bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigating the dependence of SCM simulated precipitation and clouds on the spatial scale of large‐scale forcing at SGP
Authors: Tang Shuaiqi , Zhang Minghua , Xie Shaocheng
Published: August 2017

Large‐scale forcing data, such as vertical velocity and advective tendencies, are required to drive single‐column models (SCMs), cloud‐resolving models, and large‐eddy simulations. Previous studies suggest that some errors of these model simulations could be attributed to the lack of spatial variability in the specified domain‐mean large‐scale forcing. This study investigates the spatial variability of the forcing and explores its impact on SCM simulated precipitation and clouds. A gridded large‐scale forcing data during the March 2000 Cloud Intensive Operational Period at the Atmospheric Radiation Measurement program's Southern Great Plains site is used for analysis and to drive the single‐column version of the Community Atmospheric Model Version 5 (SCAM5). When the gridded forcing data show large spatial variability, such as during a frontal passage, SCAM5 with the domain‐mean forcing is not able to capture the convective systems that are partly located in the domain or that only occupy part of the domain. This problem has been largely reduced by using the gridded forcing data, which allows running SCAM5 in each subcolumn and then averaging the results within the domain. This is because the subcolumns have a better chance to capture the timing of the frontal propagation and the small‐scale systems. Other potential uses of the gridded forcing data, such as understanding and testing scale‐aware parameterizations, are also discussed.
A spatiotemporal analysis of the relationship between near‐surface air temperature and satellite land surface temperatures using 17 years of data from the ATSR series
Authors: Good Elizabeth J. , Ghent Darren J. , Bulgin Claire E. , Remedios John J.
Published: August 2017

The relationship between satellite land surface temperature (LST) and ground‐based observations of 2 m air temperature (T2m) is characterized in space and time using >17 years of data. The analysis uses a new monthly LST climate data record (CDR) based on the Along‐Track Scanning Radiometer series, which has been produced within the European Space Agency GlobTemperature project (http://www.globtemperature.info/). Global LST‐T2m differences are analyzed with respect to location, land cover, vegetation fraction, and elevation, all of which are found to be important influencing factors. LSTnight (~10 P.M. local solar time, clear‐sky only) is found to be closely coupled with minimum T2m (Tmin, all‐sky) and the two temperatures generally consistent to within ±5°C (global median LSTnight‐Tmin = 1.8°C, interquartile range = 3.8°C). The LSTday (~10 A.M. local solar time, clear‐sky only)‐maximum T2m (Tmax, all‐sky) variability is higher (global median LSTday‐Tmax = −0.1°C, interquartile range = 8.1°C) because LST is strongly influenced by insolation and surface regime. Correlations for both temperature pairs are typically >0.9 outside of the tropics. The monthly global and regional anomaly time series of LST and T2m—which are completely independent data sets—compare remarkably well. The correlation between the data sets is 0.9 for the globe with 90% of the CDR anomalies falling within the T2m 95% confidence limits. The results presented in this study present a justification for increasing use of satellite LST data in climate and weather science, both as an independent variable, and to augment T2m data acquired at meteorological stations.
Evaluation of three temperature profiles of a sublayer scheme to simulate SST diurnal cycle in a global ocean general circulation model
Authors: Yang Xiaodan , Song Zhenya , Tseng Yu‐Heng , Qiao Fangli , Shu Qi
Published: August 2017

The diurnal cycle of sea surface temperature (SST) plays an important role in the upper ocean and climate system. One way to represents the diurnal variation of SST in Ocean General Circulation Models (OGCMs) with coarse vertical resolution is to parameterize the diurnal cycle of SST without considering detailed dynamic processes within the mixed layer. In this study, a diagnostic sublayer parameterization scheme following Schiller and Godfrey (2005) was incorporated into a global OGCM (NEMO), for the first time, to simulate the diurnal cycle of SST. Moreover, three different sublayer temperature profiles (constant, linear, and exponential) were evaluated. Comparison with satellite SST and mooring temperature data indicated that the parameterization scheme with an exponential temperature profile showed the most reasonable diurnal warming simulation results, significantly improving the probability of (from 1.7% with constant temperature profile to 13.4%) diurnal SST amplitude larger than 1.0°C. Furthermore, the mean biases in each season were all reduced to less than 0.16°C, in good agreement with observations.
Brexanolone as adjunctive therapy in super‐refractory status epilepticus
Authors: Rosenthal Eric S. , Claassen Jan , Wainwright Mark S. , Husain Aatif M. , Vaitkevicius Henrikas , Raines Shane , Hoffmann Ethan , Colquhoun Helen , Doherty James J. , Kanes Stephen J.
Published: August 2017

Objective

Super‐refractory status epilepticus (SRSE) is a life‐threatening form of status epilepticus that continues or recurs despite 24 hours or more of anesthetic treatment. We conducted a multicenter, phase 1/2 study in SRSE patients to evaluate the safety and tolerability of brexanolone (USAN; formerly SAGE‐547 Injection), a proprietary, aqueous formulation of the neuroactive steroid, allopregnanolone. Secondary objectives included pharmacokinetic assessment and open‐label evaluation of brexanolone response during and after anesthetic third‐line agent (TLA) weaning.

Methods

Patients receiving TLAs for SRSE control were eligible for open‐label, 1‐hour brexanolone loading infusions, followed by maintenance infusion. After 48 hours of brexanolone infusion, TLAs were weaned during brexanolone maintenance. After 4 days, the brexanolone dose was tapered. Safety and functional status were assessed over 3 weeks of follow‐up.

Results

Twenty‐five patients received open‐label study drug. No serious adverse events (SAEs) were attributable to study drug, as determined by the Safety Review Committee. Sixteen patients (64%) experienced ≥1 SAE. Six patient deaths occurred, all deemed related to underlying medical conditions. Twenty‐two patients underwent ≥1 TLA wean attempt. Seventeen (77%) met the response endpoint of weaning successfully off TLAs before tapering brexanolone. Sixteen (73%) were successfully weaned off TLAs within 5 days of initiating brexanolone infusion without anesthetic agent reinstatement in the following 24 hours.

Interpretation

In an open‐label cohort of limited size, brexanolone demonstrated tolerability among SRSE patients of heterogeneous etiologies and was associated with a high rate of successful TLA weaning. The results suggest the possible development of brexanolone as an adjunctive therapy for SRSE requiring pharmacological coma for seizure control. Ann Neurol 2017;82:342–352
Alkali Metal Cation Affinities of Anionic Main Group‐Element Hydrides Across the Periodic Table
Authors: Boughlala Zakaria , Fonseca Guerra Célia , Bickelhaupt F. Matthias
Published: August 2017

We have carried out an extensive exploration of gas‐phase alkali metal cation affinities (AMCA) of archetypal anionic bases across the periodic system using relativistic density functional theory at ZORA‐BP86/QZ4P//ZORA‐BP86/TZ2P. AMCA values of all bases were computed for the lithium, sodium, potassium, rubidium and cesium cations and compared with the corresponding proton affinities (PA). One purpose of this work is to provide an intrinsically consistent set of values of the 298 K AMCAs of all anionic (XHn‐1−) constituted by main group‐element hydrides of groups 14–17 along the periods 2–6. In particular, we wish to establish the trend in affinity for a cation as the latter varies from proton to, and along, the alkali cations. Our main purpose is to understand these trends in terms of the underlying bonding mechanism using Kohn–Sham molecular orbital theory together with a quantitative bond energy decomposition analyses (EDA).
Highly Active N,O Zinc Guanidine Catalysts for the Ring‐Opening Polymerization of Lactide
Authors: Schäfer Pascal M. , Fuchs Martin , Ohligschläger Andreas , Rittinghaus Ruth , McKeown Paul , Akin Enver , Schmidt Maximilian , Hoffmann Alexander , Liauw Marcel A. , Jones Matthew D. , Herres‐Pawlis Sonja
Published: August 2017

New zinc guanidine complexes with N,O donor functionalities were prepared, characterized by X‐Ray crystallography, and examined for their catalytic activity in the solvent‐free ring‐opening polymerization (ROP) of technical‐grade rac‐lactide at 150 °C. All complexes showed a high activity. The fastest complex [ZnCl2(DMEGasme)] (C1) produced colorless poly(lactide) (PLA) after 90 min with a conversion of 52 % and high molar masses (Mw=69 100, polydispersity=1.4). The complexes were tested with different monomer‐to‐initiator ratios to determine the rate constant kp. Furthermore, a polymerization with the most active complex C1 was monitored by in situ Raman spectroscopy. Overall, conversion of up to 90 % can be obtained. End‐group analysis was performed to clarify the mechanism. All four complexes combine robustness against impurities in the lactide with high polymerization rates, and they represent the fastest robust lactide ROP catalysts to date, opening new avenues to a sustainable ROP catalyst family for industrial use.
Oncostatin M causes liver fibrosis by regulating cooperation between hepatic stellate cells and macrophages in mice
Authors: Matsuda Michitaka , Tsurusaki Shinya , Miyata Naoko , Saijou Eiko , Okochi Hitoshi , Miyajima Atsushi , Tanaka Minoru
Published: August 2017

Fibrosis is an important wound‐healing process in injured tissues, but excessive fibrosis is often observed in patients with chronic inflammation. Although oncostatin M (OSM) has been reported to play crucial roles for recovery from acute liver injury by inducing tissue inhibitor of metalloproteinase 1 (Timp1) expression, the role of OSM in chronic liver injury (CLI) is yet to be elucidated. Here, we show that OSM exerts powerful fibrogenic activity by regulating macrophage activation during CLI. Genetic ablation of the OSM gene alleviated fibrosis in a mouse model of chronic hepatitis. Conversely, continuous expression of OSM in a normal mouse liver by hydrodynamic tail vein injection (HTVi) induced severe fibrosis without necrotic damage of hepatocytes, indicating that OSM is involved in the fundamental process of liver fibrosis (LF) after hepatitis. In a primary coculture of hepatic stellate cells (HSCs) and hepatic macrophages (HMs), OSM up‐regulated the expression of fibrogenic factors, such as transforming growth factor‐β and platelet‐derived growth factor in HMs, while inducing Timp1 expression in HSCs, suggesting the synergistic roles of OSM for collagen deposition in the liver. Fluorescence‐activated cell sorting analyses using OSM‐HTVi and OSM knockout mice have revealed that bone‐marrow–derived monocyte/macrophage are responsive to OSM for profibrotic activation. Furthermore, depletion or blocking of HMs by administration of clodronate liposome or chemokine inhibitor prevented OSM‐induced fibrosis. Conclusion: OSM plays a crucial role in LF by coordinating the phenotypic change of HMs and HSCs. Our data suggest that OSM is a promising therapeutic target for LF. (Hepatology 2018;67:296‐312).
Investigation of the continuous flow of the sample solution on the performance of electromembrane extraction: Comparison with conventional procedure
Authors: Nojavan Saeed , Sirani Mahsa , Asadi Sakine
Published: August 2017

In this study, electromembrane extraction from a flowing sample solution, termed as continuous‐flow electromembrane extraction, was developed and compared with conventional procedures for the determination of four basic drugs in real samples. Experimental parameters affecting the extraction efficiency were further studied and optimized. Under optimum conditions, linearity of continuous‐flow procedure was within 8.0–500 ng/mL, while it was wider for conventional procedures (2.0–500 ng/mL). Moreover, repeatability (percentage relative standard deviation) was found to range between 5.6 and 10.4% (n = 3) for the continuous‐flow procedure, with a better repeatability than that of conventional procedures (2.3–5.5% (n = 3)). Also, for the continuous‐flow procedure, the estimated detection limit (signal‐to‐noise ratio = 3) was less than 2.4 ng/mL and extraction recoveries were within 8–10%, while the corresponding figures for conventional procedures were less than 0.6 ng/mL and 42–60%, respectively. Thus, the results showed that both continuous flow and conventional procedures were applicable for the extraction of model compounds. However, the conventional procedure was more convenient to use, and thus it was applied to determine sample drugs in real urine and wastewater samples.
Fast analysis of quaternary ammonium pesticides in food and beverages using cation‐exchange chromatography coupled with isotope‐dilution high‐resolution mass spectrometry
Authors: Nardin Tiziana , Barnaba Chiara , Abballe Franco , Trenti Gianmaria , Malacarne Mario , Larcher Roberto
Published: August 2017

A fast separation based on cation‐exchange liquid chromatography coupled with high‐resolution mass spectrometry is proposed for simultaneous determination of chlormequat, difenzoquat, diquat, mepiquat and paraquat in several food and beverage commodities. Solid samples were extracted using a mixture of water/methanol/formic acid (69.6:30:0.4, v/v/v), while liquid samples were ten times diluted with the same solution. Separation was carried out on an experimental length‐modified IonPac CS17 column (2 × 15 mm2) that allowed the use of formic acid and acetonitrile as mobile phase. Detection limits for food and beverage matrices were established at 1.5 μg/L for chlormequat, difenzoquat and mepiquat, and 3 μg/L for diquat and paraquat, while for drinking water a pre‐analytical sample concentration allowed detection limits of 9 and 20 ng/L, respectively. Precision, as repeatability (RSD%), ranged from 0.2 to 24%, with a median value of 6%, and trueness, as recovery, ranged from 64 to 118%, with a median value of 96%. The method developed was successfully applied to investigate the presence of herbicide residues in commercial commodities (mineral water, orange juice, beer, tea, green coffee bean, toasted coffee powder, cocoa bean, white corn flour, rice and sugar samples).
Associations of MMP-2 and MMP-9 gene polymorphism with ulinastatin efficacy in patients with severe acute pancreatitis
Authors: Zhen Guo-Dong , Zhao Lian-Bin , Wu Shan-Shan , Chen Ming-Yu , Li Zhen-He , Zhou Sheng-Zhi , Li Zhen-Fu
Published: August 2017

We aim to explore the associations between matrix metalloproteinase (MMP) MMP-2/MMP-9 gene polymorphism with ulinastatin (UTI) efficacy in treating severe acute pancreatitis (SAP). A total of 276 SAP patients were assigned into the control (n=135) and observation (n=141) groups. PCR-restriction fragment length polymorphism (PCR-RFLP) was used for genotype and allele frequency distribution. Relevance of MMP-2/MMP-9 genotypes with UTI efficacy was analyzed. The observation group showed lowered duration in symptoms (abdominal distension, abdominal pain, tenderness, and rebound tenderness) than the control group. Laboratory analysis (serum calcium, white blood cells, serum amylase, urine amylase, APACHE-II, and Balthazar CTIS scores) were decreased, while serum albumin levels increased after 7th day of therapy. The total effective rate of UTI for patients with MMP-2 C-1306T C/C genotype was higher than those with C/T and T/T genotypes after the 7th day of therapy, which was lower in patients with MMP-9 C-1562T C/C and C/T genotypes than those with T/T genotype. The duration for symptoms in patients with MMP-9 C-1562T T/T genotype was shorter than those with C/C and C/T genotypes, which was less in patients with MMP-2 C-1306T C/C genotype than those with C/T and T/T genotypes. The improvement values of APACHE-II and Balthazar CTIS scores for patients with MMP-2 C-1306T C/C genotype were higher than those with C/T and T/T genotypes, which for patients with MMP-9 C-1562T C/C and C/T genotypes were lower than those with T/T genotype. These results demonstrated that MMP-2/MMP-9 gene polymorphism was associated with UTI efficacy for SAP.
Mitochondrial health maintenance in axons
Authors: Harbauer Angelika B.
Published: August 2017

Neurons are post-mitotic cells that must function throughout the life of an organism. The high energetic requirements and Ca2+ spikes of synaptic transmission place a burden on neuronal mitochondria. The removal of older mitochondria and the replenishment of the functional mitochondrial pool in axons with freshly synthesized components are therefore important parts of neuronal maintenance. Although the mechanism of mitochondrial protein import and dynamics is studied in great detail, the length of neurons poses additional challenges to those processes. In this mini-review, I briefly cover the basics of mitochondrial biogenesis and proceed to explain the interdependence of mitochondrial transport and mitochondrial health. I then extrapolate recent findings in yeast and mammalian cultured cells to neurons, making a case for axonal translation as a contributor to mitochondrial biogenesis in neurons.
Aspirin-triggered resolvin D1 reduces pneumococcal lung infection and inflammation in a viral and bacterial coinfection pneumonia model
Authors: Wang Hao , Anthony Desiree , Yatmaz Selcuk , Wijburg Odilia , Satzke Catherine , Levy Bruce , Vlahos Ross , Bozinovski Steven
Published: August 2017

Formyl peptide receptor 2/lipoxin A4 (LXA4) receptor (Fpr2/ALX) co-ordinates the transition from inflammation to resolution during acute infection by binding to distinct ligands including serum amyloid A (SAA) and Resolvin D1 (RvD1). Here, we evaluated the proresolving actions of aspirin-triggered RvD1 (AT-RvD1) in an acute coinfection pneumonia model. Coinfection with Streptococcus pneumoniae and influenza A virus (IAV) markedly increased pneumococcal lung load and neutrophilic inflammation during the resolution phase. Fpr2/ALX transcript levels were increased in the lungs of coinfected mice, and immunohistochemistry identified prominent Fpr2/ALX immunoreactivity in bronchial epithelial cells and macrophages. Levels of circulating and lung SAA were also highly increased in coinfected mice. Therapeutic treatment with exogenous AT-RvD1 during the acute phase of infection (day 4–6 post-pneumococcal inoculation) significantly reduced the pneumococcal load. AT-RvD1 also significantly reduced neutrophil elastase (NE) activity and restored total antimicrobial activity in bronchoalveolar lavage (BAL) fluid (BALF) of coinfected mice. Pneumonia severity, as measured by quantitating parenchymal inflammation or alveolitis was significantly reduced with AT-RvD1 treatment, which also reduced the number of infiltrating lung neutrophils and monocytes/macrophages as assessed by flow cytometry. The reduction in distal lung inflammation in AT-RvD1-treated mice was not associated with a significant reduction in inflammatory and chemokine mediators. In summary, we demonstrate that in the coinfection setting, SAA levels were persistently increased and exogenous AT-RvD1 facilitated more rapid clearance of pneumococci in the lungs, while concurrently reducing the severity of pneumonia by limiting excessive leukocyte chemotaxis from the infected bronchioles to distal areas of the lungs.
Epoxy thermoset resins with high pristine thermal conductivity
Authors: Lin Ying , Huang Xingyi , Chen Jin , Jiang Pingkai
Published: August 2017

Heat dissipation becomes a critical problem because of the miniaturisation and the increase of power density in electronic devices and electric equipment, which calls for electrical insulating materials with high thermal management capability. Epoxy thermosets have been widely used as electrical insulating materials, but suffer from their low thermal conductivity. This study reviewed the research progress on the development of epoxy thermosets with high pristine thermal conductivity. First, the thermal conduction mechanism of polymers was briefly introduced. Second, the approaches used to enhance the thermal conductivity of epoxy thermosets were summarised, which mainly dealt with the formation of microscopically anisotropic but macroscopically isotropic structure in the epoxy thermosets. Third, the applications of high thermal conductivity epoxy thermoset resins were reviewed. Finally, the review provided the existing challenges and the future directions for the development of epoxy thermosets with high pristine thermal conductivity.
Optimisation of gate‐commutated thyristors for hybrid DC breakers
Authors: Lyu Gang , Yu Zhanqing , Zeng Rong , Liu Jiapeng , Zhang Xueqiang , Long Teng , Palmer Patrick
Published: August 2017

Hybrid DC breakers (HCBs) are crucial components in modern DC systems. Integrated gate‐commutated thyristors (IGCTs) are widely used in high‐voltage HCBs due to their controllable turn‐off capabilities under high‐power conditions. The focus of this study is on the optimisation of gate‐commutated thyristors (GCTs) for HCB applications, including operation temperature and design parameters. The considerations of GCT design and operating conditions for the use in HCBs are discussed. Under those considerations, a 2D finite element model of GCT is developed to investigate the influence of the GCT design parameters on the maximum controllable current (MCC) and the safe operation area (SOA). Impedance unevenly distributed along the full wafer has been calculated to obtain accurate simulation results. Results show that the P+‐base, lifetime, and the distance between cathode and gate metallisation can all affect the MCC. In addition, GCTs can provide a higher MCC by operating at a higher temperature.
A study of problems encountered in Granger causality analysis from a neuroscience perspective
Authors: Stokes Patrick A. , Purdon Patrick L.
Published: August 2017

Significance

Granger causality analysis is a statistical method for investigating the flow of information between time series. Granger causality has become more widely applied in neuroscience, due to its ability to characterize oscillatory and multivariate data. However, there are ongoing concerns regarding its applicability in neuroscience. When are these methods appropriate? How reliably do they recover the functional structure of the system? Also, what do they tell us about oscillations in neural systems? In this paper, we analyze fundamental properties of Granger causality and illustrate statistical and conceptual problems that make Granger causality difficult to apply and interpret in neuroscience studies. This work provides important conceptual clarification of Granger causality methods and suggests ways to improve analyses of neuroscience data in the future.
Segment convolutional neural networks (Seg-CNNs) for classifying relations in clinical notes
Authors: Luo Yuan , Cheng Yu , Uzuner Özlem , Szolovits Peter , Starren Justin
Published: August 2017

We propose Segment Convolutional Neural Networks (Seg-CNNs) for classifying relations from clinical notes. Seg-CNNs use only word-embedding features without manual feature engineering. Unlike typical CNN models, relations between 2 concepts are identified by simultaneously learning separate representations for text segments in a sentence: preceding, concept1, middle, concept2, and succeeding. We evaluate Seg-CNN on the i2b2/VA relation classification challenge dataset. We show that Seg-CNN achieves a state-of-the-art micro-average F-measure of 0.742 for overall evaluation, 0.686 for classifying medical problem–treatment relations, 0.820 for medical problem–test relations, and 0.702 for medical problem–medical problem relations. We demonstrate the benefits of learning segment-level representations. We show that medical domain word embeddings help improve relation classification. Seg-CNNs can be trained quickly for the i2b2/VA dataset on a graphics processing unit (GPU) platform. These results support the use of CNNs computed over segments of text for classifying medical relations, as they show state-of-the-art performance while requiring no manual feature engineering.
Intraoperative Spinal Navigation for the Removal of Intradural Tumors: Technical Notes
Authors: Stefini Roberto , Peron Stefano , Mandelli Jaime , Bianchini Elena , Roccucci Paolo
Published: August 2017

BACKGROUND

In recent years, spinal surgery has incorporated the many advantages of navigation techniques to facilitate the placement of pedicle screws during osteosynthesis, mainly for degenerative diseases. However, spinal intradural tumors are not clearly visible by intraoperative fluoroscopy or computed tomography scans, thereby making navigation necessary.

OBJECTIVE

To evaluate the use of spinal navigation for the removal of intradural and spinal cord tumors using spinal magnetic resonance imaging (MRI) merged with intraoperative 3-dimensional (3-D) fluoro images.

METHODS

After fixing the patient reference frame on the spinous process, the 3-D fluoro images were obtained in the surgical room. Using this image as the reference, the preoperative volumetric MRI images and intraoperative 3-D fluoro images were merged using automated software or manually.

RESULTS

From January to July 2016, we performed 10 navigated procedures for intradural spinal tumors by merging MRI and 3-D fluoro images. Nine patients had an intradural extramedullary tumor, 6 had neurinomas, and 3 had meningiomas; 1 patient had an intramedullary spinal cord metastasis.

CONCLUSION

The surgically demonstrated benefits of spinal navigation for the removal of intradural tumors include the decreased risk of surgery at the wrong spinal level, a minimal length of skin incision and muscle strip, and a reduction in bone removal extension. Furthermore, this technique offers the advantage of opening the dura as much as is necessary and, in the case of intrinsic spinal cord tumors, it allows the tumor to be centered. Otherwise, this would not be visible, thus enabling the precise level and the posterior midline sulcus to be determined when performing a mielotomy.
Infertility
Authors: Cunningham Jill
Published: August 2017

Infertility is a potentially life-changing diagnosis for couples who are trying to conceive. A diagnosis of infertility and the associated management plan can lead to psychological stress, anxiety, and depression for one or both partners. Infertility affects 6% of married women of reproductive age in the United States. Once a couple is determined to be infertile, prompt referral to a specialist is indicated. Treatment varies according to the cause and may include medication, surgical intervention, or assisted reproductive technology.
To Improve Substance Use Disorder Prevention, Treatment and Recovery: Engage the Family
Authors: Ventura Alicia S. , Bagley Sarah M.
Published: August 2017

Approximately 21 million people in the United States have a substance use disorder (SUD); the number of family members impacted by a loved one's SUD is exponentially greater. Affected family members of individuals with SUDs are at high risk for developing chronic medical and psychiatric health conditions, are high utilizers of the health care system, and have high health care expenditures. Family members play a central role in the lives of many individuals with SUDs; information given to family members can have a significant impact on persons with addiction and therefore the SUD treatment that an individual might receive. Evidence-based interventions targeting affected family members have been shown to: improve health outcomes for all family members, result in better addiction treatment outcomes, and prevent adolescent substance use. Despite mounting evidence, the health care system has been hesitant to engage families in a meaningful way. Health care providers should consider how implicit and explicit assumptions about the role of family members in SUD development, treatment, and recovery may contribute to this underlying reluctance. Antiquated policies and procedures that alienate family members should be modified (e.g., limiting phone access). Family members have a right to receive professional treatment and to be educated about the difference between mutual/peer support and evidence-based treatment options. Despite the potential for family members to move the needle on the country's current addiction crisis they remain an underutilized resource. A paradigm shift will be required to get the current SUD care continuum to adopt a family-centric model.
Exploring Hearing Aid Problems: Perspectives of Hearing Aid Owners and Clinicians
Authors: Bennett Rebecca J. , Laplante-Lévesque Ariane , Meyer Carly J. , Eikelboom Robert H.
Published: August 2017

Objectives:

To gather perspectives of hearing aid owners and hearing healthcare clinicians with regard to problems that arise after hearing aid fitting and use these perspectives to generate a conceptual framework to gain a better understanding of these problems.

Design:

Participants included a group of 17 hearing aid owners and a group of 21 hearing healthcare clinicians; data collection occurred separately for each group. Participants each attended two group sessions in Perth, Western Australia, wherein they: (1) generated statements describing the problems associated with hearing aids and (2) grouped and rated the statements to identify key themes. Concept mapping was used to generate a conceptual framework.

Results:

Participants identified four concepts regarding hearing aid problems as follows: (1) hearing aid management; (2) hearing aid sound quality and performance; (3) feelings, thoughts, and behaviors; and (4) information and training. While hearing aid owners and clinicians generated similar results regarding the concepts derived, the clinicians reported that the problems identified had a greater negative impact on hearing aid success than did hearing aid owners.

Conclusions:

The magnitude and diversity of hearing aid problems identified in this study highlight the ongoing challenges that hearing aid owners face and suggest that current processes for hearing aid fitting can be improved. Problems relating to hearing aid management were most often deemed to have the greatest impact on hearing aid success and be the most preventable/solvable, and thus are a good starting point when addressing hearing aid–related problems.
Use of a Defined Surgical Approach for the Debridement of Open Tibia Fractures
Authors: Marecek Geoffrey S. , Nicholson Luke T. , Auran Richard T. , Lee Jackson
Published: August 2017

Objectives:

To determine whether a defined approach for debridement of open tibia fractures would result in no change in reoperation rate, but reduce the need for flap coverage.

Design:

Prospective cohort study.

Setting:

Academic Level 1 trauma center.

Patients:

A total of 66 patients with 68 open diaphyseal tibia fractures were included. Patients under the age of 18 and with orthopaedic trauma association open fracture classification (OTA-OFC) skin score of 3 were excluded.

Intervention:

Debridement of the open fracture through direct extension of the traumatic wound or through a defined surgical interval.

Main Outcome Measurements:

Number of operations. Need for soft-tissue transfer.

Results:

A total of 47 patients had direct extension of the traumatic wound and 21 patients had a defined surgical approach. The groups had similar proportions of Gustilo–Anderson and OTA-OFC subtypes. The average number of surgeries, including index procedure, per patient was 1.96 in the direct extension group and 1.29 in the defined approach group (P = 0.026). Flap coverage was needed in 9 patients in the direct extension group and no patients in the defined approach group (P = 0.048).

Conclusions:

A defined surgical approach to the debridement of open tibia fractures is safe and may reduce the need for flap coverage in select patients.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Long-Term Survival in Adult Patients With Severe Acute Lung Failure Receiving Veno-Venous Extracorporeal Membrane Oxygenation
Authors: Enger Tone Bull , Philipp Alois , Lubnow Matthias , Fischer Marcus , Camboni Daniele , Lunz Dirk , Bein Thomas , Müller Thomas
Published: August 2017

Objectives:

To assess long-term survival in adult patients with severe acute lung failure receiving veno-venous extracorporeal membrane oxygenation and explore risk factors for long-term mortality.

Design:

Single-center prospective cohort study.

Setting:

University Hospital Regensburg, Germany.

Patients:

All primary cases supported with veno-venous extracorporeal membrane oxygenation from 2007 to 2016 (n = 553).

Interventions:

None.

Measurements and Main Results:

Patients were followed until January 2017. Long-term survival and predictors of long-term mortality were assessed using Kaplan-Meier survival analyses and Cox proportional hazards modeling, respectively. Two hundred eighty-six patients (52%) died during follow-up (mean follow-up 4.8 yr). Two hundred seventeen patients (39%) died during hospitalization, whereas another 69 patients (12%) died during later follow-up. Among hospital survivors, the 1-month, 3-month, 1-year, and 5-year survival rates were 99%, 95%, 86%, and 76%, respectively. Higher age, immunocompromised status, and higher Sequential Organ Failure Assessment scores were associated with long-term mortality, whereas patients with out-of-center cannulation showed improved long-term survival. Due to nonproportional hazards over time, the analysis was repeated for hospital survivors only (n = 336). Only age and immunocompromised state remained significant predictors of late mortality among hospital survivors. Lower Glasgow Outcome Scale at hospital discharge and the University Hospital Regensburg pre–extracorporeal membrane oxygenation score for predicting hospital mortality in veno-venous extracorporeal membrane oxygenation patients before extracorporeal membrane oxygenation initiation were associated with late mortality in hospital survivors (p < 0.001).

Conclusions:

Whereas acute illness factors may be important in prediction of hospital outcomes in veno-venous extracorporeal membrane oxygenation patients, they do not determine late mortality in hospital survivors. Preexisting morbidity and functional ability at hospital discharge may be important determinants of long-term survival in veno-venous extracorporeal membrane oxygenation patients.
Novel therapeutic agents in the management of brain metastases
Authors: Venur Vyshak A. , Ahluwalia Manmeet S.
Published: August 2017

Purpose of review

This review aims to highlight the novel therapeutic agents in the management of brain metastases which are in various stages of clinical development. We review the results from recent clinical trials, publications and presentations at recent national and international conferences.

Recent findings

Several new systemic treatment options for brain metastases are in early or advanced clinical trials. These drugs have good intracranial and extracranial activities. As lung cancer, breast cancer, and melanoma are the three most common causes of brain metastases, most agents in clinical development are focused on these tumor types. Several of these therapies are small molecule tyrosine kinase inhibitors or monoclonal antibodies against the tyrosine kinase receptors. Another exciting development in brain metastases management is the use of immunotherapy agents. The anti-CTLA-4 and\or anti-PD-1 antibodies have shown promising intracranial activity in melanoma and nonsmall cell lung cancer patients with brain metastases.

Contemporary clinical trials have shown encouraging intracranial activity of newer tyrosine kinase inhibitors, monoclonal antibodies against tyrosine kinase receptors and immunotherapy agents in select group of patients with brain metastases. Further studies are needed to develop therapeutic strategies, in order to improve survival in patients with brain metastases.
Acalculous Cholecystitis in a Pediatric Patient With Plasmodium Falciparum Infection: A Case Report and Literature Review
Authors: Aguilera-Alonso David , López Medina Eva María , Del Rosal Teresa , Villota Arrieta Julián , Escosa-García Luis , García-Hortelano Milagros
Published: August 2017

Malaria has been associated with acute acalculous cholecystitis, a very uncommon complication in children. We present a 5-year-old girl, originally from Equatorial-Guinea, diagnosed with severe malaria with acute kidney injury, thrombocytopenia and acute acalculous cholecystitis. She was treated with intravenous quinine and clindamycin, plus cefotaxime and metronidazole with a full resolution without surgery.
Metabolic Abnormalities and Clinical Lipodystrophy in Children With Human Immunodeficiency Virus Infection
Authors: Kumar Prasanna , Suri Deepti , Vignesh Pandiarajan , Verma Attri Savita , Kumar Bhalla Anil , Singh Surjit
Published: August 2017

A cross-sectional study from a tertiary care center in India was undertaken to assess and compare the prevalence of blood glucose and lipid profile aberrations in children who received first-line antiretroviral therapy (ART; n = 63) and in children who were naïve to ART (n = 46). Impaired fasting blood glucose values were found in 7 children in ART-experienced group but none in ART-naïve group (P = 0.02). Low concentrations of high-density lipoprotein cholesterol were more prevalent in the ART-naïve group compared with ART-experienced group (54.3% vs. 22.2%; P = 0.001). Hypertriglyceridemia was noted in a significant proportion of both ART-naïve (43.5%) and ART-experienced children (39.7%). Incidence of clinical lipodystrophy was 47.7%, and there was no significant association noted between lipid profile abnormalities and lipodystrophy.
Efficacy of Pharmacologic Therapy for Eosinophilic Esophagitis
Authors: Tomizawa Yutaka , Melek John , Komaki Yuga , Kavitt Robert T. , Sakuraba Atsushi
Published: August 2017

Goals:

In order to provide a comparative evaluation of available pharmacologic treatments for eosinophilic esophagitis (EoE), we conducted a network meta-analysis.

Background:

A variety of pharmacologic treatments for EoE have been reported, however there exists a paucity of direct comparisons.

Study:

We searched randomized controlled trials using MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials database through December 2014. Studies were analyzed using a random-effects network meta-analysis to identify the most effective therapy. Subgroup analysis was performed among studies that excluded gastroesophageal reflux disease or proton-pump inhibitor responsive esophageal eosinophilia, and also among pediatric and adult populations. The ranking probability for the efficacy of each treatment was analyzed. Consistency of the included randomized controlled trials was checked by applying inconsistency and node-splitting models.

Results:

Eleven studies of a total of 456 patients were identified. Six pharmacologic treatments (budesonide suspension and viscous, fluticasone, prednisone, esomeprazole, and mepolizumab) and placebo were included in our analysis. Meta-analysis showed superiority of budesonide viscous, budesonide suspension, and fluticasone over placebo. Network meta-analysis demonstrated the rank order of efficacy as budesonide viscous, esomeprazole, prednisone, budesonide suspension, fluticasone, mepolizumab, and placebo. The results were consistent from the inconsistency model analysis and node-splitting analysis. Subgroup analysis demonstrated prednisone, budesonide suspension, and esomeprazole were the most effective when network meta-analyses were performed among studies that excluded gastroesophageal reflux disease or proton-pump inhibitor responsive esophageal eosinophilia, and among pediatric and adult populations, respectively.

Conclusions:

On the basis of this network meta-analysis, viscous budesonide was shown to be the most effective pharmacologic therapy for EoE among the reported pharmacologic treatments.
Irritable Bowel Syndrome on the US Mexico Border
Authors: Zuckerman Marc J. , Schmulson Max J. , Bashashati Mohammad , Jia Yi , Dwivedi Alok , Ortiz Melchor , Casner Nancy , Byrd Theresa , Shokar Navkiran
Published: August 2017

Goals:

To investigate the prevalence of irritable bowel syndrome (IBS), and its association with health perception and health care–seeking behavior in this Mexican American population.

Background:

The prevalence of IBS ranges from 3% to 20.4% in the United States and 4.4% to 16% in Mexico, based on Rome III and II criteria. However, its epidemiological profile in the US Mexico border is unknown.

Study:

We conducted a survey in a randomly selected indigent population (N=521) recruited into a colon cancer screening program (ACCION). The prevalence of IBS was estimated and a multivariable logistic regression was carried out to determine the associated risk factors. Results are summarized using odds ratio and 95% confidence interval (CI).

Results:

A total of 464 (89%) completed the survey (mean age, 56.7 y; female, 74.8%). Country of birth was Mexico in 90.5% and the United States in 8.2% and acculturation was more Spanish (94.8%) than English (5.2%). Overall, 5.6% (95% CI, 3.7-8.1) fulfilled criteria for IBS with a predominance among women (6.9%) versus men (1.7%) (P=0.03). On the basis of multivariable analysis, lower number of bowel movements/week (odds ratio, 0.89; 95% CI, 0.80-1.00), having a primary care physician: 4.09 (1.51-11.12), using herbal treatments: 2.76 (1.08-7.06) and a previous IBS diagnosis: 23.11 (3.44-155.45), were significantly associated with the presence of IBS.

Conclusions:

The prevalence of IBS on the US Mexico border is comparable with data obtained from studies in both countries. Consulting a primary care physician as an associated factor may reveal the high rate of health-care seeking in IBS patients, while herbal treatments may reflect a cultural influence.
Computed Tomography Features Predictive of Lymph Node Involvement in Patients With a Nonfunctioning Pancreatic Neuroendocrine Tumor
Authors: Choi Sang Hyun , Kim Hyoung Jung , Kim So Yeon , Byun Jae Ho , Kim Kyung Won , Song Ki Byung , Kim Song Cheol , Kim Myung-Hwan
Published: August 2017

Objectives

This study aims to identify the computed tomography (CT) features that may differentiate nonfunctioning pancreatic neuroendocrine tumors (NF-PanNETs) with lymph node (LN) metastasis from NF-PanNETs without lymph node metastasis.

Methods

We retrospectively analyzed 166 NF-PanNETs in 166 patients who had undergone surgical resection (median age, 53). Two radiologists evaluated the qualitative and quantitative CT findings. Through univariate and multivariate logistic regression analyses, we determined independent significant findings for differentiating NF-PanNETs with LN metastasis from NF-PanNETs without LN metastasis. Recurrence-free survival (RFS) and overall survival (OS) were compared between the 2 groups using Kaplan-Meier analysis and log-rank testing.

Results

Of the 166 NF-PanNETs, 24 (14.5%) tumors demonstrated LN metastasis. Three CT findings, radiologic LN enlargement (adjusted odds ratio [OR], 11.76; P = 0.001), liver metastasis (OR, 10.31; P = 0.027), and portal enhancement ratio of <1.238 (OR, 3.58; P = 0.033), were independently significant for differentiating NF-PanNETs with LN metastasis from NF-PanNETs without LN metastasis. Tumor size greater than 2 cm also showed a statistically marginal significance (OR, 8.47; P = 0.050). The median RFS and OS in NF-PanNETs with LN metastasis were significantly shorter than NF-PanNETs without LN metastasis (23.7 months vs 33.2 months, P < 0.001; 33.7 months vs 54.8 months, P < 0.001).

Conclusions

Four CT findings can be useful to differentiate NF-PanNETs with LN metastasis and NF-PanNETs without LN metastasis.
Thromboembolisms in Advanced Pancreatic Cancer
Authors: Ishigaki Kazunaga , Nakai Yousuke , Isayama Hiroyuki , Saito Kei , Hamada Tsuyoshi , Takahara Naminatsu , Mizuno Suguru , Mohri Dai , Kogure Hirofumi , Matsubara Saburo , Yamamoto Natsuyo , Tada Minoru , Koike Kazuhiko
Published: August 2017

Objectives

Pancreatic cancer is reported to be highly associated with thromboembolism (TE). The aim of this analysis is to clarify risk factors for TE and its clinical impact in Japanese patients with pancreatic cancer.

Methods

Data on consecutive pancreatic cancer patients receiving systemic chemotherapy between August 1999 and July 2015 were retrospectively studied. Both symptomatic and asymptomatic, arterial and venous TEs were included in the analysis. Risk factors for TE development were analyzed using a proportional hazards model with death without TE as a competing risk. The impact of TE on survival was also evaluated using a time-dependent covariate multiple Cox model.

Results

A total of 475 patients were included in the analysis, and 57 TEs (12%) were identified: 45 venous TEs and 12 arterial TEs. The median time to TE was 169 days and the median survival from TE was 65 days. Liver metastasis was the only significant risk factor for TE (subdistribution hazards ratio, 2.15; P = 0.01), and TE was significantly associated with poor prognosis (hazards ratio, 3.31; P < 0.01).

Conclusions

Thromboembolism was not uncommon in Japanese patients receiving chemotherapy for advanced pancreatic cancer and was associated with poor prognosis. Liver metastasis was the risk factor for TE.
Comparison of Clinical Data and Scores of Quality of Life, Anxiety, and Depression in Patients With Different Types of Intraductal Papillary Mucinous Neoplasms
Authors: Pezzilli Raffaele , Cucchetti Alessandro , Calculli Lucia
Published: August 2017

Objectives

This study aims to evaluate the well-being of patients with main duct intraductal papillary mucinous neoplasms (MD-IPMNs) or mixed type IPMNs (mixed-IPMNs) of the pancreas.

Methods

Twenty-two patients with MD/mixed-IPMNs of the pancreas were studied, and an equal number of patients having branch duct IPMNs (BD-IPMNs) were used as controls. The short form (SF) -12 Health Survey, State Trait Anxiety Inventory Y-1 and Y-2, General Health Questionnaire, and Beck Depression Inventory II were used to evaluate the quality of life once a year for 2 consecutive years.

Results

At basal evaluation, the SF-12 Health Survey questionnaire administered to the 44 patients showed that the values of the physical component and mental component scores were similar between the 2 groups of patients studied. The State Trait Anxiety Inventory Y-1 and Y-2, General Health Questionnaire, and Beck Depression Inventory II scores were also similar in the 2 groups at basal evaluation. No differences were found between MD/mixed-IPMNs and BD-IPMNs at the 1-year and the 2-year evaluations.

Conclusions

The well-being of patients with MD/mixed-IPMNs did not differ as compared with patients with BD-IPMNs.