bluuebunny/crossref_metadata_2025 huggingface dataset:
Electoral Rules, Interest Group Pressures, and the Price of Democratic Default
Authors: Connell Brendan J
Published: August 2019

Conventional wisdom dictates that democracies are reliable in upholding their international commitments. However, this assertion is at odds with democratic behavior in sovereign borrowing where democracies have sometimes imposed considerable losses on foreign creditors. Why do some democracies choose to renege on extremely large portions of their sovereign debt during economic crisis? This article argues that costs incurred by creditors are dependent on how the borrowing state's electoral system aggregates competing domestic economic interests. Internationally oriented economic interests prefer to minimize creditor losses since sizeable debt reductions are more likely to compromise access to foreign credit. Conversely, workers and domestic-oriented economic interests prefer to maximize losses faced by foreign creditors in order to ease the costs of austerity at home. By shaping the political incentives of policymakers, I argue that democracies with candidate-centric electoral systems should be associated with sovereign defaults that are less costly for foreign creditors. Under these electoral systems, governments hold incentives to cater primarily to internationally oriented economic interests that are best able to overcome the costs of collective action. Statistical evidence from 53 sovereign debt restructurings between 1978 and 2012 supports the main argument.
Boilerplate in International Trade Agreements
Authors: Peacock Claire , Milewicz Karolina , Snidal Duncan
Published: August 2019

New international agreements often recycle language from previous agreements, using boilerplate solutions alongside customized provisions. The presence of boilerplate in international agreements has important implications for understanding how international rules are made. The determinants behind boilerplate in international agreements have not previously been systematically evaluated. Using original data from a sample of 348 preferential trade agreements (PTAs) adopted between 1989 and 2009, we combine novel text analysis measures with Latent Order Logistic (LOLOG) graph network techniques to assess the determinants behind boilerplate in labor and environmental provisions commonly found in PTAs. Our results indicate that whereas boilerplate can be used for both efficiency and distributive purposes, international boilerplate is used primarily for efficiency gains and power-distribution considerations are not systematically important.
Celecoxib potentiates antibiotic uptake by altering membrane potential and permeability in Staphylococcus aureus
Authors: Varma Gajapati Y N , Kummari Githavani , Paik Pradip , Kalle Arunasree M
Published: August 2019

Background

We have shown previously that celecoxib enhances the antibacterial effect of antibiotics and has sensitized drug-resistant bacteria to antibiotics at low concentrations using in vitro and in vivo model systems and also using clinically isolated ESKAPE pathogens.

Objectives

To identify the mechanism of action of celecoxib in potentiating the effect of antibiotics on bacteria.

Methods

Toxicogenomic expression analysis of Staphylococcus aureus in the presence or absence of ampicillin, celecoxib or both was carried out by microarray followed by validation of microarray results by flow cytometry and real-time PCR analysis, cocrystal development and analysis.

Results

The RNA expression map clearly indicated a change in the global transcriptome of S. aureus in the presence of cells treated with ampicillin alone, which was similar to that of celecoxib-treated cells in co-treated cells. Several essential, non-essential and virulence genes such as α-haemolysin (HLA), enterotoxins and β-lactamase were differentially regulated in co-treated cells. Further detailed analysis of the expression data indicated that the ion transporters and enzymes of the lipid biosynthesis pathway were down-regulated in co-treated cells leading to decreased membrane permeability and membrane potential. Cocrystal studies using Powder-X-Ray Diffraction (PXRD) and differential scanning calorimetry (DSC) indicated interactions between celecoxib and ampicillin, which might help in the entry of antibiotics.

Conclusions

Although further studies are warranted, here we report that celecoxib alters membrane potential and permeability, specifically by affecting the Na+/K+ ion transporter, and thereby increases the uptake of ampicillin by S. aureus.
Individual Criminal Liability for Arms Exports under the ICC Statute
Authors: Bryk Linde , Saage-Maaß Miriam
Published: August 2019

Cases against corporate managers for their involvement in international crimes are rare. Still, legal precedent from the Nuremberg trials and more recent cases in national jurisdictions shows that corporate officers of arms manufacturing companies may be liable under international criminal law (ICL) when exported arms are used for the commission of war crimes. This article examines the circumstances under which corporate officers responsible for weapons exports can be criminally liable as accomplices to war crimes under Article 25(3)(c) of the Statute of the International Criminal Court (ICC). To corroborate our analysis, we use the case study of European arms exports to members of the Saudi-led coalition in Yemen. There is evidence that this coalition has been committing war crimes in Yemen since 2015. Despite factual difficulties and legal complexities such as the mens rea standard of Article 25(3)(c) ICC Statute, we argue that corporate officers involved in arms exports may be individually liable, depending on their contribution to the commission of war crimes; their knowledge and awareness of the consequences of the provision of arms due to the abundance of information in the public domain; and the international standards for corporate human rights due diligence that apply to their specific business activities.
Is sequential free flap safe in oral cancer reconstruction in the same patient? An outcome and complication analysis
Authors: Chiu Wen-Kuan , Chou Chang-Yi , Chen Shyi-Gen , Chen Chiehfeng , Wang Hsian-Jenn , Yang Ten-Fang
Published: August 2019

Background

Sequential free flap reconstruction in patient with head and neck cancer can provide reliable and effective wound coverage. Only a few studies have reported on the outcome and complications analysis but without consensus on the recipient vessels and flap chosen. Herein, we presented the outcome and analysed the risk factors for complications in sequential free flap reconstruction.

Patients and methods

Patients who had sequential free tissue transfers due to cancer recurrence, second primary cancer, or secondary correction of the soft tissue contractures and volume deficits were all included. Variables extracted included demographics, comorbidities, free flap characteristics, infection, dehiscence and flap necrosis rates.

Results

In total, 40 patients with 92 free flaps were analyzed; 42 initial and 50 sequential free flaps. The most common recipient vessels for sequential flap were contralateral superficial thyroid vessels (68%). The most common flap for both initial and sequential free flap was anterolateral thigh flap (64.3 and 62%). The success rate of sequential free flap was 92.0 compared to 92.9% for initial free flap, which showed no significant difference. Female was independently associated with delayed wound healing with an odds ratio of 90.91 (95% confidence interval 0.001–0.17, P = 0.001), as well as diabetes with an odds ratio of 31.14 (95% confidence interval 2.60–373.19, P = 0.007). Sequential free flap was not a risk factor for any complication.

Conclusions

Sequential free flap is a reliable method for head and neck surgery without more complication rate comparing to initial free flap reconstruction. More attentions should be paid on patients with preferential risk for certain complications.
Screening Mammography Outcomes: Risk of Breast Cancer and Mortality by Comorbidity Score and Age
Authors: Demb Joshua , Abraham Linn , Miglioretti Diana L , Sprague Brian L , O’Meara Ellen S , Advani Shailesh , Henderson Louise M , Onega Tracy , Buist Diana S M , Schousboe John T , Walter Louise C , Kerlikowske Karla , Braithwaite Dejana ,   for the Breast Cancer Surveillance Consortium
Published: August 2019

Background

Potential benefits of screening mammography among women ages 75 years and older remain unclear.

Methods

We evaluated 10-year cumulative incidence of breast cancer and death from breast cancer and other causes by Charlson Comorbidity Index (CCI) and age in the Medicare-linked Breast Cancer Surveillance Consortium (1999–2010) cohort of 222 088 women with no less than 1 screening mammogram between ages 66 and 94 years.

Results

During median follow-up of 107 months, 7583 were diagnosed with invasive breast cancer and 1742 with ductal carcinoma in situ; 471 died from breast cancer and 42 229 from other causes. The 10-year cumulative incidence of invasive breast cancer did not change with increasing CCI but decreased slightly with age: ages 66–74 years (CCI0 = 4.0% [95% CI = 3.9% to 4.2%] vs CCI  ≥ 2 = 3.9% [95% CI = 3.5% to 4.3%]); ages 75–84 years (CCI0 = 3.7% [95% CI = 3.5% to 3.9%] vs CCI  ≥ 2 = 3.4% [95% CI = 2.9% to 3.9%]); and ages 85–94 years (CCI0 = 2.7% [95% CI = 2.3% to 3.1%] vs CCI  ≥ 2 = 2.1% [95% CI = 1.3% to 3.0%]). The 10-year cumulative incidence of other-cause death increased with increasing CCI and age: ages 66–74 years (CCI0 = 10.4% [95% CI = 10.3 to 10.7%] vs CCI ≥ 2 = 43.4% [95% CI = 42.2% to 44.4%]), ages 75–84 years (CCI0 = 29.8% [95% CI = 29.3% to 30.2%] vs CCI ≥ 2 = 61.7% [95% CI = 60.2% to 63.3%]), and ages 85 to 94 years (CCI0 = 60.3% [95% CI = 59.1% to 61.5%] vs CCI  ≥ 2 = 84.8% [95% CI = 82.5% to 86.9%]). The 10-year cumulative incidence of breast cancer death was small and did not vary by age: ages 66–74 years = 0.2% (95% CI = 0.2% to 0.3%), ages 75–84 years = 0.29% (95% CI = 0.25% to 0.34%), and ages 85 to 94 years = 0.3% (95% CI = 0.2% to 0.4%).

Conclusions

Cumulative incidence of other-cause death was many times higher than breast cancer incidence and death, depending on comorbidity and age. Hence, older women with increased comorbidity may experience diminished benefit from continued screening.
Multicenter Validation of the CamGFR Model for Estimated Glomerular Filtration Rate
Authors: Williams Edward H , Connell Claire M , Weaver James M J , Beh Ian , Potts Harry , Whitley Cameron T , Bird Nicholas , Al-Sayed Tamer , Monaghan Phillip J , Fehr Martin , Cathomas Richard , Bertelli Gianfilippo , Quinton Amy , Lewis Paul , Shamash Jonathan , Wilson Peter , Dooley Michael , Poole Susan , Mark Patrick B , Bookman Michael A , Earl Helena , Jodrell Duncan , Tavaré Simon , Lynch Andy G , Janowitz Tobias
Published: August 2019

Important oncological management decisions rely on kidney function assessed by serum creatinine–based estimated glomerular filtration rate (eGFR). However, no large-scale multicenter comparisons of methods to determine eGFR in patients with cancer are available. To compare the performance of formulas for eGFR based on routine clinical parameters and serum creatinine not calibrated with isotope dilution mass spectrometry, we studied 3620 patients with cancer and 166 without cancer who had their glomerular filtration rate (GFR) measured with an exogenous nuclear tracer at one of seven clinical centers. The mean measured GFR was 86 mL/min. Accuracy of all models was center dependent, reflecting intercenter variability of isotope dilution mass spectrometry–creatinine measurements. CamGFR was the most accurate model for eGFR (root-mean-squared error 17.3 mL/min) followed by the Chronic Kidney Disease Epidemiology Collaboration model (root-mean-squared error 18.2 mL/min).
NLRC4 Mutation in flagellin-derived peptide CBLB502 ligand-binding domain reduces the inflammatory response but not radioprotective activity
Authors: Lai Lili , Yang Ganggang , Yao Xuelian , Wang Lei , Zhan Yiqun , Yu Miao , Yin Ronghua , Li Changyan , Yang Xiaoming , Ge Changhui
Published: August 2019

Bacterial flagellin is a pathogen-associated molecular pattern recognized by surface-localized Toll-like receptor 5 (TLR5) and cytosolic NOD-like receptor protein 4 (NLRC4). CBLB502, derived from Salmonella flagellin, exhibits high radioprotective efficacy in mice and primates by regulating TLR5 and the nuclear factor kappa B (NF-κB) signaling pathway. In this study, we examined the effects of CBLB502 and mutations in its NLRC4- and TLR5-binding domains on radioprotective efficacy and the immune inflammatory response. The results showed that CBLB502 mutation with I213A in the TLR5-binding domain significantly reduced NF-κB activity and radioprotective activity, whereas CBLB502 mutation with L292A in NLRC4-binding domain did not. Additionally, CBLB502 with both mutations greatly reduced NF-κB activity and eliminated radioprotection in mice. In contrast, NLRC4-binding domain mutation reduced the secretion of inflammatory interleukin-1β and interleukin-18. CBLB502 exerts its radioprotective effects through both the TLR5 and NLRC4 pathways. Additionally, deletion in the NLRC4-binding domain did not reduce radioprotective activity but reduced the inflammatory response.
Numerical simulations of wind-driven protoplanetary nebulae. II. signatures of atomic emission
Authors: Novikov Igor , Smith Michael
Published: August 2019

We follow up on our systematic study of axisymmetric hydrodynamic simulations of protoplanetary nebula. The aim of this work is to generate the atomic analogues of the H2 near-infrared models of Paper I with the ZEUS code modified to include molecular and atomic cooling routines. We investigate stages associated with strong $\mathrm{[Fe\, {\small II}] \, 1.64\, \mathrm{\mu m} }$ and $\mathrm{ [S\, {\small II}] \, 6716}$ Å forbidden lines, the $\mathrm{[O\, {\small I}]\, 6300}$ Å airglow line, and Hα 6563 Å emission. We simulate (80 ∼ 200 km s−1) dense (∼105 cm−3) outflows expanding into a stationary ambient medium. In the case of an atomic wind interacting with an atomic medium, a decelerating advancing turbulent shell thickens with time. This contrasts with all other cases where a shell fragments into a multitude of cometary-shaped protrusions with weak oblique shocks as the main source of gas excitation. We find that the atomic wind-ambient simulation leads to considerably higher excitation, stronger peak and integrated atomic emission as the nebula expands. The weaker emission when one component is molecular is due to the shell fragmentation into fingers so that the shock surface area is increased and oblique shocks are prevalent. Position-velocity diagrams indicate that the atomic-wind model may be most easy to distinguish with more emission at higher radial velocities. With post-AGB winds and shells often highly obscured and the multitude of configurations that are observed, this study suggests and motivates selection criteria for new surveys.
GMRT observations of a first sample of ‘Extremely Inverted Spectrum Extragalactic Radio Sources (EISERS)’ candidates in the Northern sky
Authors: Mhaskey Mukul , Krishna Gopal- , Paul Surajit , Dabhade Pratik , Salunkhe Sameer , Bhagat Shubham , Bendre Abhijit
Published: August 2019

We present an extension of our search for ‘Extremely Inverted Spectrum Extragalactic Radio Sources’ (EISERS) to the northern celestial hemisphere. With an inverted radio spectrum of slope α > +2.5, these rare sources would either require a non-standard particle acceleration mechanism (in the framework of synchrotron self-absorption hypothesis), or a severe free-free absorption which attenuates practically all of their synchrotron radiation at metre wavelengths. By applying a sequence of selection filters, a list of 15 EISERS candidates is extracted out by comparing two large-sky radio surveys, WENSS (325 MHz) and TGSS-ADR1 (150 MHz), which overlap across 1.03π steradian of the sky. Here we report quasi-simultaneous GMRT observations of these 15 EISERS candidates at 150 MHz and 325 MHz, in an attempt to accurately define their spectra below the turnover frequency. Out of the 15 candidates observed, two are confirmed as EISERS, since the slope of the inverted spectrum between these two frequencies is found to be significantly larger than the critical value αc = +2.5: the theoretical limit for the standard case of synchrotron self-absorption (SSA). For another 3 sources, the spectral slope is close to, or just above the critical value αc. Nine of the sources have GPS type radio spectra. The parsec-scale radio structural information available for the sample is also summarised.
TT Arietis: 40 yr of photometry
Authors: Bruch Albert
Published: August 2019

In an effort to characterize variations on the time-scale of hours and smaller during the high and low states of the nova-like variable TT Ari, light curves taken over the course of more than 40 yr are analysed. It is found that the well-known negative superhump observed during the high state persists until the present day at an average period of 0.132 95 d, which is slightly variable from year to year and exhibits substantial amplitude changes. The beat period between superhump and orbital period is also seen. Quasi-periodic oscillations occur at a preferred quasi-period of 18–25 min and undergo a systematic frequency evolution during a night. The available data permit for the first time a detailed investigation of the low state that is highly structured on time-scales of tens of days. On hourly time-scales, the light curve exhibits strong variations that are mostly irregular. However, during an interval of several days at the start of the low state, coherent 1.2 mag oscillations with a period of 8.90 h are seen. During the deep low state, quiet phases and strong (1.5–3 mag), highly structured flares alternate in irregular intervals of roughly 1 d. The quiet phases are modulated on the orbital period of TT Ari, suggesting reflection of the light of the primary component off the secondary. This is the first time that the orbital period is seen in photometric data.
Non-detection of fast radio bursts from six gamma-ray burst remnants with possible magnetar engines
Authors: Men Yunpeng , Aggarwal Kshitij , Li Ye , Palaniswamy Divya , Burke-Spolaor Sarah , Lee K J , Luo Rui , Demorest Paul , Tendulkar Shriharsh , Agarwal Devansh , Young Olivia , Zhang Bing
Published: August 2019

The analogy of the host galaxy of the repeating fast radio burst (FRB) source FRB 121102 and those of long gamma-ray bursts (GRBs) and superluminous supernovae (SLSNe) has led to the suggestion that young magnetars born in GRBs and SLSNe could be the central engine of repeating FRBs. We test such a hypothesis by performing dedicated observations of the remnants of six GRBs with evidence of having a magnetar central engine using the Arecibo telescope and the Robert C. Byrd Green Bank Telescope (GBT). A total of ∼20 h of observations of these sources did not detect any FRB from these remnants. Under the assumptions that all these GRBs left behind a long-lived magnetar and that the bursting rate of FRB 121102 is typical for a magnetar FRB engine, we estimate a non-detection probability of 8.9 × 10−6. Even though these non-detections cannot exclude the young magnetar model of FRBs, we place constraints on the burst rate and luminosity function of FRBs from these GRB targets.
Molecular Evolution of Auxin-Mediated Root Initiation in Plants
Authors: Yu Jie , Zhang Yuyun , Liu Wu , Wang Hua , Wen Shaoting , Zhang Yijing , Xu Lin
Published: August 2019

The root originated independently in euphyllophytes (ferns and seed plants) and lycophytes; however, the molecular evolutionary route of root initiation remains elusive. By analyses of the fern Ceratopteris richardii and seed plants, here we show that the molecular pathway involving auxin, intermediate-clade WUSCHEL-RELATED HOMEOBOX (IC-WOX) genes, and WUSCHEL-clade WOX (WC-WOX) genes could be conserved in root initiation. We propose that the “auxin>IC-WOX>WC-WOX” module in root initiation might have arisen in the common ancestor of euphyllophytes during the second origin of roots, and that this module has further developed during the evolution of different root types in ferns and seed plants.
Sudden cardiac death in dialysis patients: different causes and management strategies
Authors: Genovesi Simonetta , Boriani Giuseppe , Covic Adrian , Vernooij Robin W M , Combe Christian , Burlacu Alexandru , Davenport Andrew , Kanbay Mehmet , Kirmizis Dimitrios , Schneditz Daniel , van der Sande Frank , Basile Carlo ,   the EUDIAL Working Group of ERA-EDTA
Published: August 2019

Sudden cardiac death (SCD) represents a major cause of death in end-stage kidney disease (ESKD). The precise estimate of its incidence is difficult to establish because studies on the incidence of SCD in ESKD are often combined with those related to sudden cardiac arrest (SCA) occurring during a haemodialysis (HD) session. The aim of the European Dialysis Working Group of ERA-EDTA was to critically review the current literature examining the causes of extradialysis SCD and intradialysis SCA in ESKD patients and potential management strategies to reduce the incidence of such events. Extradialysis SCD and intradialysis SCA represent different clinical situations and should be kept distinct. Regarding the problem, numerically less relevant, of patients affected by intradialysis SCA, some modifiable risk factors have been identified, such as a low concentration of potassium and calcium in the dialysate, and some advantages linked to the presence of automated external defibrillators in dialysis units have been documented. The problem of extra-dialysis SCD is more complex. A reduced left ventricular ejection fraction associated with SCD is present only in a minority of cases occurring in HD patients. This is the proof that SCD occurring in ESKD has different characteristics compared with SCD occurring in patients with ischaemic heart disease and/or heart failure and not affected by ESKD. Recent evidence suggests that the fatal arrhythmia in this population may be due more frequently to bradyarrhythmias than to tachyarrhythmias. This fact may partly explain why several studies could not demonstrate an advantage of implantable cardioverter defibrillators in preventing SCD in ESKD patients. Electrolyte imbalances, frequently present in HD patients, could explain part of the arrhythmic phenomena, as suggested by the relationship between SCD and timing of the HD session. However, the high incidence of SCD in patients on peritoneal dialysis suggests that other risk factors due to cardiac comorbidities and uraemia per se may contribute to sudden mortality in ESKD patients.
Anterior Transpetrosal Approach and Microsurgical Resection of a Petrous Tentorial Meningioma: 3-Dimensional Operative Video
Authors: Ceccato Guilherme H W , de Fraga Gabriel S , Candido Duarte N C , de Oliveira Jean G , Rassi Marcio S , Borba Luis A B
Published: August 2019

Tentorial meningiomas are challenging tumors because of its complex relationship with vital neurovascular structures. We present the case of a 41-yr-old female with a history of right-sided facial numbness associated with pain around the ear. Magnetic resonance imaging demonstrated a lesion in the right tentorium edge closely related with the porus trigeminus, suggestive of a meningioma. Because of worsening of symptoms the patient underwent surgery for tumor removal. A standard temporo-zygomatic craniotomy was performed, followed by an extradural peeling of the middle fossa; the petrous apex was drilled allowing access to the posterior fossa dura. Dural opening was carried connecting the temporal and posterior fossa, and the tentorium was then cut to the incisura. The tumor was identified and completely removed reaching Simpson grade I resection. Postoperatively, the patient presented a right dry eye in the first days that fully improved, and also a right-sided facial paralysis (House-Brackmann grade IV) and diplopia, both recovered completely after 4 mo. We believe that facial paralysis was the result of an undesired traction of the geniculate ganglion, or upon the nerve itself. To avoid such complication, dissection over the GSPN must be carried parallel to that nerve. Facial numbness and pain improved with no neurological other deficits. Tentorial meningiomas are complex deep-seated lesions that can be successfully approached through an anterior transpetrosal route in selected cases. Informed consent was obtained from the patient for publication of this operative video. Anatomical images were a courtesy of the Rhoton Collection, American Association of Neurological Surgeons/Neurosurgical Research and Education Foundation.
Hemorrhagic Presentation of Rathke Cleft Cysts: A Surgical Case Series
Authors: Schooner Lauren , Wedemeyer Michelle A , Bonney Phillip A , Lin Michelle , Hurth Kyle , Mathew Anna , Liu C Jason , Shiroishi Mark , Carmichael John D , Weiss Martin H , Zada Gabriel
Published: August 2019

BACKGROUND

Rathke cleft cysts (RCCs) are benign sellar and suprasellar lesions commonly presenting as asymptomatic incidental findings. Rarely, RCCs hemorrhage and mimic pituitary apoplexy on presentation.

OBJECTIVE

To review a series of hemorrhagic RCCs for physicians encountering this rare presentation.

METHODS

A database review of >1700 transsphenoidal pituitary operations was performed at the USC Pituitary Center to identify patients with pathologically confirmed RCCs presenting with acute symptoms and evidence of hemorrhage at the time of surgery. Surgical treatment involved transsphenoidal RCC fenestration and drainage. Clinical, endocrine, and imaging outcomes were reviewed.

RESULTS

A total of 119 RCCs were identified, and 6 (5.0%) presented with hemorrhage mimicking pituitary apoplexy. Presenting symptoms included acute onset headaches (5/6), vision loss (2/6), and oculomotor nerve palsy (n = 1). Endocrine disturbances at presentation included pre-existing amenorrhea in all female patients (3/3), hypothyroidism (n = 2), panhypopituitarism (n = 2), and one with profound hyponatremia (Na 116 meq/L). All patients underwent endonasal transsphenoidal fenestration and drainage with no major complications. Over mean follow-up of 38.4 mo, 2/2 patients with vision loss reported improvement, and 2/5 patients with headaches reported improvement. Although all women resumed menses, patients with preoperative hypopituitarism did not experience pituitary axis improvement. Follow-up magnetic resonance imaging showed no instances of RCC recurrence with a mean imaging follow-up of 38.6 mo.

CONCLUSION

RCCs occasionally present with hemorrhage and clinical symptoms that may be confused with apoplexy. Outcomes following hemorrhagic RCC treatment are excellent when treated at tertiary pituitary centers. Although hyperprolactinemia often improves following surgery, other pituitary axis deficits typically do not.
Between Diversity, Representation and ‘Best Evidence’: Rethinking Select Committee Evidence-Gathering Practices
Authors: Beswick Danielle , Elstub Stephen
Published: August 2019

Select committees play an important role in scrutinising government policy. They have come under increasing pressure to seek evidence for their inquiries—including both formal and informal evidence—from a wider range of stakeholders. Two particular pressures can be observed within this trend. First, committees are expected to show commitment to hearing from a more diverse set of stakeholders. The second pressure relates to the representativeness of those providing evidence. Consequently, they have been urged to increase public engagement. The recent Citizens’ Assembly into adult social care points to one mechanism for engaging a ‘mini-public’ in committee inquiries. Due to their use of random and stratified sampling to recruit participants, mini-publics could diversify the evidence base and facilitate public scrutiny of the committees. However, we know little of what committee members and staffs think about these issues. In this article, we draw insights from over 60 interviews with select committee chairs, members and staff to gain insight into their perspectives on evidence diversity and the potential of mini-publics to promote this. We find that traditional approaches to inquiries are still favoured. While mini-publics are seen as a solution to the failings of current approaches to public engagement, this is for instrumental reasons, meaning that they are only valued in particular circumstances. Ultimately, further culture change is required if committee inquiries are to move substantially beyond the traditional approach.
Newly discovered associations between peritrich ciliates (Ciliophora: Peritrichia) and scale polychaetes (Annelida: Polynoidae and Sigalionidae) with a review of polychaete–peritrich epibiosis
Authors: Mikac Barbara , Semprucci Federica , Guidi Loretta , Ponti Massimo , Abbiati Marco , Balsamo Maria , Dovgal Igor
Published: August 2019

In this research, we report the presence of two ciliate protozoans of the subclass Peritrichia, Cothurnia amphicteis and C. peloscolicis, as epibionts on the chaetae of scaled polychaetes Malmgrenia lilianae, M. andreapolis (fam. Polynoidae) and Sthenelais boa (fam. Sigalionidae), from the north Adriatic (Mediterranean Sea). Both ciliate species are herein found for the first time after their original description and are redescribed, based on light and scanning electron microscopy analyses. This is the first record of an association between ciliates and polychaetes of the family Sigalionidae. Our results suggest that these host–epibiont relationships might be highly specific. We also present the first review of epibiosis between polychaetes and peritrich ciliates, indicating that this relationship is more diverse than previously thought. Forty taxa of peritrich ciliates from 12 genera and seven families are recorded as epibionts on polychaetes, while 48 polychaete taxa are known as their hosts. The relationship can be considered ectocommensalism, where the ciliates have the advantages of increased food availability. This association might be a more widespread phenomenon than currently known, because it could be easily overlooked or misinterpreted. It, therefore, deserves careful attention and further investigation.
A Retrospective Observational Study of the Neuroendocrine Stress Response in Patients Undergoing Endoscopic Transsphenoidal Surgery for Removal of Pituitary Adenomas: Total Intravenous Versus Balanced Anesthesia
Authors: Yhim Hyung-Been , Oh Hyung-Min , Yoon Hyun-Kyu , Kim Yong Hwy , Park Hee-Pyoung
Published: August 2019

Background:

Anesthetic technique affects the neuroendocrine stress response to surgery. In this retrospective study, we compared the neuroendocrine stress response in patients undergoing endoscopic transsphenoidal pituitary adenoma surgery (ETSPAS) with total intravenous anesthesia (TIVA) with propofol-remifentanil or balanced anesthesia (BAL) with sevoflurane-remifentanil.

Materials and Methods:

Eighty-nine patients undergoing ETSPAS were anesthetized with either propofol-remifentanil (TIVA group, n=62) or sevoflurane-remifentanil (BAL group, n=27). Data were retrospectively collected regarding preoperative and immediate postoperative serum levels of adrenocorticotropic hormone (ACTH) and cortisol (primary outcome measures), as well as other pituitary hormones and their target organ hormones (secondary outcome measures).

Results:

There were no significant differences in preoperative pituitary hormone levels between the 2 groups. The immediate postoperative ACTH (89.5 [62.1 to 162.6] vs. 256.0 [92.0 to 570.7] pg/mL; P<0.001) level was lower in the TIVA group than in the BAL group, whereas immediate postoperative cortisol levels were similar between the 2 groups. The immediate postoperative thyroid-stimulating hormone (1.85 [1.21 to 2.98] vs. 1.21 [0.44 to 1.71] μIU/mL; P=0.003), triiodothyronine (91.0 [82.0 to 103.0] vs. 69.1 [64.6 to 76.2] ng/dL; P<0.001), luteinizing hormone (2.2 [1.2 to 4.0] vs. 1.0 [0.5 to 2.3] mIU/mL; P=0.005), and prolactin (22.6±15.8 vs. 12.8±10.2 ng/mL; P=0.005) levels were higher in the TIVA group compared with the BAL group. In both groups, none of the patients who had sufficient preoperative ACTH without hydrocortisone supplementation (n=15) showed hypocortisolism in the immediate postoperative measurement.

Conclusions:

Compared with BAL, TIVA resulted in reduced release of ACTH and increased release of thyroid-stimulating hormone, triiodothyronine, luteinizing hormone, and prolactin in patients undergoing ETSPAS.
Postoperative Complications Associated With Metabolic Syndrome Following Adult Spinal Deformity Surgery
Authors: Ye Ivan B. , Tang Ray , Schwartz John T. , Cheung Zoe B. , Cho Samuel K.
Published: August 2019

Study Design:

A retrospective cohort study.

Objective:

The objective of this study was to examine the effect of metabolic syndrome on 30-day postoperative complications following corrective surgery for the adult spinal deformity (ASD).

Summary of Background Data:

Metabolic syndrome has been shown to increase the risk of cardiovascular morbidity and mortality. Few studies have examined the effect of metabolic syndrome on patients with ASD undergoing surgery.

Materials and Methods:

We performed a retrospective cohort study of patients who underwent spinal fusion for ASD. Patients were divided into 2 groups based on the presence or absence of metabolic syndrome, which was defined as a combination of hypertension, diabetes mellitus, and obesity. Baseline patient characteristics and operative variables were compared between the 2 groups. We also compared the incidence of 30-day postoperative complications between the 2 groups. A multivariable regression analysis was then performed to identify 30-day postoperative complications that were independently associated with metabolic syndrome.

Results:

A total of 6696 patients were included with 8.3% (n=553) having metabolic syndrome. Patients with metabolic syndrome were more likely to have renal comorbidity (P=0.042), bleeding disorder (P=0.011), American Society of Anesthesiology classification ≥3 (P<0.001), and undergo a long fusion (P=0.009). Patients with metabolic syndrome had higher rates of 30-day mortality (P=0.042), superficial surgical site infection (P=0.006), sepsis (P=0.003), cardiac complications (P<0.001), pulmonary complications (P=0.003), pulmonary embolism (P=0.050), prolonged hospitalization (P=0.010), nonhome discharge (P=0.007), and reoperation (P=0.003). Metabolic syndrome was an independent risk factor for cardiac complications [odds ratio (OR)=4.2; 95% confidence interval (CI): 1.7–10.2; P=0.001], superficial surgical site infection (OR=2.8; 95% CI: 1.4–5.7; P=0.004), sepsis (OR=2.2, 95% CI: 1.2–3.9; P=0.009), reoperation (OR=1.7; 95% CI: 1.2–2.5; P=0.006), pulmonary complications (OR=1.7; 95% CI: 1.1–2.5; P=0.017), and prolonged hospitalization (OR=1.4; 95% CI: 1.0–1.9; P=0.039).

Conclusions:

Recognition and awareness of the relationship between metabolic syndrome and postoperative complications following ASD surgery is important for preoperative optimization and perioperative care.
The Variability of Lumbar Facet Joint Synovial Cyst Recurrence Requiring Revision Surgery After Decompression-only and Decompression/Fusion
Authors: Wun Kelly , Hashmi Sohaib Z. , Maslak Joseph , Schneider Andrew D. , Katchko Karina M. , Singh Gurmit , Patel Alpesh A. , Hsu Wellington K.
Published: August 2019

Study Design:

This is a retrospective study.

Objective:

The objective of this study was to evaluate lumbar spine synovial cyst recurrence rates of decompression-alone versus decompression/fusion procedures.

Background:

Improvements in imaging modalities allow for increased diagnosis and surgical treatment of symptomatic spinal juxtafacet synovial cysts. Conservative management may be used as a first-line management strategy, however rarely provides durable, effective relief of symptoms. Surgical treatment of spinal synovial cysts ranges from decompression and cyst excision to decompression with fusion procedures. Decompression procedures alone have a higher risk of recurrence of spinal synovial cysts.

Methods:

We retrospectively reviewed 87 patients undergoing surgical treatment of lumbar spinal juxtafacet synovial cysts as a single institution over 20 years. Surgical treatment consisted of either decompression versus decompression/fusion procedures. Preoperative symptoms included back pain, radiculopathy, motor deficits, or sensory deficits. The incidence of recurrence of spinal synovial cysts at the same-site or differing sites was compared between 2 categories of surgical treatment. Revision surgical procedure rates were also evaluated.

Results:

A total of 55 (63%) patients were treated with an index decompression-only procedure for the lumbar spinal synovial cyst compared with 32 (37%) patients treated with an index decompression and fusion procedure. Fifty-eight (68%) of the lumbar spinal cysts occurred at the L4–L5 level. There were 10 (11.5%) spinal synovial cyst recurrences in the decompression-only group, and 0 recurrences in the decompression/fusion group. Revision decompression procedures were performed in 4 of the 10 (4.6%) recurrences, and 6 of 10 (6.9%) recurrences had subsequent decompression and fusion surgery. The mean time to recurrence was 23.9±17.3 months. The mean length of follow-up was 65.1±48.6 months. Both recurrence and nonrecurrence cohorts had significant symptomatic improvement using Odom criteria.

Conclusions:

Decompression and cyst excision was the more common surgical treatment of lumbar spinal synovial cysts compared with decompression/fusion procedure in our study. The rate of synovial cyst recurrence and revision surgery in patients undergoing index decompression was relatively low and comparable to current literature. Symptomatic improvement of patients undergoing decompression versus decompression/fusion was similar in our study. Although the fusion may be required for the extent of pathology or coexisting instability, decompression and excision of spinal synovial cysts provide durable, effective treatment with a known, appropriate risk of recurrence and subsequent revision surgery.
Novel MFN2 Missense Mutation Induces Hereditary Axonal Motor and Sensory Neuropathy in a Saudi Arabian Family
Authors: Al-Harbi Talal M. , Abdulmana Sameeh O. , Bashir Shahid , Dridi Walid
Published: August 2019

Hereditary axonal motor and sensory neuropathy or Charcot–Marie–Tooth type 2 (CMT2) is a common inherited peripheral neuropathy. Major symptomatologic signs vary from minimal to significant weakness and loss of sensation, feet usually affected more than hands. It may also cause visual acuity impairment, hearing loss, and skeletal deformity. CMT2 classification is based on the clinical, electrophysiological, and genetic inheritance pattern. Dominant CMT2 is classified from CMT2A to CMT2N and recessive CMT2 into CMT2B1 and CMT2B2. CMT2A is the most frequent subtype of CMT2 and caused by mutations in the mitofusin 2 (MFN2) gene. We hereby report a Saudi Arabian CMT2A patient with a variant c.58C>T of the MFN2 gene mutation.
Favorable Response in Statin-Naive Paraneoplastic Anti-HMGCR Antibody–Associated Myopathy to Single Dose of Rituximab and Persistent Remission With Management of Underlying Lung Cancer
Authors: Waheed Waqar , Jones Christine , Gentchos George , DeWitt John , Tandan Rup
Published: August 2019

Anti-HMGCR myopathy is a subtype of immune-mediated necrotizing myopathy, typically associated with exposure to statins, although a sizable minority in some cohorts are statin-naive. Although the clinical features of acute- or subacute-onset symmetrical proximal muscle weakness mimic those of other idiopathic inflammatory myopathies, necrotizing myopathy is distinguished by the histopathological findings of muscle fiber necrosis and regeneration with little to no accompanying inflammation. Several recent studies of patients with anti-HMGCR myopathy have identified a slightly increased risk of cancer. Most patients require aggressive immunotherapy, usually as a combination of 2 or 3 immunosuppressant drugs. We report a case of a statin-naive paraneoplastic anti-HMGCR myopathy, who unlike other reported cases, responded to a single dose of 1000 mg of intravenous rituximab and subsequent chemoradiation therapy for an underlying lung cancer, despite failing to completely respond to prior high-dose oral prednisone and methotrexate.
Phenotypes of Late-Onset Transthyretin Amyloid Neuropathy: A Diagnostic Challenge
Authors: Živković Saša A. , Mnatsakanova Diana , Lacomis David
Published: August 2019

Hereditary transthyretin amyloidosis (hATTR) is a rare cause of severe neuropathy, typically with progressive sensorimotor and autonomic manifestations. The clinical course is marked by progressive worsening with typical survival of 7–11 years following the onset of symptoms. The phenotype may resemble other types of neuropathy, and dysautonomia may be absent at onset delaying the diagnosis. Two medications were recently approved for treatment of hATTR neuropathy in the United States and more may follow. Three major phenotypes of hATTR include neuropathic, cardiac, and mixed. Diagnostic clues include “red-flag” symptoms reflecting typical multisystem involvement, often presenting with cardiomyopathy, gastrointestinal dysmotility, or kidney insufficiency. We present a case series of 4 patients with late-onset hATTR neuropathy who were initially diagnosed with vasculitic neuropathy and chronic inflammatory demyelinating polyneuropathy to illustrate diagnostic challenges encountered with hATTR. Early diagnosis is even more urgent now given the availability of disease modifying treatments.
Depression and Non-modifiable Patient Factors Associated with Patient Satisfaction in an Academic Orthopaedic Outpatient Clinic: Is it More Than a Provider Issue?
Authors: Tisano Breann K. , Nakonezny Paul A. , Gross Bruno S. , Martinez J. Riley , Wells Joel E.
Published: August 2019

Background

Patient satisfaction surveys play an increasingly important role in United States healthcare policy and serve as a marker of provided physician services. In attempts to improve the patient’s clinical experience, focus is often placed on components of the healthcare system such as provider interaction and other experiential factors. Patient factors are often written off as “non-modifiable”; however, by identifying and understanding these risk factors for dissatisfaction, another area for improvement and intervention becomes available.

Questions/purposes

(1) Do patients in the orthopaedic clinic with a preexisting diagnosis of depression report lower satisfaction scores than those without a preexisting diagnosis of depression? (2) What other non-modifiable patient factors influence patient-reported satisfaction?

Methods

We reviewed Press Ganey Survey scores, which assess patient experiential satisfaction with a single clinical encounter, from 3044 clinic visits (2527 patients) in adult reconstructive, sports, and general orthopaedic clinics at a single academic medical center between November 2010 and May 2017, during which time approximately 19,000 encounters occurred. Multiple patient factors including patient age, gender, race, health insurance status, number of previous clinic visits with their physician, BMI, and a diagnosis of depression were recorded. Patient satisfaction was operationalized as a binary outcome as satisfied or less satisfied, and a multiple logistic regression analysis was used to estimate the odds of being satisfied.

Results

After adjusting for all other covariates in the model, we found that patients with a diagnosis of depression were less likely to be satisfied than patients without this diagnosis (odds ratio 0.749 [95% confidence interval, 0.600-0.940]; p = 0.01). Medicare-insured patients were more likely to be satisfied than non-Medicare patients (OR 1.257 [95% CI, 1.020-1.549]; p = 0.03), patients in the sports medicine clinic were more likely to be satisfied than those seen in the general orthopaedic clinic (OR 1.397 [95% CI, 1.096-1.775]; p = 0.007), and established patients were more likely to be satisfied than new patients (OR 0.763 [95% CI, 0.646-0.902]; p = 0.002).

Conclusions

Given the association of depression with lower satisfaction with a single visit at the orthopaedic clinic, providers should screen for depression and address the issue during the outpatient encounter. The impact of such comprehensive care or subsequent treatment of depression on improving patient-reported satisfaction offers areas of future study.

Level of Evidence

Level III, therapeutic study.
Menopausal hot flashing and endothelial function in two vascular beds: findings from a cross-sectional study of postmenopausal women
Authors: Iliodromiti Stamatina , Sattar Naveed , Delles Christian , Nelson Scott M. , Gill Jason M.R. , Lumsden MaryAnn
Published: August 2019

Objective:

We sought to examine the association of menopausal hot flashing with vascular reactivity in two different vascular beds in the same cohort of postmenopausal women and explore the relationship between hot flashing and cardiovascular disease (CVD) risk profile.

Methods:

A cross-sectional study of 79 healthy postmenopausal women, 23 of whom have never had menopausal hot flashes and 56 of whom have reported hot flashes. Endothelial function at a microvascular level was measured with Laser Doppler Imaging with Iontophoresis which assesses the response to both acetylcholine (Ach, endothelium dependent) and sodium-nitroprusside (SNP, endothelium independent). Reactive Hyperemia Index (RHI) was measured with peripheral arterial tonometry as a marker of endothelial function mainly at a macrovascular level. Metabolic biomarkers including insulin sensitivity were assessed.

Results:

Women with hot flashes had enhanced microvascular response to Ach by ∼30% (P = 0.04) and to SNP by ∼31% (P = 0.02), but lower RHI by ∼13% (P = 0.05) compared with women without flashes. Hot flashing was associated with enhanced response to SNP and lower RHI after adjustment for confounders and conventional CVD risk factors. Women with hot flashes were more insulin resistant than nonflashers (HOMAIR: 1.9 (1.2-2.6) vs 1.4 (0.8-1.9), P = 0.03).

Conclusions:

Our data support the association of hot flashing with greater insulin resistance and lower macrovascular response. The paradoxical enhanced microvascular response in hot flashers could be the result of the net effect of thermoregulatory and nonnitric oxide-related pathways rather than of endothelial integrity.