bluuebunny/crossref_metadata_2025 huggingface dataset:
A direct simulation Monte Carlo study of hypersonic leading-edge separation with rarefaction effects
Authors: Prakash R. , Gai S. , O’Byrne S.
Published: June 2018

Hypersonic laminar flow separation preceded by a strong expansion can occur in practical situations such as the base flow of re-entry vehicles and flow over deflected control surfaces. A leading-edge separation configuration provides a case for studying fundamental aspects of such flow separation and reattachment in the absence of a pre-existing boundary layer. In hypersonic low-density flows, the onset of separation is complicated by the presence of rarefaction and thermal non-equilibrium. The reattachment process is also characterized by high compressibility. A computational study of the characteristics of flow separation and reattachment over such a configuration has been carried out using the direct simulation Monte Carlo code SPARTA. The salient features of separation are explained from a fluid dynamic perspective, and distinct characteristics in surface parameters are identified and discussed in detail. The physical mechanisms behind the formation as well as co-existence of primary and secondary vortices are described. The region close to the leading-edge is analyzed in detail, and the prevailing non-equilibrium aspects are presented. Various theoretical concepts, developed based on continuum flow separation, are applied to the present configuration to explore its applicability in the presence of slip, and the resulting relative variations are highlighted. The temporal evolution of flow structures at various wall temperatures is studied, and its strong dependence on the wall-to-stagnation temperature ratio is elucidated.
Origin of efficient thermoelectric performance in half-Heusler FeNb0.8Ti0.2Sb
Authors: Pang Hong-Jie , Fu Chen-Guang , Yu Hao , Chen Liu-Cheng , Zhu Tie-Jun , Chen Xiao-Jia
Published: June 2018

A half-Heusler material FeNb0.8Ti0.2Sb has been identified as a promising thermoelectric material due to its excellent thermoelectric performance at high temperatures. The origin of the efficient thermoelectric performance is investigated through a series of low-temperature (2–400 K) measurements. The high data coherence of the low and high temperatures is observed. An optimal and nearly temperature-independent carrier concentration is identified, which is ideal for the power factor. The obtained single type of hole carrier is also beneficial to the large Seebeck coefficient. The electronic thermal conductivity is found to be comparable to the lattice thermal conductivity and becomes the dominant component above 200 K. These findings again indicate that electron scattering plays a key role in the electrical and thermal transport properties. The dimensionless figure of merit is thus mainly governed by the electronic properties. These effects obtained at low temperatures with the avoidance of possible thermal fluctuations together offer the physical origin for the excellent thermoelectric performance in this material.
Theoretical and experimental study of the active control of bubble point pressure using a magnetic field and its applications
Authors: Kinefuchi K. , Kobayashi H.
Published: June 2018

Space propulsion systems use screen mesh devices as filters to block contaminants and as propellant management devices to settle the propellants. The bubble point pressure indicates the basic capillary performance for liquid acquisition of screen meshes. Actively controlling the bubble point pressure can result in flexible and efficient operation of the propulsion systems. High-performance cryogenic propellants, such as liquid hydrogen and oxygen, exhibit magnetic properties. Therefore, a method to actively control the bubble point pressure of cryogenic propellants by applying a magnetic field is proposed in this study. The magnetic pressures affect the pressure balance around the gas–liquid interface separated by the screen mesh, which can thereby control the bubble point pressure. To demonstrate the concept and theoretical basis, a bubble point experiment is conducted using a ferrofluid and solenoid. This experiment proves that the magnetic field actively controls the bubble point pressure and performs both suppression and enhancement of the liquid acquisition performance of the screen mesh. The theory related to magnetic pressures is observed to successfully predict the experimental results. The feasibility of the active control of the bubble point pressure of liquid oxygen is discussed based on the validated theory, and two applications of this technique in cryogenic propulsion systems are depicted.
Aqueous solvation from the water perspective
Authors: Ahmed Saima , Pasti Andrea , Fernández-Terán Ricardo J. , Ciardi Gustavo , Shalit Andrey , Hamm Peter
Published: June 2018

The response of water re-solvating a charge-transfer dye (deprotonated Coumarin 343) after photoexcitation has been measured by means of transient THz spectroscopy. Two steps of increasing THz absorption are observed, a first ∼10 ps step on the time scale of Debye relaxation of bulk water and a much slower step on a 3.9 ns time scale, the latter of which reflecting heating of the bulk solution upon electronic relaxation of the dye molecules from the S1 back into the S0 state. As an additional reference experiment, the hydroxyl vibration of water has been excited directly by a short IR pulse, establishing that the THz signal measures an elevated temperature within ∼1 ps. This result shows that the first step upon dye excitation (10 ps) is not limited by the response time of the THz signal; it rather reflects the reorientation of water molecules in the solvation layer. The apparent discrepancy between the relatively slow reorientation time and the general notion that water is among the fastest solvents with a solvation time in the sub-picosecond regime is discussed. Furthermore, non-equilibrium molecular dynamics simulations have been performed, revealing a close-to-quantitative agreement with experiment, which allows one to disentangle the contribution of heating to the overall THz response from that of water orientation.
Optically transparent wideband CVD graphene-based microwave antennas
Authors: Grande Marco , Bianco Giuseppe Valerio , Laneve Dario , Capezzuto Pio , Petruzzelli Vincenzo , Scalora Michael , Prudenzano Francesco , Bruno Giovanni , D'Orazio Antonella
Published: June 2018

In this paper, we numerically and experimentally demonstrate that few-layer Chemical Vapour Deposition graphene can be employed for the fabrication of fully optical transparent antennas for microwave applications. We show that planar graphene-based antennas, having a size of tens of square centimeters, can achieve relatively high gain over a wide operating bandwidth (>3.5 GHz) simultaneously covering the GPS, WiFi, Bluetooth, and 5G bands. The measured 3D radiation patterns show dipole-, quadruple-, and hexapole-behavior. These findings open up routes for the realization of innovative devices where “invisible and hidden” antennas could be integrated in smart windows or photovoltaic systems, fostering configurations for camouflage, and communications systems. Furthermore, the possibility to handle different radiation patterns could allow the engineering of complex systems such as antenna arrays devoted to beam-steering, beam-forming, and healthcare applications. Finally, combining graphene transparency and flexibility could also pave the way for the realization of wearable devices, demanding invisibility, which operate on the surface of the human body or can be integrated in transparent devices (for example, in contact lenses) reducing their invasiveness.
Gunpowder-powered captive bolts for the euthanasia of kangaroo pouch young
Authors: Hampton Jordan O.
Published: June 2018

Euthanasia of macropod pouch young becomes necessary in situations when the mother has died as a result of situations such as: culling programs, vehicle collisions, bushfires, dog attacks, and entrapment in fences. Euthanasia methods currently recommended for older (furred) pouch young are contentious, hence the need to develop a more reliable method of euthanasia. To investigate animal welfare outcomes resulting from the use of a gunpowder-powered captive bolt, an independent veterinarian observed euthanasia of 28 furred kangaroo pouch young. Pouch removal duration was zero for all animals as the captive bolt was applied in situ in the pouch. Immediate insensibility was observed for 27 (96%) of the pouch young, exceeding the commonly used animal welfare standard of 95%. Results indicate that a gunpowder-powered captive bolt can produce favourable animal welfare outcomes for euthanasing kangaroo pouch young by delivering more than 40 times the kinetic energy delivered by previously studied captive bolt units applied to pouch young. When compared with other euthanasia methods for kangaroo pouch young, the use of a gunpowder-powered captive bolt delivers favourable animal welfare outcomes.
Patterns of point-of-care test use among obstetricians and gynaecologists in the US
Authors: Rompalo Anne M. , Castleberry Neko , Widdice Lea , Schulkin Jay , Gaydos Charlotte A.
Published: June 2018

Background
Point-of-care tests (POCTs) for reproductive health conditions have existed for decades. Newer POCTs for syphilis, HIV and trichomonas are currently available and easy to use. We surveyed practicing obstetricians and gynaecologists to determine current POCT use and perceived obstacles to use. Methods: Between June and August 2016, 1000 members of the American College of Obstetricians and Gynecologists were randomly selected and invited to complete a Qualtrics (222 West river Park Drive, Provo, Utah 84604, USA) survey; 600 of these were members of the Collaborative Ambulatory Research Network. Respondents who completed at least 60% of the survey were included in the analysis. Results: Of the 1000 selected members, 749 had valid emails and 288 (38%) of these participated in and completed the survey. Of the respondents, 70% were male with a mean of 18 years in practice. Detection of sexually transmissible infections (STIs) once or twice a week was reported by 30%, whereas 45% reported detecting STIs once or twice a month. POCTs used included pregnancy tests (83%), urine dipstick (83%), wet mount tests (79%) and the vagina pH test (54.8%). Few used Gram stain (5%) and stat rapid plasma regain tests (4%). Relatively newer US Food and Drug Administration-approved POCTs were used less frequently, with 25% of respondents reporting using the Affirm VPIII (Becton, Dickinson and Company, 1 Becton Drive, Franklin Lakes, NJ 07471, USA) test use and only 10% using a rapid HIV test. The most common perceived barriers to testing were the amount of reimbursement received for performing the test (61.9%) and the payment coverage from the patient (61.3%). Conclusions: US obstetricians and gynaecologists rely on laboratory test results and traditional POCTs to diagnosis STIs. Future development and marketing of POCTs should consider not only ease and time of test performance, but also the cost of the tests to the practice and the patient, as well as reimbursement.
Chinese rhetoric
Authors: Yeung Lorrita
Published: June 2018

This study investigates the question of Chinese indirection as a result of the use of modality expressions, which is conventionally believed to be the hallmark of Chinese rhetoric (e.g.Young, 1994;Bond, 1991;Powers and Gong, 1994). The present research compares and contrasts the degree of assertiveness as reflected in the patterns of modality in two corpora of expert Chinese and English argumentative writing on the same controversial subject. Corpus evidence shows that contrary to expectations, the Chinese writers are significantly more assertive than the English in arguing their case. The frequency of use and distribution patterns of intensifiers present both quantitative and qualitative evidence for the rhetorical differences, which may be accounted for culturally.
Septins suppress the release of vaccinia virus from infected cells
Authors: Pfanzelter Julia , Mostowy Serge , Way Michael
Published: June 2018

Septins are conserved components of the cytoskeleton that play important roles in many fundamental cellular processes including division, migration, and membrane trafficking. Septins can also inhibit bacterial infection by forming cage-like structures around pathogens such as Shigella. We found that septins are recruited to vaccinia virus immediately after its fusion with the plasma membrane during viral egress. RNA interference–mediated depletion of septins increases virus release and cell-to-cell spread, as well as actin tail formation. Live cell imaging reveals that septins are displaced from the virus when it induces actin polymerization. Septin loss, however, depends on the recruitment of the SH2/SH3 adaptor Nck, but not the activity of the Arp2/3 complex. Moreover, it is the recruitment of dynamin by the third Nck SH3 domain that displaces septins from the virus in a formin-dependent fashion. Our study demonstrates that septins suppress vaccinia release by “entrapping” the virus at the plasma membrane. This antiviral effect is overcome by dynamin together with formin-mediated actin polymerization.
Mammary molecular portraits reveal lineage-specific features and progenitor cell vulnerabilities
Authors: Casey Alison E. , Sinha Ankit , Singhania Rajat , Livingstone Julie , Waterhouse Paul , Tharmapalan Pirashaanthy , Cruickshank Jennifer , Shehata Mona , Drysdale Erik , Fang Hui , Kim Hyeyeon , Isserlin Ruth , Bailey Swneke , Medina Tiago , Deblois Genevieve , Shiah Yu-Jia , Barsyte-Lovejoy Dalia , Hofer Stefan , Bader Gary , Lupien Mathieu , Arrowsmith Cheryl , Knapp Stefan , De Carvalho Daniel , Berman Hal , Boutros Paul C. , Kislinger Thomas , Khokha Rama
Published: June 2018

The mammary epithelium depends on specific lineages and their stem and progenitor function to accommodate hormone-triggered physiological demands in the adult female. Perturbations of these lineages underpin breast cancer risk, yet our understanding of normal mammary cell composition is incomplete. Here, we build a multimodal resource for the adult gland through comprehensive profiling of primary cell epigenomes, transcriptomes, and proteomes. We define systems-level relationships between chromatin–DNA–RNA–protein states, identify lineage-specific DNA methylation of transcription factor binding sites, and pinpoint proteins underlying progesterone responsiveness. Comparative proteomics of estrogen and progesterone receptor–positive and –negative cell populations, extensive target validation, and drug testing lead to discovery of stem and progenitor cell vulnerabilities. Top epigenetic drugs exert cytostatic effects; prevent adult mammary cell expansion, clonogenicity, and mammopoiesis; and deplete stem cell frequency. Select drugs also abrogate human breast progenitor cell activity in normal and high-risk patient samples. This integrative computational and functional study provides fundamental insight into mammary lineage and stem cell biology.
Revisiting Judicial Empowerment in the European Union
Authors: Pavone Tommaso
Published: June 2018

Judicial empowerment is often cited as a driver of transnational governance, particularly in the European Union. In this view, lower national courts enthusiastically began referring cases to the European Court of Justice to acquire new powers of judicial review. Revisiting this argument, I argue that path dependent, everyday practices within domestic judiciaries stemming from insufficient training in European Union law, workload pressures, and cultural aversions to judicial review can resist Europeanization even when it would lead to empowerment. The argument is evaluated via a critical case study of judicial practice in Italy that is placed in a broader comparative context.
Tverberg’s theorem is 50 years old: A survey
Authors: Bárány Imre , Soberón Pablo
Published: June 2018

This survey presents an overview of the advances around Tverberg’s theorem, focusing on the last two decades. We discuss the topological, linear-algebraic, and combinatorial aspects of Tverberg’s theorem and its applications. The survey contains several open problems and conjectures.
Evidence for a Posterior Parietal Cortex Contribution to Spatial but not Temporal Numerosity Perception
Authors: Cavdaroglu Seda , Knops André
Published: June 2018

Posterior parietal cortex (PPC) is thought to encode and represent the number of objects in a visual scene (i.e., numerosity). Whether this representation is shared for simultaneous and sequential stimuli (i.e., mode independency) is debated. We tested the existence of a common neural substrate for the encoding of these modes using fMRI. While both modes elicited overlapping BOLD response in occipital areas, only simultaneous numerosities significantly activated PPC. Unique activation for sequential numerosities was found in bilateral temporal areas. Multivoxel pattern analysis revealed numerosity selectivity in PPC only for simultaneous numerosities and revealed differential encoding of presentation modes. Voxel-wise numerosity tuning functions for simultaneous numerosities in occipital and parietal ROIs revealed increasing numerosity selectivity along an occipito-to-parietal gradient. Our results suggest that the parietal cortex is involved in the extraction of spatial but not temporal numerosity and question the idea of commonly used cortical circuits for a mode-independent numerosity representation.
Plasma fractalkine levels are associated with renal inflammation and outcomes in immunoglobulin A nephropathy
Authors: Luo Ran , Guo Shui-Ming , Li Yue-Qiang , Yang Yi , Li Meng-Lan , Han Min , He Xiao-Feng , Ge Shu-Wang , Xu Gang
Published: June 2018

Background

A recognized noninvasive biomarker to improve risk stratification of immunoglobulin A nephropathy (IgAN) patients is scarce. Fractalkine has been shown to play a key role in glomerular disease as chemoattractant, adhesion and even fibrosis factor. The current study assessed the possibility of plasma fractalkine as a novel biomarker in IgAN patients.

Methods

Plasma fractalkine was measured in 229 patients with renal biopsy consistent IgAN from 2012 to 2014, and clinical, pathological and prognostic relationships were analyzed.

Results

The plasma fractalkine levels in IgAN patients were significantly correlated with the creatinine level and 24-h urine protein by both univariate and multivariate analysis. Mesangial hypercellularity was still significantly correlated with the plasma fractalkine levels even after adjustment for other potential predictor variables by multivariate analysis. In addition, the counts of CD20+ B cells or CD68+ macrophage in renal biopsies of IgAN patients were significantly correlated with the plasma fractalkine levels, but not CD4+ and CD8+ T cells. Finally, we concluded that patients with higher plasma fractalkine levels had higher risk of poor renal outcome compared with those with lower plasma fractalkine levels. No association was observed between the CX3CR1 polymorphisms and clinical parameters including plasma fractalkine levels and prognosis. Recombinant fractalkine induced mesangial cells extracellular matrix synthesis and promoted the migration of microphage cells RAW264.7.

Conclusions

Plasma fractalkine levels were associated with creatinine level, 24-h urine protein, mesangial hypercellularity pathological damage, the CD68+ macrophage and CD20+ B cell infiltration in renal tissue and renal outcome in IgAN patients. Plasma fractalkine might be a potential prognosis novel predictor in Chinese patients with IgAN.
Clinical Image Coregistration Variability on a Dedicated Radiosurgery Unit
Authors: Ruschin Mark , Sahgal Arjun , Soliman Hany , Myrehaug Sten , Tseng Chia-Lin , Bola Ruby , Yeboah Collins , Sarfehnia Arman , Chugh Brige , Eriksson Markus , Nordström Håkan , Lee Young
Published: June 2018

BACKGROUND

On a new dedicated radiosurgery unit enabling frameless treatments, a cone-beam computed tomography (CBCT) can be used for stereotactic definition. Since magnetic resonance imaging (MRI) is used to delineate target, reproducible MRI-to-CBCT coregistration is vital for accurate target localization.

OBJECTIVE

To evaluate reproducibility of image coregistration in patient images.

METHODS

Three types of coregistration (source-to-target) were analyzed: (1) MRI-to-CT; (2) MRI-to-CBCT; and (3) CT-to-CBCT. For each patient (n = 15), each coregistration type was independently performed 5 to 30 times (total: 465 coregistrations). Each coregistration yielded a transformation matrix, which was subsequently applied to transform every point in the source image to stereotactic coordinates. Two metrics were measured: (1) target registration error (TRE): mean distance between the registered position of each target point and the average registration position of that point; (2) compound registration error (CRE): mean spatial difference between stereotactic coordinates using (A) MRI-to-CT-to-CBCT and (B) MRI-to-CBCT.

RESULTS

The median (range) of TRE was 0.11 mm (0.06-0.22 mm), 0.17 mm (0.10-0.36 mm), and 0.12 mm (0.08-0.21 mm) for MRI-to-CT, MRI-to-CBCT, and CT-to-CBCT, respectively. The TRE for MRI-to-CBCT was statistically higher than the other 2 methods (P < .01). The median (range) of CRE was 0.44 mm (0.22-0.59 mm). The maximum point CRE between patients ranged from 0.37-1.15 mm when considering all MRI points, but reduced to 0.31-0.90 mm within the central 16 cm. The CRE varied across the image volume, and typically was minimized near the center.

CONCLUSION

The variation in image coregistration is within 0.2 mm, indicating a high degree of reproducibility. The CRE varies throughout the head but is submillimeter in the central 16 cm region.
Effects of Pre- and Postanthesis Applications of Demethylation Inhibitor Fungicides on Fusarium Head Blight and Deoxynivalenol in Spring and Winter Wheat
Authors: Paul Pierce A. , Bradley Carl A. , Madden Laurence V. , Dalla Lana Felipe , Bergstrom Gary C. , Dill-Macky Ruth , Wise Kiersten A. , Esker Paul D. , McMullen Marcia , Grybauskas Arvydas , Kirk William W. , Milus Eugene , Ruden Kay
Published: June 2018

Anthesis is generally recommended as the optimum growth stage for applying a foliar fungicide to manage Fusarium head blight (FHB) and the Fusarium-associated toxin deoxynivalenol (DON) in wheat. However, because it is not always possible to treat fields at anthesis, studies were conducted to evaluate pre- and postanthesis treatment options for managing FHB and DON in spring and winter wheat. Network meta-analytical models were fitted to data from 19 years of fungicide trials, and log response ratio ([Formula: see text]) and approximate percent control ([Formula: see text]) relative to a nontreated check were estimated as measures of the effects of six treatments on FHB index (IND: mean percentage of diseased spikelets per spike) and DON. The evaluated treatments consisted of either Caramba (metconazole) applied early (at heading [CE]), at anthesis (CA), or late (5 to 7 days after anthesis; CL), or Prosaro (prothioconazole + tebuconazole) applied at the same three times and referred to as PE, PA, and PL, respectively. All treatments reduced mean IND and DON relative to the nontreated check, but the magnitude of the effect varied with timing and wheat type. CA and PA resulted in the highest [Formula: see text] values for IND, 52.2 and 51.5%, respectively, compared with 45.9% for CL, 41.3% for PL, and less than 33% for CE and PE. Anthesis and postanthesis treatments reduced mean IND by 14.9 to 29.7% relative to preanthesis treatments. The estimated effect size was also statistically significant for comparisons between CA and CL and PA and PL; CA reduced IND by 11.7% relative to CL, whereas PA reduced the disease by 17.4% relative to PL. Differences in efficacy against IND between pairs of prothioconazole + tebuconazole and metconazole treatments applied at the same timing (CE versus PE, CA versus PA, and CL versus PL) were not statistically significant. However, CA and CL outperformed PA and PL by 7 and 12.8%, respectively, in terms of efficacy against DON. All application programs had comparable efficacy against IND between spring and winter wheat types, but efficacy against DON was 10 to 16% greater for spring than winter wheat for applications made at or after anthesis. All programs led to an increase in mean grain yield and test weight relative to the nontreated check.
Cilia protein IFT88 regulates extracellular protease activity by optimizing LRP‐1–mediated endocytosis
Authors: Coveney Clarissa R. , Collins Isabella , Fie Megan Mc , Chanalaris Anastasios , Yamamoto Kazuhiro , Wann Angus K. T.
Published: June 2018

Matrix protease activity is fundamental to developmental tissue patterning and remains influential in adult homeostasis. In cartilage, the principal matrix proteoglycan is aggrecan, the protease‐mediated catabolism of which defines arthritis; however, the pathophysiologic mechanisms that drive aberrant aggrecanolytic activity remain unclear. Human ciliopathies exhibit altered matrix, which has been proposed to be the result of dysregulated hedgehog signaling that is tuned within the primary cilium. Here, we report that disruption of intraflagellar transport protein 88 (IFT88), a core ciliary trafficking protein, increases chondrocyte aggrecanase activity invitro.Wefind that the receptor for protease endocytosis in chondrocytes, LDL receptor‐related protein 1 (LRP‐1), is unevenly distributed over the cell membrane, often concentrated at the site of cilia assembly. Hypomorphic mutation of IFT88 disturbs this apparent hot spot for protease uptake, increases receptor shedding, and results in a reduced rate of protease clearance from the extracellular space. We propose that IFT88 and/or the cilium regulates the extracellular remodeling of matrix—independently of Hedgehog regulation—by enabling rapid LRP‐1–mediated endocytosis of proteases, potentially by supporting the creation of a ciliary pocket. This result highlights new roles for the cilium's machinery in matrix turnover and LRP‐1 function, with potential relevance in a range of diseases.—Coveney, C. R., Collins, I., Mc Fie, M., Chanalaris, A., Yamamoto, K., Wann, A. K. T. Cilia protein IFT88 regulates extracellular protease activity by optimizing LRP‐1–mediated endocytosis.FASEB J.32, 6771–6782 (2018).www.fasebj.org
Deletion of the stress‐response protein REDD1 promotes ceramide‐induced retinal cell death and JNK activation
Authors: Dai Weiwei , Miller William P. , Toro Allyson L. , Black Adam J. , Dierschke Sadie K. , Feehan Robert P. , Kimball Scot R. , Dennis Michael D.
Published: June 2018

The role of dyslipidemia in the development of retinal dysfunction remains poorly understood. Using an animal model of diet‐induced obesity/pre‐type 2 diabetes, we investigated molecular defects in the retina arising from consumption of a diet high in saturated fats and sugars (i.e., a Western diet). We found that feeding mice a Western diet increased the abundance of retinal sphingolipids, attenuated protein kinase B (Akt) phosphorylation, enhanced JNK activation, and increased retinal cell death. When we used palmitate or C6‐ceramide (Cer) to assess sphingolipid‐mediated signaling in cultured murine and human cells, we observed similar effects on Akt, JNK, and cell death. Furthermore, both Western diet and C6‐Cer exposure enhanced expression of the stress‐response protein regulated in development and DNA damage response 1 (REDD1) and loss of REDD1 increased C6‐Cer‐induced JNK activation and cell death. Exogenous REDD1 expression repressed JNK‐mediated phosphorylation in cultured cells. We found that thioredoxin‐interacting protein (TXNIP) expression was elevated in REDD1–deficient cell lines and C6‐Cer promoted TXNIP expression in both wild‐type and REDD1–deficient cells. Likewise, TXNIP knockdown attenuated JNK activation and caspase 3 cleavage after either C6‐Cer exposure or REDD1 deletion. The results support a model wherein Cer‐induced REDD1 expression attenuates TXNIP‐dependent JNK activation and retinal cell death.—Dai, W., Miller, W. P., Toro, A. L., Black, A. J., Dierschke, S. K., Feehan, R. P., Kimball, S. R., Dennis, M. D. Deletion of the stress‐response protein REDD1 promotes ceramide‐induced retinal cell death and JNK activation. FASEB J. 32, 6883–6897 (2018). www.fasebj.org
Pigmented Villonodular Synovitis of the Knee: An Underappreciated Source of Pain in Children and Adolescents
Authors: Willimon Samuel Clifton , Busch Michael T. , Perkins Crystal A.
Published: June 2018

Background:

Pigmented villonodular synovitis (PVNS) is a benign proliferative synovial disorder most commonly described in adults. The purpose of this study is to describe the presentation and management of a large single-center series of pediatric patients with PVNS of the knee.

Methods:

A retrospective review was performed of consecutive pediatric patients treated for PVNS at a single institution from 2001 to 2016. Inclusion criteria were patients below 20 years of age with surgical treatment of histologically proven PVNS of the knee. Review of the electronic medical record was utilized to gather demographic data, clinical presentation, affected joint, imaging findings, treatment, and disease persistence.

Results:

Over the 16-year study period, 17 pediatric patients with an average age of 11 years (range, 3 to 19 y) were treated for PVNS of the knee. The average duration of symptoms before orthopaedic evaluation was 16 months. More than half of the children were misdiagnosed with a variety of rheumatologic or orthopaedic conditions before their diagnosis of PVNS. On the basis of magnetic resonance imaging (MRI), PVNS was included as a potential diagnosis in 12 of 17 patients (71%). A total of 27 surgeries were performed in 17 patients. Ten patients were treated with a single surgery and 2 patients were treated with staged biopsy followed by synovectomy. Five patients required ≥2 therapeutic surgeries. The majority of procedures were arthroscopic synovectomies (89%). One patient required open resection of a mass in the posterior compartment of the knee and 1 patient had a manipulation under anesthesia for arthrofibrosis. Ten patients were noted to have nodular disease, 4 diffuse, and 3 mixed. At an average 15-month follow-up, 15 patients (88%) were considered to be disease-free based on clinical examination and/or follow-up MRI. Two patients (12%) had MRI studies following their last surgery with findings consistent with persistent PVNS, but only a single patient had persistent symptoms.

Conclusions:

This case series of pediatric patients with PVNS of the knee represents the largest single-center cohort in the literature. Although previously considered a disease of young adult patients, PVNS should be considered in pediatric patients with an insidious onset of joint swelling with or without pain. Symptoms may be present for months to years before diagnosis. Patients are frequently misdiagnosed, most commonly with rheumatologic diseases, bleeding disorders, or septic arthritis. MRI with gradient echo sequences is the diagnostic imaging study of choice and arthroscopic synovectomy produces good outcomes with low rates of symptomatic disease persistence.

Level of Evidence:

Level IV.
Changes in the Practice of Pediatric Orthopaedic Surgeons Over the Past Decade: Analysis of the Database of the American Board of Orthopaedic Surgery
Authors: Hosseinzadeh Pooya , DeVries Clarabelle A. , Nielsen Ena , Andras Lindsay A. , Mignemi Megan , Sawyer Jeffrey R. , Flynn John M. , Albanese Stephen A.
Published: June 2018

Background:

There has been an increase in the number of the graduates of pediatric orthopaedic fellowship programs over the past decade creating the potential for increased competition in the field. The purpose of this study was to analyze the effect of increased number of pediatric orthopaedic fellowship graduates on case volume as well as the type of procedures performed by recent graduates of pediatric orthopaedic fellowship programs from 2004 to 2014.

Methods:

Case logs submitted for the American Board of Orthopaedic Surgery Part II examination by applicants with the self-declared subspecialty of pediatric orthopaedics from 2004 to 2014 were analyzed. Cases were categorized as trauma (upper and lower extremity), spine, sports medicine, hip, deformity correction, foot and ankle, hardware removal, soft tissue procedures, and other. The period was divided into 3 sections: 2004-2007, 2008-2011, 2012-2014. Descriptive analysis was used to report the change in the volume and pattern of practices over the study period.

Results:

Although the number of pediatric orthopaedic subspecialty applicants increased from 15 to 44 from 2004 to 2014, the average cases per year increased from 2142 in 2004-2007 to 2960 in 2007-2011, and to 4160 in 2012-2014. The number of cases performed per applicant remained stable over the study period. Upper extremity trauma cases were the largest category of cases reported and increased in case volume by 141% from 2004 to 2014. Sports medicine cases increased in volume by 175%.

Conclusions:

Despite a large increase in the number of pediatric orthopaedic surgeons over the past decade, there is a concomitant increased in case volume across almost all subspecialties within pediatric orthopaedics. As such, pediatric orthopaedic surgeons who start a new practice can expect to develop a robust practice with a diverse group of pathologies.

Level of Evidence:

Level III.
Regional Differences in Diffuse Idiopathic Skeletal Hyperostosis
Authors: Hirasawa Atsuhiko , Robinson Yohan , Olerud Claes , Wakao Norimitsu , Kamiya Mitsuhiro , Murotani Kenta , Deie Masataka
Published: June 2018

Study Design.

We retrospectively reviewed computed tomography (CT) records of patients in Japan and Sweden, which are both aging populations.

Objective.

To research the influence of ethnicity and region on diffuse idiopathic skeletal hyperostosis (DISH) prevalence.

Summary of Background Data.

DISH can complicate non-surgical treatment of spinal fractures and often requires surgical intervention. We previously reported a prevalence of DISH in Japan that was higher than that reported in other studies.

Methods.

We retrospectively reviewed CT records of patients in Japan and Sweden, which have both aging populations. Patients undergoing whole body CT during trauma examinations at an acute outpatient clinic in Uppsala University Hospital in a 1-year period were eligible for inclusion. Excluded were those less than 40 and more than or equal to 90 years old, and those with previous spinal surgery. The prevalence of DISH by sex and age was determined according to radiographic criteria by Resnick. Results from Sweden were compared with the Japan data, which we previously reported.

Results.

Age of the eligible subjects (265 men and 153 women) ranged from 40 to 89 years, with a mean age of 63.4 years. Among men, 86 (32.5%) were diagnosed with DISH, and the results by age (40s, 50s, 60s, 70s, and 80s) were: 6 (10.7%), 13 (22%), 35 (46.1%), 17 (34%), and 15 (62.5%) patients, respectively. Among women, 16 (10.5%) had DISH, and the results by age were as follows: 1 (2.6%), 1 (3.3%), 2 (6.7%), 6 (22.2%), and 6 (22.2%) patients, respectively. These results did not differ from those previously published for Japan (Fisher exact test, men: P = 1, 0.27, 0.12, 0.06, and 1, respectively; women: P = 0.49, 0.62, 0.5, 0.8, and 0.3, respectively).

Conclusion.

The presented cohort study revealed that ethnicity and region may not be notable factors of DISH prevalence, since patients from both Japan and Sweden had similar DISH prevalence.

Level of Evidence: 3
Effect of Keller Funnel on the Rate of Capsular Contracture in Periareolar Breast Augmentation
Authors: Newman Ashley N. , Davison Steven P.
Published: June 2018

Background:

Capsular contracture is 1 of the most common complications after breast implant surgery and is a major indication for reoperation. Capsular contracture is believed to be a multifactorial process that is affected by implant texture, incision type, and ultimately pocket contamination. This contamination causes a biofilm that leads to capsular contracture. The intraoperative use of a Keller funnel is a mechanical way to decrease the implant’s contact with the skin and ducts, reducing bacterial contamination that can cause these biofilms. For this reason, periareolar breast augmentation has been less popular among surgeons. The purpose of this study was to examine if there was a significant difference between the rates of capsular contracture in patients having periareolar breast augmentations with the use of a Keller funnel for insertion and those having periareolar breast augmentations without Funnel use.

Methods:

This level 3 retrospective study followed 2 groups of patients, the first having periareolar breast augmentations without the use of a funnel for insertion (group A; patients n = 15; implants n = 30) and the second having periareolar breast augmentations with the use of a funnel for insertion (group B; patients n = 151; implants n = 300).

Results:

The rate of capsular contracture in group A was found to be 10% compared with a rate of capsular contracture of 1.3% for patients in group B, an 87% reduction (P = 0.0019).

Conclusions:

According to the results found in this study, the rate of capsular contracture in patients having periareolar breast augmentations after insertion with a Keller funnel was statistically significantly lower than the rate in patients having implants inserted without the assistance of a funnel, making the device useful in reducing the occurrence of postoperative capsular contracture.
Evaluation of Ocular Surface Disease in Patients With Glaucoma: Clinical Parameters, Self-report Assessment, and Keratograph Analysis
Authors: Portela Renata C. , Fares Nikoly T. , Machado Lilian F. , São Leão Amanda F. , de Freitas Denise , Paranhos Augusto , Prata Tiago S. , Gracitelli Carolina P.B.
Published: June 2018

Purpose:

To assess ocular surface disease (OSD) in glaucoma using clinical parameters, self-report assessment, and keratograph analysis.

Methods:

A total of 30 glaucoma patients and 27 subjects with cataracts (control group) were enrolled in the study. Only glaucoma patients who were using at least 1 topical intraocular pressure–lowering medication were included. An ophthalmological examination was performed, including tear break-up time (BUT), assessment of conjunctival hyperemia and keratitis, and completion of the Ocular Surface Disease Index (OSDI) questionnaire. All the patients underwent keratograph analysis including noninvasive BUT, meibography, tear meniscus height, and redness scale. Quality of life was also assessed in all the patients using National Eye Institute Visual Function Questionnaire (NEI VFQ)-25. The comparison of OSD between the 2 groups was assessed.

Results:

There was a significant difference in OSD: keratitis and conjunctival hyperemia were worse in the glaucoma group (P=0.009 and 0.008, respectively). The glaucoma group had significantly worse scores on the OSDI questionnaire (32.53±20.75 vs. 20.42±18.77; P=0.007). For the keratograph assessment, the glaucoma group had significantly smaller tear meniscus height (0.22±0.08 vs. 0.24±0.04, respectively; P=0.041); worse bulbar redness (2.06±0.67 vs. 1.70±0.45, respectively; P=0.021); higher meibography grades (2.34±1.01 vs. 1.52±0.64, respectively; P=0.001); and worse noninvasive keratograph tear BUT (5.45±4.16 vs. 8.40±5.65, respectively; P=0.023). Patients with glaucoma had a worse quality of life (60.73±18.25 vs. 76.62±8.03, respectively; P=0.039).

Conclusions:

Our findings not only confirm the high prevalence of clinical findings of OSD in glaucoma patients but also reveal new objective parameters measured by keratograph analysis.
How Do Innovative Primary Care Practices Achieve the Quadruple Aim?
Authors: Wagner Edward H. , LeRoy Lisa , Schaefer Judith , Bailit Michael , Coleman Katie , Zhan Chunliu , Meyers David
Published: June 2018

The Patient-Centered Medical Home (PCMH) now defines excellent primary care. Recent literature has begun to elucidate the components of PCMHs that improve care and reduce costs, but there is little empiric evidence that helps practices, payers, or policy makers understand how high-performing practices have improved outcomes. We report the findings from 38 such practices that fill this gap. We describe how they execute 8 functions that collectively meet patient needs. They include managing populations, providing self-management support coaching, providing integrated behavioral health care, and managing referrals. The functions provide a more actionable perspective on the work of primary care.
Transitioning Patients From Specialty Care to Primary Care
Authors: Ackerman Sara L. , Gleason Nathaniel
Published: June 2018

Growing demand for specialty care has resulted in longer wait times for appointments, particularly at US academic referral centers. A proportion of specialty visits are for routine follow-up care of stable problems, and there is evidence that primary care providers are willing and able to take responsibility for a significant proportion of these patients. However, little is known about how to transition care back to a referring primary care clinician in a manner that is acceptable to everyone involved. In this article, we describe social, legal, and financial barriers to effective care transition and propose communication strategies to overcome them.
Cetacaine Spray as an Ex Vivo “Plastic-on-Plastic” Lubricant for Airway Management Procedures
Authors: Atlas Glen , Sheikh Usman
Published: June 2018

In addition to being an aerosolized topical local anesthetic, Cetacaine Spray has the physical property of being an excellent medical lubricant for airway management and related procedures. This is a result of the constituent ingredient dipropylene glycol (DPG). However, because of the presence of benzocaine, this medication can cause methemoglobinemia if absorbed excessively. The authors speculate that aerosolized DPG may be useful as medical lubricant, independent of the local anesthetics contained within Cetacaine Spray. Further research into this potential application of DPG may be indicated.
Serum lactate level accurately predicts mortality in critically ill patients with cirrhosis with acute kidney injury
Authors: Sun Dan-Qin , Zheng Chen-Fei , Lu Feng-Bin , Van Poucke Sven , Chen Xiao-Ming , Chen Yong-Ping , Zhang Lai , Zheng Ming-Hua
Published: June 2018

Background and aim

Serum lactate levels are routinely measured in critically ill patients with cirrhosis, and hyperlactatemia is a common finding, but its prognostic value remains controversial. Our aim was to examine whether serum lactate level could be used as a predictor of outcome in critically ill patients with cirrhosis (CICP) with acute kidney injury (AKI).

Patients and methods

In this study, we included 480 consecutive patients with cirrhosis admitted to ICU, complicated with AKI, and were followed up for 365 days. Patients were divided into four groups (Q1–Q4) by serum lactate quartiles: Q1≤1.8 mg/dl, Q2=1.9–2.4 mg/dl, Q3=2.5–4.0 mg/dl, and Q4≥4.1 mg/dl. The hazard ratio (HR) and 95% confidence intervals (CIs) for hospital mortality were calculated across each quartile of serum lactate, using the Q1 as reference, and four models were built to adjust for the HR of mortality.

Results

Compared with patients in the survival group, nonsurvivors had higher serum lactate levels. Mortality rate increased progressively as the serum lactate level increased (Q1: 56.06%, Q2: 62.16%, Q3: 72.73% and Q4: 75.86%), and this relationship remained statistically significant after rigorous control of confounding factors in Q2, Q3, and Q4 with HRs of 1.03 (95% CI: 0.73–1.46), 1.40 (95% CI: 1.01–1.95), and 1.84 (95% CI: 1.28–2.64), respectively.

Conclusion

Our study brings a new perspective to the role of lactate monitoring in CICP with AKI. Elevated serum lactate levels are associated with a higher mortality rate in CICP with AKI. Elevated serum lactate levels should be part of rapid diagnosis and initiation of therapy to improve clinical outcome.
High flow nasal cannula oxygen versus noninvasive ventilation in adult acute respiratory failure: a systematic review of randomized-controlled trials
Authors: Beng Leong Lim , Wei Ming Ng , Wei Feng Lee
Published: June 2018

We reviewed the use of noninvasive ventilation (NIV) versus high flow nasal cannula (HFNC) oxygen in adult acute respiratory failure (ARF). We searched major databases and included randomized trials comparing at least NIV with HFNC or NIV+HFNC with NIV in ARF. Primary outcomes included intubation/re-intubation rates. Secondary outcomes were ICU mortality and morbidities. Five trials were included; three compared HFNC with NIV, one compared HFNC, NIV and oxygen whereas one compared HFNC+NIV with NIV. Patients had hypoxaemic ARF (PaO2/FiO2≤300 mmHg). Heterogeneity prevented result pooling. Three and two studies had superiority and noninferiority design, respectively. Patients were postcardiothoracic surgery, mixed medical/surgical patients and those with pneumonia. Two trials were conducted after extubation, two before intubation and one during intubation. Three trials reported intubation/re-intubation rates as the primary outcomes. The other two trials reported the lowest peripheral capillary oxygen saturation readings during bronchoscopy or intubation. In the former three trials, the odds ratio for intubation/re-intubation rates between HFNC versus the NIV group ranged from 0.80 (95% confidence interval: 0.54–1.19) to 1.65 (95% confidence interval: 0.96–2.84). In the latter two trials, only one reported a difference in the lowest peripheral capillary oxygen saturation between NIV+HFNC versus the NIV group during intubation [100% (interquartile range: 95–100) vs. 96% (interquartile range: 92–99); P=0.029]. The secondary outcomes included differences in ICU mortality and patient tolerability, favouring HFNC. Results were conflicting, but highlighted future research directions. These include patients with hypercapneic ARF, more severe hypoxaemia (PaO2/FiO2≤200 mmHg), a superiority design, an oxygen arm and patient-centred outcomes.
Central Line in Long‐term Parenteral Nutrition in Children
Authors: Hojsak Iva , Lacaille Florence , Gupte Girish L. , Köglmeier Jutta
Published: June 2018

Background and Aims:

The guidelines for the insertion and maintenance of the central venous catheter (CVC) in children on long‐term parenteral nutrition (PN) were published 12 years ago and studies evaluating the outcomes are limited. Therefore, the aim of the present study was to perform a survey about criteria for CVC insertion and maintenance in intestinal failure/rehabilitation centers treating children on home PN.

Methods:

An online cross‐sectional survey based on previous European Society of Paediatric Gastroenterology, Hepatology and Nutrition PN guidelines was distributed electronically to the members of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition networking group, Network for Intestinal Failure and Transplantation in Europe and tertiary pediatric gastroenterology centers in Europe.

Results:

Overall, 55 responses from 49 centers in 18 European countries and Israel were collected. The majority of respondents were from the United Kingdom (10, 19%), followed by Germany (7, 13%) and France (6, 11%). Eleven centers (21%) cared for >30 patients, 8 (15%) centers between 20 and 30 patients, 18 (34%) centers between 10 and 20 patients, and 16 (30%) <10 patients on home PN. There was a high variability in the majority of answers to the cross‐sectional survey.

Conclusions:

CVC insertion and maintenance in children on home PN varies largely amongst centers in Europe. These differences could be at least partially explained by the lack of updated guidelines and limited evidence. There is an urgent need for collaborative research to make recommendations about the best possible practice.