bluuebunny/crossref_metadata_2025 huggingface dataset:
The resonant drag instability of dust streaming in turbulent protoplanetary disc
Authors: Zhuravlev V V
Published: March 2020

Damping of the previously discovered resonant drag instability (RDI) of dust streaming in the protoplanetary disc is studied using the local approach to dynamics of gas–dust perturbations in the limit of the small dust fraction. Turbulence in a disc is represented by the effective viscosity and diffusivity in equations of motion for gas and dust, respectively. In the standard case of the Schmidt number (ratio of the effective viscosity to diffusivity) Sc = 1, the reduced description of RDI in terms of the inertial wave (IW) and the streaming dust wave (SDW) falling in resonance with each other reveals that damping solution differs from the inviscid solution simply by adding the characteristic damping frequency to its growth rate. RDI is fully suppressed at the threshold viscosity, which is estimated analytically, first, for radial drift, next, for vertical settling of dust, and at last, in the case of settling combined with a radial drift of the dust. In the last case, RDI survives up to the highest threshold viscosity, with a greater excess for smaller solids. Once Sc ≠ 1, a new instability specific for dissipative perturbations on the dust settling background emerges. This instability of the quasi-resonant nature is referred to as settling viscous instability (SVI). The mode akin to SDW (IW) becomes growing in a region of long waves provided that Sc > 1 (Sc < 1). SVI leads to an additional increase in the threshold viscosity.
Associating divergent lncRNAs with target genes by integrating genome sequence, gene expression and chromatin accessibility data
Authors: Wang Yongcui , Chen Shilong , Li Wenran , Jiang Rui , Wang Yong
Published: March 2020

Recent RNA knockdown experiments revealed that a dozen divergent long noncoding RNAs (lncRNAs) positively regulate the transcription of genes in cis. Here, to understand the regulatory mechanism of divergent lncRNAs, we proposed a computational model IRDL (Identify the Regulatory Divergent LncRNAs) to associate divergent lncRNAs with target genes. IRDL took advantage of the cross-tissue paired expression and chromatin accessibility data in ENCODE and a dozen experimentally validated divergent lncRNA target genes. IRDL integrated sequence similarity, co-expression and co-accessibility features, battled the scarcity of gold standard datasets with an increasingly learning framework and identified 446 and 977 divergent lncRNA-gene regulatory associations for mouse and human, respectively. We found that the identified divergent lncRNAs and target genes correlated well in expression and chromatin accessibility. The functional and pathway enrichment analysis suggests that divergent lncRNAs are strongly associated with developmental regulatory transcription factors. The predicted loop structure validation and canonical database search indicate a scaffold regulatory model for divergent lncRNAs. Furthermore, we computationally revealed the tissue/cell-specific regulatory associations considering the specificity of lncRNA. In conclusion, IRDL provides a way to understand the regulatory mechanism of divergent lncRNAs and hints at hundreds of tissue/cell-specific regulatory associations worthy for further biological validation.
Organic topological insulators (OTI): a dream coming true?
Authors: Zhi Danfeng , Di Chong-an , Zhu Daoben
Published: March 2020

Experimental discovery of organic topological insulators (OTI) is a dream for both topological matters and organic materials. Despite great challenges, we anticipate that the dream will become a reality by engineered studies on materials chemistry, characterization techniques and device physics of conjugated molecules.
Discovery of a transient X-ray source Suzaku J1305−4930 in NGC 4945
Authors: Ide Shuntaro , Hayashida Kiyoshi , Noda Hirofumi , Kurubi Hiroyuki , Yoneyama Tomokage , Matsumoto Hironori
Published: March 2020

We report the serendipitous discovery of a transient X-ray source, Suzaku J1305−4930, ∼3 kpc southwest of the nucleus of the Seyfert 2 galaxy NGC 4945. Among the seven Suzaku observations of NGC 4945 from 2005 to 2011, Suzaku J1305−4930 was detected four times in July and August in 2010. The X-ray spectra are better approximated with a multi-color disk model than a power-law model. At the first detection on 2010 July 4–5, its X-ray luminosity was $(8.9^{+0.2}_{-0.4}) \times 10^{38}\:$erg s−1 and the temperature at the inner-disk radius (kTin) was 1.12 ± 0.04 keV. At the last detection with Suzaku on 2010 August 4–5, the luminosity decreased to $(2.2^{+0.3}_{-0.8}) \times 10^{38}\:$erg s−1 and kTin was 0.62 ± 0.07 keV. The source was not detected on 2011 January 29, about six months after the first detection, with a luminosity upper limit of 2.4 × 1038 erg s−1. We also find an absorption feature which is similar to that reported in Cyg X-1. Assuming the standard disk, we suggest that Suzaku J1305−4930 consists of a black hole with a mass of ∼10 $M_\odot$. The relation between the disk luminosity and kTin is not reproduced with the standard model of a constant inner radius but is better approximated with a slim-disk model.
Ontogenetic changes in the elemental composition and stoichiometry of marine copepods with different life history strategies
Authors: Saiz Enric , Griffell Kaiene , Calbet Albert
Published: March 2020

We describe the ontogenetic variation in elemental and stoichiometric composition of two copepod species with very contrasted life history patterns, the calanoid Paracartia grani and the cyclopoid Oithona davisae. The first species is a broadcasting, highly productive copepod, whereas the latter is an egg-carrying copepod, much less productive. We reared cultures of both species under conditions of excess food and analyzed their C, N and P composition, and their molar ratios, along development. Both species differed on their specific P content, whereas the specific C and N content were similar. As expected, the specific P content of P. grani was higher, resulting in lower C:P and N:P ratios. Furthermore, we compared our elemental composition data with previously reported stage-specific (nauplii and adult female) maximum growth rates of these two species. We found that for O. davisae, the ontogenetic variation in specific P content agreed with the reported differences in growth rate along development; however, in the case of P. grani, in which juvenile and adult maximum growth rates are similar, the variations in specific P content along development did not reflect the growth rate pattern.
Trauma and Suicide Risk in College Students: Does Lack of Agency, Lack of Pathways, or Both Add to Further Risk?
Authors: Lucas Abigael G , Chang Edward C , Li Mingqi , Chang Olivia D , Yu Elizabeth A , Hirsch Jameson K
Published: March 2020

The present study sought to examine trauma history and hope as predictors of suicide risk in a sample of 561 college students. Furthermore, authors aimed to understand whether the lack of hope agency and hope pathways contributed to further risk for suicide, above and beyond trauma history. Results suggested that trauma history and hope agency were significant and unique predictors of suicide risk among college students. More specifically, hope agency accounted for additional variance in the prediction model of suicide risk, beyond that accounted for by trauma history. Some implications of the present findings for social work practice are discussed.
Obesity as a Source of Endogenous Compounds Associated With Chronic Disease: A Review
Authors: Smith Carr J , Perfetti Thomas A , Hayes A Wallace , Berry Sir Colin
Published: March 2020

In 2014, it was estimated that more than 1.9 billion adults were overweight with over 600 million classifiable as obese. Approximately two-thirds of U.S. adults over 20 years of age are currently overweight with about 35% classified as obese, a figure thought likely to reach 42% by 2030 in those over 18 years of age. Adipose cells from stored body fat secrete estrogen and a very large number (> 500) of biologically active substances termed adipokines, in addition to inducing, by other cell-driven effects, pathological alterations in insulin pathways. The U.S. National Cancer Institute reports that exposure to the hormone disrupting and proinflammatory effects of excess adipose tissue are associated with an increased risk for 11 different cancers. Obesity is also associated with a number of serious non-neoplastic conditions including metabolic syndrome and type 2 diabetes; menstrual cycle irregularities and lowered fertility (men and women); and abnormal bone morphology in a subset of female patients. In men hypogonadism, low testosterone levels, benign prostatic hyperplasia, and lowered sperm counts have been reported. In developed countries, the endogenous adverse health burden associated with obesity is only matched, quantitatively and qualitatively, by the exogenous toxicity of cigarette smoking. The investigation of possible hormonal and/or proinflammatory effects of chemicals should include an assessment of the profound endocrine alterations associated with obesity.
First Report of Hemp Leaf Spot Caused by a Bipolaris Species on Hemp (Cannabis sativa) in Kentucky
Authors: Szarka Desiree , Amsden Bernadette , Beale Julie , Dixon Ed , Schardl Christopher L. , Gauthier Nicole
Published: March 2020

Upon reintroduction of hemp (Cannabis sativa) in 2014, reports of a leaf spot disease became increasingly common in Kentucky. Outdoor-grown plants became severely affected with necrosis and blight symptoms, and many crops were rejected by processors either as a result of leaf and bud necrosis or as a result of reduced levels of cannabidiol. Morphological data and sequences of ITS and partial 28S rDNA identified the pathogen as Drechslera gigantea. Phylogenetic analysis grouped all isolates in a clade within Bipolaris. Dicot and monocot weed hosts within symptomatic fields were also identified. We refer to the disease as Bipolaris leaf spot, but the common reference is hemp leaf spot. This is the first report of a Bipolaris pathogen infecting C. sativa. Widespread distribution, disease severity, and extreme yield losses makes this one of the most important diseases of hemp in Kentucky.
The Safety and Efficacy of Intralesional Verapamil Versus Intralesional Triamcinolone Acetonide for Keloids and Hypertrophic Scars: A Systematic Review and Meta-analysis
Authors: Jiang Zheng-Ying , Liao Xin-Cheng , Liu Ming-Zhuo , Fu Zhong-Hua , Min Ding-Hong , Guo Guang-Hua
Published: March 2020

BACKGROUND

Keloids and hypertrophic scars often result after skin trauma. Currently, intralesional triamcinolone acetonide (TAC) is the criterion standard in nonsurgical management of keloids and hypertrophic scars. Intralesional verapamil may be an effective alternative modality, but it has been insufficiently studied. Accordingly, the study authors conducted a systematic review and meta-analysis of randomized controlled trials to compare the efficacy and safety of the two drugs.

METHODS

The study authors systematically searched the MEDLINE, EMBASE, Cochrane Library, and China National Knowledge Infrastructure databases for relevant trials published in any language through September 2018.

RESULTS

According to the four studies included in this review, TAC improved scar pliability and vascularity more than verapamil after 3 weeks (P < .05). For scar height and scar pigmentation, no statistical difference was observed between the treatments (P > .05). The difference in effects on symptoms was not statistically significant (P = .89). For pain and telangiectasia, no statistical difference was observed (P > .05). Verapamil resulted in fewer cases of skin atrophy (P < .05).

CONCLUSIONS

It appears that TAC is more effective than verapamil for improving scar pliability and vascularity in keloids and hypertrophic scars after 3 weeks of treatment. However, verapamil has fewer adverse drug reactions than TAC, which allows for a longer treatment period and the possibility that it might be effective for patients who cannot receive TAC.
Efficacy and Safety of Pirfenidone in Patients with Second-Degree Burns: A Proof-of-Concept Randomized Controlled Trial
Authors: Mecott Gabriel A. , González-Cantú Iván , Dorsey-Treviño Edgar Gerardo , Matta-Yee-Chig Daniel , Saucedo-Cárdenas Odila , Montes de Oca-Luna Roberto , Pérez-Porras Sergio , García-Pérez Mauricio M.
Published: March 2020

OBJECTIVE

Several studies suggest that pirfenidone may have a potential off-label use for wound healing. However, the effectiveness of this medication in patients with burns remains uncertain. Accordingly, investigators sought to assess wound re-epithelialization in patients with second-degree burns after adding pirfenidone to usual care.

DESIGN AND SETTING

Single-center pilot, proof-of-concept, single-blind randomized controlled trial.

PATIENTS AND INTERVENTION

Eight patients with second-degree burns were treated with occlusive hydrocolloid dressings and were randomly allocated to receive either no additional treatment or pirfenidone.

OUTCOME MEASURES

The primary outcome of the study was to evaluate wound healing between groups based on the thickness of the re-epithelialized epidermis at day 7. Secondary outcomes were to qualitatively assess the development of fibrotic tissue in the dermis, anomalies in the basal membrane, and the development of collagen fibers by histologic analysis. Liver and renal functions were measured daily to assess the overall safety of oral pirfenidone.

MAIN RESULTS

Patients treated with pirfenidone showed a remarkable improvement in wound re-epithelialization at day 7 (148.98 ± 13.64 vs 119.27 ± 15.55 μm; P = .029; 95% confidence interval, 4.14-55.29). Histologic evaluations showed less wound fibrosis in the pirfenidone group.

CONCLUSIONS

A decrease in wound healing time by enhancing wound re-epithelialization was observed with pirfenidone. Larger clinical trials are needed to reach more reliable conclusions.
Managing family dynamics when caring for older adults
Authors: Gross Sarah J.
Published: March 2020

Caring for older patients with neurocognitive disorders can be challenging, especially when family members disagree regarding optimal care. This article explores the role and utilization of mediators in the healthcare setting.
Unique features of non-IgE-mediated gastrointestinal food allergy during infancy in Japan
Authors: Yamada Yoshiyuki
Published: March 2020

Purpose of review

An increase in incidence of unique phenotypic non-IgE-mediated gastrointestinal food allergies (non-IgE GIFAs) has occurred in Japan ahead of Western countries. There are differences in clinical features of non-IgE GIFAs in Western and Japanese patients. As this phenotype has now come to be recognized internationally, we describe it in this review.

Recent findings

A large number of Japanese patients with non-IgE GIFAs present with vomiting accompanied by bloody stool, putting them between food protein-induced enterocolitis syndrome (FPIES) and food protein-induced allergic proctocolitis. Some neonates and early infants with non-IgE GIFAs who present with fever and elevated C-reactive protein have symptoms consistent with severe systemic bacterial infections (e.g., sepsis). Some of these cases have now been defined in international guidelines as chronic FPIES. Eosinophils might be involved in the inflammatory process observed. The incidence of FPIES and food protein-induced allergic proctocolitis is increasing in Western countries and likely worldwide, after it has increased in Japan.

The phenotype observed in Japan shows distinct clinical features compared with the classical phenotype, that is, increased levels of eosinophils, suggestive of ‘eosinophilic shift’ alongside symptomatic differences, making it difficult to categorize.
Altered Global Brain Signal during Physiologic, Pharmacologic, and Pathologic States of Unconsciousness in Humans and Rats
Authors: Tanabe Sean , Huang Zirui , Zhang Jun , Chen Yali , Fogel Stuart , Doyon Julien , Wu Jinsong , Xu Jianghui , Zhang Jianfeng , Qin Pengmin , Wu Xuehai , Mao Ying , Mashour George A. , Hudetz Anthony G. , Northoff Georg
Published: March 2020

Background

Consciousness is supported by integrated brain activity across widespread functionally segregated networks. The functional magnetic resonance imaging–derived global brain signal is a candidate marker for a conscious state, and thus the authors hypothesized that unconsciousness would be accompanied by a loss of global temporal coordination, with specific patterns of decoupling between local regions and global activity differentiating among various unconscious states.

Methods

Functional magnetic resonance imaging global signals were studied in physiologic, pharmacologic, and pathologic states of unconsciousness in human natural sleep (n = 9), propofol anesthesia (humans, n = 14; male rats, n = 12), and neuropathological patients (n = 21). The global signal amplitude as well as the correlation between global signal and signals of local voxels were quantified. The former reflects the net strength of global temporal coordination, and the latter yields global signal topography.

Results

A profound reduction of global signal amplitude was seen consistently across the various unconscious states: wakefulness (median [1st, 3rd quartile], 0.46 [0.21, 0.50]) versus non-rapid eye movement stage 3 of sleep (0.30 [0.24, 0.32]; P = 0.035), wakefulness (0.36 [0.31, 0.42]) versus general anesthesia (0.25 [0.21, 0.28]; P = 0.001), healthy controls (0.30 [0.27, 0.37]) versus unresponsive wakefulness syndrome (0.22 [0.15, 0.24]; P < 0.001), and low dose (0.07 [0.06, 0.08]) versus high dose of propofol (0.04 [0.03, 0.05]; P = 0.028) in rats. Furthermore, non-rapid eye movement stage 3 of sleep was characterized by a decoupling of sensory and attention networks from the global network. General anesthesia and unresponsive wakefulness syndrome were characterized by a dissociation of the majority of functional networks from the global network. This decoupling, however, was dominated by distinct neuroanatomic foci (e.g., precuneus and anterior cingulate cortices).

Conclusions

The global temporal coordination of various modules across the brain may distinguish the coarse-grained state of consciousness versus unconsciousness, while the relationship between the global and local signals may define the particular qualities of a particular unconscious state.

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Individualized Fluid Management Using the Pleth Variability Index
Authors: Fischer Marc-Olivier , Lemoine Sandrine , Tavernier Benoît , Bouchakour Chems-Eddine , Colas Vincent , Houard Marion , Greub William , Daccache Georges , Hulet Christophe , Compère Vincent , Taing Diane , Lorne Emmanuel , Parienti Jean-Jacques , Hanouz Jean-Luc ,   for the Optimization using the Pleth Variability Index (OPVI) Trial Group
Published: March 2020

Background

The present trial was designed to assess whether individualized strategies of fluid administration using a noninvasive plethysmographic variability index could reduce the postoperative hospital length of stay and morbidity after intermediate-risk surgery.

Methods

This was a multicenter, randomized, nonblinded parallel-group clinical trial conducted in five hospitals. Adult patients in sinus rhythm having elective orthopedic surgery (knee or hip arthroplasty) under general anesthesia were enrolled. Individualized hemodynamic management aimed to achieve a plethysmographic variability index under 13%, and the standard management strategy aimed to maintain a mean arterial pressure above 65 mmHg during general anesthesia. The primary outcome was the postoperative hospital length of stay decided by surgeons blinded to the group allocation of the patient.

Results

In total, 447 patients were randomized, and 438 were included in the analysis. The mean hospital length of stay ± SD was 6 ± 3 days for the plethysmographic variability index group and 6 ± 3 days for the control group (adjusted difference, 0.0 days; 95% CI, −0.6 to 0.5; P = 0.860); the theoretical postoperative hospital length of stay was 4 ± 2 days for the plethysmographic variability index group and 4 ± 1 days for the control group (P = 0.238). In the plethysmographic variability index and control groups, serious postoperative cardiac complications occurred in 3 of 217 (1%) and 2 of 224 (1%) patients (P = 0.681), acute postoperative renal failure occurred in 9 (4%) and 8 (4%) patients (P = 0.808), the troponin Ic concentration was more than 0.06 μg/l within 5 days postoperatively for 6 (3%) and 5 (2%) patients (P = 0.768), and the postoperative arterial lactate measurements were 1.44 ± 1.01 and 1.43 ± 0.95 mmol/l (P = 0.974), respectively.

Conclusions

Among intermediate-risk patients having orthopedic surgery with general anesthesia, fluid administration guided by the plethysmographic variability index did not shorten the duration of hospitalization or reduce complications.

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An Effective and Efficient Testing Protocol for Diagnosing Iron-deficiency Anemia Preoperatively
Authors: Okocha Obianuju , Dand Hardik , Avram Michael J. , Sweitzer BobbieJean
Published: March 2020

Background

Iron-deficiency anemia is a common perioperative condition and increases perioperative morbidity and mortality. Timely diagnosis and treatment are important. This retrospective cohort study tested the hypothesis that a newly developed preprocedure evaluation protocol diagnoses more patients with iron-deficiency anemia than the traditional practice of obtaining a complete blood count followed by iron studies.

Methods

The preprocedure anemia evaluation is an order for a complete blood count and reflex anemia testing, which can be completed with a single patient visit. A hemoglobin concentration of 12 g/dl or less with serum ferritin concentration less than 30 ng/ml or transferrin saturation less than 20% defined iron-deficiency anemia. Northwestern Medicine’s database was queried for preoperative clinic patients, age 16 to 89 yr, before (2015 to 2016) and after (2017 to 2018) protocol implementation. The proportion of patients diagnosed with iron-deficiency anemia before and after the preprocedure anemia evaluation implementation was compared.

Results

Before implementing the protocol, 8,816 patients were screened with a traditional complete blood count. Subsequent iron studies at the providers’ discretion diagnosed 107 (1.2%) patients with iron-deficiency anemia. Some patients were still screened with a complete blood count after implementing the protocol; 154 of 4,629 (3.3%) patients screened with a complete blood count and 738 of 2,828 (26.1%) patients screened with the preprocedure anemia evaluation were diagnosed with iron-deficiency anemia. The preprocedure anemia evaluation identified a far larger proportion of patients with iron-deficiency anemia than did the traditional complete blood count when compared both before (relative risk [95% CI], 21.5 (17.6 to 26.2); P < 0.0001) and after (7.8 [6.6 to 9.3]; P < 0.0001) its implementation.

Conclusions

The preprocedure anemia evaluation improved identification of iron-deficiency anemia preoperatively. It is more effective and efficient, allowing anemia evaluation with a single patient visit.

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Response of Chinese Anesthesiologists to the COVID-19 Outbreak
Authors: Zhang Hong-Fei , Bo Lulong , Lin Yun , Li Feng-Xian , Sun Shujun , Lin Hong-Bin , Xu Shi-Yuan , Bian Jinjun , Yao Shanglong , Chen Xiangdong , Meng Lingzhong , Deng Xiaoming
Published: March 2020

The coronavirus disease 2019, named COVID-19 officially by the World Health Organization (Geneva, Switzerland) on February 12, 2020, has spread at unprecedented speed. After the first outbreak in Wuhan, China, Chinese anesthesiologists encountered increasing numbers of infected patients since December 2019. Because the main route of transmission is via respiratory droplets and close contact, anesthesia providers are at a high risk when responding to the devastating mass emergency. So far, actions have been taken including but not limited to nationwide actions and online education regarding special procedures of airway management, oxygen therapy, ventilation support, hemodynamic management, sedation, and analgesia. As the epidemic situation has lasted for months (thus far), special platforms have also been set up to provide free mental health care to all anesthesia providers participating in acute and critical caring for COVID-19 patients. The current article documents the actions taken, lesson learned, and future work needed.
Perioperative Management of Patients Infected with the Novel Coronavirus
Authors: Chen Xiangdong , Liu Yanhong , Gong Yahong , Guo Xiangyang , Zuo Mingzhang , Li Jun , Shi Wenzhu , Li Hao , Xu Xiaohan , Mi Weidong , Huang Yuguang
Published: March 2020

The outbreak of the new Coronavirus disease, COVID-19, has been involved in 77,262 cases in China as well as in 27 other countries as of February 24, 2020. Because the virus is novel to human beings, and there is no vaccine yet available, every individual is susceptible and can become infected. Healthcare workers are at high risk, and unfortunately, more than 3,000 healthcare workers in China have been infected. Anesthesiologists are among healthcare workers who are at an even higher risk of becoming infected because of their close contact with infected patients and high potential of exposure to respiratory droplets or aerosol from their patients’ airways. In order to provide healthcare workers with updated recommendations on the management of patients in the perioperative setting as well as for emergency airway management outside of the operating room, the two largest anesthesia societies, the Chinese Society of Anesthesiology (CSA) and the Chinese Association of Anesthesiologists (CAA) have formed a task force to produce the recommendations. The task force hopes to help healthcare workers, particularly anesthesiologists, optimize the care of their patients and protect patients, healthcare workers, and the public from becoming infected. The recommendations were created mainly based on the practice and experience of anesthesiologists who provide care to patients in China. Therefore, adoption of these recommendations outside of China must be done with caution, and the local environment, culture, uniqueness of the healthcare system, and patients’ needs should be considered. The task force will continuously update the recommendations and incorporate new information in future versions.
Medial patellofemoral ligament reconstruction using a partial-thickness quadriceps tendon graft: Short-term clinical outcome retrospective case series
Authors: Elbarbary Ahmed Naser , Fotoh Dina Salem , Badr Ismail Tawfeek
Published: March 2020

Background:

The medial patellofemoral ligament (MPFL) is considered the primary restraint to lateral patellar translation. Many of the reconstruction techniques proposed recently for patellar instability require bony procedures and implant use on the patellar or femoral side. The aim of this study was to describe the short-term clinical outcomes of MPFL reconstruction using a partial-thickness quadriceps tendon graft.

Methods:

Seven patients (two men, five women; mean age 23.7±4.1 yr) with chronic patellar instability had MPFL reconstruction using a partial-thickness quadriceps tendon graft. Patients were clinically and radiographically evaluated, and a Tegner-Lysholm score obtained preoperatively and at 6 and 12 mo postoperatively.

Results:

The mean follow-up period was 18.8 mo (range, 12–30 mo). The mean Tegner-Lysholm score improved from 63±7.9 preoperatively to 89.2±6.1 postoperatively (at 12 mo). Apprehension test was negative in all patients. No redislocation, subluxation, or complications were reported during the follow-up period.

Conclusions:

MPFL reconstruction with a partial-thickness quadriceps tendon graft was effective and was associated with good short-term clinical outcomes without the need for patellar bone tunnels and without complications.

Level of Evidence:

Level IV.
Therapeutic Drug Monitoring of Dalbavancin Treatment in Severe Necrotizing Fasciitis in 3 Critically Ill Patients: A Grand Round
Authors: Corona Alberto , Agarossi Andrea , Veronese Alice , Cattaneo Dario , D'Avolio Antonio
Published: March 2020

Background:

Dalbavancin, albeit indicated for the treatment of skin structure infections, is used for a much wider range of infections. This drug is characterized by a long half-life (more than 200 hours), a favorable safety profile, and an activity against a wide array of gram-positive organisms, including several strains of Staphylococci and Enterococci.

Methods:

In this study, we presented 3 cases of critically ill patients treated with dalbavancin. All patients were therapeutically monitored for plasma dalbavancin concentrations; ultrafiltrate dalbavancin concentrations were assessed in a patient undergoing continuous renal-replacement therapy. Dalbavancin concentrations were measured using a validated liquid chromatographic method coupled with mass spectrometry.

Results:

All 3 severely ill patients experiencing necrotizing fasciitis were successfully treated during the acute phase with dalbavancin. Dalbavancin clearance in patient 3 (0.334 L/h) was considerably increased compared with values measured in the other 2 patients (0.054 and 0.075 L/h) and with data reported in the literature (0.04–0.06 L/h).

Conclusions:

Our case reports presented preliminary evidence that dalbavancin can be considered a therapeutic option for necrotizing fasciitis in intensive care unit patients. The role of hypoalbuminemia during dalbavancin exposure merits further investigation.
Reconstruction of Upper Extremity Defects by Random Pedicle Abdominal Flaps: Is It Still a Valid Option?
Authors: Jabaiti Samir , Ahmad Muayyad , AlRyalat Saif Aldeen
Published: March 2020

Background:

Traumatic soft tissue defects of the hand and upper extremities are common and may be challenging to the reconstructive surgeon. Several reconstructive procedures such as use of local, regional, distant, and free flaps have been described. This study aimed to report the techniques, outcomes, and complications of pedicle abdominal flaps in reconstructing hand and upper extremity defects.

Methods:

In this retrospective study, we included patients with different traumatic defects in the hand and upper extremities who underwent reconstruction by random pedicle abdominal flaps between 2002 and 2017 at Jordan University Hospital, Jordan. Data were collected and analyzed, and the variables studied included patient age and sex, etiology and size of the defect, complications, outcomes, and the need for further revision procedures. Appropriate statistical analysis was used to examine the potential factors affecting flap survival.

Results:

We included a total of 34 patients with a mean age of 22.2 years, ranging from 1 to 54 years. Finger degloving was seen in approximately half of the patients. Flap survival rate was 85.3%. A small area of defect was the only risk factor that significantly affected the flap failure rate.

Conclusions:

Thin pedicle abdominal flaps are a valid, affordable, and safe option in upper extremity traumatic defects, especially in situations where microsurgical techniques are unavailable or contraindicated. Extra care should be taken when the defect surface area is small.
Evaluation of elevated heart rate as a sympathetic nervous system biomarker in essential hypertension
Authors: Esler Murray , Lambert Gavin , Esler Danielle , Ika Sari Carolina , Guo Ling , Jennings Garry
Published: March 2020

Background:

There is a need for an easily accessible biomarker of sympathetic nervous activation in essential hypertension, but none exists. Heart rate (HR) has been suggested, but requires validation, now doubly important as an elevated HR in hypertension has emerged as an independent cardiovascular risk factor.

Methods:

Isotope dilution methodology was used to measure total and regional noradrenaline spillover and adrenaline secretion rates in 30 patients with unmedicated essential hypertension and in a comparator group of 48 healthy participants with normal blood pressure. The particular interest was in the relationship of measured HR to cardiac noradrenaline spillover, the measure of cardiac sympathetic activity.

Results:

Sympathetic activation was present in the patients with essential hypertension, evident in significantly increased mean cardiac, renal and total noradrenaline spillover rates. Adrenaline secretion was normal. HR in hypertension correlated directly with cardiac noradrenaline spillover (r = 0.82, P = 9.3 × 10–5), but not with renal noradrenaline spillover or adrenaline secretion. 67% of the variance in HR was attributable to differences in cardiac sympathetic activity. Among hypertensive patients there was no internal correlation between cardiac noradrenaline spillover, renal noradrenaline spillover and adrenaline secretion; the sympathetic activation commonly was not ‘global’. In healthy participants HR did not correlate with measures of sympathetic activity or adrenaline secretion.

Conclusion:

When sympathetic activation exists in essential hypertension it is differentiated, not necessarily involving all sympathetic outflows. An elevated HR proved to be a biomarker of cardiac sympathetic activation but not activation of the renal sympathetic outflow. Identifying activation of the cardiac sympathetic outflow as the prime mechanism of hypertension tachycardia is relevant to therapies which should now be considered to minimize cardiovascular risk in this clinical setting. Is an elevated HR a valid biomarker of sympathetic activation in essential hypertension? Yes, but only for the cardiac sympathetic outflow. The unavoidable principle is that regional differentiation of sympathetic responses in essential hypertension means that no simple test can ever represent each and every sympathetic outflow.
PARACENTRAL ACUTE MIDDLE MACULOPATHY IN A CASE OF HIGH-FLOW DIRECT CAROTID CAVERNOUS FISTULA
Authors: Ho Chi Yun Doreen , Yan Bernard , Symons Robert C. Andrew , Hardy Thomas G.
Published: March 2020

Purpose:

To report a case of paracentral acute middle maculopathy in a patient with high-flow carotid cavernous fistula.

Methods:

A case report of a 53-year-old male patient who sustained an iatrogenic high-flow carotid cavernous fistula and secondary paracentral acute middle maculopathy.

Results:

At review 1-week postembolization of the carotid cavernous fistula, there was no significant improvement in visual acuity, tests of optic nerve function, external ophthalmoplegia, and ptosis. Spectral domain optical coherence tomography was performed, which revealed hyperreflectivity of the parafoveal plexiform layers of the right eye with ill-defined margins straddling the inner nuclear layer.

Conclusion:

We suggest that spectral domain optical coherence tomography be performed in cases of high-flow direct carotid cavernous fistula where the best-corrected visual acuity is reduced out of keeping with other ophthalmic manifestations.
The Effects of Harm Events on 30-Day Readmission in Surgical Patients
Authors: Kandagatla Pridvi , Su Wan-Ting K. , Adrianto Indra , Jordan Jack , Haeusler Jessica , Rubinfeld Ilan
Published: March 2020

Readmission is an increasingly important focus for improvement regarding quality, value, and patient burden in our surgical patient population. We hypothesized that inpatient harm events increase the likelihood of readmission in surgical patients. We created a system-wide inpatient registry with 30-day readmission. A surgical subset was created, and harm events were tracked through the electronic health record system. Between 2015 and 2017, 37,048 surgical patient encounters met inclusion criterion. A total of 2,887 patients (7.69%) were readmitted. After multiple logistic regression of the highly significant harm measures, seven harm measures remained statistically significant (p < .05). Those with the three highest odds ratios were mucosal pressure ulcer, Clostridium difficile, and glucose <40. Incorporating harm measures to the traditional risk, predictive model for 30-day readmission improved our model performance (area under the ROC curve from 0.68 to 0.71). This study demonstrated that inpatient hospital-based harm events can be electronically monitored and used to predict 30-day readmission.
TBX4 variants and pulmonary diseases: getting out of the ‘Box’
Authors: Haarman Meindina G. , Kerstjens-Frederikse Wilhelmina S. , Berger Rolf M.F.
Published: March 2020

Purpose of review

In 2013, the association between T-Box factor 4 (TBX4) variants and pulmonary arterial hypertension (PAH) has first been described. Now – in 2020 – growing evidence is emerging indicating that TBX4 variants associate with a wide spectrum of lung disorders.

Recent findings

TBX4 variants are enriched in both children and adults with PAH. The clinical phenotype associated with a TBX4 variant seems to be milder than that in other PAH-associated gene mutations. Further, TBX4 variants have increasingly been associated with a variety of clinical and histopathological phenotypes, including lethal developmental parenchymal lung diseases such as not only acinar dysplasia in neonates, but also less outspoken parenchymal lung diseases in children and adults.

The clinical phenotype of a TBX4 variant has recently been recognised to expand from bone disorders to different types of lung diseases. Recent data suggest that variants of TBX4, a transcription factor known to be an important regulator in embryonic development, are not rare in both children and adults with PAH and/or developmental parenchymal lung diseases.
The clinical features and related factors of PICC-related upper extremity asymptomatic venous thrombosis in cancer patients
Authors: Wang Guorong , Li Yinfeng , Wu Chunlin , Guo Lin , Hao Liqiong , Liao Hongyi , Xiao Xue , Liu Shanshan , Luo Lei
Published: March 2020

Peripherally inserted central venous catheter (PICC) is the main venous access for cancer patients when they receive chemotherapy and nutritional support, but PICC-related venous thrombosis has become one of the most common and serious complications. It is very important to further explore the relationship among these features, so that prevent and treat the PICC-related thrombosis.

To investigate the clinical features and the related factors of PICC-related upper extremity asymptomatic venous thrombosis in cancer patients, and to provide theoretical basis for the prevention of venous thrombosis.

A total of 127 tumor patients with PICC catheterization were selected. Thrombus was detected by color Doppler ultrasound at different times: before catheterization and 24 hours after catheterization, and every week. The study was terminated at the time of thrombosis, and patients who did not develop thrombus were terminated after 6 weeks of follow-up. The clinical characteristics and influencing factors of asymptomatic thrombosis such as vessel diameter, blood flow velocity, thrombosis time, location, and the thrombosis stages were recorded.

The incidence of PICC-related upper limbs asymptomatic thrombosis was 48.82% (62/127), and the median time was 3 days. The incidence within 24-hour was 37.1% and within 1 week was 85.49%. A total of 81 venous thrombosis were found in 62 patients with asymptomatic thrombosis, there were 19 (23.5%) venous thrombosis in the deep veins while 62 (76.5%) in the superficial veins. Furthermore, thrombosis stages can be divided into 3 levels: stage I accounted for 51.85% (42/81), stage II accounted for 37.04% (30/81), and stage III accounted for 11.11% (9/81). The group trajectory analysis indicated the 3 changes of blood flow velocity during the follow-up period: downward trend, upward trend, and steady fluctuations. Survival analysis indicated that the cohort with downward trend have the high risk of thrombosis (67.90% vs 19.00% vs 45.10%). Cox proportional hazards model suggested that the patient's Eastern Cooperative Oncology Group score (hazard ratio [HR] 2.791, 95% confidence interval [CI] 0.08–0.76) and blood flow velocity (HR 0.250, 95% CI 2.01–3.87) was the risk of PICC-related asymptomatic thrombosis.

PICC catheterization can affect blood flow and asymptomatic thrombosis can occur at an early stage. Patient's upper limb activities should be guided to promoting blood circulation, thus effectively preventing thrombosis. Asymptomatic thrombosis can also be detected by color Doppler ultrasound system, within a recommended time of 1 week after catheterization.
High versus low ligation of inferior mesenteric artery during laparoscopic radical resection of rectal cancer
Authors: You Xiaolan , Liu Qinghong , Wu Jian , Wang Yuanjie , Huang Chuanjiang , cao Gan , Dai Jiawen , Chen Dehu , Zhou Yan
Published: March 2020

Laparoscopic radical resection is standard treatment for resectable rectal cancer. However, whether high or low inferior mesenteric artery (IMA) ligation should be performed remains controversial. This retrospective cohort study compared the advantages and disadvantages of low vs high IMA ligation in patients undergoing laparoscopic total mesorectal excision for rectal cancer.

Rectal cancer patients (n = 322) undergoing total mesorectal excision at our institution in 2010 to 17 were enrolled; 174 underwent high IMA ligation group and 148 low IMA ligation (LIMAL group). Baseline data on patients, operative indices, economic indices, pathology findings, perioperative complications, and survival in the 2 groups were analyzed retrospectively.

The low IMA ligation group had significantly higher anus retention ratio (P = .022), shorter hospital stay (P = .025), lower medical expenses (P = .032), fewer cases of anastomotic leakage (P = .023) and anastomotic stricture (P < .001), and lower incidence of postoperative genitourinary dysfunction (P = .003). Cox regression analysis indicated that local recurrence, distant metastasis, tumor differentiation, and tumor-node-metastasis stage were independently associated with survival.

Low ligation of the IMA during laparoscopic radical resection of rectal cancer appears to be associated with a lower risks for anastomotic leakage, anastomotic stricture, and genitourinary dysfunction, a shorter hospital stay, and lower costs. In contrast, the rate of lymph node harvest, tumor recurrence rate, metastasis, or mortality was not found to be related with the level of IMA ligation.
Acupuncture as adjuvant therapy for diabetic foot
Authors: Lee Maosheng , Li Huilin , Liu Deliang
Published: March 2020

Background:

Diabetic foot (DF) problems are common throughout the world, about one-fourth of them develop a foot ulcer and serious cases would suffer from amputation, which seriously affects the patient's work and life. Previous studies indicated that acupuncture as adjuvant therapy would be effective in treating DF. However, these studies have no consistent results. Therefore, the aim of our study was to explore the efficacy and safety of acupuncture as adjuvant therapy for DF.

Methods:

The randomized controlled trials associated with acupuncture therapy (or as adjuvant therapy) for DF will be included. We will search 6 electronic databases relevant to health sciences, including PubMed, Embase, the Cochrane Library, the Chinese databases Sino-Med, CNKI, and WANFANG database. All searches were from databases inception to March 30, 2019. The primary outcomes are the total curative effective rate, and the hemodynamic parameter and adverse events will be deemed as secondary outcomes. The Stata15.1 software and Review Manager (RevMan 5.3; Cochrane Collaboration, Copenhagen, Denmark) will be used for analysis, to assess the bias risk, subgroup analysis, and data synthesis.

Results:

In this systematic review and meta-analysis, we will synthesize the studies to assess the safety and efficacy of acupuncture as adjuvant therapy for DF.

Conclusion:

The summary of our study will clarify whether acupuncture as adjuvant therapy could be an efficient method for DF.
Paraffin therapy induces a decrease in the passive stiffness of gastrocnemius muscle belly and Achilles tendon
Authors: Li Ya Peng , Feng Ya Nan , Liu Chun Long , Zhang Zhi Jie
Published: March 2020

Background:

The purposes of this study were to examine the feasibility of using the MyotonPRO digital palpation device in measuring the passive stiffness of gastrocnemius muscle belly and Achilles tendon; to determine between-days test–retest reliability of MyotonPRO; and to evaluate the acute effect of paraffin therapy on stiffness measurements in healthy participants.

Methods:

It is a randomized controlled trial. Twenty healthy participants (male, n = 10; female, n = 10; total, n = 20) were recruited to evaluate the passive stiffness of gastrocnemius muscle belly and Achilles tendon. Dominant and nondominant legs were randomly divided into an experimental side (20 cases) and a control side (20 cases). The experimental side received 20 minutes of paraffin therapy.

Results:

The stiffness of muscle and tendon in the experimental side decreased significantly after paraffin therapy (P < .01), whereas no significant differences in stiffness measurements were found in the control side (P > .05). The passive stiffness of muscle and tendon was positively correlated with the ankle from 30° plantar flexion to10° dorsiflexion for dominant legs. Between-days test–retest reliability in stiffness measurements was high or very high (ICCs were above 0.737).

Conclusion:

Paraffin therapy induces a decrease in the passive stiffness of gastrocnemius muscle belly and Achilles tendon. Furthermore, the MyotonPRO can reliably determine stiffness measurements.
Associations of cardiovascular disease morbidity and mortality in the populations watching major football tournaments
Authors: Wang Huajun , Liang Lunchang , Cai Ping , Zhao Jianli , Guo Lan , Ma Huan
Published: March 2020

Background:

Whether or not increased hospitalizations and/or deaths due to cardiovascular disease during major football tournaments (MFTs) remains controversial. We undertook a systematic review and meta-analysis of published studies to assess the relationships of cardiovascular events and MFTs.

Methods:

Observational studies reporting relationship of cardiovascular disease morbidity and mortality with MFTs during the days of games or within 2 weeks after game season were included. Relative risk ratios (RR) with 95% confidence interval (CI) were pooled and analyzed using a random/fixed-effects model.

Results:

Nineteen cross-sectional observational studies that examined the association between MFTs and non-fetal cardiovascular events and mortality were found to be eligible from 3419 references, for inclusion in the systematic review and meta-analysis. Of the 10 studies reported hospitalizations due to non-fetal acute cardiovascular events, the pooled RR was 1.17 (95% CI 1.01–1.36). Of the 10 studies reported cardiovascular mortality the pooled RR was 1.03 (95% CI 1.00–1.05). Of the studies examining the mortality, 6 studies reported the lost or win of the national team. Pooling of four studies where their national teams lost the MFTs produced a RR for the mortality of 1.19 (95% CI: 1.09–1.30), and 4 studies of the 6 whose national teams won produced a pooled RR for cardiovascular mortality of 0.88 (0.79–0.98).

Conclusion:

This systematic review and meta-analysis showed an increased risk of hospitalization due to non-fetal acute cardiovascular events and cardiovascular mortality with watching MFTs.