bluuebunny/crossref_metadata_2025 huggingface dataset:
NGTS clusters survey – I. Rotation in the young benchmark open cluster Blanco 1
Authors: Gillen Edward , Briegal Joshua T , Hodgkin Simon T , Foreman-Mackey Daniel , Van Leeuwen Floor , Jackman James A G , McCormac James , West Richard G , Queloz Didier , Bayliss Daniel , Goad Michael R , Watson Christopher A , Wheatley Peter J , Belardi Claudia , Burleigh Matthew R , Casewell Sarah L , Jenkins James S , Raynard Liam , Smith Alexis M S , Tilbrook Rosanna H , Vines Jose I
Published: December 2019

We determine rotation periods for 127 stars in the ∼115-Myr-old Blanco 1 open cluster using ∼200 d of photometric monitoring with the Next Generation Transit Survey. These stars span F5–M3 spectral types (1.2 M⊙ ≳ M ≳ 0.3 M⊙) and increase the number of known rotation periods in Blanco 1 by a factor of four. We determine rotation periods using three methods: Gaussian process (GP) regression, generalized autocorrelation function (G-ACF), and Lomb–Scargle (LS) periodogram, and find that the GP and G-ACF methods are more applicable to evolving spot modulation patterns. Between mid-F and mid-K spectral types, single stars follow a well-defined rotation sequence from ∼2 to 10 d, whereas stars in photometric multiple systems typically rotate faster. This may suggest that the presence of a moderate-to-high mass ratio companion inhibits angular momentum loss mechanisms during the early pre-main sequence, and this signature has not been erased at ∼100 Myr. The majority of mid-F to mid-K stars display evolving modulation patterns, whereas most M stars show stable modulation signals. This morphological change coincides with the shift from a well-defined rotation sequence (mid-F to mid-K stars) to a broad rotation period distribution (late-K and M stars). Finally, we compare our rotation results for Blanco 1 to the similarly aged Pleiades: the single-star populations in both clusters possess consistent rotation period distributions, which suggests that the angular momentum evolution of stars follows a well-defined pathway that is, at least for mid-F to mid-K stars, strongly imprinted by ∼100 Myr.
Thermodynamics of the condensation of dust grains in Wolf–Rayet stellar winds
Authors: Gupta Anuj , Sahijpal Sandeep
Published: December 2019

Wolf–Rayet (WR) stars are the evolutionary phases of very massive stars prior to the final supernova explosion stage. These stars lose substantial mass during the WN and WC stages. The mass losses are associated with diverse elemental and isotopic signatures that represent distinct stellar evolutionary processes. WR strong winds can host environments favourable for the condensation of dust grains with diverse compositions. The condensation of dust in the outflows of massive stars is supported by a number of observations. The present work is an attempt to develop a theoretical framework for the thermodynamics associated with the condensation of dust grains in the winds of the WN and WC phases. A novel numerical code has been developed for dust condensation. In addition to the equilibrium dust condensation calculations, we have attempted, perhaps for the first time, a set of non-equilibrium scenarios for dust condensation in various WR stages. These scenarios differ in terms of the magnitude of the non-equilibrium state, defined in terms of a simulation non-equilibrium parameter. Here, we attempt to understand the effect of the simulation non-equilibrium parameter on the condensation sequence of dust grains. In general, we found that mostly C (graphite), TiC, SiC, AlN, CaS and Fe-metal are condensed in WR winds. The extent of non-equilibrium influences the relative proportions of the earliest dust condensate compared with the condensates formed at later stages subsequent to the cooling of the gas. The results indicate that dust grains that are condensed in the WC phase may make a substantial contribution of carbon-rich dust grains to the interstellar medium.
Feeding of active galactic nuclei by dynamical perturbations
Authors: Tartėnas Matas , Zubovas Kastytis
Published: December 2019

There possibly was an active galactic nuclei (AGN) episode in the Galactic Centre (GC) about 6 Myr ago, powerful enough to produce the Fermi bubbles. We present numerical simulations of a possible scenario giving rise to an activity episode: a collision between a central gas ring surrounding the supermassive black hole (SMBH) and an infalling molecular cloud. We investigate different initial collision angles between the cloud and the ring. We follow the hydrodynamical evolution of the system following the collision using gadget-3 hybrid N-body/SPH code and calculate the feeding rate of the SMBH accretion disc. This rate is then used as an input for a 1D thin α-disc model in order to calculate the AGN luminosity. By varying the disc feeding radii, we determine the limiting values for possible AGN accretion disc luminosity. Small angle collisions do not result in significant mass transport to the centre of the system, while models with highest collision angles transport close to $40{{\ \rm per\ cent}}$ of the initial matter to the accretion disc. Even with ring and cloud masses equal to $10^4 \, {\rm M_{\odot }}$, which is the lower limit of present-day mass of the circumnuclear ring in the GC, the energy released over an interval of 1.5 Myr can produce $\sim 10{{\ \rm per\ cent}}$ of that required to inflate the Fermi bubbles. If the gas ring in the GC 6 Myr ago had a mass of at least $10^5 \, {\rm M_{\odot }}$, our proposed scenario can explain the formation of the Fermi bubbles. We estimate that such high-impact collisions might occur once every ∼108 yr in our Galaxy.
Transcriptional network dynamics during the progression of pluripotency revealed by integrative statistical learning
Authors: Kim Hani Jieun , Osteil Pierre , Humphrey Sean J , Cinghu Senthilkumar , Oldfield Andrew J , Patrick Ellis , Wilkie Emilie E , Peng Guangdun , Suo Shengbao , Jothi Raja , Tam Patrick P L , Yang Pengyi
Published: December 2019

The developmental potential of cells, termed pluripotency, is highly dynamic and progresses through a continuum of naive, formative and primed states. Pluripotency progression of mouse embryonic stem cells (ESCs) from naive to formative and primed state is governed by transcription factors (TFs) and their target genes. Genomic techniques have uncovered a multitude of TF binding sites in ESCs, yet a major challenge lies in identifying target genes from functional binding sites and reconstructing dynamic transcriptional networks underlying pluripotency progression. Here, we integrated time-resolved ‘trans-omic’ datasets together with TF binding profiles and chromatin conformation data to identify target genes of a panel of TFs. Our analyses revealed that naive TF target genes are more likely to be TFs themselves than those of formative TFs, suggesting denser hierarchies among naive TFs. We also discovered that formative TF target genes are marked by permissive epigenomic signatures in the naive state, indicating that they are poised for expression prior to the initiation of pluripotency transition to the formative state. Finally, our reconstructed transcriptional networks pinpointed the precise timing from naive to formative pluripotency progression and enabled the spatiotemporal mapping of differentiating ESCs to their in vivo counterparts in developing embryos.
Rationale and protocol of the Dapagliflozin And Prevention of Adverse outcomes in Chronic Kidney Disease (DAPA-CKD) randomized controlled trial
Authors: Heerspink Hiddo J L , Stefansson Bergur V , Chertow Glenn M , Correa-Rotter Ricardo , Greene Tom , Hou Fan-Fan , Lindberg Magnus , McMurray John , Rossing Peter , Toto Roberto , Langkilde Anna Maria , Wheeler David C ,   for the DAPA-CKD Investigators, Heerspink H J L , Wheeler D C , Chertow G , Correa-Rotter R , Greene T , Hou F-F , McMurray J , Rossing P , Toto R , Stefansson B , Langkilde A M , Pfeffer Marc A , Pocock Stuart , Swedberg Karl , Rouleau Jean L , Chaturvedi Nishi , Ivanovich Peter , Levey Andrew S , Christ-Schmidt Heidi , Mann Johannes , Held Claes , Varenhorst Christoph , Holmgren Pernilla , Hallberg Theresa , Douthat Walter , Filho Roberto Pecoits , Cherney David , Hou Fan Fan , Persson Frederik , Haller Hermann , Wittmann István , Tudományegyetem Pécsi , Khullar Dinesh , Naoki Kashihara , Correa-Rotter Richardo , Escudero Elizabeth , Isidto Rey , Iloilo Healthlink , Nowicki Michal , Batiushin Mikhail , Kang Shin-Wook , Teruel José Luis Górriz , Furuland Hans , Bilchenko Oleksandr , Mark Patrick , Dwyer Jamie , Van Bui Pham
Published: December 2019

Background

Recent cardiovascular outcome trials have shown that sodium–glucose co-transporter 2 (SGLT2) inhibitors slow the progression of chronic kidney disease (CKD) in patients with type 2 diabetes at high cardiovascular risk. Whether these benefits extend to CKD patients without type 2 diabetes or cardiovascular disease is unknown. The Dapagliflozin and Prevention of Adverse Outcomes in CKD (DAPA-CKD) trial (NCT03036150) will assess the effect of the SGLT2 inhibitor dapagliflozin on renal and cardiovascular events in a broad range of patients with CKD with and without diabetes.

Methods

DAPA-CKD is a randomized, double-blind, placebo-controlled, trial in which ∼4300 patients with CKD Stages 2–4 and elevated urinary albumin excretion will be enrolled. The vast majority will be receiving a maximum tolerated dose of a renin–angiotensin system inhibitor at enrolment.

Results

After a screening assessment, eligible patients with a urinary albumin:creatinine ratio ≥200 mg/g and estimated glomerular filtration rate (eGFR) between 25 and 75 mL/min/1.73 m2 are randomly assigned to placebo or dapagliflozin 10 mg/day. Enrolment is monitored to ensure that at least 30% of patients do not have diabetes and that no more than 10% have an eGFR >60 mL/min/1.73 m2. The primary endpoint is a composite of a sustained decline in eGFR of ≥50%, end-stage renal disease, renal death or cardiovascular death. The trial will conclude when 681 primary renal events have occurred, providing 90% power to detect a 22% relative risk reduction (α level of 0.05).

Conclusion

DAPA-CKD will determine whether the SGLT2 inhibitor dapagliflozin, added to guideline-recommended therapies, safely reduces the rate of renal and cardiovascular events in patients across multiple CKD stages with and without diabetes.
Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy for Epilepsy: Systematic Review of Technique, Indications, and Outcomes
Authors: Youngerman Brett E , Save Akshay V , McKhann Guy M
Published: December 2019

BACKGROUND

For patients with focal drug-resistant epilepsy (DRE), surgical resection of the epileptogenic zone (EZ) may offer seizure freedom and benefits for quality of life. Yet, concerns remain regarding invasiveness, morbidity, and neurocognitive side effects. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has emerged as a less invasive option for stereotactic ablation rather than resection of the EZ.

OBJECTIVE

To provide an introduction to MRgLITT for epilepsy, including historical development, surgical technique, and role in therapy.

METHODS

The development of MRgLITT is briefly recounted. A systematic review identified reported techniques and indication-specific outcomes of MRgLITT for DRE in human studies regardless of sample size or follow-up duration. Potential advantages and disadvantages compared to available alternatives for each indication are assessed in an unstructured review.

RESULTS

Techniques and outcomes are reported for mesial temporal lobe epilepsy, hypothalamic hamartoma, focal cortical dysplasia, nonlesional epilepsy, tuberous sclerosis, periventricular nodular heterotopia, cerebral cavernous malformations, poststroke epilepsy, temporal encephalocele, and corpus callosotomy.

CONCLUSION

MRgLITT offers access to foci virtually anywhere in the brain with minimal disruption of the overlying cortex and white matter, promising fewer neurological side effects and less surgical morbidity and pain. Compared to other ablative techniques, MRgLITT offers immediate, discrete lesions with real-time monitoring of temperature beyond the fiber tip for damage estimates and off-target injury prevention. Applications of MRgLITT for epilepsy are growing rapidly and, although more evidence of safety and efficacy is needed, there are potential advantages for some patients.
Leukemic infiltration in the settings of acute respiratory failure
Authors: Fayed M , Evans T , Abdulhaq H
Published: December 2019

Hematological malignancies need special attention in the intensive care unit (ICU). Leukemia has numerous presentations in the ICU. Most commonly, these patients present with complications of therapy. Infection and neutropenia are major reasons for ICU admission. Pulmonary complications in patients with leukemia are often due to pneumonia, hemorrhage, edema or drug toxicity; however, pulmonary leukemic infiltration is a well-known complication in all types of pneumonia but is not well described in chronic myelomonocytic leukemia. It can contribute to a rapid decline in respiratory status. Distinguishing among infection, pulmonary edema and leukemic infiltrates can be challenging. Characteristic radiological patterns have been described but are still challenging to recognize. Critical care management in these cases can have a large impact, and early intervention could be lifesaving in the appropriate clinical setting.
The Sucrose Non-Fermenting 1-Related Protein Kinase 2 (SnRK2) Genes Are Multifaceted Players in Plant Growth, Development and Response to Environmental Stimuli
Authors: Mao Xinguo , Li Yuying , Rehman Shoaib Ur , Miao Lili , Zhang Yanfei , Chen Xin , Yu Chunmei , Wang Jingyi , Li Chaonan , Jing Ruilian
Published: December 2019

Reversible protein phosphorylation orchestrated by protein kinases and phosphatases is a major regulatory event in plants and animals. The SnRK2 subfamily consists of plant-specific protein kinases in the Ser/Thr protein kinase superfamily. Early observations indicated that SnRK2s are mainly involved in response to abiotic stress. Recent evidence shows that SnRK2s are multifarious players in a variety of biological processes. Here, we summarize the considerable knowledge of SnRK2s, including evolution, classification, biological functions and regulatory mechanisms at the epigenetic, post-transcriptional and post-translation levels.
Anti-Intellectualism, Populism, and Motivated Resistance to Expert Consensus
Authors: Merkley Eric
Published: December 2019

Scholars have maintained that public attitudes often diverge from expert consensus due to ideology-driven motivated reasoning. However, this is not a sufficient explanation for less salient and politically charged questions. More attention needs to be given to anti-intellectualism—the generalized mistrust of intellectuals and experts. Using data from the General Social Survey and a survey of 3,600 Americans on Amazon Mechanical Turk, I provide evidence of a strong association between anti-intellectualism and opposition to scientific positions on climate change, nuclear power, GMOs, and water fluoridation, particularly for respondents with higher levels of political interest. Second, a survey experiment shows that anti-intellectualism moderates the acceptance of expert consensus cues such that respondents with high levels of anti-intellectualism actually increase their opposition to these positions in response. Third, evidence shows anti-intellectualism is connected to populism, a worldview that sees political conflict as primarily between ordinary citizens and a privileged societal elite. Exposure to randomly assigned populist rhetoric, even that which does not pertain to experts directly, primes anti-intellectual predispositions among respondents in the processing of expert consensus cues. These findings suggest that rising anti-elite rhetoric may make anti-intellectual sentiment more salient in information processing.
Two Is a Crowd: An Australian Case Study on Legislative Process, Law Reform Commissions and Dealing with Duplicate Offences
Authors: Chen Jianlin
Published: December 2019

This article utilizes the sexual offence reform in Australian Capital Territory, Tasmania, and Western Australia as a case study to critically examine the perils and causes of duplicate offences. For perils, this article demonstrates that the failure to abolish a lesser offence (i.e. the procurement by false pretence offence) that was rendered redundant by a statutory expansion of the primary offence (i.e. rape vis-à-vis sex obtained by fraud) would create structural incoherency in the legal framework and impede the court from giving full effect to the plain words of the amended provision. For causes, this article identifies the positive but insufficient role of law reform commissions in ensuring appropriate treatment of the lesser duplicate offence by the legislature. The article proposes that law reform commissions should be more forcefully explicit when making recommendations relating to the abolishment of redundant offences.
The Aura of Chips: Material Engagements and the Production of Everyday Religious Difference in British Asian Street Kitchens
Authors: Zavos John
Published: December 2019

Religious difference is a significant index of social plurality in contemporary Britain. State discourses frequently project society as multi-faith, while simultaneously signaling religious others as a potential threat to social cohesion. Acknowledging the social power of these contrasting projections, this article analyses religious difference as an everyday feature of British urban pluralism. The article draws on Stuart Hall’s recognition of processes of diaporic identification, shaped in the context of the pathologizing of racial identity as a fixed form of difference. It argues that an emphasis on identification, rather than identity, invokes a critique of agential approaches to everyday religious practices. Tim Ingold’s proposition of material engagements as a “dance of animacy” provides an analytical tool to explore the production of religious difference beyond agency in this way. The article focuses on sensory engagements and diaspora food cultures in Sikh and Muslim street kitchen initiatives to explore these themes.
Effective Altruism as an Ethical Lens on Research Priorities
Authors: Garrett K. A. , Alcalá-Briseño R. I. , Andersen K. F. , Brawner J. , Choudhury R. A. , Delaquis E. , Fayette J. , Poudel R. , Purves D. , Rothschild J. , Small I. M. , Thomas-Sharma S. , Xing Y.
Published: December 2019

Effective altruism is an ethical framework for identifying the greatest potential benefits from investments. Here, we apply effective altruism concepts to maximize research benefits through identification of priority stakeholders, pathosystems, and research questions and technologies. Priority stakeholders for research benefits may include smallholder farmers who have not yet attained the minimal standards set out by the United Nations Sustainable Development Goals; these farmers would often have the most to gain from better crop disease management, if their management problems are tractable. In wildlands, prioritization has been based on the risk of extirpating keystone species, protecting ecosystem services, and preserving wild resources of importance to vulnerable people. Pathosystems may be prioritized based on yield and quality loss, and also factors such as whether other researchers would be unlikely to replace the research efforts if efforts were withdrawn, such as in the case of orphan crops and orphan pathosystems. Research products that help build sustainable and resilient systems can be particularly beneficial. The “value of information” from research can be evaluated in epidemic networks and landscapes, to identify priority locations for both benefits to individuals and to constrain regional epidemics. As decision-making becomes more consolidated and more networked in digital agricultural systems, the range of ethical considerations expands. Low-likelihood but high-damage scenarios such as generalist doomsday pathogens may be research priorities because of the extreme potential cost. Regional microbiomes constitute a commons, and avoiding the “tragedy of the microbiome commons” may depend on shifting research products from “common pool goods” to “public goods” or other categories. We provide suggestions for how individual researchers and funders may make altruism-driven research more effective.

[Formula: see text] Copyright © 2020 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Improving natural product research translation: From source to clinical trial
Authors: Sorkin Barbara C. , Kuszak Adam J. , Bloss Gregory , Fukagawa Naomi K. , Hoffman Freddie Ann , Jafari Mahtab , Barrett Bruce , Brown Paula N. , Bushman Frederic D. , Casper Steven J. , Chilton Floyd H. , Coffey Christopher S. , Ferruzzi Mario G. , Hopp D. Craig , Kiely Mairead , Lakens Daniel , MacMillan John B. , Meltzer David O. , Pahor Marco , Paul Jeffrey , Pritchett‐Corning Kathleen , Quinney Sara K. , Rehermann Barbara , Setchell Kenneth D. R. , Sipes Nisha S. , Stephens Jacqueline M. , Taylor D. Lansing , Tiriac Hervé , Walters Michael A. , Xi Dan , Zappalá Giovanna , Pauli Guido F.
Published: December 2019

While great interest in health effects of natural product (NP) including dietary supplements and foods persists, promising preclinical NP research is not consistently translating into actionable clinical trial (CT) outcomes. Generally considered the gold standard for assessing safety and efficacy, CTs, especially phase III CTs, are costly and require rigorous planning to optimize the value of the information obtained. More effective bridging from NP research to CT was the goal of a September, 2018 transdisciplinary workshop. Participants emphasized that replicability and likelihood of successful translation depend on rigor in experimental design, interpretation, and reporting across the continuum of NP research. Discussions spanned good practices for NP characterization and quality control; use and interpretation of models (computational through in vivo) with strong clinical predictive validity; controls for experimental artefacts, especially for in vitro interrogation of bioactivity and mechanisms of action; rigorous assessment and interpretation of prior research; transparency in all reporting; and prioritization of research questions. Natural product clinical trials prioritized based on rigorous, convergent supporting data and current public health needs are most likely to be informative and ultimately affect public health. Thoughtful, coordinated implementation of these practices should enhance the knowledge gained from future NP research.
Incidence of Pediatric Venous Thromboembolism After Elective Spine and Lower-Extremity Surgery in Children With Neuromuscular Complex Chronic Conditions: Do we Need Prophylaxis?
Authors: Shore Benjamin J. , Hall Matt , Matheney Travis H. , Snyder Brian , Trenor Cameron C. , Berry Jay G.
Published: December 2019

Background:

The incidence of venous thromboembolism (VTE) after elective surgery in children with mobility impairments, including those with a neuromuscular complex chronic condition (NCCC), is unknown. Therefore, our objectives were to assess the incidence of VTE after elective spine and lower-extremity surgery in children with NCCC.

Methods:

A retrospective analysis of children with NCCC undergoing elective lower-extremity and/or spinal surgeries from 2005 to 2009 included in the Pediatric Health Information Systems Plus (PHIS+) database. VTE during hospitalization for surgery was assessed through abstraction and review of ultrasound (U/S) and computed tomography results by 2 independent reviewers. VTEs related to pre-existing central venous catheters were excluded.

Results:

There were 4,583 children with NCCC who underwent orthopaedic surgery during the study period at 6 centers. Most were male (56.3%), non-Hispanic whites (72.7%), and had private insurance (52.2%). The most common NCCC diagnoses were cerebral palsy (46.7%), brain and spinal cord malformations (31.1%), and central nervous system degenerative conditions (14.5%). Forty children (0.9%) underwent U/S to assess VTE. Eighteen children (0.4%) underwent computed tomography to assess VTE. Four children (with cerebral palsy) had a positive U/S for a lower-extremity VTE (10-18 y of age), yet 2 had their VTE before surgery. Therefore, the adjusted VTE rate for children with NCCC undergoing orthopaedic lower-extremity or spine surgery was 4 per 10,000 (2 cases per 4583 surgeries). Each of the 2 cases had a known coagulation disorder preoperatively. Only 10% of the cohort used compression devices, 3% enoxaparin, and 1.6% aspirin for prophylaxis.

Conclusion:

The rate of non–central-venous-catheter-related VTE associated with orthopaedic surgery in children with NCCC is very low and lower than rates reported in healthy children.

Significance:

To our knowledge, this is the first multi-institutional study reporting the incidence of VTE in children with NCCCs undergoing elective hip and spine surgery. These data support no additional prophylaxis is required in children with NCCC undergoing elective hip and spine surgery unless other known risk factors are also present.
Neuro-ophthalmic Disease in Pediatric Glaucoma Practice
Authors: Tirpack Aubrey R. , Vanner Elizabeth A. , Sheheitli Huda , Mendoza Carlos E. , Grajewski Alana , Chang Ta C.
Published: December 2019

Precis:

Pediatric glaucoma referral to neuro-ophthalmology has a high yield for diagnosing neurological disease and neuroimaging in this cohort often uncovers intracranial abnormalities.

Purpose:

Multiple studies have examined the utility of neuro-ophthalmology referrals in an adult glaucoma patient population. No similar studies in the pediatric glaucoma population have been completed. An analysis of pediatric referral patterns and clinical characteristics can serve to guide future physician referrals and improve patient outcomes.

Materials and Methods:

A retrospective review of medical records was conducted to identify pediatric patients evaluated by both glaucoma and neuro-ophthalmology services at Bascom Palmer Eye Institute from January 2013 to August 2018. Records were reviewed for clinical examination findings, demographics, ophthalmic imaging, neuroimaging, and ultimate diagnosis.

Results:

A total of 59 patients, average age 10 years old, were included for analysis. The majority of patients were referred from pediatric glaucoma to neuro-ophthalmology (n=52, 88.1%). The most common reasons for referral included suspected nonglaucomatous optic neuropathy (n=14), optic disc swelling (n=7), color vision deficiency (n=6), and nonglaucomatous visual field defect (n=4). Referral to neuro-ophthalmology resulted in neuro-imaging in 22 patients (22/52, 42.3%), with 7 patients (7/52, 13.7%) having pathology on the scan. Ultimately, 38 patients (73.1%) referred to neuro-ophthalmology had an ultimate diagnosis unrelated to glaucoma. Color vision abnormality, optic nerve pallor, and/or retinal nerve fiber layer <70 µm in at least 1 eye were associated with a diagnosis unrelated to glaucoma. Of the 7 patients referred from neuro-ophthalmology to pediatric glaucoma, none were diagnosed with glaucoma or started on intraocular pressure lowering therapy.

Conclusions:

Patients referred from pediatric glaucoma to neuro-ophthalmology often have nonglaucomatous disease requiring subspecialty evaluation and neuroimaging. Neuroimaging in this cohort is high yield for uncovering intracranial pathology.
Predictors of Hospital-Acquired Clostridioides difficile Infection: A Systematic Review
Authors: Puro Neeraj , Joseph Reena , Zengul Ferhat D. , Cochran Kenneth J. , Camins Bernard C. , Ray Midge
Published: December 2019

Background:

Clostridioides difficile infections (CDIs) have been identified as a major health concern due to the high morbidity, mortality, and cost of treatment. The aim of this study was to review the extant literature and identify the various patient-related, medication-related, and organizational risk factors associated with developing hospital-acquired CDIs in adult patients in the United States.

Methods:

A systematic review of four (4) online databases, including Scopus, PubMed, CINAHL, and Cochrane Library, was conducted to identify empirical studies published from 2007 to 2017 pertaining to risk factors of developing hospital-acquired CDIs.

Findings:

Thirty-eight studies (38) were included in the review. Various patient-level and medication-related risk factors were identified including advanced patient age, comorbidities, length of hospital stay, previous hospitalizations, use of probiotic medications and proton pump inhibitors. The review also identified organizational factors such as room size, academic affiliation, and geographic location to be significantly associated with hospital-acquired CDIs.

Conclusion:

Validation of the factors associated with high risk of developing hospital-acquired CDIs identified in this review can aid in the development of risk prediction models to identify patients who are at a higher risk of developing CDIs and developing quality improvement interventions that might improve patient outcomes by minimizing risk of infection.
Associations of Vestibular Tests With Penn Acoustic Neuroma Quality of Life Scores After Resection of Vestibular Schwannoma
Authors: Brown Clifford Scott , Cooper Matthew W. , Peskoe Sarah B. , Risoli Thomas , Kaylie David M.
Published: December 2019

Objective:

Determine associations between preoperative caloric testing and video head impulse testing (vHIT) with baseline and postoperative Penn Acoustic Neuroma Quality of Life (PANQOL) scores following resection of vestibular schwannoma (VS).

Study Design:

Retrospective case series.

Setting:

Two tertiary referral hospitals.

Patients:

Adult patients with unilateral VS, preoperative calorics, vHIT, and dizziness handicap inventory (DHI) score.

Interventions:

Surgical resection of VS and postoperative surveys.

Main Outcome Measures:

PANQOL scores.

Results:

Forty-three patients were included (58.1% women) with a median age of 54 years (range, 28–82). Mean tumor size was 14.8 mm (σ=8.6), and 28 (65.1%) were right-sided. Average preoperative vHIT gain was 0.7 (σ = 0.3). Covert and overt saccades were present in 8 (25%) and 14 (42.4%) patients, respectively. Average preoperative unilateral weakness was 47% (σ = 33.2). Translabyrinthine approach was performed in 26 (60.5%) patients. No significant difference of PANQOL scores was noted at baseline or over time between patients with normal (>0.8) or abnormal (<0.8) gain. Patients with more unilateral weakness (>50%) had significantly higher baseline PANQOL scores compared with those with < 25% or 25 to 50% (p = 0.02), but had significant improvement in scores over time (p = 0.01). Higher preoperative DHI preoperatively was significantly associated with worse PANQOL scores at all timepoints (β=0.57, p = 0.0064). No differences in PANQOL scores amongst surgical approaches were observed.

Conclusion:

Preoperative vestibular testing with vHIT, calorics, DHI, and baseline PANQOL surveys may allow for patient counseling regarding postoperative quality of life over time.
Lesion Patterns and Possible Implications for Recovery in Acute Unilateral Vestibulopathy
Authors: Navari Elena , Casani Augusto Pietro
Published: December 2019

Objective:

To assess patterns of end-organ involvement in acute unilateral vestibulopathy (AUV) and to define the recovery.

Study Design:

Retrospective chart review.

Setting:

Tertiary academic referral hospital.

Patients and Interventions:

Fifty-nine patients fulfilling clinical criteria for AUV and evaluated using the caloric vestibular test, video head impulse test, and both cervical and ocular vestibular evoked myogenic potentials, up to 10 days from symptoms onset were included.

Main Outcome Measures:

Vestibular tests and requirements for vestibular rehabilitation were analyzed.

Results:

The most affected end-organ was the horizontal canal (97%), followed by the anterior canal (83%), utricle (73%), posterior canal (46%), and saccule (44%). Nineteen (32%) patients exhibited complete receptors lesion, while 13 (22%) exhibited damage to receptors connected with the superior division of the vestibular nerve (VN). The proportion of patients who underwent vestibular rehabilitation was higher in the latter two groups (58% for both). Partial involvement of the receptors innervated by both the division of the VN, rather than by its superior division, was detected in 22 and 24% of patients, respectively. Total or partial damage to receptors innervated by the inferior VN was not found.

Conclusion:

Deeper understanding of AUV may be achieved through identification of its patterns. Slightly more than one-half of AUV cases seemed to be associated with a nerve lesion, with a worse clinical outcome. The remaining patients exhibited selective involvement of vestibular receptors, more probably consistent with an intralabyrinthine lesion pattern and experienced better spontaneous recovery.
Cerebral Venous Sinus Thrombosis After Translabyrinthine Vestibular Schwannoma—A Prospective Study and Suggested Management Paradigm
Authors: Guazzo Emily , Panizza Benedict , Lomas Andrew , Wood Martin , Amato Damien , Alalade Andrew , Gandhi Mitesh , Bowman James
Published: December 2019

Objective:

To prospectively evaluate the incidence, risk factors and natural history of postoperative cerebral venous sinus thrombosis (pCVST) in translabyrinthine vestibular schwannoma microsurgical resection and propose a potential management paradigm.

Study Design:

Prospective, single cohort, multicenter study.

Setting:

State-wide academic tertiary referral centers.

Patients:

Fifty-four consecutive patients who underwent translabyrinthine vestibular schwannoma resection.

Main Outcome Measures:

Incidence of pCVST on postoperative imaging on Day 7, Day 28, and 12 months postoperatively. Patients and tumor characteristics, risk factors, length of stay, intraoperative parameters, complications, and follow-up were analyzed.

Results:

pCVST was demonstrated in 21 patients (38.9%) on postoperative imaging. All patients with pCVST were treated conservatively and remained asymptomatic in the immediate postoperative period and long-term follow-up. There were no instances of venous infarction, intracranial hemorrhage, or neurological deficits. A majority (61.1%) of pCVST recannalised on long-term follow up with conservative management. There was a statistical association with pCVST and surgery on the side of the non-dominant cerebral venous drainage (n = 17, 80.1%, p = 0.034). Patients with pCVST were significantly more likely to have a postoperative cerebrospinal fluid (CSF) leak (n = 5, 23.8%, p = 0.017).

Conclusion:

The incidence of pCVST following translabyrinthine vestibular schwannoma resection is much higher than previously recognized. pCVST is more likely to occur when surgery is performed on tumors situated on the side of non-dominant cerebral venous drainage. Despite the high prevalence of this iatrogenic phenomenon, all patients were asymptomatic and a majority resolved, thereby suggesting that conservative management is safe. Correlation between pCVST and increased incidence of CSF leak requires further investigation.
Mechanical Energy Dissipation Through the Ossicular Chain and Inner Ear Using Laser Doppler Vibrometer Measurement of Round Window Velocity
Authors: Ryan Matthew , Lally John , Adams Jason K. , Higgins Sophie , Ahmed Mostafa , Aden James , Esquivel Carlos , Spear Samuel A.
Published: December 2019

Hypothesis:

Round window velocity measurements should correlate closely with vibration measurements taken at proximal points along an intact chain over a set frequency range. These round window vibration measurements should be similar to the vibration measurements taken of the ossicles if mechanical energy is conserved through the vestibular organ.

Background:

To date there has not been a study which compares vibratory velocity measurements through an intact ossicular chain to the level of the round window. This study attempted to quantify the degree of mechanical energy transmission and suspected dissipation through the ossicular chain and vestibular organ through incus, stapes, and round window velocity measurements in response to sound stimulus.

Methods:

Five thawed human temporal bones with intact ossicular chain and tympanic membrane underwent complete mastoidectomy and a facial recess approach. A laser Doppler vibrometer (LDV) was mounted on the operating microscope to measure vibration of incus, stapes, and round window in response to a sound stimulus within the external auditory canal. Sound stimulus frequencies ranged from 0.5 to 4 kHz at 90 dB SPL.

Results:

Vibration velocity was measured across the frequency range for each incus, stapes, and round window. Vibration velocity curves obtained over the frequency range were similar for each of the bones with a notable resonant frequency around 2 kHz. The incus and stapes curve amplitudes were nearly identical with similar maximum velocity and frequency at which this maximal velocity was noted. Round window vibration velocity demonstrated a unique peak velocity. Transfer function measurements of the stapes and round window demonstrated markedly similar curves. The variation in velocity between temporal bones in response to the standardized stimulus was more dramatic in the round window measurements when compared with the incus and stapes.

Conclusions:

This study supports the concept that round window transfer function is equivalent to stapes footplate transfer function when subjected to the same acoustic stimuli. This study also demonstrates that the round window is a much more difficult target to measure when using LDV technology and improvements in experimental design are required to better understand round window physiology in relation to transfer of acoustic vibratory stimulus transferred throughout the middle ear. A complete and thorough understanding of the biophysical properties of the middle and inner ear are critical for optimal ossiculoplasty outcomes and the development of future ossicular prosthetics.
Association Between Vestibular Migraine and Migraine Headache: Yet to Explore
Authors: Abouzari Mehdi , Goshtasbi Khodayar , Moshtaghi Omid , Tan Donald , Lin Harrison W. , Djalilian Hamid R.
Published: December 2019

Objectives:

To evaluate if patients with a diagnosis of vestibular migraine (VM) by the International Classification of Headache Disorders (ICHD) criteria have meaningful differences in symptomatology and disease characteristics when compared to patients with concurrent vestibular symptoms and migraine that do not meet ICHD criteria.

Methods:

Patients who presented for the evaluation of vertigo were provided a detailed questionnaire about dizziness and migraine symptoms. Patients were assigned to either VM cohort (met ICHD criteria for VM) or migraine headache (MH) cohort (met ICHD criteria for migraine with or without aura but not VM). Disease characteristics, symptomatology, quality of life, and perceived stress score were compared between the cohorts.

Results:

The VM cohort demonstrated a shorter duration of vertigo episodes, 11 ± 22 hours versus 84 ± 146 hours in the MH cohort. In the VM cohort, 81% reported experiencing migraine headaches during episodes of vertigo, versus 61% in the MH cohort. All patients in the VM cohort reported a previous diagnosis of migraine headache, whereas 9% of the MH cohort had not been previously diagnosed by another physician. There was no difference in quality of life or perceived stress scores between the cohorts.

Conclusions:

A large proportion of vertigo patients with migrainous features do not meet the ICHD criteria for VM. The differences between cohorts represent selection bias rather than meaningful features unique to the cohorts. As such, VM and MH with vestibular symptoms may exist on a spectrum of the same disease process and may warrant the same treatment protocols.
Role of Macrophage Migration Inhibitory Factor in NLRP3 Inflammasome Expression in Otitis Media
Authors: Kariya Shin , Okano Mitsuhiro , Zhao Pengfei , Maeda Yukihide , Kataoka Yuko , Higaki Takaya , Makihara Seiichiro , Nishihira Jun , Tachibana Tomoyasu , Nishizaki Kazunori
Published: December 2019

Hypothesis:

Macrophage migration inhibitory factor plays an important role in the expression of interleukin (IL)-1β and the nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome in lipopolysaccharide-induced otitis media.

Background:

NLRP3 inflammasome and macrophage migration inhibitory factor are critical molecules mediating inflammation. However, the interaction between the NLRP3 inflammasome and macrophage migration inhibitory factor has not been fully examined.

Methods:

Wild-type mice and macrophage migration inhibitory factor gene-deficient (MIF−/−) mice received a transtympanic injection of either lipopolysaccharide or phosphate-buffered saline. The mice were sacrificed 24 hours after the injection. Concentrations of IL-1β, NLRP3, ASC (apoptosis-associated speck-like protein containing a caspase recruitment domain and a pyrin domain), and caspase-1 in the middle ear effusions were measured by enzyme-linked immunosorbent assay. Temporal bones were processed for histologic examination and immunohistochemistry.

Results:

In the immunohistochemical study using the wild-type mice, positive staining of macrophage migration inhibitory factor, NLRP3, ASC, and caspase-1 were observed in infiltrating inflammatory cells induced by lipopolysaccharide in the middle ear. The number of inflammatory cells caused by lipopolysaccharide administration decreased remarkably in the MIF−/− mice as compared with the wild-type mice. The concentrations of IL-1β, NLRP3, ASC, and caspase-1 increased in the lipopolysaccharide-treated wild-type mice. The MIF−/− mice with lipopolysaccharide had decreased levels of IL-1β, NLRP3, ASC, and caspase-1 as compared with the wild-type mice.

Conclusion:

Macrophage migration inhibitory factor has an important role in the production of IL-1β and the NLRP3 inflammasome. Controlling the inflammation by modulating macrophage migration inhibitory factor and the NLRP3 inflammasome may be a novel therapeutic strategy for otitis media.
Long-term clinical outcomes in patients with unstable angina undergoing percutaneous coronary interventions in a contemporary registry data from Poland
Authors: Piątek Łukasz , Janion-Sadowska Agnieszka , Piątek Karolina , Zandecki Łukasz , Zabojszcz Michał , Siudak Zbigniew , Sadowski Marcin
Published: December 2019

Background

Both unstable angina and non-ST-segment elevation myocardial infarction (NSTEMI) are still classified together in non-ST-elevation acute coronary syndromes despite the fact they substantially differ in both clinical profile and prognosis. The aim of the present study was to evaluate contemporary clinical characteristics and outcomes of unstable angina patients after percutaneous coronary intervention (PCI) in comparison with stable angina and NSTEMI in Swietokrzyskie District of Poland in years 2015–2017.

Methods

A total of 7187 patients after PCI from ORPKI Registry (38% with diagnosis of unstable angina) were included into the analysis. Impact of clinical presentation (unstable angina, stable angina, NSTEMI, STEMI) on three-year outcomes were determined.

Results

Unstable angina patients were older than stable angina but younger than NSTEMI individuals. In unstable angina group, the percentage of previous myocardial infarction (MI), PCI or coronary artery bypass grafting (CABG) was the highest among all analyzed groups. In three-year observation, the risk of death as well as MI and MACE in unstable angina after PCI was higher than stable angina angina but considerably lower than in the NSTEMI group. Multivariate analysis confirmed that prognosis in NSTEMI was substantially worse in comparison with unstable angina [relative risk (RR) 1.365, 95% confidence interval (CI): 1.126–1.655, P = 0.0015]. On the contrary in unstable angina and stable angina patients, the impact of diagnosis on mortality risk was similar (RR 1.189, 95% CI: 0.932–1.518, P = 0.1620). Parallel results were observed in respect of MI and MACE. Independent predictors of death or MACE were: age, kidney disease, hypertension, diabetes, previous stroke or previous PCI.

Conclusion

Three-year prognosis in unstable angina was considerable better in comparison with NSTEMI. On the contrary, after adjustment for baseline differences, the outcomes (death, MI, MACE) in unstable angina and stable angina patients were comparable.
Metacognitive Capacity Is Related to Self-Reported Social Functioning and May Moderate the Effects of Symptoms on Interpersonal Behavior
Authors: Fischer Melanie W. , Dimaggio Giancarlo , Hochheiser Jesse , Vohs Jenifer L. , Phalen Peter , Lysaker Paul H.
Published: December 2019

Impairments in metacognition or the ability to form integrated senses of self and others have been linked to deficits in laboratory-based measures of social functioning in schizophrenia. This study examined whether self-reported social functioning was related to metacognition in 88 adults in a nonacute phase of schizophrenia. Concurrent assessments were made of metacognition with the Metacognition Assessment Scale–Abbreviated, social functioning with the Social Functioning Scale, symptoms with the Positive and Negative Syndrome Scale, and neurocognition with the Wisconsin Card Sorting Task. Univariate correlations revealed that self-reported social functioning was related to metacognition. Symptom severity was linked to interpersonal relationships, and overall metacognition was found to significantly moderate that relationship such that the effects of symptoms on function grew less as metacognitive capacity was stronger, independent of the effects of neurocognition. This may suggest the potential of metacognitive interventions to titrate the negative effects of symptoms on social function.
Prostate Cancer, Use of Androgen Deprivation Therapy, and Cognitive Impairment
Authors: Alonso Quiñones Hector J. , Stish Bradley J. , Hagen Clinton , Petersen Ronald C. , Mielke Michelle M.
Published: December 2019

Introduction:

The association of prostate cancer and androgen deprivation therapy (ADT) use with the odds of developing mild cognitive impairment (MCI) was determined in men from the population-based Mayo Clinic Study of Aging (MCSA).

Methods:

The study included 2513 men (mean age of 73.1 y) enrolled in the MCSA. A history of prostate cancer, ADT use, and length of ADT exposure before their first MCSA visit was abstracted using the Rochester Epidemiology Project medical records-linkage system. MCI was diagnosed at the baseline visit. Logistic regression was used to determine whether prostate cancer and ADT use was associated with odds of MCI.

Results:

Of the 2513 participants, 349 (13.9%) had a history of prostate cancer; among whom 99 (28.3%) were treated with ADT before MCSA enrollment. There were 382 (15.2%) with a diagnosis of MCI. In the univariate logistic regression models, prostate cancer (odds ratio, 1.50; 95% confidence interval, 1.12-2.00), and ADT exposure (odds ratio, 1.57; 95% confidence interval, 0.96-2.58) were associated with higher odds of MCI. These associations were greatly attenuated and not significant in multivariable models.

Conclusions:

Neither a diagnosis of prostate cancer nor ADT use was associated with odds of MCI in this cross-sectional population-based study.