bluuebunny/crossref_metadata_2025 huggingface dataset:
White dwarf and subdwarf stars in the Sloan Digital Sky Survey Data Release 14
Authors: Kepler S O , Pelisoli Ingrid , Koester Detlev , Reindl Nicole , Geier Stephan , Romero Alejandra D , Ourique Gustavo , Oliveira Cristiane de Paula , Amaral Larissa A
Published: April 2019

White dwarfs carry information on the structure and evolution of the Galaxy, especially through their luminosity function and initial-to-final mass relation. Very cool white dwarfs provide insight into the early ages of each population. Examining the spectra of all stars with 3σ proper motion in the Sloan Digital Sky Survey Data Release 14, we report the classification for 20 088 spectroscopically confirmed white dwarfs, plus 415 hot subdwarfs, and 311 cataclysmic variables. We obtain Teff, log  g, and mass for hydrogen atmosphere white dwarf stars (DAs), warm helium atmosphere white dwarfs (DBs), hot subdwarfs (sdBs and sdOs), and estimate photometric Teff for white dwarf stars with continuum spectra (DCs). We find 15 793 sdAs and 447 dCs between the white dwarf cooling sequence and the main sequence, especially below $T_\mathrm{eff}\simeq 10\, 000$ K; most are likely low-mass metal-poor main-sequence stars, but some could be the result of interacting binary evolution.
Inhomogeneous reionization models in cosmological hydrodynamical simulations
Authors: Oñorbe Jose , Davies F B , Lukić Z , Hennawi J F , Sorini D
Published: April 2019

In this work we present a new hybrid method to simulate the thermal effects of reionization in cosmological hydrodynamical simulations. The method improves upon the standard approach used in simulations of the intergalactic medium (IGM) and galaxy formation without a significant increase in the computational cost, thereby allowing for efficient exploration of the parameter space. The method uses a small set of phenomenological input parameters, and combines a seminumerical reionization model to solve for the topology of reionization with an approximate model of how reionization heats the IGM, using the massively parallel Nyx hydrodynamics code which is specifically designed to solve for the structure of diffuse IGM gas. We have produced several medium-scale, high-resolution simulations (20483, Lbox = 40 Mpc h−1) with various instantaneous and inhomogeneous ${\rm H \,{\small I}}$ reionization models that use this new methodology. We study the IGM thermal properties of these models and find that large-scale temperature fluctuations extend well beyond the end of reionization. By analysing the 1D flux power spectrum of these models, we find up to ${\sim } 50{{\ \rm per\ cent}}$ differences in the large-scale properties (low modes, k ≲ 0.01 s km−1) of the post-reionization power spectrum as a result of the thermal fluctuations. We show that these differences could allow one to distinguish between different reionization scenarios with existing Lyα forest measurements. Finally, we explore the differences in the small-scale cut-off of the power spectrum, finding that, for the same heat input, models show very good agreement provided that the reionization redshift of the instantaneous reionization model occurs at the midpoint of the inhomogeneous model.
TESS observations of the asynchronous polar CD Ind: mapping the changing accretion geometry
Authors: Hakala Pasi , Ramsay Gavin , Potter Stephen B , Beardmore Andrew , Buckley David A H , Wynn Graham
Published: April 2019

We present the results of near continuous TESS optical observations of the asynchronous polar CD Ind (RX J2115−5840). The 27.9 d long light curve, with 2 min resolution, reveals remarkable changes in the magnetic accretion geometry of the system over the 7.3 d beat period. We have modelled the changes in the optical spin period pulse shape using a cyclotron emission mapping technique. The resulting cyclotron emission maps of the magnetic white dwarf reveal how the accretion geometry changes from single- to two-pole accretion and back over the beat cycle. Finally, we present the results from particle-based numerical magnetic accretion simulations, which agree with our interpretation of the changing accretion scenario.
Active galactic nucleus selection in the AKARI NEP-Deep field with the fuzzy support vector machine algorithm
Authors: Poliszczuk Artem , Solarz Aleksandra , Pollo Agnieszka , Bilicki Maciej , Takeuchi Tsutomu T , Matsuhara Hideo , Goto Tomotsugu , Takagi Toshinobu , Wada Takehiko , Ohyama Yoichi , Hanami Hitoshi , Miyaji Takamitsu , Oi Nagisa , Malkan Matthew , Murata Kazumi , Kim Helen , Tello Jorge Díaz ,   NEP Team
Published: April 2019

The aim of this work is to create a new catalog of reliable active galactic nucleus (AGN) candidates selected from the AKARI NEP-Deep field. Selection of the AGN candidates was done by applying a fuzzy support vector machine algorithm, which allows the incorporation of measurement uncertainties into the classification process. The training dataset was based on the spectroscopic data available for selected objects in the NEP-Deep and NEP-Wide fields. The generalization sample was based on the AKARI NEP-Deep field data, including objects without optical counterparts and making use of the infrared information only. A high quality catalog of 275 previously unclassified AGN candidates was prepared.
A Chandra and ALMA study of X-ray-irradiated gas in the central ∼100 pc of the Circinus galaxy
Authors: Kawamuro Taiki , Izumi Takuma , Imanishi Masatoshi
Published: April 2019

We report on a study of X-ray-irradiated gas in the central ∼100 pc of the Circinus galaxy, which hosts a Compton-thick active galactic nucleus (AGN), at 10 pc resolution using Chandra and ALMA. Based on ∼200 ks Chandra/ACIS-S data, we created an image of the Fe Kα line at 6.4 keV, tracing X-ray-irradiated dense gas. The ALMA data in Bands 6 (∼270 GHz) and 7 (∼350 GHz) cover five molecular lines: CO(J = 3–2), HCN(J = 3–2), HCN(J = 4–3), HCO+(J = 3–2), and HCO+(J = 4–3). The detailed spatial distribution of dense molecular gas was revealed, and compared to the iron line image. The molecular gas emission appeared faint in regions with bright iron emission. Motivated by this, we quantitatively discuss the possibility that the molecular gas is efficiently dissociated by AGN X-ray irradiation (i.e., creating an X-ray-dominated region). Based on a non-local thermodynamic equilibrium model, we constrained the molecular gas densities and found that they are as low as interpreted by X-ray dissociation. Furthermore, judging from inactive star formation reported in the literature, we suggest that the X-ray emission has the potential to suppress star formation, particularly in the proximity of the AGN.
CAR-BOREN SURVEY ON AMBIENT DOSE RATE DURING 2011–13 IN GUNMA PREFECTURE
Authors: Sugino Masato
Published: April 2019

A car-borne survey of air dose rate measurements was performed yearly from 2011 to 2013 to determine the levels of environmental radiation in Gunma prefecture after the Fukushima Daiichi Nuclear Power Plant accident in 2011. The results revealed that the average ambient doses in each year were 85.3 ± 34.1 nGy/h in 2011, 60.3 ± 19.9 nGy/h in 2012, and 43.5 ± 15.1 nGy/h in 2013. The ambient dose rate in 2011, which was about three times higher than the average of 27.0 ± 7.1 nGy/h in 1998, was still in safety level considering the public health, and the ambient dose rate subsequently decreased in 2013 to approximately half the 2011 level. A contour map of the ambient dose rate showed relatively higher levels in the northern and western parts of the prefecture, with relatively lower levels toward the eastern and southern parts.
Ecology and Epidemiology of Diseases of Nut Crops and Olives Caused by Botryosphaeriaceae Fungi in California and Spain
Authors: Moral Juan , Morgan David , Trapero Antonio , Michailides Themis J.
Published: April 2019

In recent decades, the cultivated area and production of nuts and olives have increased, driven by an increasing consumer interest in healthier food. Diseases of almond, pistachio, olive, and walnut crops caused by species belonging to the Botryosphaeriaceae family have caused concern worldwide. Although considerable progress has been made in elucidating the etiology of these diseases, scientific knowledge of other aspects of these diseases is more limited. In this article, we present an overview of the most important diseases caused by Botryosphaeriaceae fungi affecting almond, pistachio, olive, and walnut crops by focusing on ecology and epidemiology, primarily in California and Spain.
A Timely Problem: Parental Leave During Medical Training
Authors: Webb Allison M.B. , Hasty Brittany N. , Andolsek Kathryn M. , Mechaber Hilit F. , Harris Toi Blakley , Chatterjee Archana , Lautenberger Diana M. , Gottlieb Amy S.
Published: April 2019

Shifting demographics and concerns about burnout prevention merit a reexamination of existing structures and policies related to leaves of absence that may be necessary during medical training. In this Invited Commentary, the authors address the issue of parental leave for medical students and residents. Discussion about parental leave for these trainees is not new. Despite decades of dialogue, leave policies throughout the undergraduate and graduate medical education continuum lack standardization and are currently ill defined and inadequate. There are a number of barriers to implementation. These include stigma, financial concerns, workforce and duty hours challenges, and the historically rigid timeline for progression from one stage of medical training to the next. Potential solutions include parent-friendly curricular innovations, competency-based medical education, and provision of short-term disability insurance. Most important, adopting more flexible approaches to graduation requirements and specialty board examination eligibility must be addressed at the national level. The authors identify cultural and practical challenges to standardizing parental leave options across the medical education continuum and issue a call to action for implementing potential solutions.
Dynamic Cortical Connectivity during General Anesthesia in Healthy Volunteers
Authors: Li Duan , Vlisides Phillip E. , Kelz Max B. , Avidan Michael S. , Mashour George A. ,   for the ReCCognition Study Group
Published: April 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Recent studies of anesthetic-induced unconsciousness in healthy volunteers have focused on functional brain connectivity patterns, but the protocols rarely parallel the depth and duration of surgical anesthesia. Furthermore, it is unknown whether there is a single functional connectivity pattern that correlates with general anesthesia for the duration of prolonged anesthetic exposure.

Methods

The authors analyzed electroencephalographic data in 30 healthy participants who underwent induction of anesthesia with propofol followed by 3 h of isoflurane anesthesia at age-adjusted 1.3 minimum alveolar concentration. Functional connectivity was assessed by frequency-resolved weighted phase lag index between frontal and parietal channels and between prefrontal and frontal channels, which were classified into a discrete set of states through k-means cluster analysis. Temporal dynamics were evaluated by the occurrence rate and dwell time distribution for each state as well as the transition probabilities between states.

Results

Burst suppression was present, with mean suppression ratio reducing from 44.8 ± 32.3% to 14.0 ± 20.2% (mean ± SD) during isoflurane anesthesia (P < 0.001). Aside from burst suppression, eight connectivity states were classified by optimizing the reproducibility of clustering solutions, with each characterized by distinct properties. The temporal progression of dominant states revealed a successive shifting trajectory from the state associated with alpha frontal-parietal connectivity to those associated with delta and alpha prefrontal-frontal connectivity during induction, which was reversed during emergence. Cortical connectivity was dynamic during maintenance period, and it was more probable to remain in the same state (82.0 ± 8.3%) than to switch to a different state (P < 0.001). However, transitions to other states were structured, i.e., occurred more frequently than expected by chance.

Conclusions

Anesthesia-induced alterations of functional connectivity are dynamic despite the stable and prolonged administration of isoflurane, in the absence of any noxious stimuli. Changes in connectivity over time will likely yield more information as a marker or mechanism of surgical anesthesia than any single pattern.
Pediatric Risk Stratification Is Improved by Integrating Both Patient Comorbidities and Intrinsic Surgical Risk
Authors: Nasr Viviane G. , Staffa Steven J. , Zurakowski David , DiNardo James A. , Faraoni David
Published: April 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Recently developed risk stratification models for perioperative mortality incorporate patient comorbidities as predictors but fail to consider the intrinsic risk of surgical procedures. In this study, the authors used the American College of Surgeons National Surgical Quality Improvement Program Pediatric database to demonstrate the relationship between the intrinsic surgical risk and 30-day mortality and develop and validate an accessible risk stratification model that includes the surgical procedures in addition to the patient comorbidities and physical status.

Methods

A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program Pediatric database was performed. The incidence of 30-day mortality was the primary outcome. Surgical Current Procedural Terminology codes with at least 25 occurrences were included. Multivariable logistic regression model was used to determine the predictors for mortality including patient comorbidities and intrinsic surgical risk. An internal validation using bootstrap resampling, and an external validation of the model were performed.

Results

The authors analyzed 367,065 surgical cases encompassing 659 unique Current Procedural Terminology codes with an incidence of overall 30-day mortality of 0.34%. Intrinsic risk of surgical procedures represented by Current Procedural Terminology risk quartiles instead of broad categorization was significantly associated with 30-day mortality (P < 0.001). Predicted risk of 30-day mortality ranges from 0% with no comorbidities to 4.7% when all comorbidities are present among low-risk surgical procedures and from 0.07 to 46.7% among high-risk surgical procedures. Using an external validation cohort of 110,474 observations, the multivariable predictive risk model displayed good calibration and excellent discrimination with area under curve (c-index) equals 0.95 (95% CI, 0.94 to 0.96; P < 0.001).

Conclusions

Understanding and accurately estimating perioperative risk by accounting for the intrinsic risk of surgical procedures and patient comorbidities will lead to a more comprehensive discussion between patients, families, and providers and could potentially be used to conduct cost analysis and allocate resources.
Propofol Sedation Alters Perceptual and Cognitive Functions in Healthy Volunteers as Revealed by Functional Magnetic Resonance Imaging
Authors: Gross William L. , Lauer Kathryn K. , Liu Xiaolin , Roberts Christopher J. , Liu Suyan , Gollapudy Suneeta , Binder Jeffrey R. , Li Shi-Jiang , Hudetz Anthony G.
Published: April 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Elucidating networks underlying conscious perception is important to understanding the mechanisms of anesthesia and consciousness. Previous studies have observed changes associated with loss of consciousness primarily using resting paradigms. The authors focused on the effects of sedation on specific cognitive systems using task-based functional magnetic resonance imaging. The authors hypothesized deepening sedation would degrade semantic more than perceptual discrimination.

Methods

Discrimination of pure tones and familiar names were studied in 13 volunteers during wakefulness and propofol sedation targeted to light and deep sedation. Contrasts highlighted specific cognitive systems: auditory/motor (tones vs. fixation), phonology (unfamiliar names vs. tones), and semantics (familiar vs. unfamiliar names), and were performed across sedation conditions, followed by region of interest analysis on representative regions.

Results

During light sedation, the spatial extent of auditory/motor activation was similar, becoming restricted to the superior temporal gyrus during deep sedation. Region of interest analysis revealed significant activation in the superior temporal gyrus during light (t [17] = 9.71, P < 0.001) and deep sedation (t [19] = 3.73, P = 0.001). Spatial extent of the phonologic contrast decreased progressively with sedation, with significant activation in the inferior frontal gyrus maintained during light sedation (t [35] = 5.17, P < 0.001), which didn’t meet criteria for significance in deep sedation (t [38] = 2.57, P = 0.014). The semantic contrast showed a similar pattern, with activation in the angular gyrus during light sedation (t [16] = 4.76, P = 0.002), which disappeared in deep sedation (t [18] = 0.35, P = 0.731).

Conclusions

Results illustrate broad impairment in cognitive cortex during sedation, with activation in primary sensory cortex beyond loss of consciousness. These results agree with clinical experience: a dose-dependent reduction of higher cognitive functions during light sedation, despite partial preservation of sensory processes through deep sedation.
Impact of the World Health Organization Surgical Safety Checklist on Patient Safety
Authors: Haugen Arvid S. , Sevdalis Nick , Søfteland Eirik
Published: April 2019

The incidence of surgical complications has remained largely unchanged over the past two decades. Inherent complexity in surgery, new technology possibilities, increasing age and comorbidity in patients may contribute to this. Surgical safety checklists may be used as some of the tools to prevent such complications. Use of checklists may reduce critical workload by eliminating issues that are already controlled for. The global introduction of the World Health Organization Surgical Safety Checklist aimed to improve safety in both anesthesia and surgery and to reduce complications and mortality by better teamwork, communication, and consistency of care. This review describes a literature synthesis on advantages and disadvantages in use of surgical safety checklists emphasizing checklist development, implementation, and possible clinical effects and using a theoretical framework for quality of provided healthcare (structure—process—outcome) to understand the checklists’ possible impact on patient safety.
Dynamic Cortical Connectivity during General Anesthesia in Surgical Patients
Authors: Vlisides Phillip E. , Li Duan , Zierau Mackenzie , Lapointe Andrew P. , Ip Ka I. , McKinney Amy M. , Mashour George A.
Published: April 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Functional connectivity across the cortex has been posited to be important for consciousness and anesthesia, but functional connectivity patterns during the course of surgery and general anesthesia are unknown. The authors tested the hypothesis that disrupted cortical connectivity patterns would correlate with surgical anesthesia.

Methods

Surgical patients (n = 53) were recruited for study participation. Whole-scalp (16-channel) wireless electroencephalographic data were prospectively collected throughout the perioperative period. Functional connectivity was assessed using weighted phase lag index. During anesthetic maintenance, the temporal dynamics of connectivity states were characterized via Markov chain analysis, and state transition probabilities were quantified.

Results

Compared to baseline (weighted phase lag index, 0.163, ± 0.091), alpha frontal–parietal connectivity was not significantly different across the remaining anesthetic and perioperative epochs, ranging from 0.100 (± 0.041) to 0.218 (± 0.136) (P > 0.05 for all time periods). In contrast, there were significant increases in alpha prefrontal–frontal connectivity (peak = 0.201 [0.154, 0.248]; P < 0.001), theta prefrontal–frontal connectivity (peak = 0.137 [0.091, 0.182]; P < 0.001), and theta frontal–parietal connectivity (peak = 0.128 [0.084, 0.173]; P < 0.001) during anesthetic maintenance. Additionally, shifts occurred between states of high prefrontal–frontal connectivity (alpha, beta) with suppressed frontal–parietal connectivity, and high frontal–parietal connectivity (alpha, theta) with reduced prefrontal–frontal connectivity. These shifts occurred in a nonrandom manner (P < 0.05 compared to random transitions), suggesting structured transitions of connectivity during general anesthesia.

Conclusions

Functional connectivity patterns dynamically shift during surgery and general anesthesia but do so in a structured way. Thus, a single measure of functional connectivity will likely not be a reliable correlate of surgical anesthesia.
Case Report of Anemia Following Fetal–Maternal Hemorrhage
Authors: Coe Kristi L.
Published: April 2019

Background:

Any maternal history of blood loss, ABO or Rh incompatibility, and hydrops fetalis often leads to suspicion of neonatal anemia postnatally. When maternal history consists only of decreased fetal movement, recognition of neonatal anemia can be problematic.

Clinical Findings:

This case was a transported late preterm neonate who presented initially with persistent hypoxia unresponsive to usual respiratory support. On examination, mild paleness was noted.

Primary Diagnosis:

Anemia caused by fetal–maternal hemorrhage was the ultimate diagnosis confirmed by a Kleihauer-Betke test on maternal serum examining fetal cells.

Interventions:

Neonatal resuscitation included positive pressure ventilation, oxygen, and intubation. However, oxygenation did not improve prompting consultation with the neonatologist. Sedation and a paralytic were given. A chest radiograph ruled out pneumothoraces and pleural effusions as causative. Initiation of inhaled nitric oxide produced a mild response. Eventually, the transport nurse obtained a complete blood count indicating severe anemia, which prompted an emergent blood transfusion. The accepting neonatology team consulted with the obstetrician and a Kleihauer-Betke test was performed on mother's blood confirming a large fetal–maternal hemorrhage.

Outcomes:

This neonate responded well to blood transfusions, a pressor, and respiratory support and was discharged home at 7 days of life.

Practice Recommendations:

Recognition of postnatal anemia is vital to sustaining life and this can occur in the transport environment. When maternal history is nonspecific and a neonate is hypoxic, uncommon causes of hypoxia can be identified with consultation and a complete blood count.
CEDRA: A Tool to Help Consumers Assess Risk for Ear Disease
Authors: Klyn Niall A. M. , Kleindienst Robler Samantha , Bogle Jamie , Alfakir Razan , Nielsen Donald W. , Griffith James W. , Carlson Deborah L. , Lundy Larry , Dhar Sumitrajit , Zapala David A.
Published: April 2019

This article introduces the Consumer Ear Disease Risk Assessment (CEDRA) tool. CEDRA is a brief questionnaire designed to screen for targeted ear diseases. It offers an opportunity for consumers to self-screen for disease before seeking a hearing device and may be used by clinicians to help their patients decide the appropriate path to follow in hearing healthcare. Here we provide highlights of previously published validation in the context of a more thorough description of CEDRA’s development and implementation. CEDRA’s sensitivity and specificity, using a cut-off score of 4 or higher, was 90% and 72%, respectively, relative to neurotologist diagnoses in the initial training sample used to create the scoring algorithm (n = 246). On a smaller independent test sample (n = 61), CEDRA’s sensitivity and specificity were 76% and 80%, respectively. CEDRA has readability levels similar to many other patient-oriented questionnaires in hearing healthcare, and informal reports from pilot CEDRA-providers indicate that the majority of patients can complete it in less than 10 min. As the hearing healthcare landscape changes and provider intercession is no longer mandated, CEDRA provides a measure of safety without creating a barrier to access.
Total Breast Reconstruction with Fat Grafting Combined with Internal Tissue Expansion
Authors: Kolasinski Jerzy
Published: April 2019

Breast reconstruction procedures are currently performed as standard practice and are an integral part of breast cancer treatment. The advantages and disadvantages of particular types of reconstruction are well known. Most of them require the woman to accept a different consistency of the reconstructed breast, as is the case with implants, or to have extra scarring in the donor site and a cutaneous island with a different texture in the recipient site, as is the case with TRAM, DIEP, and other flaps. This article presents the concept of breast reconstruction with fat grafting combined with internal tissue expansion. A 44-year-old woman after a right mastectomy for invasive carcinoma T1c, N0 (IIB) was presented. After unsatisfactory treatment with fat grafting supported by BRAVA system, she was qualified for breast reconstruction with fat grafting combined with tissue expansion. An anatomic 350 cm3 breast expander with an integrated port was implanted. It was filled with saline solution up to volume of 380 ml. Then, 7 fat grafting procedures combined with gradual emptying of the expander were performed. The 50/70 principle was used, that is, 50 ml of physiological saline was removed from the expander and 70 ml of fat was injected into the subcutaneous tissue over the expander. Finally, the expander was removed and a satisfactory volume and completely natural consistency of the breast was obtained. Breast reconstruction with fat grafting combined with tissue expansion is a promising method of total breast reconstruction after mastectomy.
Repeatability of Noninvasive Keratograph 5M Measurements Associated With Contact Lens Wear
Authors: García-Montero María , Rico-del-Viejo Laura , Lorente-Velázquez Amalia , Martínez-Alberquilla Irene , Hernández-Verdejo Jose Luis , Madrid-Costa David
Published: April 2019

Objective:

To assess the intrarater repeatability of the measurements of tear meniscus height (TMH), noninvasive keratograph tear break-up time (NIKBUTs), and ocular redness measurements obtained with the Keratograph 5M (K5M) in a sample of soft silicone hydrogel contact lens (CL) wearers over 15 days.

Methods:

Prospective study over two consecutive weeks. Three measurements of TMH, NIKBUTs (NIKBUT first and NIKBUT average), and ocular redness were obtained in different sessions; the first day (baseline, at 8 hr of wear, and after lens removal) and the last day of wear—15th day (at 8 hr of wear and after lens removal). The repeatability of measurements were assessed by two intraclass correlation coefficient (ICC) forms; single measurement [ICC (2,1)] and multiple measurements (k=3) [ICC (2, k)].

Results:

Sixty-four eyes were analyzed. The repeatability of baseline TMH [ICC (2,1) greater than 0.90; coefficient of repeatability (CR)=0.06 mm] and after and during CL wear [ICC (2,k) greater than 0.90; CR≤0.07 mm] were excellent. The repeatability of baseline NIKBUT average [ICC (2,k)=0.89 (0.82–0.93); CR=6.07 sec] was maintained after CL removal but was poorer during CL wear. The repeatability of baseline NIKBUT first [ICC (2,k) =0.80 (0.69–0.87); CR=8.74 sec] was maintained after CL removal and during CL wear at moderate–good level.

Conclusions:

Intrarater repeatability of TMH, NIKBUTs, and ocular redness performed by K5M after CL wear remains stable when three measurements are performed. However, intrarater repeatability during CL wear decreased only for NIKBUT average and was not affected by time of use (15 days).
Zolpidem and Gender: Are Women Really At Risk?
Authors: Greenblatt David J. , Harmatz Jerold S. , Roth Thomas
Published: April 2019

Background

In 2013 the Food and Drug Administration (FDA) claimed the existence of new data showing women to be at risk for excessive daytime sedation and impaired driving proficiency following bedtime doses of zolpidem. The putative explanation was the reduced metabolic clearance of zolpidem and higher morning blood concentrations in women compared to men. The FDA acted to reduce the recommended dosage for women down to 50% of the dose for men. No other regulatory agency worldwide has taken similar action.

Methods

Gender effects on zolpidem pharmacokinetics, pharmacodynamics, adverse effects, clinical efficacy, and driving performance were evaluated through a further analysis of data from a previous study, together with a literature review.

Results

Women had on average 35% lower apparent clearance of zolpidem than men (236 vs 364 mL/min, P < 0.001). This difference was not explained by body weight. In some laboratory studies, women had greater functional impairment than men taking the same dose, but in all studies active drug was not distinguishable from placebo at 8 hours after oral dosage. On-the-road driving studies likewise showed no evidence of driving impairment in men or women at 8 hours after 10 mg of oral immediate-release zolpidem. No clinical trial demonstrated a gender-related difference in clinical efficacy or adverse reactions, and there was no evidence of a particular risk to women.

Conclusions

Dosage reduction in women is not supported by available scientific evidence, and may in fact lead to underdosing and the consequent hazard of inadequately treated insomnia.
Clinical application of high-resolution MRI in combination with digital subtraction angiography in the diagnosis of vertebrobasilar artery dissecting aneurysm
Authors: Zhang Meng , Ye Gengfan , Liu Yuandong , Wang Qian , Li Shuying , Wang Yunyan
Published: April 2019

Vertebrobasilar artery dissecting aneurysm (VBA-DA) is associated with serious complications and poor prognosis in patients. High-resolution magnetic resonance imaging (HR-MRI) is a noninvasive method for the diagnosis of VBA-DA.

VBA-DAs were classified according to the feature of HR-MRI in combination with digital subtraction angiography (DSA), and the clinical outcomes of different types of VBA-DAs were analyzed. Thirty-nine patients with 42 VBA-DAs were included and underwent HR-MRI, including three-dimensional T1 weighted image, three-dimensional T2 weighted image (3D-T2WI), three-dimensional time of flight MRA (3D-TOF-MRA), and three-dimensional fast imaging employing steady state acquisition (3D-FIESTA), and hematoma and flaps were compared. The follow-up was 3 to 25 months. The VBA-DAs were classified based on the images of HR-MRI and DSA, and the prognosis was analyzed.

VBA-DAs more frequently occurred on the vertebral artery, especially on the dominant vertebral artery. 3D-TOF-MRA showed high signal from hematoma, and 3D-FIESTA showed high signal from flaps. Based on HR-MRI images in combination with DSA, VBA-DAs were classified into 4 types: classical, stenosis, spiral, and hemorrhagic. The patients with the classical VBA-DAs had a higher improvement rate and a lower exacerbation rate. The patients with spiral and hemorrhagic VBA-DAs had poor clinical outcomes. The patients with stenosis VBA-DAs had poorer clinical outcomes than classical types and better clinical outcomes than spiral and hemorrhagic types.

The detection of intramural hematoma and dissection flap using HR-MRI provides basic information for the diagnosis of VBA-DA. Individualized therapeutic strategies can be designed for the treatment of VBA-DAs with different features of DSA and HR-MRI.
Crush versus Culotte stenting techniques for coronary bifurcation lesions
Authors: Chen En , Cai Wei , Chen Liang-long
Published: April 2019

Background:

In patients with complex true coronary bifurcation lesions (CBLs), Crush or Culotte stenting has been the commonest approaches of percutaneous coronary intervention (PCI). However, the optimal one remains in debate.

Methods:

A systematic review and meta-analysis of cohort studies searched from PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Chinese National Knowledge Infrastructure (CNKI), VIP information database, and WangFang Data Information Site, to compare the long-term safety and efficacy of PCI with Crush versus Culotte in patients with CBLs. The primary end point was target lesion revascularization (TLR) and secondary end points were a composite of major adverse cardiac events (MACE) including cardiac death (CD), myocardial infarction (MI), stent thrombosis (ST), and target vessel revascularization (TVR) by PCI or bypass surgery, and each individual component at long-term follow-up. Furthermore, omitting each study in turn was used to sensitivity analysis for high heterogeneity of studies.

Results:

A total of 7 studies were included to perform a meta-analysis, 3 randomized trials and 4 observational studies with 2211 patients, 1281 treated with Crush and 930 with Culotte. There was no significant difference in TLR and MACE between Crush and Culotte [RR 0.76, 95% CI (0.48–1.23), I2 = 57%; RR 0.78, 95% CI (0.47–1.29), I2 = 83%, respectively]. ST tended to be lower in patients treated with Crush [RR 0.61, 95% CI (0.37–1.01), I2 = 23%]. CD and MI were comparable between the 2 groups [RR 0.80, 95% CI (0.43–1.49), I2 = 0%; RR 0.74, 95% CI (0.49–1.13), I2 = 32%, respectively]. TVR was also associated with the similar risk [RR 0.76, 95% CI (0.49–1.16), I2 = 60%]. However, high heterogeneity was detected for TLR, MACE, and TVR, and the source of heterogeneity was DKCRUSH-III study by Chen, SL.

Conclusions:

In the treatment of coronary bifurcation lesions, TLR and MACE were not significant difference between the Crush and Culotte groups, but TLR and MACE were also regarded as high heterogeneity mainly due to better outcomes achieved by DK Crush and there was a trend toward lower ST in the Crush group. Crush, particularly DK Crush, may be superior to conventional Culotte for treatment of CBLs.

PROSPERO registration number:

CRD42018111868.
Magnetic resonance spectroscopy imaging in diagnosis of suspicious prostate cancer
Authors: Cai Weiguo , Zhu Dongyong , Byanju Sama , Chen Jie , Zhang Hanfei , Wang Yanfang , Liao Meiyan
Published: April 2019

Background:

This meta-analysis was conducted to assess the value of magnetic resonance spectroscopy imaging (MRSI) in the diagnosis of suspected prostate cancer (PC).

Methods:

We identified all the relevant papers from the EMBASE, PubMed, EBSCO, Web of Science, and Cochrane Library databases and screened the reference lists. The quality assessment of diagnostic accuracy studies-version 2 tool was used to assess the study quality. Publication bias was analyzed using Deeks’ funnel plot asymmetry test. We calculated the pooled sensitivities, specificities, positive likelihood ratios, negative likelihood ratios, diagnostic odds ratio (DOR), and 95% confidence intervals. The results were evaluated by summary receiver-operating characteristic curves (SROCs). Ultimately, a univariable meta-regression and subgroup analysis, Fagan plot, and likelihood matrix were used to analyze this review.

Results:

A total of 19 articles, which were based on patient-level analysis of PC, were included. These studies had a pooled sensitivity, specificity, DOR, and an area under the SROC of 0.86, 0.78, 22, and 0.89, respectively, by patient-level analysis. From the likelihood matrix, the summary negative likelihood ratio and positive likelihood ratio for MRSI diagnosis of PC were concentrated on the right lower quadrant, which neither confirmed nor excluded the diagnosis of cancer.

Conclusion:

MRSI has a relative application value in the diagnosis of cases of suspected PC. While MRSI is still required for diagnosis along with other clinical data and comprehensive analysis.
Prognostic impact of telomeric repeat-containing RNA expression on long-term oncologic outcomes in colorectal cancer
Authors: Bae Sung Uk , Park Won-Jin , Jeong Woon Kyung , Baek Seong Kyu , Lee Hye-Won , Lee Jae-Ho
Published: April 2019

Telomeres are transcribed into long, noncoding telomeric repeat-containing RNAs (TERRA) that have been implicated in the regulation of telomerase, the enzyme that lengthens telomeres, in heterochromatin formation at telomeres, and in telomere stability. This study aimed to evaluate the correlation between TERRA expression and long-term oncologic outcomes in colorectal cancer (CRC).

We evaluated 18p TERRA expression and telomere length using quantitative real-time PCR in 60 patients who underwent surgical resection for CRC between June 2008 and November 2010.

Patients were grouped according to 18p TERRA expression, with 29 (48.3%) and 31 (51.7%) patients in the low and high TERRA expression groups, respectively. The median follow-up period was 80 months (range 2–103). The 18p TERRA expression was marginally significantly associated with preoperative carcinoembryonic antigen (CEA; P = .082) and was significantly associated with telomere length (P < .05). Multivariate analysis revealed that preoperative CEA (hazard ratio [HR], 2.728; 95% confidence interval [CI], 0.832–8.944, P = .098) and 18p TERRA expression (HR, 0.113; 95% CI, 0.011–1.126, P = .071) were marginally significant independent prognostic factors for overall survival (OS), whereas preoperative CEA (HR, 4.254; 95% CI, 1.394–12.985, P = .011) and 18p TERRA expression (HR, 0.108; 95% CI, 0.011–1.037, P = .054) were significant independent prognostic factors for disease-free survival (DFS). According to our prognostic model with 2 prognostic factors, the OS and DFS rate increased to 76.2% and 80.63%, respectively, in patients with high 18p TERRA expression and CEA levels ≤5 (P = .178, P = .057, respectively).

18p TERRA expression was marginally significantly associated with preoperative CEA and significantly associated with telomere length, rendering it a potential prognostic factor for long-term oncologic outcomes in CRC.
Factors affecting bone age maturation during 3 years of growth hormone treatment in patients with idiopathic growth hormone deficiency and idiopathic short stature
Authors: Kang Min Jae , Kim Eun Young , Shim Young Suk , Jeong Hwal Rim , Lee Hye Jin , Yang Seung , Hwang Il Tae
Published: April 2019

To investigate the progression rate of bone age (BA) and associated factors during the first 3 years of growth hormone (GH) treatment in children with idiopathic GH deficiency (iGHD) and idiopathic short stature (ISS).

Data for prepubertal children with iGHD and ISS who were treated with recombinant human GH were obtained from the LG Growth Study Database and analyzed. Height, weight, BA, insulin-like growth factor-1 (IGF-1) level, and GH dose were recorded every 6 months. Differences between BA and chronological age (CA), BA-CA, were calculated at each measurement. This study included 92 (78 iGHD and 14 ISS) subjects.

After 3 years of GH treatment, the height z-score was −1.09 ± 0.71 (P < .001 compared to baseline), BA-CA was −1.21 ± 1.18 years (P < .001), and IGF-1 standard deviation score (SDS) was 0.43 ± 1.21 (P < .001) in the iGHD subjects; the change in BA over the 3 years was 3.68 ± 1.27 years. In the ISS subjects, the height z-score was −1.06 ± 0.59 (P < .001), BA-CA was −0.98 ± 1.23 years (P = .009), and IGF-1 SDS was 0.16 ± 0.76 (P = .648); the change in BA over the 3 years was 3.88 ± 1.36 years. The only significant factor associated with the BA progression was the BA-CA at 1 year of GH treatment (OR = 2.732, P = .001). The baseline BA-CA, IGF-1 SDS, and GH dose did not influence BA progression.

Prepubertal subjects with iGHD and ISS showed height improvement and mild BA acceleration over the first 3 years of GH treatment. However, because the BA progression rate was considered to be clinically acceptable, GH treatment may increase the predicted adult height during this period.
Relative tumor volume is a better independent prognostic factor in esophageal squamous cell carcinoma
Authors: Lv Jun , Gan Huimin , Zhang Wei , Pan Linjiang , Wang Rensheng , Qin Yutao
Published: April 2019

The present study is to evaluate the significance in prognosis of relative tumor volume (RTV) in patients with non-resectable esophageal squamous cell carcinoma (ESCC) treated by definitive radiotherapy alone or in combination with chemotherapy.

Fifty-eight consecutive patients with ESCC in UICC stage I to IV were retrospectively analyzed. Relative primary gross volume (RGTVp) was defined as primary gross volume (GTVp) divided by body volume. Relative primary gross volume for lymph nodes (RGTVnd) was defined as primary gross volume for lymph nodes (GTVnd) divided by body volume. The relationships were analyzed between overall survival (OS), disease free survival (DFS), local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and RGTVp (RGTVnd) in univariate and multivariate analyses.

The cut-off values of 0.947 and 0.007 were determined for RGTVp and RGTVnd, respectively. The 3-year OS, DFS, and LRFS for patients with RGTVp ≤ 0.947 vs RGTVp > 0.947 was 65.4% vs 25.0% (P = .001), 46.2% vs 12.5% (P = .002), and 90.1% vs 42.0% (P < .001). RGTVp was an independent risk factor for OS (P = .046), DFS (P = .015) and LRFS (P = .032), but showed no association with DMFS in univariate and multivariate analyses. The 3-year DFS and DMFS for patients with RGTVnd ≤ 0.007 vs RGTVnd > 0.007 was 44.4% vs 20.0% (P = .023), and 62.9% vs 24.6% (P < .004). RGTVnd was associated with DMFS (P = .012) in multivariate, but showed no associated with DFS.

The present study demonstrates that RTV was an independent factor relevant to prognosis for ESCC. It provides new clinical basis for personalized therapeutic regimens and might be included in the staging system.
Influenza A with hemorrhagic shock and encephalopathy syndrome in an adult
Authors: Fukuda Masafumi , Yoshida Tomohiro , Moroki Mariko , Hirayu Nobuhisa , Nabeta Masakazu , Nakamura Atsuo , Uzu Hideaki , Takasu Osamu
Published: April 2019

Introduction:

Hemorrhagic shock and encephalopathy syndrome (HSES) is a type of acute encephalopathy mainly seen in infants. It is a syndrome encompassing an onset of high fever, disturbance of consciousness, convulsion, and shock that rapidly progresses to watery diarrhea and liver and renal dysfunctions. It is extremely rare in adults, and the number of reports is limited worldwide. We report the case of an adult patient with HSES, which occurred after influenza A infection.

Patient concerns:

A 52-year-old man visited his family doctor 2 days after he noticed fever and was diagnosed with influenza A using an influenza rapid diagnosis kit; he underwent treatment on an outpatient basis. He was immediately hospitalized after developing fever, abdominal pain, malaise, and shock 16 hours after the commencement of the treatment. Abrupt acute brain swelling was noted 24 hours after hospitalization.

Diagnoses:

The antibody titer to influenza A (H3N2) was 1:40. Computed tomography obtained 24 hours after treatment initiation confirmed acute cerebral edema and cerebral herniation. Electroencephalogram at that time showed a flat line.

Interventions:

For the treatment of influenza A, laninamivir 150 mg was started immediately after the diagnosis by the family doctor, and 600 mg dose was given daily after hospitalization (or since 24 hours after the treatment initiation). For the management of shock, dobutamine 3 μg/kg/min and noradrenaline up to 0.2 μg/kg/min were used together with bolus infusion.

Outcomes:

The patient was declared brain dead on his 6th hospital day and he died on his 27th hospital day.

Conclusion:

Drastic courses such as that in our case with HSES can follow influenza infections even in adults.
Synchronous isolated splenic metastasis from cancer of hepatic flexure of colon
Authors: Zhao Huiying , Zhong Weixiang , Chen Dong , Cheng Xiaofei
Published: April 2019

Rationale:

Isolated splenic metastasis from colorectal cancer is very rare, as metastatic colorectal cancer involving the spleen is usually a manifestation of widely disseminated disease. Splenectomy is the best therapeutic option for this entity and probably the only chance for radical cure.

Patient Concerns:

A 73-year-old male presented with abdominal distension and dark red bloody stool of 6-month duration.

Diagnoses:

Synchronous isolated splenic metastasis from colorectal cancer.

Interventions:

Based on multidisciplinary team (MDT) mode, the patient underwent the primary hepatic flexure tumor resection due to his poor general condition. One month after surgery the patient began treatment with Xelox (capecitabine 1000 mg/m2, oxaliplatin 130 mg/m2) every 3 weeks. The patient underwent isolated splenic metastasis resection successfully by laparoscopic after four courses of chemotherapy.

Outcomes:

The patient's postoperative course was uneventful and he completed four courses of postoperative chemotherapy using the original chemotherapy regimen Xelox (capecitabine 1000 mg/m2, oxaliplatin 130 mg/m2). The patient was subsequently followed up every 3 months and no signs of recurrence were noted in a recent examination.

Lessons:

To the best of our knowledge, this is the first case report of isolated splenic metastasis from colorectal cancer in China. It is also the first case in which treatment was overseen by an MDT. The possibility of splenic metastasis should be considered in cases in which colorectal cancer is associated with a splenic lesion, despite its rarity. Splenectomy and adjuvant chemotherapy are the optimal therapeutic approaches, as such an approach prolongs survival and palliates the disease.
Prediction of ISUP grading of clear cell renal cell carcinoma using support vector machine model based on CT images
Authors: Sun Xiaoqing , Liu Lin , Xu Kai , Li Wenhui , Huo Ziqi , Liu Heng , Shen Tongxu , Pan Feng , Jiang Yuqing , Zhang Mengchao
Published: April 2019

Background:

To explore whether radiomics combined with computed tomography (CT) images can be used to establish a model for differentiating high grade (International Society of Urological Pathology [ISUP] grade III–IV) from low-grade (ISUP I–II) clear cell renal cell carcinoma (ccRCC).

Methods:

For this retrospective study, 3-phase contrast-enhanced CT images were collected from 227 patients with pathologically confirmed ISUP-grade ccRCC (155 cases in the low-grade group and 72 cases in the high-grade group). First, we delineated the largest dimension of the tumor in the corticomedullary and nephrographic CT images to obtain the region of interest. Second, variance selection, single variable selection, and the least absolute shrinkage and selection operator were used to select features in the corticomedullary phase, nephrographic phase, and 2-phase union samples, respectively. Finally, a model was constructed using the optimal features, and the receiver operating characteristic curve and area under the curve (AUC) were used to evaluate the predictive performance of the features in the training and validation queues. A Z test was employed to compare the differences in AUC values.

Results:

The support vector machine (SVM) model constructed using the screening features for the 2-stage joint samples can effectively distinguish between high- and low-grade ccRCC, and obtained the highest prediction accuracy. Its AUC values in the training queue and the validation queue were 0.88 and 0.91, respectively. The results of the Z test showed that the differences between the 3 groups were not statistically significant.

Conclusion:

The SVM model constructed by CT-based radiomic features can effectively identify the ISUP grades of ccRCC.