bluuebunny/crossref_metadata_2025 huggingface dataset:
Colorectal Strictures in Patients With Inflammatory Bowel Disease Do Not Independently Predict Colorectal Neoplasia
Authors: Axelrad Jordan E , Faye Adam , Slaughter James C , Harpaz Noam , Itzkowitz Steven H , Shah Shailja C
Published: July 2021

Background

Colorectal strictures have been considered independent risk factors for neoplasia in patients with inflammatory bowel disease (IBD). We examined the association between colorectal stricture and subsequent risk of colorectal neoplasia (CRN) in patients with IBD colitis undergoing colonoscopic surveillance.

Methods

We conducted a retrospective cohort analysis of patients with IBD colitis enrolled in colonoscopic surveillance for CRN at an academic medical center between 2005 and 2017. Inclusion criteria were IBD involving the colon for ≥8 years (or any duration with primary sclerosing cholangitis [PSC]) undergoing surveillance. Exclusion criteria were advanced CRN (ACRN; colorectal cancer [CRC] or high-grade dysplasia [HGD]) prior to or at enrollment, prior colectomy, or limited (<30%) disease extent or proctitis. Multivariable logistic and Cox regression analysis estimated the association between colorectal stricture on the index colonoscopy and ACRN, CRN (indefinite dysplasia, low-grade dysplasia, HGD, CRC), or colectomy.

Results

Among 789 patients with IBD undergoing CRC surveillance, 72 (9%; 70 with Crohn’s colitis) had a colorectal stricture on index colonoscopy. There was no significant difference in the frequency of ACRN or requirement for colectomy between patients with vs without a colorectal stricture (P > .05). Colorectal stricture was not associated with subsequent ACRN (adjusted odds ratio [aOR], 1.41; 95% CI, 0.49–4.07), CRN (aOR, 1.15; 95% CI, 0.51–2.58), or colectomy (aOR, 1.10; 95% CI, 0.65–1.84).

Conclusions

In this analysis of patients with IBD colitis undergoing CRN surveillance, the presence of a colorectal stricture was not independently associated with risk of ACRN or colectomy. Multicenter, prospective studies are needed to confirm these findings, particularly in patients with ulcerative colitis–associated colorectal stricture.
Mabuchi Solitons and Relative Ding Stability of Toric Fano Varieties
Authors: Yao Yi
Published: July 2021

As a generalization of Kähler–Einstein metrics for Fano manifolds with nonvanishing Futaki invariant, Mabuchi solitons are critical points of a Calabi-type energy functional. We study their existence on toric Fano varieties and the underlying algebraic stability notion: relative Ding stability. As a toy model for a YTD type correspondence, a new feature is the emergence of a nonuniformly stable case. We show a partial coercivity for the modified Ding functionals in this case and obtain singular Mabuchi solitons via a variational approach. In the unstable case, we determine the maximal destabilizer, which is a simple convex function over the moment polytope, and establish a moment–weight equality that connects the infimum of a Calabi-type energy and the Berman–Ding invariant.
M2-Deficient Single-Replication Influenza Vaccine–Induced Immune Responses Associated With Protection Against Human Challenge With Highly Drifted H3N2 Influenza Strain
Authors: Eiden Joseph , Volckaert Bram , Rudenko Oleg , Aitchison Roger , Herber Renee , Belshe Robert , Greenberg Harry , Coelingh Kathleen , Marshall David , Kawaoka Yoshihiro , Neumann Gabriele , Bilsel Pamuk
Published: July 2021

Background

Current influenza vaccines are strain specific and demonstrate low vaccine efficacy against H3N2 influenza disease, especially when vaccine is mismatched to circulating virus. The novel influenza vaccine candidate, M2-deficient single replication (M2SR), induces a broad, multi-effector immune response.

Methods

A phase 2 challenge study was conducted to assess the efficacy of an M2SR vaccine expressing hemagglutinin and neuraminidase from A/Brisbane/10/2007 (Bris2007 M2SR H3N2; clade 1). Four weeks after vaccination, recipients were challenged with antigenically distinct H3N2 virus (A/Belgium/4217/2015, clade 3C.3b) and assessed for infection and clinical symptoms.

Results

Adverse events after vaccination were mild and similar in frequency for placebo and M2SR recipients. A single dose of Bris2007 M2SR induced neutralizing antibody to the vaccine (48% of recipients) and challenge strain (27% of recipients). Overall, 54% of M2SR recipients were infected after challenge, compared with 71% of placebo recipients. The subset of M2SR recipients with a vaccine-induced microneutralization response against the challenge virus had reduced rates of infection after challenge (38% vs 71% of placebo recipients; P = .050) and reduced illness.

Conclusions

Study participants with vaccine-induced neutralizing antibodies were protected against infection and illness after challenge with an antigenically distinct virus. This is the first demonstration of vaccine-induced protection against a highly drifted H3N2 challenge virus.
Collective Recognition and Regional Parliaments: Navigating Statehood Conflict
Authors: Kyris George , Luciano Bruno
Published: July 2021

This study explores whether and how regional parliaments facilitate collective state recognition, a question that has been overlooked within a literature that focuses more on recognition by individual states or international organizations more generally. We do that through a scoping exercise of how regional parliaments of four major international organizations (AU, CoE, EU, OSCE) have responded to past and present contested statehood efforts that are associated with conflicts, such as in Palestine, Western Sahara, Kosovo, or the post-Soviet space. Based on this, we conceptualize three different stances: recognition, non-recognition, and titular recognition (of a right to, as opposed to the presence of, statehood) and we propose that these stances become apparent declaratively, through resolutions or other formal texts of regional parliaments, or institutionally (e.g., through membership). We also find that regional parliaments display a certain agency through using specific parliamentary instruments to respond to statehood claimants, promoting debates on those claims, and expressing recognition stances different from the executive bodies of the organization. Further, we illustrate these arguments through a more in-depth analysis of the European Parliament's approach toward Kosovo's statehood. In this regard, the paper offers a missing but important account of how regional parliaments facilitate collective recognition and contribute to defining what is a state, one of the most fundamental questions of international relations, which sits at the heart of long and complex conflicts. The proposed conceptual and theoretical arguments can facilitate further studies on state recognition, particularly collective recognition and the role of international organizations.
Distribution characteristics of drug resistance mutations of HIV CRF01_AE, CRF07_BC and CRF08_BC from patients under ART in Ganzhou, China
Authors: Xie Ying-Na , Zhu Feng-Xiu , Zhong You-Tian , Chen Ya-Ting , Gao Qian , Lai Xiao-Ling , Liu Jun-Jie , Huang Dan-Dan , Zhang Yu-Ning , Chen Xin
Published: July 2021

Background

Drug resistance mutation (DRM)-associated virological failure has become a critical issue for ART and the elimination of HIV.

Objectives

To investigate the distribution characteristics of DRMs of HIV CRF01_AE, CRF07_BC and CRF08_BC, the predominant subtypes in China.

Methods

Patients receiving ART up to 31 August 2020 in Ganzhou in China were recruited. Full-length sequences of the HIV pol gene were amplified from patients with virological failure. DRMs and antiretroviral susceptibility were explored using the Stanford University HIV Drug Resistance Database HIVdb Program.

Results

Overall, 279 of 2204 patients under ART were found to have virological failure. Nine HIV subtypes were identified among 211 sequences that were amplified successfully and CRF08_BC (37.0%), CRF01_AE (26.1%) and CRF07_BC (25.6%) were the most prevalent, with mutation frequencies of 44.9% (35/78), 52.7% (29/55) and 35.2% (19/54), respectively. The most common DRMs of these three subtypes were K103N and M184V, while the mutation frequencies of M41L, D67N, K70R, K101E, V106M, Y181C, K219E, H221Y and N348I were obviously different among subtypes. The resistance levels and frequencies for antiretroviral drugs for these three subtypes were similar and resistances to nevirapine, efavirenz, lamivudine and emtricitabine were the most frequently observed. Compared with CRF01_AE and CRF07_BC, CRF08_BC had higher proportions of DRMs for NRTIs and lower frequencies of resistance to NRTIs and NNRTIs.

Conclusions

The distribution characteristics of DRMs of HIV CRF01_AE, CRF07_BC and CRF08_BC were inconsistent and should be considered when selecting antiretroviral strategies, developing new drugs and controlling HIV strains containing DRMs.
Integrated Pest Management Control ofVarroa destructor(Acari: Varroidae), the Most Damaging Pest of (Apis melliferaL. (Hymenoptera: Apidae)) Colonies
Authors: Jack Cameron J , Ellis James D
Published: July 2021

Varroa destructor is among the greatest biological threats to western honey bee (Apis mellifera L.) health worldwide. Beekeepers routinely use chemical treatments to control this parasite, though overuse and mismanagement of these treatments have led to widespread resistance in Varroa populations. Integrated Pest Management (IPM) is an ecologically based, sustainable approach to pest management that relies on a combination of control tactics that minimize environmental impacts. Herein, we provide an in-depth review of the components of IPM in a Varroa control context. These include determining economic thresholds for the mite, identification of and monitoring for Varroa, prevention strategies, and risk conscious treatments. Furthermore, we provide a detailed review of cultural, mechanical, biological, and chemical control strategies, both longstanding and emerging, used against Varroa globally. For each control type, we describe all available treatments, their efficacies against Varroa as described in the primary scientific literature, and the obstacles to their adoption. Unfortunately, reliable IPM protocols do not exist for Varroa due to the complex biology of the mite and strong reliance on chemical control by beekeepers. To encourage beekeeper adoption, a successful IPM approach to Varroa control in managed colonies must be an improvement over conventional control methods and include cost-effective treatments that can be employed readily by beekeepers. It is our intention to provide the most thorough review of Varroa control options available, ultimately framing our discussion within the context of IPM. We hope this article is a call-to-arms against the most damaging pest managed honey bee colonies face worldwide.
A Randomized Trial of Calcium Plus Vitamin D Supplementation and Risk of Ductal Carcinoma In Situ of the Breast
Authors: Peila Rita , Xue Xiaonan , Cauley Jane A , Chlebowski Rowan , Manson JoAnn E , Nassir Rami , Saquib Nazmus , Shadyab Aladdin H , Zhang Zhenzhen , Wassertheil-Smoller Sylvia , Rohan Thomas E
Published: July 2021

Background

The effect of calcium plus vitamin D (CaD) supplementation on risk of ductal carcinoma in situ (DCIS) of the breast, a nonobligate precursor of invasive ductal carcinoma, is not well understood. In this secondary analysis, we examined this association in the Women’s Health Initiative CaD trial over approximately 20 years of follow-up.

Methods

A total of 36 282 cancer-free postmenopausal women (50-79 years) were randomly assigned to daily (d) calcium (1000 mg) plus vitamin D (400 IU) supplementation or to a placebo. Personal supplementation with vitamin D (≤600 IU/d, subsequently raised to 1000 IU/d) and calcium (≤1000 mg/d) was allowed. The intervention phase (median = 7.1 years), was followed by a postintervention phase (additional 13.8 years), which included 86.0% of the surviving women. A total of 595 incident DCIS cases were ascertained. Hazard ratios (HRs) plus 95% confidence intervals (CIs) were calculated.

Results

The intervention group had a lower risk of DCIS throughout follow-up (HR = 0.82, 95% CI = 0.70 to 0.96) and during the postintervention phase (HR = 0.76, 95% CI = 0.61 to 0.94). The group that used CaD personal supplements in combination with the trial intervention had a lower risk of DCIS compared with the trial placebo group that did not use personal supplementation (HR = 0.72, 95% CI = 0.56 to 0.91).

Conclusions

CaD supplementation in postmenopausal women was associated with reduced risk of DCIS, raising the possibility that consistent use of these supplements might provide long-term benefits for the prevention of DCIS.
Planning Considerations and Lessons Learned From a COVID-19 Mass Community Vaccination Center
Authors: Fischl Benjamin , Patterson Andrew T , Baxter Joseph , Watson James , Hemsworth Jesse , Valentine David , Wessler Jacob , Wong Danny
Published: July 2021

The emergency use authorization for multiple coronavirus disease 2019 (COVID-19) vaccines came at a pivotal time for the USA. In January 2021, the country exceeded 400,000 deaths from COVID-19. The USA aimed to quickly distribute and administer the Pfizer and Moderna vaccines, with bright prospects for an additional emergency use authorization for Johnson and Johnson/Janssen’s single-dose vaccine on the horizon. Part of the National Strategy for COVID-19 Response and Pandemic Preparedness was to “mount a safe, effective, comprehensive vaccination campaign” so the administration set a goal to have 100 million fully vaccinated citizens after the first 100 days in office. In order to fuel the rapid administration of vaccines, the Department of Health and Human Services was tasked to stand up new, federally supported Community Vaccination Centers across the country. The Federal Emergency Management Agency (FEMA) was the lead agency entrusted to expedite financial assistance, allocate federal equipment and supplies, and deploy federal personnel to states, tribes, territories, and other eligible applicants for vaccination efforts. Early in the process of staffing sites, FEMA recognized the need to bolster the efforts with active duty military personnel and asked for manning assistance from the Department of Defense. As a result, 222 U.S. Air Force personnel were tasked with supporting the FEMA COVID-19 vaccination operations at NRG stadium, Houston, Texas. This reflection aims to cover the lessons learned and provide meaningful insight for future mass medical operations.
Full analytical ultrarelativistic 1D solutions of a planar working surface
Authors: de la Cruz-Hernández Manuel E , Mendoza Sergio
Published: July 2021

We show that the 1D planar ultrarelativistic shock tube problem with an ultrarelativistic polytropic equation of state can be solved analytically for the case of a working surface, i.e. for the case when an initial discontinuity on the hydrodynamical quantities of the problem form two shock waves separating from a contact discontinuity. The procedure is based on the extensive use of the Taub jump conditions for relativistic shock waves, the Taub adiabatic, and performing Lorentz transformations to present the solution in a system of reference adequate for an external observer at rest. The solutions are found using a set of very useful theorems related to the Lorentz factors when transforming between systems of reference. The energy dissipated inside the working surface is relevant for studies of light curves observed in relativistic astrophysical jets and so, we provide a full analytical solution for this phenomenon assuming an ultrarelativistic periodic velocity injected at the base of the jet.
Solar oxygen abundance
Authors: Bergemann Maria , Hoppe Richard , Semenova Ekaterina , Carlsson Mats , Yakovleva Svetlana A , Voronov Yaroslav V , Bautista Manuel , Nemer Ahmad , Belyaev Andrey K , Leenaarts Jorrit , Mashonkina Lyudmila , Reiners Ansgar , Ellwarth Monika
Published: July 2021

Motivated by the controversy over the surface metallicity of the Sun, we present a re-analysis of the solar photospheric oxygen (O) abundance. New atomic models of O and Ni are used to perform non-local thermodynamic equilibrium (NLTE) calculations with 1D hydrostatic (MARCS) and 3D hydrodynamical (Stagger and Bifrost) models. The Bifrost 3D MHD simulations are used to quantify the influence of the chromosphere. We compare the 3D NLTE line profiles with new high-resolution, R$\approx 700\, 000$, spatially resolved spectra of the Sun obtained using the IAG FTS instrument. We find that the O i lines at 777 nm yield the abundance of log A(O) = 8.74 ± 0.03 dex, which depends on the choice of the H-impact collisional data and oscillator strengths. The forbidden [O i] line at 630 nm is less model dependent, as it forms nearly in LTE and is only weakly sensitive to convection. However, the oscillator strength for this transition is more uncertain than for the 777 nm lines. Modelled in 3D NLTE with the Ni i blend, the 630 nm line yields an abundance of log A(O) = 8.77 ± 0.05 dex. We compare our results with previous estimates in the literature and draw a conclusion on the most likely value of the solar photospheric O abundance, which we estimate at log A(O) = 8.75 ± 0.03 dex.
Radar observations of Draconid outbursts
Authors: Campbell-Brown M D , Stober G , Jacobi C , Kero J , Kozlovsky A , Lester M
Published: July 2021

The Draconid meteor shower shows strong bursts of activity at irregular intervals, with nearly no activity in intervening years. Five outbursts of the Draconid meteor shower were observed with specular meteor radars in Canada and Europe between 1999 and 2018. The outbursts generally lasted between 6 and 8 h, and most were not fully visible at a single geographical site, emphasizing the need for observations at multiple longitudes for short-duration shower outbursts. There is at least a factor of two difference in the peak flux as measured on different radars; the initial trail radius effect is undercorrected for Draconid meteors, which are known to be fragile.
Can a jumping-Jupiter trigger the Moon’s formation impact?
Authors: DeSouza Sandro R , Roig Fernando , Nesvorný David
Published: July 2021

We investigate the possibility that the Moon’s formation impact was triggered by an early dynamical instability of the giant planets. We consider the well-studied ‘jumping Jupiter’ hypothesis for the Solar system’s instability, where Jupiter and Saturn’s semimajor axes evolve in step-wise manner from their primordially compact architecture to their present locations. Moreover, we test multiple different configurations for the primordial system of terrestrial planets and the Moon-forming projectile, with particular focus on the almost equal masses impact. We find that the instability/migration of the giant planets excites the orbits of the terrestrial planets through dynamical perturbations, thus allowing collisions between them. About 10 per cent of the simulations lead to a collision with the proto-Earth which resulted in a final configuration of the terrestrial system that reproduces, to some extent, its present architecture. Most of these collisions occur in the hit-and-run domain, but about 15 per cent occur in the partial accretion regime, with the right conditions for a Moon-forming impact. In most of the simulations, there is a delay of more than ∼20 My between the time of the instability and the Moon-forming impact. This supports the occurrence of an early instability (<10 My after dissipation of the gas in the protoplanetary disc), compatible with the time of the Moon-forming impact (30–60 My) inferred from cosmochemical constraints. In general, the final states of the inner Solar system in our simulations show an excess of Angular Momentum Deficit, mostly attributed to the overexcitation of Mercury’s eccentricity and inclination.
First high-resolution optical spectra of the distant emission-line star VES 723 (IRAS 02110+6212)
Authors: Miroshnichenko A S , Klochkova V G , Chentsov E L , Panchuk V E , Yushkin M V , Manset N
Published: July 2021

The first high-resolution spectra (resolving powers of R ≥ 60 000) of the emission-line star VES 723, which has an unknown evolutionary status, were taken at the 6-m Big Telescope Alt-Azimuthal and the 3.6-m Canada–France–Hawaii Telescope. The spectrum is dominated with powerful emission lines of neutral hydrogen and helium, and forbidden singly ionized nitrogen. The Hα and He i lines were found to exhibit broad foundations of the emission profiles at least 250 km s−1 wide. The strongest emission lines exhibit no noticeable variations during the observing period (2011–2017) except for the He i lines. The spectra contain multicomponent interstellar absorptions of Na i and K i (mult. 1) and several strongest diffuse interstellar bands, while photospheric absorptions have not been detected. The average radial velocity of the forbidden [N ii] emission line centres was adopted as the systemic velocity (Vsys ≈ −52 km s−1), which indicates a large distance of ≈6 kpc. Our luminosity estimates of log  L/L⊙ = 3.7−4.0 for two different Gaia distance measurements, along with an effective temperature of Teff = 25 000 ± 2000 K and a fast decrease of the infrared flux longward of $\lambda \sim 10\, \mu{\rm m}$, allow us to suggest that VES 723 is neither a pre-main-sequence Herbig B[e] star nor a B[e] supergiant but rather a member of the FS CMa group of objects with the B[e] phenomenon.
Revisiting the Galactic Double Neutron Star merger and LIGO detection rates
Authors: Grunthal K , Kramer M , Desvignes G
Published: July 2021

We revisit the merger rate for Galactic double neutron star (DNS) systems in light of recent observational insight into the longitudinal and latitudinal beam shape of the relativistic DNS PSR J1906 + 0746. Due to its young age and its relativistic orbit, the pulsar contributes significantly to the estimate of the joint Galactic merger rate. We follow previous analyses by modelling the underlying pulsar population of nine merging DNS systems and study the impact and resulting uncertainties when replacing simplifying assumptions made in the past with actual knowledge of the beam shape, its extent, and the viewing geometry. We find that the individual contribution of PSR J1906 + 0746 increases to $\mathcal {R} = 6^{+28}_{-5} \, \mathrm{Myr}^{-1}$ although the values are still consistent with previous estimates, given the uncertainties. We also compute contributions to the merger rates from the other DNS systems by applying a generic beam shape derived from that of PSR J1906 + 0746, evaluating the impact of previous assumptions. We derive a joint Galactic DNS merger rate of $\mathcal {R}^{\mathrm{gen}}_{\mathrm{MW}} = 32^{+19}_{-9}\, \mathrm{Myr}^{-1}$, leading to a LIGO detection rate of $\mathcal {R}^{\mathrm{gen}}_{\mathrm{LIGO}} = 3.5^{+2.1}_{-1.0}\, \mathrm{yr}^{-1}$ (90 per cent conf. limit), considering the upcoming O3 sensitivity of LIGO. As these values are in good agreement with previous estimates, we conclude that the method of estimating the DNS merger and LIGO detection rates via the study of the radio pulsar DNS population is less prone to systematic uncertainties than previously thought.
Identification of twist-angle-dependent excitons in WS2/WSe2 heterobilayers
Authors: Wu Ke , Zhong Hongxia , Guo Quanbing , Tang Jibo , Zhang Jing , Qian Lihua , Shi Zhifeng , Zhang Chendong , Yuan Shengjun , Zhang Shunping , Xu Hongxing
Published: July 2021

Stacking atomically thin films enables artificial construction of van der Waals heterostructures with exotic functionalities such as superconductivity, the quantum Hall effect, and engineered light-matter interactions. In particular, heterobilayers composed of monolayer transition metal dichalcogenides have attracted significant interest due to their controllable interlayer coupling and trapped valley excitons in moiré superlattices. However, the identification of twist-angle-modulated optical transitions in heterobilayers is sometimes controversial since both momentum-direct (K–K) and -indirect excitons reside on the low energy side of the bright exciton in the monolayer constituents. Here, we attribute the optical transition at ∼1.35 eV in the WS2/WSe2 heterobilayer to an indirect Γ–K transition based on a systematic analysis and comparison of experimental photoluminescence spectra with theoretical calculations. The exciton wavefunction obtained by the state-of-the-art GW-Bethe-Salpeter equation approach indicates that both the electron and hole of the excitons are contributed by the WS2 layer. Polarization-resolved k-space imaging further confirms that the transition dipole moment of this optical transition is dominantly in-plane and is independent of the twist angle. The calculated absorption spectrum predicts that the so-called interlayer exciton peak coming from the K–K transition is located at 1.06 eV, but with a much weaker amplitude. Our work provides new insight into the steady-state and dynamic properties of twist-angle-dependent excitons in van der Waals heterostructures.
Travel-Related Risk Behaviors and Antibiotic Use Among Older Travelers
Authors: Costello Varea H , Tribble David , Eickhoff Christa , Tilley D Hamilton , Utz Gregory , Telu Kalyani , Ganesan Anuradha , Fraser Jamie , Lalani Tahaniyat
Published: July 2021

Background

Antibiotic stewardship in the pretravel care of older adults is important to effectively treat infections while minimizing harm from side effects and unnecessary antibiotic use. The objective of this study was to compare the characteristics, risk behaviors, infectious diseases, and antibiotic use between older (≥60 years) and younger (18–59 years) travelers.

Methods

TravMil is a prospective, observational cohort of United States (US) Department of Defense beneficiaries traveling outside the continental US for ≤6.5 months. For this analysis, we included adults enrolled pretravel between January 2010 and August 2018 and excluded active duty personnel on deployment. Pre and post-travel surveys captured trip characteristics, exposures, illnesses, and antibiotic use.

Results

A total of 1742 travelers were analyzed: 747 (42.9%) were aged ≥60 years and 995 (57.1%) were aged 18–59 years. Older travelers were less likely to engage in high-risk dietary behaviors and experience travelers’ diarrhea than younger travelers (18.2% vs 22.9%; P < .05). Influenza-like illness (12.5%) and febrile illness (3.4%) occurred less frequently in the older cohort. Antibiotic use for self-treatment was common in both age groups (25.7% vs 26.7%) and often inappropriate, for example, for treatment of occasional loose stool or mild travelers’ diarrhea (67.0% [67/100] in older adults vs 57.6% [83/144] in younger adults; P < .05), and influenza-like illness (63.4% [64/101] vs 58.6% [68/116], respectively; P < .05).

Conclusions

Older travelers were less likely to engage in high-risk behaviors and experience travelers’ diarrhea, and both age groups experienced mild, self-limited infections. Inappropriate use of antibiotics was common, suggesting that antimicrobial stewardship should be emphasized at pretravel counseling with international travelers.
Endoscopic Transcortical Selective Amygdalohippocampectomy for Mesial Temporal Lobe Epilepsy: 2-Dimensional Operative Video
Authors: Uda Takehiro , Kawashima Toshiyuki , Hattori Masato , Kojima Yuichiro , Mito Yuki , Goto Takeo
Published: July 2021

This surgical video shows a 19-yr-old woman with focal impaired awareness seizures. Seizure semiology showed no lateralizing signs. Ictal electroencephalography (EEG) failed to determine the seizure origin. Interictal EEG showed bilateral spike-and-waves at the temporal electrodes. Magnetic resonance imaging (MRI) showed suspected hippocampal sclerosis on the right side. To determine the side of the focus, depth electrodes were implanted in both hippocampi. Invasive video EEG identified the seizure origin on the right. The decision was made to perform selective amygdalohippocampectomy (SelAH) via the middle temporal gyrus (MTG). An endoscope was used to minimize the craniotomy and shorten the skin incision.

 A 5-cm linear skin incision and 2.5-cm craniotomy were made. A thin tube was inserted to the inferior horn of the lateral ventricle (Inf-H) under neuronavigation to guide the route to the Inf-H. The endoscope was introduced. A 1.5-cm corticotomy was made at the MTG, and white matter was aspirated until opening the Inf-H. The hippocampus and parahippocampal gyrus were removed with the usual steps in microsurgical SelAH. The surgical time was 4 h 20 min. The patient was discharged without complications and has remained seizure free.

 In addition to the preoperative objectives, using an endoscope widens the surgical view in the Inf-H compared with microsurgical procedures. Although seizure and cognitive outcomes are expected to be comparable to those from other methods of SelAH, invasiveness might be reduced. This appears to represent the first video report of endoscopic SelAH. The patient consented to the procedure and publication of her images and surgical video.
Selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors in pregnancy: Infant and childhood outcomes
Authors: Hendson Leonora , Shah Vibhuti , Trkulja Sandra
Published: July 2021

This position statement provides guidance for the monitoring, care, and follow-up of newborns exposed to selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) in utero. Depression and anxiety are common during pregnancy and postpartum. While there are risks to taking medications during pregnancy, untreated or incompletely managed depression and anxiety also carry risks for the newborn. Poor neonatal adaptation syndrome (PNAS) occurs in one-third of newborns exposed to SSRIs or SNRIs in utero, and is generally mild and self-limiting. The low levels of SSRIs and SNRIs excreted in breast milk are compatible with breastfeeding. Persistent pulmonary hypertension of the newborn and congenital heart defects are rare associations of exposure to SSRIs or SNRIs in utero. There are inconsistencies in the literature regarding neurodevelopmental outcomes, specifically autism spectrum disorder and attention-deficit hyperactivity disorder. The inconsistencies likely relate to other factors (i.e., genetics, maternal depression, lifestyle, and comorbidities), rather than exposure to SSRIs or SNRIs in utero. Health care providers and parents should be reassured that PNAS is generally treatable with nonpharmacological measures, and that the risk of serious adverse effects from exposure to SSRIs or SNRIs in utero is low.
Group A streptococcal pharyngitis: A practical guide to diagnosis and treatment
Authors: Sauve Laura , Forrester A Michael , Top Karina A
Published: July 2021

Group A Streptococcus (GAS) pharyngitis is a common clinical syndrome in primary care, yet controversy remains regarding the best approach to diagnosis and treatment, including the benefits of antibiotics. Children who are likely to have GAS pharyngitis based on history or physical examination should have a throat swab and, when positive, be treated with amoxicillin or penicillin. The disproportionate burden of acute rheumatic fever in Indigenous populations in Canada and special considerations for testing and treatment are discussed.
Exposure to organizational stressors and health outcomes in a sample of Italian local police officers
Authors: Marcatto Francesco , Orrico Kristal , Luis Ornella , Larese Filon Francesca , Ferrante Donatella
Published: July 2021

Exposure to organizational stressors is known to negatively affect police officers’ well-being in terms of mental and physical health and performance. In this study, we adopted the Health and Safety Executive’s Management Standards to identify specific associations between organizational stressors and health outcomes in a sample of local police officers employed in an Italian municipality (N = 111). Compared with benchmark data, participants were exposed to high risks in six out of seven organizational dimensions, and five of those (namely, Demands, Control, Managers’ Support, Relationships, and Role) displayed significant associations with psychological and physical problems, such as perceived stress, hypertension, gastrointestinal disorders, dermatitis, and musculoskeletal pain. While most stress-reduction interventions for police forces are designed at the individual level, the results of the present study also indicate the need for designing and implementing interventions aimed at addressing and preventing organizational stressors. Therefore, periodic in-depth stress assessments to identify key issues that should be the primary targets of such interventions are recommended.
Therapeutic Alliance: Patients’ Expectations Before and Experiences After Physical Therapy for Low Back Pain—A Qualitative Study With 6-Month Follow-Up
Authors: Unsgaard-Tøndel Monica , Søderstrøm Sylvia
Published: July 2021

Objective

The aim of this study was to explore patients’ expectations before and experiences after physical therapy for low back pain.

Methods

Qualitative in-depth, semi-structured interviews with patients attending physical therapy were performed before, immediately after, and 6 months after treatment. Data were analyzed from a hermeneutical perspective with decontextualization, recontextualization, and identification of themes.

Results

Patients’ pretreatment expectations to physical therapy focused around exercises and a body-oriented diagnosis. After treatment, reassurance, active listening with explanations, and personally adapted strategies for self-managing pain and regaining control over everyday activity were expressed as decisive for a meaningful therapeutic alliance.

Conclusion

Expectations before treatment focused on exercises and diagnosis. Empathetic and personally adapted education aimed at empowerment was experienced as a meaningful aspect of the therapeutic alliance after treatment. The therapeutic alliance provided a basis to integrate knowledge on the complexity of pain.

Impact

Our findings indicate that patients emphasize physical therapists’ interactional and pedagogical skills as meaningful aspects of the therapeutic alliance, which has implications for clinical practice and training physical therapist students.
Hyper-Coordinated DNA Methylation is Altered in Schizophrenia and Associated with Brain Function
Authors: Chen Junfang , Schwarz Kristina , Zang Zhenxiang , Braun Urs , Harneit Anais , Kremer Thomas , Ma Ren , Schweiger Janina , Moessnang Carolin , Geiger Lena , Cao Han , Degenhardt Franziska , Nöthen Markus M , Tost Heike , Meyer-Lindenberg Andreas , Schwarz Emanuel
Published: July 2021

DNA methylation is an epigenetic biological process that is emerging as an important mediator of environmental risk effects on the susceptibility of severe illness, such as schizophrenia. DNA methylation shows coordination across biologically-related genes, but it is not known whether the resulting network structure has a mediating effect on illness risk. Here we identified a large gene network with hyper-coordinated DNA methylation in several biological processes that are changed in the brain of patients with schizophrenia, and that are associated with schizophrenia-relevant brain function as well as genetic illness susceptibility. We found that DNA methylation was physiologically coordinated in a reproducible network that comprised 6399 genes and showed a similar architecture in blood and brain. The network was hyper-coordinated in biological processes of core importance for schizophrenia, including synaptic processes that are associated with the strongest common genetic risk variants for schizophrenia. Coordinated methylation in these processes was decreased in brain samples from donors with schizophrenia, and showed an age-dependent association with schizophrenia-relevant brain function. These results support the coordination of DNA methylation as a regulatory principle relevant to schizophrenia that may be sensitive to environmental risk exposure during specific developmental periods and compound genetic illness predisposition.
Unveiling the Patterns of Reticulated Evolutionary Processes with Phylogenomics: Hybridization and Polyploidy in the Genus Rosa
Authors: Debray Kevin , Le Paslier Marie-Christine , Bérard Aurélie , Thouroude Tatiana , Michel Gilles , Marie-Magdelaine Jordan , Bruneau Anne , Foucher Fabrice , Malécot Valéry
Published: July 2021

Reticulation, caused by hybridization and allopolyploidization, is considered an important and frequent phenomenon in the evolution of numerous plant lineages. Although both processes represent important driving forces of evolution, they are mostly ignored in phylogenetic studies involving a large number of species. Indeed only a scattering of methods exists to recover a comprehensive reticulated evolutionary history for a broad taxon sampling. Among these methods, comparisons of topologies obtained from plastid markers with those from a few nuclear sequences are favored, even though they restrict in-depth studies of hybridization and polyploidization. The genus Rosa encompasses c. 150 species widely distributed throughout the northern hemisphere and represents a challenging taxonomic group in which hybridization and polyploidization are prominent. Our main objective was to develop a general framework that would take patterns of reticulation into account in the study of the phylogenetic relationships among Rosa species. Using amplicon sequencing, we targeted allele variation in the nuclear genome as well as haploid sequences in the chloroplast genome. We successfully recovered robust plastid and nuclear phylogenies and performed in-depth tests for several scenarios of hybridization using a maximum pseudo-likelihood approach on taxon subsets. Our diploid-first approach followed by hybrid and polyploid grafting resolved most of the evolutionary relationships among Rosa subgenera, sections, and selected species. Based on these results, we provide new directions for a future revision of the infrageneric classification in Rosa. The stepwise strategy proposed here can be used to reconstruct the phylogenetic relationships of other challenging taxonomic groups with large numbers of hybrid and polyploid taxa. [Amplicon sequencing; interspecific hybridization; polyploid detection; reticulate evolution.]
Association between serum uric acid level and mortality in China
Authors: Chang Dong-Yuan , Wang Jin-Wei , Chen Min , Zhang Lu-Xia , Zhao Ming-Hui
Published: July 2021

Background:

Whether there is an association between serum uric acid (SUA) level and risk of mortality in the general population remains unclear. Based on the China National Survey of Chronic Kidney Disease linked to mortality data, a population-based cohort study was performed to investigate the association between SUA level and all-cause mortality, cardiovascular disease (CVD) mortality, and cancer mortality in China.

Methods:

The survival status of participants in the cross-sectional survey was identified from January 1, 2006 to December 31, 2017. Only 33,268 individuals with complete SUA data among the 47,204 participants were included in the analysis. We determined the rates of all-cause mortality, CVD mortality, and cancer mortality. We used Cox proportional hazards regression models to evaluate the effect of the SUA level on mortality.

Results:

During a total of 297,538.4 person-years of follow-up, 1282 deaths occurred. In the Cox proportional hazards regression model, the rate of all-cause mortality, CVD mortality, and cancer mortality had a U-shaped association with SUA levels only in men, whereas no significant associations were detected in women. For all-cause mortality in men, the multivariable-adjusted hazard ratios (HRs) in the first, second, and fourth quartiles compared with the third quartile were 1.31 (95% confidence interval [CI] 1.04–1.67), 1.17 (95% CI 0.92–1.47), and 1.55 (95% CI 1.24–1.93), respectively. For CVD mortality, the corresponding HRs were 1.47 (95% CI 1.00–2.18), 1.17 (95% CI 0.79–1.75), and 1.67 (95% CI 1.16–2.43), respectively. For the cancer mortality rate, only a marginally significant association was detected in the fourth quartile compared with the third quartile with an HR of 1.43 (95% CI 0.99–2.08).

Conclusions:

The association between SUA and mortality differed by sex. We demonstrated a U-shaped association with SUA levels for all-cause and CVD mortalities among men in China.
Escalating morphine dosage fails to elicit conditioned analgesia in a preclinical chronic neuropathic pain model
Authors: Boorman Damien C. , Keay Kevin A.
Published: July 2021

Many people with chronic pain escalate their opioid dosage to counteract tolerance effects. A treatment regimen consisting of placebos admixed with opioids has been suggested as a possible therapeutic option that could reduce the harm of long-term opioid use. However, the analgesic efficacy of such a regimen requires further investigation before widespread adoption. We have recently reported that a 4-day pharmacological conditioning procedure, which paired morphine (6 mg/kg) with contextual cues, elicited placebo analgesia in subpopulations of male (35%) and female (25%) rats with sciatic nerve chronic constriction injury (CCI). Here, we investigated how an escalating morphine dosage during conditioning affects the incidence and strength of placebo analgesia. Forty-four male, Sprague–Dawley rats received CCI. Thirty-eight (86%) rats developed strong cold allodynia by day 6 post-surgery, as measured by hind paw withdrawal (HPW) behaviour on a 5°C cold plate (120 s). In this experiment, pharmacological conditioning consisted of an escalating morphine dose over 4 days (8/9/10/12 mg/kg). This dosing regimen produced strong reductions in HPW behaviour and counteracted the effects of morphine tolerance during conditioning. However, none of the rats given the placebo treatment (n = 12) demonstrated reductions in HPW behaviour when morphine was substituted for saline (i.e. placebo analgesia), but instead showed a strong behavioural response (rearing). These results demonstrate that a high, escalating dose of morphine failed to produce conditioned placebo analgesia in rats with CCI. It is possible that admixing placebos with opioids may be similarly ineffective in chronic pain patients when the opioids regimen is high or escalating.
Nicotine-like discriminative and aversive effects of two α4β2-selective nicotine agonists, ispronicline and metanicotine
Authors: Winger Gail
Published: July 2021

An attempt to determine the receptor selective nature of some of nicotine’s behavioral effects was undertaken through the evaluation of the ability of two nicotinic α4β2*-selective receptor agonists to produce nicotine-like effects and modify rates of responding in a discrimination assay and in an aversive stimulus assay. A group of eight rats was trained to discriminate the presence of 1 mg/kg nicotine base. Another group of 4–6 rats was trained to report the aversive effects of nicotine by selecting a lever that produced one food pellet over a second lever that produced two food pellets and an intravenous injection of nicotine. Ispronicline and metanicotine, two α4β2*-selective receptor agonists, increased selection of the nicotine-appropriate lever in a dose-related manner, up to a maximum of approximately 75%. The α4β2*-selective receptor antagonist, dihydro-beta-erythroidine blocked both the discriminative stimulus effects and the rate-suppressing effects of ispronicline, metanicotine, and small, but not large doses of nicotine. The nonselective antagonist, mecamylamine, antagonized the discriminative stimulus effects of each of the three nicotine agonists as well as the rate-decreasing effects of nicotine and metanicotine. Mecamylamine did not modify the rate-decreasing effects of ispronicline. Both ispronicline and metanicotine as well as nicotine were avoided in the drug + food vs. food choice situation. The receptor-selective nature of ispronicline and metanicotine was hereby confirmed in a behavioral assay, as were earlier reports that the discriminative stimulus effects of relatively small doses of nicotine are likely mediated by activity at the α4β2* nicotine receptor.
Orexin-2 receptor antagonism in the cornu ammonis 1 region of hippocampus prevented the antinociceptive responses induced by chemical stimulation of the lateral hypothalamus in the animal model of persistent pain
Authors: Pourreza Pooya , Haghparast Amir , Sadeghi Mehdi , Nazari-Serenjeh Farzaneh , Askari Kobra , Haghparast Abbas
Published: July 2021

Orexins are excitatory neuropeptides, mainly produced by neurons located in the lateral hypothalamus, which project to many brain areas. The orexinergic system plays a fundamental role in arousal, sleep/wakefulness, feeding, energy homeostasis, motivation, reward, stress and pain modulation. As a prominent part of the limbic system, the hippocampus has been involved in formalin-induced nociception modulation. Moreover, hippocampus regions express both orexin-1 (OX1) and orexin-2 (OX2) receptors. The present study investigated the role of OX2 receptors (OX2R) within the cornu ammonis 1 (CA1) region of the hippocampus in the mediation of lateral hypothalamus-induced antinociception. Fifty-three male Wistar rats were unilaterally implanted with two separate cannulae into the lateral hypothalamus and CA1. Animals were pretreated with intra-CA1 TCS OX2 29 as an OX2R antagonist before intra-lateral hypothalamus administration of carbachol (250 nM) as a muscarinic agonist for chemical stimulation of orexinergic neurons. Formalin test was used as an animal model of persistent pain, following intra-lateral hypothalamus carbachol microinjection. Results showed that the chemical stimulation of the lateral hypothalamus significantly attenuated formalin-evoked nociceptive behaviors during both phases of the formalin test, and administration of TCS OX2 29 into the CA1 blocked these antinociceptive responses in both phases, especially in the late phase. These findings suggest that OX2 receptors in the CA1 partially mediate the lateral hypothalamus-induced antinociceptive responses in persistent inflammatory pain.
Environmental and organizational correlates and motivations for provider-sponsored health plan ownership in the post-reform era
Authors: Meese Katherine A. , Hearld Larry R. , O'Connor Stephen J. , Peterson Mary Dale , Carroll Nathan W. , Sen Bisakha
Published: July 2021

Background

The 1980s to 1990s saw many health systems in the United States enter and exit the insurance market in the form of provider-sponsored health plans (PSHPs). Reforms and value-based reimbursement methods have stimulated health care organizations to reconsider PSHP as a logical strategy.

Purpose

The aim of this study was to examine market and organizational factors associated with PSHP ownership and motivations for engaging in PSHP after health care reforms. The resource dependence theory was used as a theoretical lens.

Methodology/Approach

A sequential quantitative to qualitative mixed-methods design was used. The quantitative analysis examined data for 5,849 U.S. hospitals. Results were synthesized with qualitative findings from 10 semistructured interviews representing eight health systems in five states.

Results

Organizational and environmental characteristics were significantly associated with PSHP ownership. Hospital and payer concentration, Medicare penetration, income, unemployment rate, government, and for-profit and metro area hospitals were associated with a lower likelihood of PSHP ownership. Salaried physician arrangements, clinically integrated network membership and adoption of other risk-bearing arrangements were associated with higher odds of PSHP ownership. Interviewees described PSHP as the culmination of the journey to value-based care and as a strategy to improve patient care, compete, and diversify revenue streams.

Conclusions

Both market and organizational factors are important considerations for hospitals contemplating PSHP ownership, and motivations for ownership cover a broad range of financial, competitive, strategic, and mission-based goals.

Practice Implications

Hospitals considering PSHP ownership must carefully evaluate their competitive landscapes and organizational resources to ensure optimal conditions for this strategy. PSHP ownership has high start-up costs and requires a long-term organizational commitment.