stress responses. The purpose of this review is to present recent knowledge about the role of miRNAs in asthma and outline possible applications of miRNAs.

Recent findings

A core set of miRNAs involved in asthma includes downregulated let-7 family, miR-193b, miR-375 as well as upregulated miR-21, miR-223, miR-146a, miR-142-5p, miR-142-3p, miR-146b and miR-155. Recently it has been shown that most of the involved miRNAs increase secretion of Th2 cytokines, decrease secretion of Th1 cytokines, promote differentiation of T cells towards Th2 or play a role in hyperplasia and hypertrophy of bronchial smooth muscle cells. The profiles of miRNAs correlate with clinical characteristics, including lung function, phenotype and severity of asthma.

Recent publications confirmed crucial regulatory role of miRNAs in the pathomechanism of asthma. Some single miRNAs or their sets hold the promise for their use as asthma biomarkers facilitating diagnosis or prediction of treatment outcomes. They are also possible target of future therapies. The studies in this field are lacking though.
Current opinion in otolaryngology and head and neck surgery: clival chordoma and its management
Authors: Snyderman Carl H. , Gardner Paul A.
Published: February 2020

Purpose of review

Chordomas of the clival region are challenging tumors to treat due to their location and infiltrative behavior. The primary goal of treatment remains a gross total resection (GTR). Advances in surgical techniques, especially the adoption of endoscopic endonasal techniques, provide improved rates of surgical resection while minimizing secondary surgical morbidities.

Recent findings

Advances in the management of clival chordomas include further development of endoscopic endonasal approaches to the clivus and petroclival region, enhanced understanding of the biologic behavior of chordomas and prognostic value of molecular markers, and increased experience with newer radiation therapy modalities such as proton beam therapy.

Improved surgical techniques enhance our ability to achieve a GTR while minimizing morbidity of surgery. Molecular markers may allow stratification of patients into prognostic groups and help direct further therapy. A combination of surgery with GTR and proton beam or intensity modulated radiotherapy currently offers the best potential for cure. Therapy with new immune system modulators is promising but is reserved for clinical trials.
Evaluating the Necessity of Capsulectomy in Cases of Textured Breast Implant Replacement
Authors: Swanson Eric
Published: February 2020

Background

Capsulectomy has traditionally been recommended as a treatment for capsular contracture after breast augmentation. With the advent of breast implant–associated anaplastic large-cell lymphoma (BIA-ALCL), and the Food and Drug Administration's decision to ban Biocell textured devices, this operation has taken on new importance. This review was undertaken to better inform clinical recommendations for women with textured devices.

Methods

An electronic search was performed using PubMed to identify all the available literature on the subject of capsulectomy and open capsulotomy (the alternative treatment).

Results

Fifty-seven articles on this topic were identified. Capsulectomy was widely recommended for treatment of capsular contracture, although many authors recommended leaving thin capsular tissue behind in the absence of symptoms. En bloc resection was recommended only for women with a diagnosis of BIA-ALCL. No information supported a prophylactic role for capsulectomy in asymptomatic women with textured breast implants who are concerned regarding their future risk of BIA-ALCL. Routine pathologic examination in asymptomatic patients was not supported.

Discussion

Capsulectomy adds substantially to the surgical risk, discomfort, recovery time, and expense. Implant removal or replacement without a simultaneous capsulectomy is atraumatic and poses negligible risk.

Conclusions

Capsulectomy introduces additional morbidity and is not mandatory for asymptomatic patients. Implant removal or exchange for smooth implants without a capsulectomy may be an acceptable choice for many women who do not demonstrate capsular pathology. However, any symptoms or surgical findings suggesting pathology warrant a capsulectomy. En bloc resections are reserved for patients diagnosed with BIA-ALCL.
Acute respiratory distress syndrome in the forward environment. Retrospective analysis of acute respiratory distress syndrome cases among French Army war casualties
Authors: Schmitt Johan , Boutonnet Mathieu , Goutorbe Philippe , Raynaud Laurent , Carfantan Cyril , Luft Antoine , Pasquier Pierre , Meaudre Eric , Bordes Julien
Published: February 2020

BACKGROUND

According to the Joint Theater Trauma Registry, 26% to 33% of war casualties develop acute respiratory distress syndrome (ARDS), with high mortality. Here, we aimed to describe ARDS incidence and severity among patients evacuated from war zones and admitted to French intensive care units (ICUs).

METHODS

We performed an observational retrospective multicentric review of all patients evacuated from war zones and admitted to French ICUs between 2003 and 2018. Our analysis included all medical and trauma patients developing ARDS according to the Berlin definition. We evaluated ARDS incidence, and determined ARDS severity from arterial blood gas analysis. Analyzed parameters included invasive ventilation duration, ARDS treatments, ICU stay length, and 30-day and 90-day mortalities.

RESULTS

Among 141 included patients (84% military; median age, 30 years), 57 (42%) developed ARDS. Acute respiratory distress syndrome was mild in 13 (22%) patients, moderate in 24 (42%) patients, and severe in 20 (36%) patients. Evacuation occurred in less than 26 hours for 32 war casualties, 17 non–war-related trauma patients, and 8 medical patients. Among severe trauma patients, median Injury Severity Score was 34, and Abbreviated Injury Scale thorax was 3. Upon French ICU admission, median partial pressure of oxygen in arterial blood/inspirated fraction of oxygen ratio was 241 [144–296]. Administered ARDS treatments included intubation (98%, n = 56), protective ventilation (87%, n = 49), neuromuscular blockade (76%, n = 43), prone position (16%, n = 9), inhaled nitric oxide (10%, n = 6), almitrine (7%, n = 7), and extracorporeal life support (4%, n = 2). Median duration of invasive ventilation was 13 days, ICU stay was 18 days, 30-day mortality was 14%, and 90-day mortality was 21%.

CONCLUSION

Acute respiratory distress syndrome was frequent and severe among French patients evacuated from war theaters. Improved treatment capacities are needed in the forward environment—for example, a specialized US team can provide extracorporeal life support for highly hypoxemic war casualties.

LEVEL OF EVIDENCE

Prognostic and epidemiological study, level III.
The dose-dependent relationship between blood transfusions and infections after trauma: A population-based study
Authors: Nederpelt Charlie J. , El Hechi Majed , Parks Jonathan , Fawley Jason , Mendoza April E. , Saillant Noelle , King David R. , Fagenholz Peter J. , Velmahos George C. , Kaafarani Haytham M.A.
Published: February 2020

OBJECTIVE

The relationship between total transfusion volume and infection in the trauma patient remains unclear, especially at lower volumes of transfusion. We sought to quantify the cumulative, independent impact of transfusion within 24 hours of admission on the risk of infection in trauma patients.

METHODS

Using the Trauma Quality Improvement Program 2013 to 2016 database, we included all patients who received blood transfusions in the first 4 hours. Patients who were transferred or had incomplete/wrongly coded information on transfusion volume were excluded. Patients were divided into 20 cohorts based on the total blood product volume transfused in the first 24 hours. A composite infection variable (INF) was created, including surgical site infection, ventilator-associated pneumonia, urinary tract infection, central line associated blood stream infection, and sepsis. Univariate and stepwise multivariable logistic regression analyses were performed to study the relationship between blood transfusion and INF, controlling for demographics (e.g., age, sex), comorbidities (e.g., cirrhosis, diabetes, steroid use), severity of injury (e.g., vital signs on arrival, mechanism, Injury Severity Score), and operative and angiographic interventions.

RESULTS

Of 1,002,595 patients, 37,568 were included. The mean age was 42 ± 18.6 years, 74.6% were males, 68% had blunt trauma, and median Injury Severity Score was 25 [17–34]. Adjusting for all available confounders, odds of INF increased incrementally from 1.00 (reference, 0–2 units) to 1.23 (95% confidence interval, 1.11–1.37) for 4 units transfused to 4.89 (95% confidence interval, 2.72–8.80) for 40 units transfused. Each additional unit increased the odds of INF by 7.6%.

CONCLUSION

Transfusion of the bleeding trauma patient was associated with a dose-dependent increased risk of infectious complications. Trauma surgeons and anesthesiologists should resuscitate the trauma patient until prompt hemorrhage control while avoiding overtransfusion.

LEVEL OF EVIDENCE

Retrospective cohort study, Therapeutic IV.
A comparison of adolescent penetrating trauma patients managed at pediatric versus adult trauma centers in a mature trauma system
Authors: Rogers Frederick B. , Horst Michael A. , Morgan Madison E. , Vernon Tawnya M. , Gaines Barbara A. , Rogers Amelia T. , Gross Brian W. , Cook Alan D. , Bradburn Eric H.
Published: February 2020

BACKGROUND

While there is little debate that pediatric trauma centers (PTC) are uniquely equipped to manage pediatric trauma patients, the extent to which adolescents benefit from treatment there remains controversial. We sought to elucidate differences in management approach and outcome between PTC and adult trauma centers (ATC) for the adolescent penetrating trauma population. We hypothesized that improved mortality would be observed at ATC for this subset of patients.

METHODS

Adolescent patients (age, 15–18 years), presenting to Pennsylvania-accredited trauma centers between 2003 and 2017 with penetrating injury, were queried from the Pennsylvania Trauma Outcome Study database. Dead on arrival, transfer patients, and those admitted to a Level III or Level IV trauma center were excluded from analysis. Patient length of stay, number of complications, surgical intervention, and mortality were compared between ATC and PTC. Multilevel mixed effects logistic regression models with trauma center as the clustering variable were used to assess the impact of center type (ATC/PTC) on management approach and mortality adjusted for appropriate covariates.

RESULTS

A total of 2,630 adolescent patients met inclusion criteria (PTC: n = 428 [16.3%]; ATC: n = 2,202 [83.7%]). Pediatric trauma centers had a lower adjusted odds of mortality (adjusted odds ratio [AOR], 0.35; 95% confidence interval [CI], 0.17–0.74; p = 0.006) and a lower adjusted odds of surgery (AOR, 0.67; 95% CI, 0.0.48–0.93; p = 0.016) than their ATC counterparts. There were no differences in complication rates (AOR, 0.94; 95% CI, 0.57–1.55; p = 0.793) or length of stay longer than 4 days (AOR, 0.95; 95% CI, 0.61–1.48; p = 0.812) between the PTCs and ATCs. There were also differences in penetrating injury type between PTC and ATC.

CONCLUSION

The adolescent penetrating trauma patient population treated at PTC had less surgery performed with improved mortality compared with ATC.

LEVEL OF EVIDENCE

Therapeutic, Level IV.
Trochleaectomy: An Effective Treatment of Trochlear Pain in Monocular Patients
Authors: Mettu Pradeep , Mancini Ronald , Friedman Deborah I. , Garrity James A.
Published: February 2020

Background:

Conventional treatment options for trochlear pain arising from trochleitis or primary trochlear headache include oral anti-inflammatory medications and/or local injection of corticosteroids and local anesthetic. Trochleaectomy is an additional option to consider for monocular patients with intractable trochlear pain.

Methods:

We report 3 patients undergoing trochleaectomy for refractory trochlear pain syndromes.

Results:

Trochleaectomy resulted in resolution of their periocular discomfort.

Conclusions:

Trochleaectomy is an effective procedure to treat trochlear pain syndrome in functionally monocular patients.
Functional traits of the gut microbiome correlated with host lipid content in a natural population of
Drosophila melanogaster
Authors: Kang David , Douglas Angela E.
Published: February 2020

Most research on the nutritional significance of the gut microbiome is conducted on laboratory animals, and its relevance to wild animals is largely unknown. This study investigated the microbiome correlates of lipid content in individual wild fruit flies,
Drosophila melanogaster
. Lipid content varied 3.6-fold among the flies and was significantly correlated with the abundance of gut-derived bacterial DNA sequences that were assigned to genes contributing to 16 KEGG pathways. These included genes encoding sugar transporters and enzymes in glycolysis/gluconeogenesis, potentially promoting sugar consumption by the gut microbiome and, thereby, a lean fly phenotype. Furthermore, the lipid content of wild flies was significantly lower than laboratory flies, indicating that, as for some mammalian models, certain laboratory protocols might be obesogenic for
Drosophila
. This study demonstrates the value of research on natural populations to identify candidate microbial genes that influence ecologically important host traits.
An experimental test of the role of male mating history on paternal effects in the livebearer fish
Gambusia holbrooki
Authors: Aich Upama , Jennions Michael D. , Fox Rebecca J.
Published: February 2020

Studies often show that paternal age affects offspring fitness. However, such effects could be due either to age, or to a male's previous mating effort (which is necessarily confounded with age). We experimentally tested whether differences in the mating history of old males affect offspring performance in the mosquitofish
Gambusia holbrooki.
Upon maturation, males were housed for a duration of the natural field-breeding season (23 weeks) either with mating access to females (lifetime-mating), or with visual but no physical access to females (no-mating). We then paired these males with a female to test whether male mating history had a significant effect on their mate's breeding success or offspring performance. The daughters, but not the sons, of ‘no-mating’ treatment males matured significantly sooner, and at a significantly smaller size, than those of ‘lifetime-mating’ treatment males. There was, however, no effect of male mating history on their daughters' initial fecundity, or on proxy measures of their sons’ reproductive success. These results, when combined with earlier studies showing effects of male mating history on sperm quality, growth and immunity, suggest that variation in paternal effects currently attributed to male age could partly arise because older males have usually mated more often than younger males.
Individual differences in human voice pitch are preserved from speech to screams, roars and pain cries
Authors: Pisanski Katarzyna , Raine Jordan , Reby David
Published: February 2020

Fundamental frequency (F0, perceived as voice pitch) predicts sex and age, hormonal status, mating success and a range of social traits, and thus functions as an important biosocial marker in modal speech. Yet, the role ofF0 in human nonverbal vocalizations remains unclear, and given considerable variability inF0 across call types, it is not known whetherF0 cues to vocalizer attributes are shared across speech and nonverbal vocalizations. Here, using a corpus of vocal sounds from 51 men and women, we examined whether individual differences inF0 are retained across neutral speech, valenced speech and nonverbal vocalizations (screams, roars and pain cries). Acoustic analyses revealed substantial variability inF0 across vocal types, with meanF0 increasing as much as 10-fold in screams compared to speech in the same individual. Despite these extreme pitch differences, sexual dimorphism was preserved within call types and, critically, inter-individual differences inF0 correlated across vocal types (r= 0.36–0.80) with stronger relationships between vocal types of the same valence (e.g. 38% of the variance in roarF0 was predicted by aggressive speechF0). Our results indicate that biologically and socially relevant indexical cues in the human voice are preserved in simulated valenced speech and vocalizations, including vocalizations characterized by extremeF0 modulation, suggesting that voice pitch may function as a reliable individual and biosocial marker across disparate communication contexts.
Native and invasive squirrels show different behavioural responses to scent of a shared native predator
Authors: Twining Joshua P. , Ian Montgomery W. , Price Lily , Kunc Hansjoerg P. , Tosh David G.
Published: February 2020

Invasive species pose a serious threat to native species. In Europe, invasive grey squirrels (
Sciurus carolinensis
) have replaced native red squirrels (
Sciurus vulgaris
) in locations across Britain, Ireland and Italy. The European pine marten (
Martes martes
) can reverse the replacement of red squirrels by grey squirrels, but the underlying mechanism of how pine martens suppress grey squirrels is little understood. Research suggests the reversal process is driven by direct predation, but why the native red squirrel may be less susceptible than the invasive grey squirrel to predation by a commonly shared native predator, is unknown. A behavioural difference may exist with the native sciurid being more effective at avoiding predation by the pine marten with which they have a shared evolutionary history. In mammals, olfactory cues are used by prey species to avoid predators. To test whether anti-predator responses differ between the native red squirrel and the invasive grey squirrel, we exposed both species to scent cues of a shared native predator and quantified the responses of the two squirrel species. Red squirrels responded to pine marten scent by avoiding the feeder, increasing their vigilance and decreasing their feeding activity. By contrast, grey squirrels did not show any anti-predator behaviours in response to the scent of pine marten. Thus, differences in behavioural responses to a shared native predator may assist in explaining differing outcomes of species interactions between native and invasive prey species depending on the presence, abundance and exposure to native predators.
Gradual replacement of wild bees by honeybees in flowers of the Mediterranean Basin over the last 50 years
Authors: Herrera Carlos M.
Published: February 2020

Evidence for pollinator declines largely originates from mid-latitude regions in North America and Europe. Geographical heterogeneity in pollinator trends combined with geographical biases in pollinator studies can produce distorted extrapolations and limit understanding of pollinator responses to environmental changes. In contrast with the declines experienced in some well-investigated European and North American regions, honeybees seem to have increased recently in some areas of the Mediterranean Basin. Because honeybees can have negative impacts on wild bees, it was hypothesized that a biome-wide alteration in bee pollinator assemblages may be underway in the Mediterranean Basin involving a reduction in the relative number of wild bees. This hypothesis was tested using published quantitative data on bee pollinators of wild and cultivated plants from studies conducted between 1963 and 2017 in 13 countries from the European, African and Asian shores of the Mediterranean Sea. The density of honeybee colonies increased exponentially and wild bees were gradually replaced by honeybees in flowers of wild and cultivated plants. The proportion of wild bees at flowers was four times greater than that of honeybees at the beginning of the period, the proportions of both groups becoming roughly similar 50 years later. The Mediterranean Basin is a world biodiversity hotspot for wild bees and wild bee-pollinated plants, and the ubiquitous rise of honeybees to dominance as pollinators could in the long run undermine the diversity of plants and wild bees in the region.
Generation of antibodies against COVID-19 virus for development of diagnostic tools
Authors: Li Maohua , Jin Ronghua , Peng Ya , Wang Cuiyan , Ren Wenlin , Lv Fudong , Gong Sitao , Fang Feng , Wang Qianyun , Li Jianli , Shen Tong , Sun Hunter , Zhou Lei , Cui Yali , Song Hao , Sun Le
Published: February 2020

The COVID-19 China coronavirus started in Dec 2019 was challenged by the lack of accurate serological diagnostic tool for this deadly disease to quickly identify and isolate the infected patients. The generation of COVID-19-specific antibodies is essential for such tasks. Here we report that polyclonal and monoclonal antibodies were generated by immunizing animals with synthetic peptides corresponding to different areas of Nucleoprotein (N) of COVID-19. The specificities of the COVID-19 antibodies were assessed by Western Blot analysis against NPs from COVID-19, MERS and SARS. Antibodies were used for immunohistochemistry staining of the tissue sections from COVID-19 infected patient, as a potential diagnostic tool. A Sandwich ELISA kit was quickly assembled for quantitation of the virus/NP of COVID-19 concentrations in the vaccine preparations. Development of POCT is also aggressively undergoing.
Real-time monitoring the transmission potential of COVID-19 in Singapore, February 2020
Authors: Tariq Amna , Lee Yiseul , Roosa Kimberlyn , Blumberg Seth , Yan Ping , Ma Stefan , Chowell Gerardo
Published: February 2020

Background

The ongoing COVID-19 epidemic that spread widely in China since December 2019 is now generating local transmission in multiple countries including Singapore as of February 27, 2020. This highlights the need to monitor in real time the transmission potential of COVID-19. In Singapore, four major COVID-19 case clusters have emerged thus far.

Methods

Here we estimate the effective reproduction number, Rt, of COVID-19 in Singapore from the publicly available daily case series of imported and autochthonous cases by date of symptoms onset, after adjusting the local cases for reporting delays. We also derive the reproduction number from the distribution of cluster sizes using a branching process analysis.

Results

The effective reproduction number peaked with a mean value ∼1.1 around February 2nd, 2020 and declined thereafter. As of February 27th, 2020, our most recent estimate of Rtis at 0.5 (95% CI: 0.2,0.7) while an estimate of the overall R based on cluster size distribution is at 0.7 (95% CI: 0.5, 0.9).

Conclusion

The trajectory of the reproduction number in Singapore underscore the significant effects of containment efforts in Singapore while at the same time suggest the need to sustain social distancing and active case finding efforts to stomp out all active chains of transmission.
Neuroimaging-based Individualized Prediction of Cognition and Behavior for Mental Disorders and Health: Methods and Promises
Authors: Sui Jing , Jiang Rongtao , Bustillo Juan , Calhoun Vince
Published: February 2020

The neuroimaging community has witnessed a paradigm shift in biomarker discovery from using traditional univariate brain mapping approaches to multivariate predictive models, allowing the field to move towards a translational neuroscience era. Regression-based multivariate models (hereafter “predictive modeling”) provide a powerful and widely-used approach to predict human behavior with neuroimaging features. These studies maintain a focus on decoding individual differences in a continuously behavioral phenotype from neuroimaging data, opening up an exciting opportunity to describe the human brain at the single-subject level. In this survey, we provide an overview of recent studies that utilize machine learning approaches to identify neuroimaging predictors over the past decade. We first review regression-based approaches and highlight connectome-based predictive modeling (CPM), which has grown in popularity in recent years. Next, we systematically describe recent representative studies using these tools in the context of cognitive function, symptom severity, personality traits and emotion processing. Finally, we highlight a few challenges related to combining multimodal data, longitudinal prediction, external validations and the employment of deep learning methods that have emerged from our review of the existing literature, as well as present some promising and challenging future directions.
Conjunctival polymerase chain reaction-tests of 2019 novel coronavirus in patients in Shenyang, China
Authors: Xu Li , Zhang Xinyue , Song Wei , Sun Baijun , Mu Jinping , Wang Bing , Wang Zhiqian , Cao Yehong , Dong Xue
Published: February 2020

Purpose

The 2019 novel coronavirus(COVID-19) mainly transmitted by person-to-person through inhalation of respiratory droplets. We report the laboratory results of conjunctival PCR-tests and some clinical features of these patients in shenyang China.

Design

This is a cross-sectional non-randomized study

Subjects

The study include 14 confirmly diagnosed cases, 16 suspected cases and some medical observed patients.

Methods

All patients with diagnosed and suspected COVID-19 were admitted to a designated hospital in Shenyang, China. We collected conjunctival samples of these patients to do the laboratory tests by real time RT-PCR. Medical observed patients were enrolled if they had clinical symptoms. Then we analysed the PCR results and clinical data from eletronic medical records in order to find some relationships.

Main Outcome Measures

Clinical condition and PCR results. of conjunctival swabs compared with other specimens

Results

One of the identified case coverted from suspected case without typical clinical symptoms. Twenty-two medical observed cases were removed because none of them converted to identified cases. One of the suspected converted to identified case recently. The included cases in our study are imported cases with less underlying diseases and the severity of their infection was relatively moderate. All the conjunctival results of PCR-test were negative. Two cases had typical clinical symptoms but were finally confirmed by repeated pharynxswabtests.

Conclusion

Conjunctiva may be a transmission way of COVID-19. And ocular conjunctival swabs in combination with PCR test could be a non-invasive, convenient and feasible diagnostic method for identifying the infection of COVID-19. Emphasis on the false-negative results is vital.
Bilateral Alignment of Receptive Fields in the Olfactory Cortex
Authors: Grimaud Julien , Dorrell William , Pehlevan Cengiz , Murthy Venkatesh
Published: February 2020

Each olfactory cortical hemisphere receives ipsilateral odor information directly from the olfactory bulb and contralateral information indirectly from the other cortical hemisphere. Since neural projections to the olfactory cortex are disordered and non-topographic, spatial information cannot be used to align projections from the two sides like in the visual cortex. Therefore, how bilateral information is integrated in individual cortical neurons is unknown. We have found, in mice, that the odor responses of individual neurons to selective stimulation of each of the two nostrils are highly matched, such that odor identity decoding optimized with information arriving from one nostril transfers very well to the other side. Remarkably, these aligned responses are nevertheless asymmetric enough to allow decoding of stimulus laterality. Computational analysis shows that such matched odor tuning is incompatible with purely random connections but is explained readily by Hebbian plasticity structuring bilateral connectivity. Our data reveal that despite the distributed and fragmented sensory representation in the olfactory cortex, odor information across the two hemispheres is highly coordinated.