bluuebunny/crossref_metadata_2025 huggingface dataset:
Beef production from cull dairy cows: a review from culling to consumption
Authors: Moreira Ligia C , Rosa Guilherme J M , Schaefer Daniel M
Published: June 2021

Although more than 3 million head of dairy cows enter the food supply chain in the U.S. every year, research on this topic remains limited and scarce. Meat production from dairy cows is a significant component of beef production, accounting for almost 10% of U.S. commercial beef production. Thus, the purpose of this review is to demonstrate the importance of dairy cows as a beef source, and to provide an overview on topics from farm to meat product—culling, marketing, transportation, welfare, body composition and its relationship with lactation particularities, carcass characteristics, meat quality, and traceability. Current scientific evidence has shown that culling a dairy cow at an appropriate time has beneficial effects on cow welfare and, consequently, cow value. During marketing the dairy cow is visually evaluated for health and factors associated with its expected carcass value; thus, marketing a well-conditioned cow will ensure that the animal is fit for transportation and provides high carcass yield. However, limitations such as low body condition score, lameness or mobility problems, and visual defects remain persistent. Even though beef harvest plants accommodate cows in all body composition states, the current carcass grade system does not reflect the mature cow industry needs. Therefore, improvement of the grading system could maximize carcass utilization and increase cow carcass value by recognizing subprimal cuts that could be merchandised as whole muscle cuts. Lastly, implementation of a traceability system would unify information from the farm to harvest assisting the industry in making further advancements.
The Effect of Summer Cover Crops and Strawberry Cultivars on the Twospotted Spider Mite,Tetranychus urticae(Acari: Tetranychidae) and the Predatory Mite,Neoseiulus californicus(Acari: Phytoseidae) in Organic Strawberry Production Systems in Florida
Authors: Olaniyi Omotola G , Rhodes Elena M , Chase Carlene A , Liburd Oscar E
Published: June 2021

The twospotted spider mite, Tetranychus urticae (Koch) (Acari: Tetranychidae), is a key pest of strawberries and many other crops worldwide. Cover cropping, selecting tolerant or resistant cultivars, and biological control are important strategies of an organic management plan. In this study, we examined the effect of summer cover crops and strawberry cultivars on populations of T. urticae and a commercially available predatory mite, Neoseiulus californicus McGregor (Acari: Phytoseiidae), commonly used for T. urticae management in Florida. In the 2013–2014 season, four cover crops and eight strawberry cultivars were screened at the research station and on a commercial organic strawberry farm. The following season, the most promising cover crops (sunn hemp and hairy indigo) and cultivars, ‘Sensation’, ‘Strawberry Festival’, and ‘Winterstar’ were tested at the research station and on two small organic farms. In the 2016–2017, 2017–2018, and 2018–2019 seasons, a 4-way mix of cover crops was compared to sunn hemp and hairy indigo. In 2016–2017, ‘Florida Radiance’ was added to the three previously selected cultivars. ‘Florida Beauty’ replaced ‘Strawberry Festival’ in 2017–2018 and 2018–2019, and ‘Florida Brilliance’ replaced ‘Winterstar’ in 2018–2019. The effects of summer cover crops on both T. urticae and N. californicus were minimal. ‘Florida Brilliance’, ‘Florida Radiance’, ‘Sensation’, ‘Strawberry Festival’, and ‘Winterstar’ had lower T. urticae populations and higher yields in most seasons at most locations. The establishment and abundance of N. californicus was similar on these cultivars and was generally higher where T. urticae populations were higher. Implications for organic strawberry production in Florida are discussed.
Nitric oxide signalling in roots is required for MYB72-dependent systemic resistance induced by Trichoderma volatile compounds in Arabidopsis
Authors: Pescador Leyre , Fernandez Iván , Pozo María J , Romero-Puertas María C , Pieterse Corné M J , Martínez-Medina Ainhoa
Published: June 2021

Volatile compounds (VCs) of Trichoderma fungi trigger induced systemic resistance (ISR) in Arabidopsis that is effective against a broad spectrum of pathogens. The root-specific transcription factor MYB72 is an early regulator of ISR and also controls the activation of iron-deficiency responses. Nitric oxide (NO) is involved in the regulation of MYB72-dependent iron-deficiency responses in Arabidopsis roots, but the role of NO in the regulation of MYB72 and ISR by Trichoderma VCs remains unexplored. Using in vitro bioassays, we applied Trichoderma VCs to Arabidopsis seedlings. Plant perception of Trichoderma VCs triggered a burst of NO in Arabidopsis roots. By suppressing this burst using an NO scavenger, we show the involvement of NO in Trichoderma VCs-mediated regulation of MYB72 expression. Using an NO scavenger and the Arabidopsis lines myb72 and nia1nia2 in in planta bioassays, we demonstrate that NO signalling is required in the roots for activation of Trichoderma VCs-mediated ISR against the leaf pathogen Botrytis cinerea. Analysis of the defence-related genes PR1 and PDF1.2 points to the involvement of root NO in priming leaves for enhanced defence. Our results support a key role of root NO signalling in the regulation of MYB72 expression during the activation of ISR by Trichoderma VCs.
Dust in the central parsecs of unobscured AGN: more challenges to the torus
Authors: Prieto M Almudena , Nadolny Jakub , Fernández-Ontiveros Juan A , Mezcua Mar
Published: June 2021

A parsec-scale dusty torus is thought to be the cause of active galactic nuclei (AGN) dichotomy in the 1/2 types, narrow/broad emission lines. In a previous work, on the basis of parsec-scale resolution infrared/optical dust maps, it was found that dust filaments, few parsecs wide and several hundred parsecs long, were ubiquitous features crossing the centre of type 2 AGN, their optical thickness being sufficient to fully obscure the optical nucleus. This work presents the complementary view for type 1 and intermediate-type AGN. The same type of narrow, collimated, dust filaments are equally found at the centre of these AGN. The difference now resides in their location with respect to the nucleus, next to it but not crossing it, as it is the case in type 2, and their reduced optical thickness towards the centre, $A_V \lesssim 1.5\, \rm {mag}$, insufficient to obscure at ultraviolet nucleus wavelengths. It is concluded that large-scale, hundred parsecs to kiloparsecs long, dust filaments and lanes, reminiscent of those seen in the Milky Way, are a common ingredient to the central parsec of galaxies. Their optical thickness changes along their structure in type 2 reaching optical depths high enough to obscure the nucleus in full. Their location with respect to the nucleus and increasing gradient in optical depth towards the centre could naturally lead to the canonical type 1/2 AGN classification, making these filaments to play the role of the torus. Dust filaments and lanes show equivalent morphologies in molecular gas. Gas kinematic in the filaments indicates mass inflows at rates ${\lt}1 \, \mathrm{M}_{\odot }~ \mathrm{yr}^{-1}$.
Inferring Population Histories for Ancient Genomes Using Genome-Wide Genealogies
Authors: Speidel Leo , Cassidy Lara , Davies Robert W , Hellenthal Garrett , Skoglund Pontus , Myers Simon R
Published: June 2021

Ancient genomes anchor genealogies in directly observed historical genetic variation and contextualize ancestral lineages with archaeological insights into their geography and cultural associations. However, the majority of ancient genomes are of lower coverage and cannot be directly built into genealogies. Here, we present a fast and scalable method, Colate, the first approach for inferring ancestral relationships through time between low-coverage genomes without requiring phasing or imputation. Our approach leverages sharing patterns of mutations dated using a genealogy to infer coalescence rates. For deeply sequenced ancient genomes, we additionally introduce an extension of the Relate algorithm for joint inference of genealogies incorporating such genomes. Application to 278 present-day and 430 ancient DNA samples of >0.5x mean coverage allows us to identify dynamic population structure and directional gene flow between early farmer and European hunter-gatherer groups. We further show that the previously reported, but still unexplained, increase in the TCC/TTC mutation rate, which is strongest in West Eurasia today, was already present at similar strength and widespread in the Late Glacial Period ~10k−15k years ago, but is not observed in samples >30k years old. It is strongest in Neolithic farmers, and highly correlated with recent coalescence rates between other genomes and a 10,000-year-old Anatolian hunter-gatherer. This suggests gene-flow among ancient peoples postdating the last glacial maximum as widespread and localizes the driver of this mutational signal in both time and geography in that region. Our approach should be widely applicable in future for addressing other evolutionary questions, and in other species.
Selenium-deficient diet induces inflammatory response in the pig adrenal glands by activating TLR4/NF-κB pathway via miR-30d-R_1
Authors: Kaixin Zhang , Xuedie Gu , Jing Lan , Yiming Zhang , Khoso Pervez Ahmed , Zhaoyi Liu , Shu Li
Published: June 2021

Selenium (Se) is an important trace element to maintain the body's dynamic balance. Lack of Se can cause inflammation. Studies have shown that inflammation often leads to disorders of the hypothalamic–pituitary–adrenal axis, but the mechanism by which Se deficiency causes inflammation of the porcine adrenal glands is still unclear. In order to study the effect of Se deficiency on the adrenal glands of pigs, we obtained Se-deficient pig adrenal glands through a low-Se diet. The results of mass spectrometry showed that the Se content in the Se-deficient group was only one-tenth of the control group. We detected the expression of the toll-like receptor 4 (TLR4) and downstream factors by qRT-PCR and Western blotting, and found that the lack of Se affected the TLR4/NF-κB pathway. It is known that miR-155-3p, miR-30d-R_1, and miR-146b have all been verified for targeting relationship with TLR4. We confirmed by qRT-PCR that miR-30d-R_1 decreased most significantly in the Se-deficient pig model. Then we tested 25 selenoproteins and some indicators of oxidative stress. It is confirmed that Se deficiency reduces the antioxidant capacity and induces oxidative stress in pig adrenal tissue. In short, a diet lacking Se induces oxidative stress in pig adrenal tissues and leads to inflammation through the miR-30d-R_1/TLR4 pathway. This study provides a reference for the prevention of adrenal inflammation in pigs from a nutritional point of view.
Evidence for a chromosome origin unwinding system broadly conserved in bacteria
Authors: Pelliciari Simone , Dong Mei-Jing , Gao Feng , Murray Heath
Published: June 2021

Genome replication is a fundamental requirement for the proliferation of all cells. Throughout the domains of life, conserved DNA replication initiation proteins assemble at specific chromosomal loci termed replication origins and direct loading of replicative helicases (1). Despite decades of study on bacterial replication, the diversity of bacterial chromosome origin architecture has confounded the search for molecular mechanisms directing the initiation process. Recently a basal system for opening a bacterial chromosome origin (oriC) was proposed (2). In the model organism Bacillus subtilis, a pair of double-stranded DNA (dsDNA) binding sites (DnaA-boxes) guide the replication initiator DnaA onto adjacent single-stranded DNA (ssDNA) binding motifs (DnaA-trios) where the protein assembles into an oligomer that stretches DNA to promote origin unwinding. We report here that these core elements are predicted to be present in the majority of bacterial chromosome origins. Moreover, we find that the principle activities of the origin unwinding system are conserved in vitro and in vivo. The results suggest that this basal mechanism for oriC unwinding is broadly functionally conserved and therefore may represent an ancestral system to open bacterial chromosome origins.
External Validation and Modification of Nationwide Inpatient Sample Subarachnoid Hemorrhage Severity Score
Authors: Rawal Sapna , Rinkel Gabriel J E , Fang Jiming , Washington Chad W , Macdonald R Loch , Victor J Charles , Krings Timo , Kapral Moira K , Laupacis Andreas
Published: June 2021

BACKGROUND

The Nationwide Inpatient Sample Subarachnoid Hemorrhage (SAH) Severity Score (NIS-SSS) was developed as a measure of SAH severity for use in administrative databases. The NIS-SSS consists of International Classification of Diseases Ninth Revision (ICD-9) diagnostic and procedure codes derived from the SAH inpatient course and has been validated against the Hunt-Hess score (HH).

OBJECTIVE

To externally validate both the NIS-SSS and a modified version of the NIS-SSS (m-NIS-SSS) consisting of codes present only on admission, against the HH in a Canadian province-wide registry and administrative database of SAH patients.

METHODS

A total of 1467 SAH patients admitted to Ontario stroke centers between 2003 and 2013 with recorded HH were included. The NIS-SSS and m-NIS-SSS were validated against the HH by testing correlation between the NIS-SSS/m-NIS-SSS and HH, comparing discriminative ability of the NIS-SSS/m-NIS-SSS vs HH for poor outcome by calculating area under the curve (AUC), and comparing calibration of the NIS-SSS, m-NIS-SSS, and HH by plotting predicted vs observed outcome.

RESULTS

Correlation with HH was 0.417 (P ≤ .001) for NIS-SSS, and 0.403 (P ≤ .001) for m-NIS-SSS. AUC for prediction of poor outcome was 0.786 (0.764-0.808) for HH, 0.771 (0.748-0.793) for NIS-SSS, and 0.744 (0.721-0.767) for m-NIS-SSS. Calibration plots demonstrated that HH had the most accurate prediction of outcome, whereas the NIS-SSS and m-NIS-SSS did not accurately predict low risk of poor outcome.

CONCLUSION

The NIS-SSS and m-NIS-SSS have good external validity, and therefore, may be suitable to approximate traditional clinical scores of disease severity in SAH research using administrative data.
Perspective of drug design with high-performance computing
Authors: Li Zhe , Li Hui , Yu Kunqian , Luo Hai-Bin
Published: June 2021

The representative applications, recent advances and possible future directions of computational drug design were summarized, aiming to accelerate the drug discovery with the assistance of the fast-developing high-performance computing.
Inactivation of mitochondrial complex I stimulates chloroplast ATPase inPhyscomitrium patens
Authors: Mellon Marco , Storti Mattia , Vera-Vives Antoni M. , Kramer David M. , Alboresi Alessandro , Morosinotto Tomas
Published: June 2021

Light is the ultimate source of energy for photosynthetic organisms, but respiration is fundamental for supporting metabolism during the night or in heterotrophic tissues. In this work, we isolated Physcomitrella (Physcomitrium patens) plants with altered respiration by inactivating Complex I (CI) of the mitochondrial electron transport chain by independently targeting on two essential subunits. Inactivation of CI caused a strong growth impairment even in fully autotrophic conditions in tissues where all cells are photosynthetically active, demonstrating that respiration is essential for photosynthesis. CI mutants showed alterations in the stoichiometry of respiratory complexes while the composition of photosynthetic apparatus was substantially unaffected. CI mutants showed altered photosynthesis with high activity of both Photosystems I and II, likely the result of high chloroplast ATPase activity that led to smaller ΔpH formation across thylakoid membranes, decreasing photosynthetic control on cytochrome b6f in CI mutants. These results demonstrate that alteration of respiratory activity directly impacts photosynthesis in P. patens and that metabolic interaction between organelles is essential in their ability to use light energy for growth.
Indirect Federal Subsidy and Tax Exportation through State and Local Tax Deduction: Understanding the Impact of the 2017 Tax Reform on State and Local Governments
Authors: Wu Yonghong
Published: June 2021

The deduction of certain state and local taxes (SALT) from the U.S. federal income tax base provides substantial amounts of indirect federal subsidy to state and local governments and also allows cross-state exportation of deductible state and local taxes. The Tax Cuts and Jobs Act of 2017 (TCJA) limits the SALT deduction and increases standard deduction per filer each year. This study examines the impact of TCJA on the distribution of this indirect federal subsidy and exportation of major state and local taxes. Using individual income tax data from the Internal Revenue Service, this research shows that the law narrows the disparity in states’ receipt of the indirect federal subsidy and reduces the capacity of high-tax states to export their taxes to other states. The findings shed light on the continued debate regarding the effectiveness and fairness of this important type of intergovernmental transfer in the United States.
Middle Jurassic origin in India: a new look at evolution of Vermileonidae and time-scaled relationships of lower brachyceran flies
Authors: Wang Liang , Ding Shuangmei , Cameron Stephen L , Li Xin , Liu Yue , Yao Gang , Yang Ding
Published: June 2021

Vermileonidae (wormlions) comprises 61 described species in 12 genera and is one of the oddest and most rarely collected dipteran families. Larvae of Vermileonidae are famous for their pitfall prey behaviour, whereas the adults are rarely seen. Here we report, for the first time, the complete mitochondrial genome from members of Vermileonidae. Phylogenetic reconstruction based on a representative sampling of the order reveals new insights into relationships between the Vermileonidae and other members of lower brachyceran flies. A sister-group relationship between Vermileonidae and Xylophagidae is supported, and the higher-level clade relationships are Tabanomorpha + (Muscomorpha + (Xylophagomorpha + Stratiomyomorpha)). Combining mitochondrial genome data with a morphological phylogeny, geographical distribution and geological history, we propose that the Vermileonidae originated in India during the Middle Jurassic, spreading to Africa via land bridges during the Late Jurassic, to the Palaearctic after the collision of India with Laurasia in the Late Oligocene, and to the Nearctic in the Early Miocene, via either North Atlantic or Beringian land bridges. Wet forested regions have proved to be barriers to their dispersal, explaining their absence from Central Africa, South America and eastern North America.
Bacterial Skin Infections in Hospitalized Patients with Bullous Pemphigoid
Authors: Li Furong , Bian Wenjie , Wu Yejun , Zhu Xuejun , Chen Xixue , Wang Mingyue
Published: June 2021

OBJECTIVE

To explore the features and risk factors of bacterial skin infections (BSIs) in hospitalized patients with bullous pemphigoid (BP).

METHODS

Records were retrospectively reviewed for 110 hospitalized patients with BP admitted to Peking University First Hospital between 2013 and 2019. Bacterial species and drug resistance were assessed, and then the underlying risk factors for BSIs were evaluated.

RESULTS

Infections were present in 40% (44/110) of the patients. Staphylococcus aureus (72.7%, 32/44) was the most common bacterium, and it was highly resistant to penicillin (81.3%, 26/32), erythromycin (62.5%, 20/32), and clindamycin (56.3%, 18/32), but 100.0% sensitive to vancomycin and tigecycline. Coronary heart disease (P = .02; odds ratio [OR], 12.68), multisystem comorbidities (P = .02; OR, 3.67), hypoalbuminemia (P = .04; OR, 3.70), high levels of anti-BP180 antibodies (>112.4 U/mL; P = .003; OR, 6.43), and season (spring: reference; summer: P = .002; OR, 23.58; autumn: P = .02; OR, 12.19; winter: P = .02; OR, 13.19) were significantly associated with BSIs.

CONCLUSIONS

Hospitalized patients with BP had a high incidence of BSIs, and those patients with underlying risk factors require careful management to prevent and control BSIs.
A Framework to Assess Alarm Fatigue Indicators in Critical Care Staff
Authors: Claudio David , Deb Shuchisnigdha , Diegel Elizabeth
Published: June 2021

OBJECTIVES:

This article examines work-related and Personality personality factors that could influence health providers in experiencing alarm fatigue. The purpose of this study is to provide a basis to determine factors that may predict the potential of alarm fatigue in critical care staff.

DESIGN:

A questionnaire-based survey and an observational study were conducted to assess factors that could contribute to indicators of alarm fatigue.

INTERVENTIONS:

Factors included patient-to-staff ratio, criticality of the alarm, priority of different tasks, and personality traits.

SETTING:

The study was conducted at an eight-bed ICU in a mid-size hospital in Montana.

SUBJECTS:

Data were collected for six day shifts and six night shifts involving 24 critical care professionals. Within each 12-hour shift, six 15-minute intervals were randomly generated through work sampling for 6 days; a total of 1,080 observations were collected.

MEASUREMENTS:

Alarm fatigue was assessed with the subjective workload assessment technique and Boredom, Apathy, and Distrust Affects, which were measured through validated questionnaires. The Big Five Personality model was used to assess personality traits.

MAIN RESULTS:

Work factors including task prioritization, nurse-to-patient ratio, and length of shifts were associated with indicators of alarm fatigue. Personality traits of openness, conscientiousness, and neuroticism were also associated.

CONCLUSIONS:

We recommend assessing personality traits for critical care staff to be aware of how their individualities can affect their behavior towards alarm fatigue. We also recommend an examination of alternative strategies to reduce alarm fatigue, including examining the use of breaks, work rotation, or shift reduction.
Safety and Clinical Outcomes of Immune Checkpoint Inhibitors in Patients With Cancer and Preexisting Autoimmune Diseases
Authors: Yeung Cynthia , Kartolo Adi , Holstead Ryan , Moffat Gordon T. , Hanna Lilian , Hopman Wilma , Lakoff Joshua , Baetz Tara
Published: June 2021

Immunotherapy has revolutionized treatment outcomes in numerous cancers. However, clinical trials have largely excluded patients with autoimmune diseases (ADs) due to the risk of AD flares or predilection for developing organ-specific inflammation. The objective of this study was to evaluate the safety and efficacy of immunotherapy in patients with cancer and preexisting ADs. A retrospective, single-center study of patients with cancer initiated on immune checkpoint inhibitors between 2012 and 2019 was conducted. The primary outcome was the development of immune-related adverse events (irAEs) with respect to the presence of AD at baseline. Associations were assessed using Kaplan-Meier curves, bivariate and multivariable analyses. Of the 417 patients included in this study, 63 patients (15%) had preexisting ADs. A total of 218 patients (53%) developed at least 1 irAE. There was no association between the presence of baseline AD on the development, grade, or number of irAEs; time to irAE or irAE recovery; systemic corticosteroid or additional immunosuppressant treatment for irAEs; permanent treatment discontinuation; or overall response rate. Two smaller cohorts were studied, melanoma and non–small cell lung cancer, and there was no effect of baseline AD on overall survival on either cohort. However, a greater proportion of patients with baseline ADs had full recovery from their irAE (P=0.037). Furthermore, age below 65, baseline steroid use, and single-agent immunotherapy regimens were protective in terms of the development of irAEs. Our study suggests that immune checkpoint inhibitors have similar safety and efficacy profiles in patients with preexisting ADs.
Modernizing Withdrawal Management Services
Authors: Mocanu Victor , Cowan Nicole , Klimas Jan , Ahamad Keith , Wood Evan
Published: June 2021

Alcohol, opioid, and stimulant withdrawal syndromes are serious clinical presentations, some of which can be life-threatening if untreated. Patients presenting with withdrawal syndromes offer an important opportunity for healthcare providers to ally in deciding the most appropriate treatment setting, safely treating withdrawal symptoms, preventing potentially severe medical complications, and facilitating a transition to longer-term low-barrier substance use care including, where available, psychosocial interventions, evidence-based pharmacotherapies, and referrals for primary care-based or specialist-led services. Given that substance use disorders are chronic biopsychosocial disorders commonly characterized by periods of relapse and remission, patients presenting in substance withdrawal deserve a long-term and holistic approach to management that cannot be simply achieved in short-term withdrawal management siloed and separate from a continuum of ongoing substance use care. With this in mind, this narrative review of withdrawal management literature describes recent advances and challenges in clinical care for patients in withdrawal from alcohol, opioids, and stimulants.

Les syndromes de sevrage liés à l’alcool, aux opioïdes et aux stimulants sont des manifestations cliniques graves, dont certaines peuvent mettre la vie en danger si elles ne sont pas traitées. Les patients présentant des syndromes de sevrage offrent aux fournisseurs de soins de santé une occasion importante de s’allier pour décider du cadre de traitement le plus approprié, traiter en toute sécurité les symptômes de sevrage, prévenir les complications médicales potentiellement graves et faciliter la transition vers des soins de consommation de substances à faible barrière à long terme, y compris, lorsque disponibles, interventions psychosociales, pharmacothérapies fondées sur des données probantes et aiguillage vers des services de soins primaires ou dirigés par des spécialistes. Étant donné que les troubles liés à l’usage de substances sont des troubles biopsychosociaux chroniques généralement caractérisés par des périodes de rechute et de rémission, les patients se présentant en sevrage de substances méritent une approche à long terme et holistique de la prise en charge qui ne peut être simplement réalisée dans une gestion du sevrage à court terme cloisonnée et séparée d’un continuum des soins continus liés à l’usage de substances. Dans cet esprit, cette revue narrative de la littérature sur la gestion du sevrage décrit les progrès récents et les défis dans les soins cliniques pour les patients en sevrage d’alcool, d’opioïdes et de stimulants.
Expert consensus statement on the perioperative management of adult patients undergoing head and neck surgery and free tissue reconstruction from the Society for Head and Neck Anesthesia
Authors: Healy David W. , Cloyd Benjamin H. , Straker Tracey , Brenner Michael J. , Damrose Edward J. , Spector Matthew E. , Saxena Amit , Atkins Joshua H. , Ramamurthi Radhamangalam J. , Mehta Arpan , Aziz Michael F. , Cattano Davide , Levine Adam I. , Schechtman Samuel A. , Cavallone Laura F. , Abdelmalak Basem B.
Published: June 2021

The perioperative care of adult patients undergoing free tissue transfer during head and neck surgical (microvascular) reconstruction is inconsistent across practitioners and institutions. The executive board of the Society for Head and Neck Anesthesia (SHANA) nominated specialized anesthesiologists and head and neck surgeons to an expert group, to develop expert consensus statements. The group conducted an extensive review of the literature to identify evidence and gaps and to prioritize quality improvement opportunities. This report of expert consensus statements aims to improve and standardize perioperative care in this setting. The modified Delphi method was used to evaluate the degree of agreement with draft consensus statements. Additional discussion and collaboration was performed via video conference and electronic communication to refine expert opinions and to achieve consensus on key statements. Thirty-one statements were initially formulated, 14 statements met criteria for consensus, 9 were near consensus, and 8 did not reach criteria for consensus. The expert statements reaching consensus described considerations for preoperative assessment and optimization, airway management, perioperative monitoring, fluid management, blood management, tracheal extubation, and postoperative care. This group also examined the role for vasopressors, communication, and other quality improvement efforts. This report provides the priorities and perspectives of a group of clinical experts to help guide perioperative care and provides actionable guidance for and opportunities for improvement in the care of patients undergoing free tissue transfer for head and neck reconstruction. The lack of consensus for some areas likely reflects differing clinical experiences and a limited available evidence base.
Bone Cement Internal Auditory Canal Reconstruction to Reduce CSF Leak After Vestibular Schwannoma Retrosigmoid Approach
Authors: Zhang Lisa , Galaiya Deepa , Jackson Christopher M. , Tamargo Rafael J. , Lim Michael , Carey John , Creighton Francis X.
Published: June 2021

Objective:

To describe rates of cerebrospinal fluid (CSF) rhinorrhea after reconstruction of the IAC with calcium phosphate bone cement during retrosigmoid resections of vestibular schwannomas.

Methods:

A retrospective chart review of 177 patients who underwent retrosigmoid craniotomy and opening of the internal auditory canal for resection of a vestibular schwannoma between January 2016 and September 2019 at a tertiary referral center. Patients with other cerebellopontine angle tumor histology, neurofibromatosis type II, or those undergoing revision surgeries were excluded.

Results:

Out of 177 patients, six patients (3.4%) developed postoperative rhinorrhea. Four patients (2.3%) were taken back to the OR for mastoidectomy and repair of CSF leak. Three of these patients were noted to have a CSF leak from the peri-labyrinthine air cells, and one was found to have a leak from the craniotomy site communicating with the mastoid air cells. Two patients were conservatively managed with diuretics and had resolution of their CSF leak. Six patients (3.4%) were readmitted for postoperative infection. Two patients were diagnosed with meningitis (1.1%), one aseptic and one H. Influenza, and three patients developed surgical site infections (1.6%). One patient was empirically treated with antibiotics and ultimately had a negative CSF culture.

Conclusions:

Our results demonstrate that the use of calcium phosphate bone cement for IAC closure in retrosigmoid resection of vestibular schwannomas is a safe and effective technique with low rates of postoperative CSF rhinorrhea.
Natural History of Growing Sporadic Vestibular Schwannomas During Observation: An International Multi-Institutional Study
Authors: Marinelli John P. , Carlson Matthew L. , Hunter Jacob B. , Nassiri Ashley M. , Haynes David S. , Link Michael J. , Lohse Christine M. , Reznitsky Martin , Stangerup Sven-Eric , Caye-Thomasen Per
Published: June 2021

Objective:

Active treatment of small- or medium-sized vestibular schwannoma during wait-and-scan management is currently recommended at most centers globally once growth is detected. The primary aim of the current study was to characterize the natural history of growing sporadic vestibular schwannoma during observation.

Study Design:

Cohort study.

Setting:

Four tertiary referral centers across the United States and Denmark.

Patients:

Patients with two prior MRI scans demonstrating ≥2 mm of linear growth who continued observational management.

Intervention:

Observation with serial imaging.

Main Outcome Measure:

Subsequent linear growth-free survival (i.e., an additional ≥2 mm of growth) following initial growth of ≥2 mm from tumor size at diagnosis.

Results:

Among 3,402 patients undergoing observation, 592 met inclusion criteria. Median age at initial growth was 66 years (IQR 59–73) for intracanalicular tumors (N = 65) and 62 years (IQR 54–70) for tumors with cerebellopontine angle extension (N = 527). The median duration of MRI surveillance following initial detection of tumor growth was 5.2 years (IQR 2.4–6.9) for intracanalicular tumors and 1.0 year (IQR 1.0–3.3) for cerebellopontine angle tumors. For intracanalicular tumors, subsequent growth-free survival rates (95% CI; number still at risk) at 1, 2, 3, 4, and 5 years following the initial MRI that demonstrated growth were 77% (67–88; 49), 53% (42–67; 31), 46% (35–60; 23), 34% (24–49; 17), and 32% (22–47; 13), respectively. For cerebellopontine angle tumors, subsequent growth-free survival rates were 72% (68–76; 450), 47% (42–52; 258), 32% (28–38; 139), 26% (21–31; 82), and 22% (18–28; 57), respectively. For every 1 mm increase in magnitude of growth from diagnosis to tumor size at detection of initial growth, the HRs associated with subsequent growth were 1.64 (95% CI 1.25–2.15; p < 0.001) for intracanalicular tumors and 1.08 (95% CI 1.01–1.15; p = 0.02) for cerebellopontine angle tumors.

Conclusions:

Growth detected during observation does not necessarily portend future growth, especially for slowly growing tumors. Because early treatment does not confer improved long-term quality of life outcomes, toleration of some growth during observation is justifiable in appropriately selected cases.
Cochlear T2 Signal May Predict Hearing Outcomes After Resection of Acoustic Neuroma
Authors: Tawfik Kareem O. , McDonald Marin , Ren Yin , Moshtaghi Omid , Schwartz Marc S. , Friedman Rick A.
Published: June 2021

Objective:

Examine the impact of preoperative cochlear Fast Imaging Employing Steady-state Acquisition (FIESTA) and Constructive Interference in Steady State (CISS) signal intensity on hearing outcomes after middle cranial fossa (MCF) resection of acoustic neuroma (AN).

Methods:

Adult patients (≥18 years) who underwent MCF AN resection for hearing preservation (HP) between November 2017 and September 2019 were retrospectively reviewed. All patients had preoperative word recognition score (WRS) ≥50%. HP was defined as postoperative WRS ≥50%. A neuroradiologist blinded to patients’ clinical and audiometric outcomes reviewed patients’ preoperative magnetic resonance images. Ipsilateral-to-contralateral cochlear FIESTA/CISS signal intensity ratios were determined using hand-drawn regions of interest focused on the cochlear fluid. Preoperative and postoperative pure tone average (PTA) and WRS were reviewed.

Results:

Fifty-one patients were reviewed (60.8% female). Mean age was 47 years and mean tumor size 9.2 mm (±3.8). Hearing was preserved in 56.9% (n = 29). FIESTA/CISS signal ratios did not significantly differ between patients with and without HP. Lower FIESTA/CISS signal ratios correlated with greater declines in hearing (r = 0.322, p = 0.011 for PTA; and r = 0.384, p = 0.004 for WRS). On multivariate analysis accounting for tumor size and preoperative PTA/WRS, decreases in FIESTA/CISS signal ratios independently predicted greater declines in hearing by PTA (b = −100.9, p = 0.012) and WRS (b = 76.208), although the latter result was not statistically significant (p = 0.078).

Conclusions:

Cochlear FIESTA/CISS signal intensity may be a predictor of postoperative hearing loss after MCF AN resection. In this cohort, degraded preoperative cochlear FIESTA/CISS signal strongly predicted postoperative hearing loss.

Level of Evidence: IV.
Prevalence and Treatment Characteristics of Spastic Hypertonia on First-Time Admission to Acute Inpatient Rehabilitation
Authors: Dragojlovic Nikola , Romanoski Natasha L. , Verduzco-Gutierrez Monica , Francisco Gerard E.
Published: June 2021

Objective

The aim of the study was to report the prevalence of spasticity and treatment patterns during first-time admission to inpatient rehabilitation after acute stroke, traumatic brain injury, and spinal cord injury.

Design

This is a retrospective cohort study.

Methods

A review of 285 adult patients consecutively admitted to inpatient rehabilitation was conducted. Patients with a history of spasticity and inpatient rehabilitation course and those younger than 18 yrs were excluded. Main outcome measures are as follows: admitting diagnosis, length of stay, time from injury to admission, acute transfer rate, prevalence and severity of spasticity using Modified Ashworth Scale at admission and discharge, Functional Independence Measure scores at admission and discharge, Functional Independence Measure efficiency, and treatments for spasticity.

Results

Stroke patients had the highest prevalence of spasticity: 68% on admission and 50% at discharge. In traumatic brain injury, spasticity prevalence was 55% on admission and 30% at discharge. In spinal cord injury, spasticity prevalence was 48% on admission and 46% at discharge. Patients with spinal cord injury received the most medications to control spasticity, whereas those with traumatic brain injury and stroke received the most procedural interventions.

Conclusions

Spasticity is a common sequela of upper motor neuron injury for patients admitted to inpatient rehabilitation. Early recognition and management are essential to prevent contractures, minimize pain, and maximize functional recovery.
Dynamic Serial Cytokine Measurements During Intravenous Ca-DTPA Chelation in Gadolinium Deposition Disease and Gadolinium Storage Condition
Authors: Maecker Holden T. , Siebert Janet C. , Rosenberg-Hasson Yael , Koran Lorrin M. , Ramalho Miguel , Semelka Richard C.
Published: June 2021

Purpose

The aim of this study was to investigate the feasibility of measuring early changes in serum cytokine levels after intravenous diethylenetriaminepentaacetic acid (Ca-DTPA) chelation in patients manifesting either gadolinium deposition disease (GDD) or gadolinium storage condition (GSC) and the possible usefulness of this method in further research.

Methods

Four patients with recent-onset GDD (≤1 year) and 2 patients with long-standing GSC (4 and 9 years) underwent chelation with intravenous bolus administration of Ca-DTPA. Multiple blood draws were performed to measure serum cytokines: at T = 0 (before Ca-DTPA injection) and 1, 5, 10, 30, 60 minutes, and 24 hours after Ca-DTPA injection. Patients rated the severity of GDD symptom flare at 24 hours. The 24-hour urine Gd amounts were measured prechelation and for the 24 hours after chelation. Serum samples were analyzed blind to whether patients had GDD or GSC but with knowledge of the time points characterizing each sample.

Results

Urine samples for both GDD and GSC patients showed increases in Gd postchelation. All GDD patients experienced flare reactions postchelation; the 2 GSC patients did not. Two cytokines, EGF and sCD40L, peaked at 30 minutes postchelation in at least 4 of the 6 participants. Three cytokines, ENA78/CXCL5, EOTAXIN/CCL11, and LEPTIN, peaked at 24 hours in at least 4 of the 6 participants. Two participants were high outliers for a large number of cytokines across time points. No clear distinction between GDD and GSC was apparent from the cytokine patterns, although differences were present.

Conclusions

This pilot study describes precise temporal resolution (in the range of minutes) after a cytokine-inciting event. Select cytokines exhibited peak values at different time points. At this preliminary stage of investigation, peak cytokine release seems to reflect the amount of Gd mobilized rather than the severity of the patient symptomatic reaction. Too few subjects were studied to support statistical analysis between GDD and GSC groups, although differences were observed through visual data analysis.
New Prospects for Ultra-High-Field Magnetic Resonance Imaging in Multiple Sclerosis
Authors: Ineichen Benjamin V. , Beck Erin S. , Piccirelli Marco , Reich Daniel S.
Published: June 2021

There is growing interest in imaging multiple sclerosis (MS) through the ultra-high-field (UHF) lens, which currently means a static magnetic field strength of 7 T or higher. Because of higher signal-to-noise ratio and enhanced susceptibility effects, UHF magnetic resonance imaging improves conspicuity of MS pathological hallmarks, among them cortical demyelination and the central vein sign. This could, in turn, improve confidence in MS diagnosis and might also facilitate therapeutic monitoring of MS patients. Furthermore, UHF imaging offers unique insight into iron-related pathology, leptomeningeal inflammation, and spinal cord pathologies in neuroinflammation. Yet, limitations such as the longer scanning times to achieve improved resolution and incipient safety data on implanted medical devices need to be considered. In this review, we discuss applications of UHF imaging in MS, its advantages and limitations, and practical aspects of UHF in the clinical setting.
Fur seals do, but sea lions don't — cross taxa insights into exhalation during ascent from dives
Authors: Hooker Sascha K. , Andrews Russel D. , Arnould John P. Y. , Bester Marthán N. , Davis Randall W. , Insley Stephen J. , Gales Nick J. , Goldsworthy Simon D. , McKnight J. Chris
Published: June 2021

Management of gases during diving is not well understood across marine mammal species. Prior to diving, phocid (true) seals generally exhale, a behaviour thought to assist with the prevention of decompression sickness. Otariid seals (fur seals and sea lions) have a greater reliance on their lung oxygen stores, and inhale prior to diving. One otariid, the Antarctic fur seal (Arctocephalus gazella), then exhales during the final 50–85% of the return to the surface, which may prevent another gas management issue: shallow-water blackout. Here, we compare data collected from animal-attached tags (video cameras, hydrophones and conductivity sensors) deployed on a suite of otariid seal species to examine the ubiquity of ascent exhalations for this group. We find evidence for ascent exhalations across four fur seal species, but that such exhalations are absent for three sea lion species. Fur seals and sea lions are no longer genetically separated into distinct subfamilies, but are morphologically distinguished by the thick underfur layer of fur seals. Together with their smaller size and energetic dives, we suggest their air-filled fur might underlie the need to perform these exhalations, although whether to reduce buoyancy and ascent speed, for the avoidance of shallow-water blackout or to prevent other cardiovascular management issues in their diving remains unclear.

This article is part of the theme issue ‘Measuring physiology in free-living animals (Part I)’.
Scaling of heart rate with breathing frequency and body mass in cetaceans
Authors: Blawas Ashley M. , Nowacek Douglas P. , Rocho-Levine Julie , Robeck Todd R. , Fahlman Andreas
Published: June 2021

Plasticity in the cardiac function of a marine mammal facilitates rapid adjustments to the contrasting metabolic demands of breathing at the surface and diving during an extended apnea. By matching their heart rate (
f
H
) to their immediate physiological needs, a marine mammal can improve its metabolic efficiency and maximize the proportion of time spent underwater. Respiratory sinus arrhythmia (RSA) is a known modulation of
f
H
that is driven by respiration and has been suggested to increase cardiorespiratory efficiency. To investigate the presence of RSA in cetaceans and the relationship between
f
H
, breathing rate (
f
R
) and body mass (
M
b
), we measured simultaneous
f
H
and
f
R
in five cetacean species in human care. We found that a higher
f
R
was associated with a higher mean instantaneous
f
H
(i
f
H
) and minimum i
f
H
of the RSA. By contrast,
f
H
scaled inversely with
M
b
such that larger animals had lower mean and minimum i
f
H
s of the RSA. There was a significant allometric relationship between maximum i
f
H
of the RSA and
M
b
, but not
f
R
, which may indicate that this parameter is set by physical laws and not adjusted dynamically with physiological needs. RSA was significantly affected by
f
R
and was greatly reduced with small increases in
f
R
. Ultimately, these data show that surface
f
H
s of cetaceans are complex and the
f
H
patterns we observed are controlled by several factors. We suggest the importance of considering RSA when interpreting
f
H
measurements and particularly how
f
R
may drive
f
H
changes that are important for efficient gas exchange.

This article is part of the theme issue ‘Measuring physiology in free-living animals (Part I)’.
A capsule-associated gene of Cryptococcus neoformans, CAP64, is involved in pH homeostasis
Authors: Imanishi-Shimizu Yumi , Kamogawa Yukina , Shimada Yukino , Shimizu Kiminori
Published: June 2021

The CAP64 gene is known to be involved in capsule formation in the basidiomycete yeast Cryptococcus neoformans. A null mutant of CAP64, Δcap64, lacks a capsule around the cell wall and its acidic organelles are not stained with quinacrine. In order to clarify whether the Cap64 protein indeed maintains vacuole or vesicle acidification, so that the vesicle containing the capsule polysaccharide or DBB substrate are transported to the cell membrane side, the relationship between CAP64 and intracellular transport genes and between CAP64 and enzyme-secretion activity were analysed. Laccase activity was higher in the Δcap64 strain than in the wild-type strain, and the transcriptional levels of SAV1 and VPH1 were also higher in the Δcap64 strain than in the wild-type strain. The intracellular localization of the Cap64 protein was analysed by overexpressing an mCherry-tagged Cap64 and observing its fluorescence. The Cap64 protein was accumulated within cells in a patch-like manner. The quinacrine-stained cells were observed to analyse the acidified cell compartments; quinacrine was found to be accumulated in a patch-like manner, with the patches overlapping the fluorescence of CAP64-mCherry fusion protein. Quinacrine was thus accumulated in a patch-like fashion in the cells, and the mCherry-tagged Cap64 protein position was consistent with the position of quinacrine accumulation in cells. These results suggest that CAP64 might be involved in intracellular acidification and vesicle secretion via exocytosis.