bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamic analysis of the impact of free-air CO2 enrichment (FACE) on biomass and N uptake in two contrasting genotypes of rice
Authors: Wu Jingjing , Kronzucker Herbert J. , Shi Weiming
Published: February 2018

Elevated CO2 concentrations ([CO2]) in the atmosphere often increase photosynthetic rates and crop yields. However, the degree of the CO2 enhancement varies substantially among cultivars and with growth stage. Here, we examined the responses of two rice cultivars, Wuyunjing23 (WYJ) and IIyou084 (IIY), to two [CO2] (~400 vs ~600) and two nitrogen (N) provision conditions at five growth stages. In general, both seed yield and aboveground biomass were more responsive to elevated [CO2] in IIY than WYJ. However, the responses significantly changed at different N levels and growth stages. At the low N input, yield response to elevated [CO2] was negligible in both cultivars while, at the normal input, yield in IIY was 18.8% higher under elevated [CO2] than ambient [CO2]. Also, responses to elevated [CO2] significantly differed among various growth stages. Elevated [CO2] tended to increase aboveground plant biomass in both cultivars at the panicle initiation (PI) and the heading stages, but this effect was significant only in IIY by the mid-ripening and the grain maturity stages. In contrast, CO2 enhancement of root biomass only occurred in IIY. Elevated [CO2] increased both total N uptake and seed N in IIY but only increased seed N in WYJ, indicating that it enhanced N translocation to seeds in both cultivars but promoted plant N acquisition only in IIY. Root C accumulation and N uptake also exhibited stronger responses in IIY than in WYJ, particularly at the heading stage, which may play a pivotal role in seed filling and seed yield. Our results showed that the more effective use of CO2 in IIY compared with WYJ results in a strong response in root growth, nitrogen uptake, and in yield. These findings suggest that selection of [CO2]-responsive rice cultivars may help optimise the rice yield under future [CO2] scenarios.
Selection of optimal reference genes for quantitative RT-PCR transcript abundance analysis in white clover (Trifolium repens L.)
Authors: Narancio Rafael , John Ulrik , Mason John , Spangenberg German
Published: February 2018

Quantitative reverse transcription PCR (qRT-PCR) is a widely used method for transcript abundance analyses in plants. Relative quantification by qRT-PCR requires the use of a stably expressed reference gene. There are many ‘housekeeping’ genes reported in different plant species that are used as reference genes. However, it is important that the steady-state mRNA levels of these housekeeping genes are confirmed across different conditions and tissues in each species studied. Prior to this study, no comprehensive work had been performed in identifying optimal reference genes in white clover (Trifolium repens L.). To identify suitable reference genes in white clover, we analysed the transcript abundance stability of seven candidate genes in two organs (leaves and stolons) across two treatments (water-limited and well-watered). ΔCt, NormFinder and ANOVA tests were carried out to evaluate the mRNA level stability of candidate reference genes. According to the ΔCt results, the genes with the most stable mRNA levels were EF1α and ACT11. When stability among groups was evaluated by NormFinder, UBQ was the most stable across all organs and treatments. By multiple criteria, EF1α, followed by ACT11 and UBQ, was the most stably-expressed gene across organs and treatments, and each of these are recommended as reference genes for transcript abundance studies in white clover.
Microbial cooperation improves bioleaching recovery rates
Authors: Corbett Melissa K , Watkin Elizabeth LJ
Published: February 2018

Whilst bioleaching is primarily used to recover minerals from low-grade ores, the increasing demand for Rare Earth elements combined with supply chain concerns is opening up new avenues of extraction from mine tailings, waste products and recyclable materials. Exploration of new, novel and economically viable techniques are required to manage the coming shortage and volatility of global markets with more environmentally sound alternatives to traditional mining operations holding the key.
Incorporating fungal community ecology into invasion biology: challenges and opportunities
Authors: Egidi Eleonora , Franks Ashley E
Published: February 2018

Recently, the role of the plant-associated mycobiome (i.e. the fungal community) in influencing the competitive success of invasive plant species has received increasing attention. Fungi act as primary drivers of the plant invasion process due to their ability to form both beneficial and detrimental relationships with terrestrial plant species. Here we review the role of the plant mycobiome in promoting or inhibiting plant species invasion into foreign ecosystems. Moreover, the potential to exploit these relationships for invasive plant control and restoration of native communities is discussed. Incorporating fungal community ecology into invasion and restoration biology will aid in the management and control of invasive plant species in Australia.
Select and resequence reveals relative fitness of bacteria in symbiotic and free-living environments
Authors: Burghardt Liana T. , Epstein Brendan , Guhlin Joseph , Nelson Matt S. , Taylor Margaret R. , Young Nevin D. , Sadowsky Michael J. , Tiffin Peter
Published: February 2018

Significance

We describe an empirical approach to measure the outcomes of selection and competition in bacterial populations. This approach differs from others in that it examines selection acting on naturally occurring variation rather than new mutations. We demonstrate this method by examining selection on rhizobial bacteria living both in symbiosis with leguminous plants and independently in the soil. We identify fitness correlations across environments that could affect the maintenance of the mutualism and natural genomic variants underlying bacterial fitness. Identifying selection inside and outside of hosts may lead to future manipulation of the mutualism to increase agricultural yields.
Molecular signatures of circulating melanoma cells for monitoring early response to immune checkpoint therapy
Authors: Hong Xin , Sullivan Ryan J. , Kalinich Mark , Kwan Tanya Todorova , Giobbie-Hurder Anita , Pan Shiwei , LiCausi Joseph A. , Milner John D. , Nieman Linda T. , Wittner Ben S. , Ho Uyen , Chen Tianqi , Kapur Ravi , Lawrence Donald P. , Flaherty Keith T. , Sequist Lecia V. , Ramaswamy Sridhar , Miyamoto David T. , Lawrence Michael , Toner Mehmet , Isselbacher Kurt J. , Maheswaran Shyamala , Haber Daniel A.
Published: February 2018

Significance

Identifying predictive biomarkers of therapeutic response for melanoma patients treated with immune checkpoint inhibitors is a major challenge. By combining microfluidic enrichment for melanoma circulating tumor cells (CTCs) together with RNA-based droplet digital PCR quantitation, we have established a highly sensitive and robust platform for noninvasive, blood-based monitoring of tumor burden. Serial monitoring of melanoma patients treated with immune checkpoint inhibitors shows rapid changes in CTC score, which precede standard clinical assessment and are highly predictive of long-term clinical outcome. Early on-treatment digital monitoring of CTC dynamics may thus help identify patients likely to benefit from immune checkpoint inhibition therapy.
Hot deformation behaviour and microstructure of a high-alloy gear steel
Authors: Tang Haiyan , Yang Maosheng , Meng Wenjia , Lan Peng , Wang Chen
Published: February 2018

High strain isothermal compression tests at temperatures of 700–1200°C and strain rates of 0.1–50 s−1 were performed in a Gleeble-3800 thermal simulator to investigate the hot deformation behaviour of a high-alloy Cr–Co–Mo–Ni gear steel, and the constitution equation and hot processing map were established based on these experiments. The results show that the flow stress can be described by the constitutive equation in hyperbolic sine function, and the optimum hot working regions are at the temperature of 1000–1100°C and strain rate of 0.3–1.0 s−1. Optical microscopy observations of austenite grains indicate that dynamic recrystallisation occurs when the deformation temperature is over 900°C. The forging was successfully produced on the basis of the above-described researches.
Jasmonic acid facilitates flower opening and floral organ development through the upregulated expression of SlMYB21 transcription factor in tomato
Authors: Niwa Tomoko , Suzuki Takamasa , Takebayashi Yumiko , Ishiguro Rie , Higashiyama Tetsuya , Sakakibara Hitoshi , Ishiguro Sumie
Published: February 2018

Plants coordinate the timing of flower opening with pollen and gynoecium maturation to achieve successful pollination. However, little is known about how the coordination is executed. We found that flower bud development was paused immediately before flower opening in a jasmonic acid (JA)-insensitive tomato mutant, jai1-1. Phytohormone measurement and RNA analysis in flower buds revealed that newly synthesised JA peaked at two days before flower opening and the expression of a transcription factor gene SlMYB21 delayed in jai1-1. Buds of transgenic tomato plants expressing an artificial repressor, AtMYB24-SRDX, which was expected to impede the function of SlMYB21, aborted flower opening and resembled those of jai1-1. Furthermore, the AtMYB24-SRDX plants produced abnormal pollen grains deficient in germination and pistils that did not support pollen tube elongation. We concluded that JA facilitates the expression of SlMYB21, which coordinates flower opening, pollen maturation, and gynoecium function in tomato.
Rapid prototyping of 4043 Al-alloy parts by cold metal transfer
Authors: Nie Yunpeng , Zhang Peilei , Wu Xi , Li Guojin , Yan Hua , Yu Zhishui
Published: February 2018

The macro-structure, microstructure and mechanical properties of 4043 aluminium-alloy parts manufactured by variable polarity cold metal transfer welding (CMT + Advance) have been investigated. The results showed that processing parameters have a strong effect on the geometry, microstructures, roughness and hardness of a deposited part. The problem of the hump and arc collapse was solved by the adjustment of specific welding parameters. Different morphologies were formed at different locations according to the observation of the microstructure. The elemental segregation was found between the layers of the component. The results showed that the dimensional accuracy of the single wall forming sample could be controlled much better by means of adjusting the parameters and optimising the path, thus excellent sample would be obtained.
Securitization and the global politics of cybersecurity
Authors: Lacy Mark , Prince Daniel
Published: February 2018

In ‘Digital disaster, cyber security, and the Copenhagen school’, published in 2009, Lene Hansen and Helen Nissenbaum suggest ways in which securitization theory can help understand the politics of cybersecurity and cyberwar. What was significant about Hansen and Nissenbaum's article was the way it attempted to add newapproaches and questions to a topic that tended to occupy a space in an often highly technical discourse of security, technology and strategy, a discourse that extended in to all aspects of life in a digitizing society. This article asks: What should international relations scholars be doing in addition to the challenge and task – to become more interdisciplinary in order to be able to engage with the potential technification and hypersecuritizations of cybersecurity policy and discourse – that was set out in Hansen and Nissenbaum's article?
Modeling the human bone marrow niche in mice: From host bone marrow engraftment to bioengineering approaches
Authors: Abarrategi Ander , Mian Syed A. , Passaro Diana , Rouault-Pierre Kevin , Grey William , Bonnet Dominique
Published: February 2018

Xenotransplantation of patient-derived samples in mouse models has been instrumental in depicting the role of hematopoietic stem and progenitor cells in the establishment as well as progression of hematological malignancies. The foundations for this field of research have been based on the development of immunodeficient mouse models, which provide normal and malignant human hematopoietic cells with a supportive microenvironment. Immunosuppressed and genetically modified mice expressing human growth factors were key milestones in patient-derived xenograft (PDX) models, highlighting the importance of developing humanized microenvironments. The latest major improvement has been the use of human bone marrow (BM) niche–forming cells to generate human–mouse chimeric BM tissues in PDXs, which can shed light on the interactions between human stroma and hematopoietic cells. Here, we summarize the methods used for human hematopoietic cell xenotransplantation and their milestones and review the latest approaches in generating humanized BM tissues in mice to study human normal and malignant hematopoiesis.
Protein phosphorylation maintains the normal function of cloned human Cav2.3 channels
Authors: Neumaier Felix , Alpdogan Serdar , Hescheler Jürgen , Schneider Toni
Published: February 2018

R-type currents mediated by native and recombinant Cav2.3 voltage-gated Ca2+ channels (VGCCs) exhibit facilitation (run-up) and subsequent decline (run-down) in whole-cell patch-clamp recordings. A better understanding of the two processes could provide insight into constitutive modulation of the channels in intact cells, but low expression levels and the need for pharmacological isolation have prevented investigations in native systems. Here, to circumvent these limitations, we use conventional and perforated-patch-clamp recordings in a recombinant expression system, which allows us to study the effects of cell dialysis in a reproducible manner. We show that the decline of currents carried by human Cav2.3+β3 channel subunits during run-down is related to adenosine triphosphate (ATP) depletion, which reduces the number of functional channels and leads to a progressive shift of voltage-dependent gating to more negative potentials. Both effects can be counteracted by hydrolysable ATP, whose protective action is almost completely prevented by inhibition of serine/threonine but not tyrosine or lipid kinases. Protein kinase inhibition also mimics the effects of run-down in intact cells, reduces the peak current density, and hyperpolarizes the voltage dependence of gating. Together, our findings indicate that ATP promotes phosphorylation of either the channel or an associated protein, whereas dephosphorylation during cell dialysis results in run-down. These data also distinguish the effects of ATP on Cav2.3 channels from those on other VGCCs because neither direct nucleotide binding nor PIP2 synthesis is required for protection from run-down. We conclude that protein phosphorylation is required for Cav2.3 channel function and could directly influence the normal features of current carried by these channels. Curiously, some of our findings also point to a role for leupeptin-sensitive proteases in run-up and possibly ATP protection from run-down. As such, the present study provides a reliable baseline for further studies on Cav2.3 channel regulation by protein kinases, phosphatases, and possibly proteases.
The effect of discovery learning and problem-based learning on middle school students’ self-regulated learning
Authors: Miatun A , Muntazhimah
Published: February 2018

The aim of this research was to determine the effect of learning models on mathematics achievement viewed from student’s self-regulated learning. The learning model compared were discovery learning and problem-based learning. The population was all students at the grade VIII of Junior High School in Boyolali regency. The samples were students of SMPN 4 Boyolali, SMPN 6 Boyolali, and SMPN 4 Mojosongo. The instruments used were mathematics achievement tests and self-regulated learning questionnaire. The data were analyzed using unbalanced two-ways Anova. The conclusion was as follows: (1) discovery learning gives better achievement than problem-based learning. (2) Achievement of students who have high self-regulated learning was better than students who have medium and low self-regulated learning. (3) For discovery learning, achievement of students who have high self-regulated learning was better than students who have medium and low self-regulated learning. For problem-based learning, students who have high and medium self-regulated learning have the same achievement. (4) For students who have high self-regulated learning, discovery learning gives better achievement than problem-based learning. Students who have medium and low self-regulated learning, both learning models give the same achievement.
Mammalian genomic regulatory regions predicted by utilizing human genomics, transcriptomics, and epigenetics data
Authors: Nguyen Quan H , Tellam Ross L , Naval-Sanchez Marina , Porto-Neto Laercio R , Barendse William , Reverter Antonio , Hayes Benjamin , Kijas James , Dalrymple Brian P
Published: February 2018

Genome sequences for hundreds of mammalian species are available, but an understanding of their genomic regulatory regions, which control gene expression, is only beginning. A comprehensive prediction of potential active regulatory regions is necessary to functionally study the roles of the majority of genomic variants in evolution, domestication, and animal production. We developed a computational method to predict regulatory DNA sequences (promoters, enhancers, and transcription factor binding sites) in production animals (cows and pigs) and extended its broad applicability to other mammals. The method utilizes human regulatory features identified from thousands of tissues, cell lines, and experimental assays to find homologous regions that are conserved in sequences and genome organization and are enriched for regulatory elements in the genome sequences of other mammalian species. Importantly, we developed a filtering strategy, including a machine learning classification method, to utilize a very small number of species-specific experimental datasets available to select for the likely active regulatory regions. The method finds the optimal combination of sensitivity and accuracy to unbiasedly predict regulatory regions in mammalian species. Furthermore, we demonstrated the utility of the predicted regulatory datasets in cattle for prioritizing variants associated with multiple production and climate change adaptation traits and identifying potential genome editing targets.
Intracranial Neoplasms in the First Year of Life: Results of a Third Cohort of Patients From a Single Institution
Authors: Toescu Sebastian M , James Gregory , Phipps Kim , Jeelani Owase , Thompson Dominic , Hayward Richard , Aquilina Kristian
Published: February 2018

BACKGROUND

Brain tumors in the first year of life are rare and their management remains challenging.

OBJECTIVE

To report on the contemporary management of brain tumors in infants with reference to previous series from our institution.

METHODS

Retrospective cohort study design. Electronic/paper case note review of all brain tumors diagnosed at our institution in children aged <1 yr since the publication of our previous series.

RESULTS

Ninety-eight patients were seen. The most common presentations were with vomiting and macrocrania, at a median age of 184 d. Sixty-two percent of tumors were supratentorial. Ninety-one patients underwent 230 procedures; 7 patients had no surgery. One hundred eighteen operations were directly on brain tumors (biopsy 37, subtotal resection 47, gross total resection 34). Ninety-one cerebrospinal fluid diversions, 9 endoscopic procedures, and 13 preoperative embolizations were performed. Operative mortality was 4.4%. Tumor types in order of frequency were choroid plexus papillomas (CPP, 17), primitive neuroectodermal tumor (12), atypical teratoid/rhabdoid tumor (10), high-grade glioma (9), optic glioma (9), ependymoma (8), low-grade glioma (6), pilocytic astrocytoma (6), choroid plexus carcinoma (5), and teratoma (5), with 11 miscellaneous tumors. Survival was 93% at 1 mo (91/98), 64% at 1 yr (61/95), 44% at 5 yr (32/73), 28% at 10 yr (16/58). No patients with CPP or low-grade glioma died. Five-year survival rates were lowest for anaplastic ependymoma, primitive neuroectodermal tumor, and atypical teratoid/rhabdoid tumor. Seventy-seven percent of children reaching school age were in mainstream schooling.

CONCLUSION

Overall survival from neonatal brain tumors remains similar to previous series; analysis of tumor subtypes reveals improvements for CPP and gliomas. Despite increasing operative intervention, operative mortality continues to decline for this group of challenging patients.
Breaking Down Barriers to the Utilization of Standardized Tests and Outcome Measures in Acute Care Physical Therapist Practice: An Observational Longitudinal Study
Authors: McDonnell Brian , Stillwell Shannon , Hart Shelby , Davis Roger B
Published: February 2018

Background

Standardized tests and outcome measures (STOM) have not been consistently implemented as part of most physical therapists’ practice. Incidence of STOM use among physical therapists at Beth Israel Deaconess Medical Center was similar to low levels cited nationally among acute care physical therapists. Targeted knowledge translation (KT) strategies have been suggested to promote the application of research evidence into clinical decision making.

Purpose

The purpose of this quality improvement (QI) effort was to implement a series of interventions aimed at increasing both use and interpretation of STOM by physical therapists practicing in acute care.

Design

This study used an observational longitudinal design.

Methods

A literature review identified current barriers and facilitators to the use of STOM by physical therapists. KT strategies were tailored to the practice setting in order to target barriers and promote facilitators to the use of STOM. Data were collected through retrospective chart review at baseline and then subsequently at 4 periods following the implementation of the QI project.

Results

A statistically significant increase in both the use (primary outcome) and interpretation (secondary outcome) of STOM was observed following the implementation of KT strategies. The increase was sustained at all subsequent measurement periods.

Limitations

Limitations include the lack of a control group and the small number of setting- and diagnosis-specific STOM available for use by physical therapists practicing in acute care.

Conclusions

Implementation of KT strategies was associated with an increase in the frequency of use and interpretation of STOM. Similar QI efforts are feasible in any acute care physical therapy department and potentially other settings.
Populations of Phytophthora rubi Show Little Differentiation and High Rates of Migration Among States in the Western United States
Authors: Tabima Javier F. , Coffey Michael D. , Zazada Inga A. , Grünwald Niklaus J.
Published: February 2018

Population genetics is a powerful tool to understand patterns and evolutionary processes that are involved in plant-pathogen emergence and adaptation to agricultural ecosystems. We are interested in studying the population dynamics of Phytophthora rubi, the causal agent of Phytophthora root rot in raspberry. P. rubi is found in the western United States, where most of the fresh and processed raspberries are produced. We used genotyping-by-sequencing to characterize genetic diversity in populations of P. rubi sampled in the United States and other countries. Our results confirm that P. rubi is a monophyletic species with complete lineage sorting from its sister taxon P. fragariae. Overall, populations of P. rubi show low genetic diversity across the western United States. Demographic analyses suggest that populations of P. rubi from the western United States are the source of pathogen migration to Europe. We found no evidence for population differentiation at a global or regional (western United States) level. Finally, our results provide evidence of migration from California and Oregon into Washington. This report provides new insights into the evolution and structure of global and western United States populations of the raspberry pathogen P. rubi, indicating that human activity might be involved in moving the pathogen among regions and fields.
Variation in Fungicide Sensitivity Among Rhizoctonia Isolates Recovered from Potatoes in South Africa
Authors: Muzhinji N. , Woodhall J. W. , Truter M. , van der Waals J. E.
Published: February 2018

Rhizoctonia is a major pathogen of potato causing substantial yield losses worldwide. Control of Rhizoctonia diseases is based predominantly on the application of fungicides. However, little is known about the fungicide response variability of different Rhizoctonia anastomosis groups associated with potato diseases in South Africa. A total of 131 Rhizoctonia isolates were obtained from potato growing regions of South Africa from 2012 to 2014 and evaluated for sensitivity to fungicides in vitro and in vivo. The fungicides comprised six chemical formulations and one bio-fungicide representing seven Fungicide Resistance Action Committee groups. All Rhizoctonia anastomosis groups were sensitive to tolclofos-methyl (EC50: 0.001 to 0.098 μg a.i. ml−1) and fludioxonil (EC50: 0.06 to 0.09 μg a.i. ml−1) and showed variation in sensitivity to pencycuron, iprodione, benomyl, and Bacillus subtilis QST 713. However, for azoxystrobin, Rhizoctonia isolates exhibited variable sensitivity ranging from sensitivity (EC50: <0.09 μg a.i. ml−1) to insensitivity with EC50 values exceeding 5 μg a.i. ml−1. In greenhouse and field trials, tolclofos-methyl and fludioxonil exhibited significantly greater control of stem and black scurf whereas azoxystrobin was the least effective. This work demonstrated variable sensitivity within and among anastomosis groups of R. solani and binucleate Rhizoctonia to different fungicides. Information on fungicide sensitivity of Rhizoctonia isolates is crucial in the development of effective Rhizoctonia control strategies and facilitates monitoring of fungicide insensitive isolates in the pathogen population.
Coumestrol Confers Partial Resistance in Soybean Plants Against Cercospora Leaf Blight
Authors: Silva E. C. , Abhayawardhana P. L. , Lygin A. V. , Robertson C. L. , Liu M. , Liu Z. , Schneider R. W.
Published: February 2018

Although previous research showed that the purple symptom of Cercospora leaf blight (CLB) is associated with lower biomass of Cercospora cf. flagellaris and lower concentrations of cercosporin, a reactive oxygen species producer, as compared with blighted leaves, the hypothesis that the purple symptom is a plant reaction to the pathogen has never been tested. In this study, we demonstrated that high levels of coumestrol (COU) were associated with purple symptoms of CLB and that COU has strong antioxidant activity. Additionally, we found that COU is restricted to the pigmented areas of purple leaves, and the pigmentation is restricted to the adaxial surfaces, suggesting that COU may be acting as a sunscreen. Even though COU is associated with the purple leaf symptom, this coumestan is not the direct cause of discoloration in that COU is colorless. Quantification of chlorophyll a and b and total carotenoids suggested that blighted but not purple or asymptomatic leaves were undergoing photooxidative stress. Because the purple symptom is associated with high COU concentrations, lower biomass of C. cf. flagellaris, and lower cercosporin concentrations, we conclude that the purple symptom is a disease resistance reaction, mediated in part by COU, which provides a high level of antioxidant activity and, hence, partial resistance.
Suburethral Sling Procedures in the United States: Complications, Readmission, and Reoperation
Authors: Propst Katie , O'Sullivan David M. , Tulikangas Paul K.
Published: February 2018

(Abstracted from Int Urogynecol J 2017;28:1463–1467)

An increasingly used measure of quality care after surgery for stress urinary incontinence is the rate of hospital readmissions. However, there are few specific data on readmission rates related to incontinence procedures.
Metformin Use in Pregnancy: Promises and Uncertainties
Authors: Lindsay Robert S. , Loeken Mary R.
Published: February 2018

(Abstracted from Diabetologia 2017;60:1612–1619)

Metformin has been prescribed in pregnancy for more than 40 years, but it is since its increased use in polycystic ovarian syndrome treatment that exposure of the fetus to metformin in early pregnancy and its safety for both mother and child have been investigated more robustly. This review discusses the history, key trials, and controversies associated with metformin use in pregnancy.
Health surveillance for occupational asthma
Authors: Fishwick David , Forman Steve
Published: February 2018

Purpose of review

The outcome for workers with occupational asthma is improved for those with an earlier diagnosis. Health surveillance at work is in principle designed to identify such cases, so that the risks to the individual worker, and coworkers, can be reduced. There is recent evidence to suggest that the uptake and quality of such surveillance could be improved. This review has assessed current approaches to health surveillance for occupational asthma.

Recent findings

The article covers a review of the utility of questionnaires, lung function testing, immunological investigations, and other tests, including exhaled nitric oxide, sputum eosinophilia, and exhaled breath condensate specifically in the context of workplace-based health surveillance.

Questionnaires remain a key component of respiratory health surveillance, although maybe limited by both sensitivity and specificity for early occupational asthma. The role of lung function testing is debated, although is recommended for higher level health surveillance. Various examples of immunological testing in health surveillance are discussed, but more evidence is needed in many specific areas before more general recommendations can be made. Evidence is discussed in relation to the utility of newer approaches such as exhaled nitric oxide, sputum eosinophilia, and exhaled breath condensate.
Positive End-expiratory Pressure Alone Minimizes Atelectasis Formation in Nonabdominal Surgery
Authors: Östberg Erland , Thorisson Arnar , Enlund Mats , Zetterström Henrik , Hedenstierna Göran , Edmark Lennart
Published: February 2018

Background

Various methods for protective ventilation are increasingly being recommended for patients undergoing general anesthesia. However, the importance of each individual component is still unclear. In particular, the perioperative use of positive end-expiratory pressure (PEEP) remains controversial. The authors tested the hypothesis that PEEP alone would be sufficient to limit atelectasis formation during nonabdominal surgery.

Methods

This was a randomized controlled evaluator-blinded study. Twenty-four healthy patients undergoing general anesthesia were randomized to receive either mechanical ventilation with PEEP 7 or 9 cm H2O depending on body mass index (n = 12) or zero PEEP (n = 12). No recruitment maneuvers were used. The primary outcome was atelectasis area as studied by computed tomography in a transverse scan near the diaphragm, at the end of surgery, before emergence. Oxygenation was evaluated by measuring blood gases and calculating the ratio of arterial oxygen partial pressure to inspired oxygen fraction (Pao
2/Fio
2 ratio).

Results

At the end of surgery, the median (range) atelectasis area, expressed as percentage of the total lung area, was 1.8 (0.3 to 9.9) in the PEEP group and 4.6 (1.0 to 10.2) in the zero PEEP group. The difference in medians was 2.8% (95% CI, 1.7 to 5.7%; P = 0.002). Oxygenation and carbon dioxide elimination were maintained in the PEEP group, but both deteriorated in the zero PEEP group.

Conclusions

During nonabdominal surgery, adequate PEEP is sufficient to minimize atelectasis in healthy lungs and thereby maintain oxygenation. Thus, routine recruitment maneuvers seem unnecessary, and the authors suggest that they should only be utilized when clearly indicated.
Recent advances in the treatment of rheumatoid arthritis
Authors: Mahajan Tina D. , Mikuls Ted R.
Published: February 2018

Purpose of review

Therapies for rheumatoid arthritis (RA) continue to expand rapidly. The purpose of this review is to discuss novel treatment options, including biosimilars, that are available, as well as to highlight promising agents in development. The purpose is also to discuss new emerging safety signals associated with these drugs and to discuss strategies in tapering therapy.

Recent findings

There are several novel RA therapies. These include the interleukin-6 (IL-6) receptor blocker sarilumab, which was approved in 2017. In aggregate, the sarilumab studies show that it is effective in RA, including patients with incomplete responses to methotrexate and anti-tumor necrosis factor inhibitor, and showing superior efficacy when used in higher dose (200 mg every 2 weeks) to standard-dose adalilumab. Other drugs that are currently being studied include the IL-6 cytokine blocker sarikumab, the small targeted molecule filgotinib, and many new biosimilars. Baracitinib failed to achieve approval by the Food and Drug Administration primarily over perceived safety concerns. The two biosimilar drugs currently approved are CT-P13 and SB2, which are based on the reference product infliximab. Although this review summarizes trials examining biologic tapering, additional data are needed to guide clinicians in regards to treatment de-escalation in RA.

With the greatly expanded armamentarium of RA treatment options available, it is important for clinicians to understand the data regarding drug efficacy and safety. With remission increasingly attainable, effective drug tapering strategies are needed. Although tapering trials do exist, more studies will be needed to help guide clinical practice.
Influence of the Initial Sagittal Lumbar Alignment on Clinical and Radiological Outcomes of Single-Level Lumbar Total Disc Replacements at a Minimum 2-Year Follow-up
Authors: Faure Aymeric , Khalifé Marc , Thiebaut Benjamin , Roubineau François , Flouzat Lachaniette Charles-Henri , Dubory Arnaud
Published: February 2018

Study Design.

Retrospective cohort study

Objective.

To analyze the clinical and radiographic outcomes of patients undergoing a one-level lumbar total disc replacement (TDR), according to the initial sagittal alignment of the spine.

Summary of Background Data.

No authors have highlighted correlation between the initial spinopelvic parameters and the postoperative outcome after a one-level TDR.

Methods.

Seventy-eight patients were included: 14 TDR at L4-L5 and 64 TDR at L5-S1 level. Clinical assessment was performed on leg pain and axial back pain Visual Analog Scale (VAS), Oswestry Disability Index, and Short Form-36 Health Survey. Radiographic assessment included full spine standing anteroposterior and lateral films. Data were compared according to the initial lumbar sagittal alignment described by Roussouly.

Results.

Forty-five female patients and 33 male patients with a mean age of 41.7 years (95% confidence interval [40.3–43.1]) were included. The mean follow-up was 46.4 months (95% [40.6–51.6]). Two patients were considered as Roussouly type 1 (2.6%), 36 patients as type 2 (46.2%), 33 patients as type 3 (42.3%), and 7 patients as type 4 (9%). Preoperatively, there were no clinical differences depending on Roussouly's type of back. Pelvic incidence (P < 0.001), sacral slope (P < 0.001), lumbar lordosis (P < 0.001), and spinosacral angle (P < 0.001) were different between the Roussouly's types of back. Postoperative clinical outcome improved (P < 0.001) but did not vary according to the Roussouly types except for leg pain VAS (P = 0.03). Post hoc tests did not reveal difference between the Roussouly's types and leg pain VAS. Postoperative radiographic outcomes did not change excepted for the lumbar lordosis (P < 0.001), thoracic kyphosis (P = 0.007), and spinosacral angle (P = 0.02). The Roussouly type had no effect on the postoperative course of radiographic parameters.

Conclusion.

Equivalent clinical and radiographic outcomes have been highlighted independently of the increasing of the sacral slope for patients with one-level lumbar TDR.

Level of Evidence: 3
Normal Knee Kinematics After TKA—A Reality?
Authors: Cates Harold E. , Grieco Trevor F. , Nachtrab Jarrod K. , Dessinger Garett M. , Komistek Richard D. , Sharma Adrija
Published: February 2018

Design rationale, surgical technique, and soft tissue manipulation weigh heavily on the kinematic performance of total knee arthroplasty. As the orthopedic community continues its quest to provide more functional total knees, one must consider the importance of kinematics. Various investigations involving in vivo, in vitro, and computational methodologies have led to a sound understanding of normal knee kinematics. The results of such investigations are used in the development of new total knee arthroplasty designs and surgical technique. With years of research and development the question remains, “Do TKAs enable normal knee kinematics?” This work reviews results from published fluoroscopic research and presents new data to shed light on this question.
Achieving More Natural Motion, Stability, and Function With a Dual-Pivot ACL-substituting Total Knee Arthroplasty Design
Authors: Banks Scott A. , Meneghini Robert M.
Published: February 2018

Reports demonstrate up to 20% of total knee arthroplasty (TKA) patients are not satisfied and claim their knee does not feel normal. Failure to replicate native anterior cruciate ligament (ACL)-intact knee tibiofemoral kinematics and stability may contribute to this dissatisfaction. Originally described as medial-pivot pattern throughout flexion, recent studies have elucidated the more modern understanding of a complex motion pattern in ACL-intact knees, where walking and early flexion activities near extension exhibit a lateral-pivot pattern and medial-pivot pattern is observed in deeper flexion. A contemporary TKA design (EMPOWR 3-D; DJO Global, Vista, CA) has the potential to promote natural motion and stability by incorporating a conforming spherical lateral compartment to recreate the dual-pivot kinematics. In vivo fluoroscopic studies have confirmed this optimal kinematic pattern of medial-pivot motion during squatting and kneeling activities, with a lateral-pivot motion during walking. Further, near normal knee strength and minimized hamstrings co-contraction provide evidence for optimal intrinsic tibiofemoral stability. Emerging clinical results have been encouraging and support the modern dual-pivot kinematic understanding and in vivo function studies. Recent studies have revealed intraoperative dual-pivot femoral contact patterns optimize patient outcomes. Clinical results comparing the dual-pivot TKA and a traditional TKA design demonstrate patients with the dual-pivot TKA experience a higher level of function and a greater likelihood of a normal feeling knee. Merging the modern understanding of kinematics in ACL-intact knees with a contemporary dual-pivot TKA design may improve outcomes through optimal knee motion and stability, which may narrow the elusive 20% of TKA patients currently not satisfied.
Immune-mediated Pericarditis With Pericardial Tamponade During Nivolumab Therapy
Authors: de Almeida Daniel V.P. , Gomes Jessica R. , Haddad Fabio J. , Buzaid Antonio C.
Published: February 2018

A 69-year-old man with metastatic lung adenocarcinoma presented with pericarditis and pericardial tamponade during nivolumab treatment, despite near-complete response on images performed during response evaluation. Further investigation found no evidence of pericardial or pleural cancer involvement, and pathologic evaluation showed immune-related adverse effect. Surgical and steroid treatments were used, with excellent results, and no disease progression on follow-up despite drug discontinuation because of toxicity. Although life-threatening immune-related adverse effects are not frequent when using checkpoint inhibitors, and cardiotoxicity is very rare, different clinical manifestations may occur, and some of them can be fatal in case of inadequate management. It may be challenging to make an etiological diagnosis; however, favorable outcomes can be achieved when prompt directed treatment is promoted.
Medication overuse headache following repeated morphine, but not ∆9-tetrahydrocannabinol administration in the female rat
Authors: Kandasamy Ram , Dawson Cole T. , Hilgendorf Tammy N. , Morgan Michael M.
Published: February 2018

The potential of ∆9-tetrahydrocannabinol (THC) as a treatment for migraine depends on antinociceptive efficacy with repeated administration. Although morphine has good antinociceptive efficacy, repeated administration causes medication overuse headache (MOH) – a condition in which the intensity/frequency of migraine increases. The present study compared the effect of repeated morphine or THC administration on the magnitude and duration of migraine-like pain induced by a microinjection of allyl isothiocyanate (AITC) onto the dura mater of female rats. Acute administration of THC or morphine prevented AITC-induced depression of wheel running. This antinociception was maintained in rats treated repeatedly with THC, but not following repeated administration of morphine. Moreover, repeated morphine, but not THC administration, extended the duration of AITC-induced depression of wheel running. These data indicate that tolerance and MOH develop rapidly to morphine administration. The lack of tolerance and MOH to THC indicates that THC may be an especially effective long-term treatment against migraine.
Examining the Impact of Structural Racism on Food Insecurity
Authors: Odoms-Young Angela , Bruce Marino A.
Published: February 2018

Food insecurity is defined as “a household-level economic and social condition of limited or uncertain access to adequate food.” While, levels of food insecurity in the United States have fluctuated over the past 20 years; disparities in food insecurity rates between people of color and whites have continued to persist. There is growing recognition that discrimination and structural racism are key contributors to disparities in health behaviors and outcomes. Although several promising practices to reduce food insecurity have emerged, approaches that address structural racism and discrimination may have important implications for alleviating racial/ethnic disparities in food insecurity and promoting health equity overall.
Thrombosis and Thromboprophylaxis in Gynecology Surgery
Authors: CANTRELL LEIGH A. , GARCIA CHRISTY , MAITLAND HILLARY S.
Published: February 2018

Gynecologic surgery offers unique challenges, as pelvic surgery places patients at an increased risk of venous thromboembolism (VTE). Prevention of VTE is a goal of patients, policy makers, and surgeons. In this review, we address the current research and recommendations for VTE prophylaxis.
Healthcare's Future: Strategic Investment in Technology
Authors: Franklin Michael A.
Published: February 2018

Recent and rapid advances in the implementation of technology have greatly affected the quality and efficiency of healthcare delivery in the United States. Simultaneously, diverse generational pressures—including the consumerism of millennials and unsustainable growth in the costs of care for baby boomers—have accelerated a revolution in healthcare delivery that was marked in 2010 by the passage of the Affordable Care Act.

Against this backdrop, Maryland and the Centers for Medicare & Medicaid Services entered into a partnership in 2014 to modernize the Maryland All-Payer Model. Under this architecture, each Maryland hospital negotiates a global budget revenue agreement with the state's rate-setting agency, limiting the hospital's annual revenue to the budgetary cap established by the state.

At Atlantic General Hospital (AGH), leaders had established a disciplined strategic planning process in which the board of trustees, medical staff, and administration annually agree on goals and initiatives to achieve the objectives set forth in its five-year strategic plans. This article describes two initiatives to improve care using technology. In 2006, AGH introduced a service guarantee in the emergency room (ER); the ER 30-Minute Promise assures patients that they will be placed in a bed or receive care within 30 minutes of arrival in the ER. In 2007, several independent hospitals in the state formed Maryland eCare to jointly contract for intensive care unit (ICU) physician coverage via telemedicine. This technology allows clinical staff to continuously monitor ICU patients remotely.

The positive results of the ER 30-Minute Promise and Maryland eCare program show that technological advances in an independent, small, rural hospital can make a significant impact on its ability to maintain independence. AGH's strategic investments prepared the organization well for the transition in 2014 to a value-based payment system.
Intrasession Repeatability and Intersession Reproducibility Measurements Using VX120 Multidiagnostic Unit
Authors: Sanchez Irene , Ortiz-Toquero Sara , Martin Raul
Published: February 2018

Objective:

The VX120 multidiagnostic unit is a multidiagnostic instrument that combines several functions: autorefraction, keratometry, corneal topography, aberrometry, pachymetry, and noncontact tonometry. The purpose of this study was to determine the intrasession repeatability and the intersession reproducibility of all parameters measured by the VX120 multidiagnostic unit in a sample of normal healthy eyes.

Methods:

Three repeated measurements in the right eye of the volunteers were taken with VX120. Repeatability of the sphere, cylinder, axis, anterior corneal powers (K flat and K steep, 3-mm pupil), high- and low-order aberration root mean square (HOA-RMS and LOA-RMS, 3-mm pupil), eccentricity, white-to-white (WTW), anterior chamber depth (ACD), and central corneal thickness (CCT) (2-mm central) was analyzed. Within-subject SD (Sw), precision, repeatability, coefficient of variation (CV), and the intraclass correlation coefficient (ICC) were calculated.

Results:

The CV was low for K flat and K steep, WTW, ACD, and CCT with a range from 0.34% to 1.16%. The CV was higher for sphere, cylinder, HOA-RMS, and LOA-RMS and eccentricity with a range among 6.92% to 54.24%. The ICC showed high values in all parameters except in HOA-RMS (0.720–0.776) and eccentricity (0.889) in first session with moderate agreement. Comparing the intrasession repeatability of first and second session, statistically significant differences (P<0.01) were found between both sessions just to the CV for all parameters (except cylinder values) measured with VX120. However, nonstatistically significant differences (P>0.13) were found for Sw, precision, and repeatability values.

Conclusions:

The VX120 multidiagnostic unit provides repeatable measurements in anterior corneal power (K flat and K steep), WTW, ACD, and CCT. However sphere, cylinder, HOA-RMS, LOA-RMS, and eccentricity showed worse repeatability. Intersession reproducibility showed good results with little differences between sessions in healthy subjects.