bluuebunny/crossref_metadata_2025 huggingface dataset:
Study of Runaway Electrons in GOLEM Tokamak
Authors: Dhyani P. , Svoboda V. , Istokskaia V. , Mlynář J. , Čeřovský J. , Ficker O. , Linhart V.
Published: September 2019

High loop voltage and low-density plasma discharges at the GOLEM tokamak present favorable conditions for the study of the runaway electrons (RE). A probe is being designed and developed for the spectral measurement of the RE energy inside the last closed flux surface of GOLEM tokamak plasma. Design of the probe is based on simulation results of the FLUKA code that estimates the energy absorbed by the scintillating crystals and filters of various densities. In the simulations, graphite, stainless steel and molybdenum were tested to filter the supra-thermal electrons. Since having different light yield, YSO (Y2SiO5:Ce), NaI(Tl) and plastic (EJ-200) scintillating crystals were chosen for the simulations.
Inconsistent recognition of uncertainty in studies of climate change impacts on forests
Authors: Petr M , Vacchiano G , Thom D , Mairota P , Kautz M , Goncalves L M S , Yousefpour R , Kaloudis S , Reyer C P O
Published: September 2019

Background. Uncertainty about climate change impacts on forests can hinder mitigation and adaptation actions. Scientific enquiry typically involves assessments of uncertainties, yet different uncertainty components emerge in different studies. Consequently, inconsistent understanding of uncertainty among different climate impact studies (from the impact analysis to implementing solutions) can be an additional reason for delaying action. In this review we (a) expanded existing uncertainty assessment frameworks into one harmonised framework for characterizing uncertainty, (b) used this framework to identify and classify uncertainties in climate change impacts studies on forests, and (c) summarised the uncertainty assessment methods applied in those studies. Methods. We systematically reviewed climate change impact studies published between 1994 and 2016. We separated these studies into those generating information about climate change impacts on forests using models –‘modelling studies’, and those that used this information to design management actions—‘decision-making studies’. We classified uncertainty across three dimensions: nature, level, and location, which can be further categorised into specific uncertainty types. Results. We found that different uncertainties prevail in modelling versus decision-making studies. Epistemic uncertainty is the most common nature of uncertainty covered by both types of studies, whereas ambiguity plays a pronounced role only in decision-making studies. Modelling studies equally investigate all levels of uncertainty, whereas decision-making studies mainly address scenario uncertainty and recognised ignorance. Finally, the main location of uncertainty for both modelling and decision-making studies is within the driving forces—representing, e.g. socioeconomic or policy changes. The most frequently used methods to assess uncertainty are expert elicitation, sensitivity and scenario analysis, but a full suite of methods exists that seems currently underutilized. Discussion & Synthesis. The misalignment of uncertainty types addressed by modelling and decision-making studies may complicate adaptation actions early in the implementation pathway. Furthermore, these differences can be a potential barrier for communicating research findings to decision-makers.
The Future of Biofuels in an Electrifying Global Transportation Sector: Imperative, Prospects and Challenges
Authors: Debnath Deepayan , Khanna Madhu , Rajagopal Deepak , Zilberman David
Published: September 2019

Low carbon alternatives are an imperative for decarbonizing the transportation sector. There is growing interest in electrification of transportation but even with aggressive growth in sales, a significant share of transportation is expected to rely on liquid fuel by midcentury. Biofuels are appealing as low carbon fuels but those produced from food crops generate a food vs. fuel dilemma. We discuss the prospects for expanding biofuels, while mitigating the competition with food production though a transition to second generation biofuels from biomass as well as the potential for biotechnology to transform the agricultural sector globally to increase crop productivity and make biofuels and food production complementary. We highlight the role for policy, technological innovations, and institutions to achieve increased food and biofuel production.
Pavian: interactive analysis of metagenomics data for microbiome studies and pathogen identification
Authors: Breitwieser Florian P , Salzberg Steven L
Published: September 2019

Pavian is a web application for exploring classification results from metagenomics experiments. With Pavian, researchers can analyze, visualize and transform results from various classifiers—such as Kraken, Centrifuge and MethaPhlAn—using interactive data tables, heatmaps and Sankey flow diagrams. An interactive alignment coverage viewer can help in the validation of matches to a particular genome, which can be crucial when using metagenomics experiments for pathogen detection.

Availability and implementation

Pavian is implemented in the R language as a modular Shiny web app and is freely available under GPL-3 from http://github.com/fbreitwieser/pavian.
Macroevolutionary trends of brain mass in Primates
Authors: Melchionna M , Mondanaro A , Serio C , Castiglione S , Di Febbraro M , Rook L , Diniz-Filho J A F , Manzi G , Profico A , Sansalone G , Raia P
Published: September 2019

A distinctive trait in primate evolution is the expansion in brain mass. The potential drivers of this trend and how and whether encephalization influenced diversification dynamics in this group are hotly debated. We assembled a phylogeny accounting for 317 primate species, including both extant and extinct taxa, to identify macroevolutionary trends in brain mass evolution. Our findings show that Primates as a whole follow a macroevolutionary trend for an increase in body mass, relative brain mass and speciation rate over time. Although the trend for increased encephalization (brain mass) applies to all Primates, hominins stand out for their distinctly higher rates. Within hominins, this unique trend applies linearly over time and starts with Australopithecus africanus. The increases in both speciation rate and encephalization begin in the Oligocene, suggesting the two variables are causally associated. The substitution of early, stem Primates belonging to plesiadapiforms with crown Primates seems to be responsible for these macroevolutionary trends. However, our findings also suggest that cognitive capacities favoured speciation in hominins.
When less is more: a daring conservative approach to postpneumonectomy oesophago-pleural fistula
Authors: Girelli Lara , Prisciandaro Elena , Filippi Niccolò , Spaggiari Lorenzo
Published: September 2019

Oesophago-pleural fistula is an uncommon complication after pneumonectomy, usually related to high morbidity and mortality. Due to its rarity and heterogeneous clinical presentation, its diagnosis and management are challenging issues. Here, we report the case of a patient with a history of pneumonectomy for a tracheal tumour, who developed an asymptomatic oesophago-pleural fistula 7 years after primary surgery. In consideration of the patient’s good clinical status and after verifying the preservation of respiratory and digestive functions, a bold conservative approach was adopted. Five-year follow-up computed tomography did not disclose any sign of recurrence of disease and showed a stable, chronic fistula.
Activation of C-Type Lectin Receptor and (RIG)-I-Like Receptors Contributes to Proinflammatory Response in Middle East Respiratory Syndrome Coronavirus-Infected Macrophages
Authors: Zhao Xiaoyu , Chu Hin , Wong Bosco Ho-Yin , Chiu Man Chun , Wang Dong , Li Cun , Liu Xiaojuan , Yang Dong , Poon Vincent Kwok-Man , Cai Jianpiao , Chan Jasper Fuk-Woo , To Kelvin Kai-Wang , Zhou Jie , Yuen Kwok-Yung
Published: September 2019

Background

Human infection with Middle East respiratory syndrome coronavirus (MERS-CoV) poses an ongoing threat to public health worldwide. The studies of MERS patients with severe disease and experimentally infected animals showed that robust viral replication and intensive proinflammatory response in lung tissues contribute to high pathogenicity of MERS-CoV. We sought to identify pattern recognition receptor (PRR) signaling pathway(s) that mediates the inflammatory cascade in human macrophages upon MERS-CoV infection.

Methods

The potential signaling pathways were manipulated individually by pharmacological inhibition, small interfering ribonucleic acid (siRNA) depletion, and antibody blocking. The MERS-CoV-induced proinflammatory response was evaluated by measuring the expression levels of key cytokines and/or chemokines. Reverse transcription-quantitative polymerase chain reaction assay, flow cytometry analysis, and Western blotting were applied to evaluate the activation of related PRRs and engagement of adaptors.

Results

MERS-CoV replication significantly upregulated C-type lectin receptor (CLR) macrophage-inducible Ca2+-dependent lectin receptor (Mincle). The role of Mincle for MERS-CoV-triggered cytokine/chemokine induction was established based on the results of antibody blockage, siRNA depletion of Mincle and its adaptor spleen tyrosine kinase (Syk), and Syk pharmacological inhibition. The cytokine and/or chemokine induction was significantly attenuated by siRNA depletion of retinoic acid-inducible-I-like receptors (RLR) or adaptor, indicating that RLR signaling also contributed to MERS-CoV-induced proinflammatory response.

Conclusions

The CLR and RLR pathways are activated and contribute to the proinflammatory response in MERS-CoV-infected macrophages.
Animal Models of Congenital Cytomegalovirus Transmission: Implications for Vaccine Development
Authors: Roark Hunter K , Jenks Jennifer A , Permar Sallie R , Schleiss Mark R
Published: September 2019

Although cytomegaloviruses (CMVs) are species-specific, the study of nonhuman CMVs in animal models can help to inform and direct research aimed at developing a human CMV (HCMV) vaccine. Because the driving force behind the development of HCMV vaccines is to prevent congenital infection, the animal model in question must be one in which vertical transmission of virus occurs to the fetus. Fortunately, two such animal models—the rhesus macaque CMV and guinea pig CMV—are characterized by congenital infection. Hence, each model can be evaluated in “proof-of-concept” studies of preconception vaccination aimed at blocking transplacental transmission. This review focuses on similarities and differences in the respective model systems, and it discusses key insights from each model germane to the study of HCMV vaccines.
Effects of grain alignment efficiency on synthetic dust polarization observations of molecular clouds
Authors: King Patrick K , Chen Che-Yu , Fissel L M , Li Zhi-Yun
Published: September 2019

It is well known that the polarized continuum emission from magnetically aligned dust grains is determined to a large extent by local magnetic field structure. However, the observed significant anticorrelation between polarization fraction and column density may be strongly affected, perhaps even dominated by variations in grain alignment efficiency with local conditions, in contrast to standard assumptions of a spatially homogeneous grain alignment efficiency. Here we introduce a generic way to incorporate heterogeneous grain alignment into synthetic polarization observations of molecular clouds (MCs), through a simple model where the grain alignment efficiency depends on the local gas density as a power law. We justify the model using results derived from radiative torque alignment theory. The effects of power-law heterogeneous alignment models on synthetic observations of simulated MCs are presented. We find that the polarization fraction-column density correlation can be brought into agreement with observationally determined values through heterogeneous alignment, though there remains degeneracy with the relative strength of cloud-scale magnetized turbulence and the mean magnetic field orientation relative to the observer. We also find that the dispersion in polarization angles-polarization fraction correlation remains robustly correlated despite the simultaneous changes to both observables in the presence of heterogeneous alignment.
An automated method to detect transiting circumbinary planets
Authors: Windemuth Diana , Agol Eric , Carter Josh , Ford Eric B , Haghighipour Nader , Orosz Jerome A , Welsh William F
Published: September 2019

To date a dozen transiting ‘Tatooines’ or circumbinary planets (CBPs) have been discovered, by eye, in the data from the Kepler mission; by contrast, thousands of confirmed circumstellar planets orbiting around single stars have been detected using automated algorithms. Automated detection of CBPs is challenging because their transits are strongly aperiodic with irregular profiles. Here, we describe an efficient and automated technique for detecting circumbinary planets that transit their binary hosts in Kepler light curves. Our method accounts for large transit timing variations (TTVs) and transit duration variations (TDVs), induced by binary reflex motion, in two ways: (1) We directly correct for large-scale TTVs and TDVs in the light curves by using Keplerian models to approximate binary and CBP orbits; and (2) We allow additional aperiodicities on the corrected light curves by employing the Quasi-periodic Automated Transit Search algorithm. We demonstrate that our method dramatically improves detection significance using simulated data and two previously identified CBP systems, Kepler-35 and Kepler-64.
A Bayesian approach to matching thermonuclear X-ray burst observations with models
Authors: Goodwin A J , Galloway D K , Heger A , Cumming A , Johnston Z
Published: September 2019

We present a new method of matching observations of Type-I (thermonuclear) X-ray bursts with models, comparing the predictions of a semi-analytic ignition model with X-ray observations of the accretion-powered millisecond pulsar SAX J1808.4–3658 in outburst. We used a Bayesian analysis approach to marginalize over the parameters of interest and determine parameters such as fuel composition, distance/anisotropy factors, neutron star mass, and neutron star radius. Our study includes a treatment of the system inclination effects, inferring that the rotation axis of the system is inclined $\left(69^{+4}_{-2}\right)^\circ$ from the observers line of sight, assuming a flat disc model. This method can be applied to any accreting source that exhibits Type-I X-ray bursts. We find a hydrogen mass fraction of $0.57^{+0.13}_{-0.14}$ and CNO metallicity of $0.013^{+0.006}_{-0.004}$ for the accreted fuel is required by the model to match the observed burst energies, for a distance to the source of $3.3^{+0.3}_{-0.2}\, \mathrm{kpc}$. We infer a neutron star mass of $1.5^{+0.6}_{-0.3}\, \mathrm{M}_{\odot }$ and radius of $11.8^{+1.3}_{-0.9}\, \mathrm{km}$ for a surface gravity of $1.9^{+0.7}_{-0.4}\times 10^{14}\, \mathrm{cm}\, \mathrm{s}^{-2}$ for SAX J1808.4–3658.
Local photoionization feedback effects on galaxies
Authors: Obreja Aura , Macciò Andrea V , Moster Benjamin , Udrescu Silviu M , Buck Tobias , Kannan Rahul , Dutton Aaron A , Blank Marvin
Published: September 2019

We implement an optically thin approximation for the effects of the local radiation field from stars and hot gas on the gas heating and cooling in the N-body smoothed particle hydrodynamics code gasoline2. We resimulate three galaxies from the NIHAO project: one dwarf, one Milky Way-like, and one massive spiral, and study what are the local radiation field effects on various galaxy properties. We also study the effects of varying the ultraviolet background (UVB) model, by running the same galaxies with two different UVBs. Galaxy properties at $z$ = 0 like stellar mass, stellar effective mass radius, H i mass, and radial extent of the H i disc show significant changes between the models with and without the local radiation field, and smaller differences between the two UVB models. The intrinsic effect of the local radiation field through cosmic time is to increase the equilibrium temperature at the interface between the galaxies and their circumgalactic media (CGM), moving this boundary inwards, while leaving relatively unchanged the gas inflow rate. Consequently, the temperature of the inflow increases when considering the local radiation sources. This temperature increase is a function of total galaxy mass, with a median CGM temperature difference of one order of magnitude for the massive spiral. The local radiation field suppresses the stellar mass growth by 20 per cent by $z$ = 0 for all three galaxies, while the H i mass is roughly halved. The differences in the gas phase diagrams, significantly impact the H i column densities, shifting their peaks in the distributions towards lower NH i.
Hydrodynamic simulations of disrupted planetary accretion discs inside the core of an AGB star
Authors: Guidarelli G , Nordhaus J , Chamandy L , Chen Z , Blackman E G , Frank A , Carroll-Nellenback J , Liu B
Published: September 2019

Volume complete sky surveys provide evidence for a binary origin for the formation of isolated white dwarfs with magnetic fields in excess of a MegaGauss. Interestingly, not a single high-field magnetic white dwarf has been found in a detached system, suggesting that if the progenitors are indeed binaries, the companion must be removed or merge during formation. An origin scenario consistent with observations involves the engulfment, inspiral, and subsequent tidal disruption of a low-mass companion in the interior of a giant star during a common envelope phase. Material from the shredded companion forms a cold accretion disc embedded in the hot ambient around the proto-white dwarf. Entrainment of hot material may evaporate the disc before it can sufficiently amplify the magnetic field, which typically requires at least a few orbits of the disc. Using three-dimensional hydrodynamic simulations of accretion discs with masses between 1 and 10 times the mass of Jupiter inside the core of an Asymptotic Giant Branch star, we find that the discs survive for at least 10 orbits (and likely for 100 orbits), sufficient for strong magnetic fields to develop.
Gamma-ray luminosity function of BL Lac objects and contribution to the extragalactic gamma-ray background
Authors: Qu Yankun , Zeng Houdun , Yan Dahai
Published: September 2019

Using a significantly enlarged Fermi-LAT BL Lac objects (BL Lacs) sample, we construct the gamma-ray luminosity function (GLF) of BL Lacs, by the joint use of the space density distribution and source counts distribution. We use three well-studied forms of the GLF, i.e. the forms of pure density evolution (PDE), pure luminosity evolution (PLE), and luminosity-dependent density evolution (LDDE). The Markov Chain Monte Carlo (MCMC) technique is used to constrain model parameters. Our results suggest that LDDE model can give the best description for the BL Lac GLF. And the model shows that the BL Lacs with a harder GeV spectrum and a less luminosity evolve as strongly as flat spectrum radio quasars, and the evolution decreases as increasing luminosity. We also model the average photon spectra of BL Lacs with a double power-laws model. Using this modelled spectra, BL Lacs contribute $\sim \!20{{\ \rm per\ cent}}$ of the total extragalactic gamma-ray background (EGB) at E > 100 MeV, $\sim \!100{{\ \rm per\ cent}}$ of the EGB at E > 50 GeV, and the unresolved BL Lacs contribute $\sim\! 20 {{\ \rm per\ cent}}$ of the isotropic diffuse gamma-ray background at E > 100 MeV. A prediction of the TeV EGB spectra are given, which may be tested by the future detectors.
On the road to per cent accuracy – II. Calibration of the non-linear matter power spectrum for arbitrary cosmologies
Authors: Giblin Benjamin , Cataneo Matteo , Moews Ben , Heymans Catherine
Published: September 2019

We introduce an emulator approach to predict the non-linear matter power spectrum for broad classes of beyond-ΛCDM cosmologies, using only a suite of ΛCDM N-body simulations. By including a range of suitably modified initial conditions in the simulations, and rescaling the resulting emulator predictions with analytical ‘halo model reactions’, accurate non-linear matter power spectra for general extensions to the standard ΛCDM model can be calculated. We optimize the emulator design by substituting the simulation suite with non-linear predictions from the standard halofit tool. We review the performance of the emulator for artificially generated departures from the standard cosmology as well as for theoretically motivated models, such as f(R) gravity and massive neutrinos. For the majority of cosmologies we have tested, the emulator can reproduce the matter power spectrum with errors ${\lesssim}1{{\ \rm per\ cent}}$ deep into the highly non-linear regime. This work demonstrates that with a well-designed suite of ΛCDM simulations, extensions to the standard cosmological model can be tested in the non-linear regime without any reliance on expensive beyond-ΛCDM simulations.
CDK and Mec1/Tel1-catalyzed phosphorylation of Sae2 regulate different responses to DNA damage
Authors: Yu Tai-Yuan , Garcia Valerie E , Symington Lorraine S
Published: September 2019

Sae2 functions in the DNA damage response by controlling Mre11-Rad50-Xrs2 (MRX)-catalyzed end resection, an essential step for homology-dependent repair of double-strand breaks (DSBs), and by attenuating DNA damage checkpoint signaling. Phosphorylation of Sae2 by cyclin-dependent kinase (CDK1/Cdc28) activates the Mre11 endonuclease, while the physiological role of Sae2 phosphorylation by Mec1 and Tel1 checkpoint kinases is not fully understood. Here, we compare the phenotype of sae2 mutants lacking the main CDK (sae2-S267A) or Mec1 and Tel1 phosphorylation sites (sae2-5A) with sae2Δ and Mre11 nuclease defective (mre11-nd) mutants. The phosphorylation-site mutations confer DNA damage sensitivity, but not to the same extent as sae2Δ. The sae2-S267A mutation is epistatic to mre11-nd for camptothecin (CPT) sensitivity and synergizes with sgs1Δ, whereas sae2-5A synergizes with mre11-nd and exhibits epistasis with sgs1Δ. We find that attenuation of checkpoint signaling by Sae2 is mostly independent of Mre11 endonuclease activation but requires Mec1 and Tel1-dependent phosphorylation of Sae2. These results support a model whereby CDK-catalyzed phosphorylation of Sae2 activates resection via Mre11 endonuclease, whereas Sae2 phosphorylation by Mec1 and Tel1 promotes resection by the Dna2-Sgs1 and Exo1 pathways indirectly by dampening the DNA damage response.
Increased Incidence of Intracranial Meningiomas in Patients With Acromegaly
Authors: Engelhardt Julien , Nunes Marie-Laure , Pouchieu Camille , Ferrière Amandine , San-Galli François , Gimbert Edouard , Vignes Jean-Rodolphe , Laurent François , Berge Jérôme , Baldi Isabelle , Tabarin Antoine , Loiseau Hugues
Published: September 2019

BACKGROUND

An increased incidence of various neoplasms has been described in patients with acromegaly, and there is evidence to suggest that growth factors are risk factors for the development of meningiomas.

OBJECTIVE

To study if patients with acromegaly are more at risk for developing intracranial meningiomas.

METHODS

We conducted an observational study on 221 consecutive acromegalic patients recruited between January 1, 2000 and December 31, 2015, and 357 consecutive patients with a nonsomatotropic pituitary adenoma recruited between March 1, 2015 and December 31, 2016, in our institution. Patients underwent a gadolinium-enhanced 3D T1 brain magnetic resonance imaging to look for meningiomas. The proportion of meningiomas was compared between the 2 groups, and the standardized incidence ratio (SIR) was computed from the incidence rates of meningiomas observed in the population of acromegalic patients and compared to that of the general population given by the local registry of central nervous system tumors.

RESULTS

Patients with acromegaly had a significant risk for developing intracranial meningiomas as compared to patients without acromegaly (7.7% vs 2.2%, P = .005, OR = 3.45 [1.46; 8.15]). There was a significant increased incidence of intracranial meningiomas in patients with acromegaly (SIR = 126 [25; 367]) as compared to the general population.

CONCLUSION

Our study suggests strongly that patients with acromegaly are more at risk for developing intracranial meningiomas.
Complete Microsurgical Resection of Large Retrochiasmatic Hypothalamic Craniopharyngioma by Transpetrosal Approach: 2-Dimensional Operative Video
Authors: Zeeshan Qazi , Hernandez Juan P Carrasco , Yoh Nina T , Sekhar Laligam N
Published: September 2019

This two-dimensional video shows the technical nuances of complete microsurgical resection of a hypothalamic craniopharyngioma located in the retrochiasmatic region by the transpetrosal approach.

 This 49-yr-old man presented with progressive fatigue, excessive sleepiness, and difficulty in vision in both eyes. He was found to have right CN 3 paralysis and bitemporal hemianopsia on neurological examination. Further workup revealed panhypopituitarism. Brain magnetic resonance imaging (MRI) demonstrated a large solid retrochiasmatic hypothalamic lesion with homogeneous contrast enhancement, measuring 2.1 × 2.6 × 2.4 cm. Optic chiasm was prefixed, and the tumor was just posterior to the pituitary stalk area. The preoperative differential diagnosis included hypothalamic astrocytoma, craniopharyngioma, germinoma, and histiocytosis. Because of the prefixed chiasm, a presigmoid, transpetrosal approach was performed. Our initial plan was a large biopsy, but based on frozen section histology, we decided to excise the tumor completely. The tumor had a pseudocapsule, which was firm and yellowish. It was debulked, dissected from the surrounding hypothalamus, and removed completely. The pituitary stalk was found at the anterior and inferior ends of the tumor and was preserved.

 Postoperatively, the patient developed diabetes insipidus and requires desmopressin replacement, which was gradually tapered. For panhypopituitarism, he is receiving thyroxine, hydrocortisone, and testosterone.

 Postoperatively, patient had an improvement in vision in his left eye and ptosis was improving in the right eye with mRs 1- at 10-wk follow-up.

 An informed consent was obtained from the patient prior to the surgery, which included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides.
Cost-effectiveness and Safety of Interspinous Process Decompression (Superion)
Authors: Cairns Kevin , Deer Tim , Sayed Dawood , van Noort Kim , Liang Kevin
Published: September 2019

Objective

There are several treatment options for patients suffering from lumbar spinal stenosis, including surgical and conservative care. Interspinous spacer decompression using the Superion device offers a less invasive procedure for patients who fail conservative treatment before traditional decompression surgery. This review assesses the current cost-effectiveness, safety, and performance of lumbar spinal stenosis treatment modalities compared with the Superion interspinous spacer procedure.

Methods

EMBASE and PubMed were searched to find studies reporting on the cost-effectiveness, safety, and performance of conservative treatment, including medicinal treatments, epidural injections, physical therapy, and alternative methods, as well as surgical treatment, including laminectomy, laminectomy with fusion, and interspinous spacer decompression. Results were supplemented with manual searches.

Results

Despite substantial costs, persistent conservative treatment (>12 weeks) of lumbar spinal stenosis showed only minimal improvement in pain and functionality. When conservative treatment fails, surgery is more effective than continuing conservative treatment. Lumbar laminectomy with fusion has considerably greater cost than laminectomy alone, as the length of hospital stay increases, the costs for implants are substantial, and complications increase. Although laminectomy and the Superion have comparable outcomes, the Superion implant is positioned percutaneously. This approach may minimize the direct and indirect costs of outpatient rehabilitation and absenteeism, respectively.

Conclusions

Superion interspinous lumbar decompression is a minimally invasive procedure for patients with lumbar spinal stenosis who have failed conservative treatment. Compared with extending conservative treatment or traditional spinal surgery, interspinous lumbar decompression reduces the direct and indirect costs associated with lumbar spinal stenosis.
Why It Does Not Matter What Matters: Relation R, Personal Identity, and Moral Theory
Authors: Steuwer Bastian
Published: September 2019

Derek Parfit famously argued that personal identity is not what matters for prudential concern about the future. Instead, he argues what matters is Relation R, a combination of psychological connectedness and continuity with any cause. This revisionary conclusion, Parfit argued, has profound implications for moral theory. It should lead us, among other things, to deny the importance of the separateness of persons as an important fact of morality. Instead, we should adopt impersonal consequentialism. In this paper, I argue that Parfit is mistaken about this last step. His revisionary arguments about personal identity and rationality have no implications for moral theory. We need not decide whether Relation R or personal identity contain what matters if we want to retain the importance of the separateness of persons.
Changes in phytohormone content and associated gene expression throughout the stages of pear (Pyrus pyrifoliaNakai) dormancy
Authors: Ito Akiko , Tuan Pham Anh , Saito Takanori , Bai Songling , Kita Masayuki , Moriguchi Takaya
Published: September 2019

To elucidate the role of phytohormones during bud dormancy progression in the Japanese pear (Pyrus pyrifolia Nakai), we investigated changes in phytohormone levels of indole acetic acid (IAA), gibberellic acid (GA), abscisic acid (ABA) and trans-zeatin (tZ). Using ultra-performance liquid chromatography/mass spectrometry/mass spectrometry, we monitored phytohormone levels in the buds of field-grown and potted trees that were artificially heated to modify the timing of dormancy and flowering (spring flush) progression. We also analyzed the expression of GA- and ABA-metabolic genes during dormancy. Indole acetic acid and tZ levels were low during dormancy and increased toward the flowering stage. Gibberellic acid levels were maintained at relatively high concentrations during the dormancy induction stage, then decreased before slightly increasing prior to flowering. The low GA concentration in potted trees compared with field-grown trees indicated that GA functions in regulating tree vigor. Abscisic acid levels increased from the dormancy induction stage, peaked near endodormancy release and steadily decreased before increasing again before the flowering stage. The ABA peak levels did not always coincide with endodormancy release, but peak height correlated with flowering uniformity, suggesting that a decline in ABA concentration was not necessary for resumption of growth but the abundance of ABA might be associated with dormancy depth. From monitoring the expression of genes related to GA and ABA metabolism, we inferred that phytohormone metabolism changed significantly during dormancy, even though the levels of bioactive molecules were consistently low. Phytohormones regulate dormancy progression not only upon the reception of internal signals but also upon sensing ambient conditions.
δ-Oscillation Correlates of Anesthesia-induced Unconsciousness in Large-scale Brain Networks of Human Infants
Authors: Pappas Ioannis , Cornelissen Laura , Menon David K. , Berde Charles B. , Stamatakis Emmanuel A.
Published: September 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Functional brain connectivity studies can provide important information about changes in brain-state dynamics during general anesthesia. In adults, γ-aminobutyric acid–mediated agents disrupt integration of information from local to the whole-brain scale. Beginning around 3 to 4 months postnatal age, γ-aminobutyric acid–mediated anesthetics such as sevoflurane generate α-electroencephalography oscillations. In previous studies of sevoflurane-anesthetized infants 0 to 3.9 months of age, α-oscillations were absent, and power spectra did not distinguish between anesthetized and emergence from anesthesia conditions. Few studies detailing functional connectivity during general anesthesia in infants exist. This study’s aim was to identify changes in functional connectivity of the infant brain during anesthesia.

Methods

A retrospective cohort study was performed using multichannel electroencephalograph recordings of 20 infants aged 0 to 3.9 months old who underwent sevoflurane anesthesia for elective surgery. Whole-brain functional connectivity was evaluated during maintenance of a surgical state of anesthesia and during emergence from anesthesia. Functional connectivity was represented as networks, and network efficiency indices (including complexity and modularity) were computed at the sensor and source levels.

Results

Sevoflurane decreased functional connectivity at the δ-frequency (1 to 4 Hz) in infants 0 to 3.9 months old when comparing anesthesia with emergence. At the sensor level, complexity decreased during anesthesia, showing less whole-brain integration with prominent alterations in the connectivity of frontal and parietal sensors (median difference, 0.0293; 95% CI, −0.0016 to 0.0397). At the source level, similar results were observed (median difference, 0.0201; 95% CI, −0.0025 to 0.0482) with prominent alterations in the connectivity between default-mode and frontoparietal regions. Anesthesia resulted in fragmented modules as modularity increased at the sensor (median difference, 0.0562; 95% CI, 0.0048 to 0.1298) and source (median difference, 0.0548; 95% CI, −0.0040 to 0.1074) levels.

Conclusions

Sevoflurane is associated with decreased capacity for efficient information transfer in the infant brain. Such findings strengthen the hypothesis that conscious processing relies on an efficient system of integrated information transfer across the whole brain.
Evaluation of the Clavicle Hook Plate for Treatment of Acromioclavicular Joint Dislocation: A Cadaveric Study
Authors: Vajapey Sravya P. , Bong Matthew R. , Peindl Richard D. , Bosse Michael J. , Ly Thuan V.
Published: September 2019

Objectives:

To describe surgical technique for proper placement of the clavicle hook plate, determine whether there is subacromial impingement caused by hook plate fixation, and evaluate the mechanical strength of the clavicle hook plate construct.

Methods:

Eight fresh-frozen cadaveric shoulders with a mean age of 48 years (range, 37–69) were used. Open reduction and internal fixation of simulated Rockwood type V AC joint dislocation was performed with the clavicle hook plate. Three-dimensional computed tomography studies and arthroscopic evaluation were performed with the glenohumeral joint in different orientations to assess the position of the hook plate relative to relevant joint structures. The clavicle was then superiorly loaded to mechanical failure.

Results:

Computed tomography evaluations showed no contact between the humerus and the hook plate. Distance between the greater tuberosity and hook plate ranged from 14 to 31 mm with maximal shoulder forward flexion and 8.1–25.4 mm with maximal shoulder abduction. Arthroscopic evaluation of the subacromial space demonstrated that with maximal abduction/forward flexion, there was abutment of the rotator cuff with the hook plate in 6 of 8 specimens. In mechanical testing, mean failure load was determined to be 1011 N (range, 380–1563 N). Failure mechanisms included acromion fracture (4), slippage of the hook under acromion (3), and distal clavicle fracture (1).

Conclusions:

This study demonstrates that the clavicle hook plate reduces AC joint dislocation or distal clavicle fractures anatomically, has supra-physiologic mechanical strength, does not cause bony impingement, and exhibits rotator cuff impingement only with maximal abduction/forward flexion of the shoulder.
Cardiac organ damage in patients with Parkinson's disease and reverse dipping
Authors: Di Stefano Cristina , Sobrero Gabriele , Milazzo Valeria , Vallelonga Fabrizio , Romagnolo Alberto , Zibetti Maurizio , Milan Alberto , Veglio Franco , Maule Simona
Published: September 2019

Objective:

Patients with autonomic neuropathy associated with Parkinson's disease often show reverse dipping pattern/nocturnal hypertension at 24-h ambulatory blood pressure (BP) monitoring (24-h ABPM) and diurnal orthostatic hypotension. The aim of the study was to evaluate cardiac alterations in Parkinson's disease patients with reverse dipping, in comparison with non-reverse dippers Parkinson's disease and essential hypertensive patients.

Methods:

A total of 26 consecutive Parkinson's disease patients with reverse dipping at 24-h ABPM and no previous history of hypertension were compared with 26 non-reverse Parkinson's disease patients matched for age, sex and 24-h mean BP, and 26 essential hypertensive patients matched for nighttime mean BP. None of the Parkinson's disease patients suffered from cardiovascular diseases or were treated with antihypertensive or antihypotensive drugs. Reverse dipping was defined by a systolic day-night BP difference less than 0% at 24-h ABPM. Left ventricular (LV) hypertrophy was defined by a LV mass index at least 115 g/m2 in men and at least 95 g/m2 in women.

Results:

LV mass, indexed for BSA, was significantly higher in reverse dipping than non-reverse Parkinson's disease patients (respectively 90.2 ± 25.3 vs. 77.4 ± 13.3 g/m2, P = 0.04), and was similar to essential hypertensive patients (91.6 ± 24.8, P = 0.92). LV hypertrophy was detected in five reverse dipping Parkinson's disease patients and four hypertensive patients, but was not present in non-reverse Parkinson's disease patients (P = 0.046). Nocturnal BP values, nocturnal BP load, weighted BP variability and age were found to correlate with the increased LV mass index.

Conclusion:

Reverse dipping and nocturnal hypertension are related to higher LV mass and increased prevalence of LV hypertrophy in Parkinson's disease patients.
Multiplex Polymerase Chain Reaction Panel for Suspected Pertussis
Authors: Desjardins Michaël , Doyon-Plourde Paméla , Mousseau Sarah , Iachimov Daniela , Rallu Fabien , Quach Caroline
Published: September 2019

Background:

The use of bacterial multiplex polymerase chain reaction (PCR) in children with suspected pertussis sometimes yields unexpected positive results for Mycoplasma pneumoniae. We aimed to evaluate the clinical significance of positive M. pneumoniae results in this population.

Methods:

Retrospective cohort of consecutive patients with suspected pertussis tested with a bacterial multiplex PCR (including Bordetella pertussis and M. pneumoniae) between June 2015 and March 2017. Medical records were reviewed to compare demographics, clinical presentations and outcomes of patients positive for M. pneumoniae with those positive for B. pertussis and those with negative results, using multivariable logistic regression.

Results:

A total of 1244 patients were included as follows: 56 (4.5%) with M. pneumoniae, 116 (9.3%) with B. pertussis and 1029 (82.7%) with negative results. Mean age was respectively 4.8 years, 6.5 years and 2.8 years (P < 0.05). Children with M. pneumoniae were less likely to present with cardinal symptoms of pertussis such as paroxysmal cough [adjusted odds ratio (OR): 0.19, 95% confidence interval (CI): 0.08–0.40) but were more likely to have fever (adjusted OR: 10.53, 95% CI: 3.54–39.49) and other nonspecific respiratory symptoms compared with children with B. pertussis. Children with M. pneumoniae had very similar clinical presentations to those with a negative PCR, but were more likely to have radiologically confirmed pneumonia (adjusted OR: 5.48, 95% CI: 2.96–9.99) and were less likely to be diagnosed with a concomitant viral infection (adjusted OR: 0.32, 95% CI: 0.07–0.99).

Conclusions:

In children with suspected pertussis, the detection of M. pneumoniae is clinically relevant. However, the impact of this finding on patients’ outcome is still unclear.
A high-dose rapamycin treatment alleviates hepatopulmonary syndrome in cirrhotic rats
Authors: Chang Ching-Chih , Chuang Chiao-Lin , Hsin I-Fang , Hsu Shao-Jung , Huang Hui-Chun , Lee Fa-Yauh , Lee Shou-Dong
Published: September 2019

Background:

Rapamycin is a type of immunosuppressive agent that acts through inhibition of mammalian target of rapamycin (mTOR). Hepatopulmonary syndrome (HPS) is a lethal complication in cirrhotic patients. It is characterized by hypoxia and increased intrapulmonary shunts, in which pulmonary inflammation and angiogenesis play important roles. The current study aimed to evaluate the effect of rapamycin on HPS using the experimental model of common bile duct ligation (CBDL)-induced cirrhosis in rats.

Methods:

The rats received low-dose (0.5 mg/kg), high-dose (2 mg/kg) rapamycin, or vehicle from the 15th to the 28th day post CBDL. Then the mortality rate, hemodynamics, biochemistry parameters, arterial blood gas and plasma levels of vascular endothelial growth factor (VEGF) and tumor necrosis factor (TNF)-α were evaluated on the 28th day post CBDL. Pulmonary histopathological stains were performed, and protein expression was examined. In parallel groups, the intrapulmonary shunts of CBDL rats were measured.

Results:

Compared with the control, a high-dose rapamycin treatment decreased portal pressure and improved hypoxia in CBDL rats. It also reduced the plasma level of VEGF and TNF-α and decreased intrapulmonary shunts. Meanwhile, it ameliorated pulmonary inflammation and angiogenesis and downregulated the protein expression of mTOR, P70S6K, nuclear factor kappa B (NFκB), VEGF, and VEGF receptor 2. In contrast, low-dose rapamycin did not attenuate intrapulmonary shunts despite ameliorating portal hypertension.

Conclusion:

High-dose rapamycin ameliorates HPS in cirrhotic rats as evidenced by the alleviated hypoxia and decreased intrapulmonary shunts. Downregulation of the mTOR/P70S6K, NFκB, and VEGF signaling pathways might play a key role.
Predicting Survival of Adult Respiratory Failure Patients Receiving Prolonged (≥14 Days) Extracorporeal Membrane Oxygenation
Authors: Posluszny Joseph , Engoren Milo , Napolitano Lena M. , Rycus Peter T. , Bartlett Robert H. ,   On behalf of the ELSO member centers
Published: September 2019

Extracorporeal membrane oxygenation (ECMO) for adult respiratory failure has significantly increased, with longer duration ECMO support required in severe hypoxemia. We sought to examine independent predictors of survival of adult respiratory failure patients requiring prolonged (≥14 days) ECMO. We reviewed Extracorporeal Life Support Organization Registry data on all adult (≥18 years) patients who required P- ECMO (n = 4,361) over 10 years (2009–2018). Hospital survival was 51.3%, increased from 45.4% in our prior report of 974 patients (1989–2013). Univariate analysis confirmed factors associated with decreased mortality: younger age, white race, increased body weight, viral/bacterial pneumonia, higher positive end expiratory pressure, neuromuscular blockade, VV-ECMO mode, and decreased time from intubation to ECMO. For Pre-ECLS support, most vasopressor/inotropic drugs and nitric oxide had no association with mortality, but steroids (22% vs. 15%, p < 0.001), epinephrine (15% vs. 12%, p = 0.039), and bicarbonate (9% vs. 7%, p = 0.049) were more common in non-survivors. Extracorporeal membrane oxygenation complications (gastrointestinal hemorrhage, neurologic complications, and CPR) were associated with increased mortality. The RESP score was higher in survivors (−0.31 ± 3.36 vs. −0.83 ± 3.34, P < 0.001); however, discrimination was poor (c-statistic = 0.540 ± 0.009); it did not remain in the final model. A multivariable prediction model based on all information at ECMO initiation was fair (c-statistic = 0.670 + 0.012), but discrimination improved with the addition of ECMO complications (c-statistic = 0.675 + 0.012). These findings suggest that reducing ECMO-related complications will improve survival. We have identified predictors of mortality in prolonged ECMO patients, and inclusion of ECMO complications in a new predictive model improved discrimination.
Small intestinal bacterial overgrowth and nonalcoholic fatty liver disease: a systematic review and meta-analysis
Authors: Wijarnpreecha Karn , Lou Susan , Watthanasuntorn Kanramon , Kroner Paul T. , Cheungpasitporn Wisit , Lukens Frank J. , Pungpapong Surakit , Keaveny Andrew P. , Ungprasert Patompong
Published: September 2019

Objectives

Recent studies have suggested that small intestinal bacterial overgrowth (SIBO) could be a predisposing factor for nonalcoholic fatty liver disease (NAFLD) although the results were inconsistent. This systematic review and meta-analysis was conducted with the aim to summarize all available data.

Methods

A comprehensive literature review was conducted utilizing MEDLINE and EMBASE databases through September 2018 to identify all studies that compared the risk of NAFLD among patients with SIBO versus those without SIBO. Effect estimates from each study were extracted and combined together using the random effect, generic inverse variance method of DerSimonian and Laird.

Results

A total of 10 studies with 1093 participants fulfilled the eligibility criteria and were included in the meta-analysis. A significant association between NAFLD and SIBO was observed with the pooled odds ratio of 3.82 (95% confidence interval, 1.93–7.59; I
2 65%). Funnel plot is relatively symmetric and is not suggestive of the presence of publication bias.

Conclusion

A significant association between NAFLD and SIBO was observed in this meta-analysis.
Influence of esophageal variceal bleeding on iron status in chronic hepatitis C patients
Authors: Abbas Omaima Mahmoud , Khalifa Khaled Abd Elmoemen , Makhlouf Manal Mohamed , Osman Nahla Fekri , Abdel Razek Wael M. , Atta Asmaa Said
Published: September 2019

Background

Disorders of serum iron balance are frequently observed in chronic hepatitis C (CHC) patients. Iron overload as well as iron deficiency anemia are common clinical findings in these patients. Variceal bleeding is also a common complication. To date, no study has discussed the influence of esophageal bleeding on iron status in anemic CHC bleeders.

Objective

Was to study reticulocyte hemoglobin content (CHr) and serum hepcidin levels in anemic CHC and to evaluate the influence of variceal bleeding on patients’ iron status.

Methods

Serum hepcidin levels and CHr were assessed in 65 early phase CHC patients (20 nonanemic, 23 anemic nonbleeders, and 22 anemic bleeders), and 20 healthy controls; and were compared with the conventional indices of iron deficiency including mean corpuscular volume, mean corpuscular hemoglobin, red cell distribution width, serum iron, total iron binding capacity, transferrin saturation and ferritin.

Results

Hepcidin levels were comparable in patients groups, but were significantly lower in patients than in controls (P = 0.01). Child-Pugh class B patients showed significantly lower hepcidin levels than class A patients. CHr levels were comparable in all groups as well as all iron deficiency indices. Patients with ferritin values or less 100 ng/ml and CHr or less 29 pg/cell or Tfsat or less 16% are more likely to have iron deficiency [odds ratio (OR = 3.93, 95% confidence interval (CI) = 2.54–6.08; OR  = 10.50, 95% CI = 1.94–56.55, respectively).

Conclusion

Esophageal bleeding has an almost no influence on iron status in CHC patients. Serum hepcidin content is influenced by CHC disease rather than by anemia associated with or without esophageal bleeding and it could be used as a marker of early hepatic insufficiency. Assessing CHr content could add a potential utility in the detection of iron deficiency in CHC patients.