bluuebunny/crossref_metadata_2025 huggingface dataset:
High-energy neutrino flux from individual blazar flares
Authors: Oikonomou Foteini , Murase Kohta , Padovani Paolo , Resconi Elisa , Mészáros Peter
Published: August 2019

Motivated by the recently reported evidence of an association between a high-energy neutrino and a γ-ray flare from the blazar TXS 0506+056, we calculate the expected high-energy neutrino signal from past, individual flares, from 12 blazars, selected in declinations favourable for detection with IceCube. To keep the number of free parameters to a minimum, we mainly focus on BL Lac objects and assume the synchrotron self-Compton mechanism produces the bulk of the high-energy emission. We consider a broad range of the allowed parameter space for the efficiency of proton acceleration, the proton content of BL Lac jets, and the presence of external photon fields. To model the expected neutrino fluence, we use simultaneous multiwavelength observations. We find that in the absence of external photon fields and with jet proton luminosity normalized to match the observed production rate of ultrahigh-energy cosmic rays, individual flaring sources produce a modest neutrino flux in IceCube, $N^{\mathrm{IC,10 \,yr}}_{\nu _{\mu },{\mathrm{\gt 100~TeV}}} \lesssim 10^{-3}$ muon neutrinos with energy exceeding 100 TeV, stacking 10 yr of flare periods selected in the >800 MeV Fermi energy range, from each source. Under optimistic assumptions about the jet proton luminosity and in the presence of external photon fields, we find that the two most powerful sources in our sample, AO 0235+164, and OJ 287, would produce, in total, $N^{\mathrm{IC \times 10,10 \,yr}}_{\nu _{\mu }, \rm all~flares, \gt 100~TeV} \approx 3$ muon neutrinos during Fermi flaring periods, in future neutrino detectors with total instrumented volume ∼10 times larger than IceCube, or otherwise, constrain the proton luminosity of blazar jets.
Developing a self-consistent AGB wind model – II. Non-classical, non-equilibrium polymer nucleation in a chemical mixture
Authors: Boulangier Jels , Gobrecht D , Decin L , de Koter A , Yates J
Published: August 2019

Unravelling the composition and characteristics of gas and dust lost by asymptotic giant branch (AGB) stars is important as these stars play a vital role in the chemical life cycle of galaxies. The general hypothesis of their mass-loss mechanism is a combination of stellar pulsations and radiative pressure on dust grains. However, current models simplify dust formation, which starts as a microscopic phase transition called nucleation. Various nucleation theories exist, yet all assume chemical equilibrium, growth restricted by monomers, and commonly use macroscopic properties for a microscopic process. Such simplifications for initial dust formation can have large repercussions on the type, amount, and formation time of dust. By abandoning equilibrium assumptions, discarding growth restrictions, and using quantum mechanical properties, we have constructed and investigated an improved nucleation theory in AGB wind conditions for four dust candidates, TiO2, MgO, SiO, and Al2O3. This paper reports the viability of these candidates as first dust precursors and reveals implications of simplified nucleation theories. Monomer restricted growth underpredicts large clusters at low temperatures and overpredicts formation times. Assuming the candidates are present, Al2O3 is the favoured precursor due to its rapid growth at the highest considered temperatures. However, when considering an initially atomic chemical mixture, only TiO2-clusters form. Still, we believe Al2O3 to be the prime candidate due to substantial physical evidence in presolar grains, observations of dust around AGB stars at high temperatures, and its ability to form at high temperatures and expect the missing link to be insufficient quantitative data of Al-reactions.
Interacting young M-dwarfs in triple system – Par 1802 binary system case study
Authors: Cheng Shelley J , Vinson Alec M , Naoz Smadar
Published: August 2019

The binary star Par 1802 in the Orion Nebula presents an interesting puzzle in the field of stellar dynamics and evolution. Binary systems such as Par 1802 are thought to form from the same natal material and thus the stellar members are expected to have very similar physical attributes. However, Par 1802’s stars have significantly different temperatures despite their identical (within $3\, {\rm per\, cent}$) masses of about 0.39 M⊙. The leading proof-of-concept idea is that a third companion gravitationally induced the two stars to orbit closer than their Roche limit, which facilitated heating through tidal effects. Here we expand on this idea and study the three-body dynamical evolution of such a system, including tidal and pre-main-sequence evolution. We also include tidal heating and mass transfer at the onset of Roche limit crossing. We show, as a proof-of-concept, that mass transfer combined with tidal heating can naturally explain the observed temperature discrepancy. We also predict the orbital configuration of the possible tertiary companion. Finally, we suggest that the dynamical evolution of such a system has pervasive consequences. We expect an abundance of systems to undergo mass transfer during their pre-main-sequence time, which can cause temperature differences.
H ii versus H i in the ‘green valley’ galaxies: direct comparison
Authors: Bryukhareva Tatiana S , Moiseev Alexei V
Published: August 2019

We study the morphology and kinematics of the ionization state of the gas in four ‘green valley’ early-type galaxies at different stages of their transition from a ‘blue cloud’ of star-forming galaxies to the sequence of passive evolution. The previous H i mapping of the considered sample reveals a spatial offset between the cold gas reservoirs and stellar discs depending on the post-starburst age. Consideration of the ionized-gas properties is essential to understand the role of various feedback processes in star formation quenching. We performed long-slit and 3D optical spectroscopic observations at the 6-m Russian telescope and compared the gas and stellar kinematics. Spatial distribution of the ionized gas is in agreement with H i maps; however, the one-order higher angular resolution in the H ii velocity fields allows us to study non-circular gas motions in detail, like the AGN-driven outflow in the nucleus of J1117+51. The most intriguing result is the global H i+H ii gas counter-rotation relative to the stellar disc in J1237+39. Therefore, in this case all the observed gas in the ‘green valley’ galaxy was captured from the environment via accretion or minor merging.
The Impact of Penicillin Skin Testing on Aztreonam Stewardship and Cost Savings in Immunocompromised Cancer Patients
Authors: Foolad Farnaz , Berlin Sheila , White Candice , Dishner Emma , Jiang Ying , Taremi Mahnaz
Published: August 2019

Objective

Reported penicillin allergies result in alternative antimicrobial use and are associated with worse outcomes and increased costs. Penicillin skin testing (PST) has recently been shown to be safe and effective in immunocompromised cancer patients, yet its impact on antimicrobial costs and aztreonam utilization has not been evaluated in this population.

Method

From September 2017 to January 2018, we screened all admitted patients receiving aztreonam. Those with a self-reported history of possible immunoglobulin E (IgE)-mediated reaction to penicillin were eligible for PST with oral challenge.

Results

A total of 129 patients were screened, and 49 patients were included and underwent testing. Sixteen patients (33%) had hematologic malignancies and 33 patients (67%) had solid tumors. After PST with oral challenge, 46 patients (94%) tested negative, 1 patient tested positive on oral challenge, and 2 patients had indeterminate results. The median time from admission to testing was 2 days (interquartile range, 1–4). After testing negative, 33 patients (72%) were switched to beta-lactam therapy, which resulted in a total of 390 days of beta-lactam therapy. For identical therapy durations, the direct total antibiotic cost was $15 138.89 for beta-lactams versus $78 331.50 for aztreonam, resulting in $63 192.61 in projected savings. A significant reduction in median days of aztreonam therapy per 1000 patient days (10.0 vs 8.0; P = .005) was found during the intervention period.

Conclusions

Use of PST in immunocompromised cancer patients receiving aztreonam resulted in improved aztreonam stewardship and significant cost savings. Our study demonstrates that PST with oral challenge should be considered in all cancer patients with reported penicillin allergies.
Risk of Subsequent HIV Infection Following Sexually Transmissible Infections Among Men Who Have Sex With Men
Authors: Harney Brendan L , Agius Paul A , El-Hayek Carol , Fairley Christopher K , Chow Eric P F , Roth Norman , Tee B K , Leslie David , Tachedjian Gilda , Hellard Margaret , Stoové Mark
Published: August 2019

Background

HIV and bacterial sexually transmissible infection (STI) notifications among men who have sex with men (MSM) have increased in Australia and many other countries. The relationship between HIV infection and other STIs has been demonstrated previously. However, the relationship between the cumulative history of STIs and subsequent HIV infection remains largely unexplored and limits our understanding of the mechanisms underpinning the elevated HIV risk.

Methods

Data from HIV-negative MSM who attended high–HIV caseload primary care clinics in Melbourne, Australia, from 2007 to 2014 with 2 or more HIV and STI tests were included. Controlling for sexual behaviors self-reported at clinic visits, discrete time survival analyses using generalized linear modeling estimated the effect of an STI at the prior test event and the cumulative history of STIs (none, 1, 2, or more [repeated]) on risk of HIV infection.

Results

A total of 8941 MSM met the study criteria; 227 (2.5%) were diagnosed with HIV over the follow-up period. Adjusting for sexual behaviors, a cumulative history of repeated rectal gonorrhea infections (adjusted hazard ratio [aHR], 6.27; 95% confidence interval [CI], 2.68–14.50) and a single rectal gonorrhea infection (aHR, 2.09; 95% CI, 1.15–3.79) were associated with increased HIV infection risk.

Conclusions

Repeated and single rectal gonorrhea infections were independently associated with increased HIV infection risk. These findings suggest that MSM with any history of rectal gonorrhea, particularly repeat rectal gonorrhea, represent a group for whom preventive interventions for HIV should be emphasized.
Phase transition encoded in neural network
Authors: Kashiwa Kouji , Kikuchi Yuta , Tomiya Akio
Published: August 2019

We discuss an aspect of neural networks for the purpose of phase transition detection. To this end, we first train the neural network by feeding Ising/Potts configurations with labels of temperature so that it can predict the temperature of the input. We do not explicitly supervise whether the configurations are in the ordered/disordered phase. Nevertheless, we can identify the critical temperature from the parameters (weights and biases) of the trained neural network. We attempt to understand how temperature-supervised neural networks capture information on the phase transition by paying attention to what quantities they learn. Our detailed analyses reveal that they learn different physical quantities depending on how well they are trained. The main observation in this study is how the weights in the trained neural network can have information on the phase transition in addition to temperature.
Fatigue in inflammatory rheumatic disorders: pathophysiological mechanisms
Authors: Korte S Mechiel , Straub Rainer H
Published: August 2019

Today, inflammatory rheumatic disorders are effectively treated, but many patients still suffer from residual fatigue. This work presents pathophysiological mechanisms of fatigue. First, cytokines can interfere with neurotransmitter release at the preterminal ending. Second, a long-term increase in serum concentrations of proinflammatory cytokines increase the uptake and breakdown of monoamines (serotonin, noradrenaline and dopamine). Third, chronic inflammation can also decrease monoaminergic neurotransmission via oxidative stress (oxidation of tetrahydrobiopterin [BH4]). Fourth, proinflammatory cytokines increase the level of enzyme indoleamine-2, 3-dioxygenase activity and shunt tryptophan away from the serotonin pathway. Fifth, oxidative stress stimulates astrocytes to inhibit excitatory amino acid transporters. Sixth, astrocytes produce kynurenic acid that acts as an antagonist on the α7-nicotinic acetylcholine receptor to inhibit dopamine release. Jointly, these actions result in increased glutamatergic and decreased monoaminergic neurotransmission. The above-described pathophysiological mechanisms negatively affect brain functioning in areas that are involved in fatigue.
Increasing hybrid rye level substituting wheat grain with or without enzyme on growth performance and carcass traits of growing-finishing barrows and gilts
Authors: Smit Miranda N , Zhou Xun , Landero José L , Young Malachy G , Beltranena Eduardo
Published: August 2019

New European, fall-planted hybrid rye grown in western Canada is more resistant to ergot and fusarium and has lower content of anti-nutritional factors than common rye. We evaluated the effect of feeding increasing hybrid rye level substituting wheat grain and non-starch polysaccharide (NSP) enzyme inclusion in diets fed to growing-finishing pigs raised under western Canadian commercial conditions. In total, 1,008 pigs (~44 kg body weight [BW]) housed in 48 pens by sex, 21 pigs per pen, were fed diets with one of three rye (var. KWS Bono; KWS LOCHOW GMBH) inclusion levels substituting wheat grain: low (L; one-third of wheat replaced), medium (M; two-thirds of wheat replaced), or high (H; most wheat replaced), either without (WO) or with (W) enzyme inclusion (280 units of β-glucanase and 900 units of xylanase per kilogram feed; Endofeed W DC; GNC Bioferm) over four growth phases (Grower 2: d 0 to 22, Grower 3: d 23 to 42, Finisher 1: d 43 to 63, Finisher 2: d 64 to slaughter). Pen BW, feed added, and orts were measured on d 0, 22, 42, 63, 76, 91, and at slaughter weight (130 kg). Warm carcasses were weighed and graded (Destron). BW was not affected by either increasing hybrid rye level substituting wheat grain or enzyme inclusion throughout the trial. For the entire trial (d 0 to 76), pigs fed increasing hybrid rye level substituting wheat grain had decreased (P < 0.050) average daily feed intake (ADFI; L 3.05, M 2.98, H 2.91 kg/d) and average daily weight gain (ADG; L 1.01, M 1.00, H 0.97 kg/d). Enzyme inclusion did not affect ADFI but tended (P = 0.080) to increase ADG (WO 0.98, W 1.00 kg/d). Enzyme inclusion improved (P < 0.050) gain-to-feed ratio only in pigs fed the H rye level. Most carcass traits were not affected by either increasing hybrid rye level substituting wheat grain or enzyme inclusion. Increasing dietary hybrid rye level substituting wheat grain increased (P < 0.001) cost per tonne of feed (L 240.28, M 241.28, H 242.20 Can$/kg), but did not affect feed cost per pig or per kilogram BW gain. Enzyme inclusion increased (P < 0.001) cost per tonne of feed (WO 240.36, W 242.15 Can$/kg), but feed cost per pig (WO 82.14, W 80.44 Can$ per pig) and per kilogram BW gain (WO 0.96, W 0.94 Can$/kg gain) were reduced (P < 0.050). In conclusion, fall-planted hybrid rye can completely replace wheat grain in grower-finisher pig diets without affecting feed efficiency, feed cost per pig or feed cost per kilogram BW gain. Inclusion of NSP enzyme would be recommended for diets including high rye levels to improve feed efficiency and ADG.
Inpatient Opioid Use After Vaginal Delivery
Authors: Badreldin N. , Grobman W.A. , Yee L.M.
Published: August 2019

(Am J Obstet Gynecol. 2018;219:608.e1–608)

Inpatient opioid use may serve as a first opioid exposure for many patients undergoing labor and delivery, as well as result in subsequent opioid abuse or dependence. However, data regarding this issue in this patient population are limited; current literature largely focuses on outpatient opioid prescription and treatment for the management of postdelivery pain. Therefore, this study evaluated opioid use in women during postpartum hospitalization and identified both maternal and prescribing provider characteristics associated with opioid prescription and use.
Immediate Versus Delayed Pushing During the Second Stage of Labor
Authors: Sperling J.D. , Gossett D.R.
Published: August 2019

(JAMA. 2018;320(14):1439–1440)

In an effort to optimize cesarean delivery rates, there has been extensive research examining the management of labor. A prolonged second stage of labor is associated with adverse outcomes for both mother and infant and whether women should push immediately or delay pushing upon complete cervical dilation is still unknown.
Acute Myocardial Infarction During Pregnancy and the Puerperium in the United States
Authors: Smilowitz N.R. , Gupta N. , Guo Y. , Zhong J. , Weinberg C.R. , Reynolds H.R. , Bangalore S.
Published: August 2019

(Mayo Clin Proc. 2018;93:1404–1414)

Acute myocardial infarction (AMI) during pregnancy occurs infrequently yet accounts for 5% to 7% of maternal fatalities. In addition, there are significant risks to the developing fetus. The physiological changes in the cardiovascular system and the hypercoagulable state of pregnancy contribute to the increased risk of AMI during pregnancy. This study analyzed hospital admissions from a large national database to evaluate trends in the incidence, in-hospital management, and outcomes of AMI complicating pregnancy and the puerperium in the United States.
Alcohol, Cigarette, and Cannabis Use Between 2002 and 2016 in Pregnant Women From a Nationally Representative Sample
Authors: Agrawal A. , Rogers C.E. , Lessov-Schlaggar C.N. , Carter E.B. , Lenze S.N. , Grucza R.A.
Published: August 2019

(JAMA Pediatr. 2019;173(1):95–96)

In the National Survey of Drug Use and Health, the prevalence of cannabis use in pregnant women aged 18 to 44 years rose from 2.37% in 2002 to 3.85% in 2014. Corresponding rates of alcohol use (eg, 11.2% from 2001 to 2005 vs. 10.2% from 2011 to 2013) and cigarette smoking (eg, 13.3% in 2002 vs 12.3% in 2010) during pregnancy have declined. The purpose of this study was to provide more detailed characterization of patterns of substance use during pregnancy.
Severe Maternal Morbidity Due to Sepsis: The Burden and Preventability of Disease in New Zealand
Authors: Lepine S. , Lawton B. , Geller S. , Abels P. , MacDonald E.J.
Published: August 2019

(Aust N Z J Obstet Gynaecol. 2018;58:648–653)

Obstetric sepsis is a common cause of severe maternal morbidity (SMM) in New Zealand with its incidence appearing to be on the rise. Physiological changes of pregnancy and labor analgesia may sometimes mask symptoms of sepsis, making diagnosis of sepsis in parturients more difficult than in nonpregnant patients. Pregnancy also alters the immune system, leading to varied responses to infection. To diagnose sepsis in a more timely fashion and improve patient outcomes, obstetricians and anesthesiologists should have a low index of suspicion for sepsis in pregnant and postpartum women who present with signs of fever, tachycardia, dyspnea and other symptoms that could suggest sepsis. Over the past few years there has been the introduction of care bundles throughout medicine which are meant to improve the recognition, diagnosis, and management of sepsis. This article aimed to describe the degree of severe morbidity caused by obstetric sepsis in New Zealand, with special attention focused on possible methods of prevention.
Experimental Validation of the CompuFlo Epidural Controlled System to Identify the Epidural Space and Its Clinical Use in Difficult Obstetric Cases
Authors: Capogna G. , Camorcia M. , Coccoluto A. , Micaglio M. , Velard M.
Published: August 2019

(Int J Obstet Anesth. 2018;36:28–33)

While epidural block is commonly used in obstetrics, it may be associated with a significant failure rate. Various devices have been designed in an attempt to aid in identification of the position of the epidural needle tip using visual or auditory end-points. The CompuFlo Instrument is a computer-controlled drug-delivery system which is able to distinguish different tissue types by measuring pressure at the tip of the needle in real time. This device provides audible signals and visual graphics of exit-pressure. This study aimed to determine whether the CompuFlo is suitable for difficult epidural placement as well as examined the utility of CompuFlo during epidural placement.
Ocular Ultrasonography for Diagnosing Increased Intracranial Pressure in Patients With Severe Preeclampsia
Authors: Simenc G.B. , Ambrozic J. , Prokselj K. , Tul N. , Cvijic M. , Mirkovic T. , Lucovnika M.
Published: August 2019

(Int J Obstet Anesth. 2018;36:49–55)

In most patients (71% to 100%) with preeclampsia with severe features, signs of cerebral edema are present and confirmed by magnetic resonance imaging. Morbidity and mortality rates have been significantly improved when cerebral edema is promptly diagnosed and treated. Recently, ocular ultrasonography has been suggested to be a reliable means of detecting raised intracranial pressure (ICP) in nonpregnant populations. Specifically, optic nerve sheath diameter (ONSD) and optic disc height (ODH) as measured via ultrasound are increased in the setting of increased ICP. ONSD has been correlated to ICP measured invasively in nonpregnant patients. This study aimed to determine whether patients with preeclampsia with severe features have greater ONSD or ODH when compared with healthy pregnant women.
A Randomized Trial of Prophylactic Antibiotics for Miscarriage Surgery
Authors: Lissauer D. , Wilson A. , Hewitt C.A. , Middleton L. , Bishop J.R.B. , Daniels J. , Merriel A. , Weeks A. , Mhango C. , Mataya R. , Taulo F. , Ngalawesa T. , Chirwa A. , Mphasa C. , Tambala T. , Chiudzu G. , Mwalwanda C. , Mboma A. , Qureshi R. , Ahmed I. , Ismail H. , Oladapo O.T. , Mbaruku G. , Chibwana J. , Watts G. , Simon B. , Ditai J. , Otim Tom C. , Acam J. , Ekunait J. , Unzia H. , Iyaku M. , Makiika J.J. , Zamora J. , Roberts T. , Goranitis I. , Bar-Zeev S. , Desmond N. , Arulkumaran S. , Bhutta Z.A. , Gulmezoglu A.M. , Coomarasamy A.
Published: August 2019

(N Engl J Med. 2019;380:1012–1021)

It is unclear whether or not antibiotic prophylaxis prior to surgery to complete spontaneous abortion (removal of retained products of conception) can reduce postoperative pelvic infection. Evidence is lacking and international guidelines regarding this issue are also inconsistent. This issue is particularly concerning for women in low-income and middle-income countries, where rates of surgery for incomplete spontaneous abortion are high, and where pelvic infection can lead to serious illness and death. In order to help clarify this issue, the authors of the present study assessed the use of antibiotic prophylaxis (doxycycline and metronidazole, both inexpensive, heat-stable, and widely available) in women undergoing surgery to complete spontaneous abortion in low-resource settings.
Prophylactic Insertion of Large Bore Peripheral Intravenous Catheters in Maternity Patients for Postpartum Haemorrhage: A Cohort Study
Authors: Webster J. , Larsen E. , Booker C. , Laws J. , Marsh N.
Published: August 2019

(Aust N Z J Obstet Gynaecol. 2018;58:548–552)

In Australia, most women undergoing labor and vaginal delivery receive a peripheral intravenous catheter (PIVC) for any needed IV fluids, blood products or medications. While the smallest gauge catheter necessary is recommended by guidelines for intravenous access, many women receive a large-bore, 16 or 18 G, PIVC due to concerns about potential obstetric hemorrhage. Insertion of large-bore PIVCs can be very painful, especially when inserted in the back of the hand or wrist. This current study aimed to assess the necessity of large bore PIVCs in laboring parturients by inquiring about: any existing evidence supporting the practice; how common this practice is in Australia; the proportion of inserted PIVCs that are 18 G or larger; and the number of women requiring blood products in the peripartum period.
An Evaluation of Fetal Heart Rate Characteristics Associated With Neonatal Encephalopathy: A Case-Control Study
Authors: Frey H.A. , Liu X. , Lynch C.D. , Musindi W. , Samuels P. , Rood K.M. , Thung S.F. , Bakk J.M. , Cheng W. , Landon M.B.
Published: August 2019

(BJOG. 2018;125(11):1480–1487)

Neonatal encephalopathy (NE) is characterized by abnormal neurological function that presents with decreased level of consciousness or seizures, difficulty maintaining respirations, and abnormal reflexes or tone. This clinical condition is identified shortly after birth with an incidence of 2 to 6/1000 live births. There is incomplete understanding of the etiology of NE and no evidence-based interventions to prevent its occurrence. The objective of the study was to identify predelivery fetal heart rate (FHR) characteristics associated with NE. The hypothesis was category III FHR tracings would be associated with NE.
Transversalis Fascia Plane Block Provides Effective Postoperative Analgesia for Cesarean Section: New Indication for Known Block
Authors: Tulgar S. , Serifsoy T.E.
Published: August 2019

(J Clin Anesth. 2018;48:13–14. Doi:10.1016/j.jclinane.2018.04.006)

Adequate analgesia after cesarean section (CS) requires sensorial blockade of the subcostal (T12), ilioinguinal (L1), and iliohypogastric (T12-L1) nerves’ cutaneous branches. However, the posterior transversus abdominis plane block, commonly used for CS, may not affect the T12 and L1 cutaneous branches. Therefore, in this study, the authors reported the first effective use of the transversalis fascia plane block (TFPB) in 2 patients, which should provide blockade of the ilioinguinal and iliohypogastric nerves.
Early Effects of the Trauma Collaborative Care Intervention: Results From a Prospective Multicenter Cluster Clinical Trial
Authors:   The Major Extremity Trauma Rehabilitation Consortium (METRC)
Published: August 2019

Objectives:

To evaluate the impact of the Trauma Collaborative Care (TCC) program's early intervention components on 6-week outcomes. TCC was developed to improve psychosocial sequelae of orthopaedic trauma and includes the Trauma Survivors Network and additional collaborative care services.

Design:

Prospective, multicenter, cluster clinical trial.

Setting:

Level I Trauma Centers.

Patients:

Individuals with high-energy orthopaedic injuries requiring surgery and hospital admission: 413 patients at 6 trauma centers implementing the TCC program and 374 patients at 6 trauma centers receiving usual care.

Intervention:

TCC early intervention: patient education, peer visits, and coaching calls.

Main Outcome Measurements:

Pain rating scale, Patient Health Questionnaire—9 depression, Post-Traumatic Stress Disorder Checklist, and self-efficacy for return to work and managing finances. For each outcome, a hybrid Bayesian statistical procedure, accounting for clustering within sites and differences in baseline characteristics between sites, was used to estimate the intention-to-treat (ITT) effect and the effect under full receipt of early intervention components.

Results:

Sites varied substantially in utilization of intervention components. The posterior estimates of the ITT (full receipt) effect favor TCC for 4 (5) of the 5 endpoints. The posterior probabilities of a favorable (ITT; full receipt) TCC effect were as follows: depression (89%–93%), pain (84%–74%), post-traumatic stress disorder (68%–68%), self-efficacy for return to work (74%–76%), and self-efficacy for managing finances (47%–61%).

Conclusions:

Results suggest TCC may have a small positive effect on early outcomes, but use of the services was highly variable among sites.

Level of Evidence:

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Pain During “Noncomplex” Electrophysiological Studies and Cardiac Rhythm Device Surgery
Authors: Fikenzer Sven , Fikenzer Kati , Bauer Yvonne , Kuehl Michael , Hindricks Gerhard , Bollmann Andreas , Bode Kerstin
Published: August 2019

Background:

There are only limited data about peri-interventional pain during cardiac electrophysiological procedures without analgosedation. In this study, peri-interventional pain and recollection of it after the intervention were evaluated.

Methods:

A total of 101 patients (43 electrophysiological/ablation procedures and 58 device surgeries) reported pain on a numerical rating scale (NRS; 0–10) before (pre), during (peri), and after (post) the intervention. Maximum pain (maxNRS) and the average of pain (meanNRS) were used for statistical analysis. Peri-interventional pain was compared with postinterventional data of the recollection of peri-interventional pain (peri-post). Patients were allocated into 2 groups (with 51 and 50 patients, respectively) to evaluate the mode of patient-staff interaction on pain recollection. Depressive, anxiety, and somatic symptom scales (Patient Health Questionnaire-15, Generalized Anxiety Disorder-7, and Patient Health Questionnaire-15) were used to analyze their influence on pain recollection.

Results:

In total, 49.6% of patients (n = 50) complained of moderate to severe pain (maxNRS) at least once during the procedure. The comparison between peri and peri-post data revealed the following (median (range)—maxNRS, peri: 3 (0–10) versus peri-post: 4 (0–9) (ns), and meanNRS, peri: 1.4 (0–7) versus peri-post: 2.0 (0–6) (ns). The mode of patient-staff interaction had no influence on pain. No effect was found for psychosocial factor concerning pain and the recollection of pain. The results of the linear regression showed no influence of low-dose midazolam on recollection of pain.

Conclusion:

Half of the patients reported moderate to severe pain at least once during cardiac electrophysiological procedures without analgosedation. However, on average, patients reported only low pain levels. Postinterventional derived data on discomfort reflect the peri-interventional situation.
Pineal region metastasis with intraventricular seeding
Authors: Ji Junpeng , Gu Chunyu , Zhang Mingshan , Zhang Hongwei , Wang Haoran , Qu Yanming , Ren Ming , Ning Weihai , Yu Chunjiang
Published: August 2019

Introduction:

Tumors of the pineal region are rare, and metastatic carcinoma occurring in the pineal region is extremely rare. No previous reports have described pineal region metastasis with intraventricular seeding.

Patient concerns:

We report a case of a 51-year-old woman presented with a 1-week history of severe headache, nausea, and vomiting. Imaging examination revealed 2 lesions in the pineal region and the right lateral ventricle.

Diagnosis:

Pinealocytoma or germinoma was considered as the preoperative diagnosis. The postoperative pathological diagnosis was small cell neuroendocrine carcinoma. After bronchoscopic biopsy, small cell lung cancer was confirmed.

Interventions:

A right frontal craniotomy and a translateral ventricle approach were performed to remove 2 lesions completely. And regular radiotherapy and chemotherapy were initiated after surgery.

Outcomes:

The patient was discharged from the hospital 2 weeks after operation and went to another cancer hospital for bronchoscopic biopsy, radiotherapy, and chemotherapy. Finally, the patient died 2 years after surgical treatment.

Conclusion:

Metastatic tumors of the pineal region are very rare. For patients with pineal lesions, a diagnosis of a metastatic tumor should be considered. Retrograde cerebrospinal fluid circulation might be the reason for a secondary metastasis.
A unique fatal case of Waterhouse–Friderichsen syndrome caused by Proteus mirabilis in an immunocompetent subject
Authors: Ventura Spagnolo Elvira , Mondello Cristina , Roccuzzo Salvatore , Stassi Chiara , Cardia Luigi , Grieco Angela , Raffino Cataldo
Published: August 2019

Introduction:

The Waterhouse–Friderichsen syndrome (WFS), also known as purpura fulminans, is a potentially lethal condition described as acute hemorrhagic necrosis of the adrenal glands. It is often caused by infection. Classically, Neisseriae meningitidis represents the main microorganism related to WFS, although, infrequently, also other infectious agents are reported as a possible etiologic agent. The authors report the first case of death due to Proteus mirabilis infection, with postmortem evidence of WFS.

Patient concerns:

After a facial trauma that provoked a wound on the nose, the subject, a healthy 40-years old man, was conducted to the local hospital (in Sicily, Italy) after the primary care he was discharged. Subsequently, after 2 days of general malaise, he returned to the hospital due to the worsening of the clinical condition. During the hospitalization, hypotension, and neurological impairment appeared; the laboratory analysis showed leukocytosis and the alteration of renal, hepatic and coagulative parameters. Microbiological blood analysis resulted positive for a P mirabilis infection.

Diagnosis:

Multiorgan failure (MOF) with disseminated intravascular coagulation (DIC) due to sepsis was diagnosed.

Interventions:

The practitioners administered intensive support, antibiotic therapy, antithrombin III, vitamin K, and plasma.

Outcomes:

After 3 days the subject died. The autopsy and the microscopic investigation were performed revealing, also, the adrenal diffuse micronodular hyperplasia associated with a cortico-medullary hemorrhagic apoplexy.

Conclusion:

To our knowledge, this is the first case of MOF with WFS due to P mirabilis infection. This case report suggests that P mirabilis should be added to the list of unusual bacteria causing WFS. Furthermore, it supports the theory that any bacterium which causes DIC may cause adrenal hemorrhage and should suggest to clinicians the importance to consider a potential adrenal involvement in every patient with sepsis and DIC.
Correlation between CCL2, CALCA, and CX3CL1 gene polymorphisms and chronic pain after cesarean section in Chinese Han women
Authors: Ma Guoping , Yang Jingli , Zhao Bange , Huang Chengquan , Wang Rui
Published: August 2019

Objective:

Postoperative chronic pain is characterized by high incidence, long duration, and complex pathogenesis. The purpose of this study was to investigate the correlation between the single nucleotide polymorphisms of the CCL2 gene rs4586 (g.5974T>C), CALCA rs3781719 (−692T>C), CX3CL1 rs614230 (2342C>T), and the risk of postoperative chronic pain in Chinese Han women.

Methods:

We analyzed the CCL2 gene rs4586, CALCA rs3781719, CX3CL1 rs614230 single nucleotide polymorphism (SNPs) of 350 Chinese Han women with chronic postsurgical pain (CPSP) 6 months after cesarean section and 350 healthy women without chronic pain (HC). The levels of CCL2, CALCA, and CX3CL1 in serum were detected by enzyme-linked immunosorbent assay (ELISA).

Results:

The CCL2 rs4586 T allele and the CX3CL1 gene rs614230C allele were protective factors for CPSP risk (adjusted OR = 0.766, 95% CI: 0.675–0.865 and OR = 0.336, 95% CI: 0.644–0.835). The CALCA gene rs3781719C allele was a risk factor for CPSP (adjusted OR = 1.273, 95% CI: 1.125–1.424). CCL2 rs4586, CX3CL1 gene rs614230, and CALCA gene rs3781719 locus gene polymorphisms were associated with serum CCL2, CX3CL1, and CALCA protein levels.

Conclusion:

Our results support that CCL2 gene rs4586, CALCA rs3781719, CX3CL1 rs614230 gene polymorphism are associated with the occurrence of chronic pain after cesarean section in Chinese Han women.
A novel compound heterozygous KCNJ1 gene mutation presenting as late-onset Bartter syndrome
Authors: Li Jingyi , Hu Shoulong , Nie Yi , Wang Rongfeng , Tan Ming , Li Hongmei , Zhu Shuanli
Published: August 2019

Rationale:

Bartter syndrome is an autosomal-recessive inherited disease in which patients present with hypokalemia and metabolic alkalosis. We present 1 case with Bartter syndrome, due to a novel compound heterozygous mutation in the KCNJ1 gene encoding the ATP-sensitive inward rectifier potassium channel in the thick ascending limb of the loop of Henle.

Patient concerns:

A patient was admitted to our hospital because of weakness, polyuria, and polydipsia. At presentation to our hospital, the female Chinese patient was 34 years old and her physical examination was normal. Laboratory studies revealed hypokalemia, metabolic alkalosis, hypercalciuria, hyperparathyroidemia, and hyper-reninemia. In addition, urinary potassium was obviously higher. Computer tomography scan confirmed the patient had the bilateral medullary nephrocalcinosis.

Diagnosis:

Blood samples were received from the patient and her parents, and deoxyribonucleic acid was extracted. The genetic analysis of SLC12A1, SLC12A3, KCNJ1, CLCNKB, BSND, and CASR was performed. The compound heterozygous KCNJ1 gene mutation was validated using conventional Sanger sequencing methods.

Interventions:

The patient was treated with potassium supplementation. Her blood and urine chemistries improved over the next week. Serum potassium normalized with improvement in polyuria and polydipsia over the next month.

Outcomes:

Our patient was compound heterozygous for Thr234Ile and Thr71Met in the KCNJ1 gene. The c.701C>T variant predicted a change from a threonine codon to an isoleucine codon (p.Thr234Ile). The c.212C>T variant predicted a change from a threonine codon to a methionine codon (p.Thr71Met). The unaffected mother was heterozygous for the Thr234Ile mutation, whereas unaffected father was heterozygous for the Thr71Met mutation.

Lessons:

The phenotypes of the patient were similar to other patients with Bartter syndrome. The phenotypes of the patient could eventually be explained by the presence of the novel compound heterozygous p.Thr234Ile/p.Thr71Met variants in the KCNJ1 gene.
Management of tumor rupture and abdominal compartment syndrome in an infant with bilateral high risk stage 4 neuroblastoma
Authors: Lode Holger N. , Henze Günter , Siebert Nikolai , Ehlert Karoline , Barthlen Winfried
Published: August 2019

Rationale:

Tumor rupture and bleeding at initial presentation of infants with neuroblastoma (NBL) is a rare, but life threatening condition and challenge in pediatric oncology. Here, we report successful multidisciplinary management of an abdominal compartment syndrome as a result of tumor rupture and bleeding in an infant with bilateral high risk stage 4 NBL.

Patient concerns:

The patient was admitted to a cooperating hospital with vomiting, failure to thrive and a large mass in the abdomen and was then referred to our center.

Diagnoses:

Stage 4 NBL with MYC-N amplification and 1p36 deletion was diagnosed in an 11 months old girl. Due to rapid and massive tumor growth she developed abdominal compression with renal failure, severe bleeding, and tumor lysis syndrome (TLS).

Interventions:

Surgical decompression by enterostomy, local, and systemic bleeding control with platelets and coagulation factors, antiinfective and TLS therapy were effective in stabilizing the patient's condition. This allowed initiation of the multimodal antineoplastic treatment according to protocol NB 2004.

Outcomes:

Mechanical ventilation was stopped after 11 days, the abdominal wall was closed 3 months after the start of therapy, and treatment according to the protocol be started and successfully completed.

Lessons:

Only the immediate, coordinated multidisciplinary intervention managed to overcome the life-threatening abdominal compartment syndrome and its associated problems, eventually enabling successful curative treatment.
CTPA, DECT, MRI, V/Q Scan, and SPECT/CT V/Q for the noninvasive diagnosis of chronic thromboembolic pulmonary hypertension
Authors: Xu Shuanglan , Yang Jiao , Zhu Yun , Xu Shuangyan , Liu Jie , Deng Yishu , Wei Li , Yang Mei , Huang Xiaoxian , Cao Bing , Zhang Chunfang , Zhao Fangyun , Liu Xing , Xing Xiqian , Li Zhongming
Published: August 2019

Background:

To determine the diagnostic accuracy of techniques with chronic thromboembolic pulmonary hypertension (CTEPH) patients via a protocol for systemic review and network meta-analysis.

Methods:

We will search PubMed, EMBASE, Web of Science, and Google Scholar from inception to October 1, 2018. The reference lists of the retrieved articles are also consulted. Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) will be used to assess the risk of bias in each study. The direct meta-analyses, network meta-analyses, and ranking of competing diagnostic tests will be used by STATA 12.0 and WINBUGS 1.4. Heterogeneity and inconsistency are assessed.

Results:

This study is ongoing, will be submitted to a peer-reviewed journal publication once completed.

Conclusion:

This study will provide a comprehensive evidence summary of diagnostic test accuracy in detecting the CTEPH, and can help patients and clinicians to select appropriate or best diagnostic test.

Ethics and Communication:

No ethical approval and patient consent are required, because it is based on published researches.

PROSPERO registration number:

CRD42019121279.
Glucocorticoid treatment of suspected organizing pneumonia after H7N9 infection
Authors: Liu Huijiao , Li Jianwei , Chen Miaolian , Su Jiahao
Published: August 2019

Rationale:

H7N9 infection causes acute respiratory distress syndrome with high mortality. The use of glucocorticoids in the acute phase lessened inflammatory responses. Some case reports suggested that secondary organizing pneumonia (SOP) could occur at the recovery stage of the influenza virus infection, and the treatment with glucocorticoid was effective. However, the reports of organizing pneumonia after H7N9 infection are lacking. This study reported a patient with H7N9 virus infection who presented a suspected SOP during the recovery stage.

Patient concern:

A 68-year-old woman who was diagnosed with H7N9 viral pneumonia. After standard antiviral treatment, venous-venous extracorporeal membranous oxygenation (VV-ECMO) and other supportive treatment, the antigen in the alveolar lavage fluid turned negative, and the shadow in the lung was partially absorbed. However, the imaging manifestations were deteriorated at 3 weeks after disease onset, presented as exudation and consolidation shadow distributed under the pleura and along the bronchial vascular bundles. The oxygenation could not be improved. Repeated sputum, alveolar lavage fluid, and blood pathogen examinations showed negative results. Broad-spectrum anti-infective treatment was ineffective. However, the autoantibodies (ANA, anti-SSA/Ro60, anti-SSA/Ro52) were detected.

Diagnosis:

SOP was considered.

Interventions:

Glucocorticoid treatment begun at week 4 from the disease onset. The regimen was methylprednisolone at an initial dose of 40 mg twice a day for 1 week, tapering within 70 days until total withdrawal.

Outcomes:

The oxygenation was rapidly improved after initiation of methylprednisolone. The shadow in the lung gradually resolved, and the patient was discharged after improvement of the disease condition. The clinical disease course, imaging findings, and treatment effects in the previous cases of SOP after influenza virus infection were similar to those in this case, suggesting the occurrence of SOP after H7N9 virus infection.

Lessons:

Organizing pneumonia might occur during the recovery stage of influenza virus infection. When the clinical symptoms do not improve and the shadow in the lung shows no obvious absorption after elimination of the H7N9 influenza virus, or the clinical symptoms are aggravated again after improvement, the probability of transforming into the organizing pneumonia should be taken into consideration.
Hyperandrogenism in a girl with Turner syndrome
Authors: Diao Yuchao , Zheng Qingmei , Chen Zhihong , Dai Shuzhen , Yao Qin
Published: August 2019

Rationale:

The gonads of patients with Turner syndrome (TS) were previously thought to be funicular. There was no increase in androgen level. The gonad that is testis should be taken into account when the patient's serum testosterone level was abnormal and hypothalamic-pituitary-adrenal disease was excepted.

Patient concerns:

A 16-year-old girl was admitted to our hospital because of chromosomal abnormalities and elevated androgen levels.

Diagnosis:

Turner syndrome could be diagnosed since her chromosome karyotype was 45, XO.

Interventions:

The patient was given bilateral gonadectomy and hormone replacement therapies.

Outcome:

The level of the patient's serum testosterone was <0.45 nmol/L 2 days after the operation. Postoperative pathology showed that her right gonad was testicular tissue. The patient's menstruation was normal after the treatment of hormone replacement therapy.

Lessons:

All TS patients should get Y chromosome material screening. Gonadectomy could be done for Turner syndrome patients who have hyperandrogenism or Y chromosome material.
Intermittent alien hand syndrome caused by Marchiafava–Bignami disease
Authors: Shao Jie , Bai Rongrong , Duan Guangyu , Guan Yujia , Cui Li , Deng Hui
Published: August 2019

Rationale:

Alien Hand syndrome (AHS) is characterized in most patients by seemingly purposeful, involuntary movements of the extremities. It is not well known among physicians on account of its diverse clinical manifestations.

Patient concerns:

We present a 57-year-old Chinese man who could not stop or turn himself around as he involuntarily and uncontrollably walked forward, which had happened frequently in the month prior to treatment. He had been a heavy drinker for thirty years before the onset of the disease, with an alcohol intake of 600 to 800 ml/day.

Diagnoses:

History of alcohol intake and the brain magnetic resonance imaging findings indicated a diagnosis of Marchiafava–Bignami disease. The patient was additionally diagnosed with Alien Hand Syndrome according to his clinical symptoms.

Interventions:

The patient was treated with high doses of vitamin B for 1 month.

Outcomes:

The patient's abnormal behaviors never appeared during the treatment, and no instance of recurrence was observed during the 6 months of follow-up.

Lessons:

The clinical manifestation of AHS is non-specific. Only by considering its diverse manifestation can doctors better understand the disease and achieve early intervention.
Lateral ventriculo-peritoneal shunt treating delayed cerebrospinal fluid leak after cervical laminoplasty
Authors: Gao Wenshan , Ren Bao , Wang Xiaodong , Zhou Xiaozhe , Han Ye , An Jilong
Published: August 2019

Rationale:

Delayed cerebrospinal fluid (CSF) leak is a rare and terrible complication after cervical surgery, potentially causing morbidity or even threatening life.

Patient concerns:

A 55-year-old Chinese male, with a history of hypertension for 8 years, complained of numbness and weakness of both upper limbs for 10 years. Strength of right upper limb triceps and wrist extensor muscle was slight weakness. Bilateral Hoffman sign was positive. Cervical magnetic resonance imaging (MRI) indicated multilevel cervical spondylotic myelopathy. We performed cervical laminoplasty for that patient on August 23, 2018. Nevertheless, he abruptly complained of dizziness and vision, but the wound condition was good. Cervical MRI showed delayed cerebrospinal fluid leak on October 15, 2018.

Diagnoses:

He was diagnosed with delayed CSF leak after cervical laminoplasty.

Interventions:

We performed lateral ventriculo-peritoneal shunt (LVPS) for that patient on October 17, 2018.

Outcomes:

At 3-month follow-up, the treatment has a good outcome and there is no recurrence of clinical symptoms.

Lessons:

Delayed CSF leak after cervical laminoplasty is rare. Once diagnosed, surgery is needed as soon as possible. LVPS has been proven an effective treatment for this server disease.