bluuebunny/crossref_metadata_2025 huggingface dataset:
Two years of pulsar observations with the ultra-wide-band receiver on the Parkes radio telescope
Authors: Johnston Simon , Sobey C , Dai S , Keith M , Kerr M , Manchester R N , Oswald L S , Parthasarathy A , Shannon R M , Weltevrede P
Published: January 2021

The major programme for observing young, non-recycled pulsars with the Parkes telescope has transitioned from a narrow-band system to an ultra-wide-band system capable of observing between 704 and 4032 MHz. We report here on the initial 2 yr of observations with this receiver. Results include dispersion measure (DM) and Faraday rotation measure (RM) variability with time, determined with higher precision than hitherto, flux density measurements and the discovery of several nulling and mode changing pulsars. PSR J1703−4851 is shown to be one of a small subclass of pulsars that has a weak and a strong mode which alternate rapidly in time. PSR J1114−6100 has the fourth highest |RM| of any known pulsar despite its location far from the Galactic Centre. PSR J1825−1446 shows variations in both DM and RM likely due to its motion behind a foreground supernova remnant.
Atmospheric circulation of brown dwarfs and directly imaged exoplanets driven by cloud radiative feedback: global and equatorial dynamics
Authors: Tan Xianyu , Showman Adam P
Published: January 2021

Brown dwarfs, planetary-mass objects and directly imaged giant planets exhibit significant observational evidence for active atmospheric circulation, raising critical questions about mechanisms driving the circulation, its fundamental nature and time variability. Our previous work has demonstrated the crucial role of cloud radiative feedback on driving a vigorous atmospheric circulation using local models that assume a Cartesian geometry and constant Coriolis parameters. In this study, we extend the models to a global geometry and explore properties of the global dynamics. We show that, under relatively strong dissipation in the bottom layers of the model, horizontally isotropic vortices are prevalent at mid-to-high latitudes while large-scale zonally propagating waves are dominant at low latitudes near the observable layers. The equatorial waves have both eastward and westward phase speeds, and the eastward components with typical velocities of a few hundred  m s−1 usually dominate the equatorial time variability. Lightcurves of the global simulations show variability with amplitudes from 0.5 per cent to a few percent depending on the rotation period and viewing angle. The time evolution of simulated lightcurves is critically affected by the equatorial waves, showing wave beating effects and differences in the lightcurve periodicity to the intrinsic rotation period. The vertical extent of clouds is the largest at the equator and decreases poleward due to the increasing influence of rotation with increasing latitude. Under weaker dissipation in the bottom layers, strong and broad zonal jets develop and modify wave propagation and lightcurve variability. Our modelling results help to qualitatively explain several features of observations of brown dwarfs and directly imaged giant planets, including puzzling time evolution of lightcurves, a slightly shorter period of variability in IR than in radio wavelengths, and the viewing angle dependence of variability amplitude and IR colors.
The ASAS-SN catalogue of variable stars IX: The spectroscopic properties of Galactic variable stars
Authors: Jayasinghe T , Kochanek C S , Stanek K Z , Shappee B J , Holoien T W-S , Thompson Todd A , Prieto J L , Dong Subo , Pawlak M , Pejcha O , Pojmanski G , Otero S , Hurst N , Will D
Published: January 2021

The All-Sky Automated Survey for Supernovae provides long baseline (∼4 yr) V-band light curves for sources brighter than V≲ 17 mag across the whole sky. We produced V-band light curves for a total of ∼61.5 million sources and systematically searched these sources for variability. We identified ∼426 000 variables, including ∼219 000 new discoveries. Most (${\sim }74{ per\ cent}$) of our discoveries are in the Southern hemisphere. Here, we use spectroscopic information from LAMOST, GALAH, RAVE, and APOGEE to study the physical and chemical properties of these variables. We find that metal-poor eclipsing binaries have orbital periods that are shorter than metal-rich systems at fixed temperature. We identified rotational variables on the main-sequence, red giant branch, and the red clump. A substantial fraction (${\gtrsim }80{ per\ cent}$) of the rotating giants have large $v$rot or large near-ultraviolet excesses also indicative of fast rotation. The rotational variables have unusual abundances suggestive of analysis problems. Semiregular variables tend to be lower metallicity ($\rm [Fe/H]{\sim }-0.5$) than most giant stars. We find that the APOGEE DR16 temperatures of oxygen-rich semiregular variables are strongly correlated with the WRP − WJK colour index for $\rm T_{eff}\lesssim 3800$ K. Using abundance measurements from APOGEE DR16, we find evidence for Mg and N enrichment in the semiregular variables. We find that the Aluminum abundances of the semiregular variables are strongly correlated with the pulsation period, where the variables with $\rm P\gtrsim 60$ d are significantly depleted in Al.
Photodissociation region diagnostics across galactic environments
Authors: Bisbas Thomas G , Tan Jonathan C , Tanaka Kei E I
Published: January 2021

We present three-dimensional astrochemical simulations and synthetic observations of magnetized, turbulent, self-gravitating molecular clouds. We explore various galactic interstellar medium environments, including cosmic ray ionization rates in the range of ζCR = 10−17–$10^{-14}\, {\rm s}^{-1}$, far-UV intensities in the range of G0 = 1–103 and metallicities in the range of Z = 0.1–$2\, {\rm Z}_{\odot }$. The simulations also probe a range of densities and levels of turbulence, including cases where the gas has undergone recent compression due to cloud–cloud collisions. We examine: (i) the column densities of carbon species across the cycle of C ii, C i, and CO, along with O i, in relation to the H i-to-H2 transition; (ii) the velocity-integrated emission of [C ii] 158 μm, [13C ii] 158 μm, [C i] 609 μm and 370 μm, [O i] 63 μm and 146 μm, and of the first ten 12CO rotational transitions; (iii) the corresponding Spectral Line Energy Distributions; (iv) the usage of [C ii] and [O i] 63 μm to describe the dynamical state of the clouds; (v) the behaviour of the most commonly used ratios between transitions of CO and [C i]; and (vi) the conversion factors for using CO and C i as H2-gas tracers. We find that enhanced cosmic ray energy densities enhance all aforementioned line intensities. At low metallicities, the emission of [C ii] is well connected with the H2 column, making it a promising new H2 tracer in metal-poor environments. The conversion factors of XCO and XC i depend on metallicity and the cosmic ray ionization rate, but not on FUV intensity. In the era of ALMA, SOFIA, and the forthcoming CCAT-prime telescope, our results can be used to understand better the behaviour of systems in a wide range of galactic and extragalactic environments.
The efficiency of grain growth in the diffuse interstellar medium
Authors: Priestley F D , De Looze I , Barlow M J
Published: January 2021

Grain growth by accretion of gas-phase metals is a common assumption in models of dust evolution, but in dense gas, where the time-scale is short enough for accretion to be effective, material is accreted in the form of ice mantles rather than adding to the refractory grain mass. It has been suggested that negatively charged small grains in the diffuse interstellar medium (ISM) can accrete efficiently due to the Coulomb attraction of positively-charged ions, avoiding this issue. We show that this inevitably results in the growth of the small-grain radii until they become positively charged, at which point further growth is effectively halted. The resulting gas-phase depletions under diffuse ISM conditions are significantly overestimated when a constant grain size distribution is assumed. While observed depletions can be reproduced by changing the initial size distribution or assuming highly efficient grain shattering, both options result in unrealistic levels of far-ultraviolet extinction. We suggest that the observed elemental depletions in the diffuse ISM are better explained by higher initial depletions, combined with inefficient dust destruction by supernovae at moderate ($n_{\rm H}\sim 30 \, {\rm cm}^{-3}$) densities, rather than by higher accretion efficiences.
The ATR-WEE1 kinase module inhibits the MAC complex to regulate replication stress response
Authors: Wang Lili , Zhan Li , Zhao Yan , Huang Yongchi , Wu Chong , Pan Ting , Qin Qi , Xu Yiren , Deng Zhiping , Li Jing , Hu Honghong , Xue Shaowu , Yan Shunping
Published: January 2021

DNA damage response is a fundamental mechanism to maintain genome stability. The ATR-WEE1 kinase module plays a central role in response to replication stress. Although the ATR-WEE1 pathway has been well studied in yeasts and animals, how ATR-WEE1 functions in plants remains unclear. Through a genetic screen for suppressors of the Arabidopsis atr mutant, we found that loss of function of PRL1, a core subunit of the evolutionarily conserved MAC complex involved in alternative splicing, suppresses the hypersensitivity of atr and wee1 to replication stress. Biochemical studies revealed that WEE1 directly interacts with and phosphorylates PRL1 at Serine 145, which promotes PRL1 ubiquitination and subsequent degradation. In line with the genetic and biochemical data, replication stress induces intron retention of cell cycle genes including CYCD1;1 and CYCD3;1, which is abolished in wee1 but restored in wee1 prl1. Remarkably, co-expressing the coding sequences of CYCD1;1 and CYCD3;1 partially restores the root length and HU response in wee1 prl1. These data suggested that the ATR-WEE1 module inhibits the MAC complex to regulate replication stress responses. Our study discovered PRL1 or the MAC complex as a key downstream regulator of the ATR-WEE1 module and revealed a novel cell cycle control mechanism.
Polymer modelling unveils the roles of heterochromatin and nucleolar organizing regions in shaping 3D genome organization inArabidopsis thaliana
Authors: Di Stefano Marco , Nützmann Hans-Wilhelm , Marti-Renom Marc A , Jost Daniel
Published: January 2021

The 3D genome is characterized by a complex organization made of genomic and epigenomic layers with profound implications on gene regulation and cell function. However, the understanding of the fundamental mechanisms driving the crosstalk between nuclear architecture and (epi)genomic information is still lacking. The plant Arabidopsis thaliana is a powerful model organism to address these questions owing to its compact genome for which we have a rich collection of microscopy, chromosome conformation capture (Hi-C) and ChIP-seq experiments. Using polymer modelling, we investigate the roles of nucleolus formation and epigenomics-driven interactions in shaping the 3D genome of A. thaliana. By validation of several predictions with published data, we demonstrate that self-attracting nucleolar organizing regions and repulsive constitutive heterochromatin are major mechanisms to regulate the organization of chromosomes. Simulations also suggest that interphase chromosomes maintain a partial structural memory of the V-shapes, typical of (sub)metacentric chromosomes in anaphase. Additionally, self-attraction between facultative heterochromatin regions facilitates the formation of Polycomb bodies hosting H3K27me3-enriched gene-clusters. Since nucleolus and heterochromatin are highly-conserved in eukaryotic cells, our findings pave the way for a comprehensive characterization of the generic principles that are likely to shape and regulate the 3D genome in many species.
The search for charmed states of matter
Authors: Ball Philip
Published: January 2021

With the discovery of the Higgs boson in 2012, the Standard Model of particle physics was completed. This description encompasses all known subatomic particles and their interactions. Much of the public interest in high-energy physics now focuses on experimental searches for ‘new physics’ beyond the Standard Model. Yet it would be a mistake to imagine that the Standard Model is now fully understood. Many questions remain about the ways in which known fundamental particles interact and unite, especially at the very high energies needed to produce the most exotic varieties, such as heavy quarks (quarks are the constituents of hadrons, which include the ordinary nuclear particles protons and neutrons) and heavy leptons (leptons are members of the family that includes electrons).

The Beijing Electron-Positron Collider (BEPC), operated by the Chinese Academy of Sciences' Institute of High Energy Physics, is one of the installations that are probing these questions. It has been running since 1988, using a detector called the Beijing Spectrometer (BES). (The site also houses the Beijing Synchrotron Radiation Facility for conducting studies in condensed matter using intense X-rays.) Since 2008, these two instruments have been operating in upgraded form: the BESIII detector and BEPCII accelerator. The facility is now one of the key international centers for investigating the properties and behavior of new exotic hadrons, in particular those that include the charm quark. Italian physicist Luciano Maiani, Director of the European particle physics center CERN in Switzerland from 1999 to 2003, is one of the world leaders in this area of high-energy physics, and played a central role in the identification of the charm quark itself. NSR spoke to him about the aims of the latest work at the BEPCII, and the prospects for new discoveries.
Heart rate: control mechanisms, pathophysiology and assessment of the neurocardiac system in health and disease
Authors: Armstrong R , Wheen P , Brandon L , Maree A , Kenny R -A
Published: January 2021

The monitoring of physiological function and dysfunction is an important principle in modern medicine. Heart rate is a basic example of this type of observation, particularly assessing the neurocardiac system, which entails the autonomic nervous system and intracardiac processes. The neurocardiac axis is an underappreciated and often overlooked system which, if measured appropriately in the clinical setting, may allow identification of patients at risk of disease progression and even mortality. While heart rate itself is a simplistic tool, more information may be gathered through assessing heart rate variability and heart rate recovery time. Studies have demonstrated an association of slow heart rate recovery and lower heart rate variability as markers of elevated sympathetic and lower parasympathetic tone. These parameters have additionally been shown to relate to development of arrhythmia, heart failure, systemic inflammatory processes, ischaemic heart disease and an increased rate of mortality. The aim of this review is to detail how heart rate is homeostatically controlled by the autonomic nervous system, how heart rate can impact on pathophysiological processes, and how heart rate variability and heart rate recovery time may be used in the clinical setting to allow the neurocardiac system to be assessed.
Childhood-onset of primary Sjögren’s syndrome: phenotypic characterization at diagnosis of 158 children
Authors: Ramos-Casals Manuel , Acar-Denizli Nihan , Vissink Arjan , Brito-Zerón Pilar , Li Xiaomei , Carubbi Francesco , Priori Roberta , Toplak Nataša , Baldini Chiara , Faugier-Fuentes Enrique , Kruize Aike A , Mandl Thomas , Tomiita Minako , Gandolfo Saviana , Hashimoto Kunio , Hernandez-Molina Gabriela , Hofauer Benedikt , Mendieta-Zerón Samara , Rasmussen Astrid , Sandhya Pulukool , Sene Damien , Trevisani Virginia Fernandes Moça , Isenberg David , Sundberg Erik , Pasoto Sandra G , Sebastian Agata , Suzuki Yasunori , Retamozo Soledad , Xu Bei , Giacomelli Roberto , Gattamelata Angelica , Bizjak Masa , Bombardieri Stefano , Loor-Chavez Richard-Eduardo , Hinrichs Anneline , Olsson Peter , Bootsma Hendrika , Lieberman Scott M ,   and the Sjogren Big Data Consortium*, Kostov B , Horvath I -F , Szanto A , Seror R , Mariette X , Kvarnstrom M , Wahren-Herlenius M , Praprotnik S , Solans R , Nordmark G , Hammenfors D , Brun J G , Gheita T A , Atzeni F , Armagan B , Kilic L , Kalyoncu U , Nakamura T , Takagi Y , Consani S , Solorzano F Olivera
Published: January 2021

Objectives

To characterize the phenotypic presentation at diagnosis of childhood-onset primary SS.

Methods

The Big Data Sjögren Project Consortium is an international, multicentre registry using worldwide data-sharing cooperative merging of pre-existing clinical SS databases from the five continents. For this study, we selected those patients in whom the disease was diagnosed below the age of 19 years according to the fulfilment of the 2002/2016 classification criteria.

Results

Among the 12 083 patients included in the Sjögren Big Data Registry, 158 (1.3%) patients had a childhood-onset diagnosis (136 girls, mean age of 14.2 years): 126 (80%) reported dry mouth, 111 (70%) dry eyes, 52 (33%) parotid enlargement, 118/122 (97%) positive minor salivary gland biopsy and 60/64 (94%) abnormal salivary US study, 140/155 (90%) positive ANA, 138/156 (89%) anti-Ro/La antibodies and 86/142 (68%) positive RF. The systemic EULAR Sjögren’s syndrome disease activity index (ESSDAI) domains containing the highest frequencies of active patients included the glandular (47%), articular (26%) and lymphadenopathy (25%) domains. Patients with childhood-onset primary SS showed the highest mean ESSDAI score and the highest frequencies of systemic disease in 5 (constitutional, lymphadenopathy, glandular, cutaneous and haematological) of the 12 ESSDAI domains, and the lowest frequencies in 4 (articular, pulmonary, peripheral nerve and CNS) in comparison with patients with adult-onset disease.

Conclusions

Childhood-onset primary SS involves around 1% of patients with primary SS, with a clinical phenotype dominated by sicca features, parotid enlargement and systemic disease. Age at diagnosis plays a key role in modulating the phenotypic expression of the disease.
Serum uric acid and knee osteoarthritis in community residents without gout: a longitudinal study
Authors: Go Dong Jin , Kim Dong Hyun , Kim Jie Young , Guermazi Ali , Crema Michel Daoud , Hunter David J , Kim Hyun Ah
Published: January 2021

Objectives

Emerging evidence suggests a potential link between OA and gout; however, the association between serum uric acid (UA) itself and knee OA remains uncertain due to a lack of longitudinal studies. Here, we investigated the association between serum UA and knee OA according to cartilage status in elderly community residents without gout.

Methods

In this longitudinal study, participants without a history of gout were recruited from among the Korean cohort of the Hallym Aging Study (n = 296 for radiography study and n = 223 for MRI study). Weight-bearing knee radiographs and 1.5-T MRI scans, along with blood collection for analysis of serum UA, were performed at baseline and after 3 years. The severity and structural progression of knee OA were evaluated using the Kellgren–Lawrence grading system and the Whole-Organ MRI Score (WORMS) cartilage scoring method. Multivariable logistic regression analysis was conducted using generalized estimating equation (GEE) models.

Results

Serum UA levels were not associated with radiographic progression after adjusting for age, sex and BMI. There was no significant association between serum UA and tibiofemoral cartilage loss on MRI. However, baseline serum UA levels were negatively associated with patellofemoral cartilage loss over 3 years (adjusted odd ratio 0.70 per 1 mg/dl increase, 95% CI: 0.49, 0.98).

Conclusion

In this population-based cohort, serum UA was not a risk factor for knee OA progression. Further large-scale longitudinal studies in other populations are needed to validate the effects of UA on cartilage damage.
Focal vasculitic myositis as a primary manifestation of Behçet’s disease: a case series of 10 Korean patients in a locomotive medicine clinic
Authors: Kim Du Hwan , Kim Sun Woong , Yeo Seung Mi , Kang Min-Soo , Yoon Young Cheol , Sung Duk Hyun
Published: January 2021

Objectives

Muscle involvement in Behçet’s disease (BD) is rare, and several cases have been reported in the literature. Therefore, this study aimed to describe the clinical, laboratory and imaging findings in adult patients presenting with BD-associated myositis before the diagnosis of BD.

Methods

We retrospectively screened patients who visited a locomotive medicine clinic presenting with myalgia, local swelling, or tenderness of extremities without an established diagnosis of BD. We enrolled patients whose pain in the extremities was proven to be suggestive of focal vasculitic myositis and who were eventually diagnosed as having BD at the initial visit or during follow-up. We thoroughly reviewed the clinical, histological and imaging findings and treatment outcomes in patients who presented with focal vasculitic myositis as the primary manifestation of BD.

Results

Ten adult patients with focal vasculitic myositis as the primary manifestation of BD were enrolled. The lower and upper extremities were affected in eight and two patients, respectively. The affected lower extremities were the calf (n = 6) and thigh muscles (n = 2). The common findings of MRI included high signal intensity of the affected muscles and intermuscular fascia on fat-suppressed images, suggestive of myofascitis and oedematous changes in the subcutaneous layer. The results of skin or muscle biopsy were suggestive of vasculitis. All the patients were pain-free at the short-term follow-up (1–3 weeks) after oral steroid therapy.

Conclusion

Focal vasculitic myositis can be a primary manifestation of BD warranting medical attention. BD-associated myositis responds well to oral steroid therapy.
Hyperactivity and Seizure Induced by Tricresyl Phosphate Are Isomer Specific and Not Linked to Phenyl Valerate-Neuropathy Target Esterase Activity Inhibition in Zebrafish
Authors: Knoll-Gellida Anja , Dubrana Leslie E , Bourcier Laure M , Mercé Théo , Gruel Gaëlle , Soares Magalie , Babin Patrick J
Published: January 2021

Environmental exposure to tricresyl phosphate (TCP) may lead to severe neurotoxic effects, including organophosphate (OP)-induced delayed neuropathy. TCP has three symmetric isomers, distinguished by the methyl group position on the aromatic ring system. One of these isomers, tri-ortho-cresyl phosphate (ToCP), has been reported for years as a neuropathic OP, targeting neuropathic target esterase (NTE/PNPLA6), but its mode of toxic action had not been fully elucidated. Zebrafish eleuthero-embryo and larva were used to characterize the differential action of the TCP isomers. The symmetric isomers inhibited phenyl valerate (PV)-NTE enzymatic activity in vivo with different IC50, while no effect was observed on acetylcholinesterase activity. Moreover, the locomotor behavior was also affected by tri-para-cresyl phosphate and tri-meta-cresyl phosphate, only ToCP exposure led to locomotor hyperactivity lasting several hours, associated with defects in the postural control system and an impaired phototactic response, as revealed by the visual motor response test. The electric field pulse motor response test demonstrated that a seizure-like, multiple C-bend-spaghetti phenotype may be significantly induced by ToCP only, independently of any inhibition of PV-NTE activity. Eleuthero-embryos exposed to picrotoxin, a known gamma-aminobutyric acid type-A receptor inhibitor, exhibited similar adverse outcomes to ToCP exposure. Thus, our results demonstrated that the TCP mode of toxic action was isomer specific and not initially related to modulation of PV-NTE activity. Furthermore, it was suggested that the molecular events involved were linked to an impairment of the balance between excitation and inhibition in neuronal circuits.
Prolonged coma in scrub typhus: consider non-convulsive status epilepticus
Authors: Kalita Jayantee , Jadhav Mahesh S , Singh Varun K , Misra Usha K
Published: January 2021

Background

Scrub typhus is prevalent in the Tsutsugamushi belt and may manifest with meningoencephalitis and seizures. We report a patient with scrub typhus who had non-convulsive status epilepticus (NCSE).

Methods

A 50-y-old female with fever and altered sensorium for 5 d was diagnosed as scrub typhus based on serum IgM ELISA. She was on mechanical ventilation and received doxycycline and ceftriaxone, but did not improve until the third day of admission.

Results

An EEG revealed >2.5 Hz generalised epileptiform discharges, which were suppressed by intravenous lorazepam suggesting NCSE. Following valproate and levetiracetam, she became conscious and had a full recovery.

Conclusion

A scrub typhus patient recovers even after prolonged NCSE.
Mechanotransduction in Wound Healing: From the Cellular and Molecular Level to the Clinic
Authors: Fu Siqi , Panayi Adriana , Fan Jincai , Mayer Horacio F. , Daya Mahendra , Khouri Roger K. , Gurtner Geoffrey C. , Ogawa Rei , Orgill Dennis P.
Published: January 2021

Skin provides a critical protective barrier for humans that is often lost following burns, trauma, or resection. Traditionally, skin loss is treated with transfer of tissue from other areas of the body such as a skin graft or flap. Mechanical forces can provide powerful alternatives and adjuncts for skin replacement and scar modulation. This article first provides an overview of the various mechanical forces that affect fibroblasts, keratinocytes, endothelial cells, and adipocytes at the cellular and molecular level. This is followed by a review of the mechanical devices currently in clinical use that can substantially augment the restoration of skin integrity and reduce scarring. Methods described include tissue expanders, external volume expansion, negative-pressure wound therapy, and skin taping.

GENERAL PURPOSE

To review the various mechanical forces that affect fibroblasts, keratinocytes, endothelial cells, and adipocytes at the cellular and molecular level as well as scar-reducing mechanical devices currently in clinical use.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant will:

1. Compare and contrast the responses of various types of cells to mechanical forces.

2. Identify the mechanical devices and techniques that can help restore skin integrity.
Optimal Hemodynamic Parameters for Brain-injured Patients in the Clinical Setting: A Narrative Review of the Evidence
Authors: Ma Kan , Bebawy John F.
Published: January 2021

Defining optimal hemodynamic targets for brain-injured patients is a challenging undertaking. The physiological interference observed in various intracranial pathologies can have varying effects on cerebral physiology at different time points. This narrative review provides an overview of cerebral autoregulatory physiology and common misconceptions, and examines the physiological considerations and clinical evidence for determining optimal hemodynamic parameters in acutely brain-injured patients with relevance to modern neuroanesthesia and neurocritical care practice.
Mode of blood pressure monitoring and morbidity after noncardiac surgery
Authors: Abbott Tom E.F. , Howell Simon , Pearse Rupert M. , Ackland Gareth L.
Published: January 2021

BACKGROUND

Control of blood pressure remains a key goal of peri-operative care, because hypotension is associated with adverse outcomes after surgery.

OBJECTIVES

We explored whether increased vigilance afforded by intra-arterial blood pressure monitoring may be associated with less morbidity after surgery.

DESIGN

A prospective observational cohort study.

SETTING

Four UK secondary care hospitals.

PATIENTS

A total of 4342 patients ≥45 years who underwent noncardiac surgery.

METHODS

We compared outcome of patients who received peri-operative intra-arterial blood pressure monitoring with those whose blood pressure was measured noninvasively.

OUTCOMES

The primary outcome was peri-operative myocardial injury (high-sensitivity troponin-T ≥ 15 ng l−1 within 72 h after surgery), compared between patients who received intra-arterial versus noninvasive blood pressure monitoring. Secondary outcomes were morbidity within 72 h of surgery (postoperative morbidity survey), and vasopressor and fluid therapy. Multivariable logistic regression analysis explored associations between morbidity and age, sex, location of postoperative care, mode of blood pressure/haemodynamic monitoring and Revised Cardiac Risk Index.

RESULTS

Intra-arterial monitoring was used in 1137/4342 (26.2%) patients. Myocardial injury occurred in 440/1137 (38.7%) patients with intra-arterial monitoring compared with 824/3205 (25.7%) with noninvasive monitoring [OR 1.82 (95% CI 1.58 to 2.11), P < 0.001]. Intra-arterial monitoring remained associated with myocardial injury when adjusted for potentially confounding variables [adjusted OR 1.56 (1.29 to 1.89), P < 0.001). The results were similar for planned ICU versus ward postoperative care.

CONCLUSIONS

Intra-arterial monitoring is associated with greater risk of morbidity after noncardiac surgery, after controlling for surgical and patient factors. These data provide useful insights into the design of a definitive monitoring trial.
Pathway for the Diagnosis and Management of Pulmonary Embolism
Authors: Herzog Eyal , Elbaz-Greener Gabby , Planer David , Koren Tali , Amir Offer , Shapiro Janet , Kalish Yosef
Published: January 2021

Venous thromboembolism (VTE), the combined syndromes of deep vein thrombosis (DVT) and pulmonary embolism (PE), is currently the third most frequent acute cardiovascular syndrome globally behind myocardial infarction and stroke. PE carries substantial mortality. In the past decade, we have seen a remarkable improvement in new diagnostic tools as well as advances in therapeutic options to manage patients with PE. Still, even with recently updated society guidelines, the management of intermediate and high-risk PE requires clinician expertise and judgment. To aid healthcare providers caring for patients with acute PE, we have developed a novel, comprehensive yet straightforward, pathway for the management of patients with PE. We believe this pathway can be used in many healthcare systems around the globe. Our pathway for the diagnosis and management of PE is divided into 3 steps: the diagnosis of PE, the acute management of patients with PE, and recommendations for chronic management. The pathway requires classification of the PE by the risk of mortality and thus leads to the appropriate intensity of initial care, intervention, and monitoring. The Pulmonary Embolism Response Team (PERT) is a multispecialty team designed to guide the decision-making for the individual patient with intermediate-high or high-risk PE. The PERT team brings together specialists from different disciplines. The team convenes in real time via a platform such as WhatsApp or text messages to communicate clinical data, discuss the options, and provide consensus for a course of management. The success of this pathway to manage PE depends heavily on developing a collaborative group of specialists dedicated to provide care at each stage to patients with PE.
Altered nociception in Alzheimer disease is associated with striatal-enriched protein tyrosine phosphatase signaling
Authors: Lee Zhung-Fu , Huang Tzu-Hsuan , Chen Shih-Pin , Cheng Irene Han-Juo
Published: January 2021

Alzheimer disease (AD) is the most common form of dementia, accounting for approximately 60% of cases. In addition to memory loss, changes in pain sensitivity are found in a substantial proportion of patients with AD. However, the mechanism of nociception deficits in AD is still unclear. Here, we hypothesize that the nociception abnormality in AD is due to the aberrant activation of striatal-enriched protein tyrosine phosphatase (STEP) signaling, which modulates proteins related to nociception transduction. Our results indicated that the transgenic mice carrying human amyloid precursor protein (APP) gene had lower sensitivity to mechanical and thermal stimulation than the wild-type group at the ages of 6, 9, and 12 months. These APP mice exhibited elevated STEP activity and decreased phosphorylation of proteins involved in nociception transduction in hippocampi. The pharmacological inhibition of STEP activity using TC-2153 further reversed nociception and cognitive deficits in the APP mice. Moreover, the phosphorylation of nociception-related proteins in the APP mice was also rescued after STEP inhibitor treatment, indicating the key role of STEP in nociception alteration. In summary, this study identifies a mechanism for the reduced nociceptive sensitivity in an AD mouse model that could serve as a therapeutic target to improve the quality of life for patients with AD.
Blood biocompatibility enhancement of biomaterials by heparin immobilization: a review
Authors: Patel Himanshu
Published: January 2021

Blood contacting materials are concerned with biocompatibility including thrombus formation, decrease blood coagulation time, hematology, activation of complement system, platelet aggression. Interestingly, recent research suggests that biocompatibility is increasing by incorporating various materials including heparin using different methods. Basic of heparin including uses and complications was mentioned, in which burst release of heparin is major issue. To minimize the problem of biocompatibility and unpredictable heparin release, present review article potentially reviews the reported work and investigates the various immobilization methods of heparin onto biomaterials, such as polymers, metals, and alloys. Detailed explanation of different immobilization methods through different intermediates, activation, incubation method, plasma treatment, irradiations and other methods are also discussed, in which immobilization through intermediates is the most exploitable method. In addition to biocompatibility, other required properties of biomaterials like mechanical and corrosion resistance properties that increase by attachment of heparin are reviewed and discussed in this article.
Comparison of Immunohistochemistry and DNA Sequencing for BRAF V600E Mutation Detection in Mandibular Ameloblastomas
Authors: da Silva Marcelino Barbara M.R. , Parise Guilherme K. , do Canto Alan M. , Sassi Laurindo M. , Sarmento Dmitry J.S. , Costa Andre L.F. , Hasséus Bengt , Kjeller Göran , Schussel Juliana L. , Braz-Silva Paulo H.
Published: January 2021

This study aimed to investigate the presence of BRAF V600E mutation in mandibular ameloblastoma by comparing the results of molecular detection and immunohistochemical analysis. A 128 cases of mandibular ameloblastoma and 30 cases of dentigerous cyst (control group) were selected for analysis. Detection of BRAF V600E mutation was performed with immunohistochemistry (IHC) and polymerase chain reaction techniques. Clinico-pathologic data were collected in order to investigate possible associations with the mutation. Of the 128 cases submitted to IHC, 81.2% (108 cases) showed positivity for anti-BRAF V600E antibody, whereas 24 were negative (18.8%). Molecular analysis of the BRAF V600E mutation by polymerase chain reaction was possible in 116 cases due to DNA quality. Of these cases, 96 were positive (82.8%) and 20 negative (17.2%). All cases of dentigerous cyst were negative for BRAF V600E mutation in both techniques. Considering the sequencing as a gold standard method, the receiver operating characteristics curve analysis showed sensitivity of 0.99 and specificity of 1 (area under the curve=0.995, standard error=0.006; P<0.001; 95% confidence interval=0.983 to 1). We also tested the agreement between the techniques by using the Cohen’s κ coefficient, with κ being 0.97 (P<0.001). IHC is a reliable test for identifying the BRAF V600E mutation in ameloblastomas, presenting advantages such as being more frequently used in surgical pathology laboratories and requiring fewer critical steps for paraffin-embedded tissue compared with molecular biology techniques.
For Infants With Fractures
Authors: Bataenjer Reto , Grotzer Michael , Seiler Michelle
Published: January 2021

Objective

The objective of this study was to compare the frequency at which abuse is detected in institutions with mandatory skeletal surveys for infants with fractures to that in institutions with discretionary referral to child protection teams (CPTs).

Methods

A retrospective chart review of all infants with fractures diagnosed at an emergency department from 2014 to 2018 was conducted to analyze factors leading to a discretionary referral to CPTs and to identify the frequency of nonaccidental trauma.

Results

Seventy-two infants with a median age of 6 months were included in this study. The most frequent fracture site was the skull (73.6%), followed by fractures of the femur (12.5%) and the upper arm and forearm (each 4.2%). Discretionary referral to a CPT occurred in only 25% of cases, and abuse was detected in 2.8%.

Conclusions

The abuse detection rate in institutions with discretionary CPT referral is lower than that in institutions with mandatory skeletal surveys. Therefore, we recommend that in institutions with no mandatory skeletal surveys for infants with fractures, every infant with a fracture must be discussed with a CPT.
New Device Makes Tracheostomy Dressing Changes Easier and More Comfortable
Authors: Morris Linda L. , Kuncis Mary , Perleberg Debra , Kuczek Anna , Kashul Kristen , Zabel Douglas , Heinemann Allen W. , Semik Patrick
Published: January 2021

Purpose

This study compared the use of the tracheostomy dressing applicator (TDA) to the standard procedure for tracheostomy dressing changes.

Design

A prospective quasi-experimental study was performed.

Methods

Nineteen patients and 117 nurses answered a survey after changing the tracheostomy dressing with the TDA and using standard procedure.

Findings

Nurses rated the TDA easier to use in patients with average-sized necks and more favorably on observed discomfort in patients with average-sized and larger necks. Patients rated less discomfort with the TDA compared with the standard method of dressing change.

Conclusion

The TDA is an effective device to facilitate tracheostomy dressing changes, possibly improving compliance and decreasing skin complications.

Clinical Relevance

The TDA is a useful device that can improve efficiency of dressing changes with the potential to save time and improve outcomes.
Grief and Loss Among Veterans With Spinal Cord Injury: A Qualitative Study
Authors: Burkhart Lisa , Kale Ibuola O. , LaVela Sherri L.
Published: January 2021

Purpose

The objective of this study was to understand veteran perspectives of grief/loss associated with their spinal cord injury (SCI).

Design/Methods

Qualitative descriptive design using semistructured interviews with veterans with SCI (n = 15) was performed using interview questions informed by the literature. Analysis was conducted using a deductive/inductive approach.

Results

The 15 participants’ mean age was 64 years; six had paraplegia, eight had tetraplegia, one had unknown level of injury, six were ambulatory, and nine were not ambulatory. The grief/loss experience was individual and constant, consisting of seven phases: experiencing shock, releasing emotion, withdrawing, focusing on losses, problem solving, realizing strength and motivation, and accepting a new life. Veteran coping strategies used in each phase of the grief experience were also identified, as well as triggers that increased or decreased the grief/loss experience.

Conclusions/Clinical Relevance

A better understanding of veterans living with SCI grief experience, coping strategies, and triggering events can help healthcare providers support veterans with SCI.
Designing and Evaluating a Goal-Setting Tip Sheet for Stroke Family Caregiver Health
Authors: Bakas Tamilyn , Jones Holly , Israel Jahmeel , Kum Cleopatra , Miller Elaine L.
Published: January 2021

Purpose

The aim of the study was to design and evaluate a goal-setting tip sheet to improve stroke family caregiver health as part of the Telephone Assessment and Skill-Building Kit program.

Design

A multimethod design using open-ended questions and rating forms was used in this study.

Methods

In two studies, the goal-setting tip sheet was evaluated by caregivers (N = 12; N = 6), researchers (N = 10; N = 3), clinicians (N = 8; N = 4), and technology experts (N = 4; N = 4). Rigorous qualitative content analysis procedures were used with descriptive statistics for ratings.

Findings

Qualitative strengths and areas for improvement refined the goal-setting tip sheet. From 1 = strongly disagree to 5 = strongly agree, ratings averaged from 3.25 to 5.00 for strategies, accuracy, feasibility, and acceptability.

Conclusions

The goal-setting tip sheet was found to be accurate, feasible, and acceptable. Future research is needed to determine the impact on caregiver health.

Clinical Relevance

Stroke caregivers often neglect their own health; goal setting has the potential to improve caregiver health.
Unilateral Cleft Lip Repair Using the Chang Gung Technique
Authors: Tangco Ivy , Bhandari Kishor , Yao Chuan-Fong , Liu Amber Wei Chen , Chen Philip Kuo-Ting , Lu Ting-Chen
Published: January 2021

Objective

This retrospective study analyzed the outcomes of patients undergoing complete or incomplete unilateral cleft lip repair using the Chang Gung technique. The goal was to compare the symmetry and change of the technique through the measurement of anthropometric points on digital photographs.

Methods

From 2010 to 2016, a total of 274 complete and incomplete cleft lip patients without other craniofacial deformities were included in the study. All included patients had a minimum 1-year follow-up with frontal view photographs taken. The vermilion area, lip width, vermilion height, lateral lip length, lip height, and Cupid's bow width of both cleft and noncleft sides were measured for all patients. The Cleft Lip Component Symmetry Index was used to determine the symmetry of the cleft and noncleft sides in both incomplete and complete cleft groups.

Results

A total of 152 complete and 122 incomplete cleft lip patients were included in the study. The mean Cleft Lip Component Symmetry Index values showed that the vermilion area, lip height, and Cupid's bow width were symmetric on both cleft and noncleft sides. Lip width and lateral lip length were noted to be shorter, whereas the vermilion height was thicker on the cleft side than on the noncleft side. Significant differences between the complete and incomplete cleft group measurements were found for lateral lip length and lip height, and complete cleft measurements were shorter than those for incomplete clefts. There were no significant differences in vermilion area, lip width, vermilion height, and Cupid's bow width.

Conclusions

The outcome analysis showed that vermilion height reduction and modifications could be made for both complete and incomplete groups. The complete cleft lip has been found to have a significantly shorter lateral lip length and lip height, reflecting a more severe anatomical soft tissue deficiency in this group. A long-term outcome anthropometric point study may further verify the results of this surgical technique.
The Long-term Effect of Dobutamine on Intrinsic Myocardial Function and Myocardial Injury in Septic Rats with Myocardial Dysfunction
Authors: Tang Xiangxu , Xu Yaqian , Dai Xiaomeng , Xing Yun , Yang Duomeng , Huang Qingyang , Li Hongmei , Lv Xiuxiu , Wang Yiyang , Lu Daxiang , Wang Huadong
Published: January 2021

Dobutamine (DOB) is recommended as an inotrope for septic patients with low cardiac output, but its long-term impact on sepsis-induced cardiomyopathy remains unclear. This study investigated the long-term effect of DOB on septic myocardial dysfunction and injury. Rats were exposed to cecal ligation and puncture (CLP), the intrinsic myocardial function, other organ functions, hemodynamics, inflammatory response, serum myocardial injury biomarkers, myocardial apoptosis, and vascular permeability were determined. At 6 h after CLP, the left ventricular ±dP/dt were significantly depressed, cardiac tumor necrosis factor-α and vascular cell adhesion molecule-1 expression were increased, but not serum cardiac troponin I (cTnI), N-terminal pro-brain natriuretic peptide (NT-proBNP), heart-type fatty acid-binding protein (H-FABP), creatinine, and urea nitrogen concentrations in CLP group compared with controls. At 9 h after CLP, hepatic dysfunction was present in CLP rats compared with controls. At 6 h after CLP, DOB treatment did not affect hemodynamics, the left ventricular ±dP/dt, cytokine levels in serum and myocardium, as well as cardiomyocyte apoptosis and cardiac vascular hyperpermeability at 20 h after CLP. However, DOB (10.0 μg/kg) increased serum IL-10 level and improved survival in septic rats. These results indicate that the intrinsic myocardial depression occurs earlier than hepatic and renal dysfunction in sepsis and serum cTnI, NT-proBNP, and H-FABP are not suitable as early biomarkers for sepsis-induced myocardial dysfunction. Although DOB treatment (10.0 μg/kg) in the presence of myocardial dysfunction improves survival in septic rats, it neither improves myocardial function and hemodynamics nor attenuates myocardial injury at the later stage of sepsis.
A Randomized Porcine Study in Low Cardiac Output of Vasoactive and Inotropic Drug Effects on the Gastrointestinal Tract
Authors: Seilitz Jenny , Grafver Isabelle , Kiszakiewicz Lars , Oikonomakis Ioannis , Jansson Kjell , Axelsson Birger , Nilsson Kristofer F.
Published: January 2021

Background:

Splanchnic vasodilation by inodilators is an argument for their use in critical cardiac dysfunction. To isolate peripheral vasoactivity from inotropy, such drugs were investigated, and contrasted to vasopressors, in a fixed low cardiac output (CO) model resembling acute cardiac dysfunction effects on the gastrointestinal tract. We hypothesized that inodilators would vasodilate and preserve the aerobic metabolism in the splanchnic circulation in low CO.

Methods:

In anesthetized pigs, CO was lowered to 60% of baseline by partial inferior caval vein balloon inflation. The animals were randomized to placebo (n = 8), levosimendan (24 μg kg−1 bolus, 0.2 μg kg−1 min−1, n = 7), milrinone (50 μg kg−1 bolus, 0.5 μg kg−1 min−1, n = 7), vasopressin (0.001, 0.002 and 0.006 U kg−1 min−1, 1 h each, n = 7) or norepinephrine (0.04, 0.12, and 0.36 μg kg−1 min−1, 1 h each, n = 7). Hemodynamic variables including mesenteric blood flow were collected. Systemic, mixed-venous, mesenteric-venous, and intraperitoneal metabolites were analyzed.

Results:

Cardiac output was stable at 60% in all groups, which resulted in systemic hypotension, low superior mesenteric artery blood flow, lactic acidosis, and increased intraperitoneal concentrations of lactate. Levosimendan and milrinone did not change any circulatory variables, but levosimendan increased blood lactate concentrations. Vasopressin and norepinephrine increased systemic and mesenteric vascular resistances at the highest dose. Vasopressin increased mesenteric resistance more than systemic, and the intraperitoneal lactate concentration and lactate/pyruvate ratio.

Conclusion:

Splanchnic vasodilation by levosimendan and milrinone may be negligible in low CO, thus rejecting the hypothesis. High-dose vasopressors may have side effects in the splanchnic circulation.