bluuebunny/crossref_metadata_2025 huggingface dataset:
Ionization-driven intrinsic absorption line variability of BAL quasars in the Stripe 82 region
Authors: Vivek M
Published: April 2019

We investigate the connection between the intrinsic C iv absorption line variability and the continuum flux changes of broad absorption line (BAL) quasars using a sample of 78 sources in the Stripe 82 region. The absorption trough variability parameters are measured using the archival multi-epoch spectroscopic data from the Sloan Digital Sky Survey (SDSS), and the continuum flux variability parameters are estimated from the photometric light curves obtained by the SDSS and the Catalina Real-Time Survey surveys. We find evidence for weak correlations (ρs ∼ 0.3) between the intrinsic C iv absorption line variability and the quasar continuum variability for the final sample of 78 BAL quasars. The correlation strengths improve (ρs ∼ 0.5) for the ‘high-signal-to-noise ratio (SNR)’ sample sources that have higher spectral SNR. Using two subsets of the high-SNR sample differing on the absorption trough depth, we find that the shallow-trough subset shows an even stronger correlation (ρs ∼ 0.6), whereas the deep-trough subset does not show any correlation between the absorption line variability and the continuum variability. These results point to the important role of saturation effects in the correlation between the absorption line variability and the continuum variability of BAL quasars. Considering other effects that can also smear the correlation, we conclude that the actual correlation between the absorption line and continuum variability is even stronger.
Predictions of the pseudo-complex theory of Gravity for EHT observations – II: theory and predictions
Authors: Hess P O , Boller Th , Müller A , Stöcker H
Published: April 2019

We present a resumé on the modified theory of gravity, called pseudo-complex General Relativity (pc-GR). It is the second in a series of papers, where the first one (Boller et al. 2019; referred to as Paper I) discussed the observational consequences of pc-GR. In this paper, we concentrate on the underlying theory. PC-GR involves an algebraic extension of the standard theory of GR and it depends on two phenomenological parameters. An element included in pc-GR that is not present in standard GR is the energy–momentum tensor corresponding to an anisotropic ideal fluid, which we call dark energy. The two parameters are related to the coupling of mass to the dark energy and its fall-off as a function of r. The consequences and predictions of this theory will be discussed in the context of the observational results of the Even Horizon Telescope, expected soon. Our main result is that due to the accumulation of dark energy near a large mass, the modified theory predicts a dark ring followed by a bright ring in the emission profile of the accretion disc. We also discuss the light ring in the equatorial plane.
Electron-positron pairs in hot plasma of accretion column in bright X-ray pulsars
Authors: Mushtukov Alexander A , Ognev Igor S , Nagirner Dmitrij I
Published: April 2019

The luminosity of X-ray pulsars powered by accretion on to magnetized neutron stars covers a wide range over a few orders of magnitude. The brightest X-ray pulsars recently discovered as pulsating ultraluminous X-ray sources reach accretion luminosity above $10^{40}\, {\rm erg\ \rm s^{-1}}$ which exceeds the Eddington value more than by a factor of 10. Most of the energy is released within small regions in the vicinity of magnetic poles of accreting neutron star - in accretion columns. Because of the extreme energy release within small volume accretion columns of bright X-ray pulsars are one of the hottest places in the Universe, where the internal temperature can exceed 100 keV. Under these conditions, the processes of creation and annihilation of electron-positron pairs can be influential but have been largely neglected in theoretical models of accretion columns. In this Letter, we investigate properties of a gas of electron--positron pairs under physical conditions typical for accretion columns. We argue that the process of pair creation can crucially influence both the dynamics of the accretion process and internal structure of accretion column limiting its internal temperature, dropping the local Eddington flux and increasing the gas pressure.
EFFECTS OF ACTIVATED-CARBON-FABRIC PARAMETERS ON RESPONSE OF A NEW POLYCARBONATE-BASED INDIVIDUAL AND ENVIRONMENTAL RADON MONITOR
Authors: Sohrabi M , Ebrahiminezhad F
Published: April 2019

A new multi-purpose polycarbonate track detector (PCTD)/activated-carbon-fabric (ACF) radon monitor has been recently developed in our laboratory, a basic design of which was used for parametric studies. One 500 μm thick PCTD (3 cm x 3 cm) is used bare for detecting alphas from radon and progeny directly from air and another PCTD (3 cm x 3 cm) covered by an ACF layer (PCTD/ACF) to enhance the PCTD response by radon adsorption on its carbon active sites. The PCTDs were processed by 50 Hz−2 kV electrochemical etching method. The ACF/PCTD sensitivity was enhanced in respect to the PCTD/bare with an amplification factor (AF) defined as ratio of track density on PCTD under ACF to that of PCTD bare. Many ACF-related parameters studied affect the PCTD/ACF response among them thermal annealing of ACF, ACF thickness and distance of ACF layer to the PCTD are reported and discussed in this paper.
Phylogenetic incongruence and homoplasy in the appendages and bodies of arthropods: why broad character sampling is best
Authors: Brinkworth Andrew R , Sansom Robert , Wills Matthew A
Published: April 2019

Notwithstanding the rapidly increasing sampling density of molecular sequence data, morphological characters still make an important contribution to our understanding of the evolutionary relationships of arthropod groups. In many clades, characters relating to the number and morphological specialization of appendages are ascribed particular phylogenetic significance and may be preferentially sampled. However, previous studies have shown that partitions of morphological character matrices often imply significantly different phylogenies. Here, we ask whether a similar incongruence is observed in the appendage and non-appendage characters of arthropods. We apply tree length (incongruence length difference, ILD) and tree distance (incongruence relationship difference, IRD) tests to these partitions in an empirical sample of 53 published neontological datasets for arthropods. We find significant incongruence about one time in five: more often than expected, but markedly less often than in previous partition studies. We also find similar levels of homoplasy in limb and non-limb characters, both in terms of internal consistency and consistency relative to molecular trees. Taken together, these findings imply that sampled limb and non-limb characters are of similar phylogenetic utility and quality, and that a total evidence approach to their analysis is preferable.
Efficacy of Nail Braces for Acute and Chronic Ingrown Toenails: A Prospective Study
Authors: Wang Hsiao-Han , Yang Ting-Hua , Liu Che-Wei , Tsai Tsung-Yu , Huang Yu-Chen
Published: April 2019

BACKGROUND

Nail braces are an alternative treatment for ingrown toenails.

OBJECTIVE

This study aimed to prospectively examine the efficacy of nail braces for treatment of acute inflamed (AI)-type and chronic dystrophic–type ingrown toenails.

MATERIALS AND METHODS

The authors conducted a prospective study of patients with ingrown toenails treated at Wan Fang Hospital between January 1, 2017, and July 31, 2018. Evaluation using physician global assessment scores and patient satisfaction questionnaires was performed at 1, 3, and 6 months after the start of treatment and during the final visit. Patient demographics, treatment courses, and outcomes were compared between the 2 types of ingrown toenails.

RESULTS

Chronic dystrophic–type and AI-type ingrown toenails were observed in 25 (61 sides) and 28 patients (35 sides), respectively. Of the affected sides, 80.9%, 94.9%, and 100% achieved an excellent or fair result at 1, 3, and 6 months, respectively. Treatment duration and follow-up period were 179.2 ± 96.8 days and 281.6 ± 120.9, respectively. The recurrence rate was 7.4%. The treatment course and response were different between the 2 types of ingrown toenails.

CONCLUSION

Ingrown toenails could be effectively treated with nail braces with excellent outcomes, favorable patient satisfaction, and low recurrence rates.
Optimal Timing for Surgical Excision of Nevus Sebaceus on the Scalp: A Single-Center Experience
Authors: Kong Sook Hyun , Han Seok Hyun , Kim Ji Hyun , Oh Yong Woo , Park Hyang Joon , Suh Ho Seok , Choi Yu Sung
Published: April 2019

BACKGROUND

Treatment of nevus sebaceus (NS) on the scalp is usually surgical excision, but the optimal timing is debatable. The scalp presents significant challenges to the reconstructive surgeon because the lack of elasticity of the scalp makes the repair of defects difficult.

OBJECTIVE

The aim of this study was to investigate the optimal timing for surgical excision of NS on the scalp through postoperative outcomes.

METHODS

The authors retrospectively reviewed the postoperative cosmetic results of patients with a follow-up period of 12 to 15 months. The variables analyzed were patient demographics, preoperative tumor size, location, operative time, cosmetic results, and complications.

RESULTS

This study enrolled 62 patients, including 30 adults and 32 children. The main complications were hair loss, hypertrophic scar, and widening of the scar. The overall complication rate was 17.7%, and the complication rate in children (9/32, 28.1%) was higher than that in adults (2/30, 6.7%) (p < .05). Tumor location, shape, and size showed no association with complications.

CONCLUSION

Complications after surgical excision of NS on the scalp are more likely to occur in children than in adults. On the basis of these findings, surgical excision of NS on the scalp can be delayed until after childhood.
The Kronos Early Estrogen Prevention Study (KEEPS): what have we learned?
Authors: Miller Virginia M. , Naftolin Fredrick , Asthana Sanjay , Black Dennis M. , Brinton Eliot A. , Budoff Matthew J. , Cedars Marcelle I. , Dowling N. Maritza , Gleason Carey E. , Hodis Howard N. , Jayachandran Muthuvel , Kantarci Kejal , Lobo Rogerio A. , Manson JoAnn E. , Pal Lubna , Santoro Nanette F. , Taylor Hugh S. , Harman S. Mitchell
Published: April 2019

Objective:

The Kronos Early Estrogen Prevention Study (KEEPS) was designed to address gaps in understanding the effects of timely menopausal hormone treatments (HT) on cardiovascular health and other effects of menopause after the premature termination of the Women's Health Initiative.

Method:

The KEEPS was a randomized, double-blinded, placebo-controlled trial to test the hypothesis that initiation of HT (oral conjugated equine estrogens [o-CEE] or transdermal 17β-estradiol [t-E2]) in healthy, recently postmenopausal women (n = 727) would slow the progression of atherosclerosis as measured by changes in carotid artery intima-media thickness (CIMT).

Results:

After 4 years, neither HT affected the rate of increase in CIMT. There was a trend for reduced accumulation of coronary artery calcium with o-CEE. There were no severe adverse effects, including venous thrombosis. Several ancillary studies demonstrated a positive effect on mood with o-CEE, and reduced hot flashes, improved sleep, and maintenance of bone mineral density with both treatments. Sexual function improved with t-E2. There were no significant effects of either treatment on cognition, breast pain, or skin wrinkling. Variants of genes associated with estrogen metabolism influenced the age of menopause and variability in effects of the HT on CIMT. Platelet activation associated with the development of white matter hyperintensities in the brain.

Conclusions:

KEEPS and its ancillary studies have supported the value and safety of the use of HT in recently postmenopausal women and provide a perspective for future research to optimize HT and health of postmenopausal women. The KEEPS continuation study continues to pursue these issues.
Implementation and Experiences of Participating in a Neurologic Service Learning Clinic in a Physical Therapist Entry-Level Program: An Educational Case Report
Authors: Danzl Megan , Ulanowski Elizabeth , Carta Taylor , Bridges Ylice , Conway Devin , Vessels Lexi
Published: April 2019

Background and Purpose.

The integration of service learning (SL) in physical therapist entry-level education is a way of serving the community while also meeting curricular demands. Educational programs have successfully implemented service learning clinics (SLCs) while positively affecting the development of professionalism. Research examining specialized SLCs in programs is only just emerging. This case report describes the implementation and experiences of participating in a neurologic-specific SLC.

Case Description.

Through a partnership between the program and a local hospital, faculty, students, and members of the hospital rehabilitation leadership developed and implemented a neurologic SLC. Over the first year, 37 first- and second-year students participated. Twice a week, student dyads (first- and second-year pairs) treated patients with a neurologic diagnosis. Student reflection papers were qualitatively examined to understand the students' experiences.

Outcomes.

Three themes emerged: 1) “Find my ‘PT Self’”: Professional Growth, 2) “Out of my comfort zone”: Challenges for Novices, and 3) “Out of the books and into the real world”: Bringing Curriculum to Life.

Discussion and Conclusion.

The SLC afforded students the opportunity to treat individuals with neurological disorders, reinforce coursework, and further prepare for patient care in a neurological setting. Data regarding the value of student learning and the perceived challenges for novices will inform other programs interested in integrating SL into the curriculum, particularly a neurologic-specific experience.
Growth and Late Detection of Post-Operative Cholesteatoma on Long Term Follow-Up With Diffusion Weighted Magnetic Resonance Imaging (DWI MRI): A Retrospective Analysis From a Single UK Centre
Authors: Pai Irumee , Crossley Eleanor , Lancer Hannah , Dudau Cristina , Connor Stephen
Published: April 2019

Objective:

To evaluate the growth rate and late detection of residual cholesteatoma on long-term follow-up with diffusion weighted magnetic resonance imaging (DWI MRI) in clinically stable ears following definitive surgery, in order to define surveillance imaging protocols.

Study Design:

Retrospective case review.

Setting:

Tertiary referral center.

Patients:

Patients who underwent DWI MRI at our institution between February 2007 and May 2013 for postoperative cholesteatoma follow-up.

Intervention:

Non-echo planar imaging (non-EPI) Half-Fourier Acquisition Single-shot Turbo spin Echo (HASTE) DWI MRI.

Main outcome measures:

Intervals between the definitive surgery and the first and subsequent DWI MRI, the maximum coronal dimension of the lesion on DWI and length of follow-up.

Results:

The study evaluated 152 postoperative DWI studies performed for 88 patients. In 12 cases, DWI was initially negative but became positive on repeat imaging after a mean interval of 3.8 years from the initial cholesteatoma surgery (median 3.7 years, range 1.6–7.9). Of these, 3/12 had more than one negative/indeterminate DWI before disease was eventually detected on imaging; in this subgroup, the mean interval between surgery and positive DWI was 3.2 years (median 2.6 years, range 2.3–4.2). 39 DWI positive foci with serial imaging demonstrated a mean growth rate of 4 mm/year (median 2 mm, range 0–18).

Conclusions:

After negative initial DWI, it is proposed that interval imaging should be considered for a minimum of 5 years in stable ears following definitive cholesteatoma surgery. In view of the marked variability in growth rate, an additional interval scan between 2 and 3 years postoperatively is indicated.
Who moved my fellow: changes to Accreditation Council for Graduate Medical Education fellowships in pediatric surgery and what may be yet to come
Authors: Alaish Samuel M. , Garcia Alejandro V.
Published: April 2019

Purpose of review

Over the past 15 years, the Accreditation Council for Graduate Medical Education (ACGME) has significantly altered the regulatory framework governing fellowship training in pediatric surgery. The daily experiences of pediatric surgical trainees have been impacted by these changes, but training program directors and faculty have not developed a consistent approach to managing this shift. This review highlights the changes, which have occurred, analyzes the current state of fellowship training, and proposes potential strategies for management.

Recent findings

The implementation of work hour restrictions, increased supervision requirements, the milestone evaluation program and most recently, enforcement of required critical care experience, have caused significant changes in the curriculum. Pediatric surgical trainees record more total cases, and more minimally invasive surgical (MIS) cases, in particular, than ever before. A subset of this increase may result from trainees performing cases previously assigned to general surgery residents. Teaching cases performed by fellows have decreased. Although the relationship between these shifts in training experience and the didactic curriculum is not clear, we also note that the Pediatric Surgery Certifying Examination failure rate has increased, approaching 20% in recent years.

It is unclear whether the changes in Pediatric Surgery training programs have been effective, or (conversely) have led to unintended consequences. Paradigm shifts in our training model may be required to address the changes in surgical education and skill acquisition, so that well tolerated, competent and skillful pediatric surgeons continue to enter the workforce.
Pediatric postoperative opioid prescribing and the opioid crisis
Authors: Harbaugh Calista M. , Gadepalli Samir K.
Published: April 2019

Purpose of review

The purpose of this review is to explore the effects of the opioid crisis on pediatric patients in the postoperative setting and provide recommendations for well-tolerated opioid prescribing practices.

Recent findings

Opioid overdoses have increased among all age groups, predominantly related to overprescribing and accessibility of opioids in the home. Adverse risks of prescribed opioids include respiratory depression, gastrointestinal distress, accidental ingestion, intentional misuse, new chronic use, diversion to another user, and overdose. Well-tolerated opioid prescribing practices include multimodal pain management; prescribing guided by patient need; risk assessment for potential misuse; and comprehensive patient and family education on risks, safe storage, and disposal practices. Evolving state laws will affect varying institutional policies; thus, providers must ensure their prescribing practices are current and compliant.

All age groups have been affected by the opioid crisis, including children and adolescents. When managing postoperative pain, clinicians must balance appropriate pain management with well-tolerated opioid stewardship to minimize harm related to postoperative care.
Revalidation of a Perioperative Risk Assessment Measure for Skin
Authors: Meehan Anita J. , Beinlich Nancy R. , Bena James F. , Mangira Caroline
Published: April 2019

Background

Validated perioperative pressure injury (PI) risk assessment measures are few and often cumbersome to complete, leading to missed opportunities to identify and target prevention interventions to those patients at increased risk for developing a postsurgical PI.

Objectives

Previous validation of a six-item perioperative risk assessment measure for skin (PRAMS) was conducted in our community hospital with positive findings. The purpose of this study was to increase generalizability by revalidating the PRAMS in a larger sample.

Methods

This was a retrospective chart review of all surgical patients aged ≥18 years positioned in the supine or lateral position in a Midwest quaternary care, multispecialty, 1,500-bed hospital during a 6-month period (n = 1,526). The intent of the study was to revalidate the PRAMS. The main outcome of interest was the development of PI after surgery. Risk indicators of interest included diabetes, age, surgical time, Braden score, previous surgery, and preexisting PI. The diagnostic ability of any of the risk indicators on the development of a postsurgical PI was evaluated using sensitivity, specificity, and predictive values.

Results

Postsurgical PIs occurred in 121 patients. Comparing current to previous study results, the PRAMS was effective in identifying surgical patients at risk for PI (sensitivity = .98). Those patients with a postsurgical PI had a lower mean Braden score, were more likely to have a preexisting PI, and were more likely to have a previous surgery during the same admission (p < .001 for all risk indicators), comparing favorably to the original study. Patients without risk indicators were unlikely to develop a postsurgical PI (negative predictive value = .98).

Discussion

Results of this validation study demonstrate that the PRAMS is effective in identifying patients who developed a postsurgical PI using information readily available to the perioperative staff.
Proteinuria Is Associated With Increased Risk of Fragility Fracture in Men With or at Risk of HIV Infection
Authors: Gonciulea Anda , Wang Ruibin , Althoff Keri N. , Estrella Michelle M. , Sellmeyer Deborah E. , Palella Frank J. , Lake Jordan E. , Kingsley Lawrence A. , Brown Todd T.
Published: April 2019

Background:

Proteinuria has been associated with bone loss and fractures in general population, but data in HIV-infected population are lacking.

Setting:

Prospective, multicenter cohort study of men with or at risk of HIV infection.

Methods:

Between 2006 and 2015, urine protein measurements and bone fracture histories were ascertained semiannually in 947 HIV-infected (HIV+) and 969 HIV-uninfected (HIV−) men aged 40 years or older. Proteinuria was defined as protein-to-creatinine ratio ≥200 mg/g at ≥2 consecutive visits. Outcome measures (1) all fractures (excluding fractures of skull, face, and digits) and (2) fragility fractures (fractures of vertebral column, femur, wrist, and humerus). Multivariable Cox proportional hazards models assessed the association between proteinuria and fracture after adjusting for additional risk factors.

Results:

The overall period prevalence of proteinuria was higher among HIV+ than HIV− (29% vs 6%, P < 0.001). Men with proteinuria had a significantly higher risk of fragility fracture compared with men without proteinuria [adjusted hazard ratio (aHR) = 2.29 (1.12–4.66)] and did not differ by HIV serostatus (p-interaction = 0.83). The risk of all fractures was not statistically different between men with or without proteinuria [aHR = 1.31 (0.84–2.05)]. Among HIV+ men, the association between confirmed proteinuria and fragility fracture was attenuated [aHR = 2.12 (0.95–4.73)] after additional adjustment for CD4+ T-cell count/mm3, history of AIDS, the presence of detectable plasma HIV-1 RNA, and cumulative exposure to tenofovir disoproxil fumarate.

Conclusions:

Proteinuria was more common in HIV+ than in HIV− men and was a strong independent risk factor for fragility fracture regardless of HIV serostatus. Proteinuria should prompt consideration of a thorough evaluation for bone disease among HIV+ persons.
Ultrasonic Piezoelectric Bone Surgery Combined With Leukocyte and Platelet-Rich Fibrin and Pedicled Buccal Fat Pad Flap in Denosumab-Related Osteonecrosis of the Jaw
Authors: Şahin Onur , Odabaşi Onur , Ekmekcioğlu Ceren
Published: April 2019

Denosumab is an antiresorptive agent that is found as a humanized antibody, which inhibits the most critical pro-osteoclastogenic factor secreted by the cancer cells and shown to be required for osteoclast formation, function, and development. A severe side effect of denosumab is the osteonecrosis of the jaw (DRONJ). There are only a few studies on DRONJ treatment in the literature. The aim of this case report is to present the successful conservative management of DRONJ observed after tooth extraction at the posterior maxilla following the discontinuation of medication. To our knowledge, this is the first DRONJ case treated with using the ultrasonic piezoelectric bone surgery combined with leukocyte and platelet-rich fibrin (L-PRF) and pedicled buccal fat pad flap (PBFP). Use of ultrasonic bone surgery in combination with L-PRF and PBFP is an alternative treatment method that can be effective in exposed bone coverage and soft tissue healing at the posterior maxillary region in DRONJ patients.
The Use of Virtual Surgical-Guided Osteoplasty for Maxillofacial Brown Tumors
Authors: Wilt Danielle Christina , Kim Beomjune , Zaid Waleed
Published: April 2019

A 28-year-old African American female with end-stage renal disease on dialysis secondary to preeclampsia presented to the office as a referral for large multifocal tumors of maxilla and mandible. Surgical pathology and laboratory findings were supportive of secondary hyperparathyroidism leading to multifocal brown tumors. She underwent osteoplasty after using virtual surgical planning to create stereolithic models to visualize the tumor and fabricate cutting guides to minimize the risk of injury to adjacent nerves and teeth. Brown tumors can be resistant to medical management with unreliable regression in size. With the advent of customized surgical guides, more precise and judicious surgery can be performed on these types of tumors safely.
The Beers criteria: Not just for geriatrics anymore? Analysis of Beers criteria medications in nongeriatric trauma patients and their association with falls
Authors: Maerz Adam H. , Walker Benjamin S. , Collier Bryan R. , Tegge Allison N. , Faulks Emily R. , Bower Katie L. , Nussbaum Michael S. , Lollar Daniel I. , Hamill Mark E.
Published: April 2019

BACKGROUND

It has been well established that many classes of medications on the Beers list of Potentially Inappropriate Medications (PIMs) are associated with falls and injuries in the geriatric population, but little work has been performed to understand if similar relationships exist among the nongeriatric adult population.

METHODS

A retrospective chart review of 32 months of trauma encounters at our Level I trauma center was performed in nongeriatric adults aged 18 years to 64 years. Encounters were reviewed by mechanism of injury and intake medication reconciliation. The data were then evaluated for associations between PIMs and falls.

RESULTS

Of the 7,897 trauma encounters in the study period, 6,493 had completed medication reconciliation, and 4,154 were between the ages of 18 years and 64 years. There was a statistically significant disproportionate number of those who sustained a fall on psychoactive medications and proton pump inhibitors, and the odds of a trauma patient presenting as a fall were also significantly higher on these select classes of PIMs.

CONCLUSION

The PIMs associated with falls in the geriatric population are also associated with falls in the nongeriatric population. This study supports the judicious prescribing of these medications, as they may have risks beyond what was originally thought.

LEVEL OF EVIDENCE

Prognostic, level IV.
Lead toxicity from retained bullet fragments: A systematic review and meta-analysis
Authors: Apte Anisha , Bradford Kevin , Dente Christopher , Smith Randi N.
Published: April 2019

BACKGROUND

Firearm injury remains a public health epidemic in the United States. A large proportion of individuals with gunshot wounds subsequently have retained bullet fragments (RBF). There are no standard medical guidelines regarding bullet removal and the full extent of the consequences of RBF remains unknown.

OBJECTIVE

To determine whether there is an association among RBF, elevated blood lead levels (BLL) and lead toxicity in survivors of firearm injury 16 years and older.

METHODS

PubMed, EMBASE, CINAHL, Scopus, Cochrane Library, and Sociological Abstracts electronic databases were searched for all randomized controlled trials, prospective and retrospective cohort, case-control and cross-sectional studies published in the English language between 1988 and 2018. Quality assessment and risk of bias was evaluated using the Newcastle Ottawa Scale. A meta-analysis was performed using a random-effects model.

RESULTS

The search yielded 2,012 articles after removal of duplicates. Twelve were included after full article review. Eleven studies supported an association between elevated BLL and RBF. Bony fractures were associated with increased risk of elevated BLL in three studies. A positive relationship between BLL and the number of RBF was also shown in three studies, with one study demonstrating 25.6% increase in BLL for every natural-log increase in RBF (1–228, p < 0.01). Meta-analysis demonstrated BLL significantly higher in individuals with RBF as compared to controls (5.47 μg/dL, p < 0.01).

CONCLUSION

Patients with bony fractures or multiple RBF, who are at higher risk of elevated BLL, should be monitored for BLL in intervals of 3 months within the first year of injury. For patients who return with BLL above 5 μg/dL, all efforts must be undertaken to remove fragments if there is no potential to worsen the injury.

LEVEL OF EVIDENCE

Systematic review, Meta-analysis, level III.
Pain management in trauma patients affected by the opioid epidemic: A narrative review
Authors: Karamchandani Kunal , Klick John C. , Linskey Dougherty Melissa , Bonavia Anthony , Allen Steven R. , Carr Zyad J.
Published: April 2019

Acute and chronic pain in trauma patients remains a challenging entity, particularly in the setting of the escalating opioid epidemic. It has been reported that chronic opioid use increases the likelihood of hospital admissions as a result of traumatic injuries. Furthermore, patients admitted with traumatic injuries have a greater than average risk of developing opioid use disorder after discharge. Practitioners providing care to these patients will encounter the issue of balancing analgesic goals and acute opioid withdrawal with the challenge of reducing postdischarge persistent opioid use. Additionally, the practitioner is faced with the worrisome prospect that inadequate treatment of acute pain may lead to the development of chronic pain and overtreatment may result in opioid dependence. It is therefore imperative to understand and execute alternative nonopioid strategies to maximize the benefits and reduce the risks of analgesic regimens in this patient population. This narrative review will analyze the current literature on pain management in trauma patients and highlight the application of the multimodal approach in potentially reducing the risks of both short- and long-term opioid use.

LEVEL OF EVIDENCE

Narrative review, moderate to High.
Essentials of emergency transfusion—The complement to stop the bleed
Authors: Lewis Meghan , Shulman Ira , Hudgins Jay , Moore Ernest E. , Inaba Kenji
Published: April 2019

Over the past decade, the shift toward damage control surgery for bleeding trauma patients has come with an increased emphasis on optimal resuscitation. Two lifesaving priorities predominate: to quickly stop the bleed and effectively resuscitate the hemorrhagic shock. Blood is separated into components for efficient storage and distribution; however, bleeding patients require all components in a balanced ratio. A variety of blood products are available to surgeons, and these products have evolved over time. This review article describes the current standards for resuscitation of bleeding patients, including characteristics of all available products. The relevant details of blood donation and collection, blood banking, blood components, and future therapies are discussed, with the goal of guiding surgeons in their emergency transfusion practice.
Nitrosopumilus adriaticus sp. nov. and Nitrosopumilus piranensis sp. nov., two ammonia-oxidizing archaea from the Adriatic Sea and members of the class Nitrososphaeria
Authors: Bayer Barbara , Vojvoda Jana , Reinthaler Thomas , Reyes Carolina , Pinto Maria , Herndl Gerhard J.
Published: April 2019

Two mesophilic, neutrophilic and aerobic marine ammonia-oxidizing archaea, designated strains NF5T and D3CT, were isolated from coastal surface water of the Northern Adriatic Sea. Cells were straight small rods 0.20–0.25 µm wide and 0.49–2.00 µm long. Strain NF5T possessed archaella as cell appendages. Glycerol dibiphytanyl glycerol tetraethers with zero to four cyclopentane moieties (GDGT-0 to GDGT-4) and crenarchaeol were the major core lipids. Menaquinone MK6 : 0 was the major respiratory quinone. Both isolates gained energy by oxidizing ammonia (NH3) to nitrite (NO2
-) and used bicarbonate as a carbon source. Strain D3CT was able use urea as a source of ammonia for energy production and growth. Addition of hydrogen peroxide (H2O2) scavengers (catalase or α-keto acids) was required to sustain growth. Optimal growth occurred between 30 and 32 °C, pH 7.1 and 7.3 and between 34 and 37‰ salinity. The cellular metal abundance ranking of both strains was Fe>Zn>Cu>Mn>Co. The genomes of strains NF5T and D3CT have a DNA G+C content of 33.4 and 33.8 mol%, respectively. Phylogenetic analyses of 16S rRNA gene sequences revealed that both strains are affiliated with the class

Nitrososphaeria

, sharing ~85 % 16S rRNA gene sequence identity with

Nitrososphaera viennensis

EN76T. The two isolates are separated by phenotypic and genotypic characteristics and are assigned to distinct species within the genus

Nitrosopumilus

gen. nov. according to average nucleotide identity thresholds of their closed genomes. Isolates NF5T (=JCM 32270T =NCIMB 15114T) and D3CT (=JCM 32271T =DSM 106147T =NCIMB 15115T) are type strains of the species

Nitrosopumilus
adriaticus sp. nov. and

Nitrosopumilus

piranensis

sp. nov., respectively.
Beta rhythm events predict corticospinal motor output
Authors: Hussain Sara J , Cohen Leonardo G , Bönstrup Marlene
Published: April 2019

The beta rhythm (15-30 Hz) is a prominent signal of sensorimotor cortical activity. This rhythm is not sustained but occurs non-rhythmically as brief events of a few (1–2) oscillatory cycles. Recent work on the relationship between these events and sensorimotor performance suggests that they are the biologically relevant elements of the beta rhythm. However, the influence of these events on corticospinal excitability, a mechanism through which the primary motor cortex controls motor output, is unknown. Here, we addressed this question by evaluating relationships between beta event characteristics and corticospinal excitability in healthy adults. Results show that the number, amplitude, and timing of beta events preceding transcranial magnetic stimulation (TMS) each significantly predict MEP amplitudes. However, beta event characteristics did not explain additional MEP amplitude variance beyond that explained by mean beta power alone, suggesting that conventional beta power measures and beta event characteristics similarly capture natural variation in human corticospinal excitability. Despite this lack of additional explained variance, these results provide first evidence that endogenous beta oscillatory events shape human corticospinal excitability.
A high throughput multi-locus insecticide resistance marker panel for tracking resistance emergence and spread inAnopheles gambiae
Authors: Lucas Eric R. , Rockett Kirk A. , Lynd Amy , Essandoh John , Grisales Nelson , Kemei Brigid , Njoroge Harun , Hubbart Christina , Rippon Emily J. , Morgan John , Van’t Hof Arjen , Ochomo Eric O. , Kwiatkowski Dominic P. , Weetman David , Donnelly Martin J.
Published: April 2019

The spread of resistance to insecticides in the mosquito vectors of diseases such as malaria and dengue poses a threat to the effectiveness of control programmes, which rely largely on insecticide-based interventions. Monitoring the resistance status of mosquito populations is therefore essential, but obtaining direct phenotypic measurements of resistance is laborious and error-prone. In contrast, high-throughput genotyping offers the prospect of quick and repeatable estimates of resistance, while also allowing the genotypic markers of resistance to be tracked and studied. We developed a panel of 28 known or putative markers of resistance in the major malaria vectorAnopheles gambiae, which we use to test the association of these markers with resistance and to study their geographic distribution. We screened resistance-phenotypedAn.gambiaefrom populations from a wide swathe of Sub-Saharan Africa (Burkina Faso, Ghana, Democratic Republic of Congo (DRC) and Kenya), and found evidence of resistance association for four mutations, including a novel mutation in the detoxification geneGste2(Gste2-119V). We also identified a gene duplication inGste2which combines a resistance-associated mutant form of the gene with its wild-type counterpart, potentially alleviating the costs of resistance. Finally, we describe the distribution of the multiple evolutionary origins ofkdrresistance, finding unprecedented levels of diversity in the DRC. This panel represents the first step towards developing a quantitative predictive genotypic model of insecticide resistance that can be used to screenAn.gambiaepopulations and predict resistance status.
Targeting IL-6 reduces IgM levels and tumor growth in Waldenström macroglobulinemia
Authors: Han Weiguo , Matissek Stephan J. , Jackson David A. , Sklavanitis Brandon , Elsawa Sherine F.
Published: April 2019

The tumor microenvironment (TME) plays an important role in cancer and plays a role in resistance to therapy. In Waldenström macroglobulinemia (WM), a B-cell malignancy characterized by the overproduction of a monoclonal IgM protein, the TME plays an important role in WM biology by secreting cytokines that promote malignant phenotype. In previous work, we have shown that TME-IL-6 promotes WM cell growth and IgM secretion in WM. Tocilizumab/Actemra is an anti-IL-6R antibody, which can competitively block IL-6 binding to the IL-6R. We investigated the efficacy of Tocilizumab in a preclinical mouse model of WM that considers the role of the TME in disease biology. Hairless SCID mice were subcutaneously implanted with BCWM.1 or RPCI-WM1 and bone marrow stromal cells. Groups of mice were treated with Tocilizumab or control antibody three times/week for 5 weeks and the effect on tumor burden and disease biology were evaluated. Although Tocilizumab had no effect on mice survival, there was a reduction in tumor growth rate in mice injected with RPCI-WM1 cells treated with Tocilizumab (p=0.0394). In mice injected with BCWM.1 + stromal cells, there was a significant reduction in human IgM secretion in mice sera with Tocilizumab treatment (p=0.0099). There was no significant change in mice weight suggesting Tocilizumab induced no toxicities to the mice. Taken together, our data suggests that administration of Tocilizumab to tumor bearing mice, results in a significant reduction in tumor volume and IgM secretion. Therefore, the evaluation of the role of Tocilizumab in WM patients may provide therapeutic efficacy by reducing IgM production and slowing the rate of tumor growth.
Scaling of thermal tolerance with body mass and genome size in ectotherms: A comparison between water-and air-breathers
Authors: Leiva Félix P. , Calosi Piero , Verberk Wilco C.E.P.
Published: April 2019

Global warming appears to favour smaller-bodied organisms, but whether larger species are also more vulnerable to thermal extremes, as suggested for past mass-extinction events, is still an open question. Here, we tested whether interspecific differences in thermal tolerance (heat and cold) of ectotherm organisms are linked to differences in their body mass and genome size (as a proxy for cell size). Since the vulnerability of larger, aquatic taxa to warming has been attributed to the oxygen limitation hypothesis, we also assessed how body mass and genome size modulate thermal tolerance in species with contrasting breathing modes, habitats and life-stages. A database with the upper (CTmax) and lower (CTmin) critical thermal limits and their methodological aspects was assembled comprising more than 500 species of ectotherms. Our results demonstrate that thermal tolerance in ectotherms is dependent on body mass and genome size and these relationships became especially evident in prolonged experimental trials where energy efficiency gains importance. During long-term trials, CTmax was impaired in larger-bodied water-breathers, consistent with a role for oxygen limitation. Variation in CTmin was mostly explained by the combined effects of body mass and genome size and it was enhanced in larger-celled, air-breathing species during long-term trials, consistent with a role for depolarization of cell membranes. Our results highlight the importance of accounting for phylogeny and exposure duration. Especially when considering long-term trials, the observed effects on thermal limits are more in line with the warming-induced reduction in body mass observed during long-term rearing experiments.
The impact of sequencing depth on the inferred taxonomic composition and AMR gene content of metagenomic samples
Authors: Gweon H. Soon , Shaw Liam P. , Swann Jeremy , Maio Nicola De , AbuOun Manal , Hubbard Alasdair T. M. , Bowes Mike J. , Bailey Mark J. , Peto Tim E. A. , Hoosdally Sarah J. , Walker A. Sarah , Sebra Robert P. , Crook Derrick W. , Anjum Muna , Read Daniel S. , Stoesser Nicole ,   on behalf of the REHAB consortium
Published: April 2019

Background

Shotgun metagenomics is increasingly used to characterise microbial communities, particularly for the investigation of antimicrobial resistance (AMR) in different animal and environmental contexts. There are many different approaches for inferring the taxonomic composition and AMR gene content of complex community samples from shotgun metagenomic data, but there has been little work establishing the optimum sequencing depth, data processing and analysis methods for these samples. In this study we used shotgun metagenomics and sequencing of cultured isolates from the same samples to address these issues. We sampled three potential environmental AMR gene reservoirs (pig caeca, river sediment, effluent) and sequenced samples with shotgun metagenomics at high depth (∼200 million reads per sample). Alongside this, we cultured single-colony isolates ofEnterobacteriaceaefrom the same samples and used hybrid sequencing (short- and long-reads) to create high-quality assemblies for comparison to the metagenomic data. To automate data processing, we developed an open-source software pipeline, ‘ResPipe’.

Results

Taxonomic profiling was much more stable to sequencing depth than AMR gene content. 1 million reads per sample was sufficient to achieve <1% dissimilarity to the full taxonomic composition. However, at least 80 million reads per sample were required to recover the full richness of different AMR gene families present in the sample, and additional allelic diversity of AMR genes was still being discovered in effluent at 200 million reads per sample. Normalising the number of reads mapping to AMR genes using gene length and an exogenous spike ofThermus thermophilusDNA substantially changed the estimated gene abundance distributions. While the majority of genomic content from cultured isolates from effluent was recoverable using shotgun metagenomics, this was not the case for pig caeca or river sediment.

Conclusions

Sequencing depth and profiling method can critically affect the profiling of polymicrobial animal and environmental samples with shotgun metagenomics. Both sequencing of cultured isolates and shotgun metagenomics can recover substantial diversity that is not identified using the other methods. Particular consideration is required when inferring AMR gene content or presence by mapping metagenomic reads to a database. ResPipe, the open-source software pipeline we have developed, is freely available (https://gitlab.com/hsgweon/ResPipe).
Is mechanical receptor ligand dissociation driven by unfolding or unbinding?
Authors: Milles Lukas F. , Gaub Hermann E.
Published: April 2019

Mechanical force can play a pivotal role in biological systems. Single Molecule Force Spectroscopy, is a powerful tool to probe the mechanics of proteins and their binding partners. Yet, it remains unclear how complex dissociation of a protein-protein interaction under mechanical forces occurs. Are receptor and ligand unbinding, or are they unfolding? We utilize an approach wherein receptor and ligand are expressed as a single molecule fused by a long flexible linker. Force is applied to the complex via an ultrastable handle. Consequently, the events during and following complex dissociation can be monitored. We investigate two high-affinity systems: The cohesin-dockerin type I interaction in which we find that a binding partner unfolds upon complex dissociation, and a colicin-immunity protein complex in which both proteins unfold completely upon unbinding. Mechanical receptor ligand dissociation thus can encompass unfolding of one or both binding partners.
Population receptive fields of human primary visual cortex organised as DC-balanced bandpass filters
Authors: Kristensen Daniel Gramm , Sandberg Kristian
Published: April 2019

The response to visual stimulation of population receptive fields (pRF) in the human visual cortex can be accurately modelled with a Difference of Gaussians model, yet many aspects of their organisation remain poorly understood. Here, we examined the theoretical underpinnings of this model and argue that the DC-balanced Difference of Gaussians (DoG) holds a number of advantages over a DC-biased DoG. Through functional magnetic resonance imaging (fMRI) pRF mapping, we compared performance of DC-balanced and DC-biased models in human primary visual cortex and found that when model complexity is taken into account, the DC-balanced model is preferred. Finally, we present evidence indicating that the BOLD signal DC-offset contains information related to the processing of visual stimuli. Taken together, the results indicate that V1 neurons are at least frequently organised in the exact constellation that allows them to function as bandpass-filters, which allows for the separation of stimulus contrast and luminance. We further speculate that if the DoG models stimulus contrast, the DC-offset may reflect stimulus luminance. These findings suggest that it may be possible to separate contrast and luminance processing in fMRI experiments and this could lead to new insights on the haemodynamic response.
Non-uniform Crowding Enhances Transport: Relevance to Biological Environments
Authors: Collins Matthew , Mohajerani Farzad , Ghosh Subhadip , Guha Rajarshi , Lee Tae-Hee , Butler Peter J. , Sen Ayusman , Velegol Darrell
Published: April 2019

The cellular cytoplasm is crowded with macromolecules and other species that occupy up to 40% of the available volume. Previous studies have reported that for high crowder molecule concentrations, colloidal tracer particles have a dampened diffusion due to the higher solution viscosity. However, these studies employed uniform distributions of crowder molecules. We report a scenario, previously unexplored experimentally, of increased tracer transport driven by a non-uniform concentration of crowder macromolecules. In gradients of polymeric crowder, tracer particles undergo transport several times higher than that of their bulk diffusion rate. The direction of the transport is toward regions of lower crowder concentration. Mechanistically, hard-sphere interactions and the resulting volume exclusion between the tracer and crowder increases the effective diffusion by inducing a convective motion of tracers. Strikingly, soft deformable particles show even greater enhancement in transport in crowder gradients compared to similarly sized hard particles. We propose a model that supports the data and quantifies a “diffusiophoretic buoyancy force” when a tracer is in a gradient of crowder concentration. Overall, this demonstration of enhanced transport in non-uniform distributions of crowder is anticipated to clarify aspects of multi-component intracellular transport.