bluuebunny/crossref_metadata_2025 huggingface dataset:
A Day in the Life: Identification of Developmentally Regulated MicroRNAs in the Colorado Potato Beetle (Leptinotarsa decemlineata; Coleoptera: Chrysomelidae)
Authors: Wiebe K F , Elebute O O , LeMoine C M R , Cassone B J
Published: January 2020

The Colorado potato beetle (Leptinotarsa decemlineata (Say)) is an important pest of the cultivated potato (Solanum tuberosum (L.) [Solanales: Solanaceae]). With its broad resistance toward commonly used insecticides, it is clear that more sophisticated control strategies are needed. Due to their importance in insect development, microRNAs (miRNAs) represent a potential tool to employ in insect control strategies. However, most studies conducted in this area have focused on model species with well-annotated genomes. In this study, next-generation sequencing was used to catalogue the miRNAs produced by L. decemlineata across all eight stages of its development, from eggs to adults. For most stages, the length of miRNAs peaked between 21 and 22 nt, though it was considerably longer for the egg stage (26 nt). Global profiling of miRNAs revealed three distinct developmental clusters: 1) egg stage; 2) early stage (first, second, and third instar); and 3) late stage (fourth instar, prepupae, pupae, and adult). We identified 86 conserved miRNAs and 33 bonafide novel miRNAs, including stage-specific miRNAs and those not previously identified in L. decemlineata. Most of the conserved miRNAs were found in multiple developmental stages, whereas the novel miRNAs were often stage specific with the bulk identified in the egg stage. The identified miRNAs have a myriad of putative functions, including growth, reproduction, and insecticide resistance. We discuss the putative roles of some of the most notable miRNAs in the regulation of L. decemlineata development, as well as the potential applications of this research in Colorado potato beetle management.
The Returns to Elite University Education: a Quasi-Experimental Analysis
Authors: Anelli Massimo
Published: January 2020

I take advantage of a discontinuity in the probability of admission to a highly selective private university to estimate causal returns to investing in elite university education. I use a newly assembled data set that combines individual administrative records about high school attendance, university admission, university attendance, and tax returns. I find a discontinuity in income of 38 log points at the admission cutoff. The fuzzy regression discontinuity estimate for the elite enrollment effect is 58 log points. This should be interpreted as the average treatment effect for students applying to the elite university who are close to the cutoff and chose to enroll. When I take into account the evidence that students enrolling in the elite university tend to make different field choices, the net institutional enrollment premium is 41 log points. Cumulated over 15 years, the net-of-tuition elite premium is €246,991. I explore potential channels explaining the sizeable enrollment effects and I find that students just above the admission cutoff are 15 percentage points more likely to complete a university degree, they are 26 percentage points more likely to graduate on time and attend university with substantially higher quality peers.
A pooled analysis of primary hepatic angiosarcoma
Authors: Zeng Dong , Cheng Jianan , Gong Zhihua , Chen Jianghong , Long Haixia , Zhu Bo
Published: January 2020

Background

Angiosarcoma is an aggressive and malignant neoplasm. Primary hepatic angiosarcoma is extremely rare and accounts for only approximately 5% of all angiosarcomas. Therefore, many doctors do not know enough about this disease; this lack of knowledge motivated us to perform this study.

Methods

We carried out a systematic review of the literature published worldwide from 1990 to 2019 to study the main characteristics, demographics, treatment and prognosis of primary hepatic angiosarcoma.

Result

A total of 219 patients were included in this study. Patients were mainly middle-aged and elderly at diagnosis, with an average age at onset of 56.7 years. The vast majority of patients (61.5%) presented with abdominal pain or distension. Of 143 patients with clear records of metastasis, 31.5% (45 patients) had distant metastasis. The median overall survival time was only 6 months, and the 1- and 2-year survival rates were 30.4 and 17.3%, respectively. Sex, age, tumor size and metastasis at diagnosis showed no correlation with survival rate. Hepatic rupture was a significant predictor of survival. Surgery is a major treatment choice, and adjuvant chemotherapy can improve the prognosis of patients. Hepatic artery embolization is mainly used in cases of tumor rupture. However, liver transplantation is not advised.

Conclusion

We presented an overview of the demographics, tumor characteristics and treatment outcomes of the largest number of primary hepatic angiosarcoma patients investigated to date. We highlight the use of routine physical examinations and surgery combined with adjuvant chemotherapy to improve the outcomes in these cases.
Plural Marking and d-Linking in Spanish Interrogatives
Authors: Maldonado Mora
Published: January 2020

What is the semantic import of number morphology? This question has been traditionally addressed by focusing on singular and plural noun phrases. The present work brings interrogative phrases into the picture. We analyse Spanish bare interrogative ‘quién’ and its plural counterpart ‘quiénes’. Unlike which-questions in both English and Spanish, the behaviour of quién- and quiénes-interrogatives cannot be easily explained by most accounts of semantic number. In contrast, we argue that the distribution of these interrogatives in Spanish can be well accounted for by assuming that the plural ‘quiénes’ triggers a strong plurality presupposition, and can only be used in d-linking contexts, whereas ‘quién’ carries no specific requirement, as far as its semantics is concerned. As a result, our proposal shows that current approaches to number marking need to be refined in order to account for cross-linguistic and within-language variation.
An aphid effector promotes barley susceptibility through suppression of defence gene expression
Authors: Escudero-Martinez Carmen , Rodriguez Patricia A , Liu Shan , Santos Pablo A , Stephens Jennifer , Bos Jorunn I B
Published: January 2020

Aphids secrete diverse repertoires of effectors into their hosts to promote the infestation process. While ‘omics’ approaches facilitated the identification and comparison of effector repertoires from a number of aphid species, the functional characterization of these proteins has been limited to dicot (model) plants. The bird cherry-oat aphid Rhopalosiphum padi is a pest of cereal crops, including barley. Here, we extend efforts to characterize aphid effectors with regard to their role in promoting susceptibility to the R. padi–barley interaction. We selected three R. padi effectors based on sequence similarity to previously characterized Myzus persicae effectors and assessed their subcellular localization, expression, and role in promoting plant susceptibility. Expression of R. padi effectors RpC002 and Rp1 in transgenic barley lines enhanced plant susceptibility to R. padi but not M. persicae, for which barley is a poor host. Characterization of Rp1 transgenic barley lines revealed reduced gene expression of plant hormone signalling genes relevant to plant–aphid interactions, indicating that this effector enhances susceptibility by suppressing plant defences in barley. Our data suggest that some aphid effectors specifically function when expressed in host species, and feature activities that benefit their corresponding aphid species.
Rule Following, Anxiety, and Authenticity
Authors: Egan David
Published: January 2020

This paper argues that the problematic of rule following in Wittgenstein's Philosophical Investigations and Heidegger's analysis of anxiety in Being and Time have analogous structures. Working through these analogies helps our interpretation of both of these authors. Contrasting sceptical and anti-sceptical readings of Wittgenstein helps us to resolve an interpretive puzzle about what an authentic response to anxiety looks like for Heidegger. And considering the importance of anxiety to Heidegger's conception of authenticity allows us to locate in Wittgenstein's later philosophy a covert appeal to something resembling Heideggerian authenticity.
G279.0+1.1: a new extended source of high-energy gamma-rays
Authors: Araya M
Published: January 2020

G279.0+1.1 is a supernova remnant (SNR) with poorly known parameters, first detected as a dim radio source and classified as an evolved system. An analysis of data from the Fermi-Large Area Telescope (LAT) revealing for the first time an extended source of gamma-rays in the region is presented. The diameter of the GeV region found is ${\sim} 2{^{\circ}_{.}}8$, larger than the latest estimate of the SNR size from radio data. The gamma-ray emission covers most of the known shell and extends further to the north and east of the bulk of the radio emission. The photon spectrum in the 0.5–500 GeV range can be described by a simple power law, $\frac{\mathrm{ d}N}{\mathrm{ d}E} \propto E^{-\Gamma }$, with a spectral index of Γ = 1.86 ± 0.03stat ± 0.06sys. In the leptonic scenario, a steep particle spectrum is required and a distance lower than the previously estimated value of 3 kpc is favoured. The possibility that the high-energy emission results from electrons that already escaped the SNR is also investigated. A hadronic scenario for the gamma-rays yields a particle spectral index of ∼2.0 and no significant constraints on the distance. The production of gamma-rays in old SNRs is discussed. More observations of this source are encouraged to probe the true extent of the shell and its age.
Force on a neutron quantized vortex pinned to proton fluxoids in the superfluid core of cold neutron stars
Authors: Sourie Aurélien , Chamel Nicolas
Published: January 2020

The superfluid and superconducting core of a cold rotating neutron star (NS) is expected to be threaded by a tremendous number of neutron quantized vortices and proton fluxoids. Their interactions are unavoidable and may have important astrophysical implications. In this paper, the various contributions to the force acting on a single vortex to which fluxoids are pinned are clarified. The general expression of the force is derived by applying the variational multifluid formalism developed by Carter and collaborators. Pinning to fluxoids leads to an additional Magnus type force due to proton circulation around the vortex. Pinning in the core of an NS may thus have a dramatic impact on the vortex dynamics, and therefore on the magnetorotational evolution of the star.
A systematic study of proto-neutron star convection in three-dimensional core-collapse supernova simulations
Authors: Nagakura Hiroki , Burrows Adam , Radice David , Vartanyan David
Published: January 2020

This paper presents the first systematic study of proto-neutron star (PNS) convection in three dimensions (3D) based on our latest numerical fornax models of core-collapse supernova (CCSN). We confirm that PNS convection commonly occurs, and then quantify the basic physical characteristics of the convection. By virtue of the large number of long-term models, the diversity of PNS convective behaviour emerges. We find that the vigour of PNS convection is not correlated with CCSN dynamics at large radii, but rather with the mass of PNS − heavier masses are associated with stronger PNS convection. We find that PNS convection boosts the luminosities of νμ, ντ, $\bar{\nu }_{\mu }$, and $\bar{\nu }_{\tau }$ neutrinos, while the impact on other species is complex due to a competition of factors. Finally, we assess the consequent impact on CCSN dynamics and the potential for PNS convection to generate pulsar magnetic fields.
Cartoon Images on E-juice Labels: A Descriptive Analysis
Authors: Seitz Christopher M , Orsini Muhsin Michael , Jung Grace , Butler Kate
Published: January 2020

Introduction

Although previous studies have found cartoons in electronic cigarette (e-cigarette) advertisements, social media posts, and a small sample of labels, there has yet to be an analysis of cartoons located on the labels attached to bottles of e-juice (the solution that contains nicotine and other chemicals). As such, the objective of this study was to analyze the prevalence and types of cartoons on e-juice labels.

Methods

Two researchers independently analyzed the presence and types of cartoons on the labels of e-juice flavors available on eliquid.com. Based on the Master Settlement Agreement’s definition of a cartoon, the cartoons were placed into five categories: (1) comically exaggerated people, (2) comically exaggerated animals, (3) comically exaggerated creatures, (4) anthropomorphic creatures, or (5) extra-human creatures.

Results

There was a total of 1587 brands that offered 7135 e-juice products. Of those, 311 brands (19%) offered 1359 products (19%) that contained cartoons on the e-juice labels. From the labels that contained cartoons, 790 (58%) were of comically exaggerated people, 247 (18%) were of anthropomorphic creatures, 212 (16%) were of comically exaggerated animals, 73 (5%) were of comically exaggerated creatures, and 37 (3%) were of extra-human creatures

Conclusions

Given the previous success of Joe Camel on youth tobacco use, the prevalence of cartoon images found in this study is noteworthy. In addition, the number of brands that had cartoons on e-juice labels indicates that this issue is pervasive among businesses that sell e-juice.

Implications

This study adds to the body of knowledge on this topic by describing a concerning number of cartoons located on e-juice labels, indicating a need for policy that prohibits the use of cartoon images in e-cigarette packaging.
Risk Factors for Neuropathic Pain in Middle-Aged and Elderly People: A Five-Year Longitudinal Cohort in the Yakumo Study
Authors: Imagama Shiro , Ando Kei , Kobayashi Kazuyoshi , Nakashima Hiroaki , Seki Taisuke , Hamada Takashi , Machino Masaaki , Ota Kyotaro , Tanaka Satoshi , Morozumi Masayoshi , Kanbara Shunsuke , Ito Sadayuki , Ishiguro Naoki , Hasegawa Yukiharu
Published: January 2020

Objective

To determine the risk factors for new neuropathic pain (NeP) after five years in healthy middle-aged and elderly volunteers.

Design

Prospective longitudinal cohort study (Yakumo study).

Setting

Clinical evaluation in a health checkup.

Subjects

A total of 366 people (male N = 146, female N = 220, average age = 63.5 years) who did not have NeP in 2013 were examined.

Methods

NeP was diagnosed based on a painDETECT questionnaire score ≥13. Body mass index (BMI), comorbidity, low back pain (LBP), sciatica, physical ability, grip and back muscle strength, osteoporosis, sarcopenia, frailty, spinal alignment, and quality of life (QOL) with the SF36 in 2013 were compared between NeP(+) and NeP(-) subjects in 2018 using multivariate logistic regression analysis.

Results

The NeP(+) rate in 2018 was 5.2%, with no significant differences in age and gender. NeP(+) subjects had significantly lower BMI, severe sciatica, poor gait ability, higher rates of osteoporosis and sarcopenia, greater lumbar kyphosis and spinal inclination, and poorer mental health in 2013. Poor gait ability (odds ratio [OR] = 8.05), low BMI (OR = 2.31), lumbar kyphosis (OR = 1.38), low percentage of the young adult mean (OR = 1.15), and low mental QOL (OR = 1.06) were identified as significant and independent risk factors for new NeP after five years.

Conclusions

This longitudinal cohort study identified five independent risk factors for development of new NeP after five years, with related factors of spinal inclination, sarcopenia, and sciatica. New NeP may be prevented by intervention or treatment of these factors at an early stage in relatively healthy middle-aged and elderly people.
An approach to constrain models of accreting neutron stars with the use of an equation of state
Authors: Dohi Akira , Hashimoto Masa-aki , Yamada Rio , Matsuo Yasuhide , Fujimoto Masayuki Y
Published: January 2020

We investigate X-ray bursts during the thermal evolution of an accreting neutron star that corresponds to the X-ray burster GS 1826$-$24. Physical quantities of the neutron star are included using an equation of state below and above the nuclear matter density. We adopt an equation of state and construct an approximate network that saves computational time and calculates nuclear energy generation rates accompanying the abundance evolutions. The mass and radius of the neutron star are found by solving the stellar evolution equations from the center to the surface; this involves necessary information such as the nuclear energy generation in accreting layers, heating from the crust, and neutrino emissions inside the stellar core. We reproduce the light curve and recurrence time of the X-ray burst from GS 1826$-$24 within the standard deviation of 1$\sigma$ for the assumed accretion rate, metallicity, and equation of state. It is concluded that the observed recurrence time is consistent with the theoretical model with metallicity of the initial CNO elements $Z_{\rm CNO} = 0.01$. We suggest that the nuclear reaction rates responsible for the $rp$-process should be examined in detail, because the rates may change the shape of the light curve and our conclusion.
A novel formulation of the primordial black hole mass function
Authors: Suyama Teruaki , Yokoyama Shuichiro
Published: January 2020

Computations of the primordial black hole (PBH) mass function discussed in the literature have conceptual issues. They stem from the fact that the mass function is a differential quantity and the standard criterion of the PBH formation from the seed primordial fluctuations cannot be directly applied to the computation of the differential quantities. We propose a new criterion of the PBH formation, which is the addition of one extra condition to the existing one. By doing this, we derive a formal expression of the PBH mass function without introducing any ambiguous interpretations that exist in the previous studies. Once the underlying primordial fluctuations are specified, the PBH mass function can be in principle determined by the new formula. As a demonstration of our formulation, we compute the PBH mass function analytically for the case where the perturbations are Gaussian and the space is 1 dimension.
Integrating Motivational Interviewing in Pain Neuroscience Education for People With Chronic Pain: A Practical Guide for Clinicians
Authors: Nijs Jo , Wijma Amarins J , Willaert Ward , Huysmans Eva , Mintken Paul , Smeets Rob , Goossens Mariëlle , van Wilgen C Paul , Van Bogaert Wouter , Louw Adriaan , Cleland Josh , Donaldson Megan
Published: January 2020

Pain neuroscience education (PNE) and motivational interviewing (MI) have been widely implemented and tested in the field of chronic pain management, and both strategies have been shown to be effective in the short term (small effect sizes) for the management of chronic pain. PNE uses contemporary pain science to educate patients about the biopsychosocial nature of the chronicity of their pain experience. The goal of PNE is to optimize patients’ pain beliefs/perceptions to facilitate the acquisition of adaptive pain–coping strategies. MI, on the other hand, is a patient-centered communication style for eliciting and enhancing motivation for behavior change by shifting the patient away from a state of indecision or uncertainty. Conceptually, PNE and MI appear to be complementary interventions, with complementary rather than overlapping effects; MI primarily improves cognitive and behavioral awareness and, potentially, adherence to treatment principles, whereas PNE potentially increases pain knowledge/beliefs, awareness, and willingness to explore psychological factors that are potentially associated with pain. Therefore, combining PNE with MI might lead to improved outcomes with larger and longer-lasting effect sizes. The combined use of PNE and MI in patients having chronic pain is introduced here, along with a description of how clinicians might be able to integrate PNE and MI in the treatment of patients experiencing chronic pain. Clinical trials are needed to examine whether combining PNE with MI is superior to PNE or MI alone for improving pain and quality of life in patients having chronic pain.
The reliability of immunoassays to detect autoantibodies in patients with myositis is dependent on autoantibody specificity
Authors: Tansley Sarah L , Li Danyang , Betteridge Zoe E , McHugh Neil J
Published: January 2020

Objectives

In order to address the reliability of commercial assays to identify myositis-specific and -associated autoantibodies, we aimed to compare the results of two commercial immunoassays with the results obtained by protein immunoprecipitation.

Methods

Autoantibody status was determined using radio-labelled protein immunoprecipitation for patients referred to our laboratory for myositis autoantibody characterization. For each autoantibody of interest, the sera from 25 different patients were analysed by line blot (Euroline Myositis Antigen Profile 4, EuroImmun, Lübeck, Germany) and dot blot (D-Tek BlueDiver, Diagnostic Technology, Belrose, NSW, Australia). Sera from 134 adult healthy controls were analysed.

Results

Overall commercial assays performed reasonably well, with high agreement (Cohen’s κ >0.8). Notable exceptions were the detection of rarer anti-synthetases with κ < 0.2 and detection of anti-TIF1γ, where κ was 0.70 for the line blot and 0.31 for dot blot. Further analysis suggested that the proportion of patients with anti-TIF1γ may recognize a conformational epitope, limiting the ability of blotting-based assays that utilize denatured antigen to detect this clinically important autoantibody. A false-positive result occurred in 13.7% of samples analysed by line blot and 12.1% analysed by dot blot.

Conclusion

The assays analysed do not perform well for all myositis-specific and -associated autoantibodies and overall false positives are relatively common. It is crucial that clinicians are aware of the limitations of the methods used by their local laboratory. Results must be interpreted within the clinical context and immunoprecipitation should still be considered in selected cases, such as apparently autoantibody-negative patients where anti-synthetase syndrome is suspected.
Habitual physical activity patterns in a nationally representative sample of U.S. adults
Authors: Malone Susan K , Patterson Freda , Grunin Laura , Melkus Gail D , Riegel Barbara , Punjabi Naresh , Yu Gary , Urbanek Jacek , Crainiceanu Ciprian , Pack Allan
Published: January 2020

Physical inactivity is a leading determinant of noncommunicable diseases. Yet, many adults remain physically inactive. Physical activity guidelines do not account for the multidimensionality of physical activity, such as the type or variety of physical activity behaviors. This study identified patterns of physical activity across multiple dimensions (e.g., frequency, duration, and variety) using a nationally representative sample of adults. Sociodemographic characteristics, health behaviors, and clinical characteristics associated with each physical activity pattern were defined. Multivariate finite mixture modeling was used to identify patterns of physical activity among 2003–2004 and 2005–2006 adult National Health and Nutrition Examination Survey participants. Chi-square tests were used to identify sociodemographic differences within each physical activity cluster and test associations between the physical activity clusters with health behaviors and clinical characteristics. Five clusters of physical activity patterns were identified: (a) low frequency, short duration (n = 730, 13%); (b) low frequency, long duration (n = 392, 7%); (c) daily frequency, short duration (n = 3,011, 55%); (d) daily frequency, long duration (n = 373, 7%); and (e) high frequency, average duration (n = 964, 18%). Walking was the most common form of activity; highly active adults engaged in more varied types of activity. High-activity clusters were comprised of a greater proportion of younger, White, nonsmoking adult men reporting moderate alcohol use without mobility problems or chronic health conditions. Active females engaged in frequent short bouts of activity. Data-driven approaches are useful for identifying clusters of physical activity that encompass multiple dimensions of activity. These activity clusters vary across sociodemographic and clinical subgroups.
Differential Susceptibility of Xylella fastidiosa Strains to Synthetic Bactericidal Peptides
Authors: Baró Aina , Mora Isabel , Montesinos Laura , Montesinos Emilio
Published: January 2020

The kinetics of cell inactivation and the susceptibility of Xylella fastidiosa subspecies fastidiosa, multiplex, and pauca to synthetic antimicrobial peptides from two libraries (CECMEL11 and CYCLO10) were studied. The bactericidal effect was dependent on the relative concentrations of peptide and bacterial cells, and was influenced by the diluent, either buffer or sap. The most bactericidal and lytic peptide was BP178, an enlarged derivative of the amphipathic cationic linear undecapeptide BP100. The maximum reduction in survivors after BP178 treatment occurred within the first 10 to 20 min of contact and at micromolar concentrations (<10 μM), resulting in pore formation in cell membranes, abundant production of outer membrane vesicles, and lysis. A threshold ratio of 109 molecules of peptide per bacterial cell was estimated to be necessary to initiate cell inactivation. There was a differential susceptibility to BP178 among strains, with DD1 being the most resistant and CFBP 8173 the most susceptible. Moreover, strains showed a proportion of cells under the viable but nonculturable state, which was highly variable among strains. These findings may have implications for managing the diseases caused by X. fastidiosa.
The role of atopy in asthma development and persistence
Authors: Di Cicco Maria , D’Elios Sofia , Peroni Diego G. , Comberiati Pasquale
Published: January 2020

Purpose of review

Asthma is the most common chronic disease in pediatric age. Childhood-onset asthma, as opposed to adult-onset asthma, is typically characterized by a personal and often a family history of atopy and related markers of type 2-mediated inflammation. However, the interplay between atopy and asthma development is more complex than a linear dose–response relationship.

Recent findings

Family and personal history of atopic diseases have been confirmed as major risk factors for asthma occurrence and persistence in children. Early life and multiple sensitizations to aeroallergens significantly increase the risk of asthma development in school age. Early life lower respiratory tract viral infections, especially caused by rhinovirus, also increase the susceptibility to atopic asthma in childhood. Human rhinovirus type C receptor CDHR3 polymorphisms have been shown to affect receptor epithelial expression, activation, and asthma development and exacerbation severity in children. Atopic sensitization and respiratory viral infections can synergistically enhance the susceptibility to asthma through multiple mechanisms, including the IgE-mediated inhibition of innate antiviral responses to rhinovirus. Emerging evidence shows that several nonatopic factors are also involved in the asthma pathogenesis in genetically predisposed individuals, including early life exposure to environmental factors, and lung and gut microbiome composition.

The current review outlines recent data on the complex role of atopy in asthma pathogenesis and persistence, and addresses new research topics such as the role of epigenetics and the lung microbiome.
Percutaneous Surgery for Mild to Severe Hallux Valgus
Authors: Robinson Peter W. , Lam Peter
Published: January 2020

Percutaneous surgery for hallux valgus correction is increasing in popularity. Third generation techniques under image intensifier control, with rigid internal fixation have improved the reproducibility and reliability of this technique. Percutaneous hallux valgus surgery has been shown to decrease immediate and early postoperative pain compared with open distal osteotomies, with comparable patient reported outcome scores. The transverse osteotomy, under image intensifier guidance gives complete control of metatarsal head correction in all planes of movement. The stability relies on rigid fixation of the first screw in both medial and lateral cortices of the first metatarsal shaft. Accurate screw placement is crucial. Rigid internal fixation allows early full weight-bearing and range of motion exercises, ensuring early return to function. The dorsomedial eminence must be removed to prevent ongoing discomfort. The technique including tips and tricks is described in detail.

Level of Evidence: Level II.
Vecuronium- and Esmolol-Induced Pseudohypernatremia Due to Drug Interference With Ion-Selective Electrodes
Authors: Polsky Tracey G. , Salmon Eloise , Welsh Sarah S. , Lim Derick , Feng Sheng , Ballester Lance , Ehlayel Abdulla M. , Hewlett Jennifer L. , Denburg Michelle R. , Boyer Donald L. , Beier Ulf H.
Published: January 2020

Objectives:

We observed that patients treated with continuous vecuronium or esmolol infusions showed elevated plasma sodium measurements when measured by the routine chemistry analyzer as part of the basic metabolic panel (Vitros 5600; Ortho Clinical Diagnostics, Raritan, NJ), but not by blood gas analyzers (RAPIDLab 1265; Siemens, Tarrytown, NY). Both instruments use direct ion-selective electrode technology, albeit with different sodium ionophores (basic metabolic panel: methyl monensin, blood gas: glass). We questioned if the basic metabolic panel hypernatremia represents artefactual pseudohypernatremia.

Design:

We added vecuronium bromide or esmolol hydrochloric acid to pooled plasma samples and compared sodium values measured by both methodologies. We queried sodium results from the electronic medical records of patients admitted at Children’s Hospital of Philadelphia from 2016 to 2018 and received vecuronium and/or esmolol infusion treatment during their admissions.

Setting:

PICU of a quaternary, free-standing children’s hospital.

Patients:

Children admitted to the hospital who received vecuronium and/or esmolol infusion.

Measurements and Main Results:

Sodium was measured in pooled plasma samples by basic metabolic panel and blood gas methodologies after adding vecuronium bromide or esmolol hydrochloric acid, leading to a dose-response increase in basic metabolic panel sodium measurements. A repeated measures regression analysis of our electronic medical records showed that the vecuronium dose predicted the Δ sodium (basic metabolic panel–blood gas) sodium within 12 hours of the vecuronium administration (p < 0.0018). Esmolol showed a similar trend (p = 0.13). This occurred primarily in central line samples with continuous vecuronium or esmolol infusions.

Conclusions:

Vecuronium and esmolol can falsely elevate direct ion-selective electrode sodium measurements on Vitros chemistry analyzers. Unexpectedly high sodium measurements in patients receiving vecuronium and/or esmolol infusions should be further investigated with an alternate sample type (i.e., peripheral blood) or measurement methodology (i.e., blood gas) to guide treatment decisions.
Inhaled Tranexamic Acid As a Novel Treatment for Pulmonary Hemorrhage in Critically Ill Pediatric Patients: An Observational Study
Authors: O’Neil Erika R. , Schmees Lindsay R. , Resendiz Karla , Justino Henri , Anders Marc M.
Published: January 2020

Objectives:

To describe the use of inhaled or endotracheally instilled tranexamic acid in critically ill pediatric patients for the treatment of pulmonary hemorrhage, which can be severe, life-threatening, and include potentially high-risk management procedures.

Design:

Retrospective observational study from 2011-2018 with patients followed until hospital discharge.

Setting:

Free-standing children’s hospital with an annual ICU volume of more than 3,500 yearly admissions.

Patients:

Pediatric patients, ages 0 to 18 years, admitted to an ICU and who received at least one dose of inhaled or endotracheally instilled tranexamic acid were included.

Interventions:

Inhaled or endotracheally instilled tranexamic acid.

Measurements and Main Results:

This study described the efficacy and adverse effects of patients who received inhaled or endotracheally instilled tranexamic acid. A total of 19 patients met inclusion criteria; median age was 72 months (11–187 mo), most patients were female (11, 58%), and almost half our patients (8, 42%) had congenital heart disease. Nine of 19 encounters (47%) had diffuse alveolar hemorrhage, four (21%) had pulmonary hemorrhage related to major aortopulmonary collateral arteries, two (11%) had mucosal airway bleeding, two (11%) were iatrogenic, one had a pulmonary embolism, and one patient did not have their etiology of pulmonary hemorrhage determined. Cessation of pulmonary hemorrhage was achieved in 18 of 19 patients (95%) with inhaled tranexamic acid with no major adverse events recorded.

Conclusions and Relevance:

We demonstrate that inhaled tranexamic acid may be safely used to treat pulmonary hemorrhage from varied etiologies in critically ill pediatric patients. Prospective studies are required in this vulnerable population to determine optimal dosing and delivery strategies, as well as to define any differential effect according to etiology.
Does Transcatheter Aortic Valve Implantation for Aortic Stenosis Impact on Cognitive Function?
Authors: Gu Sophie , Coakley Daniel , Chan Danny , Beska Benjamin , Singh Fateh , Edwards Richard , Kunadian Vijay
Published: January 2020

Aortic stenosis (AS) is the most common valvular heart disease among elderly patients in developed countries. Surgical valve replacement is indicated for severe AS to relieve the obstructed outflow tract. Transcatheter aortic valve implantation (TAVI) has emerged as an alternative for patients with severe AS, particularly in those with high surgical risk. TAVI is a less invasive approach with favorable survival outcomes in high-risk patients compared with open surgery. Despite the remarkable success of TAVI, there is a growing concern on the incidence of postprocedural cognitive impairment. This review aims to evaluate the incidence of cognitive impairment following TAVI and to identify the potential contributing factors.
Mineralocorticoid Receptor Antagonist Use in Heart Failure With Reduced Ejection Fraction and End-Stage Renal Disease Patients on Dialysis
Authors: Bhinder Jasjit , Patibandla Saikrishna , Gupta Chhaya A. , Levine Avi , Gass Alan L. , Lanier Gregg M.
Published: January 2020

Mineralocorticoid receptor antagonists (MRAs) are known to have a proven mortality benefit in heart failure with reduced ejection fraction (HFrEF) without kidney disease. As patients with end-stage renal disease (ESRD) requiring either peritoneal dialysis or hemodialysis were excluded in clinical trials of HFrEF, the data are scant on the appropriate use of MRAs in this population. The unknown efficacy, along with concerns of adverse effects such as hyperkalemia, has limited the willingness of clinicians to consider using MRAs in these patients. However, it is unclear whether the risk of hyperkalemia is present if a patient is oliguric or anuric. Current guidelines recommend against the use of MRAs in patients with chronic kidney disease, but do not address the use of MRAs in patients requiring dialysis. This article will review the epidemiology of heart failure in ESRD, the pathophysiological derangements of the renin–angiotensin–aldosterone system in patients with kidney disease, and the results from case series and trials of the use of MRAs in ESRD with HFrEF. Although limited to several small trials using MRAs in peritoneal and hemodialysis patients with or without HFrEF, the current literature appears to show the potential for clinical benefits with little risk.
Biomarkers of Aortopathy in Marfan Syndrome
Authors: Iskandar Zaid , Mordi Ify , Lang Chim C. , Huang Jeffrey T. J. , Choy Anna-Maria
Published: January 2020

Marfan Syndrome (MFS) is an autosomal dominant, genetically inherited connective tissue disorder which primarily affects the cardiovascular system, but can also have systemic manifestations. First described in 1896, MFS has a prevalence of around 1/5000 in the general population. It is becoming increasingly common to see patients with MFS in a clinical setting due to the improved care of patients with adult congenital heart disease and general improvement in survival. Mortality, however, remains high largely due to the risk of aortic dissection as a result of the aortic root dilatation frequently seen in these patients. Contemporary management has therefore been focused on imaging-based surveillance to prevent these catastrophic events and intervene surgically in a timely manner. However, it is increasingly recognized that some patients do suffer aortic dissection below the expected threshold for surgical intervention. With this in mind, there has been interest in the role of biomarkers as an adjunct to imaging in the care of these patients. This article will provide an overview of the literature on potential biomarkers studied so far in MFS, as well as potential future directions.
Comprehensive Review of Cardiovascular Diseases, Diabetes, and Hypercholesterolemia in Lebanon
Authors: Jelwan Yara A. , Asbeutah Abdul Aziz A. , Welty Francine K.
Published: January 2020

The Middle East and North Africa regions, including Lebanon, have recently witnessed rapid urbanization and modernization over the last couple of decades that has led to a dramatic transformation affecting lifestyle and diet. The World Health Organization reports that the leading cause of death in Lebanon is due to cardiovascular disease (CVD) at 47% of all-cause mortality. Over the last 30 years, especially the last 10, the population of Lebanon has changed dramatically due to the effect of wars in the region and refugees seeking asylum. With a population of around 4.5 million and a relatively high rate of consanguinity in Lebanon, a variety of novel mutations have been discovered explaining several familial causes of hypercholesterolemia, diabetes mellitus, congenital heart disease, and cardiomyopathies. Due to the Syrian civil war, 1.5 million Syrian refugees now reside in Lebanon in either low-income housing or tented settlements. A National Institutes of Health study is examining diabetes and CVD in Syrian refugees in comparison to native Lebanese. We provide the first review of CVD in Lebanon in its metabolic component including coronary artery disease and its risk factors, mainly hyperlipidemia and diabetes mellitus, and its structural component, including congenital heart disease, valvular heart disease, cardiomyopathies, and heart failure. The knowledge in this review has been compiled to guide clinicians and assist researchers in efforts to recognize risk factors for disease, improve delivery of health care, and prevent and treat CVDs in Lebanon, both for the native Lebanese and Syrian refugees.
The Cumulative Effect of Prior Maltreatment on Emotional and Physical Health of Children in Informal Kinship Care
Authors: Lee Eunju , Kramer Catherine , Choi Mi Jin , Pestine-Stevens Althea , Huang Yufan
Published: January 2020

Objective:

Millions of children cared for by their grandparents or other kin without a biological parent present are not part of the foster care system. Maltreatment may have precipitated out-of-home care arrangements, but most children in informal kinship care are not being tracked or receiving services. Importantly, the extent of previous child welfare involvement and its association with well-being among this population are not well known.

Methods:

Kinship caregivers known to social service and community agencies were recruited for this study. Caregivers who agreed to participate rated the physical and emotional health of children under their care. Maternal mental health and demographic data were collected, and matched records of children were retrieved from the state child welfare database. The nested structure of children within families was addressed using a generalized estimating equation model.

Results:

The sample included 365 children from 274 families. Only 25% of the children were in private kinship care with no known Child Protective Services (CPS) involvement. An average of 2.37 open CPS cases were observed for those in voluntary kinship care. One out of 4 children scored below the clinical level of emotional health. The number of CPS cases and kin caregiver's parenting stress were inversely associated with child's physical and emotional health. The presence of maternal mental health problem was significantly associated with poor child emotional well-being.

Conclusion:

Many children in informal kinship care experienced multiple episodes of maltreatment. This study's results add further evidence of the cumulative negative effects of child maltreatment on child well-being. Children in informal kinship care are in need of services to mitigate their traumatic experiences.
A High Plasma Lamotrigine Concentration at Week 2 as a Risk Factor for Lamotrigine-Related Rash
Authors: Suzuki Takeshi , Mihara Kazuo , Nagai Goyo , Kagawa Shoko , Nakamura Akifumi , Nemoto Kenji , Kondo Tsuyoshi
Published: January 2020

Background:

Reportedly, a high plasma concentration of lamotrigine plays a role in the development of lamotrigine-related rash. The relationship between plasma concentrations of lamotrigine at week 2 and the lamotrigine-related rash was prospectively studied in 84 patients (22 males and 62 females) with treatment-resistant depressive disorder during an 8-week treatment of lamotrigine augmentation.

Methods:

Eighty-four depressed patients with an insufficient response to at least 3 psychotropics, including antidepressants, mood stabilizers, and atypical antipsychotics, were included. The diagnoses were major depressive disorder (n = 39), bipolar I disorder (n = 10), and bipolar II disorder (n = 35). The final doses of lamotrigine were 100 mg/d for 57 subjects who were not taking valproate and 75 mg/d for 27 subjects taking valproate. Blood sampling was performed at week 2. Lamotrigine plasma concentrations were measured using high-performance liquid chromatography. The development of lamotrigine-related rash was assessed during the 8-week treatment.

Results:

Six females developed lamotrigine-related rash. The mean plasma lamotrigine concentrations at week 2 were significantly (P = 0.009) higher in the rash group (4.81 ± 1.23 μmol/L) than in the nonrash group (3.35 ± 1.39 μmol/L). Receiver-operating characteristic analysis indicated that a plasma lamotrigine concentration of 4.38 μmol/L or greater at week 2 was significantly (P < 0.0001) predictive of lamotrigine-related rash. The proportion of patients with a lamotrigine concentration of 4.38 μmol/L or greater was significantly divided by the cutoff point into the rash group and the nonrash group (5/1 versus 13/65, P = 0.001).

Conclusions:

This study suggests that a high plasma lamotrigine concentration during week 2 is a risk factor for lamotrigine-related rash and a plasma lamotrigine concentration of 4.38 μmol/L may be a considered a threshold for rash in treatment-resistant depressive disorder.
CHANGES IN CHORIOCAPILLARIS, SATTLER, AND HALLER LAYER THICKNESSES IN CENTRAL SEROUS CHORIORETINOPATHY AFTER HALF-FLUENCE PHOTODYNAMIC THERAPY
Authors: Flores-Moreno Ignacio , Arcos-Villegas Gabriel , Sastre Marina , Ruiz-Medrano Jorge , Arias-Barquet Luis , Duker Jay S. , Ruiz-Moreno José M.
Published: January 2020

Purpose:

To determinate the variation in thickness of the individual choroidal layers in patients with central serous chorioretinopathy treated with half-fluence photodynamic therapy.

Methods:

Twenty-two eyes were evaluated with spectral-domain optical coherence tomography. The images were taken before photodynamic therapy, 3 months, and 6 months after the treatment. Two investigators performed these measurements: 1) choroidal thickness (CT), 2) Haller layer thickness, defined as the most external layer containing a 100-μm vessel, and 3) choriocapillaris + Sattler layer (C&S). Nine measurements were taken in the macular region.

Results:

Choroidal thickness before photodynamic therapy was 471.8 µm ± 145.8. The Haller layer was 358.4 µm ± 122.6, and C&S was 114.3 µm ± 27.8. At 3-month follow-up, CT was 441.1 µm ± 150.7, Haller layer 348.8 µm ± 127.6, and C&S 92.4 µm ± 27.9. At 6-month follow-up, CT was 420.4 µm ± 118.4, Haller layer 331.8 µm ± 97.2, and C&S 89.5 µm ± 28.0. Using a multilevel mixed-effects linear regression, CT was found to be reduced at both 3 months (P < 0.03) and at 6 months (P < 0.001), Haller layer showed no significant reduction at 3 months (P = 0.483) or at 6 months (P = 0.055), and C&S showed reduction at 3 months (P < 0.001) and at 6 months (P < 0.001). Fellow nonaffected eyes showed no statistical variation at 3-month and 6-month follow-up.

Conclusion:

Reduction in CT in patients affected by central serous chorioretinopathy after half-fluence photodynamic therapy occurs primarily in the choriocapillaris and medium diameter vessel layers of the choroid in a short- and medium-term follow-up.
Femtosecond laser-integrated anterior segment optical coherence tomography to detect preexisting posterior capsular dehiscence and increase safety in posterior polar cataracts
Authors: Sachdev Mahipal S. , Malik Raghav , Gupta Hemlata , Sachdev Ritika , Sachdev Gitansha Shreyas
Published: January 2020

Purpose:

To determine the efficacy of the femtosecond laser with integrated anterior segment optical coherence tomography (AS-OCT) for the detection of posterior capsular dehiscence in posterior polar cataracts (PPCs). To evaluate the safety of phacoemulsification in these eyes undergoing femtosecond laser–assisted cataract surgery (FLACS).

Setting:

Centre For Sight Group of Eye Hospitals, a chain of tertiary eyecare hospitals in India.

Design:

Prospective interventional case series.

Methods:

The study included eyes with PPCs undergoing FLACS using the CATALYS femtosecond platform. Real-time OCT guidance was used to image the posterior capsule (PC), which was then classified as intact or dehiscent. The femtosecond laser was used for the creation of capsulotomy, nuclear fragmentation, and corneal incisions. In all eyes, the posterior offset (distance between the posterior extent of nucleotomy and the PC) was increased to enable a thick epinuclear cushion. Intraoperative status of the PC was noted, and the specificity and the sensitivity of AS-OCT to detect a preexisting posterior capsular defect was determined.

Results:

The cohort included 50 eyes (40 patients), in which a posterior capsular discontinuity on AS-OCT was observed in 7 eyes (14%). Five (10%) of these 7 eyes developed an intraoperative posterior capsular rent (PCR) A sensitivity and negative predictive value of 100% was noted. No case of nucleus drop was noted.

Conclusions:

Femtosecond laser with integrated AS-OCT is a relevant and helpful tool to detect and increase the safety in preexisting posterior capsular dehiscence, alerting the surgeon ahead of phacoemulsification.