bluuebunny/crossref_metadata_2025 huggingface dataset:
Relations between topography, feeding sites, and foraging behavior of the vampire bat, Desmodus rotundus
Authors: Rocha Felipe , Ulloa-Stanojlovic Francisco Miroslav , Rabaquim Vanessa Cristina Victor , Fadil Paulo , Pompei Júlio César , Brandão Paulo Eduardo , Dias Ricardo Augusto
Published: October 2019

The vampire bat (Desmodus rotundus) plays a crucial role in the maintenance and transmission of the rabies virus to humans and livestock, impacting public health and economic production. Its importance lies not only in its capacity to transmit the virus but also in its ability to adapt to anthropic changes, as expressed in its wide geographic distribution in Latin America. Deforestation, livestock intensification, and other human activities have reduced the abundance of its wild prey but have also provided new and abundant shelter and foraging resources for the vampire bats. We used radiotelemetry to evaluate relations between topography, feeding site choice, and foraging behavior in southeastern Brazil, where three occupied D. rotundus roosts, out of 11 possible, were systematically monitored throughout a 1-year period once every 2 months. Sixty-two vampire bats were captured; biometric data were collected and 44 radiotransmitters were installed in adult individuals, producing telemetry data that were recorded in VHF receptors installed in the farms. Elevation of the roosts was related to the farms attacked by the vampire bats. Understanding the use of the environment and resources by vampire bats is critical to improving rabies control aiming at the reduction of disease impacts. From the perspective of the official veterinary service, telemetry would be ineffective as a rabies surveillance system due to the costs and limitations of the available technology. However, livestock rabies control measures would be greatly improved if ecological characteristics of the vampire bat were considered.
HLA-B-associated transcript 3 (Bat3) stabilizes and activates p53 in a HAUSP-dependent manner
Authors: Zhang Rui , Cui Di , Xue Teng , Lang Yue , Zhang Yunfan , Li Lianjie , Sun Haili , Kuang Yu , Li Gebin , Tang Jun
Published: October 2019

The p53 pathway is a highly complex signaling network including several key regulators. HAUSP is a critical component of the p53 pathway acting as a deubiquitinase for both p53 and its key repressor Mdm2. Here, we identified a novel HAUSP-interacting protein, HLA-B-associated transcript 3 (Bat3) and found it to be capable of inducing p53 stabilization and activation via a HAUSP-dependent mechanism, resulting in cell growth inhibition. Surprisingly, the deubiquitylating enzymatic activity of HAUSP was not required for this phenomenon. Co-immunoprecipitation showed that p53 coexisted in a complex with Bat3 and HAUSP in vivo, and HAUSP may serve as a binding mediator to enhance the interaction between p53 and Bat3. Further studies revealed that formation of this three-protein complex interfered with the binding of p53 to its proteasome receptor S5a and promoted the accumulation of p53 in nucleus. Notably, Mdm2 protein abundance is also regulated by Bat3 in the presence of HAUSP. Overexpression of Bat3 and HAUSP increases Mdm2 protein levels without influencing the p53–Mdm2 interaction and Mdm2-mediated p53 ubiquitination, indicating that Bat3–HAUSP-mediated protein stabilization is not specific to p53 and different mechanisms may be involved in Bat3-mediated regulation of p53–Mdm2 pathway. Together, our study unravels a novel mechanism by which p53 is stabilized and activated by HAUSP-mediated interaction with Bat3 and implies that Bat3 might function as a tumor suppressor through the stabilization of p53.
The Influence of Larval Stage and Density on Oviposition Site-Selection Behavior of the Afrotropical Malaria Mosquito Anopheles coluzzii (Diptera: Culicidae)
Authors: Mwingira Victor S , Spitzen Jeroen , Mboera Leonard E G , Torres-Estrada José L , Takken Willem
Published: October 2019

In the selection of oviposition sites female mosquitoes use various cues to assess site quality to optimize survival of progeny. The presence of conspecific larvae influences this process. Interactive effects of oviposition site selection were studied in the malaria mosquito Anopheles coluzzii Coetzee & Wilkerson in dual- and no-choice assays, by exposing single gravid mosquitoes to oviposition cups containing 1) larvae of different developmental stages, 2) larvae-conditioned water (LCW), and 3) cups where visual cues of conspecific larvae were absent. Early-stage conspecific larvae had a positive effect on the oviposition response. By contrast, late stages of conspecific larvae had a negative effect. Oviposition choice was dependent on larval density. Moreover, in oviposition cups where larvae were hidden from view, late-stage larvae had a significant negative effect on oviposition suggesting the involvement of olfactory cues. LCW had no effect on oviposition response, indicating involvement of chemicals produced by larvae in vivo. It is concluded that the presence of larvae in a breeding site affects the oviposition response depending on the development stage of the larvae. These responses appear to be mediated by olfactory cues emitted by the larval habitat containing live larvae, resulting in the enhanced reproductive fitness of the females.
Laparoscopic sleeve gastrectomy following multiple failed endoscopic sleeve gastroplasties
Authors: Alhayo Sam , Devadas Michael
Published: October 2019

Endoscopic sleeve gastroplasty (ESG) is a new obesity control modality. Limited data are available to describe post ESG findings and approaches to surgically revise this procedure. Two female patients with persistent obesity despite multiple ESG procedures underwent laparoscopic sleeve gastrectomy (LSG). Pre- and post-ESG, LSG body mass index (BMI), weight, and excess weight loss percentage (EWL%) were recorded. Endoscopic findings and revisional LSG technique were carefully documented. Pre-ESG BMI of the patients were 44 and 52 kg/m2. Pre-LSG BMI were 44.6 and 50 kg/m2. Pre-LSG gastroscopy and laparoscopy revealed complete dehiscence of ESG sutures with full-thickness invasion of these sutures and titanium clips through the gastric wall and some intraperitoneal adhesions. At 7-month follow-up, BMI are 40.3 and 35.7 kg/m2 and EWL% are 39 and 43%, respectively. This is the first study reporting LSG following failed ESG. ESG can lead to significant complications. LSG is achievable post-ESG and has superior results to it.
Intrapericardial rupture of distal aortic arch aneurysm
Authors: Yokoyama Yujiro , Nakajima Masato
Published: October 2019

Intrapericardial rupture of an aortic arch aneurysm is a rare and catastrophic event that requires emergency treatment. Recent development of thoracic endovascular repair has contributed to improved outcomes for the treatment of ruptured aneurysm of the thoracic aorta. However, when there is an aneurysm that involves the arch vessels, the treatment strategy, including conventional open surgery and endovascular stenting, is still controversial. We performed life-saving emergency total arch replacement using a modified elephant-trunk procedure for two cases of intrapericardial rupture of an aortic arch aneurysm. Prompt institution of cardiopulmonary bypass is effective for reducing the risk of re-rupture. Hybrid operation caries the risk of re-rupture during the procedure because it is performed under heparinization without blood pressure control. Open surgery is still a good option for such cases.
Restless Dickens: A Victorian Life in Motion, 1872–1927
Authors: Whitehead Lucy
Published: October 2019

By comparing John Forster’s The Life of Charles Dickens (1872–1874) with subsequent amateur forms of biographical activity in the period 1872–1927, this essay aims to challenge lingering conceptualizations of the material properties of Victorian biography as smooth and standardized. I argue that the parity of practice revealed between Forster’s biography and the various composite forms of biographical narrative that came in its wake, such as Grangerizations and photography collections, throws into question the supposed unity of Forster’s original text. It shows the ways in which his Dickens was always an unstable and metamorphosing figure, tracing an alternative genealogy for the subsequent forms of memorialization that push these biographical qualities further. It demonstrates continuities of preoccupation and practice in biographical activity 1872–1927, producing a narrative of Victorian and Modernist biography that emphasizes connection rather than rupture. Examining these composite forms of biographical narrative also reveals the proto-cinematic way in which they juxtapose and sequence similar but marginally different Dickenses, in order to create the sense of a figure temporally, physically and mentally in motion. From Forster’s text onwards, Dickens is thus produced materially as well as verbally as a ‘restless’ subject, continually poised between stasis and movement. The recurring biographical use of montage, collage and compilation in order to put the subject in motion suggests a previously unconsidered dimension to the ancestry of cinema. It also works to extend our understanding of the media available to Victorian biography.
Radiation-hydrodynamical models of X-ray photoevaporation in carbon-depleted circumstellar discs
Authors: Wölfer Lisa , Picogna Giovanni , Ercolano Barbara , van Dishoeck Ewine F
Published: October 2019

The so-called transition discs provide an important tool to probe various mechanisms that might influence the evolution of protoplanetary discs and therefore the formation of planetary systems. One of these mechanisms is photoevaporation due to energetic radiation from the central star, which can in principal explain the occurrence of discs with inner cavities like transition discs. Current models, however, fail to reproduce a subset of the observed transition discs, namely objects with large measured cavities and vigorous accretion. For these objects the presence of (multiple) giant planets is often invoked to explain the observations. In our work, we explore the possibility of X-ray photoevaporation operating in discs with different gas-phase depletion of carbon and show that the influence of photoevaporation can be extended in such low-metallicity discs. As carbon is one of the main contributors to the X-ray opacity, its depletion leads to larger penetration depths of X-rays in the disc and results in higher gas temperatures and stronger photoevaporative winds. We present radiation-hydrodynamical models of discs irradiated by internal X-ray + EUV radiation assuming carbon gas-phase depletions by factors of three, 10, and 100 and derive realistic mass-loss rates and profiles. Our analysis yields robust temperature prescriptions as well as photoevaporative mass-loss rates and profiles which may be able to explain a larger fraction of the observed diversity of transition discs.
BiGG Models 2020: multi-strain genome-scale models and expansion across the phylogenetic tree
Authors: Norsigian Charles J , Pusarla Neha , McConn John Luke , Yurkovich James T , Dräger Andreas , Palsson Bernhard O , King Zachary
Published: October 2019

The BiGG Models knowledge base (http://bigg.ucsd.edu) is a centralized repository for high-quality genome-scale metabolic models. For the past 12 years, the website has allowed users to browse and search metabolic models. Within this update, we detail new content and features in the repository, continuing the original effort to connect each model to genome annotations and external databases as well as standardization of reactions and metabolites. We describe the addition of 31 new models that expand the portion of the phylogenetic tree covered by BiGG Models. We also describe new functionality for hosting multi-strain models, which have proven to be insightful in a variety of studies centered on comparisons of related strains. Finally, the models in the knowledge base have been benchmarked using Memote, a new community-developed validator for genome-scale models to demonstrate the improving quality and transparency of model content in BiGG Models.
Sodium-glucose cotransporter 2 inhibition: towards an indication to treat diabetic kidney disease
Authors: Górriz Jose Luis , Navarro-González Juan F , Ortiz Alberto , Vergara Ander , Nuñez Julio , Jacobs-Cachá Conxita , Martínez-Castelao Alberto , Soler Maria Jose
Published: October 2019

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have clearly demonstrated their beneficial effect in diabetic kidney disease (DKD) on top of the standard of care [blood glucose control, renin–angiotensin system blockade, smoking cessation and blood pressure (BP) control], even in patients with overt DKD. However, the indication of this drug class is still blood glucose lowering in type 2 diabetic patients with estimated glomerular filtration rate >45 mL/min/1.73 m2. Based on the new evidence, several scientific societies have emphasized the preferential prescription of SGLT2i for patients at risk of heart failure or kidney disease, but still within the limits set by health authorities. A rapid positioning of both the European Medicines Agency and the US Food and Drug Administration will allow patients with overt DKD to benefit from SGLT2i. Clinical experience suggests that SGLT2i safety management may in part mirror renin–angiotensin blockade safety management in patients with overt DKD. This review focuses on the rationale for an indication of SGTL2i in DKD. We further propose clinical steps for maximizing the safety of SGLT2i in DKD patients on other antidiabetic, BP or diuretic medication.
Clinical Outcomes of Clofazimine Use for Rapidly Growing Mycobacterial Infections
Authors: Carey George B , Tebas Pablo , Vinnard Christopher , Kim Deborah , Hadjiliadis Denis , Hansen-Flaschen John , Dorgan Daniel , Glaser Laurel , Barton Grant , Hamilton Keith W
Published: October 2019

Background

Rapidly growing mycobacteria (RGM) have high rates of intrinsic antibiotic resistance and require prolonged antibiotic therapies associated with considerable toxicity. Less toxic and more effective therapies are needed. One promising agent is clofazimine (CFZ), an antibiotic with favorable in vitro data but limited clinical data in RGM.

Methods

We performed a retrospective cohort study of all patients treated for RGM infection with a CFZ-containing regimen in the University of Pennsylvania Health System between 1/1/2010 and 12/31/2016. Primary outcome was clinical cure, defined as no evidence of clinical or microbiologic infection recurrence after 1 year following the completion of treatment. Secondary outcomes included clinical, radiologic, and microbiologic response; all-cause mortality; infection-specific mortality; and treatment-related adverse events. Descriptive and unadjusted analyses were performed to elucidate associations between pertinent demographic and comorbidity data, clinical presentation, treatment history, and treatment outcomes.

Results

We treated 55 patients with CFZ for RGM infection during the study period in combination with a median of 5 other antibiotic agents during each treatment course. Clinical cure with initial treatment regimen was achieved in 43% of patients with pulmonary infection and 71% of patients with non-pulmonary infection. CFZ was well tolerated in our cohort and was discontinued prematurely in 20% of patients, but only in the context of discontinuing all antibiotic agents.

Conclusions

As part of multidrug therapy, CFZ is well tolerated and may be effective in patients with RGM infection, especially non-pulmonary and non-Mycobacterium abscessus complex infections.
Effect of bambermycin and dietary distillers grains concentration on growth performance and carcass characteristics of finishing steers1
Authors: Smith Zachary K , Crawford Grant I , Loe Erik R
Published: October 2019

An experiment was conducted comparing medicated feed additives (MFA) bambermycin or monensin sodium and tylosin phosphate in feedlot diets containing modified distillers grains (mDGS). Crossbred steers (n = 256; initial full BW 418 ± 28.5 kg) were allocated into three weight blocks in a randomized complete block design with a 2 × 2 factorial arrangement of treatments. The factors were: MFA (bambermycin at 20 mg/steer daily or monensin + tylosin at 380 and 90 mg/steer daily, respectively) and mDGS inclusion (15% and 30% of diet DM). Twenty-four pens were utilized, resulting in six replications per treatment. Steers were fed a diet consisting of a 1:1 combination of dry-rolled and high-moisture corn with the roughage portion of the diet consisting of corn silage and corn stover. Steers in the heaviest two blocks were marketed after 104 d and steers in the lightest block were marketed after 126 d. Overall average daily gain (ADG) tended (P = 0.08) to be greater for bambermycin vs. monensin and tylosin, and was not affected (P = 0.17) by mDGS level. Dry matter intake was lower (P ≤ 0.05) with 30% mDGS with monensin and tylosin than with any other treatment. Feed efficiency was not affected by mDGS, MFA, or their interaction (P ≥ 0.30). Marbling scores were greater (P = 0.01) greater for bambermycin vs. monensin and tylosin, and tended (P = 0.08) to be greater with 15% mDGS than with 30% mDGS. Carcasses from steers fed bambermycin had a greater percentage of USDA choice than those fed with monensin and tylosin (P = 0.01). Liver abscess occurrence was not affected (P ≥ 0.17) by MFA, mDGS, or their interaction. Results from this experiment indicate that including bambermycin in feedlot diets containing 30% mDGS results in increased DMI when compared with including monensin and tylosin in 30% mDGS diet without the risk for increases in liver abscess occurrence.
KLF15‐activating Twist2 ameliorated hepatic steatosis by inhibiting inflammation and improving mitochondrial dysfunction via NF‐κB‐FGF21 or SREBP1c‐FGF21 pathway
Authors: Zhou Lulu , Li Qinjin , Chen Ao , Liu Na , Chen Ning , Chen Xiaojun , Zhu Lin , Xia Benzeng , Gong Yuqing , Chen Xiaodong
Published: October 2019

Twist‐related protein 2 (TWIST2) is identified as a basic helix‐loop‐helix (b‐HLH) transcription repressor by dimerizing with other b‐HLH proteins. The significance of TWIST2 has been emphasized in various tumors; however, few studies report its functions in metabolism and metabolic diseases. Here we aimed to explore the novel role and regulation mechanism of TWIST2 in hepatic steatosis. Our results showed that Twist2 knockdown caused mice obesity, insulin resistance, and hepatic steatosis, which were accompanied with inflammation, endoplasmic reticulum stress, and mitochondrial dysfunction. In vitro, TWIST2 overexpression ameliorated hepatocellular steatosis, inhibited inflammation, and improved mitochondrial content and function with a fibroblast growth factor 21 (FGF21)‐dependent pattern. NF‐κB negatively regulated FGF21 transcription by directly binding to FGF21 promoter DNA, which was eliminated by TWIST2 overexpression by inhibiting NF‐κB expression and translocation to nucleus. TWIST2 overexpression decreased intracellular reactive oxygen species level, increased mitochondrial DNA and biogenesis, and enhanced ATP production and antioxidation ability. Additionally, TWIST2 expression was repressed by insulin‐targeting sterol regulatory element‐binding protein 1c (SREBP1c) and forkhead box protein O1 and was enhanced by dexamethasone targeting Krüppel‐like factor 15, which directly interacted with Twist2 promoter DNA. Together, our studies identify an important role and regulation mechanism of TWIST2 in maintaining hepatic homeostasis by ameliorating steatosis, inflammation, and oxidative stress via the NF‐κB‐FGF21 or SREBP1c‐FGF21 pathway, which may provide a new therapeutic scheme for nonalcoholic fatty liver disease.—Zhou, L., Li, Q., Chen, A., Liu, N., Chen, N., Chen, X., Zhu, L., Xia, B., Gong, Y., Chen, X. KLF15‐activating Twist2 ameliorated hepatic steatosis by inhibiting inflammation and improving mitochondrial dysfunction via NF‐κB‐FGF21 or SREBP1c‐FGF21 pathway. FASEB J. 33, 14254‐14269 (2019). www.fasebj.org
The Many Uses of Chemical Shift Imaging in Body MRI
Authors: Shechtel Joanna Leigh , Petruzzi Peter T.
Published: October 2019

Chemical shift imaging is a relatively fast MR sequence, which is valuable in characterizing pathologies in multiple organ systems to help narrow the differential diagnosis or make a definitive diagnosis. Characterization by chemical shift imaging is based on three principles: detection of intracytoplasmic lipid, India-ink artifact, and susceptibility artifact.
Imaging in Acute Intestinal Obstruction
Authors: Mian Memoona , Swamy Nayanatara , Angtuaco Teresita
Published: October 2019

Acute intestinal obstruction is a common cause of morbidity in patients who present with an acute abdomen and accounts for 20% of admissions for “surgical abdomen.” Imaging is important in confirming the diagnosis and identifying the underlying cause. Safe and effective management depend on prompt and accurate diagnosis. Bowel obstruction is subdivided into small and large bowel obstruction, based on the site of luminal narrowing. The causative factors for the two subgroups are usually quite different.
Nurse Empowerment a Key Factor in Cardiac Arrest Survival of Hospitalized Patients
Authors: Rosenberg Karen , Todd Betsy
Published: October 2019

According to this study:

Important differences exist in the organizational structure and function of rapid response teams (RRTs) at top-performing versus non–top-performing hospitals for in-hospital cardiac arrest survival.

Top-performing hospitals tend to have dedicated RRT staff who collaborate with bedside nurses in the surveillance of at-risk patients, both during a rapid response activation and afterward.
Thousands Gather in Singapore for the 2019 ICN Biennial Congress
Authors: Burton Erica
Published: October 2019

Editor's note: The International Council of Nurses (ICN) is a federation of more than 130 international nursing organizations. For more information, see the ICN website at www.icn.ch.
Long-term Outcomes of Injection Drug-related Infective Endocarditis Among People Who Inject Drugs
Authors: Suzuki Joji , Johnson Jennifer A. , Montgomery Mary W. , Hayden Margaret C. , Price Christin N. , Solomon Daniel A. , Liebschutz Jane M. , Schnipper Jeffrey L. , Weiss Roger D.
Published: October 2019

Objectives:

Infective endocarditis (IE) among people who inject drugs is associated with high rates of mortality and repeat episodes of endocarditis. We sought to report on longer-term clinical outcomes of patients with IE who were offered buprenorphine or methadone treatment for opioid use disorder (OUD) at their initial hospital admission.

Methods:

Individuals with OUD hospitalized between 2013 and 2015 with IE were included for the retrospective study. The following data were extracted from the medical record: sociodemographic data, mortality, repeat episodes of endocarditis, and evidence of ongoing buprenorphine and methadone treatment. The impact of medication use on mortality and repeat episode of endocarditis was examined using survival analysis.

Results:

Overall, 26 individuals were included in the study. The mean duration of follow-up was 45.0 months (SD 7.2, range 34.0–56.0). During the index admission, 8 received buprenorphine, 8 received methadone, and 10 declined medications. During the follow-up period, 4 (15.4%) individuals died and 10 (38.5%) individuals experienced a repeat episode of endocarditis. Survival analysis of mortality (log-rank P = 0.066) and repeat episode of endocarditis (log-rank P = 0.86) comparing those who received buprenorphine, received methadone, and declined medication did not differ significantly.

Conclusions:

Initiation of medication treatment alone may not be sufficient to impact long-term mortality and rates of repeat episode of endocarditis. More research is needed to identify optimal treatment strategies for people who inject drugs with IE.
Assessing the Effect of Middle Ear Effusions on Wideband Acoustic Immittance Using Optical Coherence Tomography
Authors: Won Jungeun , Monroy Guillermo L. , Huang Pin-Chieh , Hill Malcolm C. , Novak Michael A. , Porter Ryan G. , Spillman Darold R. , Chaney Eric J. , Barkalifa Ronit , Boppart Stephen A.
Published: October 2019

Objectives:

Wideband acoustic immittance (WAI) noninvasively assesses middle ear function by measuring the sound conduction over a range of audible frequencies. Although several studies have shown the potential of WAI for detecting the presence of middle ear effusions (MEEs), determining the effects of MEE type and amount on WAI in vivo has been challenging due to the anatomical location of middle ear cavity. The purpose of this study is to correlate WAI measurements with physical characteristics of the middle ear and MEEs determined by optical coherence tomography (OCT), a noninvasive optical imaging technique.

Design:

Sixteen pediatric subjects (average age of 7 ± 4 years) were recruited from the primary care clinic at Carle Foundation Hospital (Urbana, IL). A total of 22 ears (normal: 15 ears, otitis media with effusion: 6 ears, and acute otitis media: 1 ear, based on physician’s diagnosis) were examined via standard otoscopy, tympanometry, OCT imaging, and WAI measurements in a busy, community-based clinical setting. Cross-sectional OCT images were analyzed to quantitatively assess the presence, type (relative turbidity based on the amount of scattering), and amount (relative fluid level) of MEEs. These OCT metrics were utilized to categorize subject ears into no MEE (control), biofilm without a MEE, serous-scant, serous-severe, mucoid-scant, and mucoid-severe MEE groups. The absorbance levels in each group were statistically evaluated at α = 0.05.

Results:

The absorbance of the control group showed a similar trend when compared with a pediatric normative dataset, and the presence of an MEE generally decreased the power absorbance. The mucoid MEE group showed significantly less power absorbance from 2.74 to 4.73 kHz (p < 0.05) when compared with the serous MEE group, possibly due to the greater mass impeding the middle ear system. Similarly, the greater amount of middle ear fluid contributed to the lower power absorbance from 1.92 to 2.37 kHz (p< 0.05), when compared with smaller amounts of fluid. As expected, the MEEs with scant fluid only significantly affected the power absorbance at frequencies greater than 4.85 kHz. A large variance in the power absorbance was observed between 2 and 5 kHz, suggesting the dependence on both the type and amount of MEE.

Conclusions:

Physical characteristics of the middle ear and MEEs quantified from noninvasive OCT images can be helpful to understand abnormal WAI measurements. Mucoid MEEs decrease the power absorbance more than serous MEEs, and the greater amounts of MEE decreases the power absorbance, especially at higher (>2 kHz) frequencies. As both the type and amount of MEE can significantly affect WAI measurements, further investigations to correlate acoustic measurements with physical characteristics of middle ear conditions in vivo is needed.
The Pararectus Approach in Acetabular Surgery: Radiological and Clinical Outcome
Authors: Wenzel Lisa , von Rüden Christian , Thannheimer Andreas , Becker Johannes , Brand Andreas , Augat Peter , Perl Mario
Published: October 2019

Objectives:

To evaluate radiological fracture reduction and clinical results using the pararectus approach in complex acetabular fractures involving the anterior column.

Design:

Retrospective database analysis of prospectively collected data.

Setting:

Level 1 trauma center.

Patients/Participants:

61 patients (48 male and 13 female) with a median age of 55 (range 17–91) years were included. According to the chosen surgical approach, they were divided into 2 groups. The P-group included 43 patients, among them 32 male and 11 female patients with a median age of 55 (range 17–90) years. Eighteen patients [16 male, 2 female; median age: 53 (range 23–91) years] were treated through the ilioinguinal approach (I-group).

Intervention:

Anterior surgical procedures through the pararectus or the ilioinguinal approach.

Main Outcome Measured:

Reduction results were rated according to the modified Matta criteria using a measurement protocol of hip joint gaps and steps in computed tomography scans. Operation time, complications, and clinical outcomes median one year postoperatively were compared.

Results:

In the pararectus group reduction was anatomical in 21 out of 40 analyzed patients (52.5%), imperfect in 11 patients (27.5%), and poor in 8 patients (20%). The mean joint step reduction was 3.7 mm, and the mean joint gap reduction was 12.1 mm. In the ilioinguinal group reduction was anatomical in 9 out of 18 patients (50%), imperfect in 4 patients (22%), and poor in 5 patients (28%). The mean joint step reduction was 1 mm, and the mean joint gap reduction was 7 mm. Operation time was significantly shorter in the P-group (mean: 49 minutes; P < 0.001).

Conclusions:

This study indicates that acetabular fracture reduction using the pararectus approach is at least comparable with the ilioinguinal approach independent of patients' age. A relevant advantage of the pararectus approach was seen in a significantly shorter operation time.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Mechanical Effects of Bone Substitute and Far-Cortical Locking Techniques in 2-Part Proximal Humerus Fracture Reconstruction: A Cadaveric Study
Authors: Hast Michael W. , Chin Matthew , Schmidt Elaine C. , Sanville Jennifer , Van Osten George Karl , Mehta Samir
Published: October 2019

Objectives:

To make direct comparisons of the biomechanical properties of a control (CTL) group and implants that were augmented with far cortical locking (FCL), bone substitute material (BSM), and a combination of both (ALL) to determine which fixation is most effective in reducing implant failure.

Methods:

The constructs were tested with osteopenic cadaveric specimens in a two-part fracture model. Specimens were subjected to a battery of nondestructive torsion and axial compression tests, followed by a cyclic test. Construct stiffness and cycles to failure were documented, pre- and post-test fluoroscopy was performed, and implant and bone kinematics were quantified.

Results:

During nondestructive testing, the BSM group exhibited significantly increased torsional and axial stiffness compared with the FCL (P = 0.006, P < 0.001) group and ALL group (P < 0.001, P = 0.006). There were no significant differences in resistance to cyclic loading between groups. Fluoroscopic analysis indicated significant differences in the motions of nonlocked cannulated screws (used in BSM and ALL) versus locked screws (used in CTL and FCL).

Conclusions:

Patients with poor bone quality and proximal humerus fracture may necessitate added compliance or rigidity to achieve fixation. Both have exhibited favorable biomechanical characteristics in this cadaveric 2-part proximal humerus fracture model.
Increased Staphylococcus aureus Biofilm Formation on Biodegradable Poly(3-Hydroxybutyrate)-Implants Compared with Conventional Orthopedic Implants: An In Vitro Analysis
Authors: Ferlic Peter W. , Liebensteiner Michael , Nogler Michael , Weinberg Annelie M. , Kühn Klaus-Dieter , Coraça-Huber Débora
Published: October 2019

Objective:

To compare the biofilm formation on a biodegradable material, poly(3-hydroxybutyrate) (PHB), with that on conventional titanium (Ti) and steel (St) implant material.

Methods:

Pins made of the different materials were incubated in Müller-Hinton broth inoculated with 2 × 105 colony-forming units (CFU)·mL−1 of Staphylococcus aureus for 2 and 7 days and then sonicated for the disruption of the biofilms. CFU were counted to quantify the number of bacteria in the biofilm, and the cell proliferation assay 2,3-Bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H- tetrazolium-5-carboxanilid salt was used to evaluate their metabolic activity. Scanning electron microscopy visualized the structure of the biofilm.

Results:

We found a significantly higher metabolic activity and CFU count in the biofilm of PHB pins compared with St and Ti pins (analysis of variance, P < 0.0001). Scanning electron microscopy revealed structured biofilms on PHB pins already after 2 days of incubation, which was not observed on the other tested implants.

Conclusion:

PHB implants seem to provide an environment that advantages the formation of biofilms of S. aureus, a common pathogen in implant-related infections. The amount of biofilm is higher on PHB implant compared with conventionally used orthopedic titanium and steel implants. To overcome the potential risk of surgical site infections linked to the clinical use of PHB implants, possible modifications of the material, increasing its antibacterial properties, need to be further investigated.
Tantalum Fusion Device in Anterior Cervical Discectomy and Fusion For Treatment of Cervical Degeneration Disease
Authors: Wang Yufu , Wei Rongzhi , Subedi Dipendra , Jiang Hongxing , Yan Jinglong , Li Jing
Published: October 2019

Study Design:

This is a systematic review and meta-analysis study.

Objective:

The purpose of this systematic review and meta-analysis study is to evaluate the outcomes of a tantalum fusion device in anterior cervical discectomy and fusion (ACDF) for the treatment of cervical degeneration disease.

Summary of Background Data:

A great interest has raised for porous tantalum in cervical fusion, but several studies reported the divergent clinical outcome and fusion rate. No systematic review and meta-analysis has been conducted up to present to evaluate the outcomes of the tantalum fusion device.

Methods:

We comprehensively searched multiple databases for studies that investigated the tantalum fusion device in ACDF. The retrieved results were last updated on February 15, 2018. Outcomes of interest comprised of operative parameters, fusion rate, the incidence of adverse events as well as patient-reported outcomes, including the Neck Disability Index (NDI) score, Visual Analog Scale (VAS) score, Short Form-36 Physical Component Scores and complications.

Results:

Ten studies included were included in this review and 6 randomized controlled trial studies included. All studies were pooled to evaluate the outcome of fusion rate, NDI, and VAS after tantalum fusion treatment. The results of the meta-analysis showed that implantation of the tantalum fusion device is associated with significantly shorter operative and fewer adverse events when compared with autologous iliac crest bone graft. However, no difference was found with regards to the fusion rate, NDI, VAS, and global assessment.

Conclusions:

Through this systemic review and meta-analysis, no significant difference was found with regards to fusion rate, postoperative NDI, and VAS between tantalum fusion and iliac crest bone graft in ACDF. More longer-term and randomized studies with large samples are warranted to validate any association found in this study.

Level of Evidence:

Level II.
Wearable Technology in Spine Surgery
Authors: Lee Thomas J. , Galetta Matthew S. , Nicholson Kristen J. , Cifuentes Elizabeth , Goyal Dhruv K.C. , Mangan John J. , Fang Taolin , Schroeder Gregory D. , Kepler Christopher K. , Vaccaro Alexander R.
Published: October 2019

Although patient-reported outcome measures (PROMs) provide valuable insight into the effectiveness of spine surgery, there still remain limitations on measuring outcomes in this manner. Among other deficiencies, PROMs do not always correlate with more objective measures of surgery success. Wearable technology, such as pedometers, tri-axis accelerometer, or wearable cameras, may allow physicians to track patient progress following spine surgery more objectively. Recently, there has been an emphasis on using wearable devices to measure physical activity and limb and spine function. Wearable devices could play an important role as a supplement to PROMs, although they might have to be substantiated through adequate controlled studies to identify normative data for patients presenting with common spine disorders. This review will detail the current state of wearable technology applications in spine surgery and its direction as its utilization expands.
Host-Response Subphenotypes Offer Prognostic Enrichment in Patients With or at Risk for Acute Respiratory Distress Syndrome*
Authors: Kitsios Georgios D. , Yang Libing , Manatakis Dimitris V. , Nouraie Mehdi , Evankovich John , Bain William , Dunlap Daniel G. , Shah Faraaz , Barbash Ian J. , Rapport Sarah F. , Zhang Yingze , DeSensi Rebecca S. , Weathington Nathaniel M. , Chen Bill B. , Ray Prabir , Mallampalli Rama K. , Benos Panayiotis V. , Lee Janet S. , Morris Alison , McVerry Bryan J.
Published: October 2019

Objectives:

Classification of patients with acute respiratory distress syndrome into hyper- and hypoinflammatory subphenotypes using plasma biomarkers may facilitate more effective targeted therapy. We examined whether established subphenotypes are present not only in patients with acute respiratory distress syndrome but also in patients at risk for acute respiratory distress syndrome (ARFA) and then assessed the prognostic information of baseline subphenotyping on the evolution of host-response biomarkers and clinical outcomes.

Design:

Prospective, observational cohort study.

Setting:

Medical ICU at a tertiary academic medical center.

Patients:

Mechanically ventilated patients with acute respiratory distress syndrome or ARFA.

Interventions:

None.

Measurements and Main Results:

We performed longitudinal measurements of 10 plasma biomarkers of host injury and inflammation. We applied unsupervised latent class analysis methods utilizing baseline clinical and biomarker variables and demonstrated that two-class models (hyper- vs hypoinflammatory subphenotypes) offered improved fit compared with one-class models in both patients with acute respiratory distress syndrome and ARFA. Baseline assignment to the hyperinflammatory subphenotype (39/104 [38%] acute respiratory distress syndrome and 30/108 [28%] ARFA patients) was associated with higher severity of illness by Sequential Organ Failure Assessment scores and incidence of acute kidney injury in patients with acute respiratory distress syndrome, as well as higher 30-day mortality and longer duration of mechanical ventilation in ARFA patients (p < 0.0001). Hyperinflammatory patients exhibited persistent elevation of biomarkers of innate immunity for up to 2 weeks postintubation.

Conclusions:

Our results suggest that two distinct subphenotypes are present not only in patients with established acute respiratory distress syndrome but also in patients at risk for its development. Hyperinflammatory classification at baseline is associated with higher severity of illness, worse clinical outcomes, and trajectories of persistently elevated biomarkers of host injury and inflammation during acute critical illness compared with hypoinflammatory patients. Our findings provide strong rationale for examining treatment effect modifications by subphenotypes in randomized clinical trials to inform precision therapeutic approaches in critical care.
Agmatine Protects Against the Progression of Sepsis Through the Imidazoline I2 Receptor-Ribosomal S6 Kinase 2-Nuclear Factor-κB Signaling Pathway
Authors: Li Xuanfei , Zhu Junyu , Tian Lixing , Ma Xiaoyuan , Fan Xia , Luo Li , Yu Jing , Sun Yu , Yang Xue , Tang Wanqi , Ma Wei , Yan Jun , Xu Xiang , Liang Huaping
Published: October 2019

Objectives:

The knowledge that agmatine is found in the human body has existed for several years; however, its role in sepsis has not yet been studied. In the present study, we investigate the role of agmatine in the progression and treatment of sepsis.

Design:

Clinical/laboratory investigations.

Setting:

Medical centers/University-based research laboratory.

Subjects:

Elective ICU patients with severe sepsis and healthy volunteers; C57BL/6 mice weighing 18–22 g.

Interventions:

Serum agmatine level and its associations with inflammatory markers were assessed in patients with sepsis. Agmatine was administered intraperitoneally to mice before a lipopolysaccharide challenge. Human peripheral blood mononuclear cells and murine macrophages were pretreated with agmatine followed by lipopolysaccharide stimulation.

Measurements and Main Results:

Serum agmatine levels were significantly decreased in patients with sepsis and lipopolysaccharide-induced mice, and correlated with Acute Physiology and Chronic Health Evaluation II score, procalcitonin, tumor necrosis factor-α, and interleukin-6 levels. In a therapeutic experiment, exogenous agmatine attenuated the cytokine production of peripheral blood mononuclear cells from patients with sepsis and healthy controls. Agmatine also exerted a significant beneficial effect in the inflammatory response and organ damage and reduced the death rate in lipopolysaccharide-induced mice. Imidazoline I2 receptor agonist 2-benzofuran-2-yl blocked the pharmacological action of agmatine; whereas, other imidazoline receptor ligands did not. Furthermore, agmatine significantly impaired the inflammatory response by inactivating nuclear factor-κB, but not protein 38 mitogen-activated protein kinase, c-Jun N-terminal kinase, extracellular signal-regulated kinase, and inducible nitric oxide synthase signaling in macrophages. Activation of imidazoline I2 receptor or knockdown of ribosomal S6 kinase 2 counteracted the effects of agmatine on phosphorylation and degradation of inhibitor of nuclear factor-κBα.

Conclusions:

Endogenous agmatine metabolism correlated with the progression of sepsis. Supplemental exogenous agmatine could ameliorate the lipopolysaccharide-induced systemic inflammatory responses and multiple organ injuries through the imidazoline I2 receptor-ribosomal S6 kinase 2-nuclear factor-κB pathway. Agmatine could be used as both a clinical biomarker and a promising pharmaconutrient in patients with severe sepsis.
High-Frequency Oscillatory Ventilation and Ventilator-Induced Lung Injury: Size Does Matter
Authors: Herrmann Jacob , Lilitwat Weerapong , Tawhai Merryn H. , Kaczka David W.
Published: October 2019

Objectives:

The theoretical basis for minimizing tidal volume during high-frequency oscillatory ventilation may not be appropriate when lung tissue stretch occurs heterogeneously and/or rapidly. The objective of this study was to assess the extent to which increased ventilation heterogeneity may contribute to ventilator-induced lung injury during high-frequency oscillatory ventilation in adults compared with neonates on the basis of lung size, using a computational model of human lungs.

Design:

Computational modeling study.

Setting:

Research laboratory.

Subjects:

High-fidelity, 3D computational models of human lungs, scaled to various sizes representative of neonates, children, and adults, with varying injury severity. All models were generated from one thoracic CT image of a healthy adult male.

Interventions:

Oscillatory ventilation was simulated in each lung model at frequencies ranging from 0.2 to 40 Hz. Sinusoidal flow oscillations were delivered at the airway opening of each model and distributed through the lungs according to regional parenchymal mechanics.

Measurements and Main Results:

Acinar flow heterogeneity was assessed by the coefficient of variation in flow magnitudes across all acini in each model. High-frequency oscillatory ventilation simulations demonstrated increasing heterogeneity of regional parenchymal flow with increasing lung size, with decreasing ratio of deadspace to total acinar volume, and with increasing frequency above lung corner frequency and resonant frequency. Potential for resonant amplification was greatest in injured adult-sized lungs with higher regional quality factors indicating the presence of underdamped lung regions.

Conclusions:

The potential for ventilator-induced lung injury during high-frequency oscillatory ventilation is enhanced at frequencies above lung corner frequency or resonant frequency despite reduced tidal volumes, especially in adults, due to regional amplification of heterogeneous flow. Measurements of corner frequency and resonant frequency should be considered during high-frequency oscillatory ventilation management.
Acute Respiratory Distress Syndrome Following Pediatric Trauma: Application of Pediatric Acute Lung Injury Consensus Conference Criteria
Authors: Killien Elizabeth Y. , Huijsmans Roel L. N. , Ticknor Iesha L. , Smith Lincoln S. , Vavilala Monica S. , Rivara Frederick P. , Watson R. Scott
Published: October 2019

Objectives:

To assess the incidence, severity, and outcomes of pediatric acute respiratory distress syndrome following trauma using Pediatric Acute Lung Injury Consensus Conference criteria.

Design:

Retrospective cohort study.

Setting:

Level 1 pediatric trauma center.

Patients:

Trauma patients less than or equal to 17 years admitted to the ICU from 2009 to 2017.

Interventions:

None.

Measurements and Main Results:

We queried electronic health records to identify patients meeting pediatric acute respiratory distress syndrome oxygenation criteria for greater than or equal to 6 hours and determined whether patients met complete pediatric acute respiratory distress syndrome criteria via chart review. We estimated associations between pediatric acute respiratory distress syndrome and outcome using generalized linear Poisson regression adjusted for age, injury mechanism, Injury Severity Score, and serious brain and chest injuries. Of 2,470 critically injured children, 103 (4.2%) met pediatric acute respiratory distress syndrome criteria. Mortality was 34.0% among pediatric acute respiratory distress syndrome patients versus 1.7% among patients without pediatric acute respiratory distress syndrome (adjusted relative risk, 3.7; 95% CI, 2.0–6.9). Mortality was 50.0% for severe pediatric acute respiratory distress syndrome at onset, 33.3% for moderate, and 30.5% for mild. Cause of death was neurologic in 60.0% and multiple organ failure in 34.3% of pediatric acute respiratory distress syndrome nonsurvivors versus neurologic in 85.4% of nonsurvivors without pediatric acute respiratory distress syndrome (p = 0.001). Among survivors, 77.1% of pediatric acute respiratory distress syndrome patients had functional disability at discharge versus 30.7% of patients without pediatric acute respiratory distress syndrome patients (p < 0.001), and only 17.5% of pediatric acute respiratory distress syndrome patients discharged home without ongoing care versus 86.4% of patients without pediatric acute respiratory distress syndrome (adjusted relative risk, 1.5; 1.1–2.1).

Conclusions:

Incidence and mortality associated with pediatric acute respiratory distress syndrome following traumatic injury are substantially higher than previously recognized, and pediatric acute respiratory distress syndrome development is associated with high risk of poor outcome even after adjustment for underlying injury type and severity.