bluuebunny/crossref_metadata_2025 huggingface dataset:
Straining the Strain Diagnosis
Authors: Croskerry Pat
Published: June 2020

In this case, a woman in her late 30s was brought to the emergency department (ED) following a motor vehicle collision. She was a passenger in a car that was T-boned on the passenger side. Her principal complaint was neck pain. After plain radiographs showed no bony injury, she was discharged with cervical strain. She presented again to the same ED on three further occasions before her correct diagnosis was made. Aspects of implicit bias are highlighted in her care.
Postpartum Adaptation: Normal, Baby Blues, Baby Pinks
Authors: Robinson Gail Erlick
Published: June 2020

This chapter on postpartum adaptation/baby blues describes the transient symptoms of sadness, tearfulness, irritability, and insomnia know as the “baby blues” experienced by 50% to 80% of new mothers. This is not a sign of depression but, rather, the consequences of the massive bio-psycho-social changes that occur after the birth of a child. No specific treatment other than education and reassurance is required. Most often these symptoms resolve spontaneously within the first 2 to 3 weeks. Occasionally, they continue and develop into a major depression so women should be reassessed within the first 6 weeks postpartum to ensure the symptoms have cleared.
Postpartum Obsessive-Compulsive Disorder
Authors: Kaplan Danielle A. , Greene Judy A.
Published: June 2020

This chapter on postpartum obsessive-compulsive disorders reviews the occurrence of symptoms such as intrusive thoughts about the baby being harmed, the mother harming the baby, or perceived health problem or developmental delays in the infant. She may feel compelled to constantly check on the child and frequently seek medical consultation for her concerns. She may be overly preoccupied with hygiene and safety. The mother feels very distressed by these thoughts and fears, which can lead to a depression. Despite her thoughts about harming the baby, these women are not at risk of actually hurting their infants. Family support and reassurance is important. Cognitive-behavioral therapy can be helpful, but antidepressant medication may also be required.
Traumatic Childbirth and Postpartum Posttraumatic Stress Disorder
Authors: Brown Kara M. , Mittal Leena P.
Published: June 2020

This chapter on posttraumatic stress disorder (PTSD) in the postpartum reviews the disorder that may occur following: a traumatic birth during which the mother is injured: postpartum medical problems such as hemorrhage or the occurrence of a defect or medical complications in the newborn. Symptoms of PTSD include nightmares, intrusive thoughts, flashbacks, hypervigilance, avoidance of triggers, depressed mood, and a pessimistic view of the future. It is important to screen for PTSD after a traumatic birth as women often hesitate to come forward as they feel ashamed, lack insight into symptoms, lack support, or fear reproach. It is essential to attend to any residual physical trauma or pain following the delivery. Cognitive-behavioral therapy is the treatment of choice. Medication may be helpful including selective serotonin reuptake inhibitors and prazosin to help educe nightmares.
Eating Disorders in the Postpartum Period
Authors: Sutandar Kalam
Published: June 2020

The chapter on eating disorders in the postpartum addresses the issues of mothers who have anorexia nervosa or binge eating disorders. Women with anorexia nervosa may become particularly upset about the weight gain that comes with pregnancy. Extreme dieting may make them weak and have problems focusing on the baby’s needs. Warning signs include dieting that is associated with decreasing weight goals, increase in criticism of one’s body, social isolation, amenorrhea, and purging. They may also restrict the nutrition of their baby. Women with binge eating disorder may suffer secretly as they may not have abnormal weights. Hiding away to binge may interfere with care of the infant.
When Boo Boos Are Bad
Authors: Jafari Kaileen , Wall Jessica J.
Published: June 2020

Blunt abdominal trauma in the pediatric patient with patterned bruising, such as the seatbelt sign or the handlebar sign, are highly associated with intra-abdominal injury. Laboratory studies are recommended to assess for solid organ injury, while imaging recommendations include consideration of a focused assessment with sonography in trauma (FAST) exam or computerized tomography of the abdomen and pelvis. Further, it is crucial to have a high index of suspicion for nonaccidental trauma in children with abdominal bruising and no clear history of injury.
I Kneed help!
Authors: Das Kristol
Published: June 2020

This chapter reviews a case of an adolescent presenting to the emergency department with unilateral knee pain after a traumatic fall. This chapter reviews key history questions, physical exam maneuvers including special tests to examine the knee, the workup and management of this case presentation based on pediatric literature. Specifically, the chapter reviews indications to obtain x-rays versus other imaging modalities and the sensitivity and specificity of special tests based on recent data. Follow-up and subspecialty referral indications for knee pain are also reviewed. Lastly, the epidemiology, pathophysiology, management and natural history of this patient’s unique diagnosis are briefly discussed.
What Goes Up and Up—Comes Down and Down
Authors: Puri Ajay K. , Underwood Philipp J.
Published: June 2020

Salter-Harris (SH) fractures involve the physis and constitute up to 35% of all pediatric fractures. The main concern with SH fractures is premature physeal closure (PPC) due to disruption of the growth plate. SH I and II fractures have low rates of PPC. Fractures that are successfully reduced without significant residual angulation or displacement can be immobilized and referred to an orthopedic surgeon as an outpatient. SH III, IV, and V fractures that are identified require orthopedic consultation in the emergency department due to their higher rates of growth arrest often requiring operative intervention. It is important that patients be evaluated for neurovascular compromise before and after reduction. Conscious sedation is often required to manipulate and reduce a displaced fracture.
It’s “Nap” Time!
Authors: Hua Angela
Published: June 2020

Pediatric sedation is a useful tool in the emergency department to help safely manage patients’ pain and anxiety, while performing necessary diagnostic and therapeutic procedures. As sedation is not entirely without risk, the healthcare provider may try alternative methods, such as distraction and pain control, prior to resorting to sedation. However, when those methods are inadequate, sedation may be necessary. There are a number of factors to keep in mind to safely conduct a sedation in the emergency setting. This chapter covers the candidacy of pediatric patients for sedation, the monitoring during and after sedation, and some of the commonly used agents for a short sedation.
FOOSH—OUCH!
Authors: Huang Victor , Jalali Nima , McCarty Bryan , Underwood Philipp J.
Published: June 2020

A twelve-year-old boy presents with right wrist pain after a fall onto outstretched hand (FOOSH). The injury was isolated to the right wrist, which was swollen, visibly deformed, but neurovascularly intact distally. Imaging revealed a distal radial and ulna fracture with dorsal displacement. Injuries after a FOOSH include physeal fractures, incomplete fractures, supracondylar fractures, and soft-tissue injuries. Open fractures and neurovascular compromise warrant emergent orthopedic consultation. Displaced fractures should be reduced in the ED and immobilized in a sugar tong splint. Local anesthetics and procedural sedation are important tools to relieve pain and improve patient cooperation. Due to the risks of sedation, physicians should have a systemic approach to evaluate the patient and prepare the monitoring and airway equipment. There are many different medications and routes available. It is important for the physician to be aware of the side effects and discuss this with the patient and parents.
Pleural diseases
Authors: de Fonseka D. , Lee Y.C. Gary , Maskell N.A.
Published: June 2020

Pleural disease is a common problem, affecting 3,000 per million population each year, contributing to a significant workload for every chest physician. Pleural effusion is the commonest pleural pathology, closely followed by pneumothorax. Pleural effusion is a common clinical problem which can complicate a range of lung and systemic diseases. Most cases can be diagnosed by pleural fluid analysis and pleural biopsy. Common causes of a transudative effusion are heart failure and liver cirrhosis; common causes of an exudative effusion are malignancy, empyema/parapneumonic effusion, and tuberculosis. Low pH and low glucose levels are found in pleural fluid caused by very intense inflammatory processes, most commonly pleural infection, or malignancy. Where an effusion remains undiagnosed, specifically treatable conditions such as pulmonary embolism and drug-induced pleuritis should be reconsidered.
Basaglia after Basaglia
Authors: Mezzina Roberto
Published: June 2020

Basaglia anticipated, more than 50 years ago, the paradigm shift from ‘illness’ to the ‘person’—a shift that the recovery movement proposes today, both from a theoretical and a practical point of view. Mental illness can be seen as an artefact, shaped by the institution, and can be defined as a double that conceals human experience. Deinstitutionalization is underlined as the main strategy to overturn the oppression of people with psychosocial disabilities in the asylum and beyond, to mobilize resources for their recovery and social integration, as well as to create services and supports in the community. The passage from needs to citizenship rights, the social dimension of recovery, and the issue of empowerment are mediated by the role of community-based services. The experience of Trieste, begun in 1971, can be seen as the ‘practically true’ invoked by Franco Basaglia. The legislation of 1978 was based on the recognition of human rights as conformed today by the Convention on the Rights of Persons with Disabilities (CRPD).
Spain
Authors: Basauri Victor Aparicio
Published: June 2020

This chapter analyses the influence of Franco Basaglia and the organization ‘Psichiatria Democrática’ on the Spanish critical movements. These movements appeared in 1971 and were organized through a clandestine group known as the ‘Psychiatric Coordinator’. This organization linked professionals (mainly young psychiatrists) who had initiated innovative experiences in various psychiatric hospitals. These developments generated conflict when opposing the norms of the dictatorship. From 1975, and especially after the approval of the 1978 Constitution, the critical movement was a force for change in mental health structures in Spain, through the established organization, the Spanish Association of Neuropsychiatry. This effort made it possible to generate the psychiatric reform in 1985 that advocated community mental health and deinstitutionalization policies. Franco Basaglia began his contacts with the Spanish critical professionals in 1970, and the relationship was maintained periodically until 1980, the year of his death.
Deinstitutionalization, the welfare state, and social engineering
Authors: Topor Alain
Published: June 2020

In Sweden, the mental hospitals were closed by the end of the 1990s. Basaglia influenced the Swedish reality not through his and his colleagues’ words, but through their practical transformation of these words into reality. Sweden is a pragmatic and social ‘engineering’ country. In Italy, Swedish mental health workers and administrators found a clear organization of the services and a social orientation that appealed to their cultural background. This resulted in a compromise underpinning the normalization of the users’ living conditions and civil rights. Services around daily life were transferred from psychiatric care to the municipalities’ social services. Thus was psychiatry offered the possibility to be considered as a medical specialization, as others. Today, the work of Basaglia and his colleagues provides tools to analyse new contradictions between (1) mental health and normality; (2) evidence-based interventions and deinstitutionalization; and (3) the new institutional landscape and control.
The globular cluster system of the Auriga simulations
Authors: Halbesma Timo L R , Grand Robert J J , Gómez Facundo A , Marinacci Federico , Pakmor Rüdiger , Trick Wilma H , Busch Philipp , White Simon D M
Published: June 2020

We investigate whether the galaxy and star formation model used for the Auriga simulations can produce a realistic globular cluster (GC) population. We compare statistics of GC candidate star particles in the Auriga haloes with catalogues of the Milky Way (MW) and Andromeda (M31) GC populations. We find that the Auriga simulations do produce sufficient stellar mass for GC candidates at radii and metallicities that are typical for the MW GC system (GCS). We also find varying mass ratios of the simulated GC candidates relative to the observed mass in the MW and M31 GCSs for different bins of galactocentric radius metallicity (rgal–[Fe/H]). Overall, the Auriga simulations produce GC candidates with higher metallicities than the MW and M31 GCS and they are found at larger radii than observed. The Auriga simulations would require bound cluster formation efficiencies higher than 10 per cent for the metal-poor GC candidates, and those within the Solar radius should experience negligible destruction rates to be consistent with observations. GC candidates in the outer halo, on the other hand, should either have low formation efficiencies, or experience high mass-loss for the Auriga simulations to produce a GCS that is consistent with that of the MW or M31. Finally, the scatter in the metallicity as well as in the radial distribution between different Auriga runs is considerably smaller than the differences between that of the MW and M31 GCSs. The Auriga model is unlikely to give rise to a GCS that can be consistent with both galaxies.
K2-HERMES II. Planet-candidate properties from K2 Campaigns 1-13
Authors: Wittenmyer Robert A , Clark Jake T , Sharma Sanjib , Stello Dennis , Horner Jonathan , Kane Stephen R , Stevens Catherine P , Wright Duncan J , Spina Lorenzo , Čotar Klemen , Asplund Martin , Bland-Hawthorn Joss , Buder Sven , Casey Andrew R , De Silva Gayandhi M , D’Orazi Valentina , Freeman Ken , Kos Janez , Lewis Geraint , Lin Jane , Lind Karin , Martell Sarah L , Simpson Jeffrey D , Zucker Daniel B , Zwitter Tomaz
Published: June 2020

Accurate and precise radius estimates of transiting exoplanets are critical for understanding their compositions and formation mechanisms. To know the planet, we must know the host star in as much detail as possible. We present complete results for planet-candidate hosts from the K2-HERMES survey, which uses the HERMES multi-object spectrograph on the Anglo-Australian Telescope to obtain $R\sim 28\, 000$ spectra for more than 30 000 K2 stars. We present complete host-star parameters and planet-candidate radii for 224 K2 candidate planets from C1–C13. Our results cast severe doubt on 30 K2 candidates, as we derive unphysically large radii, larger than 2RJup. This work highlights the importance of obtaining accurate, precise, and self-consistent stellar parameters for ongoing large planet search programs – something that will only become more important in the coming years, as TESS begins to deliver its own harvest of exoplanets.
The polarized spectral energy distribution of NGC 4151
Authors: Marin F , Le Cam J , Lopez-Rodriguez E , Kolehmainen M , Babler B L , Meade M R
Published: June 2020

NGC 4151 is among the most well-studied Seyfert galaxies that does not suffer from strong obscuration along the observer’s line of sight. This allows to probe the central active galactic nucleus (AGN) engine with photometry, spectroscopy, reverberation mapping, or interferometry. Yet, the broad-band polarization from NGC 4151 has been poorly examined in the past despite the fact that polarimetry gives us a much cleaner view of the AGN physics than photometry or spectroscopy alone. In this paper, we compile the 0.15–89.0 μm total and polarized fluxes of NGC 4151 from archival and new data in order to examine the physical processes at work in the heart of this AGN. We demonstrate that, from the optical to the near-infrared (IR) band, the polarized spectrum of NGC 4151 shows a much bluer power-law spectral index than that of the total flux, corroborating the presence of an optically thick, locally heated accretion flow, at least in its near-IR emitting radii. Specific signatures from the atmosphere of the accretion structure are tentatively found at the shortest ultraviolet (UV) wavelengths, before the onset of absorption opacity. Otherwise, dust scattering appears to be the dominant contributor from the near-UV to near-IR polarized spectrum, superimposed on to a weaker electron component. We also identify a change in the polarization processes from the near-IR to the mid-IR, most likely associated with the transition from Mie scattering to dichroic absorption from aligned dust grains in the dusty torus or narrow-line region. Finally, we present and discuss the very first far-infrared polarization measurement of NGC 4151 at 89 μm.
Constraining X-ray emission in HBL blazars using multiwavelength observations
Authors: Wierzcholska Alicja , Wagner Stefan J
Published: June 2020

The X-ray spectrum of extreme high-energy peaked BL Lac-type blazars is located in the synchrotron branch of the broad-band spectral energy distribution (SED), at energies below the peak. A joint fit of the extrapolated X-ray spectra together with a host galaxy template allows characterizing the synchrotron branch in the SED. The X-ray spectrum is usually characterized either with a pure or a curved power-law model. In the latter case, however, it is hard to distinguish an intrinsic curvature from excess absorption. In this paper, we focus on five well-observed blazars: 1ES 0229+200, PKS 0548−322, RX J 1136+6737, 1ES 1741+196, and 1ES 2344+514. We constrain the infrared to X-ray emission of these five blazars using a model that is characterized by the host galaxy, spectral curvature, absorption, and ultraviolet (UV) excess to separate these spectral features. In the case of four sources, namely 1ES 0229+200, PKS 0548−322, 1ES 1741+196, and 1ES 2344+514, the spectral fit with the atomic neutral hydrogen from the Leiden Argentina Bonn Survey results in a significant UV excess present in the broad-band SED. Such excess can be interpreted as an additional component, for example, a blue bump. However, in order to describe spectra of these blazars without such excess, additional absorption to the atomic neutral hydrogen from the Leiden Argentina Bonn Survey is needed.
Testing the reliability of fast methods for weak lensing simulations: wl-moka on pinocchio
Authors: Giocoli Carlo , Monaco Pierluigi , Moscardini Lauro , Castro Tiago , Meneghetti Massimo , Metcalf R Benton , Baldi Marco
Published: June 2020

The generation of simulated convergence maps is of key importance in fully exploiting weak lensing by large-scale structure (LSS) from which cosmological parameters can be derived. In this paper, we present an extension of the pinocchio code that produces catalogues of dark matter haloes so that it is capable of simulating weak lensing by Modify LSS into Large Scale Structures (LSS). Like wl-moka, the method starts with a random realization of cosmological initial conditions, creates a halo catalogue and projects it on to the past light-cone, and paints in haloes assuming parametric models for the mass density distribution within them. Large-scale modes that are not accounted for by the haloes are constructed using linear theory. We discuss the systematic errors affecting the convergence power spectra when Lagrangian perturbation theory at increasing order is used to displace the haloes within pinocchio, and how they depend on the grid resolution. Our approximate method is shown to be very fast when compared to full ray-tracing simulations from an N-body run and able to recover the weak lensing signal, at different redshifts, with a few percent accuracy. It also allows for quickly constructing weak lensing covariance matrices, complementing pinocchio’s ability of generating the cluster mass function and galaxy clustering covariances and thus paving the way for calculating cross-covariances between the different probes. This work advances these approximate methods as tools for simulating and analysing survey data for cosmological purposes.
G-quadruplexes offer a conserved structural motif for NONO recruitment to NEAT1 architectural lncRNA
Authors: Simko Eric A J , Liu Honghe , Zhang Tao , Velasquez Adan , Teli Shraddha , Haeusler Aaron R , Wang Jiou
Published: June 2020

The long non-coding RNA NEAT1 serves as a scaffold for the assembly of paraspeckles, membraneless nuclear organelles involved in gene regulation. Paraspeckle assembly requires NEAT1 recruitment of the RNA-binding protein NONO, however the NEAT1 elements responsible for recruitment are unknown. Herein we present evidence that previously unrecognized structural features of NEAT1 serve an important role in these interactions. Led by the initial observation that NONO preferentially binds the G-quadruplex conformation of G-rich C9orf72 repeat RNA, we find that G-quadruplex motifs are abundant and conserved features of NEAT1. Furthermore, we determine that NONO binds NEAT1 G-quadruplexes with structural specificity and provide evidence that G-quadruplex motifs mediate NONO-NEAT1 association, with NONO binding sites on NEAT1 corresponding largely to G-quadruplex motifs, and treatment with a G-quadruplex-disrupting small molecule causing dissociation of native NONO-NEAT1 complexes. Together, these findings position G-quadruplexes as a primary candidate for the NONO-recruiting elements of NEAT1 and provide a framework for further investigation into the role of G-quadruplexes in paraspeckle formation and function.
Efficacy of Bezlotoxumab in Participants Receiving Metronidazole, Vancomycin, or Fidaxomicin for Treatment of Clostridioides (Clostridium) difficile Infection
Authors: Dubberke Erik R , Gerding Dale N , Kelly Ciarán P , Garey Kevin W , Rahav Galia , Mosley Audrey , Tipping Robert , Dorr Mary Beth
Published: June 2020

Background

In phase 3 MODIFY I/II trials, bezlotoxumab significantly reduced recurrence of Clostridioides (Clostridium) difficile infection (rCDI) over 12 weeks. Choice of CDI antibacterial treatment may affect CDI-related outcomes; therefore, this prespecified analysis assessed if the magnitude of bezlotoxumab-induced rCDI reduction was influenced by the antibiotic administered.

Methods

In MODIFY I/II (NCT01241552/NCT01513239), participants received a single infusion of bezlotoxumab (10 mg/kg) or placebo during anti-CDI treatment. Using pooled data from MODIFY I/II, initial clinical cure (ICC) and rCDI were assessed in metronidazole-, vancomycin-, and fidaxomicin-treated subgroups.

Results

Of 1554 participants in MODIFY I/II, 753 (48.5%) received metronidazole, 745 (47.9%) vancomycin, and 56 (3.6%) fidaxomicin. Fewer participants receiving metronidazole had a prior CDI episode in the previous 6 months (12.9%) or ≥1 risk factor for rCDI (66.0%) vs participants receiving vancomycin (41.2% and 83.6%, respectively) and fidaxomicin (55.4% and 89.3%, respectively). ICC rates were similar in the bezlotoxumab (metronidazole, 81.0%; vancomycin, 78.5%; fidaxomicin, 86.7%) and placebo groups (metronidazole, 81.3%; vancomycin, 79.6%; fidaxomicin, 76.9%). In placebo-treated participants, the rCDI was lower in the metronidazole subgroup vs the vancomycin and fidaxomicin subgroups (metronidazole, 28.0%; vancomycin, 38.4%; fidaxomicin, 35.0%). When analyzed by subsets based on history of CDI, rCDI rates were similar in the metronidazole and vancomycin groups. rCDI rates were lower in all antibiotic subgroups for bezlotoxumab vs placebo (metronidazole: rate difference [RD], –9.7%; 95% confidence interval [CI], –16.4% to –3.1%; vancomycin: RD, –15.4%; 95% CI, –22.7% to –8.0%; fidaxomicin: RD, –11.9%; 95% CI, –38.1% to 14.3%).

Conclusion

Bezlotoxumab reduces rCDI vs placebo in participants receiving metronidazole and vancomycin, with a similar effect size in participants receiving fidaxomicin.
Incidence of Tuberculosis During the First Year of Antiretroviral Treatment in West African HIV-Infected Adults
Authors: Tchakounte Youngui Boris , Coffie Patrick , Messou Eugène , Poda Armel , Fortes Deguenonvo Louise , Hawerlander Denise , Minga Albert , Balestre Eric , Dabis François , Marcy Olivier
Published: June 2020

We estimated tuberculosis incidence during the first year on antriretroviral therapy without isoniazid-preventive treatment in 6938 West African HIV-infected adults at 3.33 cases per 100 person-years (95% CI, 2.85–3.80). In multivariate Poisson models, sites in Cote d’Ivoire, male gender, low body mass index, low hemoglobin, low CD4 count, and young age were significantly associated with higher incidence.
A Second Population-Based Cohort Study in Cameroon Confirms the Temporal Relationship Between Onchocerciasis and Epilepsy
Authors: Chesnais Cédric B , Bizet Charlotte , Campillo Jérémy T , Njamnshi Wepnyu Y , Bopda Jean , Nwane Philippe , Pion Sébastien D , Njamnshi Alfred K , Boussinesq Michel
Published: June 2020

To confirm our earlier evidence of a temporal and dose–response relationship between onchocerciasis and epilepsy, we conducted another cohort study in a different setting in Cameroon. Individuals whose Onchocerca volvulus microfilarial density (Ov-MFD) was measured in 1992–1994 when they were children were revisited in 2019 to determine if they acquired epilepsy. With reference to individuals with no microfilariae in 1992–1994, the relative risks of acquiring epilepsy were 0.96, 2.76, 3.67, and 11.87 in subjects with initial Ov-MFD of 1–7, 8–70, 71–200, and > 200 microfilariae per skin snip, respectively. This study further demonstrates reproducibility using the Bradford Hill’s criteria for causality.
Serum syndecan-1, hyaluronan and thrombomodulin levels in patients with lupus nephritis
Authors: Yu Kelvin Y C , Yung Susan , Chau Mel K M , Tang Colin S O , Yap Desmond Y H , Tang Alexander H N , Ying Shirley K Y , Lee Cheuk Kwong , Chan Tak Mao
Published: June 2020

Objectives

We investigated circulating syndecan-1, HA and thrombomodulin levels in patients with biopsy-proven Class III/IV ± V LN and their clinico-pathological associations. Patients with non-renal SLE or non-lupus chronic kidney disease, and healthy subjects served as controls.

Methods

Serum syndecan-1, HA and thrombomodulin levels were determined by ELISAs.

Results

Syndecan-1, HA and thrombomodulin levels were significantly higher during active LN compared with remission (P < 0.01, for all), and correlated with the level of proteinuria, estimated glomerular filtration rate, anti-dsDNA antibodies, complement 3 and serum creatinine. Longitudinal studies showed that syndecan-1 and thrombomodulin levels increased prior to clinical renal flare by 3.6 months, while HA level increased at the time of nephritic flare, and the levels decreased in parallel with treatment response. Receiver operating characteristic curve analysis showed that syndecan-1 and thrombomodulin levels distinguished patients with active LN from healthy subjects, LN patients in remission, patients with active non-renal lupus and patients with non-lupus chronic kidney disease (receiver operating characteristic area under curve of 0.98, 0.91, 0.82 and 0.95, respectively, for syndecan-1; and area under curve of 1.00, 0.84, 0.97 and 0.79, respectively, for thrombomodulin). HA level distinguished active LN from healthy subjects, LN patients in remission and non-lupus chronic kidney disease (receiver operating characteristic area under curve of 0.82, 0.71 and 0.90, respectively) but did not distinguish between renal vs non-renal lupus. Syndecan-1 and thrombomodulin levels correlated with the severity of interstitial inflammation, while HA level correlated with chronicity grading in kidney biopsies of active LN.

Conclusion

Our findings suggest potential utility of serum syndecan-1, thrombomodulin and HA levels in clinical management, and their potential contribution to LN pathogenesis.
Genomics-enabled analysis of specialized metabolism in bioenergy crops: Current progress and challenges
Authors: Tiedge Kira , Muchlinski Andrew , Zerbe Philipp
Published: June 2020

Plants produce a staggering diversity of specialized small molecule metabolites that play vital roles in mediating environmental interactions and stress adaptation. This chemical diversity derives from dynamic biosynthetic pathway networks that are often species-specific and operate under tight spatiotemporal and environmental control. A growing divide between demand and environmental challenges in food and bioenergy crop production have intensified research on these complex metabolite networks and their contribution to crop fitness. High-throughput omics technologies provide access to ever-increasing data resources for investigating plant metabolism. However, the efficiency of using such system-wide data to decode the gene and enzyme functions controlling specialized metabolism has remained limited; due largely to the recalcitrance of many plants to genetic approaches and the lack of ‘user-friendly’ biochemical tools for studying the diverse enzyme classes involved in specialized metabolism. With emphasis on terpenoid metabolism in the bioenergy crop switchgrass as an example, this review aims to illustrate current advances and challenges in the application of DNA synthesis and synthetic biology tools for accelerating the functional discovery of genes, enzymes and pathways in plant specialized metabolism. These technologies have accelerated knowledge development on the biosynthesis and physiological roles of diverse metabolite networks across many ecologically and economically important plant species and can provide resources for application to precision breeding and natural product metabolic engineering.
Speciation patterns in theForficula auriculariaspecies complex: cryptic and not so cryptic taxa across the western Palaearctic region
Authors: González-Miguéns Rubén , Muñoz-Nozal Eva , Jiménez-Ruiz Yolanda , Mas-Peinado Paloma , Ghanavi Hamid R , García-París Mario
Published: June 2020

Forficula auricularia (the European earwig) is possibly a complex of cryptic species. To test this hypothesis, we performed: (1) a phylogeographic study based on fragments of the mitochondrial COI and the nuclear ITS2 markers on a wide geographic sampling, (2) morphometric analyses of lineages present in Spain and (3) niche overlap analyses. We recovered five reciprocally monophyletic ancient phylogroups with unique historical patterns of distribution, climatic niches and diversification. External morphology was conserved and not correlated with speciation events, except in one case. Phylogenetic placement of the morphologically distinct taxon renders F. auricularia paraphyletic. Based on the congruence of the phylogenetic units defined by mtDNA and nuclear sequence data, we conclude that phylogroups have their own historical and future evolutionary trajectory and represent independent taxonomic units. Forficula auricularia is a complex of at least four species: the morphologically diagnosable Forficula aeolica González-Miguéns & García-París sp. nov., and the cryptic taxa: Forficula mediterranea González-Miguéns & García-París sp. nov., Forficula dentataFabricius, 1775stat. nov. and Forficula auriculariaLinnaeus, 1758s.s. We also provide new synonymy for F. dentata.
The Fusarium graminearum t-SNARE Sso2 Is Involved in Growth, Defense, and DON Accumulation and Virulence
Authors: O’Mara Sean P. , Broz Karen , Boenisch Marike , Zhong Zixuan , Dong Yanhong , Kistler H. Corby
Published: June 2020

The plant-pathogenic fungus Fusarium graminearum, causal agent of Fusarium head blight (FHB) disease on small grain cereals, produces toxic trichothecenes that require facilitated export for full virulence. Two potential modes of mycotoxin transport are membrane-bound transporters, which move toxins across cellular membranes, and N-ethylmaleimide-sensitive factor attachment receptor (SNARE)-mediated vesicular transport, by which toxins may be packaged as cargo in vesicles bound for organelles or the plasma membrane. In this study, we show that deletion of a gene (Sso2) for a subapically localized t-SNARE protein results in growth alteration, increased sensitivity to xenobiotics, altered gene expression profiles, and reduced deoxynivalenol (DON) accumulation in vitro and in planta as well as reduced FHB symptoms on wheat. A double deletion mutant generated by crossing the ∆sso2 deletion mutant with an ATP-binding cassette transporter deletion mutant (∆abc1) resulted in an additive reduction in DON accumulation and almost complete loss of FHB symptoms in planta. These results suggest an important role of Sso2-mediated subapical exocytosis in FHB progression and xenobiotic defense and are the first report of an additive reduction in F. graminearum DON accumulation upon deletion of two distinct modes of cellular export. This research provides useful information which may aid in formulating novel management plans of FHB or other destructive plant diseases.
Perioperative Interventions to Minimize Blood Loss at the Time of Hysterectomy for Uterine Leiomyomas: A Systematic Review and Meta-analysis
Authors: Gingold Julian A. , Chichura Anna , Harnegie Mary Pat , Kho Rosanne M.
Published: June 2020

(Abstracted from J Minim Invasive Gynecol 2019;26:1234–1252)

Almost 70% of white and more than 80% of black premenopausal women are affected by uterine leiomyomas. Medical or conservative procedures can manage many leiomyoma-related symptoms.
Computerized Analysis of Intrapartum Fetal Heart Rate Patterns and Adverse Outcomes in the INFANT Trial
Authors: Steer P. J. , Kovar I. , McKenzie C. , Griffin M. , Linsell L.
Published: June 2020

(Abstracted from BJOG 2019;126:1354–1361)

During the 1960s and 1970s, intermittent auscultation was replaced by the alternative method of continuous electronic fetal monitoring (EFM) and cardiotocography (electronic monitoring of the fetal heart rate [FHR] and uterine contractions, or CTG). Meta-analyses have reported a 59% drop in intrapartum deaths attributable to hypoxia and a reduced risk of neonatal seizures, but a 2017 Cochrane review concluded that while EFM did reduce the rates of neonatal seizures, it did not provide “clear differences in cerebral palsy, infant mortality, or other standard measures of neonatal well-being.” Human error in interpreting the FHR pattern is a possible explanation for the ineffectiveness of EFM.
Association of Early Postnatal Transfer and Birth Outside a Tertiary Hospital With Mortality and Severe Brain Injury in Extremely Preterm Infants: Observational Cohort Study With Propensity Score Matching
Authors: Helenius Kjell , Longford Nicholas , Lehtonen Liisa , Modi Neena , Gale Chris
Published: June 2020

(Abstracted from BMJ 2019;367:l5678)

Approximately 1 in 20 preterm infants in high-income countries are born at less than 28 weeks' gestation with increased risk of death and morbidity. Previous studies have shown improved outcomes when care is provided in tertiary hospitals as compared with nontertiary hospitals; this study aims to examine the rate of adverse outcomes for those preterm infants who underwent postnatal transfer to a tertiary facility in England.
Identifying Occult Maternal Malignancies From 1.93 Million Pregnant Women Undergoing Noninvasive Prenatal Screening Tests
Authors: Ji Xing , Li Jia , Huang Yonghua , Sung Pi-Lin , Yuan Yuying , Liu Qiang , Chen Yan , Ju Jia , Zhou Yafeng , Huang Shujia , Chen Fang , Han Yuan , Yuan Wen , Fan Cheng , Zhao Qiang , Wu Haitao , Feng Suihua , Liu Weiqiang , Li Zhihua , Chen Jingsi , Chen Min , Yao Hong , Zeng Li , Ma Tao , Fan Shushu , Zhang Jinman , Yuen Ka Yiu , Cheng So Hin , Shan Chik Irene Wing , Liu Nien-Tzu , Zhu Jianyu , Lin Siyuan , Cao Jeremy , Tong Steve , Shan Zhiyuan , Li Wenyan , Hekmat Mohammad Reza , Garshasbi Masoud , Suela Javier , Torres Yaima , Cigudosa Juan C. , Pérez Ruiz F. J. , Rodríguez Laura , García Mónica , Bernik Janez , Traven Eva , Reš Uršula , Tul Nataša , Tseng Ching-Fong , Zhao Depeng , Sun Luming , Pan Qiong , Shen Li , Dai Mengyao , Wang Yuying , Wang Jian , Yang Huanming , Yin Ye , Duan Tao , Zhu Baosheng , Choolani Mahesh , Jin Xin , Chen Yingwei , Mao Mao
Published: June 2020

(Abstracted from Genet Med 2019;21:2293–2302)

Noninvasive prenatal screening for aneuploidy using cell-free DNA (cfDNA) has been used since 2011 to identify fetal genetic disorders such as trisomies 13, 18, and 21. However, these tests can give false-positive results or fail all together when other conditions, such as maternal cancer, are present.
Prevalence of Survival Without Major Comorbidities Among Adults Born Prematurely
Authors: Crump Casey , Winkleby Marilyn A. , Sundquist Jan , Sundquist Kristina
Published: June 2020

(Abstracted from JAMA 2019;322(16):1580–1588)

More than 95% of preterm infants in developed countries now survive into adulthood. However, with a worldwide preterm birth rate of 10.6%, associated increased relative risks of cardiometabolic, respiratory, and neuropsychiatric disorders in adulthood prove concerning.
Postoperative Hypotension after Noncardiac Surgery and the Association with Myocardial Injury
Authors: Liem Victor G. B. , Hoeks Sanne E. , Mol Kristin H. J. M. , Potters Jan Willem , Grüne Frank , Stolker Robert Jan , van Lier Felix
Published: June 2020

Background

Intraoperative hypotension has been associated with postoperative morbidity and early mortality. Postoperative hypotension, however, has been less studied. This study examines postoperative hypotension, hypothesizing that both the degree of hypotension severity and longer durations would be associated with myocardial injury.

Methods

This single-center observational cohort was comprised of 1,710 patients aged 60 yr or more undergoing intermediate- to high-risk noncardiac surgery. Frequent sampling of hemodynamic monitoring on a postoperative high-dependency ward during the first 24 h after surgery was recorded. Multiple mean arterial pressure (MAP) absolute thresholds (50 to 75 mmHg) were used to define hypotension characterized by cumulative minutes, duration, area, and time-weighted-average under MAP. Zero time spent under a threshold was used as the reference group. The primary outcome was myocardial injury (a peak high-sensitive troponin T measurement 50 ng/l or greater) during the first 3 postoperative days.

Results

Postoperative hypotension was common, e.g., 2 cumulative hours below a threshold of 60 mmHg occurred in 144 (8%) patients while 4 h less than 75 mmHg occurred in 824 (48%) patients. Patients with myocardial injury had higher prolonged exposures for all characterizations. After adjusting for confounders, postoperative duration below a threshold of 75 mmHg for more than 635 min was associated with myocardial injury (adjusted odds ratio, 2.68; 95% CI, 1.46 to 5.07, P = 0.002). Comparing multiple thresholds, cumulative durations of 2 to 4 h below a MAP threshold of 60 mmHg (adjusted odds ratio, 3.26; 95% CI, 1.57 to 6.48, P = 0.001) and durations of more than 4 h less than 65 mmHg (adjusted odds ratio, 2.98; 95% CI, 1.78 to 4.98, P < 0.001) and 70 mmHg (adjusted odds ratio, 2.18; 95% CI, 1.37 to 3.51, P < 0.001) were also associated with myocardial injury. Associations remained significant after adjusting for intraoperative hypotension, which independently was not associated with myocardial injury.

Conclusions

In this study, postoperative hypotension was common and was independently associated with myocardial injury.

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Population-based Treatment Patterns and Outcomes for Stage III Non–Small Cell Lung Cancer Patients
Authors: Yusuf Dimas , Walton Ryan N. , Hurry Manjusha , Farrer Christie , Bebb D. Gwyn , Cheung Winson Y.
Published: June 2020

Background:

Most patients with stage III non–small cell lung cancer (NSCLC) develop metastases and succumb to their cancer. Approaches to the treatment of stage III disease can be highly variable. Understanding current treatment patterns can inform the optimal integration of emerging therapies. In this study, we describe contemporary treatment patterns and outcomes for a population-based cohort of stage III NSCLC patients from a large Canadian province.

Methods:

On the basis of the provincial cancer registry, all adult patients diagnosed with stage III NSCLC from April 1, 2010 to March 31, 2015 were identified. Analyses of these patients’ existing electronic medical records and administrative claims data were conducted to describe patient characteristics, treatment patterns, and survival outcomes.

Results:

In total, we screened 6438 patients diagnosed with NSCLC, of whom 1151 (17.9%) had stage III disease. Among them, 61.2% were stage IIIA, 36.4% were stage IIIB, and 2.4% were unspecified. Median age at diagnosis was 70 (22 to 94) years and 50.2% were men. In this cohort, a significant proportion of patients received only palliative radiotherapy (35.6%), palliative chemotherapy (8.8%), or best supportive care (24.8%) as initial treatment. Conversely, relatively few underwent concurrent chemoradiotherapy (11.7%) or trimodality therapy (1.7%). Surgery±adjuvant treatments were performed in 14.8% of stage III patients. Median overall survival was 13.2 months (95% confidence interval [CI], 12.2-14.0) among stage III patients. Patients who received initial curative treatment had statistically significant better survival compared with those who received noncurative treatment (P<0.001); median overall survival 29.8 months (95% CI, 22.3-34.6) and 8.9 months (95% CI, 7.6-11.6), respectively.

Conclusions

In a population-based setting that includes community, regional, and tertiary cancer centers, use of concurrent chemoradiotherapy and trimodality therapy in stage III NSCLC was low despite evidence supporting the potential benefits of these strategies.
Identifying and managing infectious disease syndemics in patients with HIV
Authors: Bromberg Daniel J. , Mayer Kenneth H. , Altice Frederick L.
Published: June 2020

Purpose of review

We will present recent articles focusing on HIV synergistic interactions with other sexually transmitted infections, tuberculosis, and hepatitis, as well as recent advances in the study of social and behavioral determinants that facilitate this clustering of infectious disease. For each synergistic interaction, we highlight evidence-based interventions that clinicians and policymakers should consider to tackle HIV and infectious disease syndemics.

Recent findings

Significant advances in understanding the behavioral and structural determinants of HIV and other infectious disease synergisms have been made in the past years. Intervention strategies based on these new models have also been developed. It is now well understood that treating infectious disease syndemics will require a multidisciplinary and multipronged approach.

HIV is synergistic with multiple other infectious diseases because the risk behaviors that lead to HIV acquisition may be similar to the other infections. The influence of HIV on the other infection may be due to immunosuppression associated with disease progression resulting in increased susceptibility (e.g., HIV and tuberculosis), especially when patients are not virologically suppressed using antiretroviral therapy. In reverse, another infectious disease may, when not treated, influence HIV disease progression. Social/structural determinants like homelessness, mass incarceration, and structural discrimination precipitate psychiatric comorbidity, substance use, and risky sex behavior which lead to the spread and co-occurrence of infectious disease.
Serum phosphorus levels are associated with carotid intima-media thickness in asymptomatic postmenopausal women
Authors: Kim Hyeongsoo , Kim Jeong Sook , Cho SiHyun , Kim Jong-Youn
Published: June 2020

Objective:

Serum phosphorous is a significant risk factor for increased carotid intima-media thickness. Increased thickness of the carotid intima is a known cause of cardiovascular disease. Coronary heart disease is a significant cause of mortality and morbidity in postmenopausal women. This study aimed to compare the relationship between serum phosphorous concentration and carotid intima-media thickness in healthy asymptomatic postmenopausal women.

Methods:

A retrospective review of the medical records from a health checkup center in Gangnam Severance hospital between March 2007 and September 2017 was conducted. We examined asymptomatic postmenopausal female patients with age range between 56 and 66 (N = 361) who underwent measurement of carotid intima-media thickness by B-mode ultrasonography. The physiological variables analyzed included mean blood pressure, body mass index, renal function (serum creatinine and estimated glomerular filtration rate), cholesterol levels (total cholesterol, triglyceride, and high- and low-density lipoprotein), serum phosphorous, calcium, electrolytes, diabetic status, hypertension, and albumin.

Results:

Pearson correlation test showed that carotid intima-media thickness was significantly associated with age (r = 0.192, P < 0.001), mean blood pressure (r = 0.116, P = 0.029), diastolic blood pressure (r = 0.146, P = 0.029), serum phosphorous (r = 0.134, P = 0.012), and lactate dehydrogenase (r = 0.106, P = 0.047). On the basis of age-adjusted multivariate linear regression analysis, carotid intima-media thickness was significantly correlated with serum phosphorous levels (β = 0.273, P = 0.022) in asymptomatic menopausal women. Increased carotid intima-media thickness (cut-off 1.5 mm) was detected, although serum phosphorous was within the normal range (2.8-4.5 mg/dL).

Conclusions:

Serum phosphorus concentration is significantly associated with carotid intima-media thickness in asymptomatic menopausal women.