bluuebunny/crossref_metadata_2025 huggingface dataset:
The Origin of Fine Sediment Determines the Observations of Suspended Sediment Fluxes Under Unsteady Flow Conditions
Authors: Juez Carmelo , Hassan Marwan A. , Franca Mário J.
Published: July 2018

Field observations in a wide range of environments have shown that sediment availability is a major control on the suspended sediment observations in streams. Here we examine, via laboratory experiments, how the amount of proximal in‐channel fine sediment storage relative to the upstream fine sediment distal supply influences the observations of suspended sediment concentrations in streams. Experiments under idealized conditions in a laboratory flume with different ratios of proximal and distal sediment supplies were conducted under a varying flow regime. In addition, the role of the sediment particle size of the supplied sediment on suspended sediment observations was explored. The combinations of proximal and distal sediment supply result in multiple responses of the channel bed and sediment quantity within the channel bed, and the responses adjust through aggradation and degradation. The signature of sediment concentration observed at the upstream section of the channel, given by the distal supply, differs from the downstream observations of the total conveyed sediment (distal and proximal), as shown by an in‐phase analysis of sediment concentration‐discharge plots. Furthermore, we show that nonuniform sediment mixtures may result in a change in the direction of the hysteresis observed between sediment concentration and discharge (i.e., from a clockwise hysteresis to a counterclockwise hysteresis). We also demonstrate that the ratio between sediment distal supply and proximal sediment availability modulates the magnitude of the aggradation/degradation processes in the channel reach and thus the joint observations of sediment concentration and discharge.
Beam steering for OAM beams using time‐modulated circular arrays
Authors: Song Qilong , Wang Yang , Liu Kai , Zhang Jie , Wang Yang
Published: July 2018

The theory of time‐modulated circular arrays in respect of generating orbital angular momentum (OAM) beams at harmonic frequencies is analysed. Without using expensive phase shifters in phased arrays, beam steering for OAM beams is achieved using switches connected to array elements. The model of an eight‐element time‐controlled circular array is derived with the method of time‐modulation beam steering techniques. Simulation results show that beam steering for OAM beams is realised, which indicates the effectiveness of the proposed method.
Secure differential compressive spectrum sensing with 1‐bit quantisation
Authors: Farrag Mohammed
Published: July 2018

In this study, the authors propose a secure cooperative spectrum sensing algorithm that is based on compressive sampling theory and employed in wide‐band cognitive radio network. The proposed algorithm seeks to reduce the hardware complexity of the spectrum sensing node by reducing the reported data from this node to the fusion centre and/or other sensing nodes. Due to the spatial correlation between the received primary users' signals at the sensing nodes, the difference between the measurement vectors of any two sensing nodes is expected to be very small when it is compared with the value of the measurement vector itself. The expected reduction in the dynamic range of the difference measurement vector motivates to use the 1‐bit quantiser where only 10bit per measurement is retained, representing its sign. Moreover, the proposed algorithm is impregnable against spectrum sensing data falsification attacks. Both the fusion centre and sensing nodes utilise the proposed authentication algorithm to pick out data from the trustful nodes only to estimate its output data. According to the simulation results, the proposed system guarantees more safeguard to the license primary user while preserves the unlicensed secondary user throughput.
Decentralised gradient projection method for economic dispatch problem with valve point effect
Authors: Elsheakh Yousif , Zou Suli , Ma Zhongjing , Zhang Baihai
Published: July 2018

This study is centred around the economic dispatch (ED) problem of thermal generating units over a multi‐time interval, to have generators collectively meet the load demand and network losses while minimising the system fuel costs. The underlying optimisation problem displays non‐convexity due to the consideration of the valve point effect and ramping rates limit of generators. Additionally, the system operator by itself cannot determine the behaviours of generators since they are not willing to share their own cost functions and wish to make decisions by themselves. In view of these reasons, the authors provide a decentralised method based on gradient projection and piecewise approximation for the ED problem. It is shown that the proposed method converges to the global optimum when applying appropriate step‐size parameters. The performance of the proposed method is demonstrated on the IEEE standard 5 and 10 units test systems, and via comparisons with the existed methods in the literature.
Big Data for transportation and mobility: recent advances, trends and challenges
Authors: Torre‐Bastida Ana Isabel , Del Ser Javier , Laña Ibai , Ilardia Maitena , Bilbao Miren Nekane , Campos‐Cordobés Sergio
Published: July 2018

Big Data is an emerging paradigm and has currently become a strong attractor of global interest, specially within the transportation industry. The combination of disruptive technologies and new concepts such as the Smart City upgrades the transport data life cycle. In this context, Big Data is considered as a new pledge for the transportation industry to effectively manage all data this sector required for providing safer, cleaner and more efficient transport means, as well as for users to personalize their transport experience. However, Big Data comes along with its own set of technological challenges, stemming from the multiple and heterogeneous transportation/mobility application scenarios. In this survey we analyze the latest research efforts revolving on Big Data for the transportation and mobility industry, its applications, baselines scenarios, fields and use case such as routing, planning, infrastructure monitoring, network design, among others. This analysis will be done strictly from the Big Data perspective, focusing on those contributions gravitating on techniques, tools and methods for modeling, processing, analyzing and visualizing transport and mobility Big Data. From the literature review a set of trends and challenges is extracted so as to provide researchers with an insightful outlook on the field of transport and mobility.
OPEX of hybrid DC/AC power systems with large penetration of offshore wind taking into account spinning reserves
Authors: Aragüés‐Peñalba Mònica , Rimez Johan , Van Hertem Dirk , Gomis‐Bellmunt Oriol
Published: July 2018

This study presents a method to analyse the secure and optimal operation of transmission systems consisting of both HVDC (high‐voltage direct current) and high‐voltage alternating current interconnections under a scenario of high penetration of offshore wind and taking into account the system spinning reserves. Different reliability management strategies are assumed, accounting for a single AC element and/or a single DC element outage and taking into consideration the probability of failure of the different power system components. The cost of operation of the system and the wind energy curtailed over the operating time are determined. This method is applied to a study case, based on the CIGRÉ HVDC Test System. The system behaviour over a complete year is modelled using realistic wind generation and demand based on scaling data from the Belgian power system.
Day‐ahead voltage scheduling method based on a two‐stage robust optimisation for VSC‐HVDC connected wind farms
Authors: Jiang Mang , Guo Qinglai , Sun Hongbin
Published: July 2018

Considering the capacitor banks and on‐load tap changer (OLTC) applied in the voltage‐source‐converter‐based high‐voltage direct‐current (VSC‐HVDC) systems with large‐scale wind farm integration, this study presents a day‐ahead voltage scheduling method to avoid frequent adjustment of the slow discrete devices. Using this method, the AC side voltage of the wind farm side VSC (WFVSC), capacitor banks and OLTC can be scheduled optimally. The scheduling ensures a discrete but large change, while real‐time automatic voltage control (AVC) in wind farms offers a continuous and a fine response to the volatility of wind power. This ordination is realised by a two‐stage robust optimisation utilising wind power forecasting. Furthermore, a reasonable simplification method is proposed to address non‐linear constraints and make the problem solvable. Based on Monte Carlo simulation, case studies are conducted for both simple and real systems to verify the validity and superiority of the method. The results show that the scheduling enhances the AVC effect under the randomness of wind power output and enables collaboration among diverse devices in the vicinity. The system operation outperforms other methods in terms of the voltage profile and dynamic reactive power reserves.
Intervention Effects of “Girls on the Move” on Increasing Physical Activity: A Group Randomized Trial
Authors: Robbins Lorraine B , Ling Jiying , Sharma Dhruv B , Dalimonte-Merckling Danielle M , Voskuil Vicki R , Resnicow Kenneth , Kaciroti Niko , Pfeiffer Karin A
Published: July 2018

Background

Limited intervention success in increasing and sustaining girls’ moderate-to-vigorous physical activity (MVPA) underscores a need for continued research.

Purpose

The aim of this study was to evaluate the effect of a 17-week Girls on the Move (GOTM) intervention on increasing MVPA among fifth- to eighth-grade girls.

Methods

This study is a group (cluster) randomized trial, including 24 schools, pair matched and assigned to intervention (n = 12) or control (n = 12) conditions. Participants included 1,519 girls in racially diverse public schools in urban, underserved areas of the Midwestern USA. The intervention included three components: (i) 90-min after-school physical activity (PA) club offered 3 days/week; (ii) two motivational, individually tailored counseling sessions; and (iii) an interactive Internet-based session at the midpoint of the intervention. Main outcome measures were weighted mean minutes of MVPA per week post-intervention and at 9-month follow-up measured via accelerometer.

Results

No between-group differences occurred for weighted mean minutes of MVPA per week at post-intervention (B = –0.08, p = .207) or 9-month follow-up (B = –0.09, p = .118) while controlling for baseline MVPA.

Conclusions

Research is needed to identify interventions that assist girls in attaining and maintaining adequate PA.

ClinicalTrials.gov Identifier

NCT01503333.
Quantitative trait loci identification for brain endophenotypes via new additive model with random networks
Authors: Wang Xiaoqian , Chen Hong , Yan Jingwen , Nho Kwangsik , Risacher Shannon L , Saykin Andrew J , Shen Li , Huang Heng ,   for the ADNI
Published: July 2018

Motivation

The identification of quantitative trait loci (QTL) is critical to the study of causal relationships between genetic variations and disease abnormalities. We focus on identifying the QTLs associated to the brain endophenotypes in imaging genomics study for Alzheimer’s Disease (AD). Existing research works mainly depict the association between single nucleotide polymorphisms (SNPs) and the brain endophenotypes via the linear methods, which may introduce high bias due to the simplicity of the models. Since the influence of QTLs on brain endophenotypes is quite complex, it is desired to design the appropriate non-linear models to investigate the associations of genotypes and endophenotypes.

Results

In this paper, we propose a new additive model to learn the non-linear associations between SNPs and brain endophenotypes in Alzheimer’s disease. Our model can be flexibly employed to explain the non-linear influence of QTLs, thus is more adaptive for the complex distribution of the high-throughput biological data. Meanwhile, as an important computational learning theory contribution, we provide the generalization error analysis for the proposed approach. Unlike most previous theoretical analysis under independent and identically distributed samples assumption, our error bound is based on m-dependent observations, which is more appropriate for the high-throughput and noisy biological data. Experiments on the data from Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort demonstrate the promising performance of our approach for identifying biological meaningful SNPs.

Availability and implementation

An executable is available at https://github.com/littleq1991/additive_FNNRW.
Analysis of single amino acid variations in singlet hot spots of protein–protein interfaces
Authors: Ozdemir E Sila , Gursoy Attila , Keskin Ozlem
Published: July 2018

Motivation

Single amino acid variations (SAVs) in protein–protein interaction (PPI) sites play critical roles in diseases. PPI sites (interfaces) have a small subset of residues called hot spots that contribute significantly to the binding energy, and they may form clusters called hot regions. Singlet hot spots are the single amino acid hot spots outside of the hot regions. The distribution of SAVs on the interface residues may be related to their disease association.

Results

We performed statistical and structural analyses of SAVs with literature curated experimental thermodynamics data, and demonstrated that SAVs which destabilize PPIs are more likely to be found in singlet hot spots rather than hot regions and energetically less important interface residues. In contrast, non-hot spot residues are significantly enriched in neutral SAVs, which do not affect PPI stability. Surprisingly, we observed that singlet hot spots tend to be enriched in disease-causing SAVs, while benign SAVs significantly occur in non-hot spot residues. Our work demonstrates that SAVs in singlet hot spot residues have significant effect on protein stability and function.

Availability and implementation

The dataset used in this paper is available as Supplementary Material. The data can be found at http://prism.ccbb.ku.edu.tr/data/sav/ as well.

Supplementary information

Supplementary data are available at Bioinformatics online.
CisPi: a transcriptomic score for disclosing cis-acting disease-associated lincRNAs
Authors: Wang Zhezhen , Cunningham John M , Yang Xinan H
Published: July 2018

Motivation

Long intergenic noncoding RNAs (lincRNAs) have risen to prominence in cancer biology as new biomarkers of disease. Those lincRNAs transcribed from active cis-regulatory elements (enhancers) have provided mechanistic insight into cis-acting regulation; however, in the absence of an enhancer hallmark, computational prediction of cis-acting transcription of lincRNAs remains challenging. Here, we introduce a novel transcriptomic method: a cis-regulatory lincRNA–gene associating metric, termed ‘CisPi’. CisPi quantifies the mutual information between lincRNAs and local gene expression regarding their response to perturbation, such as disease risk-dependence. To predict risk-dependent lincRNAs in neuroblastoma, an aggressive pediatric cancer, we advance this scoring scheme to measure lincRNAs that represent the minority of reads in RNA-Seq libraries by a novel side-by-side analytical pipeline.

Results

Altered expression of lincRNAs that stratifies tumor risk is an informative readout of oncogenic enhancer activity. Our CisPi metric therefore provides a powerful computational model to identify enhancer-templated RNAs (eRNAs), eRNA-like lincRNAs, or active enhancers that regulate the expression of local genes. First, risk-dependent lincRNAs revealed active enhancers, over-represented neuroblastoma susceptibility loci, and uncovered novel clinical biomarkers. Second, the prioritized lincRNAs were significantly prognostic. Third, the predicted target genes further inherited the prognostic significance of these lincRNAs. In sum, RNA-Seq alone is sufficient to identify disease-associated lincRNAs using our methodologies, allowing broader applications to contexts in which enhancer hallmarks are not available or show limited sensitivity.

Availability and implementation

The source code is available on request. The prioritized lincRNAs and their target genes are in the Supplementary Material.

Supplementary information

Supplementary data are available at Bioinformatics online.
piMGM: incorporating multi-source priors in mixed graphical models for learning disease networks
Authors: Manatakis Dimitris V , Raghu Vineet K , Benos Panayiotis V
Published: July 2018

Motivation

Learning probabilistic graphs over mixed data is an important way to combine gene expression and clinical disease data. Leveraging the existing, yet imperfect, information in pathway databases for mixed graphical model (MGM) learning is an understudied problem with tremendous potential applications in systems medicine, the problems of which often involve high-dimensional data.

Results

We present a new method, piMGM, which can learn with accuracy the structure of probabilistic graphs over mixed data by appropriately incorporating priors from multiple experts with different degrees of reliability. We show that piMGM accurately scores the reliability of prior information from a given expert even at low sample sizes. The reliability scores can be used to determine active pathways in healthy and disease samples. We tested piMGM on both simulated and real data from TCGA, and we found that its performance is not affected by unreliable priors. We demonstrate the applicability of piMGM by successfully using prior information to identify pathway components that are important in breast cancer and improve cancer subtype classification.

Availability and implementation

http://www.benoslab.pitt.edu/manatakisECCB2018.html

Supplementary information

Supplementary data are available at Bioinformatics online.
Starting Young: Trends in Opioid Therapy Among US Adolescents and Young Adults With Inflammatory Bowel Disease in the Truven MarketScan Database Between 2007 and 2015
Authors: Wren Anava A , Bensen Rachel , Sceats Lindsay , Dehghan Melody , Yu Helen , Wong Jessie J , MacIsaac Donna , Sellers Zachary M , Kin Cindy , Park K T
Published: July 2018

Background

Opioids are commonly prescribed for relief in inflammatory bowel disease (IBD). Emerging evidence suggests that adolescents and young adults are a vulnerable population at particular risk of becoming chronic opioid users and experiencing adverse effects.

Objectives

This study evaluates trends in the prevalence and persistence of chronic opioid therapy in adolescents and young adults with IBD in the United States.

Method

A longitudinal retrospective cohort analysis was conducted with the Truven MarketScan Database from 2007 to 2015. Study subjects were 15–29 years old with ≥2 IBD diagnoses (Crohn’s: 555/K50; ulcerative colitis: 556/K51). Opioid therapy was identified with prescription claims within the Truven therapeutic class 60: opioid agonists. Persistence of opioid use was evaluated by survival analysis for patients who remained in the database for at least 3 years following index chronic opioid therapy use.

Results

In a cohort containing 93,668 patients, 18.2% received chronic opioid therapy. The annual prevalence of chronic opioid therapy increased from 9.3% in 2007 to 10.8% in 2015 (P < 0.01), peaking at 12.2% in 2011. Opioid prescriptions per patient per year were stable (approximately 5). Post hoc Poisson regression analyses demonstrated that the number of opioid pills dispensed per year increased with age and was higher among males. Among the 2503 patients receiving chronic opioid therapy and followed longitudinally, 30.5% were maintained on chronic opioid therapy for 2 years, and 5.3% for all 4 years.

Conclusion

Sustained chronic opioid use in adolescents and young adults with IBD is increasingly common, underscoring the need for screening and intervention for this vulnerable population.
A Review of Current Standards and the Evolution of Histopathology Nomenclature for Laboratory Animals
Authors: Elmore Susan A , Cardiff Robert , Cesta Mark F , Gkoutos Georgios V , Hoehndorf Robert , Keenan Charlotte M , McKerlie Colin , Schofield Paul N , Sundberg John P , Ward Jerrold M
Published: July 2018

The need for international collaboration in rodent pathology has evolved since the 1970s and was initially driven by the new field of toxicologic pathology. First initiated by the World Health Organization’s International Agency for Research on Cancer for rodents, it has evolved to include pathology of the major species (rats, mice, guinea pigs, nonhuman primates, pigs, dogs, fish, rabbits) used in medical research, safety assessment, and mouse pathology. The collaborative effort today is driven by the needs of the regulatory agencies in multiple countries, and by needs of research involving genetically engineered animals, for “basic” research and for more translational preclinical models of human disease. These efforts led to the establishment of an international rodent pathology nomenclature program. Since that time, multiple collaborations for standardization of laboratory animal pathology nomenclature and diagnostic criteria have been developed, and just a few are described herein. Recently, approaches to a nomenclature that is amenable to sophisticated computation have been made available and implemented for large-scale programs in functional genomics and aging. Most terminologies continue to evolve as the science of human and veterinary pathology continues to develop, but standardization and successful implementation remain critical for scientific communication now as ever in the history of veterinary nosology.
A Trilinear Restriction Estimate for the Hyperbolic Paraboloid with Sharp Dependence on Transversality
Authors: Ponce Vanegas Felipe
Published: July 2018

The problem of restriction in harmonic analysis revolves around the operator $\mathcal{R}:f\mapsto \hat{f}|_{S}$, where $S$ is a manifold in $\mathbb{R}^n$. A fundamental inequality of the multilinear theory of the restriction operator is $\big \lVert{\prod _{k=1}^{n}\mathcal{R}^{*} f_{k}}\big \rVert _{L^{2/(n-1)}(\mathbb{R}^{n})}\le C\prod _{k=1}^{n}\lVert{f_k}\rVert _{L^{2}(S_k)}$, where $\mathcal{R}^{*}$ is the dual operator and the hypersurfaces $S_k$ satisfy a condition of transversality. This estimate was proven by Bennett, Carbery, and Tao, up to logarithmic losses, but without optimal dependence on transversality in the constant $C$. For subsets of the paraboloid in $\mathbb{R}^{3}$, Ramos got the sharp dependence on transversality. In this paper we extend this result to subsets of the hyperbolic paraboloid.
Developing and maintaining clinical decision support using clinical knowledge and machine learning: the case of order sets
Authors: Zhang Yiye , Trepp Richard , Wang Weiguang , Luna Jorge , Vawdrey David K , Tiase Victoria
Published: July 2018

Development and maintenance of order sets is a knowledge-intensive task for off-the-shelf machine-learning algorithms alone. We hypothesize that integrating clinical knowledge with machine learning can facilitate effective development and maintenance of order sets while promoting best practices in ordering. To this end, we simulated the revision of an “AM Lab Order Set” under 6 revision approaches. Revisions included changes in the order set content or default settings through 1) population statistics, 2) individualized prediction using machine learning, and 3) clinical knowledge. Revision criteria were determined using electronic health record (EHR) data from 2014 to 2015. Each revision’s clinical appropriateness, workload from using the order set, and generalizability across time were evaluated using EHR data from 2016 and 2017. Our results suggest a potential order set revision approach that jointly leverages clinical knowledge and machine learning to improve usability while updating contents based on latest clinical knowledge and best practices.
Expanding Spectrum of Toxoplasma gondii: Thymoma and Toxoplasmic Encephalitis
Authors: Chastain Daniel B , Sams Joeanna I , Steele Gregory M , Lowder Lindsey O , Franco-Paredes Carlos
Published: July 2018

In this brief report, we describe a 76-year-old patient with thymoma who underwent craniotomy for a left parietal lobe mass with pathologic findings consistent with Toxoplasma gondii encephalitis in the absence of any features of thymoma with immunodeficiency/Good’s syndrome. His clinical course suggested likely Toxoplasma reactivation.
Improving the Sensitivity of Real-time PCR Detection of Group B Streptococcus Using Consensus Sequence-Derived Oligonucleotides
Authors: Khatami Ameneh , Randis Tara M , Chamby Anna , Hooven Thomas A , Gegick Margaret , Suzman Evan , A’Hearn-Thomas Brady , Steenhoff Andrew P , Ratner Adam J
Published: July 2018

Group B Streptococcus (GBS) is a perinatal pathogen and an emerging cause of disease in adults. Culture-independent GBS detection relies on polymerase chain reaction (PCR) of conserved genes, including sip. We demonstrate suboptimal sensitivity of the existing sip PCR strategy and validate an improved method based on consensus sequences from >100 GBS genomes.
Estimation of human-edible protein conversion efficiency, net protein contribution, and enteric methane production from beef production in the United States
Authors: Baber Jessica R , Sawyer Jason E , Wickersham Tryon A
Published: July 2018

A model was developed to estimate beef’s contribution toward meeting human protein requirements using a summative model of net protein contribution (NPC) and methane production. NPC was calculated by multiplying the ratio of human-edible protein (HeP) in beef to the HeP in feedstuffs by the protein quality ratio (PQR). PQR describes the change in biological value of HeP that occurs when plant-derived HeP is converted to beef. An NPC > 1 indicates that the production system is positively contributing to meeting human requirements; systems with NPC < 1 reduce the net protein available to meet human requirements. Scenarios were arranged as a 2 × 2 factorial with two sets of dietary inputs and two sets of production parameters. Dietary inputs represented either inputs used in a previous report estimating HeP (previous diet; PD) or inputs more representative of conventional beef production systems (current diet; CD). Production parameters were either drawn from previous reports (previous parameters; PP) or chosen to characterize current industry standards (current parameters; CP). The HeP conversion efficiency (HePCE) for current industry diets and production parameters (CDCP) (kg HeP yield/kg HeP input) was greatest in the cow–calf sector (2,640.83) compared with stocker (5.22) and feedlot (0.34), and other scenarios followed a similar trend. In addition, the entire production system had an HePCE of 0.99 for CDCP; the previous model diets and production parameters (PDPP) scenario estimated HePCE to be 0.46, and other scenarios were in between. For the CDCP scenario, 56%, 10%, and 34% of the HeP were produced in the cow–calf, stocker, and feedlot sectors; PDPP was similar (59%, 13%, and 28%, respectively). PQR averaged 3.04, 3.04, and 2.64 for cow–calf, stocker, and feedlot sectors, respectively, indicating each sector enhances the biological value of the HeP fed. The NPC was greatest for the cow–calf sector (8,794), followed by the stocker and feedlot sectors (8.85 and 0.23, respectively). The entire beef value chain had a PQR of 2.68 and NPC ranged from 1.01 to 3.11, which correspond to PDPP and CDCP, respectively. Overall, 3.05 kg of CH4 were produced per kilogram HeP for CDCP and 2.58 for PDPP, with the cow–calf sector being greater than the feedlot sector (4.53 vs. 0.94 kg CH4/kg HeP, CDCP). Our results suggest that each individual beef sector and the entire value chain produce more high-quality HeP than is consumed in production. Accordingly, beef is a net contributor to meeting human protein requirements.
Treatment of Kratom Withdrawal and Addiction With Buprenorphine
Authors: Khazaeli Azin , Jerry Jason M. , Vazirian Mohsen
Published: July 2018

In this article, we describe a middle-aged woman with a history of addiction to opioid medications who eventually became dependent on kratom. Her kratom-related withdrawal symptoms responded to a trial of buprenorphine-naloxone. Subsequently, she was maintained on this medication.
Pulmonary manifestations of systemic lupus erythematosus and Sjögren's syndrome
Authors: Lopez Velazquez Marco , Highland Kristin B.
Published: July 2018

Purpose of review

Systemic lupus erythematosus (SLE) and Sjögren syndrome are chronic autoimmune inflammatory disorders that can present with multiorgan involvement including the lungs. This review will focus on recent literature pertaining to the epidemiology, pathogenesis, clinical presentation and diagnosis and management of SLE and Sjögren syndrome-associated pulmonary conditions.

Recent findings

Pulmonary manifestations of both disease entities have been well characterized and lung involvement can be observed during the course of the disease in most cases. Pulmonary manifestations of SLE and Sjögren syndrome can be classified based on anatomical site of involvement; and the large and small airways, lung parenchyma, lung vasculature, pleura and respiratory muscles can be involved. The pleura is most commonly involved in SLE, whereas the airways are most commonly involved in primary Sjögren's syndrome (pSS). Sleep disturbances have also been described in both entities.

Although further research into treatment strategies for the pulmonary complications seen in SLE and pSS is needed, the clinician should be aware of the risk factors and clinical presentation of the various pulmonary complications in SLE and pSS in order to identify patients who should be screened and/or have modifications in treatment strategies to mitigate the morbidity and mortality associated with these complications.
Autologous Bone Graft Harvest Using the Reamer–Irrigator–Aspirator
Authors: Yee Michael A. , Hundal Rajbir S. , Perdue Aaron M. , Hake Mark E.
Published: July 2018

Initially developed to reduce intramedullary pressures during long bone intramedullary nail placement, the reamer–irrigator–aspirator (RIA) can be used to harvest large volume autologous bone graft from the intramedullary canal of a long bone. This case-based surgical technique video demonstrates the appropriate techniques that should be applied while using the RIA to obtain autologous bone graft from the femur. A large volume of bone graft, generally between 30 and 90 cm3, can be obtained using a single RIA procedure. The bone graft harvested from the intramedullary canal is excellent regarding its biochemical properties, with several studies reporting higher levels of growth factors and stem cells when compared with iliac crest bone graft. Surgical technique is key to maximize bone graft harvest, as well as to avoid complications including iatrogenic fracture, intraarticular penetration, and fragmentation of either the reamer head from the drive shaft or the guide wire. Pearls and pitfalls regarding sizing of the reamer head, determination of starting point, guide wire placement, reamer advancement, and diligent use of fluoroscopic imaging are highlighted during this video. Finally, outcomes regarding healing of long bone defects when using RIA-derived autologous bone graft and reduction in postoperative pain at the graft donor site are briefly reviewed.
Open Reduction Internal Fixation of the Lisfranc Complex
Authors: Uppal Harmeeth S.
Published: July 2018

Lisfranc injuries are uncommon; however, if left untreated, it can have a detrimental effect causing deformity, chronic pain, and mid-foot arthrosis. Injury can include disruption of the first through fifth tarsometatarsal joints as well as variant patterns that include the involvement of the metatarsals, the naviculocuneiform articulation, and the cuboid. There is controversy regarding the benefits of open reduction internal fixation versus arthrodesis. Regardless, anatomical reduction is paramount to obtaining a good functional outcome. This video details the surgical approach and the reduction and fixation strategy of a high-energy Lisfranc complex fracture dislocation.
Fixation of a Proximal Humerus Fracture Using a Polyaxial Locking Plate and Endosteal Fibular Strut
Authors: Shah Kalpit N. , Sobel Andrew D. , Paxton E. Scott
Published: July 2018

Proximal humerus fractures have a bimodal distribution and are most commonly seen in the elderly and are the third most common fracture pattern seen in the elderly. There is also a subset of these fractures that occur in younger patients secondary to higher energy mechanisms. Nonoperative management is often advocated for a majority of patients, but surgical fixation is often pursued for younger patients or active, older patients with significantly displaced and reconstructable fractures. The most common options for fixation include open reduction and internal fixation with locking plates and intramedullary nailing. Percutaneous pinning and non–locking plate fixation have lost favor with the advent of improved fixation techniques. Recently developed polyaxial locking plates and the use of endosteal fibular strut grafts offer an excellent option for the fixation of these injuries. In this video, we discuss the case of a 47-year-old man with a four-part proximal humerus fracture.
Features of Adult Hyperammonemia Not Due to Liver Failure in the ICU
Authors: Sakusic Amra , Sabov Moldovan , McCambridge Amanda J. , Rabinstein Alejandro A. , Singh Tarun D. , Mukesh Kumar , Kashani Kianoush B. , Cook David , Gajic Ognjen
Published: July 2018

Objectives:

To evaluate the epidemiology of hyperammonemia unrelated to liver failure in the critical care setting.

Design:

Retrospective case series.

Setting:

Critically ill patients admitted to ICUs at Mayo Clinic, Rochester, MN (medical ICU, two mixed medical-surgical ICUs, coronary care unit, or the cardiosurgical ICU) between July 1, 2004, and October 31, 2015.

Patients:

Adult critically ill patients with hyperammonemia not related to acute or chronic liver failure. We excluded patients with diagnosis of moderate or severe liver disease, hyperbilirubinemia, and patients who denied the use of their medical records.

Interventions:

None.

Measurements and Main Results:

Of 3,908 ICU patients with hyperammonemia, 167 (4.5%) had no evidence of acute or chronic liver failure. One-hundred one patients (60.5%) were male with median age of 65.7 years (interquartile range, 50–74.5 yr) and median serum ammonia level of 68 µg/dL (interquartile range, 58–87 µg/dL). Acute encephalopathy was present in 119 patients (71%). Predisposing conditions included malnutrition 27 (16%), gastric bypass six (3.6%), total parenteral nutrition four (2.4%); exposure to valproic acid 17 (10%); status epilepticus 11 (6.6%), high tumour burden 19 (11.3%), and renal failure 82 (49.1%). Urea cycle defects were diagnosed in seven patients (4.1%). Hospital mortality was high (30%), and median ammonia level was higher among the nonsurvivors (74 vs 67 µg/dL; p = 0.05). Deaths were more likely in hyperammonemic patients who were older (p = 0.016), had greater illness severity (higher Acute Physiology and Chronic Health Evaluation III score, p < 0.01), malignancy (p < 0.01), and solid organ transplantation (p = 0.04), whereas seizure disorder was more common in survivors (p = 0.02). After adjustment, serum ammonia level was not associated with increased mortality.

Conclusions:

Hyperammonemia occurs in a substantial minority of critically ill patients without liver failure. These patients have a poor prognosis, although ammonia level per se is not independently associated with mortality. Serum ammonia should be measured when risk factors are present, such as nutritional deficiencies and protein refeeding, treatment with valproic acid, high tumour burden, and known or suspected urea cycle abnormalities.
Benzodiazepine Use and Neuropsychiatric Outcomes in the ICU: A Systematic Review*
Authors: Kok Lotte , Slooter Arjen J. , Hillegers Manon H. , van Dijk Diederik , Veldhuijzen Dieuwke S.
Published: July 2018

Objectives:

A systematic assessment of the role of benzodiazepine use during ICU stay as a risk factor for neuropsychiatric outcomes during and after ICU admission.

Data Sources:

PubMed/Medline, EMBASE, The Cochrane Library, CINAHL, and PsychINFO.

Study Selection:

Databases were searched independently by two reviewers for studies in adult (former) ICU patients, reporting benzodiazepine use, and neuropsychiatric outcomes of delirium, posttraumatic stress disorder, depression, anxiety, and cognitive dysfunction.

Data Extraction:

Data were extracted using a piloted extraction form; methodological quality of eligible studies was assessed by applying the Quality Index checklist.

Data Synthesis:

Forty-nine of 3,066 unique studies identified were included. Thirty-five studies reported on neuropsychiatric outcome during hospitalization, 12 after discharge, and two at both time points. Twenty-four studies identified benzodiazepine use as a risk factor for delirium, whereas seven studies on delirium or related outcomes did not; six studies reported mixed findings. Studies with high methodological quality generally found benzodiazepine use to be a risk factor for the development of delirium. Five studies reported an association between benzodiazepine use and symptoms of posttraumatic stress disorder, depression, anxiety, and cognitive dysfunction after ICU admission; five studies reported mixed findings, and in four studies, no association was found. No association was found with methodological quality and sample size for these findings. Meta-analysis was not feasible due to major differences in study methods.

Conclusions:

The majority of included studies indicated that benzodiazepine use in the ICU is associated with delirium, symptoms of posttraumatic stress disorder, anxiety, depression, and cognitive dysfunction. Future well-designed studies and randomized controlled trials are necessary to rule out confounding by indication.
The Impact of Early Adequate Treatment on Extubation and Discharge Alive of Patients With Pseudomonas aeruginosa-Related Ventilator-Associated Pneumonia*
Authors: Sommer Harriet , Timsit Jean-François , von Cube Maja , Schumacher Martin , Darmon Michael , Schwebel Carole , Ruckly Stéphane , Wolkewitz Martin
Published: July 2018

Objectives:

We aim to examine the effect of early adequate treatment in comparison with inadequate or delayed treatment on being extubated or discharged alive over time, in patients with Pseudomonas aeruginosa-related ventilator-associated pneumonia.

Design:

Retrospective analyses of a prospective observational multicenter cohort study.

Setting:

ICU.

Patients:

Patients of the French prospective database (OUTCOMEREA) were included if they acquired a ventilator-associated pneumonia due to P. aeruginosa between 1997 and 2014 and were mechanically ventilated for more than 48 hours.

Interventions:

Early adequate treatment in comparison with inadequate or delayed adequate treatment.

Measurements and Main Results:

Multistate models were applied to estimate the time-dependent probability of being extubated or discharged alive, and separate Cox regression analyses were used to assess the treatment effect on all important events that influence the outcome of interest. A propensity score-adjusted innovative regression technique was used for a combined and comprehensive patient-relevant summary effect measure. No evidence was found for a difference between adequate and inadequate or delayed treatment on being extubated or discharged alive. However, for all patients, the probability of being extubated or discharged alive remains low and does not exceed 50% even 40 days after a P. aeruginosa-related ventilator-associated pneumonia.

Conclusions:

Early adequate treatment does not seem to be associated with an improved prognosis. Its potential benefit requires further investigation in larger observational studies.
Pollutant composition modification of the effect of air pollution on progression of coronary artery calcium
Authors: Keller Joshua P. , Larson Timothy V. , Austin Elena , Barr R. Graham , Sheppard Lianne , Vedal Sverre , Kaufman Joel D. , Szpiro Adam A.
Published: July 2018

Background:

Differences in traffic-related air pollution (TRAP) composition may cause heterogeneity in associations between air pollution exposure and cardiovascular health outcomes. Clustering multipollutant measurements allows investigation of effect modification by TRAP profiles.

Methods:

We measured TRAP components with fixed-site and on-road instruments for two 2-week periods in Baltimore, Maryland. We created representative TRAP profiles for cold and warm seasons using predictive k-means clustering. We predicted cluster membership for 1005 participants in the Multi-Ethnic Study of Atherosclerosis and Air Pollution with follow-up between 2000 and 2012. We estimated cluster-specific relationships between coronary artery calcification (CAC) progression and long-term exposure to fine particulate matter (PM2.5) and oxides of nitrogen (NOX).

Results:

We identified two clusters in the cold season, notable for higher ratios of gases and ultrafine particles, respectively. A 5-μg/m3 difference in PM2.5 was associated with 17.0 (95% confidence interval [CI] = 7.2, 26.7) and 42.6 (95% CI = 25.7, 59.4) Agatston units/year CAC progression among participants in clusters 1 and 2, respectively (effect modification P = 0.006). A 40 ppb difference in NOX was associated with 22.2 (95% CI = 7.7, 36.7) and 41.9 (95% CI = 23.7, 60.2) Agatston units/year CAC progression in clusters 1 and 2, respectively (P = 0.08). Similar trends occurred using clusters identified from warm season measurements. Clusters correlated highly with baseline pollution level.

Conclusions:

Clustering TRAP measurements identified spatial differences in composition. We found evidence of greater CAC progression rates per unit PM2.5 exposures among people living in areas characterized by high ratios of ultrafine particle counts relative to NOX concentrations.
Safety and Efficacy in Prasugrel- Versus Ticagrelor-Treated Patients With ST-Elevation Myocardial Infarction
Authors: Dimitroulis Dimitrios , Golabkesh Milad , Naguib David , Knoop Betül , Dannenberg Lisa , Helten Carolin , Pöhl Martin , Jung Christian , Kelm Malte , Zeus Tobias , Polzin Amin
Published: July 2018

Prasugrel and ticagrelor are recommended over clopidogrel in patients with ST-elevation myocardial infarction (STEMI). In this registry analysis, we compared efficacy and safety of ticagrelor and prasugrel P2Y12 inhibition in patients with STEMI. We included 318 patients in this single-center analysis. Twelve-month follow-up was conducted during ambulatory care at our department. Patients were on dual antiplatelet therapy with aspirin and ticagrelor or prasugrel during the follow-up period. Prescription of prasugrel or ticagrelor, respectively, was according to the preference of the treating physician. Major adverse cardiac and cerebrovascular events (MACCE) [death, myocardial infarction (MI), stroke, and unplanned reintervention] and thrombolysis in myocardial infarction (TIMI) bleeding (major/minor) were registered during hospitalization and follow-up. TIMI bleeding events were more frequent in ticagrelor-treated patients [17 vs. 5 patients, hazard ratio (HR) 2.85, 95% confidence interval (CI) 1.2–6.6; log-rank P value = 0.01]. Prasugrel-treated patients were significantly younger (ticagrelor 63 ± 12 years vs. prasugrel 57 ± 10; P < 0.0001). Besides that, patients' characteristics were similar in both groups. Multivariate analysis revealed that ticagrelor medication was independently associated with bleeding risk after adjustment for age, percutaneous coronary intervention approach (femoral vs. radial), diabetes mellitus, and kidney function (HR 3.01; 95% CI 1.0–7.4; P = 0.043). In patients treated with ticagrelor, 35 MACCE were detected. There was no difference as compared to prasugrel-treated patients (24 events, HR 1.24, 95% CI 0.79–2.09; log-rank P value = 0.41). TIMI bleeding events were more frequent in ticagrelor-treated patients with STEMI during 12-month follow-up. There were no differences in MACCE between groups in this registry analysis.
Simvastatin Treatment Protects Myocardium in Noncoronary Artery Cardiac Surgery by Inhibiting Apoptosis Through miR-15a-5p Targeting
Authors: Zhou Li , Liu Xiang , Wang Zhen-Qing , Li Yan , Shi Mao-Mao , Xu Zhe , Ou Zhi-Jun , Li Hua-Ming , Cheng Tian-Pu , Jian Yu-Peng , Zhang Wen , Liu Chen , Zhang Xi , Quon Michael J. , Zhang Chun-Xiang , Xu Ying-Qi , Wang Zhi-Ping , Ou Jing-Song
Published: July 2018

Simvastatin treatment is cardioprotective in patients undergoing noncoronary artery cardiac surgery. However, the mechanisms by which simvastatin treatment protects the myocardium under these conditions are not fully understood. Seventy patients undergoing noncoronary cardiac surgery, 35 from a simvastatin treatment group and 35 from a control treatment group, were enrolled in our clinical study. Simvastatin (20 mg/d) was administered preoperatively for 5–7 days. Myocardial tissue biopsies were taken before and after surgery. Apoptosis was detected by TUNEL staining. The expressions of Bcl-2 and Bak in myocardial tissue were detected by immunoblotting. The expressions of miRNA and Bcl-2 mRNA were detected by quantitative real-time polymerase chain reaction assays. Cardiomyocytes were isolated from rat and cultured cells. MiR-15a-5p mimic was transfected into cardiomyocytes, and the Bcl-2 was detected by immunoblotting. TUNEL staining showed significantly less myocardial apoptosis in the simvastatin treatment group when compared with the control treatment group. Protein expression of Bcl-2 was increased in the simvastatin treatment group before surgery, and Bak expression was increased in the control treatment group after surgery. Further comparisons showed that Bcl-2/Bak ratios were reduced in the control treatment group but were not significantly changed in the simvastatin treatment group after surgery. Furthermore, microarray assays revealed that miR-15a-5p was significantly decreased by simvastatin treatment. This was validated by quantitative real-time polymerase chain reaction analysis. MiR-15a-5p was predicted to target Bcl-2 mRNA at nucleotide positions 2529–2536. This was validated by luciferase binding assays. Coincident with the change in miR-15a-5p, the mRNA expression of Bcl-2 was increased in the simvastatin treatment group. MiR-15a-5p mimic significantly inhibited Bcl-2 expression in cardiomyocytes. Our findings strongly suggest that simvastatin treatment preoperatively protected the myocardium in patients undergoing noncoronary artery cardiac surgery, at least in part, by inhibiting apoptosis via suppressing miR-15a-5p expression, leading to increasing expression of Bcl-2 and decreasing expression of Bak.
Managing Menopause by Combining Evidence With Clinical Judgment
Authors: FLORES VALERIE A. , PAL LUBNA
Published: July 2018

Menopause occurring before the age of 40 harbors unique challenges as well as lifetime burden resulting from premature deprivation from ovarian hormones, primarily estrogen. Cessation of ovarian function before age 40 is considered premature (ovarian insufficiency), whereas if occurring before age 45, it is deemed “early.” Early/premature menopause may be idiopathic, medically, or surgically induced. Regardless of the cause, for such women, menopausal hormone therapy is truly replacement and should continue until at least the average age of menopause. Hormone therapy offers the benefit of symptom control, and prevention of health consequences associated with premature loss of ovarian hormones.