bluuebunny/crossref_metadata_2025 huggingface dataset:
The “birth of death”: MRI step-by-step reveals the early appearance of a bone marrow infarct
Authors: Barakat Elie , Guischer Nathalie , Houssiau Frédéric , Lecouvet Frederic E.
Published: March 2019

The magnetic resonance imaging (MRI) appearance of an “established” bone marrow infarct is well-known, consisting of an area of preserved bone marrow signal surrounded by a serpiginous line. We report the uncommon observation of the very early phases of appearance of a bone marrow infarct, showing its progressive de novo appearance on MR images paralleling clinical symptoms and high-dose systemic steroid administration in a young female patient, presenting with acute knee pain. The initial knee MR examination performed one week after pain onset showed no abnormality. One week later, a second examination showed subtle ill-defined dotted signal abnormalities of the bone marrow of uncertain significance, of high signal on PDFS sequences. A third MR study obtained again one week later showed more evident findings with confluence of the high signal “dots” into a serpiginous line with a geographical appearance of the lesion, corresponding to the typical MRI presentation of bone marrow infarcts. Follow-up MRI at seven weeks showed definitive stability of this bone marrow infarct. A whole-body MRI performed for whole skeleton screening revealed multiple bone marrow infarcts typical for systemic avascular necrosis. This case represents a novel observation of the “birth” of a bone marrow infarct, from early intriguing changes to its typical ring-shaped appearance on MR images. It also reminds of the key role of MRI for early diagnosis of bone marrow infarcts and illustrates the emerging role of whole-body MRI for the detection of multifocal, asymptomatic skeletal involvement by ischemic lesions in systemic osteonecrosis.
Pulmonary Atresia with Ventricular Septal Defect: Rare Presentation with Coronary-to-Pulmonary Artery Collaterals from Both Right and Left Coronaries
Authors: Ballal Paritosh , Menon Sabarinath , Babu Sarvana , Dharan Baiju S. , Kiran Molli , Baruah Sudip Dutta , Ramanan Sowmya V. , Karunakaran Jayakumar
Published: March 2019

Pulmonary atresia with ventricular septal defect and coronary-dependent pulmonary circulation arising from both major coronary arteries is rare. Dependence of pulmonary blood flow on the coronaries and the risk of early development of pulmonary vascular obstructive disease warrant early surgical repair in these patients. We report a case of a ten-month-old infant with pulmonary atresia with ventricular septal defect and coronary artery-to-main pulmonary artery connections who was successfully managed with ligation of the coronary fistulas and intracardiac repair.
Incidence and Characteristics of Humeral Shaft Fractures After Subpectoral Biceps Tenodesis
Authors: Overmann Archie L. , Colantonio Donald F. , Wheatley Benjamin M. , Volk William R. , Kilcoyne Kelly G. , Dickens Jonathan F.
Published: March 2019

Background:

Biceps tenodesis is a procedure that can address biceps and labral pathology. While there is an increased risk of humeral fracture after biceps tenodesis, it has been described only in case reports.

Purpose:

To identify the incidence, demographics, and characteristics of humeral shaft fractures after biceps tenodesis.

Study Design:

Case series; Level of evidence, 4.

Methods:

The US Military Health System Data Repository was searched for patients with a Current Procedural Terminology code for biceps tenodesis between January 2013 and December 2016. The cohort of identified patients was then searched for those assigned a code for humeral fracture per the International Classification of Diseases, 9th Revision and 10th Revision. The electronic health records and radiographs of patients who were diagnosed with a humeral fracture were then evaluated to confirm that the fracture was related to the biceps tenodesis. Records were then reviewed for patient demographics, radiographs, operative reports, and clinical notes.

Results:

A total of 15,085 biceps tenodeses were performed between January 2013 and December 2016. There were 11 postoperative and 1 intraoperative humeral fractures. The incidence of fracture was <0.1%. All fractures were extra-articular spiral fractures that propagated through the tenodesis site. Eight patients were treated with functional bracing, 3 with open reduction and internal fixation, and 1 with a soft tissue biceps tenodesis revision. Of 8 patients successfully treated nonoperatively, 6 regained full range of shoulder motion. Only 2 of the 4 patients who required operative treatment regained full range of shoulder motion.

Conclusion:

Humeral shaft fracture after biceps tenodesis is a rare complication that occurs in 7.9 out of 10,000 cases. Fractures occurred after various methods of fixation, including suture anchor, cortical button, and interference screw. Most patients were initially treated nonoperatively, and those who healed usually achieved full range of motion; however, those who required operative intervention often had restricted range of motion on final follow-up. Future studies should determine risk factors for fracture after biceps tenodesis.
Andexanet Alfa: A Recombinant Modified Human Factor Xa Protein for Drug Reversal of Rivaroxaban and Apixaban
Authors: Abuan Irene , Wong Kristine H. , Bolinske Benjamin , Hale Katherine S.
Published: March 2019

Objective: To review the pharmacology, safety, and efficacy of andexanet alfa (andexanet), a recombinant modified human factor Xa protein for reversal of factor Xa inhibitors. Data Sources: English-language articles were obtained from MEDLINE (1966 to February 2019) using the following key words: andexanet, andexanet alfa, AndexXa, factor Xa, antidote, and reversal. Citations from selected articles were used to identify additional sources. Study Selection and Data Extraction: Available published articles reporting results of human studies of andexanet alfa were reviewed for inclusion. Prescribing information was used to obtain additional information regarding pharmacology, adverse events, contraindications, and precautions. Data Synthesis: Andexanet is a recombinant modified human factor Xa protein indicated for reversal of rivaroxaban and apixaban in patients with life-threatening or uncontrolled bleeding. Onset of action is rapid and sustained throughout bolus and infusion administration. Medication effects subside 1 to 3 hours postadministration. Andexanet is administered as a bolus followed by a 120-minute continuous infusion. Anti-factor Xa activity was reduced by 95% and 92% in apixaban and rivaroxaban groups, respectively, on infusion completion. Thrombin regeneration occurred within 2 to 5 minutes in up to 96% of patients. Minor infusion reactions and gastrointestinal upset were reported most. A black box warning for thrombotic events, cardiac arrest, ischemia, and sudden death should be noted. Conclusions: Andexanet is effective in reversing rivaroxaban and apixaban anticoagulation due to reduction of anti-factor Xa activity in healthy patients and those with acute major bleeds. Safety concerns, including thrombotic risks, exist and should be assessed against individual patient factors.
Transcriptomics of atopy and atopic asthma in white blood cells from children and adolescents
Authors: Jiang Yale , Gruzieva Olena , Wang Ting , Forno Erick , Boutaoui Nadia , Sun Tao , Merid Simon K. , Acosta-Pérez Edna , Kull Inger , Canino Glorisa , Antó Josep M. , Bousquet Jean , Melén Erik , Chen Wei , Celedón Juan C.
Published: March 2019

Early allergic sensitisation (atopy) is the first step in the development of allergic diseases such as atopic asthma later in life. Genes and pathways associated with atopy and atopic asthma in children and adolescents have not been well characterised.

A transcriptome-wide association study (TWAS) of atopy and atopic asthma in white blood cells (WBCs) or whole blood was conducted in a cohort of 460 Puerto Ricans aged 9–20 years (EVA-PR study) and in a cohort of 250 Swedish adolescents (BAMSE study). Pathway enrichment and network analyses were conducted to further assess top findings, and classification models of atopy and atopic asthma were built using expression levels for the top differentially expressed genes (DEGs).

In a meta-analysis of the study cohorts, both previously implicated genes (e.g. IL5RA and IL1RL1) and genes not previously reported in TWASs (novel) were significantly associated with atopy and/or atopic asthma. Top novel genes for atopy included SIGLEC8 (p=8.07×10−13), SLC29A1 (p=7.07×10−12) and SMPD3 (p=1.48×10−11). Expression quantitative trait locus analyses identified multiple asthma-relevant genotype–expression pairs, such as rs2255888/ALOX15. Pathway enrichment analysis uncovered 16 significantly enriched pathways at adjusted p<0.01, including those relevant to T-helper cell type 1 (Th1) and Th2 immune responses. Classification models built using the top DEGs and a few demographic/parental history variables accurately differentiated subjects with atopic asthma from nonatopic control subjects (area under the curve 0.84).

We have identified genes and pathways for atopy and atopic asthma in children and adolescents, using transcriptome-wide data from WBCs and whole blood samples.
Traffic exposures, air pollution and outcomes in pulmonary arterial hypertension: a UK cohort study analysis
Authors: Sofianopoulou Eleni , Kaptoge Stephen , Gräf Stefan , Hadinnapola Charaka , Treacy Carmen M. , Church Colin , Coghlan Gerry , Gibbs J. Simon R. , Haimel Matthias , Howard Luke S. , Johnson Martin , Kiely David G. , Lawrie Allan , Lordan James , MacKenzie Ross Robert V. , Martin Jennifer M. , Moledina Shahin , Newnham Michael , Peacock Andrew J. , Price Laura C. , Rhodes Christopher J. , Suntharalingam Jay , Swietlik Emilia M. , Toshner Mark R. , Wharton John , Wilkins Martin R. , Wort Stephen J. , Pepke-Zaba Joanna , Condliffe Robin , Corris Paul A. , Di Angelantonio Emanuele , Provencher Steeve , Morrell Nicholas W.
Published: March 2019

While traffic and air pollution exposure is associated with increased mortality in numerous diseases, its association with disease severity and outcomes in pulmonary arterial hypertension (PAH) remains unknown.

Exposure to particulate matter with a 50% cut-off aerodynamic diameter ≤2.5 μm (PM2.5), nitrogen dioxide (NO2) and indirect measures of traffic-related air pollution (distance to main road and length of roads within buffer zones surrounding residential addresses) were estimated for 301 patients with idiopathic/heritable PAH recruited in the UK National Cohort Study of Idiopathic and Heritable PAH. Associations with transplant-free survival and pulmonary haemodynamic severity at baseline were assessed, adjusting for confounding variables defineda priori.

Higher estimated exposure to PM2.5was associated with higher risk of death or lung transplant (unadjusted hazard ratio (HR) 2.68 (95% CI 1.11–6.47) per 3 μg·m−3; p=0.028). This association remained similar when adjusted for potential confounding variables (HR 4.38 (95% CI 1.44–13.36) per 3 μg·m−3; p=0.009). No associations were found between NO2exposure or other traffic pollution indicators and transplant-free survival. Conversely, indirect measures of exposure to traffic-related air pollution within the 500–1000 m buffer zones correlated with the European Society of Cardiology/European Respiratory Society risk categories as well as pulmonary haemodynamics at baseline. This association was strongest for pulmonary vascular resistance.

In idiopathic/heritable PAH, indirect measures of exposure to traffic-related air pollution were associated with disease severity at baseline, whereas higher PM2.5exposure may independently predict shorter transplant-free survival.
Video-assisted thoracic lobectomyversusstereotactic body radiotherapy for stage I nonsmall cell lung cancer in elderly patients: a propensity matched comparative analysis
Authors: Detillon Deniece D.E.M.A. , Aarts Mieke J. , De Jaeger Katrien , Van Eijck Casper H.J. , Veen Eelco J.
Published: March 2019

Comparative studies of the overall survival (OS) in elderly patients with nonsmall cell lung cancer (NSCLC) after surgery or stereotactic body radiotherapy (SBRT) have been limited by mixed extents of resection and different surgical approaches.

792 patients aged ≥65 years with clinical stage I NSCLC underwent video-assisted thoracic surgery (VATS) lobectomy or SBRT between 2010 and 2015. The propensity score-matched primary analysis included data from the full cohort; the secondary analysis included data from a subgroup of patients with data on pulmonary function.

Median OS for unmatched patients was 77 months for patients undergoing VATS lobectomy and 38 months for SBRT. The 1-, 3- and 5-year OS rates after VATS lobectomy were 92%, 76% and 65%, and after SBRT were 90%, 52% and 29% (p<0.001). Median OS for matched patients in the primary analysis was 77 months for patients undergoing VATS lobectomy and 33 months for SBRT. The 1-, 3- and 5-year OS rates after VATS lobectomy were 91%, 68% and 58%, and after SBRT were 87%, 46% and 29% (p<0.001). The survival advantage with VATS lobectomy persisted in the secondary analysis after adjusting for non-matched variables (p=0.034).

We suggest that elderly patients with stage I NSCLC undergoing VATS lobectomy have a better rate of OS than patients undergoing SBRT, irrespective of matching. This could be clinically important in decision-making for elderly patients who can tolerate surgery.
Algorithm-supported, mass and sequence diversity-oriented random peptide library design
Authors: Kalafatovic Daniela , Mauša Goran , Todorovski Toni , Giralt Ernest
Published: March 2019

Random peptide libraries that cover large search spaces are often used for the discovery of new binders, even when the target is unknown. To ensure an accurate population representation, there is a tendency to use large libraries. However, parameters such as the synthesis scale, the number of library members, the sequence deconvolution and peptide structure elucidation, are challenging when increasing the library size. To tackle these challenges, we propose an algorithm-supported approach to peptide library design based on molecular mass and amino acid diversity. The aim is to simplify the tedious permutation identification in complex mixtures, when mass spectrometry is used, by avoiding mass redundancy. For this purpose, we applied multi (two- and three-)-objective genetic algorithms to discriminate between library members based on defined parameters. The optimizations led to diverse random libraries by maximizing the number of amino acid permutations and minimizing the mass and/or sequence overlapping. The algorithm-suggested designs offer to the user a choice of appropriate compromise solutions depending on the experimental needs. This implies that diversity rather than library size is the key element when designing peptide libraries for the discovery of potential novel biologically active peptides.
Prophylactic Irradiation of Tracts in Patients With Malignant Pleural Mesothelioma: An Open-Label, Multicenter, Phase III Randomized Trial
Authors: Bayman Neil , Appel Wiebke , Ashcroft Linda , Baldwin David R. , Bates Andrew , Darlison Liz , Edwards John G. , Ezhil Veni , Gilligan David , Hatton Matthew , Jegannathen Apurna , Mansy Talal , Peake Michael D. , Pemberton Laura , Rintoul Robert C. , Snee Michael , Ryder W. David , Taylor Paul , Faivre-Finn Corinne
Published: March 2019

PURPOSE

Prophylactic irradiation to the chest wall after diagnostic or therapeutic procedures in patients with malignant pleural mesothelioma (MPM) has been a widespread practice across Europe, although the efficacy of this treatment is uncertain. In this study, we aimed to determine the efficacy of prophylactic radiotherapy in reducing the incidence of chest wall metastases (CWM) after a procedure in MPM.

METHODS

After undergoing a chest wall procedure, patients with MPM were randomly assigned to receive prophylactic radiotherapy (within 42 days of the procedure) or no radiotherapy. Open thoracotomies, needle biopsies, and indwelling pleural catheters were excluded. Prophylactic radiotherapy was delivered at a dose of 21 Gy in three fractions over three consecutive working days, using a single electron field adapted to maximize coverage of the tract from skin surface to pleura. The primary outcome was the incidence of CWM within 6 months from random assignment, assessed in the intention-to-treat population. Stratification factors included epithelioid histology and intention to give chemotherapy.

RESULTS

Between July 30, 2012, and December 12, 2015, 375 patients were recruited from 54 centers and randomly assigned to receive prophylactic radiotherapy (n = 186) or no prophylactic radiotherapy (n = 189). Participants were well matched at baseline. No significant difference was seen in the incidence of CWM at 6 months between the prophylactic radiotherapy and no radiotherapy groups (no. [%]: 6 [3.2] v 10 [5.3], respectively; odds ratio, 0.60; 95% CI, 0.17 to 1.86; P = .44). Skin toxicity was the most common radiotherapy-related adverse event in the prophylactic radiotherapy group, with 96 patients (51.6%) receiving grade 1; 19 (10.2%), grade 2; and 1 (0.5%) grade 3 radiation dermatitis (Common Terminology Criteria for Adverse Events, version 4.0).

CONCLUSION

There is no role for the routine use of prophylactic irradiation to chest wall procedure sites in patients with MPM.
Patients’ Medical and Psychosocial Experiences After Detection of a CDH1 Variant With Multigene Panel Testing
Authors: Hamilton Jada G. , Long Jessica M. , Brandt Amanda C. , Brower Jamie , Symecko Heather , Salo-Mullen Erin E. , Christian Stephanie N. , Harstad Tricia , Couch Fergus J. , Garber Judy E. , Offit Kenneth , Robson Mark E. , Domchek Susan M.
Published: March 2019

PURPOSE

Germline CDH1 pathogenic variants (PV) are associated with hereditary diffuse gastric cancer and lobular breast cancer. Although prevalence of CDH1 PV is low in the general population, detection of these variants is increasing with the growing use of multigene panel testing. Little is known about the experiences of individuals tested for CDH1 variants in the multigene panel testing era.

METHODS

Participants recruited from the Prospective Registry of Multiplex Testing completed a cross-sectional self-report survey regarding CDH1 genetic testing experiences, medical management, and psychosocial adaptation.

RESULTS

Discordance existed in interpretations of CDH1 results; 13.3% of cases had disagreements in variant classifications among commercial laboratories, and 21.4% had disagreements between participant self-report and ClinVar classification. Survey data were available from 57 individuals reporting either PV (n = 16) or variants of uncertain significance (VUS; n = 41). Those with PV were more likely than those with VUS to report receiving a recommendation for prophylactic gastrectomy, although only 40.0% of those with PV received this recommendation. Participants with VUS were less satisfied with their health care providers’ knowledge and reported less CDH1 knowledge, distress, and worry about discrimination. Participants with PV perceived greater breast cancer risks, but similar gastric cancer risks, as those with VUS.

CONCLUSION

Few individuals with CDH1 PV report receiving recommendations for prophylactic gastrectomy, and no differences in perceived gastric cancer risk were observed based on participants’ CDH1 results, suggesting serious unmet informational needs.
The Liver–α-Cell Axis and Type 2 Diabetes
Authors: Wewer Albrechtsen Nicolai J , Pedersen Jens , Galsgaard Katrine D , Winther-Sørensen Marie , Suppli Malte P , Janah Lina , Gromada Jesper , Vilstrup Hendrik , Knop Filip K , Holst Jens J
Published: March 2019

Both type 2 diabetes (T2D) and nonalcoholic fatty liver disease (NAFLD) strongly associate with increasing body mass index, and together these metabolic diseases affect millions of individuals. In patients with T2D, increased secretion of glucagon (hyperglucagonemia) contributes to diabetic hyperglycemia as proven by the significant lowering of fasting plasma glucose levels following glucagon receptor antagonist administration. Emerging data now indicate that the elevated plasma concentrations of glucagon may also be associated with hepatic steatosis and not necessarily with the presence or absence of T2D. Thus, fatty liver disease, most often secondary to overeating, may result in impaired amino acid turnover, leading to increased plasma concentrations of certain glucagonotropic amino acids (e.g., alanine). This, in turn, causes increased glucagon secretion that may help to restore amino acid turnover and ureagenesis, but it may eventually also lead to increased hepatic glucose production, a hallmark of T2D. Early experimental findings support the hypothesis that hepatic steatosis impairs glucagon’s actions on amino acid turnover and ureagenesis. Hepatic steatosis also impairs hepatic insulin sensitivity and clearance that, together with hyperglycemia and hyperaminoacidemia, lead to peripheral hyperinsulinemia; systemic hyperinsulinemia may itself contribute to worsen peripheral insulin resistance. Additionally, obesity is accompanied by an impaired incretin effect, causing meal-related glucose intolerance. Lipid-induced impairment of hepatic sensitivity, not only to insulin but potentially also to glucagon, resulting in both hyperinsulinemia and hyperglucagonemia, may therefore contribute to the development of T2D at least in a subset of individuals with NAFLD.
Electroencephalography in Epilepsy Evaluation
Authors: Chen Hai , Koubeissi Mohamad Z.
Published: March 2019

PURPOSE OF REVIEW

Epilepsy is a heterogeneous disorder that is often associated with abnormal electroencephalogram (EEG) findings. This article provides an overview of common EEG findings in epileptic disorders. The physiologic basis of EEG and intracranial EEG studies is also discussed.

RECENT FINDINGS

EEG is widely used in clinical practice. Because of the paroxysmal nature of seizure disorders, interictal epileptiform discharges, such as spikes and sharp waves, are often used to support the diagnosis of epilepsy when a habitual seizure is not captured by EEG. Interictal and ictal EEG findings also underlie the classification of seizures and epilepsy. Continuous critical care EEG monitoring has become an invaluable study in the diagnosis and treatment of subclinical seizures and nonconvulsive status epilepticus. Intracranial EEG with subdural or intraparenchymal electrodes is warranted when localization of the seizure focus and mapping of eloquent brain areas are required to plan epilepsy surgery.

The EEG is a key tool in the diagnosis of epilepsy. Interictal and ictal EEG findings are crucial for the confirmation and classification of seizure disorders. Intracranial EEG monitoring is also indispensable for planning surgery for some patients.
Epilepsy Overview and Revised Classification of Seizures and Epilepsies
Authors: Pack Alison M.
Published: March 2019

PURPOSE OF REVIEW

The classification of seizures, epilepsies, and epilepsy syndromes creates a framework for clinicians, researchers, and patients and their families. This classification has evolved over the years, and in 2017 the International League Against Epilepsy (ILAE) published an operational classification of seizures and epilepsies. Understanding this classification is important in the diagnosis, treatment, and understanding of seizures and epilepsies, including epilepsy incidence.

RECENT FINDINGS

The 2017 ILAE classification system builds on newly formulated definitions of seizures and epilepsy. Seizure classification begins by determining whether the initial manifestations of the seizure are focal or generalized. If the onset of the seizure is missed or unclear, the seizure is of unknown onset. Focal seizures are classified according to the individual’s level of awareness, the most prominent motor or nonmotor features of the seizure, and whether the focal seizure evolves to a bilateral tonic-clonic seizure. Similarly, generalized seizures are classified according to motor or nonmotor manifestations. Motor seizures are either tonic-clonic or other motor seizures. Nonmotor generalized seizures primarily refer to absence seizures. Similar to seizure classification, the epilepsies can be classified as focal or generalized. In addition, the new classification system recognizes two new categories: combined generalized and focal epilepsy and unknown epilepsy. The concept of an epilepsy syndrome has been introduced under the new classification system and refers to a cluster of features incorporating seizure types, EEG, imaging, and other features including genetics. The new classification system emphasizes the etiology of seizures and epilepsies.

The recent ILAE seizure and epilepsy classification system aims to create a framework to better classify seizures and the epilepsies. Universal adoption and implementation of this system will enable patients, their families, clinicians, and researchers to better define and treat the epilepsies. Incidence studies have not generally classified seizures and the epilepsies, and use of this classification system, which emphasizes etiology, will lead to a better understanding of epilepsy incidence.
Identification and Treatment of Drug-Resistant Epilepsy
Authors: Yoo Ji Yeoun , Panov Fedor
Published: March 2019

PURPOSE OF REVIEW

Drug-resistant epilepsy is a potentially life-threatening condition affecting one-third of people living with epilepsy. Despite existing evidence of improved outcomes in patients who received surgical treatment compared to continued medical treatment, epilepsy surgery remains underused in patients with drug-resistant epilepsy. This article discusses the gap between evidence and practice and common misconceptions about epilepsy surgery and reviews the current diagnostic and therapeutic surgical options.

RECENT FINDINGS

Three randomized controlled trials comparing the medical versus surgical treatment for patients with drug-resistant epilepsy have shown the superiority of surgery in controlling seizures and improving patients’ quality of life. In addition to resective surgery, neuromodulation through devices such as responsive neurostimulation and vagal nerve stimulation have also shown efficacy in seizure control that increases over time. Diagnostic and therapeutic surgical tools are tailored to the needs of each patient.

Appropriate patients with drug-resistant epilepsy benefit more from epilepsy surgery than from continuing medical treatment. These patients should be referred to comprehensive epilepsy centers where a thorough presurgical workup and surgical options can be provided. The gap between evidence and practice can be bridged by education, community outreach, and providers’ earnest efforts to improve the quality of life of patients with epilepsy.
Titration of Bivalirudin Infusion in the Pediatric Cardiac Catheterization Laboratory: A Case Report
Authors: Streiff Agathe , DiNardo James , Zaleski Katherine
Published: March 2019

Bivalirudin is a direct thrombin inhibitor that is used as a procedural anticoagulant during percutaneous coronary interventions and cardiac surgery for patients with heparin-resistant thrombosis or heparin-induced thrombocytopenia. There is a robust literature describing its safety and efficacy in adults; however, its use in the pediatric population is relatively rare, with dosing extrapolated from adult data. In this case report, we describe a 4-year-old with complex congenital heart disease and history of heparin-induced thrombocytopenia who required bivalirudin dose uptitration during cardiac catheterization.
Perioperative Intravenous Lidocaine Infusion Adverse Reaction: A Case Report
Authors: Kramer MaryJo E. , Holtan Elizabeth E. , Ives Amy L. , Wall Russell T.
Published: March 2019

Intravenous lidocaine is increasingly being utilized as an opioid-sparing analgesic. A 55-year-old man with well-controlled human immunodeficiency virus on highly active antiretroviral therapy was prescribed a lidocaine infusion at 1 mg/kg/h for postoperative pain. On postoperative day 2, the patient experienced 4 unresponsive episodes with tachycardia, hypertension, and oxygen desaturation. Serum lidocaine level was available 2 days later (high 6.3 µg/mL, therapeutic range 2.5–3.5 µg/mL). There is significant pharmacokinetic interaction between lidocaine and this patient’s human immunodeficiency virus medications. This case highlights the need for a readily accessible list of medications that caution against lidocaine. We propose in-house serum lidocaine levels to monitor patients at an increased risk for toxicity.
Spontaneous Coronary Artery Dissection in the Postoperative Period: A Case Report
Authors: Bendinelli Valentina , Lefebvre Pascal , Daper Anne
Published: March 2019

Spontaneous coronary artery disease is an uncommon and likely underdiagnosed cause of sudden cardiac death affecting typically young and middle-aged women. We report a case of spontaneous coronary artery disease in the postoperative period in a female patient who developed an acute coronary event after gynecologic surgery. The patient was clinically asymptomatic except for mild hemodynamic instability and ST-segment–elevation myocardial infarction seen on electrocardiogram. Spontaneous coronary artery disease was diagnosed with coronary angiography, and a pharmacological therapy was instituted with favorable results.
Complications of Congenital Hernia in Pregnancy: A Case Report
Authors: Vasquez Daniela N. , Basualdo María N. , Aphalo Vanina M. , Carreras Lucía P. , Plotnikow Gustavo A. , Intile Alfredo D. , Moreira Joaquín
Published: March 2019

Congenital hernias, frequently misdiagnosed during pregnancy, are potentially fatal and require prompt repair. A pregnant woman with medical history of repaired congenital hernia was admitted with misdiagnosis of preeclampsia. Physical examination and chest x-ray revealed a Bochdalek hernia. Transitory stabilization prompted surgeons to postpone hernia repair, but an urgent thoracotomy was required to relieve a subsequent bowel obstruction that was complicated by an intrathoracic colonic perforation. Emergent cesarean delivery was required with a good maternal and fetal outcome. A multidisciplinary team was present in the operating room. All monitoring catheters were placed in advance in the intensive care unit. During recovery, the patient experienced ventricular fibrillation, presumed to be a manifestation of takotsubo syndrome, which responded favorably to cardiopulmonary resuscitation.
Repeat Subdural Hematoma After Uncomplicated Lumbar Drain Discontinuation: A Case Report
Authors: Rosario Lauren E. , Rajan Govind R.
Published: March 2019

Lumbar drains are commonly placed to monitor spinal cerebrospinal fluid (CSF) pressures and drain CSF to augment spinal cord perfusion. Excessive CSF drainage or persistent leakage through the dural puncture site can lead to cerebral hypotension and creation of an intracranial subdural hematoma. Anesthesia providers need to be aware of the risk of subdural hematoma development after major thoracoabdominal surgery where placement and subsequent removal of a lumbar drain have occurred. We present a patient who had recurrent subdural hematoma secondary to persistent undiagnosed CSF leak from the dural puncture site after uncomplicated placement and removal of a lumbar drain.
Role of glycogen in development and adult fitness in Drosophila
Authors: Yamada Takayuki , Habara Okiko , Yoshii Yuka , Matsushita Ryota , Kubo Hitomi , Nojima Yosui , Nishimura Takashi
Published: March 2019

The polysaccharide glycogen is an evolutionarily conserved storage form of glucose. However, the physiological significance of glycogen metabolism on homeostatic control throughout the animal life cycle remains incomplete. Here, we report a Drosophila fruit fly that is defective for glycogen metabolism. Null mutants of glycogen synthase (GlyS) and glycogen phosphorylase (GlyP) displayed growth defects and larval lethality, indicating that glycogen plays a crucial role in larval development. Unexpectedly, however, a certain population of larvae developed into adults with normal morphology. Semi-lethality in glycogen mutants during the larval period can be attributed to the presence of circulating sugar trehalose. Homozygous glycogen mutants produced offspring, indicating that glycogen stored in oocytes is dispensable for embryogenesis. GlyS and GlyP mutants showed distinct metabolic defects in the levels of circulating sugars and triglycerides in a life stage-specific manner. In adults, glycogen as an energy reserve is not crucial for physical fitness and lifespan under nourished conditions, but glycogen becomes important under energy stress conditions. This study provides a fundamental understanding of the stage-specific requirements for glycogen metabolism in the fruit fly.
Impact of Eccentric or Concentric Training on Body Composition and Energy Expenditure
Authors: TOURON JULIANNE , PERRAULT HÉLÈNE , JULIAN VALÉRIE , MAISONNAVE LAURA , DEAT PHILIPPE , AUCLAIR-RONZAUD JULIETTE , SALLES JÉRÔME , WALRAND STÉPHANE , HERMET JULIEN , RIGAUDIERE JEAN-PAUL , LEBECQUE PATRICE , MALPUECH-BRUGERE CORINNE , MONTAURIER CHRISTOPHE , PEREIRA BRUNO , COXAM VÉRONIQUE , COSTES FRÉDÉRIC , RICHARD RUDDY
Published: March 2019

Purpose

To compare the effects of 8-wk eccentric (ECC) versus concentric (CON) training using downhill and uphill running in rats on whole body composition, bone mineral density (BMD), and energy expenditure.

Methods

Animals were randomly assigned to one of the following groups: 1) control (CTRL), 2) +15% uphill-running slope (CON), 3) −15% downhill-running slope (ECC15), and 4) −30% downhill-running slope (ECC30). Those programs enabled to achieve conditions of isopower output for CON and ECC15 and of iso-oxygen uptake (V˙O2) for CON and ECC30. Trained rats ran 45 min at 15 m·min−1 five times per week. Total body mass, fat body mass, and lean body mass (LBM) measured through EchoMRI™, and 24-h energy expenditure including basal metabolic rate (BMR) assessed using PhenoMaster/LabMaster™ cage system were obtained before and after training. At sacrifice, the right femur was collected for bone parameters analysis.

Results

Although total body mass increased in all groups over the 8-wk period, almost no change occurred for fat body mass in exercised groups (CON, −4.8 ± 6.18 g; ECC15, 0.6 ± 3.32 g; ECC30, 2.6 ± 6.01 g). The gain in LBM was mainly seen for ECC15 (88.9 ± 6.85 g) and ECC30 (101.6 ± 11.07 g). ECC was also seen to positively affect BMD. An increase in BMR from baseline was seen in exercise groups (CON, 13.9 ± 4.13 kJ·d−1; ECC15, 11.6 ± 5.10 kJ·d−1; ECC30, 18.3 ± 4.33 kJ·d−1) but not in CTRL one. This difference disappeared when BMR was normalized for LBM.

Conclusions

Results indicate that for iso-V˙O2 training, the impact on LBM and BMD is enhanced with ECC as compared with CON, and that for isopower but lower V˙O2 ECC, an important stimulus for adaptation is still observed. This provides further insights for the use of ECC in populations with cardiorespiratory exercise limitations.
Beyond Truth-Telling: Preference Estimation with Centralized School Choice and College Admissions
Authors: Fack Gabrielle , Grenet Julien , He Yinghua
Published: March 2019

We propose novel approaches to estimating student preferences with data from matching mechanisms, especially the Gale-Shapley deferred acceptance. Even if the mechanism is strategy-proof, assuming that students truthfully rank schools in applications may be restrictive. We show that when students are ranked strictly by some ex ante known priority index (e.g., test scores), stability is a plausible and weaker assumption, implying that every student is matched with her favorite school/college among those she qualifies for ex post. The methods are illustrated in simulations and applied to school choice in Paris. We discuss when each approach is more appropriate in real-life settings. (JEL D11, D12, D82, I23)
Disrupting Education? Experimental Evidence on Technology-Aided Instruction in India
Authors: Muralidharan Karthik , Singh Abhijeet , Ganimian Alejandro J.
Published: March 2019

We study the impact of a personalized technology-aided after-school instruction program in middle-school grades in urban India using a lottery that provided winners with free access to the program. Lottery winners scored 0.37 σ higher in math and 0.23 σ higher in Hindi over just a 4.5-month period. IV estimates suggest that attending the program for 90 days would increase math and Hindi test scores by 0.6 σ and 0.39 σ respectively. We find similar absolute test score gains for all students, but much greater relative gains for academically-weaker students. Our results suggest that well-designed, technology-aided instruction programs can sharply improve productivity in delivering education. (JEL I21, I26, I28, J24, O15)
(Mis)Allocation, Market Power, and Global Oil Extraction
Authors: Asker John , Collard-Wexler Allan , De Loecker Jan
Published: March 2019

We propose an approach to measuring the misallocation of production in a market that compares actual industry cost curves to undistorted (counterfactual ) supply curves. As compared to traditional, TFPR-based, misallocation measures, this approach leverages cost data, such that results are readily mapped to welfare metrics. As an application, we analyze global crude oil extraction and quantify the extent of misallocation therein, together with the proportion attributable to market power. From 1970 to 2014, we find substantial misallocation, in the order of US$744 billion, 14.1 percent to 21.9 percent of which is attributable to market power. (JEL D24, F23, L13, L71, Q35)
Management of pulmonary nodules
Authors: McNulty William , Baldwin David
Published: March 2019

Pulmonary nodules are frequently detected during clinical practice and require a structured approach in their management in order to identify early lung cancers and avoid harm from over investigation. The article reviews the 2015 British Thoracic Society guidelines for the management of pulmonary nodules and the evidence behind them.
Radical technologies: Blockchain as an organizational movement
Authors: Koletsi Maria
Published: March 2019

The emergence of blockchain technology has created a debate regarding technologies’ socio-cultural symbolism. Prevailing as alternative or complementary to internet technology, blockchain’s decentralized radical architecture reflects organizational change, enhancement of degrees of freedom, for individual identities and communities, new schemes of distributed trust and privacy, transformation of power relations and social reality perception. The current paper aims to contribute to the ongoing debate, from an organizational and socio-psychological perspective, discussing the key elements of a socially grounded technology, like any other technological product within the history of humanity. Through an evolutionary lens, blockchain technology is examined as a decentralized grassroots organizational movement at birth, influencing and, at the same time, be influenced, by science, culture, as well as by other aspects of individual and collective networked life, apart from the economy. Social sciences and cyber sciences are in a crossroad where society and technology integrate creating a mixed socio-technological or techno-social reality. Therefore, it is of high importance for them, to address the new epistemological challenges by developing new methodologies and tools, independently from any utopian or dystopian predictions.
Virtual networks: Why do students use Instagram?
Authors: Kaperonis Stavros
Published: March 2019

Instagram has become the bridge between consumers who share moments from their lives and companies that share their products and services with the users. Instagram stands out from the other social media networks thanks to user-friendly toolkit that provides photo editing, video sharing and Instagram stories. This conceptual model research investigates the impact of Instagram on user's attitude. Data were collected from young Instagram users in order to measure if there is a relationship between specific factors of Instagram and user attitude through Structural Equation Modeling (SEM). In this research, will be analyzed the consumer behavior in social media and particularly on Instagram. As a first stage of our research we are going to develop the theoretical study for Instagram users (n=200) at the age of 18-34, investigating the behavior of use Instagram which is determined by social presence. This study presents a theoretical conceptual model based on the theory of social presence, perceived pleasure, perceived usefulness and perceived value on Instagram and the potential connection of those factors to the user attitude.
Digital crime and crime within a digital environment: The child pornography case
Authors: Sykas Stylianos
Published: March 2019

The constant transition to the digital world is not simple or problem-free. Along with the remarkable progress in real time borderless communication and the broad and immediate access to any information, one cannot help but notice that delinquency and crime took their chances. Regulating cyberspace, due to its limitless nature, proved difficult and quite challenging for the lawmakers worldwide. Especially, the issue of child pornography has become one of the thorns of our times. Even though the involvement of children in pornography has been taking place for many years and in various forms, the issue only became controversial and it attracted the attention of our societies and legal regimes as soon as the Internet proliferated and software related inventions contributed in the manufacturing of child pornography. This proposal presents a brief introduction to cybercrime as defined by legal entities, addresses the controversial issue of real and virtual child pornography and proposes the involvement of social sciences in regulating the matter.
Innovation infrastructure and small businesses: situation, estimates, modeling
Authors: Вилисов Валерий , Vilisov Valery , Вилисова Анна , Vilisova Anna
Published: March 2019

Presents an analysis of patterns and features innovative development factors and elements of innovation infrastructure in developed and developing economies of the world, including Russian. A set of mathematical economic models assessing the potential of innovative development of the economic entity. The technique of small enterprises transition to innovative development. For professionals in the field of innovation management, researchers, graduate students and doctoral candidates
EFEITOS DA DIETA HIPERLIPÍDICA, CONTENDO GORDURA SATURADA, SOBRE A QUALIDADE ÓSSEA DE RATOS WISTAR MACHOS NA VIDA ADULTA
Authors: Nunes Harrison Maycon Vieira , Pereira Aline D’avila , Brasil Sabrina Castro , Armada Luciana , Santos Rachel , Boaventura Gilson Teles , Da Costa Carlos Alberto Soares
Published: March 2019

Objetivos: Avaliar a influência da ingestão de banha de porco sobre a composição óssea de ratos machos aos 120 dias de idade. Metodologia: Foram utilizados ratos Wistar, machos, provenientes do Laboratório de Nutrição Experimental da Universidade Federal Fluminense (LabNE/UFF), mantidos em Biotério com temperatura (25 a 27ºC), ciclo claro/escuro (12-12h), recebendo água ad libitum por um período de oito semanas. Os grupos, divididos em controle, que recebeu ração a base de caseína (GC, n=12) e experimental, que recebeu ração com acréscimo de banha de porco (GH, n=12), foram acompanhados até completarem 120 dias. Ao final do experimento, os animais foram anestesiados. Foi coletado o fêmur para posteriores análises. A análise estatística foi realizada através do programa GraphPadPrism (versão 5.00, 2007, San Diego, USA). Resultados: Os resultados foram expressos como média ± erro padrão da média (EPM), considerando o nível de significância de P < 0,05. O GH (6,938 ±0,030 mm) apresentou maior (p<0,05) largura da diáfise com relação ao GC (4,430±0,040 mm). No teste biomecânico, foi observado que a força máxima do GC=102,200±10,210N e GH=126,100±4,341N e o módulo elástico GC=471415±44457MPa e GH=570013±24575MPa foram maiores no grupo hiperlipídico (p < 0,05), respectivamente. A composição óssea femural, foi observado maior (p<0,05) DMO do GH (0,15±0,001g/cm²) em relação ao GC (0,144±0,002g/cm²). Discussão e Conclusões: A dieta hiperlipídica contendo gordura saturada influenciou na estrutura óssea, mas não resultou em qualidade óssea inferior.DOI: 10.12957/demetra.2019.34223
CARACTERIZAÇÃO DE UM GRUPO DE ERVAS MEDICINAIS COMERCIALIZADAS NO ESTADO DO RIO DE JANEIRO ATRAVÉS DE ESPECTROSCOPIA POR XRF
Authors: Luiz Leandro Da Conceição , Silva Deborah Demarque Martins da , Costa Andresa De Souza , Batista Rafaela Tavares , Freitas Renato Pereira de
Published: March 2019

O uso de plantas medicinais pela população brasileira é uma prática tradicional, sendo muitas vezes, o único recurso utilizado na atenção básica de saúde. Dentro do contexto das novas técnicas analíticas instrumentais, a espectroscopia por Fluorescência de Raios X se destaca, sendo utilizada principalmente para áreas em que a obtenção de rápido perfil de constituintes é indispensável. Para as amostras, utilizou-se plantas medicinais de uso comum, são elas: Arnica Brasileira(Solidago microglossa D. C.), Camomila (Chamomilla recutita (L.) Rauschert), Boldo do Chile (Peumus boldus Molina), Capim Cidreira (Cymbopogon citratus D. C. (Stapf)) e Ginseng Brasileiro (Pfaffia Paniculata (Martius) Kuntze). Este trabalho tem como objetivo analisar qualitativamente, por meio de Fluorescência de Raios X, a composição elementar das plantas medicinais selecionadas que são comumente comercializadas na cidade do Rio de Janeiro e regiões. Por meio dos espectros de energia gerados, foram observados: Ca, K, Fe, Zn, Ni, entre outros. As amostras de Boldo do Chile, Camomila e Arnica apresentaram grande número de contagens de fótons para o Ca e K, já o Capim cidreira apresentou elevado número de fótons para o Fe e Ni. Contudo, uma das amostras de Boldo do Chile se destacou como preocupante, devido um pico, no espectro, referente a energia que corresponde ao metal pesado, chumbo (Pb).
POSSIBILIDADES E LIMITAÇÕES DA TERAPIA NUTRICIONAL ENTERAL NA COMPREENSÃO DE CUIDADORES E PROFISSIONAIS DE UMA REDE PÚBLICA DE SAÚDE EM REGIÃO DE FRONTEIRA
Authors: Führ Aline Luiza , Ciachi Érika Marafon
Published: March 2019

Objetivo: Analisar possibilidades, limites e desafios da terapia de nutrição enteral domiciliar na rede pública de saúde e o perfil nutricional de pacientes pós-alta hospitalar de Foz do Iguaçu, PA. Métodos: Estudo de delineamento transversal e quanti-qualitativo. Participaram do estudo 12 indivíduos usuários de nutrição enteral domiciliar (com e sem acompanhamento nutricional); 12 cuidadores e oito profissionais de saúde. Na coleta de dados, utilizaram-se anamnese nutricional (usuários) e entrevistas (profissionais e cuidadores). As entrevistas foram gravadas, transcritas e analisadas na perspectiva teórica de Bardin; para o perfil nutricional, utilizaram-se fita inelástica e adipômetro, comparando-se os resultados às recomendações. Resultados e discussão: Houve predomínio do gênero feminino e de adultos para cuidadores e profissionais, enquanto entre os indivíduos em nutrição enteral, de idosos e mulheres. Sete destes estavam sob dieta manipulada; a frequência de complicações foi maior no grupo sem acompanhamento nutricional, assim como de óbitos e perfil antropométrico menos satisfatório. Os cuidadores mostraram-se desorientados e inseguros em relação à condução da nutrição enteral no domicílio, sobretudo no grupo desassistido por nutricionista. Profissionais e cuidadores apontaram a importância de acompanhamento profissional após a alta hospitalar e de oferta de dietas; fragilidades na rede pela ausência de fluxo, orientações padronizadas e encaminhamentos; com indicação de protocolo em rede para a condução da terapia de nutrição enteral domiciliar. Conclusões: Estes resultados mostram a notoriedade de formação dos cuidadores, equipe multiprofissional e intervenção gestora no cuidado domiciliar.DOI: 10.12957/demetra.2019.36926