bluuebunny/crossref_metadata_2025 huggingface dataset:
Topology and obliquity of core magnetic fields in shaping seismic properties of slowly rotating evolved stars
Authors: Loi Shyeh Tjing
Published: April 2021

It is thought that magnetic fields must be present in the interiors of stars to resolve certain discrepancies between theory and observation (e.g. angular momentum transport), but such fields are difficult to detect and characterize. Asteroseismology is a powerful technique for inferring the internal structures of stars by measuring their oscillation frequencies, and succeeds particularly with evolved stars, owing to their mixed modes, which are sensitive to the deep interior. The goal of this work is to present a phenomenological study of the combined effects of rotation and magnetism in evolved stars, where both are assumed weak enough that first-order perturbation theory applies, and we focus on the regime where Coriolis and Lorentz forces are comparable. Axisymmetric ‘twisted-torus’ field configurations are used, which are confined to the core and allowed to be misaligned with respect to the rotation axis. Factors such as the field radius, topology and obliquity are examined. We observe that fields with finer-scale radial structure and/or smaller radial extent produce smaller contributions to the frequency shift. The interplay of rotation and magnetism is shown to be complex: we demonstrate that it is possible for nearly symmetric multiplets of apparently low multiplicity to arise even under a substantial field, which might falsely appear to rule out its presence. Our results suggest that proper modelling of rotation and magnetism, in a simultaneous fashion, may be required to draw robust conclusions about the existence/non-existence of a core magnetic field in any given object.
Towards a better understanding of supernova environments: a study of SNe 2004dg and 2012P in NGC 5806 with HST and MUSE
Authors: Sun Ning-Chen , Maund Justyn R , Crowther Paul A , Fang Xuan , Zapartas Emmanouil
Published: April 2021

Core-collapse supernovae (SNe) are the inevitable fate of most massive stars. Since most stars form in groups, SN progenitors can be constrained with information of their environments. It remains challenging to accurately analyse the various components in the environment and to correctly identify their relationships with the SN progenitors. Using a combined data set of VLT/MUSE spatially resolved integral field unit (IFU) spectroscopy and HST/ACS+WFC3 high-spatial-resolution imaging, we present a detailed investigation of the environment of the Type II-P SN 2004dg and Type IIb SN 2012P. The two SNe occurred in a spiral arm of NGC 5806, where a star-forming complex is apparent with a giant H ii region. By modelling the ionized gas, a compact star cluster and the resolved stars, we derive the ages and extinctions of stellar populations in the vicinity of the SNe. The various components are consistent with a sequence of triggered star formation as the spiral density wave swept through their positions. For SNe 2004dg and 2012P, we identify their host stellar populations and derive initial masses of $10.0^{+0.3}_{-0.2}$ and $15.2^{+2.0}_{-1.0}$ M⊙ for their progenitors, respectively. Both results are consistent with those from pre-explosion images or nebular-phase spectroscopy. SN 2012P is spatially coincident but less likely to be coeval with the star-forming complex. As in this case, star formation bursts on small scales may appear correlated if they are controlled by any physical processes on larger scales; this may lead to a high probability of chance alignment between older SN progenitors and younger stellar populations.
The effect of flanking bases on direct and triplet sensitized cyclobutane pyrimidine dimer formation in DNA depends on the dipyrimidine, wavelength and the photosensitizer
Authors: Lu Chen , Gutierrez-Bayona Natalia Eugenia , Taylor John-Stephen
Published: April 2021

Cyclobutane pyrimidine dimers (CPDs) are the major products of DNA produced by direct absorption of UV light, and result in C to T mutations linked to human skin cancers. Most recently a new pathway to CPDs in melanocytes has been discovered that has been proposed to arise from a chemisensitized pathway involving a triplet sensitizer that increases mutagenesis by increasing the percentage of C-containing CPDs. To investigate how triplet sensitization may differ from direct UV irradiation, CPD formation was quantified in a 129-mer DNA designed to contain all 64 possible NYYN sequences. CPD formation with UVB light varied about 2-fold between dipyrimidines and 12-fold with flanking sequence and was most frequent at YYYR and least frequent for GYYN sites in accord with a charge transfer quenching mechanism. In contrast, photosensitized CPD formation greatly favored TT over C-containing sites, more so for norfloxacin (NFX) than acetone, in accord with their differing triplet energies. While the sequence dependence for photosensitized TT CPD formation was similar to UVB light, there were significant differences, especially between NFX and acetone that could be largely explained by the ability of NFX to intercalate into DNA.
Preferential CEBP binding to T:G mismatches and increased C-to-T human somatic mutations
Authors: Yang Jie , Horton John R , Akdemir Kadir C , Li Jia , Huang Yun , Kumar Janani , Blumenthal Robert M , Zhang Xing , Cheng Xiaodong
Published: April 2021

DNA cytosine methylation in mammals modulates gene expression and chromatin accessibility. It also impacts mutation rates, via spontaneous oxidative deamination of 5-methylcytosine (5mC) to thymine. In most cases the resulting T:G mismatches are repaired, following T excision by one of the thymine DNA glycosylases, TDG or MBD4. We found that C-to-T mutations are enriched in the binding sites of CCAAT/enhancer binding proteins (CEBP). Within a CEBP site, the presence of a T:G mismatch increased CEBPβ binding affinity by a factor of >60 relative to the normal C:G base pair. This enhanced binding to a mismatch inhibits its repair by both TDG and MBD4 in vitro. Furthermore, repair of the deamination product of unmethylated cytosine, which yields a U:G DNA mismatch that is normally repaired via uracil DNA glycosylase, is also inhibited by CEBPβ binding. Passage of a replication fork over either a T:G or U:G mismatch, before repair can occur, results in a C-to-T mutation in one of the daughter duplexes. Our study thus provides a plausible mechanism for accumulation of C-to-T human somatic mutations.
Arena3Dweb: interactive 3D visualization of multilayered networks
Authors: Karatzas Evangelos , Baltoumas Fotis A , Panayiotou Nikolaos A , Schneider Reinhard , Pavlopoulos Georgios A
Published: April 2021

Efficient integration and visualization of heterogeneous biomedical information in a single view is a key challenge. In this study, we present Arena3Dweb, the first, fully interactive and dependency-free, web application which allows the visualization of multilayered graphs in 3D space. With Arena3Dweb, users can integrate multiple networks in a single view along with their intra- and inter-layer connections. For clearer and more informative views, users can choose between a plethora of layout algorithms and apply them on a set of selected layers either individually or in combination. Users can align networks and highlight node topological features, whereas each layer as well as the whole scene can be translated, rotated and scaled in 3D space. User-selected edge colors can be used to highlight important paths, while node positioning, coloring and resizing can be adjusted on-the-fly. In its current version, Arena3Dweb supports weighted and unweighted undirected graphs and is written in R, Shiny and JavaScript. We demonstrate the functionality of Arena3Dweb using two different use-case scenarios; one regarding drug repurposing for SARS-CoV-2 and one related to GPCR signaling pathways implicated in melanoma. Arena3Dweb is available at http://bib.fleming.gr:3838/Arena3D or http://bib.fleming.gr/Arena3D.
The human tRNA-guanine transglycosylase displays promiscuous nucleobase preference but strict tRNA specificity
Authors: Fergus Claire , Al-qasem Mashael , Cotter Michelle , McDonnell Ciara M , Sorrentino Emiliano , Chevot Franciane , Hokamp Karsten , Senge Mathias O , Southern John M , Connon Stephen J , Kelly Vincent P
Published: April 2021

Base-modification can occur throughout a transfer RNA molecule; however, elaboration is particularly prevalent at position 34 of the anticodon loop (the wobble position), where it functions to influence protein translation. Previously, we demonstrated that the queuosine modification at position 34 can be substituted with an artificial analogue via the queuine tRNA ribosyltransferase enzyme to induce disease recovery in an animal model of multiple sclerosis. Here, we demonstrate that the human enzyme can recognize a very broad range of artificial 7-deazaguanine derivatives for transfer RNA incorporation. By contrast, the enzyme displays strict specificity for transfer RNA species decoding the dual synonymous NAU/C codons, determined using a novel enzyme-RNA capture-release method. Our data highlight the broad scope and therapeutic potential of exploiting the queuosine incorporation pathway to intentionally engineer chemical diversity into the transfer RNA anticodon.
Living with a central nervous system (CNS) tumor: findings on long-term survivorship from the NIH Natural History Study
Authors: Rogers James L , Vera Elizabeth , Acquaye Alvina , Briceno Nicole , Jammula Varna , King Amanda L , Leeper Heather , Quezado Martha M , Gonzalez Alarcon Javier , Boris Lisa , Burton Eric , Celiku Orieta , Choi Anna , Christ Alexa , Crandon Sonja , Grajkowska Ewa , Leggiero Nicole , Lollo Nicole , Penas-Prado Marta , Reyes Jennifer , Siegel Christine , Theeler Brett J , Timmer Michael , Wall Kathleen , Wu Jing , Aldape Kenneth , Gilbert Mark R , Armstrong Terri S
Published: April 2021

Background

Primary central nervous system (CNS) tumors are often associated with high symptom burden and a poor prognosis from the time of diagnosis. The purpose of this study is to describe patient-reported outcomes (PRO) data from long-term survivors (LTS; ≥5-year survival post-diagnosis).

Methods

Clinical/treatment/molecular characteristics and PROs (symptom burden/interference (MDASI-BT/SP), perceived cognition (Neuro-QoL), anxiety/depression (PROMIS), and general health status (EQ-5D-3L)) were collected on 248 adult LTS between 9/2016 and 8/2019. Descriptive statistics and regression analysis were used to report results.

Results

Participants had a median age of 47 years (19-82) and were primarily White (83%) males (51%) with high-grade tumors (59%) and few mutations. Forty-two percent of the 222 brain tumor LTS reported no moderate-to-severe symptoms, whereas 45% reported three or more; most common symptoms were fatigue (40%), difficulty remembering (29%), and drowsiness (28%). Among spine tumor LTS (n = 42), nearly half reported moderate-to-severe weakness, pain, fatigue, and numbness/tingling, with 72% experiencing activity-related interference. Severe anxiety, depression, and cognitive symptoms were reported in up to 23% of the sample. Brain tumor LTS at higher risk for severe symptoms were more likely to be young, unemployed, and have poor KPS (Karnofsky Performance Status), whereas high symptom-risk spinal cord tumor LTS had poor KPS and received any tumor treatment.

Conclusions

Findings indicate LTS fall into distinct cohorts with no significant symptoms or very high symptom burden, regardless of tumor grade or mutational profile. These LTS data demonstrate the need for survivorship care programs and future studies to explore the symptom trajectory of all CNS tumor patients for prevention and early interventions.
R-CHOP Chemotherapy for Disseminated Mycobacterium avium Complex Disease due to Anti-Interferon-Gamma Autoantibodies: A Case Report
Authors: Uno Shunsuke , Uehara Eisuke , Kimura Toshiki , Sakagami Takuro , Namkoong Ho , Uchida Sho , Uwamino Yoshifumi , Hasegawa Naoki
Published: April 2021

A 77-year-old Japanese man with disseminated Mycobacterium avium complex (MAC) disease due to anti-interferon-gamma autoantibodies received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) chemotherapy because of non-Hodgkin lymphoma complication. The hepatobiliary nodules due to MAC resolved with R-CHOP and multidrug antimycobacterial treatment. R-CHOP could serve as an alternative adjunctive therapy for patients with anti-interferon-gamma autoantibodies.
Species limits and taxonomy in birds
Authors: Winker Kevin , Rasmussen Pamela C
Published: April 2021

Despite the acknowledged importance of defining avian species limits to scientific research, conservation, and management, in practice, they often remain contentious. This is true even among practitioners of a single species concept and is inevitable owing to the continuous nature of the speciation process, our incomplete and changing understanding of individual cases, and differing interpretations of available data. This issue of Ornithology brings together several papers on species limits, some more theoretical and general, and others case studies of specific taxa. These are viewed primarily through the lens of the biological species concept (BSC), by far the most widely adopted species concept in influential ornithological works. The more conceptual contributions focus on the importance of the integrative approach in species delimitation; the importance of considering selection with the increasing use of genomic data; examinations of the effectiveness of the Tobias et al. character-scoring species limits criteria; a review of thorny issues in species delimitation using examples from Australo-Papuan birds; and a review of the process of speciation that addresses how population divergence poses challenges. Case studies include population genomics of the American Kestrel (Falco sparverius); an integrative taxonomic analysis of Graceful Prinia (Prinia gracilis) that suggests two species are involved; and a reevaluation of species limits in Caribbean Sharp-shinned Hawk (Accipiter striatus) taxa.
Intensive and app-delivered occupational therapy to improve upper extremity function in early diffuse cutaneous systemic sclerosis: a pilot two-arm trial
Authors: Murphy Susan L , Barber Mary , Huang Suiyuan , Sabbagh Maya , Cutter Gary , Khanna Dinesh
Published: April 2021

Objective

SSc reduces upper extremity function and performance of everyday activities; however, there are few evidence-based rehabilitation interventions. This study examined short and longer-term effects of two occupational therapy interventions on hand disability.

Methods

Participants with diffuse cutaneous SSc were randomized to one of two 18-week interventions: Intensive group, receiving eight weekly in-person occupational therapy sessions with App-delivered home exercises, or App Alone group. The primary outcome was QuickDASH hand disability; secondary outcomes were physical function (PROMIS scale), and total active hand motion. Linear mixed models were used to examine treatment effects.

Results

Most participants were female (72%); the mean age was 52 years (13.4) (n = 32). There were no significant between-group effects on QuickDASH (P = 1.0; mean change −6.4 on 0–100 scale in both groups at 18 weeks). Left lateral pinch, an exploratory outcome, improved in App Alone compared with Intensive from baseline to 18 weeks. Within groups, the Intensive group had the largest improvements after 8 weeks (−8.5 on QuickDASH; P = 0.03), but then lost gains from 8 to 18 weeks while the App Alone group had modest improvements from baseline to 8 weeks, but then continued to improve. Of completers, 50% had clinically meaningful improvement on QuickDASH in the Intensive group and 64% had improvement in App Alone.

Conclusion

Both interventions showed beneficial effects on hand disability. Participants in the App Alone group improved equally to the Intensive group at 18 weeks. Our findings provide support for further study into telehealth rehabilitation approaches.

Trial registration

NCT03482219
A novel grey scale and Power Doppler ultrasonographic score for idiopathic inflammatory myopathies: Siena Myositis Ultrasound Grading Scale
Authors: Conticini Edoardo , Falsetti Paolo , Al Khayyat Suhel Gabriele , Baldi Caterina , Bellisai Francesca , Bardelli Marco , Sota Jurgen , Cantarini Luca , Frediani Bruno
Published: April 2021

Objectives

No clear-cut guidelines exist on the use of diagnostic procedures for idiopathic inflammatory myopathies (IIM) and only minimal and conflicting data report the use of ultrasound (US). In this regard, we aimed to assess if grey-scale (GS) and Power Doppler (PD) US, graded with a 0–3-point scale, may be a reliable tool in a cohort of patients affected by IIM.

Methods

All patients underwent US examination of both thighs in axial and longitudinal scans. Oedema and atrophy, both assessed in GS and PD, were graded with a 0–3-point scale. Spearman’s test was used to identify the correlations between US and clinical and serological variables.

Results

A total of 20 patients were included. Six and two patients were evaluated twice and three times, respectively. Muscle oedema was found to be directly correlated with physician global assessment (PhGA), serum myoglobin and PD and negatively with disease duration. PD score was positively correlated to PhGA and negatively to disease duration. Muscle atrophy directly correlated with Myositis Damage Index, disease duration and patient’s age. The single-thigh sub-analysis evidenced a direct correlation between PD score and Manual Muscle Test.

Conclusions

In our cohort, we found that oedema and PD are strictly related to early, active myositis, suggesting that an inflamed muscle should appear swollen, thickened and with Doppler signal. Conversely, muscle atrophy reflects the age of the patient and the overall severity of the disease. Such findings shed a new, promising, light on the role of US in diagnosis and monitoring of IIMs.
EURADOS STRATEGIC RESEARCH AGENDA 2020: VISION FOR THE DOSIMETRY OF IONISING RADIATION
Authors: Harrison R M , Ainsbury E , Alves J , Bottollier-Depois J-F , Breustedt B , Caresana M , Clairand I , Fantuzzi E , Fattibene P , Gilvin P , Hupe O , Knežević Ž , Lopez M A , Olko P , Olšovcová V , Rabus H , Rühm W , Silari M , Stolarczyk L , Tanner R , Vanhavere F , Vargas A , Woda C
Published: April 2021

Since 2012, the European Radiation Dosimetry Group (EURADOS) has developed its Strategic Research Agenda (SRA), which contributes to the identification of future research needs in radiation dosimetry in Europe. Continued scientific developments in this field necessitate regular updates and, consequently, this paper summarises the latest revision of the SRA, with input regarding the state of the art and vision for the future contributed by EURADOS Working Groups and through a stakeholder workshop. Five visions define key issues in dosimetry research that are considered important over at least the next decade. They include scientific objectives and developments in (i) updated fundamental dose concepts and quantities, (ii) improved radiation risk estimates deduced from epidemiological cohorts, (iii) efficient dose assessment for radiological emergencies, (iv) integrated personalised dosimetry in medical applications and (v) improved radiation protection of workers and the public. This SRA will be used as a guideline for future activities of EURADOS Working Groups but can also be used as guidance for research in radiation dosimetry by the wider community. It will also be used as input for a general European research roadmap for radiation protection, following similar previous contributions to the European Joint Programme for the Integration of Radiation Protection Research, under the Horizon 2020 programme (CONCERT). The full version of the SRA is available as a EURADOS report (www.eurados.org).
The relationship between childhood stress and distinct stages of dynamic behavior monitoring in adults: neural and behavioral correlates
Authors: Wu Jianhui , Liu Yutong , Fang Huihua , Qin Shaozheng , Kohn Nils , Duan Hongxia
Published: April 2021

Childhood adversity is a major risk factor for emotional and cognitive disorders later in adulthood. Behavior monitoring, one of the most important components of cognitive control, plays a crucial role in flexible interaction with the environment. Here, we test a novel conceptual model discriminating between two distinct dimensions of childhood adversity (i.e. deprivation and threat) and examine their relations to dynamic stages of behavior monitoring. Sixty young healthy adults participated in this study using event-related potentials and the dynamic stages of behavior monitoring including response inhibition, error detection and post-error adjustments were investigated in a classical Go/NoGo task. Multiple regression analyses revealed that participants with higher severity of childhood adversity recruited more controlled attention, as indicated by larger (more negative) conflict detection–related NoGo-N2 amplitudes and larger (more negative) error detection–related error-related negativity amplitudes. Higher severity of childhood abuse (an indicator of threat) was related to smaller (less positive) error appraisal–related error positivity amplitudes on the neural level and subsequently lower post-error accuracy on the behavioral level. These results suggested that prefrontal-supported controlled attention is influenced by universal adversity in childhood while the error-related behavioral adjustment is mainly affected by childhood abuse, indicating the dimensions of deprivation and threat are at least partially distinct.
The orbitofrontal cortex, food reward, body weight and obesity
Authors: Rolls Edmund T
Published: April 2021

In primates including humans, the orbitofrontal cortex is the key brain region representing the reward value and subjective pleasantness of the sight, smell, taste and texture of food. At stages of processing before this, in the insular taste cortex and inferior temporal visual cortex, the identity of the food is represented, but not its affective value. In rodents, the whole organisation of reward systems appears to be different, with reward value reflected earlier in processing systems. In primates and humans, the amygdala is overshadowed by the great development of the orbitofrontal cortex. Social and cognitive factors exert a top-down influence on the orbitofrontal cortex, to modulate the reward value of food that is represented in the orbitofrontal cortex. Recent evidence shows that even in the resting state, with no food present as a stimulus, the liking for food, and probably as a consequence of that body mass index, is correlated with the functional connectivity of the orbitofrontal cortex and ventromedial prefrontal cortex. This suggests that individual differences in these orbitofrontal cortex reward systems contribute to individual differences in food pleasantness and obesity. Implications of how these reward systems in the brain operate for understanding, preventing and treating obesity are described.
Six-State Amino Acid Recoding is not an Effective Strategy to Offset Compositional Heterogeneity and Saturation in Phylogenetic Analyses
Authors: Hernandez Alexandra M , Ryan Joseph F
Published: April 2021

Six-state amino acid recoding strategies are commonly applied to combat the effects of compositional heterogeneity and substitution saturation in phylogenetic analyses. While these methods have been endorsed from a theoretical perspective, their performance has never been extensively tested. Here, we test the effectiveness of six-state recoding approaches by comparing the performance of analyses on recoded and non-recoded data sets that have been simulated under gradients of compositional heterogeneity or saturation. In our simulation analyses, non-recoding approaches consistently outperform six-state recoding approaches. Our results suggest that six-state recoding strategies are not effective in the face of high saturation. Furthermore, while recoding strategies do buffer the effects of compositional heterogeneity, the loss of information that accompanies six-state recoding outweighs its benefits. In addition, we evaluate recoding schemes with 9, 12, 15, and 18 states and show that these consistently outperform six-state recoding. Our analyses of other recoding schemes suggest that under conditions of very high compositional heterogeneity, it may be advantageous to apply recoding using more than six states, but we caution that applying any recoding should include sufficient justification. Our results have important implications for the more than 90 published papers that have incorporated six-state recoding, many of which have significant bearing on relationships across the tree of life. [Compositional heterogeneity; Dayhoff 6-state recoding; S&R 6-state recoding; six-state amino acid recoding; substitution saturation.]
Efficacy of tailored recommendations to promote healthy lifestyles: a post hoc analysis of a randomized controlled trial
Authors: Barroso María , Zomeño M Dolors , Díaz Jorge L , Pérez Silvia , Martí-Lluch Ruth , Cordón Ferran , Ramos Rafel , Cabezas Carmen , Salvador Gemma , Castell Conxa , Schröder Helmut , Grau María
Published: April 2021

Prevention is the key to stopping the ravages of cardiovascular diseases, the main cause of death worldwide. The objective was to analyze the efficacy of tailored recommendations to promote healthy lifestyles. Parallel-arm randomized controlled trial with 1 year follow-up. Individuals aged 35–74 years from Girona (Spain) randomly selected from a population with no cardiovascular diseases at baseline were included. Participants in the intervention group received a brochure with tailored healthy choices according to the individual risk profile and a trained nurse explained all recommendations in detail in a 30 min consultation. One year changes in smoking, Mediterranean diet adherence, physical activity, and weight were analyzed with McNemar, Student’s t, Wilcoxon, and Fisher exact tests according to an intention-to-treat strategy. Of 955 individuals (52.3% women; mean age 50 [±10] years) randomly allocated to the intervention or control group, one participant in each group presented a cardiovascular event and 768 (81%) were reexamined at 1 year follow-up. The prevalence of nonsmokers increased in both the intervention and control groups (78.1%–82.5%, p = <.001, and 76.7% to 78.8%, p = .015, respectively); however, significance persisted only in the intervention group when stratified by sex, age group, and educational level. Adherence to a Mediterranean diet increased in the intervention group (22.3%–26.5%, p = .048). In conclusion, a brief personalized intervention with science-based recommendations according to individual risk profiles appears to improve healthy lifestyles, particularly nonsmoking and adherence to a Mediterranean diet. This promising intervention system offers evidence-based recommendations to develop healthy lifestyles.
Concerted control of the LaRAV1-LaCDKB1;3 module by temperature during dormancy release and reactivation of larch
Authors: Li Wan-Feng , Kang Yanhui , Zhang Yao , Zang Qiao-Lu , Qi Li-Wang
Published: April 2021

Dormancy release and reactivation of temperate-zone trees involve the temperature-modulated expression of cell-cycle genes. However, information on the detailed regulatory mechanism is limited. Here, we compared the transcriptomes of the stems of active and dormant larch trees, emphasizing the expression patterns of cell-cycle genes and transcription factors and assessed their relationships and responses to temperatures. Twelve cell-cycle genes and 31 transcription factors were strongly expressed in the active stage. Promoter analysis suggested that these 12 genes might be regulated by transcription factors from 10 families. Altogether, 73 cases of regulation between 16 transcription factors and 12 cell-cycle genes were predicted, while the regulatory interactions between LaMYB20 and LaCYCB1;1, and LaRAV1 and LaCDKB1;3 were confirmed by yeast one-hybrid and dual-luciferase assays. Last, we found that LaRAV1 and LaCDKB1;3 had almost the same expression patterns during dormancy release and reactivation induced naturally or artificially by temperature, indicating that the LaRAV1-LaCDKB1;3 module functions in the temperature-modulated dormancy release and reactivation of larch trees. These results provide new insights into the link between temperature and cell-cycle gene expression, helping to understand the temperature control of tree growth and development in the context of climate change.
Limited Evidence for Accumulation of Latent Infections of Canker-Causing Pathogens in Shoots of Stone Fruit and Nut Crops in California
Authors: Luo Yong , Niederholzer Franz J. A. , Lightle Dani M. , Felts Dan , Lake John , Michailides Themis J.
Published: April 2021

Prevalence of latent infections of the canker-causing fungi Botryosphaeria dothidea and species of Cytospora, Diplodia, Lasiodiplodia, Neofusicoccum, and Phomopsis in young shoots of almond, prune, and walnut trees in California was studied to test the hypotheses that latent infections accumulate from current-season shoots to 1-year-old shoots in the orchard and there are distinct associations among pathogen taxa present as latent infections in the same shoot. Samples of newly emerged and 1-year-old shoots were periodically collected in each almond, prune, and walnut orchard for two growing seasons. A real-time quantitative PCR assay was used to quantify latent infection with three parameters: incidence, molecular severity, and latent infection index. Diplodia spp. were absent from most samples. For almond, Lasiodiplodia spp. and Cytospora spp. were detected with a maximum incidence >90%, while B. dothidea and Neofusicoccum spp. incidence was <20% in most cases. In prune orchards, the incidence levels of B. dothidea were >50% in most cases, while those of Cytospora spp. and Lasiodiplodia spp. were 30 to 60% and 30 to 100%, respectively. For walnut, many samplings showed higher incidence in 1-year-old (30 to 80%) than in newly emerged shoots (10 to 50%). Accumulation of latent infection between the two shoot age classes was detected in only a few cases. The percentages of samples showing coexistence of two, three, and four pathogen taxa in the same shoot were 20 to 25, <10, and <5%, respectively. Pairwise associations among pathogen taxa in the same shoot were significant in many cases.
Supporting the Quadruple Aim Using Simulation and Human Factors During COVID-19 Care
Authors: Wong Ambrose H. , Ahmed Rami A. , Ray Jessica M. , Khan Humera , Hughes Patrick G. , McCoy Christopher Eric , Auerbach Marc A. , Barach Paul
Published: April 2021

The health care sector has made radical changes to hospital operations and care delivery in response to the coronavirus disease (COVID-19) pandemic. This article examines pragmatic applications of simulation and human factors to support the Quadruple Aim of health system performance during the COVID-19 era. First, patient safety is enhanced through development and testing of new technologies, equipment, and protocols using laboratory-based and in situ simulation. Second, population health is strengthened through virtual platforms that deliver telehealth and remote simulation that ensure readiness for personnel to deploy to new clinical units. Third, prevention of lost revenue occurs through usability testing of equipment and computer-based simulations to predict system performance and resilience. Finally, simulation supports health worker wellness and satisfaction by identifying optimal work conditions that maximize productivity while protecting staff through preparedness training. Leveraging simulation and human factors will support a resilient and sustainable response to the pandemic in a transformed health care landscape.
Expected Versus Experienced Health-Related Quality of Life Among Patients Recovering From Cancer Surgery
Authors: Panda Nikhil , Solsky Ian , Neal Brandon J. , Hawrusik Becky , Lipsitz Stuart , Lubitz Carrie C. , Gibbons Chris , Brindle Mary , Sinyard Robert D. , Onnela Jukka-Pekka , Cauley Christy E. , Haynes Alex B.
Published: April 2021

Introduction:

Patient expectations of the impact of surgery on postoperative health-related quality of life (HRQL) may reflect the effectiveness of patient-provider communication. We sought to compare expected versus experienced HRQL among patients undergoing cancer surgery.

Methods:

Adults undergoing cancer surgery were eligible for inclusion (2017–2019). Preoperatively, patients completed a smartphone-based survey assessing expectations for HRQL 1 week and 1, 3, and 6 months postoperatively based on the 8 short-form 36 (SF36) domains (physical functioning, physical role limitations, pain, general health, vitality, social functioning, emotional role limitations, and mental health). Experienced HRQL was then assessed through smartphone-based SF36 surveys 1, 3, and 6 months postoperatively. Correlations between 1- and 6-month trends in expected versus experienced HRQL were determined.

Results:

Among 101 consenting patients, 74 completed preoperative expectations and SF36 surveys (73%). The mean age was 54 years (SD 14), 49 (66%) were female, and the most common operations were for breast (34%) and abdominal (31%) tumors. Patients expected HRQL to worsen 1 week after surgery and improve toward minimal disability over 6 months. There was poor correlation (≤±0.4) between 1- and 6-month trends in expected versus experienced HRQL in all SF36 domains except for moderate correlation in physical functioning (0.50, 95% confidence interval [0.22–0.78], P < 0.001) and physical role limitations (0.41, 95% confidence interval [0.05–0.77], P = 0.024). Patients expected better HRQL than they experienced.

Conclusions:

Preoperative expectations of postoperative HRQL correlated poorly with lived experiences except in physical health domains. Surgeons should evaluate factors which inform expectations around physical and psychosocial health and use these data to enhance shared decision-making.
Long Thoracic Nerve Transfer for Children With Brachial Plexus Injuries
Authors: Kluemper Chase , Aversano Mike , Kozin Scott , Zlotolow Dan A.
Published: April 2021

Introduction:

The transfer of intraplexal and extraplexal nerves for restoration of function in children with traumatic and birth brachial plexus palsies has become well accepted. Little has been written about using the long thoracic nerve (LTN) as a donor in reanimation of the upper extremity. The authors present a case series of nerve transfers using the LTN as a donor in brachial plexus injury.

Methods:

A retrospective chart review was performed over a 10-year period at a single institution. The primary outcome measure was the active movement scale.

Results:

Fourteen patients were included in the study: 10 birth injury patients and 4 blunt trauma patients. Average follow-up time was 21.3 and 10.75 months, respectively. The best outcomes were seen when the LTN was used for reinnervation of the obturator nerve in free functioning muscle transfers. The next most successful recipients were the musculocutaneous and axillary nerves. Outcomes were poor in transfers to the posterior interosseous fascicles of the radial nerve and the radial nerve branches to the triceps.

Discussion:

The LTN may be a potential nerve donor for musculocutaneous or axillary nerve reinnervation in patients with brachial plexus injuries when other donors are not available during a primary plexus reconstruction. However, the best use may be for delayed neurotization of a free functioning muscle transfer after the initial plexus reconstruction has failed and no other donors are available.

Level of Evidence:

Level IV—therapeutic study.
A New Low Dose of Tranexamic Acid for Decreasing the Rate of Blood Loss in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis
Authors: Halpern Lloyd M. , Bronson William E. , Kogan Clark J.
Published: April 2021

Background:

Previous studies have demonstrated that the use of tranexamic acid (TXA) reduces blood loss and transfusion requirements in children undergoing scoliosis surgery. Although TXA is safe and effective, significant adverse events have been reported. Using the lowest effective dose of TXA is advisable. We evaluated a new low dosing regimen for TXA based on an improved pharmacokinetic model and therapeutic plasma concentration. The purpose of this study is to evaluate the effectiveness of this new low dosing regimen in reducing blood loss and transfusion requirements in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion when compared with a control group who did not receive TXA.

Methods:

We retrospectively reviewed 90 consecutive patients with idiopathic scoliosis undergoing posterior spinal fusion at our institution from 2017 to 2020. Forty patients received TXA at the new dosing regimen (10 mg/kg load, 5 mg/kg/h infusion) and 50 patients were in the non-TXA control group. The same 2 orthopaedic surgeons, working as a team, performed all surgical procedures. We assessed the use of TXA as an independent risk factor for estimated blood loss and transfusion requirement after adjusting for age, surgical duration, body mass index, major coronal curve, and sex.

Results:

A comparison of the intraoperative cumulative blood loss in the 2 groups showed a significantly lower blood loss in the TXA group. (583.5±272.0 vs. 479.5±288.7 mL, P=0.03) This difference persisted when blood loss was calculated as percent of total blood volume and per vertebral level. Transfusion requirements were lower in the TXA group (4/50 patients vs. 0/40 patients, P=0.13). No patient in the TXA group required a blood transfusion during their hospitalization.

Conclusion:

This study is the first to provide evidence that a new low dosing regimen of TXA can significantly reduce blood loss and transfusion requirements for idiopathic scoliosis patients and supports the need for a prospective, randomized clinical trial to confirm these findings.

Level of Evidence:

Level III—retrospective cohort study.
The Use of Halo Gravity Traction in Severe, Stiff Scoliosis
Authors: Rocos Brett , Reda Luke , Lebel David E. , Dodds Michael K. , Zeller Reinhard
Published: April 2021

Purpose:

The correction of severe, stiff scoliosis in children is challenging. One method used to reduce the risk is preoperative halo gravity traction (HGT). In this study, the authors sought to define the efficiency and safety of HGT and characterize the chronology of the correction seen.

Method:

A consecutive group of pediatric patients with severe spinal deformities was treated with HGT before definitive correction. A standard protocol with the daily addition of weight to 50% of body weight at 3 weeks was used. Traction remained in place until signs of impending neurological complication or 6 weeks, whichever was sooner.

Results:

Twenty-four patients were included with a mean age of 11.8 years. The mean coronal deformity was 123 degrees, with a T1-L5 height of 234 mm. The mean duration of traction was 42 days with a mean improvement in height of 72 mm with 82% occurring over the first 3 weeks. Hundred percent of the angular and 98% of T1-L5 height correction was reached by 6 weeks.

One patient showed early signs of a cranial nerve palsy prompting early surgery and 8 patients showed pin loosening, 1 of which required revision of their halo. One patient underwent a slower progression of traction because of transitory urinary disturbance. Following fusion, angular correction of the major curve was 49%.

Conclusion:

HGT is a safe treatment for severe, stiff scoliosis because it can respond to early signs of impending neurological impairment. The first 3 weeks of treatment, reaching 50% of body weight as a traction force accounts for 80% of correction, with the remaining 20% in the following 2 weeks. At least 4 weeks of traction is recommended when following this protocol.
Anterior Cervical Discectomy and Fusion Versus Conservative Treatment for Cervical Angina Conservative Treatment
Authors: Chien Jui-Teng , Hsieh Min-Hong , Yang Chang-Chen , Chen Ing-Ho , Lee Ru-Ping
Published: April 2021

Study Design:

This study employed a retrospective study design.

Objective:

This retrospective cohort study aimed to compare the outcomes of anterior cervical discectomy and fusion (ACDF), and those of conservative treatment for patients with cervical angina.

Summary of Background Data:

Cervical angina is typically characterized by intolerable and paroxysmal angina-like precordial pain, which is caused by cervical disk degeneration in patients without definitive cardiovascular abnormalities. Diagnosis is either delayed or neglected because of its various clinical manifestations. Whether conservative or surgical treatment is appropriate remains controversial because of the lack of comparative studies.

Materials and Methods:

From 2009 to 2016, 163 patients with cervical angina with advanced chest pain, tightness, or palpitation were retrospectively studied. Twenty-three patients underwent ACDF, and the other 140 patients were treated nonsurgically by medication, physical therapy, collar immobilization, or stellate ganglion block. Japanese Orthopedic Association (JOA) score and 20-point autonomic nervous system (ANS) score were assessed pretreatment and posttreatment. Patients’ satisfaction was assessed using the Odom criteria.

Results:

The average age of the patients was 50 years, and most of them were females. The average follow-up was 25.5 months. The pretreatment JOA and 20-point ANS scores in the conservative and ACDF groups were 13.3 versus 11.7 (P=0.110) and 13.0 versus 13.3 (P=0.928), respectively. Generalized estimating equation analysis showed that posttreatment JOA and ANS scores at each observation interval improved significantly in the ACDF group (P<0.001). Angina-like symptoms also improved significantly in the ACDF group (P<0.001). During an average 2-year follow-up, good or excellent results were obtained in 78.2% of surgical patients and 35% of nonsurgical patients.

Conclusions:

Compared with conservative therapy, surgical treatment with ACDF for cervical angina provided better and more consistent relief from angina-like symptoms and overall sympathetic symptoms.

Level of Evidence:

Level III.
Outcome Related to Level of Targeted Temperature Management in Postcardiac Arrest Syndrome of Low, Moderate, and High Severities: A Nationwide Multicenter Prospective Registry
Authors: Nishikimi Mitsuaki , Ogura Takayuki , Nishida Kazuki , Hayashida Kei , Emoto Ryo , Matsui Shigeyuki , Matsuda Naoyuki , Iwami Taku
Published: April 2021

OBJECTIVES:

The optimal target temperature during targeted temperature management for patients after cardiac arrest remains under debate. The aim of this study was to evaluate the association between targeted temperature management at lower target temperatures and the neurologic outcomes among patients classified by the severity of postcardiac arrest syndrome.

DESIGN:

A multicenter observational study from the out-of-hospital cardiac arrest registry of the Japanese Association for Acute Medicine, which is a nationwide prospective registry of out-of-hospital cardiac arrest patients.

SETTING:

A total of 125 critical care medical centers or hospitals with an emergency care department across Japan.

PATIENTS:

A total of 1,111 out-of-hospital cardiac arrest patients who had received targeted temperature management.

MEASUREMENTS AND MAIN RESULTS:

We divided all 1,111 postcardiac arrest syndrome patients treated with targeted temperature management into two groups: those who received targeted temperature management at a lower target temperature (33–34°C) and those who received targeted temperature management at a higher target temperature (35–36°C). In regard to classification of the patients, we divided the patients into three categories of severity (low, moderate, and high severities) using the risk classification tool, post-Cardiac Arrest Syndrome for Therapeutic hypothermia, which was previously validated. The primary outcome was the percentage of patients with a good neurologic outcome at 30 days, and the secondary outcome was the survival rate at 30 days. Multivariate analysis showed that targeted temperature management at 33–34°C was significantly associated with a good neurologic outcome and survival at 30 days in the moderate severity (odds ratio, 1.70 [95% CI, 1.03–2.83] and 1.90 [95% CI, 1.15–3.16], respectively), but not in the patients of low or high severity (pinteraction = 0.033). Propensity score analysis also showed that targeted temperature management at 33–34°C was associated with a good neurologic outcome in the moderate-severity group (p = 0.022).

CONCLUSIONS:

Targeted temperature management at 33–34°C was associated with a significantly higher rate of a good neurologic outcome in the moderate-severity postcardiac arrest syndrome group, but not in the low- or high-severity group.
Comparing Minor Hand Procedures Performed with or without the Use of a Tourniquet: A Randomized Controlled Trial
Authors: Saleh Eli , Saleh Joseph , Govshievich Alexander , Ferland-Caron Geneviève , Lin Jenny C. , Tremblay Dominique M.
Published: April 2021

Background:

Carpal tunnel syndrome and trigger finger are two of the most common conditions treated by the hand surgeon. During these procedures, a tourniquet is often used to minimize bleeding and improve visualization of the operative field. However, it may be associated with pain and discomfort. To date, there are few prospective studies investigating the safety and patient-centered outcomes of tourniquet-free minor hand procedures.

Methods:

This is a randomized controlled trial comparing patients undergoing open carpal tunnel or trigger finger release with or without the use of a tourniquet. Perioperative subjective patient experience was investigated for both techniques. This was measured based on a numerical rating scale for pain, anxiety, and overall satisfaction. In addition, this was an equivalence trial in terms of operative time, bleeding scores, and perioperative complication rates.

Results:

A total of 67 patients were recruited. Both groups were similar with respect to distribution of age, sex, handedness, anti-platelet use, and tobacco use. Median scores for operative time, anxiety, and overall satisfaction were comparable between the 2 groups. With regard to patient discomfort, median scores were significantly higher in the tourniquet group when compared with the no tourniquet group (3.58 versus 1.68, respectively, P = 0.02). Bleeding scores for the tourniquet group were significantly lower than for the no tourniquet group (1.14 versus 1.90, respectively, P = 0.001).

Conclusions:

The application of wide awake local anesthesia no tourniquet (WALANT) in minor hand surgery procedures has been shown to decrease tourniquet-associated discomfort, improving perioperative patient experience. Additionally, it demonstrated the noninferiority of the tourniquet-free technique with respect to operative time and the rate of perioperative complications.
Intraoral Genioplasty—A Newer Technique
Authors: Saleh Eli , Saleh Joseph , Saleh Benjamin
Published: April 2021

In this article, we present a new surgical approach to the mandible that can be used for implant placement or osseus genioplasty. This approach is virtually scarless, helps in reducing blood loss due to a subperiosteal dissection, may theoretically reduce the risk of mental nerve damage, and helps reduce postoperative functional recovery time, as the mentalis muscle is never transected, only reflected.