bluuebunny/crossref_metadata_2025 huggingface dataset:
A probabilistic account of the concept of cross-transfer and inferential interactions for trace materials
Authors: Taroni Franco , Juchli Patrick , Aitken Colin
Published: October 2020

The analysis of inferential interactions plays an important role in the description of the line of reasoning for a forensic evaluator in a case involving the cross-transfer of evidence. It is possible the two items of evidence may mean more to an evaluator when considered jointly than they do if considered separately. An approach to the evaluation of evidence, with particular attention to the factors that need to be considered, is described for a case involving the cross-transfer of evidence. A formula is given which may be used to define the possible interactions between the evidence transferred in each direction and hence ease the interpretation of such evidence. Numerical examples are given from a classical fibre evidence scenario.
A new era of fine structure constant measurements at high redshift
Authors: Milaković Dinko , Lee Chung-Chi , Carswell Robert F , Webb John K , Molaro Paolo , Pasquini Luca
Published: October 2020

New observations of the quasar HE0515−4414 have been made, aided by the Laser Frequency Comb (LFC), using the HARPS spectrograph on the ESO 3.6m telescope. We present three important advances for α measurements in quasar absorption spectra from these observations. First, the data have been wavelength calibrated using LFC and ThAr methods. The LFC wavelength calibration residuals are six times smaller than when using the standard ThAr calibration. We give a direct comparison between α measurements made using the two methods. Secondly, spectral modelling was performed using Artificial Intelligence (fully automated, all human bias eliminated), including a temperature parameter for each absorption component. Thirdly, in contrast to previous work, additional model parameters were assigned to measure α for each individual absorption component. The increase in statistical uncertainty from the larger number of model parameters is small and the method allows a substantial advantage; outliers that would otherwise contribute a significant systematic, possibly corrupting the entire measurement, are identified and removed, permitting a more robust overall result. The $z$abs = 1.15 absorption system along the HE0515−4414 sightline yields 40 new α measurements. We constrain spatial fluctuations in α to be Δα/α ≤ 9 × 10−5 on scales $\approx \!\! {20}\, {\rm km\, s}^{-1}$, corresponding to $\approx 25\,$kpc if the $z$abs = 1.15 system arises in a 1Mpc cluster. Collectively, the 40 measurements yield Δα/α = −0.27 ± 2.41 × 10−6, consistent with no variation.
Cosmological simulations of the same spiral galaxy: the impact of baryonic physics
Authors: Nuñez-Castiñeyra A , Nezri E , Devriendt J , Teyssier R
Published: October 2020

The interplay of star formation (SF) and supernova (SN) feedback in galaxy formation is a key element for understanding galaxy evolution. Since these processes occur at small scales, it is necessary to have sub-grid models that recover their evolution and environmental effects at the scales reached by cosmological simulations. In this work, we present the results of the Mochima simulation, where we simulate the same spiral galaxy inhabiting a Milky Way (MW) size halo in a cosmological environment changing the sub-grid models for SN feedback and SF. We test combinations of the Schmidt law and a multifreefall based SF with delayed cooling feedback or mechanical feedback. We reach a resolution of 35 pc in a zoom-in box of 36 Mpc. For this, we use the code $\rm{\small RAMSES}$ with the implementation of gas turbulence in time and trace the local hydrodynamical features of the star-forming gas. Finally, we compare the galaxies at redshift 0 with global and interstellar medium observations in the MW and local spiral galaxies. The simulations show successful comparisons with observations. Nevertheless, diverse galactic morphologies are obtained from different numerical implementations. We highlight the importance of detailed modelling of the SF and feedback processes, especially for simulations with a resolution that start to reach scales relevant for molecular cloud physics. Future improvements could alleviate the degeneracies exhibited in our simulated galaxies under different sub-grid models.
Interpretation of the power spectrum of the quiet Sun photospheric turbulence
Authors: Goldman Itzhak
Published: October 2020

Observational power spectra of the photospheric magnetic field turbulence, of the quiet-sun, were presented in a recent paper by Abramenko & Yurchyshyn. Here, I focus on the power spectrum derived from the observations of the Near InfraRed Imaging Spectrapolarimeter operating at the Goode Solar Telescope. The latter exhibits a transition from a power law with index −1.2 to a steeper power law with index −2.2, for smaller spatial scales. This paper presents an interpretation of this change. Furthermore, this interpretation provides an estimate for the effective width of the turbulent layer probed by the observations. The latter turns out to be practically equal to the depth of the photosphere.
Inner dusty regions of protoplanetary discs – II. Dust dynamics driven by radiation pressure and disc winds
Authors: Vinković Dejan , Čemeljić Miljenko
Published: October 2020

We explore dust flow in the hottest parts of protoplanetary discs using the forces of gravity, gas drag, and radiation pressure. Our main focus is on the optically thin regions of dusty disc, where the dust is exposed to the most extreme heating conditions and dynamical perturbations: the surface of optically thick disc and the inner dust sublimation zone. We utilize results from two numerically strenuous fields of research. The first is the quasi-stationary solutions on gas velocity and density distributions from mangetohydrodynamical (MHD) simulations of accretion discs. This is critical for implementing a more realistic gas drag impact on dust movements. The second is the optical depth structure from a high-resolution dust radiation transfer. This step is critical for a better understanding of dust distribution within the disc. We describe a numerical method that incorporates these solutions into the dust dynamics equations. We use this to integrate dust trajectories under different disc wind models and show how grains end up trapped in flows that range from simple accretion on to the star to outflows into outer disc regions. We demonstrate how the radiation pressure force plays one of the key roles in this process and cannot be ignored. It erodes the dusty disc surface, reduces its height, resists dust accretion on to the star, and helps the disc wind in pushing grains outwards. The changes in grain size and porosity significantly affect the results, with smaller and porous grains being influenced more strongly by the disc wind and radiation pressure.
e-MutPath: computational modeling reveals the functional landscape of genetic mutations rewiring interactome networks
Authors: Li Yongsheng , Burgman Brandon , Khatri Ishaani S , Pentaparthi Sairahul R , Su Zhe , McGrail Daniel J , Li Yang , Wu Erxi , Eckhardt S Gail , Sahni Nidhi , Yi S Stephen
Published: October 2020

Understanding the functional impact of cancer somatic mutations represents a critical knowledge gap for implementing precision oncology. It has been increasingly appreciated that the interaction profile mediated by a genomic mutation provides a fundamental link between genotype and phenotype. However, specific effects on biological signaling networks for the majority of mutations are largely unknown by experimental approaches. To resolve this challenge, we developed e-MutPath (edgetic Mutation-mediated Pathway perturbations), a network-based computational method to identify candidate ‘edgetic’ mutations that perturb functional pathways. e-MutPath identifies informative paths that could be used to distinguish disease risk factors from neutral elements and to stratify disease subtypes with clinical relevance. The predicted targets are enriched in cancer vulnerability genes, known drug targets but depleted for proteins associated with side effects, demonstrating the power of network-based strategies to investigate the functional impact and perturbation profiles of genomic mutations. Together, e-MutPath represents a robust computational tool to systematically assign functions to genetic mutations, especially in the context of their specific pathway perturbation effect.
The European Nucleotide Archive in 2020
Authors: Harrison Peter W , Ahamed Alisha , Aslam Raheela , Alako Blaise T F , Burgin Josephine , Buso Nicola , Courtot Mélanie , Fan Jun , Gupta Dipayan , Haseeb Muhammad , Holt Sam , Ibrahim Talal , Ivanov Eugene , Jayathilaka Suran , Balavenkataraman Kadhirvelu Vishnukumar , Kumar Manish , Lopez Rodrigo , Kay Simon , Leinonen Rasko , Liu Xin , O’Cathail Colman , Pakseresht Amir , Park Youngmi , Pesant Stephane , Rahman Nadim , Rajan Jeena , Sokolov Alexey , Vijayaraja Senthilnathan , Waheed Zahra , Zyoud Ahmad , Burdett Tony , Cochrane Guy
Published: October 2020

The European Nucleotide Archive (ENA; https://www.ebi.ac.uk/ena), provided by the European Molecular Biology Laboratory's European Bioinformatics Institute (EMBL-EBI), has for almost forty years continued in its mission to freely archive and present the world's public sequencing data for the benefit of the entire scientific community and for the acceleration of the global research effort. Here we highlight the major developments to ENA services and content in 2020, focussing in particular on the recently released updated ENA browser, modernisation of our release process and our data coordination collaborations with specific research communities.
NMR structure of a vestigial nuclease provides insight into the evolution of functional transitions in viral dsDNA packaging motors
Authors: Mahler Bryon P , Bujalowski Paul J , Mao Huzhang , Dill Erik A , Jardine Paul J , Choi Kyung H , Morais Marc C
Published: October 2020

Double-stranded DNA viruses use ATP-powered molecular motors to package their genomic DNA. To ensure efficient genome encapsidation, these motors regulate functional transitions between initiation, translocation, and termination modes. Here, we report structural and biophysical analyses of the C-terminal domain of the bacteriophage phi29 ATPase (CTD) that suggest a structural basis for these functional transitions. Sedimentation experiments show that the inter-domain linker in the full-length protein promotes oligomerization and thus may play a role in assembly of the functional motor. The NMR solution structure of the CTD indicates it is a vestigial nuclease domain that likely evolved from conserved nuclease domains in phage terminases. Despite the loss of nuclease activity, fluorescence binding assays confirm the CTD retains its DNA binding capabilities and fitting the CTD into cryoEM density of the phi29 motor shows that the CTD directly binds DNA. However, the interacting residues differ from those identified by NMR titration in solution, suggesting that packaging motors undergo conformational changes to transition between initiation, translocation, and termination. Taken together, these results provide insight into the evolution of functional transitions in viral dsDNA packaging motors.
Scyphozoan jellyfish (Cnidaria, Medusozoa) from Amazon coast: distribution, temporal variation and length–weight relationship
Authors: Banha Thomás N S , Morandini André C , Rosário Renan P , Martinelli Filho José E
Published: October 2020

Despite the importance of jellyfish in marine ecosystems, many basic biological and ecological aspects remain understudied, especially in tropical regions. Here, we report on scyphozoan jellyfish distribution and ecology to the Amazon coast for the first time, adding the records of Chrysaora lactea, Lychnorhiza lucerna and Stomolophus fritillarius. We also review the records for the three species for the whole Brazilian coastline, describe temporal variability within an Amazon estuary and length–weight relationships. The three species displayed a widespread distribution on the Brazilian coast. In the studied estuary, the species are unevenly distributed throughout the year and their presence was not clearly correlated with environmental factors examined, although L. lucerna is more common during the dry season, as indicated by multivariate and correlation analysis. The length–weight relationships were significant for both L. lucerna (R2 = 0.86, P < 0.0001) and S. fritillarius (R2 = 0.75, P < 0.0001). Jellyfish variability is still unexplained within the estuary despite our 3-year sampling. These jellyfish may be more abundant during the dry season due to the retraction of the amazon plume, but additional sampling designs and methods are needed to test this hypothesis.
Point-of-care lung ultrasound predicts in-hospital mortality in acute heart failure
Authors: Araiza-Garaygordobil D , Gopar-Nieto R , Martínez-Amezcua P , Cabello-López A , Manzur-Sandoval D , García-Cruz E , De la Fuente-Mancera J C , Martínez-Gutiérrez J , Luna-Carrera M J , Lerma-Landeros E , Gutiérrez-González F M , González-Pacheco H , Briseño-De la Cruz J L , Arias-Mendoza A
Published: October 2020

Background

B-lines have been associated with adverse clinical outcomes in patients with heart failure (HF) when found at hospital discharge or during outpatient visits. Whether lung ultrasound (LUS) assessed B-lines may predict in-hospital mortality in patients with acute HF is still undetermined.

Aim

To evaluate the association between B-lines on admission and in-hospital mortality among patients admitted with acute HF.

Methods

Hand-held LUS was used to examine patients with acute HF. LUS was performed in eight chest zones with a pocket ultrasound device and analyzed offline. The association between B-lines and in-hospital mortality was assessed using Cox regression models.

Results

We included 62 patients with median age 56 years, 69.4% men, and median left ventricle ejection fraction 25%. The sum of B-lines ranged from 0 to 53 (median 6.5). An optimal receiver operating characteristic-determined cut-off of ≥19 B-lines demonstrated a sensitivity of 57% and a specificity of 86% (area under the curve 0.788) for in-hospital mortality. The incremental prognostic value of LUS when compared with lung crackles or peripheral edema by integrated discrimination improvement was 12.96% (95% CI: 7.0–18.8, P = 0.02). Patients with ≥19 B-lines had a 4-fold higher risk of in-hospital mortality (HR 4.38; 95% CI: 1.37–13.95, P < 0.01).

Conclusion

In patients admitted with acute HF, point-of-care LUS measurements of pulmonary congestion (B-lines) are associated with in-hospital mortality.
Combined use of QRISK3 and SCORE as predictors of carotid plaques in patients with rheumatoid arthritis
Authors: Corrales Alfonso , Vegas-Revenga Nuria , Atienza-Mateo Belén , Corrales-Selaya Cristina , Prieto-Peña Diana , Rueda-Gotor Javier , Portilla Virginia , Blanco Ricardo , Castañeda Santos , Ferraz-Amaro Iván , Llorca Javier , González-Gay Miguel A
Published: October 2020

Objective

Because carotid plaques predict the development of cardiovascular events in RA, we aimed to assess if the combined use of the systematic coronary risk evaluation (SCORE) and the QRISK3 algorithms allows for the identification of RA patients with carotid plaques in a defined population-based RA inception cohort.

Methods

A set of consecutive RA patients without a history of diabetes, chronic kidney disease or cardiovascular events were studied by carotid US between 2012 and 2019. Modified SCORE (mSCORE) for RA based on the 2015/2016 updated EULAR recommendations and QRISK3 algorithms were retrospectively tested using baseline data obtained at the time of the carotid US assessment.

Results

A total of 466 (54%) of 865 patients had carotid plaques. Using dichotomized QRISK3 and EULAR mSCORE, 73.2% (95% CI: 68.4.8, 77.6) of patients with QRISK ≥ 10% and EULAR mSCORE < 5% had plaque. In this group, the diagnostic odds ratio was 5.79 (95% CI: 4.14, 8.10). However, if both algorithms were above their thresholds of high cardiovascular risk (QRISK ≥ 10% and EULAR mSCORE ≥ 5%), the sensitivity increased up to 83.3% (95% CI: 72.1, 91.4) and the diagnostic odds ratio up to 10.6 (95% CI: 5.13, 22.0). When the risk charts scales were used as continuous variables, both QRISK3 and EULAR mSCORE were found positively associated with plaque. For each 1% QRISK3 or EULAR mSCORE increase, the probability of having plaques multiplied by 1.14 and 1.22, respectively. However, the effects of both algorithms did not multiply by each other.

Conclusions

. The combined use of QRISK3 and EULAR mSCORE allows for the identification of most RA patients at high risk of carotid plaques.
Structural and Functional Connectivity of Visual Cortex in Schizophrenia and Bipolar Disorder: A Graph-Theoretic Analysis
Authors: Reavis Eric A , Lee Junghee , Altshuler Lori L , Cohen Mark S , Engel Stephen A , Glahn David C , Jimenez Amy M , Narr Katherine L , Nuechterlein Keith H , Riedel Philipp , Wynn Jonathan K , Green Michael F
Published: October 2020

Visual processing abnormalities in schizophrenia (SZ) are poorly understood, yet predict functional outcomes in the disorder. Bipolar disorder (BD) may involve similar visual processing deficits. Converging evidence suggests that visual processing may be relatively normal at early stages of visual processing such as early visual cortex (EVC), but that processing abnormalities may become more pronounced by mid-level visual areas such as lateral occipital cortex (LO). However, little is known about the connectivity of the visual system in SZ and BD. If the flow of information to, from, or within the visual system is disrupted by reduced connectivity, this could help to explain perceptual deficits. In the present study, we performed a targeted analysis of the structural and functional connectivity of the visual system using graph-theoretic metrics in a sample of 48 SZ, 46 BD, and 47 control participants. Specifically, we calculated parallel measures of local efficiency for EVC and LO from both diffusion weighted imaging data (structural) and resting-state (functional) imaging data. We found no structural connectivity differences between the groups. However, there was a significant group difference in functional connectivity and a significant group-by-region interaction driven by reduced LO connectivity in SZ relative to HC, whereas BD was approximately intermediate to the other 2 groups. We replicated this pattern of results using a different brain atlas. These findings support and extend theoretical models of perceptual dysfunction in SZ, providing a framework for further investigation of visual deficits linked to functional outcomes in SZ and related disorders.
Impact of chronic stylet-feeder infestation on folivore-induced signaling and defenses in a conifer
Authors: Rigsby Chad M , Body Mélanie J A , May Amelia , Oppong Anita , Kostka Amy , Houseman Nick , Savage Suzanne , Whitney Elizabeth R , Kinahan Ian G , Deboef Brenton , Orians Colin M , Appel Heidi M , Schultz Jack C , Preisser Evan L
Published: October 2020

Our understanding of how conifers respond biochemically to multiple simultaneous herbivore attacks is lacking. Eastern hemlock (Tsuga canadensis; ‘hemlock’) is fed on by hemlock woolly adelgid (Adelges tsugae; ‘adelgid’) and by later-instar gypsy moth (Lymantria dispar; ‘gypsy moth’) caterpillars. The adelgid is a stylet-feeding insect that causes a salicylic acid (SA)-linked response in hemlock, and gypsy moth larvae are folivores that presumably cause a jasmonic acid (JA)-linked response. This system presents an opportunity to study how invasive herbivore–herbivore interactions mediated through host biochemical responses. We used a factorial field experiment to challenge chronically adelgid-infested hemlocks with gypsy moth caterpillars. We quantified 17 phytohormones, 26 phenolic and terpene metabolites, and proanthocyanidin, cell wall-bound (CW-bound) phenolic, and lignin contents. Foliage infested with adelgid only accumulated gibberellins and SA; foliage challenged by gypsy moth only accumulated JA phytohormones. Gypsy moth folivory on adelgid-infested foliage reduced the accumulation of JA phytohormones and increased the SA levels. Both herbivores increased CW-bound phenolics and gypsy moth increased lignin content when feeding alone but not when feeding on adelgid-infested foliage. Our study illustrates the importance of understanding the biochemical mechanisms and signaling antagonism underlying tree responses to multiple stresses and of disentangling local and systemic stress signaling in trees.
Physiochemical and molecular features of the necrotic lesion in the Heterobasidion–Norway spruce pathosystem
Authors: Liu Mengxia , Jaber Emad , Zeng Zhen , Kovalchuk Andriy , Asiegbu Fred O
Published: October 2020

In the forest of Northern Hemisphere, the fungi Heterobasidion annosum (Fr.) Bref. s.l. causes severe root and stem rot diseases, dramatically reducing the wood quality of conifer trees. The hallmark of the host response during the infection process is the formation of necrotic lesions and reaction zones. To characterize physiochemical and molecular features of the necrotic lesion, we conducted artificial inoculations on Norway spruce plants at different developmental stages: seedlings, young and mature trees. The results were further compared against data available on the formation of reaction zones. Strong necrosis browning or enlarged necrotic lesions were observed in infected tissues. This was accompanied by elevated pH. However, the increased pH, around 6.0 in necrotic lesions, was not as high as that documented in reaction zones, above 7.0 as marked by the intensity of the blue colour in response to 2,6-dichlorophenol indophenol dye. Peroxidase activity increased in infected plants and RNA-seq analysis of necrotic lesions showed marked upregulation of defence-related genes. Our findings highlight similarities and differences between the reaction zone and necrotic lesion formation in response of conifer trees to biotic stress.
Treponema pallidum in female sex workers from the Brazilian Marajó Archipelago: prevalence, risk factors, drug-resistant mutations and coinfections
Authors: Coelho Evelen C , Souza Samara B , Costa Camila Carla S , Costa Luana M , Pinheiro Luiz Marcelo L , Machado Luiz Fernando A , Silva-Oliveira Gláucia C , Martins Luísa Caricio , Frade Paula Cristina R , Oliveira-Filho Aldemir B
Published: October 2020

Background

Female sex workers (FSWs) are an especially vulnerable group for syphilis and other sexually transmitted infection (STIs). This study determined the prevalence of syphilis in FSWs and factors associated with this disease in the Marajó Archipelago (northern Brazil), as well as the frequency of point mutations (A2058G and A2059G) in the 23S rRNA gene of Treponema pallidum and coinfections with hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis D virus (HDV).

Methods

FSWs were diagnosed using a rapid qualitative test and the isolates were evaluated for the presence of point mutations by real-time PCR. Blood samples with T. pallidum were tested for the presence of HBV, HCV and HDV by ELISA and confirmed by real-time PCR. The factors associated with syphilis were identified using Poisson regression models.

Results

Overall, 41.1% FSWs tested positive for syphilis and 23.5% were infected with strains having A2058G/A2059G point mutations. HBV (23.0%) and HCV (8.1%) were detected among FSWs with syphilis. Six factors were associated with syphilis: low levels of education, reduced income, drug use, unprotected sex, a lengthy career in prostitution and a lack of regular medical check-ups.

Conclusions

These findings indicate an urgent need for implementation of effective strategies to diagnose, prevent and treat syphilis, as well as other STIs, in this Brazilian region.
Bacterial Community Members Increase Bacillus subtilis Maintenance on the Roots of Arabidopsis thaliana
Authors: Eckshtain-Levi Noam , Harris Susanna Leigh , Roscios Reizo Quilat , Shank Elizabeth Anne
Published: October 2020

Plant-growth-promoting bacteria (PGPB) are used to improve plant health and promote crop production. However, because some PGPB (including Bacillus subtilis) do not maintain substantial colonization on plant roots over time, it is unclear how effective PGPB are throughout the plant growing cycle. A better understanding of the dynamics of plant root community assembly is needed to develop and harness the potential of PGPB. Although B. subtilis is often a member of the root microbiome, it does not efficiently monoassociate with plant roots. We hypothesized that B. subtilis may require other primary colonizers to efficiently associate with plant roots. We utilized a previously designed hydroponic system to add bacteria to Arabidopsis thaliana roots and monitor their attachment over time. We inoculated seedlings with B. subtilis and individual bacterial isolates from the native A. thaliana root microbiome either alone or together. We then measured how the coinoculum affected the ability of B. subtilis to colonize and maintain on A. thaliana roots. We screened 96 fully genome-sequenced strains and identified five bacterial strains that were able to significantly improve the maintenance of B. subtilis. Three of these rhizobacteria also increased the maintenance of two strains of B. amyloliquefaciens commonly used in commercially available bioadditives. These results not only illustrate the utility of this model system to address questions about plant–microbe interactions and how other bacteria affect the ability of PGPB to maintain their relationships with plant roots but also may help inform future agricultural interventions to increase crop yields.

[Formula: see text] Copyright © 2020 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Pathogenesis and Immune Response in Resistant and Susceptible Cultivars of Grapevine (Vitis spp.) Against Elsinoë ampelina Infection
Authors: Han Rui , Yin Wuchen , Ahmad Bilal , Gao Peijia , Li Zhi , Wang Xiping
Published: October 2020

Elsinoë ampelina is the main cause of grape anthracnose, and the majority of grapevine cultivars are susceptible to this fungus. Some Chinese wild grape cultivars are resistant, however. It is therefore apt to compare the pathogenesis and immune responses in susceptible and resistant cultivars of grapevine to explore the detailed molecular and biochemical mechanisms of resistance to this fungus. In this study, ultrastructural and histopathological observations were used to demonstrate the resistance responses to E. ampelina in the resistant Chinese wild cultivar Vitis quinquangularis clone ‘Shang-24’ and the susceptible cultivars V. davidii ‘Tangwei’ and V. vinifera ‘Thompson Seedless’. Seventy-two hours postinoculation (hpi) with E. ampelina, brown necrotic spots were clearly visible on the leaves of the susceptible ‘Tangwei’ and ‘Thompson Seedless’. The infection was characterized by rapid colonization of the host cells by hyphae and massive spread of the pathogen in the intercellular spaces, ultimately leading to host cell collapse, cuticle dissolution, and extensive hyphal growth. In the resistant clone ‘Shang-24’, the conidia were lysed, a large quantity of electronically dense matter appeared, the hyphal growth was suppressed, and the host cells remained intact. In addition, six genes associated with disease resistance were differentially expressed in the susceptible and resistant cultivars. These disease-related genes were significantly up-regulated following infection with E. ampelina. This study illustrates the differences in infection and colonization of E. ampelina in resistant and susceptible grape leaves.
Major Short-term Complications of Arterial Cannulation for Monitoring in Children
Authors: Gleich Stephen J. , Wong Ashley V. , Handlogten Kathryn S. , Thum Daniel E. , Nemergut Michael E.
Published: October 2020

Background

Perioperative arterial cannulation in children is routinely performed. Based on clinical observation of several complications related to femoral arterial lines, the authors performed a larger study to further examine complications. The authors aimed to (1) describe the use patterns and incidence of major short-term complications associated with arterial cannulation for perioperative monitoring in children, and (2) describe the rates of major complications by anatomical site and age category of the patient.

Methods

The authors examined a retrospective cohort of pediatric patients (age less than 18 yr) undergoing surgical procedures at a single academic medical center from January 1, 2006 to August 15, 2016. Institutional databases containing anesthetic care, arterial cannulation, and postoperative complications information were queried to identify vascular, neurologic, and infectious short term complications within 30 days of arterial cannulation.

Results

There were 5,142 arterial cannulations performed in 4,178 patients. The most common sites for arterial cannulation were the radial (N = 3,395 [66.0%]) and femoral arteries (N = 1,528 [29.7%]). There were 11 major complications: 8 vascular and 3 infections (overall incidence, 0.2%; rate, 2 per 1,000 lines; 95% CI, 1 to 4) and all of these complications were associated with femoral arterial lines in children younger than 5 yr old (0.7%; rate, 7 per 1,000 lines; 95% CI, 4 to 13). The majority of femoral lines were placed for cardiac procedures (91%). Infants and neonates had the greatest complication rates (16 and 11 per 1,000 lines, respectively; 95% CI, 7 to 34 and 3 to 39, respectively).

Conclusions

The overall major complication rate of arterial cannulation for monitoring purposes in children is low (0.2%). All complications occurred in femoral arterial lines in children younger than 5 yr of age, with the greatest complication rates in infants and neonates. There were no complications in distal arterial cannulation sites, including more than 3,000 radial cannulations.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Civilian Ballistic Tibia Shaft Fractures Compared With Blunt Tibia Shaft Fractures: Open or Closed?
Authors: Prather John C. , Montgomery Tyler , Cone Brent , Quade Jonathan H. , Fellows Kenneth , Devine Thomas L. , Spitler Clay A.
Published: October 2020

Objectives:

To identify a group of ballistic tibia fractures, report the outcomes of these fractures, and compare them with both closed and open tibia fractures sustained by blunt mechanisms. We hypothesized that ballistic tibia fractures and blunt open fractures would have similar outcomes.

Design:

Retrospective cohort study.

Setting:

A single Level-1 trauma center.

Patients/Participants:

Adult patients presenting with ballistic (44), blunt closed (179), or blunt open (179) tibia fractures.

Intervention:

Intramedullary stabilization of tibia fracture.

Main Outcomes:

Unplanned reoperation, soft tissue reconstruction, nonunion, compartment syndrome, and fracture-related infection.

Results:

Compared with the blunt closed group, the ballistic fracture group required more operations (P < 0.01), had a higher occurrence of soft tissue reconstruction (P < 0.01), and higher incidence of compartment syndrome (P = 0.02). Ballistic and blunt closed groups did not significantly differ in rates of unplanned reoperation (P = 0.67), nonunion (11.4% vs. 4.5%, P = 0.08), or deep infection (9.1% vs. 5.6%, P = 0.49). In comparison to the blunt open group, the ballistic group required a similar number of operations (P = 0.12), had similar rates of unplanned reoperation (P = 0.10), soft tissue reconstruction (P = 0.56), nonunion (11.4% vs. 17.9%, P = 0.49), and fracture-related infection (9.1% vs. 10.1%, P = 1.0) but a higher incidence of compartment syndrome (15.9% vs. 5.0%, P = 0.02).

Conclusions:

Ballistic tibia fractures require more surgeries and have higher rates of soft tissue reconstruction than blunt closed fractures and seem to have outcomes similar to lower severity open fractures. We found a significantly higher rate of compartment syndrome in ballistic tibia fractures than both open and closed blunt fractures. When treating ballistic tibia fractures, surgeons should maintain a high level of suspicion for the development of compartment syndrome and counsel patients that ballistic tibia fractures seem to behave like an intermediate category between closed and open fractures sustained through blunt mechanisms.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Predictors of Improved Early Clinical Outcomes After Elective Implant Removal
Authors: Kempton Laurence B. , Gaski Greg E. , Brown Krista , McKinley Todd O. , Virkus Walter W.
Published: October 2020

Objectives:

To determine preoperative factors predictive of improvement in pain and function after elective implant removal. We hypothesized that patients undergoing orthopaedic implant removal to relieve pain would have significant improvements in both pain and function.

Design:

Prospective cohort study.

Setting:

Level I Trauma Center.

Patients/Participants:

One hundred eighty-nine patients were enrolled after consenting for orthopaedic implant removal to address residual pain. One hundred sixty-three were available for 3-month follow-up.

Main Outcome Measurement:

Preoperative and postoperative outcome measures including Patient Reported Outcomes Measurement Information System (PROMIS) scores were compared. Preoperative scores, surgeon prediction of pain improvement, and palpable implants were analyzed as predictors of outcomes.

Results:

Median PROMIS physical function and pain interference scores and visual analogue scale significantly improved by 6, 8, and 2 points, respectively (P< 0.001 for all). Worse preinjury scores predicted improvement in respective postoperative outcomes (P< 0.001 for all). Surgeon prediction of improvement was associated with improved PROMIS pain interference (P= 0.005), patient subjective assessment of pain improvement (P= 0.03), and subjective percent of pain remaining at 3 months (P= 0.02). Implant superficial palpability was not predictive for any postoperative outcomes.

Conclusions:

Although the primary indication for implant removal in this population was pain relief, many patients also had a clinically relevant improvement in physical function. In addition, patients who start with worse global indices of pain and function are more likely to improve after implant removal. This suggests that implant-related pain directly contributes to global dysfunction.

Level of Evidence:

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Pain, Depression, and Posttraumatic Stress Disorder Following Major Extremity Trauma Among United States Military Serving in Iraq and Afghanistan: Results From the Military Extremity Trauma and Amputation/Limb Salvage Study
Authors: Castillo Renan C. , Carlini Anthony R. , Doukas William C. , Hayda Roman A. , Frisch Harold M. , Andersen Romney C. , D'Alleyrand Jean-Claude , Mazurek Michael T. , Ficke James R. , Keeling John J. , Pasquina Paul F. , Wain Harold J. , MacKenzie Ellen J.
Published: October 2020

Objectives:

Assess the burden and co-occurrence of pain, depression, and posttraumatic stress disorder (PTSD) among service members who sustained a major limb injury, and examine whether these conditions are associated with functional outcomes.

Design:

A retrospective cohort study.

Setting:

Four U.S. military treatment facilities: Walter Reed Army Medical Center, National Naval Medical Center, Brooke Army Medical Center, and Naval Medical Center San Diego.

Patients/Participants:

Four hundred twenty-nine United States service members who sustained a major limb injury while serving in Afghanistan or Iraq met eligibility criteria upon review of their medical records.

Intervention:

Not applicable.

Main Outcome Measurements:

Outcomes assessed were: function using the short musculoskeletal functional assessment; PTSD using the PTSD Checklist and diagnostic and statistical manual criteria; pain using the chronic pain grade scale.

Results:

Military extremity trauma and amputation/limb salvage patients without pain, depression, or PTSD, were, on average, about one minimally clinically important difference (MCID) from age- and gender-adjusted population norms. In contrast, patients with low levels of pain and no depression or PTSD were, on average, one to 2 MCIDs from population norms. Military extremity trauma and amputation/limb salvage patients with either greater levels of pain, and who experience PTSD, depression, or both, were 4 to 6 MCIDs from population norms. Regression analyses adjusting for injury type (upper or lower limb, salvage or amputation, and unilateral or bilateral), age, time to interview, military rank, presence of a major upper limb injury, social support, presence of mild traumatic brain injury/concussion, and combat experiences showed that higher levels of pain, depression, and PTSD were associated with lower one-year functional outcomes.

Conclusions:

Major limb trauma sustained in the military results in significant long-term pain and PTSD. Overall, the results are consistent with the hypothesis that pain, depression, and PTSD are associated with disability in this population.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Do Thoracic Spinal Deformities Affect Outcomes of Spinal Cord Stimulators
Authors: Malige Ajith , Kantzos Andrew , Sokunbi Gbolabo O.
Published: October 2020

Study Design.

Retrospective chart review.

Objective.

The aim of this study was to ascertain whether the presence of structural thoracic deformities affects outcomes of permanent SCS placement.

Summary of Background Data.

Neural modulation via spinal cord stimulators (SCSs) has become an accepted treatment option for various chronic pain syndromes. In most cases, the surgeon desires accurate midline positioning of the paddle lead, allowing for flexibility of unilateral or bilateral coverage of pain patterns. Structural spinal deformities (scoliosis or kyphosis) often result from coronal, sagittal, and rotatory deformity that can make midline placement more difficult.

Methods.

Between 2013 and 2017, two-hundred forty-one charts of patients who underwent permanent SCS placement at our suburban hospital were reviewed. Demographic information, numerical rating system (NRS) pain scores, Oswestry Disability Index (ODI) scores, and opioid medication usage were recorded at baseline and after permanent stimulator placement. Thoracic scoliosis and kyphosis angles were measured using spinal radiographs. The effect of each structural deformity on NRS, ODI, and narcotic medication usage changes from baseline was analyzed.

Results.

Overall, 100 patients were included in our cohort. Fifty-six patients had measured thoracic spinal deformities (38% with scoliosis, 31% with kyphosis). There was no significant difference in NRS scores, ODI scores, or narcotic usage change between patients with scoliosis and those without (P = 0.66, P = 0.57, P = 0.75) or patients with kyphosis and those without (P = 0.51, P = 0.31, P = 0.63). Bivariate linear regression analysis showed that scoliotic and kyphotic angles were not significant predictors of NRS (P = 0.39, P = 0.13), ODI (P = 0.45, P = 0.07), and opioid usage (P = 0.70, P = 0.90) change, with multivariate regression analyses confirming these findings.

Conclusion.

SCSs can be effective options for treating lumbar back pain and radiculopathy. Our study suggests that the presence of mild structural deformities does not adversely affect outcomes of permanent SCS placement and as such should not preclude this population from benefiting from such therapies.

Level of Evidence: 4
Vorinostat and fenretinide synergize in preclinical models of T-cell lymphoid malignancies
Authors: Makena Monish Ram , Nguyen Thinh H. , Koneru Balakrishna , Hindle Ashly , Chen Wan-Hsi , Verlekar Dattesh U. , Kang Min H. , Reynolds C. Patrick
Published: October 2020

T-cell lymphoid malignancies (TCLMs) are in need of novel and more effective therapies. The histone deacetylase (HDAC) inhibitors and the synthetic cytotoxic retinoid fenretinide have achieved durable clinical responses in T-cell lymphomas as single agents, and patients who failed prior HDAC inhibitor treatment have responded to fenretinide. We have previously shown fenretinide synergized with the class I HDAC inhibitor romidepsin in preclinical models of TCLMs. There exist some key differences between HDAC inhibitors. Therefore, we determined if the pan-HDAC inhibitor vorinostat synergizes with fenretinide. We demonstrated cytotoxic synergy between vorinostat and fenretinide in nine TCLM cell lines at clinically achievable concentrations that lacked cytotoxicity for non-malignant cells (fibroblasts and blood mononuclear cells). In vivo, vorinostat + fenretinide + ketoconazole (enhances fenretinide exposures by inhibiting fenretinide metabolism) showed greater activity in subcutaneous TCLM xenograft models than other groups. Fenretinide + vorinostat increased reactive oxygen species (ROS, measured by 2′,7′-dichlorodihydrofluorescein diacetate dye), resulting in increased apoptosis (via transferase dUTP nick end labeling assay) and histone acetylation (by immunoblotting). The synergistic cytotoxicity, apoptosis, and histone acetylation of fenretinide + vorinostat was abrogated by the antioxidant vitamin C. Like romidepsin, vorinostat combined with fenretinide achieved synergistic cytotoxic activity and increased histone acetylation in preclinical models of TCLMs, but not in non-malignant cells. As vorinostat is an oral agent and not a P-glycoprotein substrate it may have advantages in such combination therapy. These data support conducting a clinical trial of vorinostat combined with fenretinide in relapsed and refractory TCLMs.
The Use of High-Flow Nasal Oxygen in the ICU as a First-Line Therapy for Acute Hypoxemic Respiratory Failure Secondary to Coronavirus Disease 2019
Authors: McDonough Gregory , Khaing Phue , Treacy Taylor , McGrath Christopher , Yoo Erika J.
Published: October 2020

Objectives:

Limited evidence is available regarding the role of high-flow nasal oxygen in the management of acute hypoxemic respiratory failure secondary to coronavirus disease 2019. Our objective was to characterize outcomes associated with high-flow nasal oxygen use in critically ill adult patients with coronavirus disease 2019-associated acute hypoxemic respiratory failure.

Design:

Observational cohort study between March 18, 2020, and June 3, 2020.

Setting:

Nine ICUs at three university-affiliated hospitals in Philadelphia, PA.

Patients:

Adult ICU patients with confirmed coronavirus disease 2019 infection admitted with acute hypoxemic respiratory failure.

Interventions:

None.

Measurements and Main Results:

Of 266 coronavirus disease 2019 ICU admissions during the study period, 124 (46.6%) received some form of noninvasive respiratory support. After exclusions, we analyzed 83 patients who were treated with high-flow nasal oxygen as a first-line therapy at or near the time of ICU admission. Patients were predominantly male (63.9%). The most common comorbidity was hypertension (60.2%). Progression to invasive mechanical ventilation was common, occurring in 58 patients (69.9%). Of these, 30 (51.7%) were intubated on the same day as ICU admission. As of June 30, 2020, hospital mortality rate was 32.9% and the median hospital length of stay was 15 days. Among survivors, the most frequent discharge disposition was home (51.0%). In comparing patients who received high-flow nasal oxygen alone (n = 54) with those who received high-flow nasal oxygen in conjunction with noninvasive positive-pressure ventilation via face mask (n = 29), there were no differences in the rates of endotracheal intubation or other clinical and utilization outcomes.

Conclusions:

We observed an overall high usage of high-flow nasal oxygen in our cohort of critically ill patients with acute hypoxemic respiratory failure secondary to coronavirus disease 2019. Rates of endotracheal intubation and mortality in this cohort were on par with and certainly not higher than other published series. These findings should prompt further considerations regarding the use of high-flow nasal oxygen in the management algorithm for coronavirus disease 2019-associated acute hypoxemic respiratory failure.
Evaluation of the Efficacy and Safety of Inhaled Epoprostenol and Inhaled Nitric Oxide for Refractory Hypoxemia in Patients With Coronavirus Disease 2019
Authors: DeGrado Jeremy R. , Szumita Paul M. , Schuler Brian R. , Dube Kevin M. , Lenox Jesslyn , Kim Edy Y. , Weinhouse Gerald L. , Massaro Anthony F.
Published: October 2020

Objectives:

The objectives of this study were to evaluate the efficacy and safety of inhaled epoprostenol and inhaled nitric oxide in patients with refractory hypoxemia secondary to coronavirus disease 2019.

Design:

Retrospective single-center study.

Setting:

ICUs at a large academic medical center in the United States.

Patients:

Thirty-eight adult critically ill patients with coronavirus disease 2019 and refractory hypoxemia treated with either inhaled epoprostenol or inhaled nitric oxide for at least 1 hour between March 1, 2020, and June 30, 2020.

Interventions:

Electronic chart review.

Measurements and Main Results:

Of 93 patients screened, 38 were included in the analysis, with mild (4, 10.5%), moderate (24, 63.2%), or severe (10, 26.3%), with acute respiratory distress syndrome. All patients were initiated on inhaled epoprostenol as the initial pulmonary vasodilator and the median time from intubation to initiation was 137 hours (68–228 h). The median change in Pao
2/Fio
2 was 0 (–12.8 to 31.6) immediately following administration of inhaled epoprostenol. Sixteen patients were classified as responders (increase Pao
2/Fio
2 > 10%) to inhaled epoprostenol, with a median increase in Pao
2/Fio
2 of 34.1 (24.3–53.9). The mean change in Pao
2 and Spo
2 was –0.55 ± 41.8 and –0.6 ± 4.7, respectively. Eleven patients transitioned to inhaled nitric oxide with a median change of 11 (3.6–24.8) in Pao
2/Fio
2. A logistic regression analysis did not identify any differences in outcomes or characteristics between the responders and the nonresponders. Minimal adverse events were seen in patients who received either inhaled epoprostenol or inhaled nitric oxide.

Conclusions:

We found that the initiation of inhaled epoprostenol and inhaled nitric oxide in patients with refractory hypoxemia secondary to coronavirus disease 2019, on average, did not produce significant increases in oxygenation metrics. However, a group of patients had significant improvement with inhaled epoprostenol and inhaled nitric oxide. Administration of inhaled epoprostenol or inhaled nitric oxide may be considered in patients with severe respiratory failure secondary to coronavirus disease 2019.