bluuebunny/crossref_metadata_2025 huggingface dataset:
Utility of Non-EPI DWI MRI in the Management of Pediatric Cholesteatoma
Authors: T.M Sreenivasa Murthy , Nagadi Anita , Mohan Sneha Krishna
Published: January 2019

Introduction Cholesteatoma in children can be acquired or congenital and is generally extensive. The most commonly used technique for the removal of cholesteatoma is intact canal wall mastoidectomy. This invariably leads to second-look surgery to assess for recurrence or residual cholesteatoma. Magnetic resonance imaging (MRI) with non–echo-planar imaging (non-EPI) diffusion-weighted imaging (DWI) is an accurate noninvasive imaging option that can be used in diagnosing primary cholesteatoma. This can also be used to diagnose residual or recurrent cholesteatoma in patients who have undergone intact canal wall mastoidectomy.

Case Report A 7-year-old male patient presented with a 1-week history of foul-smelling discharge from the right ear. On examination, a polypoidal mass with keratinized debris was seen. A diagnosis of cholesteatoma of right ear was made. Imaging with high-resolution computed tomography (HRCT) of the temporal bone and non-EPI DWI MRI confirmed the same. The child underwent an intact canal wall mastoidectomy and was followed up at 2 years with non-EPI DWI MRI to monitor any residual or recurrent cholesteatoma.

Conclusion Non-EPI DWI MRI provides a convenient, accurate, and noninvasive method of evaluating and monitoring for residual or recurrent cholesteatoma and thus helps avoid unnecessary second-look surgery.
Controllable excitation of quasi-linear and bullet modes in a spin-Hall nano-oscillator
Authors: Divinskiy B. , Demidov V. E. , Urazhdin S. , Freeman R. , Rinkevich A. B. , Demokritov S. O.
Published: January 2019

We experimentally demonstrate that both quasi-linear and nonlinear self-localized bullet modes of magnetization auto-oscillation can be excited by dc current in a nano-gap spin Hall nano-oscillator, by utilizing the geometry with an extended gap. The quasi-linear mode is stable at low driving currents, while the bullet mode is additionally excited at larger currents and becomes increasingly dominant with increasing current. Time-resolved measurements show that the formation of the bullet mode is delayed relative to the quasi-linear mode by up to 100 nanoseconds, demonstrating that the mechanisms of formation of these modes are fundamentally different. We discuss the relationship between the observed behaviors and the formation of an unstable nonlinear magnon condensate.
O-band InAs/GaAs quantum-dot microcavity laser on Si (001) hollow substrate by
in-situ
hybrid epitaxy
Authors: Zhang Bin , Wei Wen-Qi , Wang Jian-Huan , Wang Hai-Ling , Zhao Zhuang , Liu Lei , Cong Hui , Feng Qi , Liu Huiyun , Wang Ting , Zhang Jian-Jun
Published: January 2019

Recent years, the emergence of hyper-scale data centers boosted the research field of integrated silicon photonics. One of the major challenges for compact photonic integrated circuits is silicon based lasers. In this paper, we demonstrate optically pumped InAs/GaAs quantum-dot micropillar laser on exact Si (001) by (111)-faceted-sawtooth Si hollow structure via IV/III-V hybrid epitaxy. The lasing threshold of InAs/GaAs quantum-dot micropillar is as low as 20 μW with the pillar diameter of 15 μm. Moreover, the micropillar laser is capable of operating at maximum temperature up to 100 °C.
Coulomb interactions in high-coherence femtosecond electron pulses from tip emitters
Authors: Bach Nora , Domröse Till , Feist Armin , Rittmann Thomas , Strauch Stefanie , Ropers Claus , Schäfer Sascha
Published: January 2019

Tip-based photoemission electron sources offer unique properties for ultrafast imaging, diffraction, and spectroscopy experiments with highly coherent few-electron pulses. Extending this approach to increased bunch-charges requires a comprehensive experimental study on Coulomb interactions in nanoscale electron pulses and their impact on beam quality. For a laser-driven Schottky field emitter, we assess the transverse and longitudinal electron pulse properties in an ultrafast transmission electron microscope at a high photoemission current density. A quantitative characterization of electron beam emittance, pulse duration, spectral bandwidth, and chirp is performed. Due to the cathode geometry, Coulomb interactions in the pulse predominantly occur in the direct vicinity to the tip apex, resulting in a well-defined pulse chirp and limited emittance growth. Strategies for optimizing electron source parameters are identified, enabling advanced ultrafast transmission electron microscopy approaches, such as phase-resolved imaging and holography.
A low-disorder metal-oxide-silicon double quantum dot
Authors: Kim J.-S. , Hazard T. M. , Houck A. A. , Lyon S. A.
Published: January 2019

One of the biggest challenges impeding the progress of metal-oxide-silicon (MOS) quantum dot devices is the presence of disorder at the Si/SiO2 interface which interferes with controllably confining single and few electrons. In this work, we have engineered a low-disorder MOS quantum double-dot device with critical electron densities, i.e., the lowest electron density required to support a conducting pathway, approaching critical electron densities reported in high quality Si/SiGe devices and commensurate with the lowest critical densities reported in any MOS device. Utilizing a nearby charge sensor, we show that the device can be tuned to the single-electron regime where charging energies of ≈8 meV are measured in both dots, consistent with the lithographic size of the dot. Probing a wide voltage range with our quantum dots and charge sensor, we detect three distinct electron traps, corresponding to a defect density consistent with the ensemble measured critical density. Low frequency charge noise measurements at 300 mK indicate a 1/f noise spectrum of 3.4 μeV/Hz1∕2 at 1 Hz and magnetospectroscopy measurements yield a valley splitting of 110 ± 26 μeV. This work demonstrates that reproducible MOS spin qubits are feasible and represent a platform for scaling to larger qubit systems in MOS.
Allied health professionals in Queensland Health returning to work after maternity leave: hours of work and duration of time on part-time hours
Authors: Hulcombe Julie , Capra Sandra , Whitehouse Gillian
Published: January 2019

Objective
The aim of this study was to provide a detailed description of the flexible working arrangements (FWA) used by allied health professionals (AHP) on return from maternity leave. This is a crucial issue for staff management practices in a changing regulatory context.

Methods
A retrospective convenience sample of AHP employed by Queensland Health (QH) in 2006, using deidentified payroll data, was analysed descriptively to determine employment status on return from maternity leave in 2006 to December 2014. A qualitative study that surveyed managers of AHP departments was subsequently undertaken to complement the data from the payroll study. Twelve managers, across six allied health professions in three hospitals in south-east Queensland were surveyed for this component.

Results
The payroll study included 169 employees (138 full-time equivalent (FTE)), 61 of whom resigned over the study period. Of those who returned to work after the 2006 maternity event (n=152), 92% (n=140) initially returned part-time. At 31 December 2014, of the 108 staff working for QH, 77% (n=83) were part-time. In total, 75.4 FTE positions were released over the 8-year period through reduced working hours and resignations. The perceptions of surveyed managers were consistent with the data from the payroll study.

Conclusion
The study showed that most AHPs who took maternity leave returned to work part-time and remained part-time for an extended period. The data suggest that managers could permanently backfill a proportion of hours released due to FWA after maternity leave without major budgetary risk due to the need to accommodate existing employees’ entitlements. However, this would require a significant policy change.

What is known about this topic?
Current research on this topic has concentrated on the benefits of paid maternity leave, timing of return to work and use of FWA by employees on return to work after maternity leave.

What does this paper add?
This paper presents the first comprehensive data on patterns of return to work and part-time hours following maternity leave for AHP employees. Access to a unique payroll dataset provided the opportunity to describe this for a cohort of AHP employees over a period of 8 years following a maternity event. A survey of AHP managers’ experience with maternity leave and return to work arrangements supported the findings, underlining the associated difficulties with staff management.

What are the implications for practitioners?
The hours released through resignations or reduced hours over this period of study suggest that management could backfill a proportion of released hours permanently, or at least offer temporary staff longer-term contracts, once an employee returns from maternity leave on reduced hours
Distribution of epipelic algae and related environmental nutrients in Taihu Lake, revealed by HPLC analysis
Authors: Song Yuzhi , Xue Yan , Gao Yongxia , Jin Yan
Published: January 2019

Epipelic algal biomass and composition (determined by HPLC pigment analysis) and related environmental nutrients were investigated in a phytoplankton-dominated area (Meiliang Bay), a macrophyte-dominated area (East Taihu Lake) and a transition zones (Gonghu Bay) in a shallow eutrophic freshwater lake (Taihu Lake, eastern China). Surface sediment samples were collected at 11 sampling sites in April and August 2016. Average epipelic algal biomass for Meiliang Bay, Gonghu Bay and East Taihu Lake was 6.5, 4.9 and 4.6μg chlorophyll (Chl)-ag–1 sediment respectively in April, and 3.8, 7.4 and 2.7μg Chl-ag–1 sediment respectively in August. The maximum biomass of epipelic algae appeared at the G1 sampling site (9.6μg Chl-ag–1 sediment) in August, whereas the minimum biomass of epipelic algae appeared at the E4 sampling site (1.7μg Chl-ag–1 sediment). Pigment (fucoxanthin, zeaxanthin and Chl-b) to Chl-a ratios indicated that epipelic algae were primarily diatoms, secondarily cyanobacteria and lastly green algae in Taihu Lake. Epipelic algae were significantly correlated with total nitrogen in the water and total phosphorus in the sediment (P<0.05), except for green algae. In general, using pigment as an indicator revealed that the epiphytic algal community varied over time and space. The distribution of variations in epipelic algae was related to the heterogeneity of environmental factors.
1H Quantitative NMR analyses of β-asarone and related compounds for quality control of Acorus rhizome herbal drugs in terms of the effects of their constituents on in vitro acetylcholine esterase activity
Authors: Lynn Nwe Haymar , Linn Thein Zaw , Yanmei Cui , Shimozu Yuuki , Taniguchi Shoko , Hatano Tsutomu
Published: January 2019

We used quantitative nuclear magnetic resonance analyses to measure the contents of major constituents of Acorus rhizome materials used as herbal drugs. The inhibitory effects of crude n-hexane extracts and their individual constituents on in vitro acetylcholine esterase activity were evaluated. The crude extracts had unexpectedly weak inhibitory effects (46–64% inhibition at 1.0 mg/mL), despite the high content (46–64%) of β-asarone, which independently had a potent effect (IC50 2.9 µM [0.61 µg/mL]). Further investigation revealed participation of eudesmin A, a lignan constituent, in the suppression of the inhibitory effect of β-asarone.
An experimental strategy unveiling exosomal microRNAs 486‐5p, 181a‐5p and 30d‐5p from hypoxic tumour cells as circulating indicators of high‐risk rectal cancer
Authors: Bjørnetrø Tonje , Redalen Kathrine Røe , Meltzer Sebastian , Thusyanthan Nirujah Sivarajah , Samiappan Rampradeep , Jegerschöld Caroline , Handeland Karianne Risberg , Ree Anne Hansen
Published: January 2019

Tumour hypoxia contributes to poor treatment outcome in locally advanced rectal cancer (LARC) and circulating extracellular vesicles (EVs) as potential biomarkers of tumour hypoxia and adverse prognosis have not been fully explored. We examined EV miRNAs from hypoxic colorectal cancer cell lines as template for relevant miRNAs in LARC patients participating in a prospective biomarker study (NCT01816607). Five cell lines were cultured under normoxia (21% O2) or hypoxia (0.2% O2) for 24 h, and exosomes were isolated by differential ultracentrifugation. Using a commercial kit, exosomes were precipitated from 24 patient plasma samples collected at the time of diagnosis. Exosome size distribution and protein cargo were determined by cryo‐electron microscopy, nanoparticle tracking analysis, immunoblotting and flow cytometry. The vesicles harboured strong cell line‐specific miRNA profiles with 35 unique miRNAs differentially expressed between hypoxic and normoxic cells. Six of these miRNAs were considered candidate‐circulating markers of tumour hypoxia in the patients based on the frequency or magnitude of variance in hypoxic versus normoxic cell line experiments and prevalence in patient plasma. Of these, low plasma levels of exosomal miR‐486‐5p and miR‐181a‐5p were associated with organ‐invasive primary tumour (p = 0.029) and lymph node metastases (p = 0.024), respectively, both attributes of adverse LARC prognosis. In line with this, the plasma level of exosomal miR‐30d‐5p was elevated in patients who experienced metastatic progression (p = 0.036). Our strategy confirmed that EVs from colorectal cancer cell lines were exosomes containing the oxygen‐sensitive miRNAs 486‐5p, 181a‐5p and 30d‐5p, which were retrieved as circulating markers of high‐risk LARC.
The transport and surface reactivity of O atoms during the atmospheric plasma etching of hydrogenated amorphous carbon films
Authors: Mokhtar Hefny Mohamed , Nečas David , Zajíčková Lenka , Benedikt Jan
Published: January 2019

A remote microscale atmospheric pressure plasma jet with a He/O2 gas mixture is used to etch a hydrogenated amorphous carbon layer. The etched profiles are measured by means of imaging spectroscopic reflectometry, a powerful technique providing a 2D map of the film thickness (etched profile) and also film properties. Additionally, the 2D axially symmetric fluid model of the gas flow and species transport combined with the basic kinetic model of the reaction of O atoms with O2 molecules has been solved to study the transport and surface reactivity of O atoms. The model provides a spatially resolved and surface-integrated O atom loss rate at the surface. The situation with convection-dominated species transport and fast recombination reactions of O atoms in the volume leads to a strong dependence of the etched profile on the O2 admixture and O atom surface loss probability β. By comparing etched profiles with the simulation results, the O atom surface reaction probability of β = 0.2%–0.6% could be estimated. The modeled O atom loss rate at the surface was always higher and with the same trend as the etching rate, corroborating that O atoms are the main etching species. The presented data and simulation results show that the fastest surface-integrated etching rate is achieved not under conditions with the highest O density on the jet axis, but at lower O2 admixtures due to reduced recombination losses in the gas phase.
Safety and Efficacy of C-reactive Protein–guided Antibiotic Use to Treat Acute Respiratory Infections in Tanzanian Children: A Planned Subgroup Analysis of a Randomized Controlled Noninferiority Trial Evaluating a Novel Electronic Clinical Decision Algorithm (ePOCT)
Authors: Keitel Kristina , Samaka Josephine , Masimba John , Temba Hosiana , Said Zamzam , Kagoro Frank , Mlaganile Tarsis , Sangu Willy , Genton Blaise , D’Acremont Valerie
Published: January 2019

Background

The safety and efficacy of using C-reactive protein (CRP) to decide on antibiotic prescription among febrile children at risk of pneumonia has not been tested.

Methods

This was a randomized (1:1) controlled noninferiority trial in 9 primary care centers in Tanzania (substudy of the ePOCT trial evaluating a novel electronic decision algorithm). Children aged 2–59 months with fever and cough and without life-threatening conditions received an antibiotic based on a CRP-informed strategy (combination of CRP ≥80 mg/L plus age/temperature-corrected tachypnea and/or chest indrawing) or current World Health Organization standard (respiratory rate ≥50 breaths/minute). The primary outcome was clinical failure by day (D) 7; the secondary outcomes were antibiotic prescription at D0, secondary hospitalization, or death by D30.

Results

A total of 1726 children were included (intervention: 868, control: 858; 0.7% lost to follow-up). The proportion of clinical failure by D7 was 2.9% (25/865) in the intervention arm vs 4.8% (41/854) in the control arm (risk difference, –1.9% [95% confidence interval {CI}, –3.7% to –.1%]; risk ratio [RR], 0.60 [95% CI, .37–.98]). Twenty of 865 (2.3%) children in the intervention arm vs 345 of 854 (40.4%) in the control arm received antibiotics at D0 (RR, 0.06 [95% CI, .04–.09]). There were fewer secondary hospitalizations and deaths in the CRP arm: 0.5% (4/865) vs 1.5% (13/854) (RR, 0.30 [95% CI, .10–.93]).

Conclusions

CRP testing using a cutoff of ≥80 mg/L, integrated into an electronic decision algorithm, was able to improve clinical outcome in children with respiratory infections while substantially reducing antibiotic prescription.

Clinical Trials Registration

NCT02225769.
Effect of Early Oseltamivir Treatment on Mortality in Critically Ill Patients With Different Types of Influenza: A Multiseason Cohort Study
Authors: Lytras Theodore , Mouratidou Elisavet , Andreopoulou Anastasia , Bonovas Stefanos , Tsiodras Sotirios
Published: January 2019

Background

The available evidence on whether neuraminidase inhibitors reduce mortality in patients with influenza is inconclusive and focuses solely on influenza A/H1N1pdm09. We assessed whether early oseltamivir treatment (≤48 hours from symptom onset) decreases mortality compared to late treatment in a large cohort of critically ill patients with influenza of all types.

Methods

The study included all adults with laboratory-confirmed influenza hospitalized in intensive care units (ICUs) in Greece over 8 seasons (2010–2011 to 2017–2018) and treated with oseltamivir. The association of early oseltamivir with mortality was assessed with log-binomial models and a competing risks analysis estimating cause-specific and subdistribution hazards for death and discharge. Effect estimates were stratified by influenza type and adjusted for multiple covariates.

Results

A total of 1330 patients were studied, of whom 622 (46.8%) died in the ICU. Among patients with influenza A/H3N2, early treatment was associated with significantly lower mortality (relative risk, 0.69 [95% credible interval {CrI}, .49–.94]; subdistribution hazard ratio, 0.58 [95% CrI, .37–.88]). This effect was purely due to an increased cause-specific hazard for discharge, whereas the cause-specific hazard for death was not increased. Among survivors, the median length of ICU stay was shorter with early treatment by 1.8 days (95% CrI, .5–3.5 days). No effect on mortality was observed for A/H1N1 and influenza B patients.

Conclusions

Severely ill patients with suspected influenza should be promptly treated with oseltamivir, particularly when A/H3N2 is circulating. The efficacy of oseltamivir should not be assumed to be equal against all types of influenza.
Competent demand pull and technological flows within sectoral systems: the evidence on differences within Europe
Authors: Antonelli Cristiano , Gehringer Agnieszka
Published: January 2019

The paper implements the competent demand-pull hypothesis that grafts the advances of the economics of knowledge on the Kaldor–Schmookler demand-pull approach. Demand-pulling effects occur only if the increase of derived demand for both capital and intermediary inputs is accompanied by knowledge interactions carried by market transactions. The competent demand-pull hypothesis rejuvenates the standard demand-pull approach through the focus on the sectoral architecture of market-embedded inter-sectoral knowledge linkages between competent users and innovative producers. We measure such market-embedded and competent influence with the derived demand for intermediates—taken from input–output tables—accounting for productivity increases downstream. The empirical evidence from dynamic panel estimations for the European Union (EU) over the period 1995–2007 suggests the presence of strong and positive competent demand impulses, but the effects vary between three EU sectoral systems, the EU core, the East and the South.
A Kaldor–Schumpeter model of cumulative growth
Authors: Romero João P
Published: January 2019

Taking into account the relevance of the Kaldorian and the Schumpeterian contributions to macroeconomic growth theory, this paper proposes a growth model that combines the insights of these two traditions while solving some of the most important limitations of the original Kaldor–Dixon–Thirlwall model. This model takes into account the main factors emphasised by the Kaldorian and the Schumpeterian literatures, while keeping the importance of both demand- and supply-side factors for economic growth. The model shows that higher research intensity can generate higher equilibrium growth, stressing the possibility that an increase in the growth rate of foreign output can exert a negative impact on the domestic economy, provided that the negative effect of higher foreign non-price competitiveness is larger than the positive demand effect. The proposed Kaldor–Schumpeter growth model was also transposed to a multi-sectoral setting that indicates that changes in the performance of a given sector affect the performance of the other sectors through inter-sector demand externalities by easing the balance-of-payment constraint.
Coronary vascular function in patients with resistant hypertension and normal myocardial perfusion: a propensity score analysis
Authors: Gaudieri Valeria , Acampa Wanda , Rozza Francesco , Nappi Carmela , Zampella Emilia , Assante Roberta , Mannarino Teresa , Mainolfi Ciro , Petretta Mario , Verberne Hein J , Arumugam Parthiban , Cuocolo Alberto
Published: January 2019

Aims

Impaired myocardial perfusion reserve (MPR) may occur earlier than coronary atherosclerosis and it may be an early manifestation of developing coronary artery disease (CAD) in patients with resistant hypertension (RH). We evaluated the relationship between RH and MPR in patients with systemic arterial hypertension after balancing for coronary risk factors.

Methods and results

We studied 360 subjects without overt CAD and normal myocardial perfusion at stress-rest 82Rb positron emission tomography/computed tomography. To account for differences in baseline characteristics between patients with resistant and controlled hypertension, we created a propensity score-matched cohort considering clinical variables and coronary risk factors. Before matching, patients with RH were significantly older, had higher prevalence of male gender and hypercholesterolaemia, and showed significantly lower global hyperaemic myocardial blood flow (MBF) and MPR compared with those with controlled hypertension, while baseline MBF and coronary artery calcium (CAC) content were similar in both groups. After matching, there were no significant differences in clinical variables and coronary risk factors between patients with resistant and controlled hypertension, but patients with RH still had lower hyperaemic MBF and MPR (both P < 0.001). At univariable and multivariable linear regression analyses, age, RH, and CAC resulted significant predictors of lower MPR values (all P < 0.05).

Conclusion

After balancing clinical characteristic by propensity score analysis, patients with RH had a blunted hyperaemic MBF and MPR compared with patients with controlled hypertension. The identification of impaired MPR could help to identify early structural alterations of the arterial walls in patients with RH.
Taxation Measures under the Energy Charter Treaty after the Yukos Awards Articles 21(1) and 21(5) Revisited
Authors: Green Martínez Sebastián
Published: January 2019

As the number of investment arbitrations under the Energy Charter Treaty has soared in recent years, parties and arbitrators have faced arguments concerning its Article 21 on taxation measures, which had seldom been applied before.

In 2014, the tribunal ruling on the Yukos trilogy held that even though Article 21 excludes taxation from the scope of the treaty, the carve-out could apply “only to bona fide taxation actions, i.e., actions that are motivated by the purpose of raising general revenue for the State”. Article 21 also provides that in cases regarding expropriation “[t]he Investor or the Contracting Party alleging expropriation shall refer the issue of whether the tax is an expropriation or whether the tax is discriminatory to the relevant Competent Tax Authority. Failing such referral by the Investor” in cases of investor-state arbitration, the tribunal “shall make a referral to the relevant Competent Tax Authorities”. The Yukos tribunal considered said referral to be a futile exercise when it is unequivocal that the host State acted in bad faith towards the foreign investor. As a consequence of the Yukos trilogy, the Energy Charter Secretariat has published a report on the issue that recommends potential amendments to clarify Article 21. A number of investor-state arbitral tribunals have also addressed these issues since the Yukos trilogy.

Taking a public international law approach, this article critically explores awards and decisions rendered by those tribunals, paying particular attention to their findings on Article 21 vis-à-vis the sovereign power to tax. This article concludes that recent awards dealing with Article 21 arguments have struck an appropriate balance between the prerogatives of States and their obligations under the Energy Charter Treaty. Thus, the article affirms that no amendment seems necessary.
Post-partum acute kidney injury: sorting placental and non-placental thrombotic microangiopathies using the trajectory of biomarkers
Authors: Meibody Fleuria , Jamme Matthieu , Tsatsaris Vassilis , Provot François , Lambert Jérôme , Frémeaux-Bacchi Véronique , Ducloy-Bouthors Anne-Sophie , Jourdain Mercédès , Delmas Yahsou , Perez Pierre , Darmian Julien , Wynckel Alain , Rebibou Jean-Michel , Coppo Paul , Rafat Cédric , Rondeau Eric , Frimat Luc , Hertig Alexandre
Published: January 2019

Background

Among the severe complications of preeclampsia (PE), acute kidney injury (AKI) is problematic if features of thrombotic microangiopathy (TMA) are present. Although a haemolysis enzyme liver low-platelets syndrome is considerably more frequent, it is vital to rule out a flare of atypical haemolytic and uraemic syndrome (aHUS). Our objective was to improve differential diagnosis procedures in post-partum AKI.

Methods

A total of 105 cases of post-partum AKI, admitted to nine different regional French intensive care units from 2011 to 2015, were analysed. Analysis included initial and final diagnosis, renal features, haemostasis and TMA parameters, with particular focus on the dynamics of each component within the first days following delivery. A classification and regression tree (CART) was used to construct a diagnostic algorithm.

Results

AKI was attributed to severe PE (n = 40), post-partum haemorrhage (n = 33, including 13 renal cortical necrosis) and ‘primary’ TMA (n = 14, including 10 aHUS and 4 thrombotic thrombocytopenic purpura). Congruence between initial and final diagnosis was low (63%). The dynamics of haemoglobin, haptoglobin and liver enzymes were poorly discriminant. In contrast, the dynamic pattern of platelets was statistically different between primary TMA-related AKI and other groups. CART analysis independently highlighted the usefulness of platelet trajectory in the diagnostic algorithm. Limitations of this study include that only the most severe cases were included in this retrospective study, and the circumstantial complexity is high.

Conclusion

Trajectory of platelet count between admission and Day 3 helps to guide therapeutic decisions in cases of TMA-associated post-partum AKI. Our study also strongly suggests that during the post-partum period, there may be a risk of transient, slowly recovering TMA in cases of severe endothelial injury in women without a genetic mutation known to induce aHUS.
Reoperation for Proximal Adjacent Segment Pathology in Posterior Cervical Fusion Constructs that Fuse to C2 vs C3
Authors: Xia Yuanxuan , Xu Risheng , Kosztowski Thomas A , Ramhmdani Seba , Ahmed A Karim , Lo Sheng-Fu L , Bydon Ali
Published: January 2019

BACKGROUND

Few studies have described rates of proximal clinical adjacent segment pathology (CASP) after posterior cervical decompression and fusion (PCDF).

OBJECTIVE

To investigate rates of proximal CASP at C2 vs C3 in PCDFs for degenerative spine disease.

METHODS

A retrospective review of 380 cases of PCDF for degenerative disease with proximal constructs ending at C2 vs C3 was performed. Minimum follow-up was 12 mo. The primary outcome was proximal CASP requiring reoperation. Variable analysis included demographic, operative, and complication data.

RESULTS

There were 119 patients in the C2 group and 261 in the C3 group with no significant differences in age, gender, comorbidities, presenting symptoms, or complications. Vertebral artery injury rates were 0.8% in the C2 group and 0.0% in the C3 group (P = .12). No patients in the C2 group had reoperation for proximal CASP, while 5.0% of patients in the C3 group did (P = .01). Patients with arthrodesis up to C3 had an increased risk of proximal failure when the fusion construct crossed the cervicothoracic junction (P = .03). Multivariate logistic regression analysis showed no factors that were independently associated with re-instrumentation for proximal CASP.

CONCLUSION

Instrumenting to the C2 level reduces the risk for proximal CASP compared to fusion only up to C3. The type of instrumentation used at these 2 levels, form of ASP disease at C1-C2, and natural motion of the relevant proximal adjacent joint may contribute to this difference. Furthermore, within the C3 cohort, fusion across the cervicothoracic junction increased the risk for proximal CASP.
Long-Term Effect of Decompressive Craniectomy on Intracranial Pressure and Possible Implications for Intracranial Fluid Movements
Authors: Lilja-Cyron Alexander , Andresen Morten , Kelsen Jesper , Andreasen Trine Hjorslev , Fugleholm Kåre , Juhler Marianne
Published: January 2019

BACKGROUND

Decompressive craniectomy (DC) is used in cases of severe intracranial hypertension or impending intracranial herniation. DC effectively lowers intracranial pressure (ICP) but carries a risk of severe complications related to abnormal ICP and/or cerebrospinal fluid (CSF) circulation, eg, hygroma formation, hydrocephalus, and “syndrome of the trephined.”

OBJECTIVE

To study the long-term effect of DC on ICP, postural ICP regulation, and intracranial pulse wave amplitude (PWA).

METHODS

Prospective observational study including patients undergoing DC during a 12-mo period. Telemetric ICP sensors (Neurovent-P-tel; Raumedic, Helmbrechts, Germany) were implanted in all patients. Following discharge from the neuro intensive care unit (NICU), scheduled weekly ICP monitoring sessions were performed during the rehabilitation phase.

RESULTS

A total of 16 patients (traumatic brain injury: 7, stroke: 9) were included (median age: 55 yr, range: 19-71 yr). Median time from NICU discharge to cranioplasty was 48 d (range: 16-98 d) and during this period, mean ICP gradually decreased from 7.8 ± 2.0 mm Hg to –1.8 ± 3.3 mm Hg (P = .02). The most pronounced decrease occurred during the first month. Normal postural ICP change was abolished after DC for the entire follow-up period, ie, there was no difference between ICP in supine and sitting position (P = .67). PWA was markedly reduced and decreased from initially 1.2 ± 0.7 mm Hg to 0.4 ± 0.3 mm Hg (P = .05).

CONCLUSION

Following NICU discharge, ICP decreases to negative values within 4 wk, normal postural ICP regulation is lost and intracranial PWA is diminished significantly. These abnormalities might have implications for intracranial fluid movements (eg, CSF and/or glymphatic flow) following DC and warrants further investigations.
Pas de deux of electricity and magnetism: an interview with Sang-Wook Cheong
Authors: Zhao Weijie
Published: January 2019

Materials can be ferroelectric, having a spontaneous electric polarization that can be reversed by an external electric field, or they can be ferromagnetic, exhibiting spontaneous magnetization that is switchable by an applied magnetic field. However, until the 1960s, scientists did not expect that these two ferroic properties could co-exist in a single material. Today, materials exhibiting more than one of the primary ferroic properties are called multiferroics. Here, the primary ferroic properties can be ferroelectricity, ferromagnetism, antiferromagnetism, ferroelasticity, ferrotoroidicity or others. Basically, the multiferroic effect originates from the simultaneous breaking of space inversion and time-reversal symmetries. Multiferroics can be imagined as a pas de deux of electricity and magnetism. Recently, National Science Review interviewed Professor Sang-Wook Cheong from Rutgers University, who is one of the pioneering scientists in this field. Cheong talked about the multiferroics field, which has been fast developing since the early 2000s. His introductions and opinions on diverse multiferroic materials and potential multiferroic devices, as well as future research directions, may provide a useful resource for researchers both inside and outside the multiferroic research field.
Influence of bulk motion of an infalling plasma in line-forming region on cyclotron line in accreting X-ray pulsars
Authors: Nishimura Osamu
Published: January 2019

We examine the effect of the bulk motion of an infalling plasma on the properties (energy, width and depth) of a cyclotron line, including the effect of gravitational light bending as well as variation of the magnetic field. The cyclotron line energy decreases with increasing bulk velocity. Moreover, the dependence of the line energy on viewing angle becomes stronger as bulk velocity increases. As a result, the amount of a variation of the line energy with angle increases with increasing bulk velocity. On considering the two-dimensional structure of an accretion column, the bulk velocity in the line-forming region that is expected to be located around the walls of an accretion column can be considerably different from that in the continuum-formation region because of the decrease in the radiation energy density near the walls of the accretion column. In addition, the bulk velocity in the line-forming region can considerably depend on the beam pattern generated in the continuum-forming region because the bulk velocity is decelerated by photons propagating not across the magnetic field but along it. In the present paper, we demonstrate that the observed amount of a variation of the line energy with pulse phase can be explained by a variation of the bulk velocity with beam pattern, i.e., luminosity, using a cylindrical geometry with an accretion mound where a continuum spectrum is formed.
Methotrexate persistence and adverse drug reactions in patients with juvenile idiopathic arthritis
Authors: Kearsley-Fleet Lianne , Vicente González Laura , Steinke Douglas , Davies Rebecca , De Cock Diederik , Baildam Eileen , Beresford Michael W , Foster Helen E , Southwood Taunton R , Thomson Wendy , Hyrich Kimme L ,   Biologics for Children with Rheumatic Diseases (BCRD) Study and the British Society for Paediatric and Adolescent Rheumatology Etanercept Cohort Study (BSPAR-ETN)
Published: January 2019

Objectives

This analysis aims to calculate MTX monotherapy persistence and describe the occurrence of and factors associated with the occurrence of adverse drug reactions (ADRs) with MTX.

Methods

Patients with JIA starting MTX monotherapy from two UK studies were included. Patient characteristics, treatment details and ADR occurrence were collected at treatment start, 6 months, 1 year and annually. The following groups of ADRs were included: gastrointestinal, elevated liver enzymes, leukopenia, drug hypersensitivity, rash, needle phobia and any events leading to permanent MTX discontinuation. Treatment exposure was calculated from MTX start until MTX monotherapy cessation, last follow-up or 31 December 2017 (cut-off), whichever came first. Survival analysis assessed the time on MTX monotherapy and the time to the first ADR on MTX monotherapy within 2 years. Multivariable logistic regression assessed characteristics associated with any ADR and gastrointestinal ADRs.

Results

A total of 577 patients started MTX. At 2 years, 310 (54%) were no longer on MTX monotherapy. Reasons included ineffectiveness (60%; 161/185 started a biologic), adverse event (25%), remission (8%) and patient/family decision (3%). Over this time, 212 (37%) patients experienced one or more ADR; commonly gastrointestinal (68%) or elevated liver enzymes (26%). Lower physician global assessment and older age predicted any ADR and gastrointestinal ADR, respectively. Patients with polyarticular RF and JIA had reduced odds of both any ADR and a gastrointestinal ADR.

Conclusion

After 2 years, more than half the patients were no longer on MTX monotherapy, while more than one-third experienced one or more ADR, most commonly gastrointestinal. Research focusing on identifying which children will respond and/or experience ADRs is crucial to inform treatment decisions and management planning.
Financial Loss Aversion Illusion*
Authors: Merkle Christoph
Published: January 2019

We test the proposition that investors’ ability to cope with financial losses is much better than they expect. In a panel survey of investors from a large bank in the UK, we ask for their subjective ratings of anticipated returns and experienced returns. The time period covered by the panel (2008–10) is one where investors experienced frequent losses and gains in their portfolios. This period offers a unique setting to evaluate investors’ hedonic experiences. We examine how the subjective ratings behave relative to expected portfolio returns and experienced portfolio returns. Loss aversion is strong for anticipated outcomes; investors are twice as sensitive to negative expected returns as to positive expected returns. However, when evaluating experienced returns, the effect diminishes by more than half and is well below commonly found loss aversion coefficients. This suggests that a large part of investors’ financial loss aversion results from an affective forecasting error.
What surgical oncology providers and women with sporadic breast cancer should not forget in the decision-making about contralateral prophylactic mastectomy
Authors: Franceschini Gianluca , Di Leone Alba , Masetti Riccardo
Published: January 2019

Women with sporadic breast cancer should consider unilateral surgery as first choice for local treatment. Contralateral prophylactic mastectomy should be offered to patients with BRCA mutation.
Single Nucleotide Polymorphism Analysis Using KASP Assay Reveals Genetic Variability in Rotylenchulus reniformis
Authors: Khanal Churamani , Kularathna Manjula T. , Ray Jeffery D. , Stetina Salliana R. , McGawley Edward C. , Overstreet Charles
Published: January 2019

This study employed single nucleotide polymorphisms (SNPs) to determine the genetic variability present in 26 isolates of Rotylenchulus reniformis from Louisiana, Mississippi, Arkansas, South Carolina, Georgia, Hawaii, and Alabama. Genomic DNA from reniform nematode was extracted and increased quantitatively using the process of whole genome amplification. More than 162 putative SNPs were identified, 31 of which were tested using a KASP kompetitive allele-specific PCR genotyping assay. Of the SNPs tested, 13, 17, and 19 SNPs revealed genetic variability within reniform nematode isolates from Louisiana, Mississippi, and Arkansas, respectively. Seven SNPs elucidated genetic differences among isolates of reniform nematode from Louisiana, Mississippi, and Arkansas. Eight SNPs determined genetic variability among individual isolates from South Carolina, Georgia, Hawaii, and Alabama. This study is the first to report genetic variability in geographic isolates of reniform nematode employing a SNP assay. This study also demonstrated that SNP markers can be used to evaluate isolates of R. reniformis and could be useful to assess their genetic diversity, origin, and distribution. Such information would be extremely useful in resistance breeding programs.
Use of GLP-1 receptor agonists in patients with T2DM and chronic kidney disease
Authors: Aldrich Sarah , Ashjian Emily
Published: January 2019

Diabetes mellitus is the leading cause of chronic kidney disease (CKD) in the US. An increasing number of glucagon-like peptide-1 receptor agonists are available for diabetes management. Differences between medications in this class, as well as limited data on patients with CKD, underscore the importance of a patient-centered approach to care.
Pediatric Emergency Room Transfers: Are They Warranted?
Authors: Song Xuyang , Case Alexandria L. , Carroll Rory , Abzug Joshua M.
Published: January 2019

Background:

Emergency room transfers to a higher level of care are a vital component of modern health care, as optimal care of patients requires providing access to specialized personnel and facilities. However, literature has shown that orthopaedic transfers to a higher level of care facility are frequently unnecessary. The purpose of this study was to assess the appropriateness of pediatric orthopaedic transfers to a tertiary care center and the factors surrounding these transfers.

Methods:

All pediatric orthopaedic transfers to the pediatric emergency department (ED) were evaluated over a 4-year period. A retrospective chart review was performed to assess the factors surrounding the transfer including patient demographics, time of transfer, day of transfer, insurance status, outcome of transfer, and diagnosis. Three independent variables were utilized to assess the appropriateness of the transfer: the need for an operative procedure, the need for conscious sedation, and the need for a closed reduction in the ED.

Results:

A total of 218 pediatric orthopaedic emergency room transfers were evaluated, of which 86% of them involved an acute fracture. Twenty-seven percent (59/218) of the transfers occurred on the weekend, with over half (61%) of these transfers being initiated between 6 pm and 6 am. Approximately half (47%) of the transfers involved patients with Medicaid. Fifty-five percent (120/218) of cases required a procedure in the operating room and 22% (49/218) had a closed reduction performed in the ED. Conscious sedation was provided in the ED for 22% (48/218) of patients. Twenty-two percent (47/218) of transfers did not require a trip to the operating room, conscious sedation, nor a closed reduction procedure in the ED.

Conclusion:

The vast majority of pediatric orthopaedic transfers are warranted as they required operative intervention, a closed reduction maneuver, or conscious sedation in the ED.

Level of Evidence:

Level III—Therapeutic.
Treatment of Osteochondral Lesions of Talus With Extracellular Matrix Cartilage Allografts
Authors: Natsuhara Kyle M. , Sarcon Aida , Kreulen Christopher , Giza Eric
Published: January 2019

The treatment of osteochondral lesions of the talus (OLTs) can be challenging. Currently, there exists a wide variety of treatment options to address OLTs, and the development of new, innovative surgical techniques has continued to evolve. The use of extracellular matrix cartilage allografts, or BioCartilage, is a biological agent that can be utilized as an adjunct to bone marrow stimulation. There are early promising clinical, radiographic, and histologic results. Therefore, it is prudent to understand the application of extracellular matrix cartilage allograft in the treatment of OLTs. We will provide a detailed review of the surgical technique and postoperative management, as well as guidelines for the indications for the procedure.
The Saline Load Test is Effective at Diagnosing Traumatic Arthrotomies of the Wrist
Authors: Gittings Daniel J. , Fryhofer George W. , Hast Michael W. , Steinberg David R. , Levin L. Scott , Gray Benjamin L.
Published: January 2019

Background:

The saline load test has previously been shown to be an effective tool to diagnose traumatic arthrotomies, but no studies have assessed the test’s efficacy in the wrist. The purpose of this study was to investigate the amount of fluid required during a saline load test to detect intra-articular wrist involvement of traumatic wounds with high sensitivity.

Methods:

A cadaveric study was conducted using 7 thawed, fresh-frozen forequarter amputations from 7 different donors (3 male, 4 female). Specimen age (mean: 67.7 y, range: 52 to 80 y), laterality (1 right, 6 left), body weight (mean: 164.3 lbs, range: 100 to 223 lbs), and wrist range of motion (ROM) was assessed before testing. The wrist capsule was punctured with an 11-blade scalpel through the 6R radiocarpal portal site under fluoroscopic guidance to ensure the injury was intra-articular. A 19-G needle was then placed through the 3,4 radiocarpal portal site and confirmed with fluoroscopy to ensure intra-articular placement. Normal saline was then injected at a steady rate into the 3,4 radiocarpal portal site until extravasation of the saline was observed from the 6R radiocarpal arthrotomy site. The volume of saline required for extravasation from the 6R radiocarpal arthrotomy was recorded as the volume required to detect the arthrotomy. A plot of saline volumes (by percentile) was created, and a logarithmic distribution was calculated. A Wilcoxon rank-sum test was used to compare injection volumes between male and female specimens, and Pearson Coefficients were used to determine any correlations between injection volume and ROM.

Results:

The average amount of saline that resulted in extravasation was 4 mL (range: 2 to 7 mL). In order to identify 75%, 90%, 95%, and 99% of the simulated wrist arthrotomies, 5 (95% confidence interval: 3-7), 6 (4-9), 7 (4-10), and 9 (5-14) mL were required, respectively. Pretest ROM did not correlate with saline volume.

Conclusions:

This study demonstrates the efficacy of the saline load test in detecting traumatic arthrotomies of the wrist joint with 95% sensitivity after loading 7 mL of saline. Prompt and accurate diagnosis of traumatic arthrotomies is paramount to guide management and optimize postinjury outcomes.