bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term clinical outcomes of salvage pelvic radiation therapy for oligo-recurrent pelvic lymph nodes after definitive external-beam radiation therapy for non-metastatic prostate cancer
Authors: Sato Genki Edward , Aizawa Rihito , Nakamura Kiyonao , Takayama Kenji , Inoue Takahiro , Yamasaki Toshinari , Kobayashi Takashi , Akamatsu Shusuke , Ogawa Osamu , Mizowaki Takashi
Published: June 2020

Although salvage external-beam radiation therapy (EBRT) is an attractive treatment option for pelvic lymph nodal recurrence (PeNR) in patients with prostate cancer (PCa), limited data are available regarding its long-term efficacy. This study examined the long-term clinical outcomes of patients who underwent salvage pelvic radiation therapy (sPRT) for oligo-recurrent pelvic lymph nodes after definitive EBRT for non-metastatic PCa. Patients who developed PeNR after definitive EBRT and were subsequently treated with sPRT at our institution between November 2007 and December 2015 were retrospectively analyzed. The prescribed dose was 45–50.4 Gy (1.8–2 Gy per fraction) to the upper pelvis, with up to 54–66 Gy (1.8–2 Gy per fraction) for recurrent nodes. Long-term hormonal therapy was used as neoadjuvant and/or adjuvant therapy. The study population consisted of 12 consecutive patients with PeNR after definitive EBRT (median age: 73 years). The median follow-up period was 58.9 months. The 5-year overall survival, PCa-specific survival, biochemical failure-free, clinical failure-free, and castration-resistant PCa-free rates were 82.5, 100.0, 62.3, 81.8, and 81.8%, respectively. No grade 2 or higher sPRT-related late toxicities occurred. In conclusion, more than half of the study patients treated with sPRT had a long-term disease-free status with acceptable morbidities. Moreover, most of the patients maintained hormonal sensitivity. Therefore, this approach may be a promising treatment method for oligo-recurrent pelvic lymph nodes.
Clinical Value of Detecting Anti-Mutated Citrullinated Vimentin, Anti-Cyclic Citrullinated Peptide, Red Cell Distribution Width and 25-Hydroxyvitamin D in the Diagnosis of Rheumatoid Arthritis
Authors: Tan Liming , Gong Yangyang , Zhang Qian , Zhang Haocheng , Lu Xiaoxia , Huang Huijin
Published: June 2020

Objectives

To investigate the clinical value of detecting anti–mutated citrullinated vimentin (anti-MCV), anti-citrullinated peptide (anti-CCP), red-blood-cell distribution width (RDW), and 25-hydroxyvitamin D (25-[OH]D) in the diagnosis of rheumatoid arthritis (RA).

Methods

We enrolled 119 patients with RA, 114 control individuals without RA (disease controls), and 40 healthy controls in our study (Han Chinese). Anti-CCP and anti-MCV were detected by enzyme-linked immunosorbent assay (ELISA), 25-(OH)D was detected by electrochemical luminescence, and RDW was calculated by erythrocyte parameters detected via the electric resistance method.

Results

The serum levels of anti-CCP and anti-MCV in RA were higher than those in disease controls and healthy controls (P <.01). The areas under the curve (AUCs) of anti-MCV, anti-CCP, RDW, and 25-(OH)D were 0.857, 0.890, 0.611, and 0.569 respectively (P <.05). In various combinations of indicators, when RDW, 25-(OH)D, and anti-CCP; or RDW, 25-(OH)D, anti-CCP, and anti-MCV were connected in parallel, the sensitivity was the highest (all 94.1%). Also, when RDW, 25-(OH)D, anti-CCP, and anti-MCV were connected in series, the sensitivity was the lowest (13.4%).

Conclusions

Anti-CCP and anti-MCV are ideal indices for RA diagnosis. Also, in combination with RDW and 25-(OH)D, the diagnostic level will be improved, as well as the sensitivity and specificity, which is significant for the differential diagnosis of RA.
ASAS census of twins
Authors: Bakış Volkan , Eker Zeki , Sarı Oğuzhan , Yücel Gökhan , Sonbaş Eda
Published: June 2020

Twin binaries were identified among the eclipsing binaries with δ > –30° listed in the All Sky Automated Survey (ASAS) catalogue. In addition to the known twin binaries in the literature, 68 new systems have been identified and photometric and spectroscopic observations were done. Colour, spectral type, temperature, ratio of radii and masses of the components have been derived and are presented. Including 12 twin binary systems that exist in both ASAS and the catalogue of absolute parameters of detached eclipsing binary stars, a total of 80 twin detached binary systems have been statistically studied. A comparison of the spectral type distribution of the twins with those of detached eclipsing binary stars in the ASAS database shows that the spectral type distribution of twins is similar to that of detached systems. This result has been interpreted as indicating that there is no special formation mechanism for twins compared to normal detached binaries. As a result of our case study for HD 154010, a twin binary, we present the precise physical parameters of the system.
Thermal spectra of thin accretion discs of finite thickness around Kerr black holes
Authors: Zhou Menglei , Abdikamalov Askar B , Ayzenberg Dimitry , Bambi Cosimo , Grinberg Victoria , Tripathi Ashutosh
Published: June 2020

The analysis of the thermal spectrum of geometrically thin and optically thick accretion discs of black holes, the so-called continuum-fitting method, is one of the leading techniques for measuring black hole spins. Current models normally approximate the disc as infinitesimally thin, while in reality the disc thickness is finite and increases as the black hole mass accretion rate increases. Here we present an XSPEC model to calculate the multitemperature blackbody spectrum of a thin accretion disc of finite thickness around a Kerr black hole. We test our new model with an RXTE observation of the black hole binary GRS 1915+105. We find that the spin value inferred with the new model is slightly higher than the spin value obtained with a model with an infinitesimally thin disc, but the difference is small and the effect is currently subdominant with respect to other sources of uncertainties in the final spin measurement.
LOFAR observations of X-ray cavity systems
Authors: Bîrzan L , Rafferty D A , Brüggen M , Botteon A , Brunetti G , Cuciti V , Edge A C , Morganti R , Röttgering H J A , Shimwell T W
Published: June 2020

We present LOFAR observations at 120–168 MHz of 42 systems with possible X-ray cavities in their hot atmosphere, of which 17 are groups or ellipticals, 19 are nearby clusters (z < 0.3), and six are higher redshift clusters (z > 0.3). The X-ray cavities, formed by the radio lobes of the central active galactic nucleus (AGN), are evidence of radio-mode AGN feedback. In the groups and ellipticals sample, half of the systems have X-ray cavities for which no associated lobe emission was detected. Conversely, we report the discovery of large radio lobes in NGC 6338, extending far beyond the emission reported previously in the literature. In the case of the nearby clusters, our observations show that there is little low-frequency radio emission that extends beyond the cavities (e.g. MS 0735.6+7421, A2052). For the first time, we report secure cavity-radio associations in 2A 0335+096, ZwCl 2701, and ZwCl 8276 that strengthens their interpretation as AGN-created cavities. However, in some known cavity systems (e.g. A1795 and ZwCl 3146) we report the lack of detectable low-frequency radio emission associated with the cavities. Our sample of higher redshifts systems is small, and unfortunately the present LOFAR observations are not able to resolve the lobes in many of them. Nevertheless, our sample represents one of the best available for investigating the connection between radio and jet power in radio-mode AGN feedback.
The Herschel SPIRE Fourier Transform Spectrometer Spectral Feature Finder I. The Spectral Feature Finder and Catalogue
Authors: Hopwood R , Valtchanov I , Spencer L D , Scott J , Benson C , Marchili N , Hładczuk N , Polehampton E T , Lu N , Makiwa G , Naylor D A , Gom B G , Noble G , Griffin M J
Published: June 2020

We provide a detailed description of the Herschel/SPIRE Fourier Transform Spectrometer (FTS) Spectral Feature Finder (FF). The FF is an automated process designed to extract significant spectral features from SPIRE FTS data products. Optimizing the number of features found in SPIRE-FTS spectra is challenging. The wide SPIRE-FTS frequency range (447–1568 GHz) leads to many molecular species and atomic fine structure lines falling within the observed bands. As the best spectral resolution of the SPIRE-FTS is ∼1.2 GHz, there can be significant line blending, depending on the source type. In order to find, both efficiently and reliably, features in spectra associated with a wide range of sources, the FF iteratively searches for peaks over a number of signal-to-noise ratio (SNR) thresholds. For each threshold, newly identified features are rigorously checked before being added to the fitting model. At the end of each iteration, the FF simultaneously fits the continuum and features found, with the resulting residual spectrum used in the next iteration. The final FF products report the frequency of the features found and the associated SNRs. Line flux determination is not included as part of the FF products, as extracting reliable line flux from SPIRE-FTS data is a complex process that requires careful evaluation and analysis of the spectra on a case-by-case basis. The FF results are 100 per cent complete for features with SNR greater than 10 and 50–70 per cent complete at SNR of 5. The FF code and all FF products are publicly available via the Herschel Science Archive.
High and Highly Variable Spontaneous Mutation Rates in Daphnia
Authors: Ho Eddie K H , Macrae Fenner , Latta Leigh C , McIlroy Peter , Ebert Dieter , Fields Peter D , Benner Maia J , Schaack Sarah
Published: June 2020

The rate and spectrum of spontaneous mutations are critical parameters in basic and applied biology because they dictate the pace and character of genetic variation introduced into populations, which is a prerequisite for evolution. We use a mutation–accumulation approach to estimate mutation parameters from whole-genome sequence data from multiple genotypes from multiple populations of Daphnia magna, an ecological and evolutionary model system. We report extremely high base substitution mutation rates (µ-n,bs = 8.96 × 10−9/bp/generation [95% CI: 6.66–11.97 × 10−9/bp/generation] in the nuclear genome and µ-m,bs = 8.7 × 10−7/bp/generation [95% CI: 4.40–15.12 × 10−7/bp/generation] in the mtDNA), the highest of any eukaryote examined using this approach. Levels of intraspecific variation based on the range of estimates from the nine genotypes collected from three populations (Finland, Germany, and Israel) span 1 and 3 orders of magnitude, respectively, resulting in up to a ∼300-fold difference in rates among genomic partitions within the same lineage. In contrast, mutation spectra exhibit very consistent patterns across genotypes and populations, suggesting the mechanisms underlying the mutational process may be similar, even when the rates at which they occur differ. We discuss the implications of high levels of intraspecific variation in rates, the importance of estimating gene conversion rates using a mutation–accumulation approach, and the interacting factors influencing the evolution of mutation parameters. Our findings deepen our knowledge about mutation and provide both challenges to and support for current theories aimed at explaining the evolution of the mutation rate, as a trait, across taxa.
More Than One-to-Four via 2R: Evidence of an Independent Amphioxus Expansion and Two-Gene Ancestral Vertebrate State for MyoD-Related Myogenic Regulatory Factors (MRFs)
Authors: Aase-Remedios Madeleine E , Coll-Lladó Clara , Ferrier David E K
Published: June 2020

The evolutionary transition from invertebrates to vertebrates involved extensive gene duplication, but understanding precisely how such duplications contributed to this transition requires more detailed knowledge of specific cases of genes and gene families. Myogenic differentiation (MyoD) has long been recognized as a master developmental control gene and member of the MyoD family of bHLH transcription factors (myogenic regulatory factors [MRFs]) that drive myogenesis across the bilaterians. Phylogenetic reconstructions within this gene family are complicated by multiple instances of gene duplication and loss in several lineages. Following two rounds of whole-genome duplication (2R WGD) at the origin of the vertebrates, the ancestral function of MRFs is thought to have become partitioned among the daughter genes, so that MyoD and Myf5 act early in myogenic determination, whereas Myog and Myf6 are expressed later, in differentiating myoblasts. Comparing chordate MRFs, we find an independent expansion of MRFs in the invertebrate chordate amphioxus, with evidence for a parallel instance of subfunctionalization relative to that of vertebrates. Conserved synteny between chordate MRF loci supports the 2R WGD events as a major force in shaping the evolution of vertebrate MRFs. We also resolve vertebrate MRF complements and organization, finding a new type of vertebrate MRF gene in the process, which allowed us to infer an ancestral two-gene state in the vertebrates corresponding to the early- and late-acting types of MRFs. This necessitates a revision of previous conclusions about the simple one-to-four origin of vertebrate MRFs.
A sensitive assay for dNTPs based on long synthetic oligonucleotides, EvaGreen dye and inhibitor-resistant high-fidelity DNA polymerase
Authors: Purhonen Janne , Banerjee Rishi , McDonald Allison E , Fellman Vineta , Kallijärvi Jukka
Published: June 2020

Deoxyribonucleoside triphosphates (dNTPs) are vital for the biosynthesis and repair of DNA. Their cellular concentration peaks during the S phase of the cell cycle. In non-proliferating cells, dNTP concentrations are low, making their reliable quantification from tissue samples of heterogeneous cellular composition challenging. Partly because of this, the current knowledge related to the regulation of and disturbances in cellular dNTP concentrations derive mostly from cell culture experiments with little corroboration at the tissue or organismal level. Here, we fill the methodological gap by presenting a simple non-radioactive microplate assay for the quantification of dNTPs with a minimum requirement of 4–12 mg of biopsy material. In contrast to published assays, this assay is based on long synthetic single-stranded DNA templates (50–200 nucleotides), an inhibitor-resistant high-fidelity DNA polymerase, and the double-stranded-DNA-binding EvaGreen dye. The assay quantified reliably less than 50 fmol of each of the four dNTPs and discriminated well against ribonucleotides. Additionally, thermostable RNAse HII-mediated nicking of the reaction products and a subsequent shift in their melting temperature allowed near-complete elimination of the interfering ribonucleotide signal, if present. Importantly, the assay allowed measurement of minute dNTP concentrations in mouse liver, heart and skeletal muscle.
Multicenter registry analysis comparing survival on home hemodialysis and kidney transplant recipients in Australia and New Zealand
Authors: Ethier Isabelle , Cho Yeoungjee , Hawley Carmel , Pascoe Elaine M , Roberts Matthew A , Semple David , Nadeau-Fredette Annie-Claire , Wong Germaine , Lim Wai H , Sypek Matthew P , Viecelli Andrea K , Campbell Scott , van Eps Carolyn , Isbel Nicole M , Johnson David W
Published: June 2020

Background

In the era of organ shortage, home hemodialysis (HHD) has been identified as the possible preferential bridge to kidney transplantation. Data are conflicting regarding the comparability of HHD and transplantation outcomes. This study aimed to compare patient and treatment survival between HHD patients and kidney transplant recipients.

Methods

The Australia and New Zealand Dialysis and Transplant Registry was used to include incident HHD patients on Day 90 after initiation of kidney replacement therapy and first kidney-only transplant recipients in Australia and New Zealand from 1997 to 2017. Survival times were analyzed using the Kaplan–Meier product-limit method comparing HHD patients with subtypes of kidney transplant recipients using the log-rank test. Adjusted analyses were performed with multivariable Cox proportional hazards regression models for time to all-cause mortality. Time-to-treatment failure or death was assessed as a composite secondary outcome.

Results

The study compared 1411 HHD patients with 4960 living donor (LD) recipients, 6019 standard criteria donor (SCD) recipients and 2427 expanded criteria donor (ECD) recipients. While LD and SCD recipients had reduced risks of mortality compared with HHD patients [LD adjusted hazard ratio (HR) = 0.57, 95% confidence interval (CI) 0.46–0.71; SCD HR = 0.65 95% CI 0.52–0.79], the risk of mortality was comparable between ECD recipients and HHD patients (HR = 0.90, 95% CI 0.73–1.12). LD, SCD and ECD kidney recipients each experienced superior time-to-treatment failure or death compared with HHD patients.

Conclusions

This large registry study showed that kidney transplant offers a survival benefit compared with HHD but that this advantage is not significant for ECD recipients.
Hypoperfusion warm ischaemia time in renal transplants from donors after circulatory death
Authors: Kostakis Ioannis D , Kassimatis Theodoros , Flach Clare , Karydis Nikolaos , Kessaris Nicos , Loukopoulos Ioannis
Published: June 2020

Background

The donor hypoperfusion phase before asystole in renal transplants from donors after circulatory death (DCD) has been considered responsible for worse outcomes than those from donors after brain death (DBD).

Methods

We included 10 309 adult renal transplants (7128 DBD and 3181 DCD; 1 January 2010–31 December 2016) from the UK Transplant Registry. We divided DCD renal transplants into groups according to hypoperfusion warm ischaemia time (HWIT). We compared delayed graft function (DGF) rates, primary non-function (PNF) rates and graft survival among them using DBD renal transplants as a reference.

Results

The DGF rate was 21.7% for DBD cases, but ∼40% for DCD cases with HWIT ≤30 min (0–10 min: 42.1%, 11–20 min: 43%, 21–30 min: 38.4%) and 60% for DCD cases with HWIT >30 min (P < 0.001). All DCD groups showed higher DGF risk than DBD renal transplants in multivariable analysis {0–10 min: odds ratio [OR] 2.686 [95% confidence interval (CI) 2.352–3.068]; 11–20 min: OR 2.531 [95% CI 2.003–3.198]; 21–30 min: OR 1.764 [95% CI 1.017–3.059]; >30 min: OR 5.814 [95% CI 2.798–12.081]}. The highest risk for DGF in DCD renal transplants with HWIT >30 min was confirmed by multivariable analysis [versus DBD: OR 5.814 (95% CI 2.798–12.081) versus DCD: 0–10 min: OR 2.165 (95% CI 1.038–4.505); 11–20 min: OR 2.299 (95% CI 1.075–4.902); 21–30 min: OR 3.3 (95% CI 1.33–8.197)]. No significant differences were detected regarding PNF rates (P = 0.713) or graft survival (P = 0.757), which was confirmed by multivariable analysis.

Conclusions

HWIT >30 min increases the risk for DGF greatly, but without affecting PNF or graft survival.
Experience With the Pipeline Embolization Device for Posterior Circulations Aneurysms: A Multicenter Cohort Study
Authors: Griessenauer Christoph J , Enriquez-Marulanda Alejandro , Taussky Philipp , Biswas Arundhati , Grandhi Ramesh , Xiang Sissi , Hong Tao , Rinaldo Lorenzo , Lanzino Giuseppe , Brinjikji Waleed , Burkhardt Jan-Karl , Kan Peter , Ghuman Mandeep , Yang Victor X D , Chen Karen , Aziz-Sultan Mohammad A , Ghorbani Mohammad , Schirmer Clemens M , Goren Oded , Dalal Shamsher S , Killer-Oberpfalzer Monika , Müller-Thies-Broussalis Erasmia , Koch Matthew J , Stapleton Christopher J , Patel Aman B , Foreman Paul M , Cress Marshall C , Hirschl Robert A , Krings Timo , Zhang Hongqi , Dmytriw Adam A
Published: June 2020

BACKGROUND

The Pipeline Embolization Device (PED; Medtronic) has been used off-label for the treatment of challenging posterior circulation aneurysms. Data on this modality are primarily limited to small retrospective single-center series.

OBJECTIVE

To assess safety and efficacy of this treatment by establishing an international, multicenter collaboration.

METHODS

Consecutive posterior circulation aneurysms treated with the PED from 2012 to 2019 across 11 neurovascular centers were retrospectively reviewed. Baseline demographics, aneurysm and treatment characteristics, complications, occlusion status, and functional outcome were assessed.

RESULTS

There were 149 posterior circulation aneurysms treated with PED in 146 patients. A total of 24 (16.4%) patients presented with subarachnoid hemorrhage. Most aneurysms were dissecting/blister (36.2%) in morphology, followed by saccular (35.6%) and fusiform (28.2%). The most common locations were the vertebral (51.7%) and basilar arteries (22.8%). Complete or near-complete occlusion (>90%) was achieved in 90.9% of aneurysms at a median follow-up of 12 mo. Dissecting/blister aneurysms were most likely to occlude (P = .06). Symptomatic neurologic complications occurred in 9.4% of aneurysms, associated with larger size, ruptured presentation, presentations with brain stem compression, cranial nerve palsy, or stroke. Favorable functional outcome (modified Rankin Score 0-2) was achieved in 86.2% of patients. There were 6 fatalities of which 4 occurred in aneurysmal subarachnoid hemorrhage patients.

CONCLUSION

This multicenter study shows that PED for the treatment of posterior circulation is preferentially used for the treatment of fusiform and dissecting/blister aneurysm morphologies. Despite the challenges presented by these less-common morphologies, flow diversion may be performed with a neurologic complication rate of about 10% and favorable long-term aneurysm occlusion rates.
Guidelines for the Management of Severe Traumatic Brain Injury: 2020 Update of the Decompressive Craniectomy Recommendations
Authors: Hawryluk Gregory W J , Rubiano Andres M , Totten Annette M , O’Reilly Cindy , Ullman Jamie S , Bratton Susan L , Chesnut Randall , Harris Odette A , Kissoon Niranjan , Shutter Lori , Tasker Robert C , Vavilala Monica S , Wilberger Jack , Wright David W , Lumba-Brown Angela , Ghajar Jamshid
Published: June 2020

When the fourth edition of the Brain Trauma Foundation's Guidelines for the Management of Severe Traumatic Brain Injury were finalized in late 2016, it was known that the results of the RESCUEicp (Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension) randomized controlled trial of decompressive craniectomy would be public after the guidelines were released. The guideline authors decided to proceed with publication but to update the decompressive craniectomy recommendations later in the spirit of “living guidelines,” whereby topics are updated more frequently, and between new editions, when important new evidence is published. The update to the decompressive craniectomy chapter presented here integrates the findings of the RESCUEicp study as well as the recently published 12-mo outcome data from the DECRA (Decompressive Craniectomy in Patients With Severe Traumatic Brain Injury) trial. Incorporation of these publications into the body of evidence led to the generation of 3 new level-IIA recommendations; a fourth previously presented level-IIA recommendation remains valid and has been restated. To increase the utility of the recommendations, we added a new section entitled Incorporating the Evidence into Practice. This summary of expert opinion provides important context and addresses key issues for practitioners, which are intended to help the clinician utilize the available evidence and these recommendations.

The full guideline can be found at: https://braintrauma.org/guidelines/guidelines-for-the-management-of-severe-tbi-4th-ed#/.
Overexpression of HGF/MET axis along with p53 inhibition induces de novo glioma formation in mice
Authors: Qin Yuan , Musket Anna , Kou Jianqun , Preiszner Johanna , Tschida Barbara R , Qin Anna , Land Craig A , Staal Ben , Kang Liang , Tanner Kirk , Jiang Yong , Schweitzer John B , Largaespada David A , Xie Qian
Published: June 2020

Background

Aberrant MET receptor tyrosine kinase (RTK) activation leads to invasive tumor growth in different types of cancer. Overexpression of MET and its ligand hepatocyte growth factor (HGF) occurs more frequently in glioblastoma (GBM) than in low-grade gliomas. Although we have shown previously that HGF-autocrine activation predicts sensitivity to MET tyrosine kinase inhibitors (TKIs) in GBM, whether it initiates tumorigenesis remains elusive.

Methods

Using a well-established Sleeping Beauty (SB) transposon strategy, we injected human HGF and MET cDNA together with a short hairpin siRNA against Trp53 (SB-hHgf.Met.ShP53) into the lateral ventricle of neonatal mice to induce spontaneous glioma initiation and characterized the tumors with H&E and immunohistochemistry analysis. Glioma sphere cells also were isolated for measuring the sensitivity to specific MET TKIs.

Results

Mixed injection of SB-hHgf.Met.ShP53 plasmids induced de novo glioma formation with invasive tumor growth accompanied by HGF and MET overexpression. While glioma stem cells (GSCs) are considered as the tumor-initiating cells in GBM, both SB-hHgf.Met.ShP53 tumor sections and glioma spheres harvested from these tumors expressed GSC markers nestin, GFAP, and Sox 2. Moreover, specific MET TKIs significantly inhibited tumor spheres’ proliferation and MET/MAPK/AKT signaling.

Conclusions

Overexpression of the HGF/MET axis along with p53 attenuation may transform neural stem cells into GSCs, resulting in GBM formation in mice. These tumors are primarily driven by the MET RTK pathway activation and are sensitive to MET TKIs. The SB-hHgf.Met.ShP53 spontaneous mouse glioma model provides a useful tool for studying GBM tumor biology and MET-targeting therapeutics.
Comparison Between Supraclavicular Versus Video-Assisted Intrathoracic Phrenic Nerve Section for Transfer in Patients With Traumatic Brachial Plexus Injuries: Case Series
Authors: Socolovsky Mariano , Cardoso Marcio de Mendonça , Lovaglio Ana , di Masi Gilda , Bonilla Gonzalo , de Amoreira Gepp Ricardo
Published: June 2020

BACKGROUND

The phrenic nerve has been extensively reported to be a very powerful source of transferable axons in brachial plexus injuries. The most used technique used is supraclavicular sectioning of this nerve. More recently, video-assisted thoracoscopic techniques have been reported as a good alternative, since harvesting a longer phrenic nerve avoids the need of an interposed graft.

OBJECTIVE

To compare grafting vs phrenic nerve transfer via thoracoscopy with respect to mean elbow strength at final follow-up.

METHODS

A retrospective analysis was conducted among patients who underwent phrenic nerve transfer for elbow flexion at 2 centers from 2008 to 2017. All data analysis was performed in order to determine statistical significance among the analyzed variables.

RESULTS

A total of 32 patients underwent supraclavicular phrenic nerve transfer, while 28 underwent phrenic nerve transfer via video-assisted thoracoscopy. Demographic characteristics were similar in both groups. A statistically significant difference in elbow flexion strength recovery was observed, favoring the supraclavicular phrenic nerve section group against the intrathoracic group (P = .036). A moderate though nonsignificant difference was observed favoring the same group in mean elbow flexion strength. Also, statistical differences included patient age (P = .01) and earlier time from trauma to surgery (P = .069).

CONCLUSION

Comparing supraclavicular sectioning of the nerve vs video-assisted, intrathoracic nerve sectioning to restore elbow flexion showed that the former yielded statistically better results than the latter, in terms of the percentage of patients who achieve at least level 3 MRC strength at final follow-up. Furthermore, larger scale prospective studies assessing the long-term effects of phrenic nerve transfers remain necessary.
Diffusion Timescales of Magmatic Processes in the Moinui Lava Eruption at Mauna Loa, Hawai`i, as Inferred from Bimodal Olivine Populations
Authors: Couperthwaite F K , Thordarson T , Morgan D J , Harvey J , Wilson M
Published: June 2020

The 2·1 ka Moinui lava flow field, erupted from the southwest rift zone of Mauna Loa, Hawai`i, exhibits striking textural and geochemical variations, that can be used to interpret magma processes pre-, syn- and post-eruption. From this lava flow, the duration of magma storage and storage conditions, the timescales over which magma is transported to the surface, and flow emplacement mechanisms at Mauna Loa are determined. Electron microprobe analysis (EMPA) and diffusion chronometry of olivine crystals identify two distinct crystal populations: a primitive, polyhedral olivine population with core compositions of Fo90–88 and a more evolved, platy olivine population with core compositions of Fo83–82. Fe–Mg diffusion modelling of these olivine populations gives distinct timescales for each population; platy olivines yield timescales of days up to a few weeks, while polyhedral olivines yield timescales of months to years. Despite the nature of a well-insulated pāhoehoe flow, meaning that post-emplacement diffusion continues for some time, a wealth of time information can be retrieved concerning pre-eruptive magmatic processes as well as the processes associated with the lava extrusion. The short timescales obtained from the platy olivine crystals and the observed equilibrium between its cores and ambient melt suggest late-stage nucleation and crystal growth in the shallow conduit and during lava emplacement. Conversely, the longer timescales and olivine-melt disequilibrium of the polyhedral olivine crystals suggests accumulation from a deeper source and subsequent transportation to shallow magma storage beneath the summit of Mauna Loa months, or even years before eruption. The chemical and textural details of the Moinui lava reflect the mode of flow emplacement and may have implications for the interpretation of the distribution of spinifex and cumulate olivine within komatiites; high-temperature, low-viscosity lavas, common in the Archean.
Uncertainty, Investor Sentiment, and Innovation
Authors: Dicks David , Fulghieri Paolo
Published: June 2020

We develop a theory of innovation waves, investor sentiment, and merger activity based on Knightian uncertainty. Uncertainty-averse investors are more optimistic on an innovation when they can make contemporaneous investments in multiple uncertain projects. Innovation waves occur when there is a critical mass of innovative companies, and are characterized by stronger investor sentiment, higher equity valuation, and hot initial public offering markets. Our approach to investor sentiment is not based on erroneous beliefs disjoint from economic fundamentals, but depends on uncertainty on the fundamentals. Our model can explain sector-specific booms uncorrelated with aggregate economic activity and the overall stock market.
Anaemia in asymptomatic parasite carriers living in urban, rural and peri-urban settings of Gabon
Authors: Moutongo Mouandza R , M'bondoukwe N P , Obiang Ndong G P , Nzaou Nziengui A , Batchy Ognagosso F B , Nziengui Tirogo C , Moutombi Ditombi B , Mawili-Mboumba D P , Bouyou-Akotet M K
Published: June 2020

Background

This cross-sectional study was carried out in different settlements of Gabon to determine the influence of single or multiple parasite carriage on haemoglobin (Hb) levels.

Methods

Between April 2015 and June 2016, healthy volunteers from urban, peri-urban and rural areas were screened for malaria, blood filariasis and intestinal parasitic infections using microscopic methods. Hb concentration was measured with a Hemocue analyser. The association between parasite carriage and anaemia was assessed.

Results

Among the 775 volunteers examined, 319 (41.2%) were from rural villages and 76.0% were adults. Filariasis, intestinal parasitic infections, Plasmodium falciparum and polyparasitism were detected in 15.6, 14.6, 9.5 and 6.8% of participants, respectively. Anaemia prevalence was 72.6%, with rates of mild, moderate and severe anaemia being 30.9, 61.1 and 8.0%, respectively. The median Hb level was lowest in the presence of hookworms (7.1 g/dl [interquartile range {IQR} 6.8–7.5]), Schistosoma intercalatum (6.9 g/dl), Trichuris trichiura (10.1 g/dl [IQR 8.9–11.5]) and Plasmodium falciparum (10.0 g/dl [IQR 9.1–11.2]) compared with filariaemia (12.1 g/dl [IQR 10.5–13.2]) (p=0.03). Moderate to severe anaemia predominated among those single-infected with P. falciparum (69.5%) or co-infected with intestinal parasitic infections and P. falciparum (76.2%), while it was found in only 23.2% of individuals with filariasis. All participants with soil-transmitted helminths and more than half with a Blastocystis sp. (68.8%) infection had moderate anaemia.

Conclusions

The prevalence of anaemia is high. Asymptomatic parasite carriage is associated with anaemia in this surveyed population in Gabon.
Complications: Second Victim
Authors: Herring John A.
Published: June 2020

Introduction:

Physicians and surgeons in all specialties encounter and manage complications throughout their careers. Little attention has been given to a surgeon’s emotional experience and reaction to the stresses of managing complications.

Methods:

The author has reviewed relevant literature and added observations from 4 decades of experience with a pediatric orthopedic faculty. The author also reviewed the types of complications and principles of successful management of surgical complications.

Results and Discussion:

A small number of published articles dealing with the issues of physician and surgeon responses to stressful occurrences were found. Proper management of complications will markedly reduce the stress upon the surgeon. Analysis of the complications with colleagues is essential to the reduction of feelings of guilt, and are useful in preventing future events. Discussions of the accompanying stress between the surgeon and colleagues, family, and occasionally counselors are helpful in achieving resolution and emotional healing.

Conclusions:

Greater attention to emotional stress issues affecting caregivers, and especially surgeons, is needed. This should happen at all levels of education from medical school through postgraduate training, and in the everyday practice of surgery. Research to clarify the effectiveness of various interventions is needed.
WT1, PRAME, and PR3 mRNA Expression in Acute Myeloid Leukemia (AML)
Authors: Steger Brigitte , Floro Lajos , Amberger Daniel C. , Kroell Tanja , Tischer Johanna , Kolb Hans-Jochem , Schmetzer Helga Maria
Published: June 2020

Several tumor-associated antigens (TAAs) were recently identified, that could qualify as targets for immunotherapy, they could qualify (on RNA-level) for monitoring of tumor load. Here, we studied the expression levels of the immunogenic antigens PRAME (preferentially expressed antigen of melanoma), WT1 (Wilms’ tumor gene), and PR3 (proteinase 3) on myeloid blasts by real-time quantitative polymerase chain reaction and correlated these data to the state and course of disease and to the defined subgroups of acute myeloid leukemia (AML). At first diagnoses, 41 of 47 patients tested showed overexpression of PRAME (87%), 38 of WT1 (81%), and 26 of PR3 (55%), with the highest expression levels for PRAME (2048-fold), followed by WT1 (486-fold) and PR3 (196-fold). Thereby, with 70%, the most frequent combination at first diagnoses was detected to be PRAME and WT1 (33/47 patients). Overall, 21 patients (45%) revealed overexpression for all 3 TAAs. Moreover, the highest expression levels of PRAME were found to be correlated with the FAB subtype M5, cytogenetic unfavorable risk groups, and AMLs arising from myelodysplasia (secondary AML; P=0.02). To compare TAA expression levels in the course of disease, expression data were calculatory adjusted to 100% blasts, revealing a relative increase in the PRAME expression levels during the course of persistent disease (3/4 cases). Independent of stage of disease, by trend, higher TAA expression levels were found on blasts derived from peripheral blood than those derived from the bone marrow. In conclusion, it is suggested that vaccine strategies for cancer immunotherapy should comprise different TAA peptides anticipating the diverse TAA expression levels on blasts evolving during the course of disease or treatment.
Thromboxane A2 receptor contributes to the activation of rat pancreatic stellate cells induced by 8-epi-prostaglandin F2α
Authors: Zhang Xiao-Li , Li Fei , Cui Ye-Qing , Liu Shuang , Sun Hai-Chen
Published: June 2020

Background

Pancreatic stellate cells (PSCs) activation plays a critical role in the development of chronic pancreatitis. Previous studies confirmed that thromboxane A2 receptor (TxA2r) was overexpressed in activated PSCs in rats. The purpose of this study was to investigate the role of TxA2r in the activation of PSCs induced by 8-epi-prostaglandin F2α(8-epi-PGF2α).

Methods

TxA2r expression in both quiescent and activated PSCs was detected by immunocytochemistry and immunoblot assay. Isolated PSCs were treated with 8-epi-PGF2α(10−6, 10−7, 10−8mol/L) for 48 h, and SQ29548 (10−4, 10−6, and 10−7mol/L), a TxA2r-specific antagonist for 48 h, respectively, to identify the drug concentration with the best biological effect and the least cytotoxicity. Then isolated PSCs were treated with SQ29548 (10−4 mol/L) for 2 h, followed by 10−7mol/L 8-epi-PGF2αfor 48 h. Real-time polymerase chain reaction was performed to detect the messenger RNA (mRNA) levels of α-smooth muscle actin (α-SMA) and collagen I. Comparisons between the groups were performed using Student'sttest.

Results

TxA2r was up-regulated in activated PSCsin vitrocompared with quiescent PSCs (allP < 0.001). Compared with the control group, different concentrations of 8-epi-PGF2αsignificantly increased mRNA levels of α-SMA (10−6 mol/L: 2.23 ± 0.18vs.1.00 ± 0.07,t = 10.70,P < 0.001; 10−7mol/L: 2.91 ± 0.29vs.1.01 ± 0.08,t = 10.83,P < 0.001; 10−8mol/L, 1.67 ± 0.07vs.1.00 ± 0.08,t = 11.40,P < 0.001) and collagen I (10−6 mol/L: 2.68 ± 0.09vs.1.00 ± 0.07,t = 24.94,P < 0.001; 10−7mol/L: 2.12 ± 0.29vs.1.01 ± 0.12, t = 6.08,P < 0.001; 10−8mol/L: 1.46 ± 0.15vs.1.00 ± 0.05,t = 4.93,P = 0.008). However, different concentrations of SQ29548 all significantly reduced the expression of collagen I (10−4 mol/L: 0.55 ± 0.07vs.1.00 ± 0.07,t = 10.47,P < 0.001; 10−6mol/L: 0.56 ± 0.10vs.1.00 ± 0.07,t = 6.185,P < 0.001; 10−7mol/L: 0.27 ± 0.04vs.1.00 ± 0.07,t = 15.41,P < 0.001) and α-SMA (10−4 mol/L: 0.06 ± 0.01vs.1.00 ± 0.11,t = 15.17,P < 0.001; 10−6mol/L: 0.28 ± 0.03vs.1.00 ± 0.11,t = 11.29,P < 0.001; 10−7mol/L: 0.14 ± 0.04vs.1.00 ± 0.11,t = 12.86,P < 0.001). After being treated with SQ29548 (10−4 mol/L) and then 8-epi-PGF2α(10−7 mol/L), the mRNA levels of α-SMA (0.20 ± 0.08vs.1.00 ± 0.00,t = 17.46,P < 0.001) and collagen I (0.69 ± 0.13vs.1.00 ± 0.00,t = 4.20,P = 0.014) in PSCs were significantly lower than those of the control group.

Conclusions

The results show that 8-epi-PGF2αpromoted PSCs activation, while SQ29548 inhibited PSCs activation induced by 8-epi-PGF2α. The result indicated that TxA2r plays an important role during PSC activation and collagen synthesis induced by 8-epi-PGF2αin vitro. This receptor may provide a potential target for more effective antioxidant therapy for pancreatic fibrosis.
Clinical Outcomes of Allogeneic Ocular Surface Stem Cell Transplantation in Pediatric Patients
Authors: Cheung Albert Y. , Sarnicola Enrica , Eslani Medi , Wright Elizabeth , Goebel Jens , Hooper David K. , Govil Amit , Kurji Khaliq H. , Holland Edward J.
Published: June 2020

Purpose:

To describe the outcomes of allograft ocular surface stem cell transplantation (OSST) and the complication profile of systemic immunosuppression (SI) in pediatric patients with limbal stem cell deficiency.

Methods:

This was a retrospective interventional case series from a single tertiary referral institution of 20 eyes from 13 patients who 1) underwent allograft OSST surgery, 2) were 18 years or less at time of OSST, and 3) received SI with 4) a minimum of 12-months follow-up. The main outcome measures were ocular surface stability, visual acuity, and SI adverse events.

Results:

The mean age of patients was 15.1 ± 3.2 years (range 9–18 years). The mean follow-up was 5.6 ± 5.0 years after OSST. At the last follow-up, 15 eyes (75%) had a stable ocular surface, 1 eye (5%) developed partial failure, and 4 eyes (20%) developed total surface failure. Preoperative mean logarithm of the minimum angle of resolution visual acuity 1.5 improved to 1.1 at the last follow-up (P = 0.1); when 4 eyes of 3 nonadherent patients were excluded, the results were more pronounced and statistically significant (1.5 improved to 1.0, P = 0.002). SI was tolerated well by all patients with minimal adverse events.

Conclusions:

OSST provides a stable ocular surface and is a successful treatment option for pediatric patients with limbal stem cell deficiency. SI is well-tolerated with a minimal complication profile.
Surgical Treatment for Cerebrospinal Fluid Leaks in Patients With Inner Ear Malformations
Authors: Bois Emilie , Demondion Sophie , Elmaleh Monique , François Martine , Teissier Natacha , Van Den Abbeele Thierry
Published: June 2020

Objective:

The aim of this study is to present our technique of surgical closure in a series of patients suffering from cerebrospinal fluid (CSF) leak due to inner ear malformations.

Study Design and Setting:

We conducted a retrospective study in our tertiary care academic department of pediatric otolaryngology.

Patients:

We did include all patients who presented a CSF leak or bacterial meningitis (one episode or recurrent) related to a malformation of the inner ear.

Intervention(s):

Through a retro-auricular or endaural approach we performed a filling of the vestibule cavity with multiple fragments of cartilage with perichondrium introduced through the oval window, after stapedectomy until a near-complete sealing was obtained. After the surgery, all patients received a treatment with acetazolamide during 15 days.

Main Outcome Measure(s):

We did evaluate our technics with the recurrence of CSF leak.

Results:

Thirteen patients, from 1 to 14, were operated with our technics. With a follow-up of 4.4 ± 4.7 years, only one patient needed a second intervention. None had a novel episode of meningitis. We observed no complication. The leak was observed in the oval fossa in 11 cases.

Conclusions:

Our “minimally invasive” technique of vestibular obliteration with cartilage inserted through the oval window after stapedectomy did demonstrate its safety and reliability.
Association of portal venous system thrombosis with endoscopic variceal treatment: a systematic review and meta-analysis
Authors: Wang Le , Guo Xiaozhong , Xu Xiangbo , Philips Cyriac Abby , Primignani Massimo , Mendez-Sanchez Nahum , Li Qianqian , Zheng Kexin , Qi Xingshun
Published: June 2020

The association of endoscopic variceal treatment (EVT) with the development of portal venous system thrombosis (PVST) in liver cirrhosis remains uncertain. A systematic review and meta-analysis aimed to investigate the incidence of PVST after EVT and to explore the association of EVT with the development of PVST in liver cirrhosis. All relevant studies were searched via the PubMed, EMBASE, and Cochrane Library databases. The incidence of PVST in patients treated with and without EVT was pooled. Risk ratios with 95% confidence intervals (CIs) were calculated. Heterogeneity among studies was calculated. Meta-regression, sensitivity, and subgroup analyses were used to analyze the source of heterogeneity. Thirteen studies involving a total of 833 patients were included. The pooled incidence of PVST after EVT was 10.4% (95% CI, 4.9–17.7%). There was a statistically significant heterogeneity (I
2 = 83.3%, P < 0.0001). Meta-regression, sensitivity, and subgroup analyses did not find the source of heterogeneity. Four studies compared the incidence of PVST between patients treated with and without EVT. The incidence of PVST was significantly higher in the EVT group than that in the no-EVT group (risk ratio: 2.23; 95% CI, 1.11–4.49; P = 0.02). The heterogeneity was not statistically significant (I
2 = 0%, P = 0.43). In conclusion, PVST after EVT may not be scare, and EVT may increase the risk of PVST in liver cirrhosis.
Ventricular Weight Increases Proportionally With Total Heart Weight in Postmortem Population
Authors: Loper Nicole , Garland Jack , Ondruschka Benjamin , Lamberts Regis R. , Stables Simon , Tse Rexson
Published: June 2020

Heart weight is routinely measured at postmortem examination and is critical to determine whether the heart is enlarged (ie, cardiomegaly). Cardiomegaly has the potential to cause sudden death by being electrically unstable, resulting in fatal arrhythmias. The majority of fatal cardiac arrhythmias is ventricular in origin and is assumed that ventricular size is disproportionately larger in cardiomegaly. This prospective study compared ventricular weight (VW) and total heart weight (THW) in 40 consecutive cases. The results, unexpectedly, showed that VW increases proportionally and linearly with THW in normal and enlarged hearts (THW, >500 g) and did not increase disproportionally with increased THW. The ratio of VW/THW did not have any significant correlation or difference with sex, height, weight, and cardiac causes of death but did have a negative correlation with age. Further studies are indicated to document the morphological changes when the heart enlarges, which may aid in understanding the pathophysiology of sudden death from cardiomegaly.
Predictors of Serious Opioid-Related Adverse Drug Events in Hospitalized Patients
Authors: Minhaj Faisal Syed , Rappaport Stephen H. , Foster Justin , Gashlin Lauren Z.
Published: June 2020

Objective

Opioids are high-risk medications in the inpatient setting because of their potential for significant patient harm. The primary objective was to identify risk factors that predispose inpatients to develop opioid-related adverse drug events (ORADE) requiring the use of naloxone.

Methods

In a retrospective case-control study, patients were included according to the following criteria: 18 years or older, 1 administered opioid doses or more, and admitted for 24 hours or more. Patients were excluded if they had a prehospital drug overdose, other indications for naloxone use, or were admitted to an intensive care unit, psychiatric medical unit, or in the emergency department. Patients were classified as cases if naloxone was administered and a selection of controls were frequency matched 2:1 based on medical or surgical status. A logistic regression model was used to evaluate for risk factors for ORADE.

Results

A total of 275 cases and 592 control patients were included into the final analysis. Variables that were associated with greater odds of naloxone administration included age of 65 years or older, female, length of stay, pulmonary diagnoses, use of gabapentinoids, and patient-controlled analgesia use. Antihistamines, continuous infusion, and intermittent nurse administered intravenous bolus routes had a negative association with naloxone use.

Conclusions

Several risk factors were found to be associated with ORADE supporting many of the previously described risk factors, and the discovery of potential new ones, such as gabapentinoid use. Health care providers should consider the risk factors for hospitalized patients receiving opioids who may warrant lower doses, additional monitoring, or alternative agents.