bluuebunny/crossref_metadata_2025 huggingface dataset:
The lifecycle of molecular clouds in nearby star-forming disc galaxies
Authors: Chevance Mélanie , Kruijssen J M Diederik , Hygate Alexander P S , Schruba Andreas , Longmore Steven N , Groves Brent , Henshaw Jonathan D , Herrera Cinthya N , Hughes Annie , Jeffreson Sarah M R , Lang Philipp , Leroy Adam K , Meidt Sharon E , Pety Jérôme , Razza Alessandro , Rosolowsky Erik , Schinnerer Eva , Bigiel Frank , Blanc Guillermo A , Emsellem Eric , Faesi Christopher M , Glover Simon C O , Haydon Daniel T , Ho I-Ting , Kreckel Kathryn , Lee Janice C , Liu Daizhong , Querejeta Miguel , Saito Toshiki , Sun Jiayi , Usero Antonio , Utomo Dyas
Published: December 2019

It remains a major challenge to derive a theory of cloud-scale ($\lesssim100$ pc) star formation and feedback, describing how galaxies convert gas into stars as a function of the galactic environment. Progress has been hampered by a lack of robust empirical constraints on the giant molecular cloud (GMC) lifecycle. We address this problem by systematically applying a new statistical method for measuring the evolutionary timeline of the GMC lifecycle, star formation, and feedback to a sample of nine nearby disc galaxies, observed as part of the PHANGS-ALMA survey. We measure the spatially resolved (∼100 pc) CO-to-H α flux ratio and find a universal de-correlation between molecular gas and young stars on GMC scales, allowing us to quantify the underlying evolutionary timeline. GMC lifetimes are short, typically $10\!-\!30\,{\rm Myr}$, and exhibit environmental variation, between and within galaxies. At kpc-scale molecular gas surface densities $\Sigma _{\rm H_2}\ge 8\,\rm {M_\odot}\,{{\rm pc}}^{-2}$, the GMC lifetime correlates with time-scales for galactic dynamical processes, whereas at $\Sigma _{\rm H_2}\le 8\,\rm {M_\odot}\,{{\rm pc}}^{-2}$ GMCs decouple from galactic dynamics and live for an internal dynamical time-scale. After a long inert phase without massive star formation traced by H α (75–90 per cent of the cloud lifetime), GMCs disperse within just $1\!-\!5\,{\rm Myr}$ once massive stars emerge. The dispersal is most likely due to early stellar feedback, causing GMCs to achieve integrated star formation efficiencies of 4–10 per cent. These results show that galactic star formation is governed by cloud-scale, environmentally dependent, dynamical processes driving rapid evolutionary cycling. GMCs and H ii regions are the fundamental units undergoing these lifecycles, with mean separations of $100\!-\!300\,{{\rm pc}}$ in star-forming discs. Future work should characterize the multiscale physics and mass flows driving these lifecycles.
Galaxy And Mass Assembly (GAMA): Defining passive galaxy samples and searching for the UV upturn
Authors: Phillipps S , Ali S S , Bremer M N , De Propris R , Sansom A E , Cluver M E , Alpaslan M , Brough S , Brown M J I , Davies L J M , Driver S P , Grootes M W , Holwerda B W , Hopkins A M , James P A , Pimbblet K , Robotham A S G , Taylor E N , Wang L
Published: December 2019

We use data from the GAMA and GALEX surveys to demonstrate that the UV upturn, an unexpected excess of ultraviolet flux from a hot stellar component, seen in the spectra of many early-type galaxies, arises from processes internal to individual galaxies with no measurable influence from the galaxies’ larger environment. We first define a clean sample of passive galaxies without a significant contribution to their UV flux from low-level star formation. We confirm that galaxies with the optical colours of red sequence galaxies often have signs of residual star formation, which, without other information, would prevent a convincing demonstration of the presence of UV upturns. However, by including (NUV−u) and WISE (W2–W3) colours, and FUV data where it exists, we can convincingly constrain samples to be composed of non-star-forming objects. Using such a sample, we examine GALEX photometry of low-redshift GAMA galaxies in a range of low-density environments, from groups to the general field, searching for UV upturns. We find a wide range of (NUV−r) colours, entirely consistent with the range seen – and attributed to the UV upturn – in low-redshift red sequence cluster galaxies. The range of colours is independent of group multiplicity or velocity dispersion, with isolated passive galaxies just as likely to have blue UV-to-optical colours, implying significant upturn components, as those in richer groups and in the previous data on clusters. This is supported by equivalent results for (FUV−r) colours which are clear indicators of upturn components.
Probing the early phases of high-mass star formation with 6.7 GHz methanol masers
Authors: Paulson Sonu Tabitha , Pandian Jagadheep D
Published: December 2019

Methanol masers at 6.7 GHz are the brightest of class II methanol masers and have been found exclusively towards massive star-forming regions. These masers can thus be used as a unique tool to probe the early phases of massive star formation. We present here a study of the spectral energy distributions of 320 6.7 GHz methanol masers chosen from the Methanol Multibeam catalogue, which fall in the Hi-GAL range (|l| ≤ 60°, |b| ≤ 1°). The spectral energy distributions are constructed from 870 to 70 µm using data from the ATLASGAL and Hi-GAL surveys. The emission from cold dust is modelled by a single grey body component fit. We estimate the clump properties such as mass, far-infrared luminosity, and column density using the best-fitting parameters of the SED fits. Considering the Kauffman criteria for massive star formation, we find that all but a few maser hosts have the potential to harbour at least one high-mass star. The physical properties of the methanol maser hosts are also discussed. The evolutionary stages of 6.7 GHz maser sources, explored using the mass luminosity diagram, suggest that they are predominantly associated with high-mass stars with the majority being in the accretion phase. However, we observe a small number of sources that could possibly be related to intermediate- or low-mass stars.
Quality controls induced by aberrant translation
Authors: Inada Toshifumi
Published: December 2019

During protein synthesis, translating ribosomes encounter many challenges imposed by various types of defective mRNAs that can lead to reduced cellular fitness and, in some cases, even threaten cell viability. Aberrant translation leads to activation of one of several quality control pathways depending on the nature of the problem. These pathways promote the degradation of the problematic mRNA as well as the incomplete translation product, the nascent polypeptide chain. Many of these quality control systems feature critical roles for specialized regulatory factors that work in concert with conventional factors. This review focuses on the mechanisms used by these quality control pathways to recognize aberrant ribosome stalling and discusses the conservation of these systems.
Cytosine epigenetic modification modulates the formation of an unprecedented G4 structure in the WNT1 promoter
Authors: Wang Zi-Fu , Li Ming-Hao , Chu I-Te , Winnerdy Fernaldo R , Phan Anh T , Chang Ta-Chau
Published: December 2019

Time-resolved imino proton nuclear magnetic resonance spectra of the WT22m sequence d(GGGCCACCGGGCAGTGGGCGGG), derived from the WNT1 promoter region, revealed an intermediate G-quadruplex G4(I) structure during K+-induced conformational transition from an initial hairpin structure to the final G4(II) structure. Moreover, a single-base C-to-T mutation at either position C4 or C7 of WT22m could lock the intermediate G4(I) structure without further conformational change to the final G4(II) structure. Surprisingly, we found that the intermediate G4(I) structure is an atypical G4 structure, which differs from a typical hybrid G4 structure of the final G4(II) structure. Further studies of modified cytosine analogues associated with epigenetic regulation indicated that slight modification on a cytosine could modulate G4 structure. A simplified four-state transition model was introduced to describe such conformational transition and disclose the possible mechanism for G4 structural selection caused by cytosine modification.
Artificial escape from XCI by DNA methylation editing of the CDKL5 gene
Authors: Halmai Julian A N M , Deng Peter , Gonzalez Casiana E , Coggins Nicole B , Cameron David , Carter Jasmine L , Buchanan Fiona K B , Waldo Jennifer J , Lock Samantha R , Anderson Johnathon D , O’Geen Henriette , Segal David J , Nolta Jan , Fink Kyle D
Published: December 2019

A significant number of X-linked genes escape from X chromosome inactivation and are associated with a distinct epigenetic signature. One epigenetic modification that strongly correlates with X-escape is reduced DNA methylation in promoter regions. Here, we created an artificial escape by editing DNA methylation on the promoter of CDKL5, a gene causative for an infantile epilepsy, from the silenced X-chromosomal allele in human neuronal-like cells. We identify that a fusion of the catalytic domain of TET1 to dCas9 targeted to the CDKL5 promoter using three guide RNAs causes significant reactivation of the inactive allele in combination with removal of methyl groups from CpG dinucleotides. Strikingly, we demonstrate that co-expression of TET1 and a VP64 transactivator have a synergistic effect on the reactivation of the inactive allele to levels >60% of the active allele. We further used a multi-omics assessment to determine potential off-targets on the transcriptome and methylome. We find that synergistic delivery of dCas9 effectors is highly selective for the target site. Our findings further elucidate a causal role for reduced DNA methylation associated with escape from X chromosome inactivation. Understanding the epigenetics associated with escape from X chromosome inactivation has potential for those suffering from X-linked disorders.
Crystal structure of human cytoplasmic tRNAHis-specific 5′-monomethylphosphate capping enzyme
Authors: Liu Yining , Martinez Anna , Yamashita Seisuke , Tomita Kozo
Published: December 2019

BCDIN3 domain containing RNA methyltransferase, BCDIN3D, monomethylates the 5′-monophosphate of cytoplasmic tRNAHis with a G−1:A73 mispair at the top of an eight-nucleotide-long acceptor helix, using S-adenosyl-l-methionine (SAM) as a methyl group donor. In humans, BCDIN3D overexpression is associated with the tumorigenic phenotype and poor prognosis in breast cancer. Here, we present the crystal structure of human BCDIN3D complexed with S-adenosyl-l-homocysteine. BCDIN3D adopts a classical Rossmann-fold methyltransferase structure. A comparison of the structure with that of the closely related methylphosphate capping enzyme, MePCE, which monomethylates the 5′-γ-phosphate of 7SK RNA, revealed the important residues for monomethyl transfer from SAM onto the 5′-monophosphate of tRNAHis and for tRNAHis recognition by BCDIN3D. A structural model of tRNAHis docking onto BCDIN3D suggested the molecular mechanism underlying the different activities between BCDIN3D and MePCE. A loop in BCDIN3D is shorter, as compared to the corresponding region that forms an α-helix to recognize the 5′-end of RNA in MePCE, and the G−1:A73 mispair in tRNAHis allows the N-terminal α-helix of BCDIN3D to wedge the G−1:A73 mispair of tRNAHis. As a result, the 5′-monophosphate of G−1 of tRNAHis is deep in the catalytic pocket for 5′-phosphate methylation. Thus, BCDIN3D is a tRNAHis-specific 5′-monomethylphosphate capping enzyme that discriminates tRNAHis from other tRNA species, and the structural information presented in this study also provides the molecular basis for the development of drugs against breast cancers.
Eosinophil count and mortality risk in incident hemodialysis patients
Authors: Kang Duk-Hee , Lee Yuji , Kleine Carola Ellen , Lee Yong Kyu , Park Christina , Hsiung Jui-Ting , Rhee Connie M , Kovesdy Csaba P , Kalantar-Zadeh Kamyar , Streja Elani
Published: December 2019

Background

Eosinophils are traditionally known as moderators of allergic reactions; however, they have now emerged as one of the principal immune-regulating cells as well as predictors of vascular disease and mortality in the general population. Although eosinophilia has been demonstrated in hemodialysis (HD) patients, associations of eosinophil count (EOC) and its changes with mortality in HD patients are still unknown.

Methods

In 107 506 incident HD patients treated by a large dialysis organization during 2007–11, we examined the relationships of baseline and time-varying EOC and its changes (ΔEOC) over the first 3 months with all-cause mortality using Cox proportional hazards models with three levels of hierarchical adjustment.

Results

Baseline median EOC was 231 (interquartile range 155–339) cells/μL and eosinophilia (>350 cells/μL) was observed in 23.4% of patients. There was a gradual increase in EOC over time after HD initiation with a median ΔEOC of 5.1 (IQR −53–199) cells/μL, which did not parallel the changes in white blood cell count. In fully adjusted models, mortality risk was highest in subjects with lower baseline and time-varying EOC (<100 cells/μL) and was also slightly higher in patients with higher levels (≥550 cells/μL), resulting in a reverse J-shaped relationship. The relationship of ΔEOC with all-cause mortality risk was also a reverse J-shape where both an increase and decrease exhibited a higher mortality risk.

Conclusions

Both lower and higher EOCs and changes in EOC over the first 3 months after HD initiation were associated with higher all-cause mortality in incident HD patients.
Intracranial Atherosclerosis: A Disease of Functional, not Anatomic Stenosis? How Trans-Stenotic Pressure Gradients Can Help Guide Treatment
Authors: Zanaty Mario , Rossen James D , Roa Jorge A , Nakagawa Daichi , Hudson Joseph S , Kasab Sami Al , Limaye Kaustubh , Asi Khaled , Dandapat Sudeepta , Jabbour Pascal , Samaniego Edgar A , Hasan David M
Published: December 2019

Background

Most trials have assessed intracranial atherosclerotic disease (ICAD) severity based on angiographic stenosis. However, anatomic stenosis might not accurately identify the actual state of functional post-stenotic flow limitation.

Objective

To investigate whether angiographic stenosis correlates with physiologic distal flow limitation, measured as trans-stenotic pressure gradients, in ICAD patients.

Methods

In patients referred for endovascular treatment of anterior circulation symptomatic ICAD who failed maximal medical therapy (MMT) per SAMMPRIS (Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis) criteria, angiographic luminal diameters and percentages of stenosis were correlated with trans-stenotic pressure gradients, calculated as distal/proximal pressure ratios (DPPR) and proximal minus distal pressure gradients (PDPG), by way of Spearman correlation coefficients.

Results

Nine patients (3 men, 6 women) were evaluated. Atherosclerotic lesions’ locations included internal carotid artery in 5 subjects (2 cavernous, 3 supraclinoid) and proximal middle cerebral artery (M1) in 4 patients. Mean percentage of stenosis was 80 ± 8% (range 75%-94%). Minimal lumen diameter at the most stenotic ICAD site ranged from 0.2 to 0.9 mm (0.59 ± 0.41 mm). DPPR ranged from 0.38 to 0.63 (0.56 ± 0.14). PDPG ranged from 35 to 57 mm Hg (50 ± 8 mm Hg). Spearman coefficients showed no correlation between DPPR or PDPG and angiographic minimal luminal diameters or percentages of stenosis. There were no procedural complications related to trans-stenotic pressure measurements.

CONCLUSION

Angiographic stenosis does not reflect the physiologic severity of distal flow limitation in patients with ICAD. Hemodynamic assessment using trans-stenotic pressure ratios and gradients may serve as a more reliable predictive biomarker for MMT failure and response to revascularization.
The AtHB1 Transcription Factor Controls the miR164-CUC2 Regulatory Node to Modulate Leaf Development
Authors: Miguel Virginia N , Manavella Pablo A , Chan Raquel L , Capella Mat�as
Published: December 2019

The presence of small tooth-like indentations, or serrations, characterizes leaf margins of Arabidopsis thaliana plants. The NAC family member CUP-SHAPED COTYLEDON 2 (CUC2), which undergoes post-transcriptional gene silencing by three micro-RNA genes (MIR164A, B and C), controls the extension of leaf serration. Here, we analyzed the role of AtHB1, a transcription factor (TF) belonging to the homeodomain-leucine zipper subfamily I, in shaping leaf margins. Using mutants with an impaired silencing pathway as background, we obtained transgenic plants expressing AtHB1 over 100 times compared to controls. These plants presented an atypical developmental phenotype characterized by leaves with deep serration. Transcript measurements revealed that CUC2 expression was induced in plants overexpressing AtHB1 and repressed in athb1 mutants, indicating a positive regulation exerted by this TF. Moreover, molecular analyses of AtHB1 overexpressing and mutant plants revealed that AtHB1 represses MIR164 transcription. We found that overexpression of MIR164B was able to reverse the serration phenotype of plants overexpressing AtHB1. Finally, chromatin immunoprecipitation assays revealed that AtHB1 was able to bind in vivo the promoter regions of all three MIR164 encoding loci. Altogether, our results indicate that AtHB1 directly represses MIR164 expression to enhance leaf serration by increasing CUC2 levels.
A Systematic Literature Review of Spine Neurostimulation Therapies for the Treatment of Pain
Authors: Deer Timothy R , Grider Jay S , Lamer Tim J , Pope Jason E , Falowski Steven , Hunter Corey W , Provenzano David A , Slavin Konstantin V , Russo Marc , Carayannopoulos Alexios , Shah Jay M , Harned Michael E , Hagedorn Jonathan M , Bolash Robert B , Arle Jeff E , Kapural Leo , Amirdelfan Kasra , Jain Sameer , Liem Liong , Carlson Jonathan D , Malinowski Mark N , Bendel Markus , Yang Ajax , Aiyer Rohit , Valimahomed Ali , Antony Ajay , Craig Justin , Fishman Michael A , Al-Kaisy Adnan A , Christelis Nick , Rosenquist Richard W , Levy Robert M , Mekhail Nagy
Published: December 2019

Objective

To conduct a systematic literature review of spinal cord stimulation (SCS) for pain.

Design

Grade the evidence for SCS.

Methods

An international, interdisciplinary work group conducted literature searches, reviewed abstracts, and selected studies for grading. Inclusion/exclusion criteria included randomized controlled trials (RCTs) of patients with intractable pain of greater than one year’s duration. Full studies were graded by two independent reviewers. Excluded studies were retrospective, had small numbers of subjects, or existed only as abstracts. Studies were graded using the modified Interventional Pain Management Techniques–Quality Appraisal of Reliability and Risk of Bias Assessment, the Cochrane Collaborations Risk of Bias assessment, and the US Preventative Services Task Force level-of-evidence criteria.

Results

SCS has Level 1 evidence (strong) for axial back/lumbar radiculopathy or neuralgia (five high-quality RCTs) and complex regional pain syndrome (one high-quality RCT).

Conclusions

High-level evidence supports SCS for treating chronic pain and complex regional pain syndrome. For patients with failed back surgery syndrome, SCS was more effective than reoperation or medical management. New stimulation waveforms and frequencies may provide a greater likelihood of pain relief compared with conventional SCS for patients with axial back pain, with or without radicular pain.
Conventional versus ultrasound treat to target: no difference in magnetic resonance imaging inflammation or joint damage over 2 years in early rheumatoid arthritis
Authors: Sundin Ulf , Aga Anna-Birgitte , Skare Øivind , Nordberg Lena B , Uhlig Till , Hammer Hilde B , van der Heijde Désirée , Kvien Tore K , Lillegraven Siri , Haavardsholm Espen A ,   the ARCTIC study group
Published: December 2019

Objective

To investigate whether an ultrasound-guided treat-to-target strategy for early RA would lead to reduced MRI inflammation or less structural damage progression compared with a conventional treat-to-target strategy.

Methods

A total of 230 DMARD-naïve early RA patients were randomized to an ultrasound tight control strategy targeting DAS <1.6, no swollen joints and no power Doppler signal in any joint or a conventional strategy targeting DAS <1.6 and no swollen joints. Patients in both arms were treated according to the same DMARD escalation strategy. MRI of the dominant hand was performed at six time points over 2 years and scored according to the OMERACT RA MRI scoring system. A total of 218 patients had baseline and one or more follow-up MRIs and were included in the analysis. The mean MRI score change from baseline to each follow-up and the 2 year risk for erosive progression were compared between arms.

Results

MRI bone marrow oedema, synovitis and tenosynovitis improved over the first year and was sustained during the second year of follow-up, with no statistically significant differences between the ultrasound and the conventional arms at any time point. The 2 year risk for progression of MRI erosions was similar in both treatment arms: ultrasound arm 39%, conventional arm 33% [relative risk 1.16 (95% CI 0.81, 1.66), P = 0.40].

Conclusion

Incorporating ultrasound information in treatment decisions did not lead to reduced MRI inflammation or less structural damage compared with a conventional treatment strategy. The findings support that systematic use of ultrasound does not provide a benefit in the follow-up of patients with early RA.

Trial registration number

Clinicaltrials.gov, http://clinicaltrials.gov, NCT01205854.
Screening for Hepatitis B Virus Infection in Pregnant Women: US Preventive Services Task Force Reaffirmation Recommendation Statement
Authors: Owens Douglas K. , Davidson Karina W. , Krist Alex H. , Barry Michael J. , Cabana Michael , Caughey Aaron B. , Doubeni Chyke A. , Epling John W. , Kemper Alex R. , Kubik Martha , Landefeld C. Seth , Mangione Carol M. , Pbert Lori , Silverstein Michael , Simon Melissa A. , Tseng Chien-Wen , Wong John B.
Published: December 2019

(Abstracted from JAMA 2019;322(4):349–354)

In 2009, the US Preventive Services Task Force (USPSTF) recommended that pregnant women be screened for hepatitis B virus (HBV) infection. It cited strong evidence that the benefit of screening substantially outweighed the harm.
Sonographic Lower Uterine Segment Thickness After Prior Cesarean Section to Predict Uterine Rupture: A Systematic Review and Meta-analysis
Authors: Swift Brenna E. , Shah Prakesh S. , Farine Dan
Published: December 2019

(Abstracted from Acta Obstet Gynecol Scand 2019;98:830–841)

Cesarean delivery rates in the United States were 32% in 2015. This high rate is coupled with dramatically decreased rates of trial of labor after cesareans (TOLACs) in recent years that may indicate fear of potential complications (such as uterine rupture).
Reduced Sensitivity to Anesthetic Agents upon Lesioning the Mesopontine Tegmental Anesthesia Area in Rats Depends on Anesthetic Type
Authors: Minert Anne , Baron Mark , Devor Marshall
Published: December 2019

Background

The brainstem mesopontine tegmental anesthesia area is a key node in circuitry responsible for anesthetic induction and maintenance. Microinjecting the γ-aminobutyric acid–mediated (GABAergic) anesthetic pentobarbital in this nucleus rapidly and reversibly induces general anesthesia, whereas lesioning it renders the animal relatively insensitive to pentobarbital administered systemically. This study investigated whether effects of lesioning the mesopontine tegmental anesthesia area generalize to other anesthetic agents.

Methods

Cell-selective lesions were made using ibotenic acid, and rats were later tested for changes in the dose–response relation to etomidate, propofol, alfaxalone/alfadolone, ketamine, and medetomidine delivered intravenously using a programmable infusion pump. Anesthetic induction for each agent was tracked using five behavioral endpoints: loss of righting reflex, criterion for anesthesia (score of 11 or higher), criterion for surgical anesthesia (score of 14 or higher), antinociception (loss of pinch response), and deep surgical anesthesia (score of 16).

Results

As reported previously for pentobarbital, on-target mesopontine tegmental anesthesia area lesions reduced sensitivity to the GABAergic anesthetics etomidate and propofol. The dose to achieve a score of 16 increased to 147 ± 50% of baseline in control animals ± SD (P = 0.0007; 7 lesioned rats and 18 controls) and 136 ± 58% of baseline (P = 0.010; 6 lesioned rats and 21 controls), respectively. In contrast, responsiveness to the neurosteroids alfaxalone and alfadolone remained unchanged compared with baseline (94 ± 24%; P = 0.519; 6 lesioned rats and 18 controls) and with ketamine increased slightly (90 ± 11%; P = 0.039; 6 lesioned rats and 19 controls). The non-GABAergic anesthetic medetomidine did not induce criterion anesthesia even at the maximal dose tested. The dose to reach the maximal anesthesia score actually obtained was unaffected by the lesion (112 ± 8%; P = 0.063; 5 lesioned rats and 18 controls).

Conclusions

Inability to induce anesthesia in lesioned animals using normally effective doses of etomidate, propofol, and pentobarbital suggests that the mesopontine tegmental anesthesia area is the effective target of these, but not necessarily all, GABAergic anesthetics upon systemic administration. Cortical and spinal functions are likely suppressed by recruitment of dedicated ascending and descending pathways rather than by direct, distributed drug action.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Operative Versus Nonoperative Outcomes of Middle-Third Clavicle Fractures: A Systematic Review and Meta-Analysis
Authors: Amer Kamil , Smith Brendan , Thomson Jennifer E. , Congiusta Dominick , Reilly Mark C. , Sirkin Michael S. , Adams Mark R.
Published: December 2019

Objectives:

Middle third clavicle fractures have long been managed conservatively with immobilization. Some patients, especially those with completely displaced or shortened clavicle fractures are now thought to have increased risk of nonunion or symptomatic malunion. The authors performed a meta-analysis to study the incidence of nonunion and symptomatic malunion and test the hypothesis that surgical fixation of these fractures significantly lowers the risk of these complications.

Methods:

A search was performed in the PubMed, Embase, and Cochrane Library databases for randomized clinical trials and quasi-experimental trials that compare outcomes of operative and nonoperative management for clavicle fractures that are fully (100%) displaced or have greater than 2 cm of shortening. Pooled patient data were used to construct forest plots for the meta-analysis.

Results:

Eleven studies including 497 patients who were treated and 457 patients treated conservatively were analyzed. Patients managed operatively had significantly lower relative risk of developing nonunion [0.17 (95% confidence interval 0.08–0.33)] and symptomatic malunion [0.13 (95% confidence interval 0.05–0.37)]. Plate fixation significantly reduced the risk of nonunion, but intramedullary nail fixation did not. There was no difference in Constant–Murley or DASH scores between the 2 treatment groups or in the rate of secondary operative procedures.

Conclusions:

Patients who undergo operative fixation of displaced middle-third clavicle fractures have a lower incidence of nonunion and symptomatic malunion. The clinical significance of this effect is uncertain, as functional scores were similar in both groups. Further research into the risk factors for nonunion and symptomatic malunion will be necessary to determine which patients benefit from operative fixation.

Level of Evidence:

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Using Reflective Teaching Program to Explore Health-Promoting Behaviors in Nursing Students
Authors: CHANG Yi-Ya , CHEN Miao-Chuan
Published: December 2019

Background

The attitudes of nurses toward health promotion affect patients. However, current classroom teaching does not provide nursing students with actual experiences. An experiential and reflective teaching design will help nursing students practice actual health behaviors and record their feelings. This will help nursing students better understand the difficulties and feelings experienced by nurses when encouraging patients to make behavioral changes in clinical settings.

Purpose

This study aimed to explore the experiences and factors affecting health-promoting learning with reflective teaching in nursing students.

Methods

This explorative study integrated the “reflective assessment, engagement, and action-reflection” strategy of reflective teaching into the standard health-promotion teaching curriculum to understand the experiences of nursing students when executing health-promoting behaviors. Fifty-seven second-year nursing students from a university in northern Taiwan participated in this course, which was conducted between September 2017 and January 2018. The data were collected from the contents of the reflective journals written by the nursing students and analyzed using thematic analysis.

Results

The three health-promoting behaviors performed by most of the students were regular exercise, balanced and healthy diet, and adequate daily water intake. The feelings experienced by the nursing students during the execution of health-promoting behaviors included easier said than done, compromise and adjustment, and continuation of health behaviors. Accommodation, peer encouragement, and support were important, facilitating factors of health-promoting behaviors in this study.

Conclusions/Implications for Practice

The results of this study may serve as a reference for nursing lecturers when employing reflective teaching in the classroom. Reflective teaching designs for actual experiences help nursing students experience the crucial factors and benefits of executing health-promoting behaviors.
Environmental exposures and the risk of inflammatory bowel disease: a case-control study from Saudi Arabia
Authors: Algethmi Wafaa , Baumann Cedric , Alnajjar Wed , Sroji Aaliah , Alsahafi Majid , Jawa Hani , Qari Yousef , Peyrin-Biroulet Laurent , Saadah Omar I. , Mosli Mahmoud
Published: December 2019

Background and aims:

Environmental exposures play a key role in inflammatory bowel disease pathogenesis. The incidence of IBD has increased in the Arabic Peninsula with a disease phenotype that seems to differ from that of Western countries. We aimed to examine the association between environmental exposures and the risk of IBD in Saudi Arabia.

Patients and methods:

We performed a case-control study comparing Saudi individuals with confirmed IBD and healthy controls. All subjects completed a detailed questionnaire that included data on demographics, clinical characteristics, childhood exposures, socioeconomic exposures, and parent factors. Associations between risk factors and inflammatory bowel disease were investigated through univariate and multivariate regression analysis.

Results:

The analysis included 82 patients and 160 controls. According to multiple logistic regression analysis, holding a University/Master degree education level or a PhD degree reduced the risk of inflammatory bowel disease by 10-fold (odds ratio = 0.1, confidence interval = 0.1–0.3), receiving seven vaccines or more during childhood increased the risk of developing inflammatory bowel disease by nine-fold (odds ratio = 9.2, confidence interval = 2.9–29.4) and maternal use of oral contraceptives pills increased the risk by 11-fold (odds ratio = 11.4, confidence interval = 3.3–39.3).

Conclusion:

Inflammatory bowel disease occurrence was independently associated with education level, number of childhood vaccination, and maternal use of oral contraceptives pills in this population of inflammatory bowel disease patients. This is the first study examining environmental exposures as risk factors for inflammatory bowel disease in Saudi Arabia.
Prognostic factors in hepatocellular carcinoma patients undergoing transarterial chemoembolization and radioembolization: a retrospective study
Authors: Jeliazkova Petia , Umgelter Andreas , Braren Rickmer , Kaissis Georgios , Mustafa Mona , Einwächter Henrik
Published: December 2019

Objective:

Most patients with hepatocellular carcinoma are diagnosed at intermediate or advanced stages (BCLC B or C) and undergo palliative local treatments such as transarterial chemoembolization or selective internal radiation therapy, also called radioembolization. In terms of liver function and tumor extent, stages BCLC B and C comprise a wide spectrum of tumor manifestations. Predictors of survival in these patients undergoing transarterial chemoembolization and selective internal radiation therapy might help stratification into different prognostic groups and help to select the optimal treatment modality.

Methods:

In this retrospective study, all patients with hepatocellular carcinoma who underwent transarterial chemoembolization between January 2010 and December 2014 and all hepatocellular carcinoma patients who underwent selective internal radiation therapy between August 2012 and December 2016 were recruited. The prognostic value of pretherapeutic clinical and laboratory parameters for the prediction of overall survival was analyzed using uni- and multi-variable Cox regression models.

Results:

We enrolled 129 patients in the transarterial chemoembolization group and 34 patients in the selective internal radiation therapy group. The predictive value of the albumin-bilirubin grade was validated for both the transarterial chemoembolization and the selective internal radiation therapy group. Multivariable analysis identified albumin-bilirubin grade and tumor size as independent predictors for the transarterial chemoembolization group and tumor size, serum albumin and serum sodium as independent predictors for the selective internal radiation therapy group.

Conclusion:

While measures of liver dysfunction predicted survival similarly in both cohorts, we found tumor size to predict survival differently in transarterial chemoembolization- and selective internal radiation therapy-treated patients. Tumor size might help to select the most appropriate treatment in hepatocellular carcinoma patients, although this finding has to be validated in further studies.
Neutrophil-lymphocyte ratio predicts the therapeutic benefit of neoadjuvant transarterial chemoembolization in patients with resectable hepatocellular carcinoma
Authors: Hong Young Mi , Cho Mong , Yoon Ki Tae , Ryu Je Ho , Yang Kwang Ho , Jeon Ung Bae , Hwang Tae Ho
Published: December 2019

Background and aims:

All published meta-analyses failed to demonstrate that preoperative transarterial chemoembolization improves the clinical outcomes of patients with resectable hepatocellular carcinoma. The present study aimed to investigate the utility of systemic inflammatory cells as a tumor biology marker predicting therapeutic benefit of neoadjuvant transarterial chemoembolization in patients with resectable hepatocellular carcinoma.

Materials and methods:

We retrospectively investigated 441 hepatocellular carcinoma patients who underwent curative resection. Among 441 patients, 73 patients underwent preoperative transarterial chemoembolization, and 368 patients did not. We compared recurrence-free survival and overall survival between transarterial chemoembolization plus sequential resection group and resection only group. We analyzed whether pretreatment neutrophil-lymphocyte ratio demonstrates survival benefit in each groups.

Results:

No significant difference was observed in recurrence-free or overall survival between both groups. In the transarterial chemoembolization plus sequential resection group, the 5-year overall survival in patients with high neutrophil-lymphocyte ratio (≥1.6) was significantly lower than that in patients with low neutrophil-lymphocyte ratio (78.4% and 100%, P = 0.027). High neutrophil-lymphocyte ratio was associated with vascular invasion (P = 0.033).

Conclusion:

Neutrophil-lymphocyte ratio can be considered as a predictive factor of long-term survival and used to identify patients with resectable hepatocellular carcinoma who benefit from neoadjuvant transarterial chemoembolization.
Fontan-associated liver disease: pathophysiology, investigations, predictors of severity and management
Authors: Keung Charlotte Y. , Zentner Dominica , Gibson Robert N. , Phan Dang-Khoa H. , Grigg Leeanne E. , Sood Siddharth , Nicoll Amanda J.
Published: December 2019

Cardiac hepatopathy is the liver injury resulting from congestion and ischaemia associated with acute or chronic heart failure. The improved longevity of adults with operated congenital heart disease who develop heart failure as an increasingly late event makes this form of liver injury increasingly clinically relevant. Patients with congenital heart disease with a single ventricle anomaly, who require creation of a Fontan circulation, are particularly vulnerable as they have elevated venous filling pressures with chronic liver congestion. Progression to liver fibrosis and eventually cirrhosis may occur, with its associated risks of liver failure and hepatocellular carcinoma. This risk likely increases over the patient’s lifetime, related to the duration post-surgical repair and reflects the chronicity of congestion. Liver biopsy is rarely performed due to a higher risk of complications in the setting of elevated venous pressures, and the frequent use of anticoagulation. Non-invasive methods of liver assessment are poorly validated and different factors require consideration compared to other chronic liver diseases. This review discusses the current understanding of cardiac hepatopathy in congenital heart disease patients with a Fontan circulation. This entity has recently been called Fontan Associated Liver Disease in the literature, with the term useful in recognising that the pathophysiology is incompletely understood, and that long-standing venous pressure elevation and hypoxaemia are presumed to play an additional significant role in the pathogenesis of the liver injury.
Colorectal sessile serrated lesion with large size or synchronous neoplasm: a prospective study
Authors: Chavali Laxmi B. , Hu Kun , Sheth Anish , Gao Nan , Xiong Wei , Zhang Lanjing
Published: December 2019

Background

Colorectal sessile serrated lesion (SSL) with synchronous neoplasm or large size are linked to higher risk of cancer, but their characteristics are unclear.

Methods

We prospectively included consecutive colorectal hyperplasic polyp and SSL collected at our institution from August 2011 to August 2012. The following data were collected and analyzed: age, gender, polyp site, aggregated polyp size, history of polyp, and synchronous neoplasm.

Results

We collected 437 specimens including 353 (80.8%) hyperplasic polyp and 84 (19.2%) SSL. Compared with hyperplasic polyp, SSL was independently associated with proximal colon [odds ratio (OR) 3.61, P< 0.001], larger size (OR 3.98, P< 0.001), but not history of polyp, age or gender. Large SSL (≥1 vs <1 cm) was associated with polyp site (P= 0.035) and synchronous advanced adenoma and cancer (P< 0.001). SSL with synchronous adenoma and cancer were more likely found in males (OR 1.91, P= 0.001), elderly (OR 1.02, P= 0.033), and patients with the index polyp in proximal colon (OR 1.32, P= 0.022), but not related to history of adenoma and cancer. Moreover, synchronous adenoma, SSL and cancer were independently associated with male gender (OR 1.90, P< 0.001), but surprisingly not older age, histology of index polyp (SSL vs hyperplasic polyp), index-polyp site or history of adenoma and cancer.

Conclusions

This prospective study shows male gender is associated with both synchronous adenoma and cancer, and synchronous adenoma, SSL and cancer, while index polyp site is associated with synchronous adenoma and cancer.
Elevated serum procalcitonin levels and their association with the prognosis of patients with liver cirrhosis
Authors: Sato Sho , Sato Shunsuke , Tsuzura Hironori , Ikeda Yuji , Hayashida Sho , Takahashi Sho , Amano Nozomi , Murata Ayato , Shimada Yuji , Iijima Katuyori , Nagahara Akihito , Genda Takuya
Published: December 2019

Objectives

Bacterial infection is a major complication in patients with liver cirrhosis. Procalcitonin is an early diagnostic marker of bacterial infection. This study aimed to investigate the association between the serum procalcitonin levels and the prognosis of patients with liver cirrhosis.

Methods

We retrospectively analyzed the serum procalcitonin levels in 236 hospitalized patients with liver cirrhosis. The impact of the serum procalcitonin level on their prognoses was evaluated using multivariate Cox proportional hazards analyses and the Kaplan–Meier method.

Results

The serum procalcitonin level was higher (≥0.05 ng/mL) in 151 (64%) patients, and it was significantly higher in the patients with Child-Turcotte-Pugh class C than in those with Child-Turcotte-Pugh classes A/B. Patients with refractory ascites, hepatic encephalopathy, gastrointestinal bleeding, and bacterial infections had elevated serum procalcitonin levels. The multivariate analyses showed a serum procalcitonin level ≥0.05 ng/mL was an independent prognostic factor for liver cirrhosis (hazard ratio = 1.64; 95% confidence interval = 1.07–2.53; P = 0.024). During a median follow-up interval of 2.1 years, the three-year cumulative survival rates for the patients with normal and elevated serum procalcitonin levels were 72.9 and 56.0%, respectively (P < 0.001). The subgroup analyses that stratified the patients according to age, the Child-Turcotte-Pugh classification, and the presence of liver cancer showed the serum procalcitonin level was significantly associated with their prognoses.

Conclusions

The patients with liver cirrhosis had higher serum procalcitonin levels, regardless of local bacterial infections, and higher procalcitonin levels were associated with poor prognoses.
Trial of SAGE-217 in Patients With Major Depressive Disorder
Authors: Gunduz-Bruce Handan , Silber Christopher , Kaul Inder , Rothschild Anthony J. , Riesenberg Robert , Sankoh Abdul J. , Li Haihong , Lasser Robert , Zorumski Charles F. , Rubinow David R. , Paul Steven M. , Jonas Jeffrey , Doherty James J. , Kanes Stephen J.
Published: December 2019

(Abstracted from N Engl J Med 2019;381(10):903–911)

Positive allosteric modification of GABAA receptors via SAGE-217, an oral synthetic neurosteroid, has been proposed as a treatment for major depressive disorder.
Labor Induction in Late-Onset Fetal Growth Restriction: Foley Balloon Versus Vaginal Dinoprostone
Authors: Villalain Cecilia , Herraiz Ignacio , Quezada María Soledad , Arriaga Paula Gómez , Simón Elisa , Gómez-Montes Enery , Galindo Alberto
Published: December 2019

(Abstracted from Fetal Diagn Ther 2019;46(1):67–74)

Fetal growth restriction (FGR) is associated with a higher risk of perinatal complications and death, as well as neurodevelopmental delay. Once FGR is diagnosed, delivery is the main therapeutic measure.
Impact of Glycemic Control on Risk of Mortality and Complications in Trauma Patients
Authors: Rajaei Mohammad , Bosarge Patrick L. , Griffin Russell L. , McGwin Gerald , Jansen Jan O. , Kerby Jeffrey D.
Published: December 2019

The impact of diabetes mellitus on outcomes in trauma patients continues to attract interest, but data regarding the impact of longer term glycemic control are still lacking. This study evaluated the effect of long-term glycemic control on outcomes. Trauma patients presenting to the University of Alabama at Birmingham Hospital, between 2011 and 2018, were stratified into 4 groups, based on admission Hemoglobin A1c (HbA1c) level. A Poisson regression with robust error variance was used to estimate risk ratios and associated confidence intervals for the association between HbA1C and specific outcomes. A total of 26,134 patients were included. Patients without diabetes or excellent glycemic control (ND-EGC) had shorter hospital and ICU stay as well as fewer days on ventilator support. Compared with those with ND-EGC, the renal failure risk was higher for those with moderate (risk ratio [RR] 2.53, 95% confidence interval [CI] 1.76–3.63) and poor glycemic control (RR 3.20, 95% CI 2.18–4.71). Urinary tract infection risk was also higher for those with poor control (RR 1.83, 95% CI 1.17–2.02). Observed associations were of similar strength for pneumonia and mortality for all less-than-excellent glycemic control groups. In conclusion, trauma patients with worse long-term glycemic control had increased risks of developing pneumonia, renal failure, urinary tract infection, and death. HbA1c can prognosticate the risks and outcomes of diabetic trauma patients.
Regulatory Roles of Human Surfactant Protein B Variants on Genetic Susceptibility to Pseudomonas Aeruginosa Pneumonia-Induced Sepsis
Authors: Yang Fengyong , Zhang Jing , Yang Yi , Ruan Feng , Chen Xinghua , Guo Junping , Abdel-Razek Osama , Zuo Yi Y. , Wang Guirong
Published: December 2019

Surfactant protein B (SP-B) is essential for life and plays critical roles in host defense and lowering alveolar surface tension. A single-nucleotide polymorphism (SNP rs1130866) of human SP-B (hSP-B) alters the N-linked glycosylation, thus presumably affecting SP-B function. This study has investigated the regulatory roles of hSP-B genetic variants on lung injury in pneumonia-induced sepsis.

Methods:

Wild-type (WT) FVB/NJ and humanized transgenic SP-B-T and SP-B-C mice (expressing either hSP-B C or T allele without mouse SP-B gene) were infected intratracheally with 50 μL (4 × 104 colony-forming units [CFUs]/mouse) Pseudomonas aeruginosa Xen5 or saline, and then killed 24 or 48 h after infection. Bacterial dynamic growths were monitored from 0 to 48 h postinfection by in vivo imaging. Histopathological, cellular, and molecular changes of lung tissues and bronchoalveolar lavage fluid (BALF) were analyzed. Surface tension of surfactants was determined with constrained drop surfactometry.

Results:

SP-B-C mice showed higher bioluminescence and CFUs, increased inflammation and mortality, the higher score of lung injury, and reduced numbers of lamellar bodies in type II cells compared with SP-B-T or WT (P < 0.05). Minimum surface tension increased dramatically in infected mice (P < 0.01) with the order of SP-B-C > SP-B-T > WT. Levels of multiple cytokines in the lung of infected SP-B-C were higher than those of SP-B-T and WT (P < 0.01). Furthermore, compared with SP-B-T or WT, SP-B-C exhibited lower SP-B, higher NF-κB and NLRP3 inflammasome activation, and higher activated caspase-3.

Conclusions:

hSP-B variants differentially regulate susceptibility through modulating the surface activity of surfactant, cell death, and inflammatory signaling in sepsis.