bluuebunny/crossref_metadata_2025_split huggingface dataset:
Black widow evolution: magnetic braking by an ablated wind
Authors: Ginzburg Sivan , Quataert Eliot 
Published: May 2020

ABSTRACTBlack widows are close binary systems in which a millisecond pulsar is orbited by a companion, a few per cent the mass of the sun. It has been suggested that the pulsar’s rotationally powered γ-ray luminosity gradually evaporates the companion, eventually leaving behind an isolated millisecond pulsar. The evaporation efficiency is determined by the temperature Tch ∝ F2/3 to which the outflow is heated by the flux F on a dynamical time-scale. Evaporation is most efficient for companions that fill their Roche lobes. In this case, the outflow is dominated by a cap around the L1 point with an angle θg ∼ (Tch/Tg)1/2, and the evaporation time is tevap = 0.46(Tch/Tg)−2 Gyr, where Tg &gt; Tch is the companion’s virial temperature. We apply our model to the observed black widow population, which has increased substantially over the last decade, considering each system’s orbital period, companion mass, and pulsar spin-down power. While the original black widow (PSR B1957+20) evaporates its companion on a few Gyr time-scale, direct evaporation on its own is too weak to explain the overall population. We propose instead that the evaporative wind couples to the companion’s magnetic field, removes angular momentum from the binary, and maintains stable Roche lobe overflow. While a stronger wind carries more mass, it also reduces the Alfvén radius, making this indirect magnetic braking mechanism less dependent on the flux $t_{\rm mag}\propto t_{\rm evap}^{1/3}$. This reduces the scatter in evolution times of observed systems, thus better explaining the combined black widow and isolated millisecond pulsar populations.
Clinical, molecular, and radiomic profile of gliomas with FGFR3-TACC3 fusions
Authors: Di Stefano Anna Luisa , Picca Alberto , Saragoussi Edouard , Bielle Franck , Ducray Francois , Villa Chiara , Eoli Marica , Paterra Rosina , Bellu Luisa , Mathon Bertrand , Capelle Laurent , Bourg Véronique , Gloaguen Arnaud , Philippe Cathy , Frouin Vincent , Schmitt Yohann , Lerond Julie , Leclerc Julie , Lasorella Anna , Iavarone Antonio , Mokhtari Karima , Savatovsky Julien , Alentorn Agusti , Sanson Marc ,   TARGET study group
Published: May 2020

AbstractBackgroundActionable fibroblast growth factor receptor 3 (FGFR3)–transforming acidic coiled-coil protein 3 fusions (F3T3) are found in approximately 3% of gliomas, but their characteristics and prognostic significance are still poorly defined. Our goal was to characterize the clinical, radiological, and molecular profile of F3T3 positive diffuse gliomas.MethodsWe screened F3T3 fusion by real-time (RT)-PCR and FGFR3 immunohistochemistry in a large series of gliomas, characterized for main genetic alterations, histology, and clinical evolution. We performed a radiological and radiomic case control study, using an exploratory and a validation cohort.ResultsWe screened 1162 diffuse gliomas (951 unselected cases and 211 preselected for FGFR3 protein immunopositivity), identifying 80 F3T3 positive gliomas. F3T3 was mutually exclusive with IDH mutation (P &lt; 0.001) and EGFR amplification (P = 0.01), defining a distinct molecular cluster associated with CDK4 (P = 0.04) and MDM2 amplification (P = 0.03). F3T3 fusion was associated with longer survival for the whole series and for glioblastomas (median overall survival was 31.1 vs 19.9 mo, P = 0.02) and was an independent predictor of better outcome on multivariate analysis.F3T3 positive gliomas had specific MRI features, affecting preferentially insula and temporal lobe, and with poorly defined tumor margins. F3T3 fusion was correctly predicted by radiomics analysis on both the exploratory (area under the curve [AUC] = 0.87) and the validation MRI (AUC = 0.75) cohort. Using Cox proportional hazards models, radiomics predicted survival with a high C-index (0.75, SD 0.04), while the model combining clinical, genetic, and radiomic data showed the highest C-index (0.81, SD 0.04).ConclusionF3T3 positive gliomas have distinct molecular and radiological features, and better outcome.
Bridging the treatment gap in infant medulloblastoma: molecularly informed outcomes of a globally feasible regimen
Authors: Baroni Lorena V , Sampor Claudia , Gonzalez Adriana , Lubieniecki Fabiana , Lamas Gabriela , Rugilo Carlos , Bartels Ute , Heled Ayala , Smith Kyle S , Northcott Paul A , Bouffet Eric , Alderete Daniel , Ramaswamy Vijay 
Published: May 2020

Abstract

Background
Infant medulloblastoma represents an enormous challenge in neuro-oncology, due to their simultaneous high-risk of recurrence and high risk of severe neurodevelopmental sequelae with craniospinal irradiation. Currently infant medulloblastoma are treated with intensified protocols, either comprising intraventricular methotrexate or autologous transplant, both of which carry significant morbidity and are not feasible in the majority of the world. We sought to evaluate the molecular predictors of outcome in a cohort of infants homogeneously treated with induction chemotherapy, focal radiation and maintenance chemotherapy.

Methods
In a retrospective analysis, 29 young children treated with a craniospinal irradiation sparing strategy from Hospital Garrahan in Buenos Aires were profiled using Illumina HumanMethylationEPIC arrays, and correlated with survival.

Results
Twenty-nine children (range, 0.3–4.6 y) were identified, comprising 17 sonic hedgehog (SHH), 10 Group 3/4, and 2 non-medulloblastomas. Progression-free survival (PFS) across the entire cohort was 0.704 (95% CI: 0.551–0.899). Analysis by t-distributed stochastic neighbor embedding revealed 3 predominant groups, SHHβ, SHHγ, and Group 3. Survival by subtype was highly prognostic with SHHγ having an excellent 5-year PFS of 100% (95% CI: 0.633–1) and SHHβ having a PFS of 0.56 (95% CI: 0.42–1). Group 3 had a PFS of 0.50 (95% CI: 0.25–1). Assessment of neurocognitive outcome was performed in 11 patients; the majority of survivors fell within the low average to mild intellectual disability, with a median IQ of 73.5.

Conclusions
We report a globally feasible and effective strategy avoiding craniospinal radiation in the treatment of infant medulloblastoma, including a robust molecular correlation along with neurocognitive outcomes.
The Application of Regional Cerebral Oxygenation Monitoring in the Prediction of Cerebral Hypoperfusion During Carotid Endarterectomy
Authors: Yu Bin , Peng Yuming , Qiao Hui , Liu Bin , Wang Mingran , Yang Xiaocui , Han Ruquan 
Published: May 2020

Background:
The aim of this study was to assess the diagnostic ability of near-infrared spectroscopy-monitored regional cerebral oxygen saturation (rSO2) to detect cerebral hypoperfusion during internal carotid artery (ICA) clamping compared with motor and somatosensory evoked potential (EP) monitoring.

Methods:
This prospective study recruited consecutive patients undergoing carotid endarterectomy under general anesthesia. Significant EP changes (defined as >50% decrease in ipsilateral somatosensory EP amplitude or disappearance of contralateral motor EP on >2 consecutive stimulations) during ICA clamping were considered a warning sign for cerebral hypoperfusion. If significant EP changes occurred, the amplitude of the EPs and simultaneous rSO2 values were recorded before therapeutic intervention. The relationship between reductions in rSO2 and EP amplitudes was analyzed using Spearman rank-correlation analysis. Receiver operating characteristic curve analysis was used to calculate the optimal cutoff value for the relative reduction in rSO2. False-positive rates were evaluated according to immediate postoperative motor outcomes.

Results:
A total of 203 patients were included for analysis, of whom 23 developed significant EP changes during ICA clamping. There was a positive relationship between decreases in EP amplitude and rSO2 (R
2=0.15, P=0.02). A rSO2 reduction ≥16% from baseline had the optimal diagnostic performance for the detection of cerebral hypoperfusion (area under the receiver operating characteristic curve=0.82; 95% confidence interval: 0.76-0.87). The false-positive rate was 8.9%.

Conclusions:
Decreases in rSO2 correlated with decreases in EP amplitude during ICA clamping. A relative reduction in rSO2 ≥16% could serve as a warning for clamping-associated cerebral hypoperfusion. The 8.9% false-positive rate is a potential clinical limitation of the use of rSO2 to predict postoperative neurological deficits.
Close to Home
Authors: Ziegler Tammy Ruiz , Kuebelbeck Amy 
Published: May 2020

Background:
Advances in prenatal testing and diagnosis have resulted in more parents learning during pregnancy that their child may die before or shortly after birth. These advances in testing and diagnosis have also resulted in more parents choosing, despite the diagnosis, to continue their pregnancies and pursue a palliative approach to their infant's short life. Perinatal hospice and palliative care is a growing model of care developed in response to these parents' previously unmet needs. A seldom-discussed opportunity to provide this care exists in outlying community hospitals, which are ideally placed to provide care close to home for families who have chosen comfort measures and time with their child.

Purpose:
This article reviews the definition and utility of perinatal palliative care, the population it serves, attempts to support a rational for development of community-based programs, and describes one community hospital's experience with perinatal palliative care in their community.*

Methods/Search Strategy:
This article describes the development and processes of a perinatal palliative care program at a community hospital in Fredericksburg, Virginia.

Implications for Practice:
Perinatal palliative care can be developed with the assistance of already existing training materials, resources, and staff. While the cohort of patients may be small, implementing perinatal palliative care in a community setting may result in wider availability of this care and more accessible options for these families.

Implications for Research:
Research possibilities include developing a template for creating a perinatal palliative care program at community hospitals that could be replicated elsewhere; assessing parental satisfaction and quality indicators of perinatal palliative care at community hospitals and at referral hospitals; and assessing outcomes in various settings.
The Use of Inhaled Nitric Oxide in Congenital Diaphragmatic Hernia
Authors: Novotny Ashley M. 
Published: May 2020

Background:
Congenital diaphragmatic hernia (CDH) is a complex congenital defect of the diaphragm that allows abdominal contents to herniate into the chest cavity, altering pulmonary development, and leading to pulmonary hypoplasia and hypertension. Patient presentation is variable in severity, making management difficult. Many common management strategies have improved the survival rate of infants with CDH, including gentle ventilation and permissive hypercapnia. Inhaled nitric oxide (iNO) is a potent, pulmonary vasodilator that has shown to improve oxygenation while decreasing pulmonary pressure in infants with pulmonary hypertension. While many institutions utilize iNO in the treatment of pulmonary hypertension, the role of iNO as a treatment for CDH is controversial.

Purpose:
The purpose of this literature review is to establish a better understanding of CDH including embryology, patient presentation, and management strategies, and to analyze the use and effect of iNO on patients in this population.

Methods/Search Strategy:
A systemic search of PubMed, CINHAL, and Medline was performed to identify research articles studying the use of iNO on patients with pulmonary hypertension secondary to CDH.

Findings/Results:
Three studies were utilized in this review to assess the current use and effectiveness of iNO in patients with CDH.

Implications for Practice:
This review summarized the pathophysiology, embryology, patient presentation, and management strategies, as well as reviewed literature on the effectiveness of iNO on pulmonary hypertension secondary to CDH.

Implications for Research:
Further research is indicated to determine alternative treatment modalities and establish evidence-based practice protocols to standardize care in infants with CDH.
Physiological Stability in Very Preterm Infants During Skin-to-Skin Contact as Assessed by Near-Infrared Spectroscopy
Authors: Blomqvist Ylva Thernström , Karlsson Victoria , Dawit Feven , Sindelar Richard , Ågren Johan 
Published: May 2020

Background:
Skin-to-skin contact (SSC) has been demonstrated to allow adequate thermal stability in high-technology settings with extremely preterm infants, while other aspects on how SSC influences basic physiological parameters have been less extensively investigated.

Purpose:
To evaluate physiological stability during SSC and incubator care in a group of preterm infants born at a gestational age (GA) of 32 weeks or less and receiving respiratory support.

Methods:
Descriptive, observational study including 10 preterm infants (GA 22-32 weeks, postnatal age 2-48 days) were evaluated during SSC compared with flanking time periods in the incubator. Cerebral and systemic regional oxygen saturation (rSao
2), pulse oximetry (Spo
2), heart rate (HR), and body temperature were recorded, and the fractional tissue oxygen extraction (fTOE) was calculated.

Results:
A total of 16 periods of SSC (mean duration 3 hours 30 minutes) were evaluated, 9 during nasal continuous positive airway pressure and 7 during mechanical ventilation. Cerebral rSao
2 was 68% ± 4% (SE) and 69% ± 4% during incubator care and SSC, respectively (P = .56). Somatic rSao2 was 64% ± 4% during incubator care and 66% ± 4% during SSC (P = .54). Also, fTOE, HR, and Spo
2 was similar during the 2 modes of care. Body temperature increased during SSC (P < .01).

Implications for Practice:
The present study reveals no differences in cerebral and somatic tissue oxygenation between periods of SSC and care in the incubator. The findings indicate that SSC supports physiological stability also during management of very preterm infants receiving respiratory support.

Implications for Research:
Further studies directed to further optimize SSC performance should enable its safe implementation at gradually lower gestational and postnatal ages.
Elagolix Treatment for Up to 12 Months in Women With Heavy Menstrual Bleeding and Uterine Leiomyomas
Authors: Simon James A. , Al-Hendy Ayman , Archer David F. , Barnhart Kurt T. , Bradley Linda D. , Carr Bruce R. , Dayspring Thomas , Feinberg Eve C. , Gillispie Veronica , Hurtado Sandra , Kim JinHee , Liu Ran , Owens Charlotte D. , Muneyyirci-Delale Ozgul , Wang Alice , Watts Nelson B. , Schlaff William D. 
Published: May 2020

OBJECTIVE:
To investigate the safety and efficacy of elagolix, an oral gonadotropin-releasing hormone antagonist, with hormonal add-back therapy for up to 12 months in women with heavy menstrual bleeding associated with uterine leiomyomas.

METHODS:
Elaris UF-EXTEND was a phase 3 extension study that evaluated an additional 6 months (up to 12 months total) of elagolix 300 mg twice daily with hormonal add-back therapy (estradiol 1 mg and norethindrone acetate 0.5 mg once daily) in women who completed an initial 6 months of the same treatment in one of two preceding phase 3 studies. The primary endpoint was the percentage of women with both less than 80 mL menstrual blood loss during final month and a 50% or greater reduction in menstrual blood loss from baseline to final month. Safety evaluations included adverse events and bone mineral density changes. The planned sample size of UF-EXTEND was based on estimated rollover and discontinuation rates in the two preceding studies.

RESULTS:
From September 2016 to March 2019, 433 women were enrolled in UF-EXTEND. Of these women, 218 received up to 12 months of elagolix with add-back therapy; the mean±SD age of this group was 42.4±5.4 years and 67.3% were black. The percentage of women who met the primary endpoint in this elagolix with add-back group was 87.9% (95% CI [83.4–92.3]). The most frequently reported adverse events with up to 12 months of elagolix plus add-back therapy were hot flush (6.9%), night sweats (3.2%), headache (5.5%), and nausea (4.1%). Mean percent decreases in bone mineral density from baseline to extension month 6 were significantly less with elagolix plus add-back therapy than with elagolix alone {between-group difference in lumbar spine: −3.3 (95% CI [−4.1 to −2.5])}.

CONCLUSION:
Up to 12 months of elagolix with add-back therapy provided sustained reduction in menstrual blood loss in women with uterine leiomyomas, with the addition of add-back therapy attenuating the hypoestrogenic effects of elagolix alone. No new or unexpected safety concerns were associated with an additional 6 months of elagolix with addback therapy.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02925494.

FUNDING SOURCE:
AbbVie Inc funded this study.
Vanishing Twins Conceived Through Fresh In Vitro Fertilization
Authors: Harris Amy L. , Sacha Caitlin R. , Basnet Kristen M. , James Kaitlyn E. , Freret Taylor S. , Kaimal Anjali J. , Yeh John , Souter Irene , Roberts Drucilla J. , Toth Thomas L. 
Published: May 2020

OBJECTIVE:
To characterize the obstetric outcomes and placental pathology in live births arising from vanishing twin pregnancies compared with nonreduced in vitro fertilization (IVF) pregnancies.

METHODS:
This is a retrospective cohort study of live births resulting from fresh embryo transfers after IVF cycles with autologous oocytes from 2004 through 2017 at a large academic fertility center. Clinical information and pathology reports were reviewed. Placental diagnoses were coded using established nosology by expert placental pathologists. Analysis of variance, Kruskal-Wallis, Pearson's χ2, and Fisher exact tests were used, as appropriate, to compare pathology categories between pregnancy outcomes. Mixed effects logistic regression models were generated to reveal the association between pregnancy outcome and placenta pathology, controlling for pregnancies arising in the same woman and various suspected confounders.

RESULTS:
Of 905 fresh autologous IVF cycles with placental pathology available for review, we identified 73 vanishing twin pregnancies (8.1%), 556 singleton pregnancies (61.4%), and 276 twin pregnancies (30.5%). Vanishing twin syndrome was not associated with preterm delivery, route of delivery, growth restriction or other obstetric outcomes as compared with IVF singleton pregnancies. However, vanishing twin syndrome pregnancies showed distinctive placental pathologies including an increased rate of small placentas (less than the 10th percentile by weight), with more anatomical abnormalities than IVF singleton pregnancies (odds ratio 1.73, 95% CI 0.94–3.19; adjusted odds ratio 2.15, 95% CI 1.08–4.28). The frequency of placental vascular and inflammatory pathologies associated with IVF vanishing twin syndrome pregnancies were similar to that of IVF singleton pregnancies. Loss of a twin after 8 weeks of gestation was not associated with greater risks of placental pathologies.

CONCLUSION:
In vitro fertilization pregnancies affected by vanishing twin syndrome did not have significant differences in obstetric or perinatal outcomes as compared with twin or singleton gestations. However, early twin loss was potentially associated with differences in placental development associated with a higher rate of small placentas and other anatomic pathologies.
Provisional Minifragment Plate Fixation of Acetabular Fractures—A Technical Trick
Authors: Shannon Steven F. , Stevens Kali N. , Nascone Jason W. , O'Toole Robert V. , Eglseder W. Andrew , Sciadini Marcus F. 
Published: May 2020

Summary:
Acetabular fractures may not always be amenable to classic clamp-assisted reductions and interfragmentary lag screw fixation. The routine clamp-assisted reductions with limited osseous territory availability can inhibit typical 3.5-mm reconstruction plate application. Provisional minifragment plate fixation of these fracture patterns with subsequent clamp removal allows for definitive plate application. The provisional minifragment plates may also be retained to theoretically augment fixation. The authors present a step-by-step technique and clinical series of 57 patients demonstrating provisional minifragment fixation of elementary (n = 8) and associated (n = 49) acetabular fractures.
Hansen Disease (Leprosy) and Armadillo Exposure in Arkansas: A Case Series
Authors: Carlock Sarah , Fulton Edward H. , Rosenbaum Eric , Mukasa Leonard , Gardner Jerad M. , Shalin Sara C. , Kaley Jennifer R. 
Published: May 2020

Background:
Although most cases of Hansen disease (HD) in the United States are imported from endemic areas, a subset of cases are relate to exposure to nine-banded armadillos. Several recent cases of HD in Arkansas occurred in patients who had not traveled to endemic areas and who reported variable degrees of armadillo exposure.

Objective:
The purpose of this study was to report 6 cases of HD diagnosed in Arkansas between 2004 and 2016. The secondary purpose was to explore the correlation between exposure to the nine-banded armadillo as it pertains to transmission of the disease.

Methods:
The referring clinician of each patient was contacted to gather information regarding the patient's clinical presentation, armadillo exposure, and travel history. In addition, the Arkansas Department of Health was consulted to review the demographics of individuals diagnosed with HD in the past 15 years and to review the distribution of HD throughout the state of Arkansas.

Results:
Six domestic cases of HD were associated with both direct and indirect exposure to armadillos.

Limitations:
Armadillo exposure may be underreported in patients with HD because of fear of stigmatization and/or lack of access to care.

Conclusions:
Direct exposure to armadillos does not appear to be required for transmission of HD making a soil-mediated mechanism of indirect exposure plausible.
Epithelioid Fibrous Histiocytoma With Dot-Like Perinuclear ALK Expression and PRKAR2A-ALK Fusion
Authors: Dawson Kellen , Bridge Julia A. , Sumegi Janos , Royce Thomas , Gardner Jerad M. , Shalin Sara C. 
Published: May 2020

Abstract:
Epithelioid fibrous histiocytoma (EFH) is a rare, benign, cutaneous neoplasm. This fibrohistiocytic tumor was once believed to be a variant of fibrous histiocytoma, but EFH is now known to be a distinct entity based on the presence of
ALK
gene rearrangements in most cases. The pattern of immunohistochemical expression of ALK in EFH in the literature thus far describes both granular cytoplasmic staining and nuclear staining. We present a case of EFH with dot-like Golgi pattern perinuclear ALK expression, a previously undescribed staining pattern. We surmised this unique staining pattern could be due to a novel fusion partner, and using FISH, we confirmed a rearrangement of the
ALK
(2p23) locus. Further investigation with whole transcriptome sequencing led to the discovery of
PRKAR2A-ALK
fusion, and the function of this fusion partner reflects a Golgi-predominant localization of the protein. Attention to the distinct immunohistochemical pattern of ALK expression may provide clues to the function of the fusion partner.