bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intrinsic physiological properties underlie auditory response diversity in the avian cochlear nucleus
Authors: Brown David H. , Hyson Richard L. 
Published: January 2019

Sensory systems exploit parallel processing of stimulus features to enable rapid, simultaneous extraction of information. Mechanisms that facilitate this differential extraction of stimulus features can be intrinsic or synaptic in origin. A subdivision of the avian cochlear nucleus, nucleus angularis (NA), extracts sound intensity information from the auditory nerve and contains neurons that exhibit diverse responses to sound and current injection. NA neurons project to multiple regions ascending the auditory brain stem including the superior olivary nucleus, lateral lemniscus, and avian inferior colliculus, with functional implications for inhibitory gain control and sound localization. Here we investigated whether the diversity of auditory response patterns in NA can be accounted for by variation in intrinsic physiological features. Modeled sound-evoked auditory nerve input was applied to NA neurons with dynamic clamp during in vitro whole cell recording at room temperature. Temporal responses to auditory nerve input depended on variation in intrinsic properties, and the low-threshold K+ current was implicated as a major contributor to temporal response diversity and neuronal input-output functions. An auditory nerve model of acoustic amplitude modulation produced synchrony coding of modulation frequency that depended on the intrinsic physiology of the individual neuron. In Primary-Like neurons, varying low-threshold K+ conductance with dynamic clamp altered temporal modulation tuning bidirectionally. Taken together, these data suggest that intrinsic physiological properties play a key role in shaping auditory response diversity to both simple and more naturalistic auditory stimuli in the avian cochlear nucleus. NEW & NOTEWORTHY This article addresses the question of how the nervous system extracts different information in sounds. Neurons in the cochlear nucleus show diverse responses to acoustic stimuli that may allow for parallel processing of acoustic features. The present studies suggest that diversity in intrinsic physiological features of individual neurons, including levels of a low voltage-activated K+ current, play a major role in regulating the diversity of auditory responses.
Serum Vaspin as a Predictor of Adverse Cardiac Events in Acute Myocardial Infarction
Authors: Zhou Xiang , Chen Yuqi , Tao Yifei , Zhang Wei , Xu Weiting , Lu Xiang 
Published: January 2019

Background

The involvement of vaspin (visceral adipose tissue–derived serpin) in the development of atherosclerotic cardiovascular diseases has been documented. This study was designed to explore the prognostic value of serum vaspin in patients with acute myocardial infarction (
AMI
).

Methods and Results

We included 1036
AMI
patients in a cohort study and determined the association between serum vaspin and major adverse cardiac events (
MACE
) using Cox regression analysis. The receiver operating characteristic curve indicated that serum vaspin could significantly differentiate patients with
MACE
, and the optimal cutoff value was 0.62 ng/mL. The Kaplan–Meier survival curve showed that patients with lower vaspin levels had higher incidence of
MACE
. Multivariate Cox regression analysis revealed that low vaspin was an independent predictor of
MACE
(hazard ratio: 0.74; 95%
CI
, 0.48–0.96;
P
=0.029), together with age; previous histories of
AMI
, heart failure, hypertension, and diabetes mellitus; Killip class; revascularization; CRP (C‐reactive protein); and NT‐proBNP (N‐terminal pro–B‐type natriuretic peptide). Integrated discrimination and net reclassification improvements for
MACE
were significantly improved by addition of vaspin to the model of traditional risk factors. Moreover, low vaspin was a valuable predictor of heart failure hospitalization (hazard ratio: 0.58; 95%
CI
, 0.37–0.89;
P
=0.005) and recurrent
AMI
(hazard ratio: 0.72; 95%
CI
, 0.53–0.95;
P
=0.036) after adjustment for conventional cardiovascular risk factors.

Conclusions

Our study suggests that serum vaspin is a significant prognostic marker of
MACE
in
AMI
patients.
Not Just Arterial Damage: Increased Incidence of Venous Thromboembolic Events in Cardiovascular Patients With Elevated Plasma Levels of Apolipoprotein CIII
Authors: Olivieri Oliviero , Turcato Gianni , Moruzzi Sara , Castagna Annalisa , Girelli Domenico , Pizzolo Francesca , Friso Simonetta , Sandri Marco , Bassi Antonella , Martinelli Nicola 
Published: January 2019

Background

Apolipoprotein
CIII
(apo
CIII
) is a crucial player in triglyceride‐rich lipoprotein metabolism, but may also act pleiotropically, provoking inflammatory responses and stimulating coagulation. Elevated apo
CIII
plasma levels have been associated with increased activity of coagulation factors. Since these features of prothrombotic diathesis are linked with venous thromboembolism (
VTE
), we hypothesized that apo
CIII
plays a role in
VTE
.

Methods and Results

We recorded nonfatal
VTE
events in 1020 patients (age 63.3±11.4 years; 29.1% women) with or without coronary artery disease (79.1% with coronary artery disease and 20.9% without coronary artery disease) during a long follow‐up. Complete plasma lipid and apolipoproteins were available for all patients. Forty‐five patients (4.4%) experienced nonfatal
VTE
events during a median follow‐up period of 144 months. Apo
CIII
plasma concentration at enrollment was higher in patients with VTE compared with patients without
VTE
(12.2 [95% CI, 11.10–13.5] mg/dL vs 10.6 [95% CI, 10.4–10.9] mg/dL, respectively;
P
=0.011). Patients with apo
CIII
levels above the median value (10.6 mg/dL) exhibited an increased risk of
VTE
(incidence rate, 6.0 [95%
CI
, 4.0–8.0] vs 1.8 [95%
CI,
0.7–2.9]
VTE
events/1000 person‐years; unadjusted hazard ratio [
HR
], 3.42 [95%
CI
, 1.73–6.75];
P
<0.001). This association was confirmed after adjustment for sex, age, coronary artery disease diagnosis, body mass index, hypertension, and anticoagulant treatment at enrollment (
HR
, 2.66; 95%
CI
, 1.31–5.37 [
P
=0.007]), with inclusion of lipid parameters in the Cox model (HR, 3.74; 95%
CI
, 1.24–11.33 [
P
=0.019]), and even with exclusion of patients who died at follow‐up (
HR,
3.92; 95%
CI
, 1.68–9.14 [
P
=0.002]) or patients taking anticoagulants (
HR
, 3.39; 95%
CI
, 1.72–6.69 [
P
<0.001]).

Conclusions

Our results suggest that high plasma apo
CIII
concentrations may predict an increased risk of
VTE
in patients with cardiovascular disease.
Diagnosis of the Dynamic Efficiency of Latent Heat Release and the Rapid Intensification of Supertyphoon Haiyan (2013)
Authors: Kuo Hung-Chi , Tsujino Satoki , Huang Chien-Chang , Wang Chung-Chieh , Tsuboki Kazuhisa 
Published: January 2019

AbstractBefore landfall in the Philippines, Supertyphoon Haiyan in 2013 experienced a period of rapid intensification (RI) with the maximum wind speed increasing by 31 m s−1 in 24 h. A 2-km horizontal resolution full-physics cloud-resolving model is used to study the RI of Haiyan. To aid in the diagnosis of RI, we employ a dynamic efficiency factor (DEF), which is based on axisymmetric gradient wind vortex theory. The DEF measures the efficacy of convective heating at any point in generating kinetic energy. The DEF is large in the presence of strong baroclinicity near the eyewall. The simulated tropical cyclone (TC) becomes more symmetric and resembles the observations of Haiyan during the RI period. Our results highlight the nonlinear feedback process in which deep convection becomes collocated with the large DEF area near the eyewall. With the intensity increase, the eyewall convection results in significant subsidence warming at the edge of the eye rather than at the center of the eye. The overall eye warming enhances the baroclinicity near the eyewall and the system DEF in the eye-core region is increased by 33% before and after the RI onset. The vortex intensity increase during the RI period also leads to large unbalanced radial inflow in the boundary layer. The large radial inflow causes the deep convection to occur in the region of large inertial stability inside the radius of maximum wind. The deep convection further efficiently intensifies the TC. Our simulation emphasizes the importance of model resolution in simulating the internal nonlinear processes of RI.
A Reduced-Space Ensemble Kalman Filter Approach for Flow-Dependent Integration of Radar Extrapolation Nowcasts and NWP Precipitation Ensembles
Authors: Nerini Daniele , Foresti Loris , Leuenberger Daniel , Robert Sylvain , Germann Urs 
Published: January 2019

Abstract
A Bayesian precipitation nowcasting system based on the ensemble Kalman filter is formulated. Starting from the last available radar observations, the prediction step of the filter consists of a stochastic radar extrapolation technique, while the correction step updates the radar extrapolation nowcast using information from the most recent forecast by the numerical weather prediction model (NWP). The result is a flow-dependent and seamless blending scheme that is based on the spread of the nowcast and NWP ensembles, used as the definition of the forecast error. To simplify the matrix operations, the Bayesian update is performed in the subspace spanned by the principal components, hence the term reduced space. Synthetic data experiments demonstrated that the Bayesian nowcast correctly captures the flow dependency in both the NWP forecast and the radar extrapolation skills. Four experiments with real precipitation data and a relatively small ensemble size (21 members) represented a first test under realistic conditions, such as stratiform wintertime precipitation and localized summertime convection. The skill was quantified in terms of fractions skill score at 32-km scale and 2.0 mm h−1 intensity. The results indicate that the system is able to produce blended forecasts that are at least as skillful as the nowcast-only or the NWP-only forecasts at any lead time.
Exploring the Relationship Between Lifestyle Behaviors and Health-Related Quality of Life Among Older Adults With Diabetes
Authors: Qin Weidi , Blanchette Julia E. , Murrock Carolyn 
Published: January 2019

Purpose The purpose of the study was to examine the association between 3 lifestyle behaviors (smoking, physical activity, and fruit and vegetable consumption) and health-related quality of life (HRQOL) among older adults diagnosed with diabetes. Methods A sample of the US population 65 years and older who were diagnosed with diabetes from the 2015 Behavioral Risk factor Surveillance System (N = 11 503) was analyzed. The 4 HRQOL measures were self-rated health, physically unhealthy days, mentally unhealthy days, and impaired activity days in the past month. Multiple logistic regression analysis was conducted to predict HRQOL. Results The multiple logistic regression results showed that smoking and lack of physical activity were significant predictors for higher odds of fair or poor self-rated health, more physically unhealthy days, more mentally unhealthy days, and more impaired activity days during past 30 days. No significant relationship was found between fruit and vegetable consumption and any HRQOL measure. Conclusions Findings imply that diabetes education could continue and enhance efforts in smoking cessation and increase physical activity to promote the HRQOL among older adults diagnosed with diabetes. In addition, the measure of fruit and vegetable consumption should be further studied to reflect the needs of older adults with diabetes.
Nontraumatic rupture of the costal margin: a single-center experience
Authors: Mary Parks Ruth , Jadoon Mehmood , Duffy John 
Published: January 2019

Background Rupture of the costal margin is uncommon. Whilst most often seen after major trauma, we describe its occurrence in patients with no direct chest trauma. Methods A search was performed in our thoracic surgery database for all patients with rupture of the costal margin. Patients were excluded if the injury was a result of trauma. Data were collected on sex, age, body mass index, profession, past medical history, smoking status, presenting complaint, mechanism of injury, and management. Results There were 9 patients with rupture of the costal margin that was caused in all cases by a severe coughing fit. All patients were male and the mean age was 62.5 years (range 47–76 years). Chronic obstructive pulmonary disease was present in 6 cases. Presentations included a palpable defect (5 cases), cough (9 cases), and chest pain (6 cases). On radiological examination, all patients had widening of the rib space, 4 had associated rib fractures, and 5 had lung herniation. Time from injury to presentation was 12 months (range 1–24 months). All patients underwent surgery and were followed-up for 59 months (range 8–129 months). Two patients suffered major complications in the immediate postoperative period. Conclusions Rupture of the costal margin, in the absence of direct trauma, is characterized by pain, a palpable defect, and lung herniation. It is associated with widening of the rib space and rib fractures, and can be treated surgically with success but not without significant risks.
Oral Ketamine or Midazolam or Low Dose Combination for Premedication in Children
Authors: Darlong V. , Shende D. , Subramanyam M. S. , Sunder R. , Naik A. 
Published: January 2019

This randomized controlled trial was designed to evaluate whether the combination of low dose oral midazolam (0.25 mg/kg) and low dose oral ketamine (3 mg/kg) provides better premedication than oral midazolam (0.5 mg/kg) or oral ketamine (6 mg/kg). Seventy-eight children of ASA physical status I or II scheduled for elective ophthalmic surgery were randomly divided into three groups and given premedication in the holding area 30 minutes before surgery. Two subjects from each group vomited the medication and were excluded, leaving 72 subjects for further analysis. The onset of sedation was earlier in the combination group than the other two groups. At 10 minutes after premedication 12.5% in the combination group had an acceptable sedation score compared with none in the other two groups. After 20 minutes 54% in the combination group had an acceptable sedation score, 21% in the midazolam group and 16% in the ketamine group (P<0.05). There were no significant differences in the parental separation score, response to induction and emergence score. The mean time for best parental separation score was significantly less in the combination group (19±8 min) than either the midazolam (28±7) or ketamine (29±7 min) groups (P<0.05). Recovery was earlier in the combination group, as the time required to reach a modified Aldrete score of 10 was significantly less in the combination group (22±5 min) than in the oral midazolam (36±11 min) or ketamine (38±8 min) groups. The incidence of excessive salivation was significantly higher in the ketamine alone group (P<0.05). In conclusion, the combination of oral ketamine (3 mg/kg) and midazolam (0.25 mg/kg) has minimal side effects and gives a faster onset and more rapid recovery than ketamine 6 mg/kg or midazolam 0.5 mg/kg for premedication in children.
Muscle Weakness after Muscle Relaxants: An Audit of Clinical Practice
Authors: Alkhazrajy W. , Khorasanee A. D. , Russell W. J. 
Published: January 2019

Residual muscle weakness after general anaesthesia, assessed using handgrip strength, was audited in a teaching hospital. The relationships between residual weakness, the use of muscle relaxants and patient characteristics were examined. Handgrip strength was measured preoperatively, one hour postoperatively and one day postoperatively using a hand dynamometer in 151 patients having general anaesthesia. Forty-nine patients received no muscle relaxant, 34 patients received vecuronium and 68 received rocuronium. Patients were managed by their anaesthetist according to that anaesthetist's clinical choice. All patients who received muscle relaxants received neostigmine. One hour postoperatively, there was a decline in handgrip strength of 16% for the no relaxant group, 24% for vecuronium and 29% for rocuronium. The degree of weakness for the relaxant groups was unrelated to age (P=0.89) but was strongly influenced by the patient's sex. Almost all of the increased weakness with relaxants was found in the female patients. The mean decline in handgrip strength in the male patients who received either vecuronium or rocuronium was similar to that seen when relaxants had not been used (P=0.40). One hour postoperatively, female patients showed a marked decrease in handgrip strength after both vecuronium and rocuronium (32% and 34% respectively, combined P=0.01). These results suggest that in usual clinical practice at our institution, female patients are more likely to have residual weakness after muscle relaxants.
Assessment of Outcome over a 10-year Period of Patients Admitted to a Multidisciplinary Adult Intensive Care Unit with Haematological and Solid Tumours
Authors: Moran J. L. , Solomon P. J. , Williams P. J. 
Published: January 2019

The risk factors for time to mortality, censored at 30 days, of patients admitted to an adult teaching hospital ICU with haematological and solid malignancies were assessed in a retrospective cohort study. Patients, demographics and daily ICU patient data, from admission to day 8, were identified from a prospective computerized database and casenote review in consecutive admissions to ICU with haematological and solid tumours over a 10-year period (1989–99). The cohort, 108 ICU admissions in 89 patients was of mean age (±SD) 55±14 years; 43% were female. Patient diagnoses were leukaemia (35%), lymphoma (38%) and solid tumours (27%). Median time from hospital to ICU admission was five days (range 0–67). On ICU admission, 50% had septic shock and first day APACHE II score was 28±9. Forty-six per cent of patients were ventilated. ICU and 30-day mortality were 39% and 54% respectively. Multivariate Cox model predictors (P<0.05), using only ICU admission day data were: Charlson comorbidity index (CCI), time to ICU admission (days) and mechanical ventilation. For daily data (admission through day 8), predictors were: cohort effect (2nd vs 1st five-year period); CCI; time to ICU admission (days); APACHE II score and mechanical ventilation. Outcomes were considered appropriate for severity of illness and demonstrated improvement over time. Ventilation was an independent outcome determinant. Controlling for other factors, mortality has improved over time (1st vs 2nd five year period). Analysis restricted to admission data alone may be insensitive to particular covariate effects.
Diagnosis and Outcome from Suspected Mesenteric Ischaemia following Cardiac Surgery
Authors: Edwards M. , Sidebotham D. , Smith M. , Leemput J. V. , Anderson B. 
Published: January 2019

A three-year retrospective chart review was undertaken of all post-cardiothoracic ICU patients who underwent laparotomy for suspected mesenteric ischaemia, or who had the diagnosis confirmed at post mortem. The aim was to compare the clinical and diagnostic characteristics of cardiothoracic patients with suspected mesenteric ischaemia with patients who had a confirmed diagnosis. There were 3024 admissions to the cardiothoracic ICU over the three-year period. Twenty-six laparotomies were performed for suspected mesenteric ischaemia and 15 were positive for mesenteric ischaemia. The overall incidence of mesenteric ischaemia was 17/3024 (0.6%). Mortality for patients with mesenteric ischaemia was 13/17 (76%). Ischaemia was limited to a single segment of bowel in the four survivors. Mortality in patients who had a negative laparotomy for suspected mesenteric ischaemia was 7/11 (64%), attributable to cardiovascular failure (2/11) and multi-organ dysfunction syndrome (5/11). No clinical, biochemical or haematological test was discriminatory for mesenteric ischaemia. In patients with proven ischaemia, 7/13 plain abdominal radiographs were positive for ischaemia and 7/7 radiographs were negative for ischaemia in patients with no ischaemia (P=0.05, PPV 1.0, NPV 0.5, sensitivity 54%, specificity 100%). Neither routine clinical investigations nor plain abdominal radiography reliably diagnose mesenteric ischaemia when the diagnosis is suspected clinically. Early laparotomy is recommended in these patients and further investigation may delay this procedure unnecessarily. The presence of mesenteric ischaemia identifies a cohort of patients with high mortality.
A Teenager with Severe Asthma Exacerbation following Ibuprofen
Authors: Palmer G. M. 
Published: January 2019

Aspirin-sensitive asthma, aspirin-intolerant asthma, aspirin- (or non-steroidal anti-inflammatory drug [NSAID]) exacerbated respiratory disease are terms for a disorder commonly described as affecting adults aged >30y. With this perception, ibuprofen was administered for postoperative pain management to a 17-year-old boy with allergic rhinitis and previous severe asthma (at a time when well controlled), who then had a severe asthma exacerbation. Analysis of the literature in response to this case highlights four points: 1) NSAID-exacerbated asthma is not only a disorder of adults; it occurs in up to of 2% in asthmatic children, approaching probably 30% in older children with severe asthma and nasal disease. 2) The asthmatic reaction is dose-dependent and can occur with sub-therapeutic doses. Oral NSAID/aspirin challenge should be conducted in an environment where a severe asthma exacerbation can be appropriately managed. 3) The therapeutic use of non-selective [COX-1 preferential] NSAIDs should be avoided when sensitivity is known or suspected in adults and teenagers with severe asthma and chronic rhinosinusitis or nasal polyps. Use of these agents in younger children with mild episodic wheeze is probably safe. 4) Paracetamol use is probably safe, but aspirin-exacerbated respiratory disease may occur with clinical doses in a subgroup of aspirin-exacerbated respiratory disease patients. COX-2 selective inhibitors are probably safe, although this is controversial. Opioids and tramadol are suitable analgesic alternatives for patients with known or suspected susceptibility.
Variation in Preoperative Assessment of Cardiac Output Reserve and Likelihood of Transfusion among Anaesthetists: A Pilot Study
Authors: Harrison M. J. 
Published: January 2019

The aim of this pilot study was to investigate anaesthetists’ assessment of the ability of patients to increase cardiac output over a range of clinical scenarios and of their perceived ‘likelihood of transfusion’ in these scenarios. Specialist anaesthetists were given a questionnaire with clinical cues in the form of diagnoses about theoretical patients. They were asked to use 100 mm visual analogue scales (VAS) for their assessments of each patient's cardiac reserve and their ‘likelihood of transfusion’ of these patients; the endpoints of the VAS being ‘Very low’ (0 mm) to ‘High’ (100 mm), and ‘Do not transfuse’ (0 mm) to ‘Transfuse’ (100 mm) respectively. The assessment of patients’ cardiac output reserve by anaesthetists (n=54) showed great variation; for example, a patient with severe aortic stenosis was perceived overall to have a limited ability to increase cardiac output (mean VAS 16 mm) but there was considerable variation between anaesthetists (25–75 percentiles 10 mm to 21 mm). Assessment of ‘likelihood of transfusion’ (n=42) also had great variation; as an example a patient with ‘angina’ with a haemoglobin of 95 gt-1 was perceived overall to have an average likelihood of transfusion of 50 mm, but the 25–75 percentiles ranged from 33 mm to 71 mm. This study suggests that inter-anaesthetist variability in the assessment of a patient's ‘cardiac output reserve’ and his ‘likelihood of transfusion’ is large.