Post-mortem CT: is coronary angiography required in the presence of a high coronary artery calcium score?

AIM

To test whether a high coronary artery score predicts that the subsequent post-mortem computed tomography (PMCT) with angiography (PMCTA) will diagnose significant coronary artery disease (CAD); to test the diagnostic impact of assuming there is significant CAD based on a high coronary artery calcium (CAC) score alone; and (3) to test whether the clinical CAC score threshold (400) is the most accurate to make this prediction.

MATERIALS AND METHODS

CAC scoring and PMCTA were performed in cases of adult sudden natural death. Angiography was reviewed to determine if there was sufficient CAD to give as the cause of death. Data were analysed to test whether high calcium score predicts significant CAD.

RESULTS

PMCTA with CAC score was successful in 100/104 PMCT examinations and in 87/100 angiography examinations (87%). Forty-six cases (46%) had a CAC score of >400, the clinical level of severe disease. CAD was given as the cause of death in 31 (67%) of these cases. Angiography was successful in 39 of these cases (84.7%) and showed severe CAD in all but one (97%). Twenty-five (25%) cases were diagnosed with a CAD death without a high CAC score.

CONCLUSION

Although CAC score can neither diagnose nor exclude death due to CAD, the addition of angiography adds little diagnostic information to a high CAC score. If PMCT investigation is to exclude trauma and provide a medical cause of death on the "balance of probabilities", angiography is not required when the calcium score >400. This could reduce the number of patients requiring angiography by almost 50%.

Beam Energy and Centrality Dependence of Direct-Photon Emission from Ultrarelativistic Heavy-Ion Collisions

The PHENIX collaboration presents first measurements of low-momentum (0.4<p_{T}<3  GeV/c) direct-photon yields from Au+Au collisions at sqrt[s_{NN}]=39 and 62.4 GeV. For both beam energies the direct-photon yields are substantially enhanced with respect to expectations from prompt processes, similar to the yields observed in Au+Au collisions at sqrt[s_{NN}]=200. Analyzing the photon yield as a function of the experimental observable dN_{ch}/dη reveals that the low-momentum (>1  GeV/c) direct-photon yield dN_{γ}^{dir}/dη is a smooth function of dN_{ch}/dη and can be well described as proportional to (dN_{ch}/dη)^{α} with α≈1.25. This scaling behavior holds for a wide range of beam energies at the Relativistic Heavy Ion Collider and the Large Hadron Collider, for centrality selected samples, as well as for different A+A collision systems. At a given beam energy, the scaling also holds for high p_{T} (>5  GeV/c), but when results from different collision energies are compared, an additional sqrt[s_{NN}]-dependent multiplicative factor is needed to describe the integrated-direct-photon yield.

Total laparoscopic repair of Spigelian hernia with undescended testis

Spigelian hernia is very rare in the paediatric age group. We present the case of an 11-month-old male child who presented with left Spigelian hernia with the left undescended testis in its sac. Hernia repair with orchidopexy was done using total laparoscopic approach. It is the first reported case of total laparoscopic repair of Spigelian hernia with undescended testis in the paediatric age group.

Pseudorapidity Dependence of Particle Production and Elliptic Flow in Asymmetric Nuclear Collisions of p+Al, p+Au, d+Au, and ^{3}He+Au at sqrt[s_{NN}]=200 GeV

Asymmetric nuclear collisions of p+Al, p+Au, d+Au, and ^{3}He+Au at sqrt[s_{NN}]=200  GeV provide an excellent laboratory for understanding particle production, as well as exploring interactions among these particles after their initial creation in the collision. We present measurements of charged hadron production dN_{ch}/dη in all such collision systems over a broad pseudorapidity range and as a function of collision multiplicity. A simple wounded quark model is remarkably successful at describing the full data set. We also measure the elliptic flow v_{2} over a similarly broad pseudorapidity range. These measurements provide key constraints on models of particle emission and their translation into flow.

Recurrent reciprocal copy number variants: Roles and rules in neurodevelopmental disorders

Deletions and duplications, called reciprocal CNVs when they occur at the same locus, are implicated in neurodevelopmental phenotypes ranging from morphological to behavioral. In this article, we propose three models of how differences in gene expression in deletion and duplication genotypes may result in deleterious phenotypes. To explore these models, we use examples of the similarities and differences in clinical phenotypes of five reciprocal CNVs known to cause neurodevelopmental disorders: 1q21.1, 7q11.23, 15q13.3, 16p11.2, and 22q11.2. These models and examples may inform some insights into better understanding of gene-phenotype relationships. © 2018 Wiley Periodicals, Inc. Develop Neurobiol 78: 519-530, 2018.

Measurements of Multiparticle Correlations in d+Au Collisions at 200, 62.4, 39, and 19.6 GeV and p+Au Collisions at 200 GeV and Implications for Collective Behavior

Recently, multiparticle-correlation measurements of relativistic p/d/^{3}He+Au, p+Pb, and even p+p collisions show surprising collective signatures. Here, we present beam-energy-scan measurements of two-, four-, and six-particle angular correlations in d+Au collisions at sqrt[s_{NN}]=200, 62.4, 39, and 19.6 GeV. We also present measurements of two- and four-particle angular correlations in p+Au collisions at sqrt[s_{NN}]=200  GeV. We find the four-particle cumulant to be real valued for d+Au collisions at all four energies. We also find that the four-particle cumulant in p+Au has the opposite sign as that in d+Au. Further, we find that the six-particle cumulant agrees with the four-particle cumulant in d+Au collisions at 200 GeV, indicating that nonflow effects are subdominant. These observations provide strong evidence that the correlations originate from the initial geometric configuration, which is then translated into the momentum distribution for all particles, commonly referred to as collectivity.

Low Altitude Solar Magnetic Reconnection, Type III Solar Radio Bursts, and X-ray Emissions

Type III solar radio bursts are the Sun's most intense and frequent nonthermal radio emissions. They involve two critical problems in astrophysics, plasma physics, and space physics: how collective processes produce nonthermal radiation and how magnetic reconnection occurs and changes magnetic energy into kinetic energy. Here magnetic reconnection events are identified definitively in Solar Dynamics Observatory UV-EUV data, with strong upward and downward pairs of jets, current sheets, and cusp-like geometries on top of time-varying magnetic loops, and strong outflows along pairs of open magnetic field lines. Type III bursts imaged by the Murchison Widefield Array and detected by the Learmonth radiospectrograph and STEREO B spacecraft are demonstrated to be in very good temporal and spatial coincidence with specific reconnection events and with bursts of X-rays detected by the RHESSI spacecraft. The reconnection sites are low, near heights of 5-10 Mm. These images and event timings provide the long-desired direct evidence that semi-relativistic electrons energized in magnetic reconnection regions produce type III radio bursts. Not all the observed reconnection events produce X-ray events or coronal or interplanetary type III bursts; thus different special conditions exist for electrons leaving reconnection regions to produce observable radio, EUV, UV, and X-ray bursts.

Nuclear Dependence of the Transverse-Single-Spin Asymmetry for Forward Neutron Production in Polarized p+A Collisions at sqrt[s_{NN}]=200 GeV

During 2015, the Relativistic Heavy Ion Collider (RHIC) provided collisions of transversely polarized protons with Au and Al nuclei for the first time, enabling the exploration of transverse-single-spin asymmetries with heavy nuclei. Large single-spin asymmetries in very forward neutron production have been previously observed in transversely polarized p+p collisions at RHIC, and the existing theoretical framework that was successful in describing the single-spin asymmetry in p+p collisions predicts only a moderate atomic-mass-number (A) dependence. In contrast, the asymmetries observed at RHIC in p+A collisions showed a surprisingly strong A dependence in inclusive forward neutron production. The observed asymmetry in p+Al collisions is much smaller, while the asymmetry in p+Au collisions is a factor of 3 larger in absolute value and of opposite sign. The interplay of different neutron production mechanisms is discussed as a possible explanation of the observed A dependence.

Structural explanation of poor prognosis of amyotrophic lateral sclerosis in the non-demented state

BACKGROUND AND PURPOSE

Amyotrophic lateral sclerosis (ALS), a motor neuron disease, is associated with various cortical symptoms including mild cognitive decline with behavior changes, suggesting the involvement of extra-motor areas in ALS. Our aim was to investigate the specific patterns of brain atrophy in sporadic, impaired ALS patients without commonly known genetic mutations using voxel-based morphometry.

MATERIALS AND METHODS

Forty-seven patients with sporadic ALS and 28 age-matched healthy controls were recruited. ALS participants were divided into three groups according to comprehensive neuropsychological testing: pure (ALS-pure), cognitive impairment (ALSci) and behavioral impairment (ALSbi). Quantitative comparison of brain atrophy patterns was performed amongst these three groups using voxel-based analysis. All analyses were adjusted for total intracranial volume, age, sex, disease duration and functional disability score.

RESULTS

The ALSci group exhibited decreased volume in the left cerebellum, fusiform gyrus, optic radiations and corticospinal tracts compared to healthy controls. ALSci patient imaging showed decreased brain volume in the bilateral cerebellum, right putamen gray matter and bilateral superior longitudinal fasciculi white matter compared to pure ALS patients (P < 0.001 uncorrected, corrected for the entire volume). Compared to healthy controls, ALS-pure and ALSbi groups did not show any significant volume changes in gray and white matter.

CONCLUSIONS

These findings also support the hypothesis that ALS pathogenesis has a dual focality of onset (cortex and anterior horn) with contiguous spread outwards. Additionally, neuropsychological features may be an important predictor of progression and survival rates in ALS.

Congenital facial teratoma in a neonate: Surgical management and outcome

Teratomas are among the most common tumors of childhood, but craniofacial teratomas are rare. They can be diagnosed antenatally. Craniofacial teratomas may cause airway obstruction in the newborn. We present a case of a newborn male child who was diagnosed to have a facial tumor in the 8^th month of gestation. He was delivered normally and had no respiratory or feeding difficulties. He was also found to have a cleft palate. Serum alpha fetoprotein levels were normal. He underwent excision on day of life 9. At 11 months follow-up, he is well with no evidence of recurrence and good functional outcome.

Simultaneous and coordinated rotational switching of all molecular rotors in a network

A range of artificial molecular systems has been created that can exhibit controlled linear and rotational motion. In the further development of such systems, a key step is the addition of communication between molecules in a network. Here, we show that a two-dimensional array of dipolar molecular rotors can undergo simultaneous rotational switching when applying an electric field from the tip of a scanning tunnelling microscope. Several hundred rotors made from porphyrin-based double-decker complexes can be simultaneously rotated when in a hexagonal rotor network on a Cu(111) surface by applying biases above 1 V at 80 K. The phenomenon is observed only in a hexagonal rotor network due to the degeneracy of the ground-state dipole rotational energy barrier of the system. Defects are essential to increase electric torque on the rotor network and to stabilize the switched rotor domains. At low biases and low initial rotator angles, slight reorientations of individual rotors can occur, resulting in the rotator arms pointing in different directions. Analysis reveals that the rotator arm directions are not random, but are coordinated to minimize energy via crosstalk among the rotors through dipolar interactions.

A systematic review and meta-analysis of the relative efficacy and safety of treatment regimens for HIV-associated cerebral toxoplasmosis: is trimethoprim-sulfamethoxazole a real option?

OBJECTIVES

The objective of this study was to perform a systematic review and meta-analysis of the literature to evaluate the efficacy and safety of therapies for cerebral toxoplasmosis in HIV-infected adults. The pyrimethamine plus sulfadiazine (P-S) combination is considered the mainstay therapy for cerebral toxoplasmosis and pyrimethamine plus clindamycin (P-C) is the most common alternative treatment. Although trimethoprim-sulfamethoxazole (TMP-SMX) has potential advantages, its use is infrequent.

METHODS

We searched PubMed and four other databases to identify randomized controlled trials (RCTs) and cohort studies. Two independent reviewers searched the databases, identified studies and extracted data. Risk ratios (RRs) were pooled across studies using random-effects models.

RESULTS

Nine studies were included (five RCTs, three retrospective cohort studies and one prospective cohort study). In comparison to P-S, treatment with P-C or TMP-SMX was associated with similar rates of partial or complete clinical response [P-C: RR 0.87; 95% confidence interval (CI) 0.70-1.08; TMP-SMX: RR 0.97; 95% CI 0.78-1.21], radiological response (P-C: RR 0.92; 95% CI 0.82-1.03), skin rash (P-C: RR 0.81; 95% CI 0.56-1.17; TMP-SMX: RR 0.17; 95% CI 0.02-1.29), gastrointestinal impairment (P-C: RR 5.16; 95% CI 0.66-40.11), and drug discontinuation because of adverse events (P-C: RR 0.32; 95% CI 0.07-1.47). Liver impairment was more frequent with P-S than P-C (P-C vs. P-S: RR 0.48; 95% CI 0.24-0.97).

CONCLUSIONS

The current evidence fails to identify a superior regimen in terms of relative efficacy or safety for the treatment of HIV-associated cerebral toxoplasmosis. Use of TMP-SMX as preferred treatment may be consistent with the available evidence and other real-world considerations. Larger comparative studies are needed.

Design, synthesis and microbiological evaluation of ampicillin-tetramic acid hybrid antibiotics

Exploiting iron-uptake pathways by conjugating β-lactam antibiotics with iron-chelators such as catechol and hydroxamic acid is a proven strategy to overcome permeability-related resistance in Gram-negative bacteria. Since naturally occurring iron chelating tetramic acids have not been previously examined for this purpose, an exploratory series of novel ampicillin-tetramic acid hybrids that structurally resemble ureidopenicillins was designed and synthesized. The new analogs were evaluated for the ability to chelate iron and their MIC activities determined against a representative panel of clinically significant bacterial pathogens. The tetramic acid β-lactam hybrids demonstrated a high affinity to iron in the order of 10⁻³⁰ M³. The hybrids were less active against Gram-positive bacteria. However, against Gram-negative bacteria, their activity was species dependent with several hybrids displaying improved activity over ampicillin against wild-type Pseudomonas aeruginosa. The anti-Gram-negative activities of the hybrids improved in the presence of clavulanic acid revealing that the tetramic acid moiety did not provide added protection against β-lactamases. Additionally, the hybrids were found to be efflux pump substrates as their activities markedly improved against pump-inactivated strains. Unlike the catechol and hydroxamic acid siderophore β-lactam conjugates, the activities of the hybrids did not improve under iron-deficient conditions. These results suggest that the tetramic acid hybrids gain permeability via different membrane receptors, or they are out competed by native bacterial siderophores with stronger affinities for iron. This study provides a foundation for the further exploitation of the tetramic acid moiety to achieve novel β-lactam anti-Gram-negative agents, providing that efflux and β-lactamase mediated resistance is addressed.

ID: 103: COMPARATIVE ANTIMICROBIAL EFFICACY OF TWO HAND-HYGIENE PRODUCTS IN INTENSIVE CARE UNITS: A RANDOMIZED CONTROLLED TRIAL

Background

Contaminated hands of healthcare workers (HCW) are an important source of transmission of healthcare-associated infections in the intensive care unit (ICU). Alcohol-based hand sanitizers, the primary form of hand hygiene in healthcare settings, are effective but do not provide sustained antimicrobial activity. The aim of this study was to quantitatively visualize the immediate and persistent antimicrobial effectiveness of 1% chlorhexidine gluconate (CHG)+61% ethanol versus 70% ethanol at 2-time points: immediately after application on normal skin flora and after hand contamination with environmental microbes in the ICU.

Methods

A prospective, randomized, double-blind clinical trial with crossover design and paired data was done in three medical ICUs in a large academic teaching hospital. Eligible personnel included permanent and temporary HCWs involved with direct patient care in the ICU. HCWs were randomly assigned to one of two hand hygiene products using a crossover design. Hand prints were obtained immediately after hand hygiene was performed and again after spending >5 minutes in the ICU common areas. The numbers of aerobic colony-forming units (CFU) were compared for the two groups after log transformation.

Results

A total of 51 HCWs completed testing of both products. On bare hands, use of CHG+alcohol was associated with significantly lower recovery of aerobic CFU, both immediately after use (0.27±0.38 and 0.88±0.55 log10 CFU; P=.035) and after spending time in the ICU common areas (1.81±0.48 and 2.17±0.35 log10 CFU; P<.0001). Both of the antiseptics were well tolerated by HCWs with no adverse events.

Conclusions

The CHG+alcohol product was associated with significantly lower aerobic bacterial colony counts on hands of healthcare personnel, both immediately after use and after spending time in ICU common areas. Further studies are needed to determine if the use of the CHG+alcohol product results in sustained antimicrobial protection against healthcare-associated pathogens on hands of HCW.

ID: 100: A SYSTEMATIC REVIEW AND META-ANALYSIS OF THE RELATIVE EFFICACY AND SAFETY OF TREATMENT REGIMENS FOR HIV-ASSOCIATED CEREBRAL TOXOPLASMOSIS

Aim

The objective of this study was to perform a systematic review and meta-analysis of the literature to evaluate efficacy and safety of therapies for cerebral toxoplasmosis in HIV-infected adults. Pyrimethamine plus sulfadiazine (P-S) combination is considered the mainstay therapy for cerebral toxoplasmosis and pyrimethamine plus clindamycin (P-C) is the most common alternative treatment. Although, trimethoprim-sulfamethoxazole (TMP-SMX) has potential advantages, its use is infrequent.

Methods

Design: Systematic review and meta-analysis. We searched PubMed and 4 other databases to identify randomized controlled trials (RCTs) and cohort studies. Two independent reviewers searched and identified studies and extracted data. Risk ratios (RRs) were pooled across studies using random-effects models.

Results

Nine studies were included (5 RCTs, 3 retrospective cohorts, 1 prospective cohort). In comparison to P-S, treatment with P-C or TMP-SMX had similar partial or complete clinical response (P-C: RR 0.87, 95%CI 0.70–1.08; TMP-SMX: RR 0.97, 95%CI 0.78–1.21), radiological response (P-C: RR 0.92, 95%CI 0.82–1.03), skin rash (P-C: RR 0.81, 95%CI 0.56–1.17; TMP-SMX: RR 0.17, 95%CI 0.02–1.29), gastrointestinal impairment (P-C: RR 5.16, 95%CI 0.66–40.11), and drug discontinuation due to adverse events (P-C: RR 0.32, 95%CI 0.07–1.47). Liver impairment was more frequent with P-S than P-C (P-C vs P-S: RR 0.48, 95% CI 0.24–0.97).

Conclusions

The current evidence fails to identify one superior regimen in terms of relative efficacy or safety for the treatment of HIV-associated cerebral toxoplasmosis. Use of TMP-SMX as preferred treatment may be consistent with the available evidence and other real world considerations. Larger comparative studies are needed.

ID: 24: BENEFITS AND RISKS OF WARFARIN WITH AND WITHOUT ASPIRIN IN PATIENTS WITH CORONARY ARTERY DISEASE OR CEREBROVASCULAR ACCIDENT: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Background

Previous studies have shown that secondary prophylaxis of non-embolic stroke remains challenging. Randomized controlled trials (RCTs) evaluating warfarin with or without aspirin to prevent stroke have yielded mixed results. We conducted a meta-analysis of RCTs to evaluate the efficacy of warfarin (with and without aspirin) in patients with coronary artery disease (CAD) or ischemic stroke/ transient ischemic attack (TIA).

Methods

We searched 6 electronic databases published from 1980–2014. RCTs reporting the benefits (reduced incidence of stroke) and risks (mortality, intracranial bleeds, major and minor bleeds) of warfarin (with and without aspirin) therapy were included. Trials were stratified by intensity of the therapeutic international normalized ratio (INR): low (INR<2), intermediate (INR 2–3) and high (INR>3). Risk ratios (RRs) were pooled using random-effects models.

Results

Twenty-five RCTs (30,939 patients) met our inclusion criteria. Intermediate intensity warfarin with aspirin compared with aspirin alone significantly reduced the risk of secondary strokes [RR 0.48, 95% confidence interval (CI) 0.29–0.80], but increased the risk of major bleeding (RR 2.54, CI 1.70–3.79); there were no significant differences in mortality (RR 1.00, CI 0.80–1.25) and intracranial bleeding (RR 3.03, CI 0.48–19.20). Intermediate intensity warfarin without aspirin compared with aspirin alone, significantly increased major bleeding (RR 2.11, CI 1.45–3.06); there were no significant differences for stroke (RR 0.84, CI 0.66–1.08), mortality (RR1.21, CI 0.90–1.63) and intracranial bleeding (RR 1.87, CI 0.94–3.70).

Conclusions

Use of intermediate intensity warfarin with aspirin reduced the risk of stroke at the price of increased bleeding. Most anticoagulation increased the risk of major bleeding with no effect on mortality. Studies with oral anticoagulants with aspirin for secondary prevention should be considered.

ID: 43: INSULIN RESISTANCE AND ENDOMETRIAL CANCER RISK: A SYSTEMATIC REVIEW AND META-ANALYSIS

Aim

It has been suggested that chronic hyperinsulinemia from insulin resistance is involved in the etiology of endometrial cancer (EC). We performed a systematic review and meta-analysis to assess whether insulin resistance is associated with the risk of EC.

Methods

We searched PubMed-Medline, Embase, Scopus, and Web of Science for articles published from database inception through 30th September 2014. We included all observational studies evaluating components defining insulin resistance in women with and without EC. Quality of the included studies was assessed by Newcastle-Ottawa scale. Random effects models and inverse variance method were used to meta-analyze the association between insulin resistance components and EC.

Results

Twenty-five studies satisfied our inclusion criteria. Fasting insulin levels (13 studies, n=4088) were higher in women with EC (mean difference [MD] 33.94 pmol/L, 95% confidence interval [CI] 15.04–52.85, p=0.0004). No differences were seen in postmenopausal versus pre- and postmenopausal subgroup analysis. Similarly, non-fasting/fasting C-peptide levels (five studies, n=1938) were also higher in women with EC (MD 0.14 nmol/L, 95% CI 0.08–0.21, p<0.00001). Homeostatic model assessment – insulin resistance (HOMA-IR) values (six studies, n=1859) in EC patients were significantly higher than in women without EC (MD 1.13, 95% CI 0.20–2.06, p=0.02). There was moderate-to-high heterogeneity among the included studies.

Conclusion

Currently available epidemiologic evidence is suggestive of significantly higher risk of EC in women with high fasting insulin, non-fasting/fasting C-peptide and HOMA-IR values.

ID: 98: EFFECTIVENESS OF DAILY CHLORHEXIDINE BATHING FOR REDUCING GRAM NEGATIVE INFECTIONS: A META-ANALYSIS

Background

Multiple studies have demonstrated that daily chlorhexidine gluconate (CHG) bathing is associated with a significant reduction in infections caused by Gram positive pathogens. However, there is limited data on the effectiveness of daily CHG bathing on gram negative infections. The aim of this study was to determine if daily CHG bathing is effective in controlling and preventing gram negative infections in adult ICU patients.

Methods

We searched MEDLINE and 3 other databases for original studies comparing daily CHG bathing to soap and water bathing. All studies investigating the effectiveness of daily CHG bathing on gram negative infections were eligible. Two investigators extracted data independently on baseline characteristics, study design, form and concentration of CHG, incidence and outcomes related to gram negative infections. Data were combined by means of a random-effects model and pooled relative risk ratios (RRs) and 95% confidence intervals (CIs) were derived for overall gram negative infections and individual gram negative pathogens.

Results

Eleven studies (n=27,793 patients) met the inclusion criteria. Of these, 13,852 patients received daily CHG bathing, and 13,941 patients daily bathing with soap and water. Daily CHG bathing was not associated with a lower risk of gram negative infections (2.03% vs. 2.38%; RR 0.84; 95%CI: 0.64–1.09, P=.19). Subgroup analysis demonstrated that daily CHG bathing significantly reduced the risk of gram negative infections caused by Acinetobacter (RR, 0.33; 95% CI: 0.17–0.66, P<.00001) but was not effective for E. coli, Klebsiella, Enterobacter and Pseudomonas associated gram negative infections.

Conclusions

In a meta-analysis of 11 studies, the use of daily CHG was not associated with a lower risk of gram negative infections. However, daily CHG bathing appears to be effective for Acinetobacter associated gram negative infections. There is a need for larger and better designed trials with adequate power with gram negative infections as the primary endpoint to determine the effectiveness of daily CHG bathing.

Abstract ID: 98 Figure 1

Centrality-Dependent Modification of Jet-Production Rates in Deuteron-Gold Collisions at √[s(NN)]=200 GeV

Jet production rates are measured in p+p and d+Au collisions at sqrt[s_{NN}]=200  GeV recorded in 2008 with the PHENIX detector at the Relativistic Heavy Ion Collider. Jets are reconstructed using the R=0.3 anti-k_{t} algorithm from energy deposits in the electromagnetic calorimeter and charged tracks in multiwire proportional chambers, and the jet transverse momentum (p_{T}) spectra are corrected for the detector response. Spectra are reported for jets with 12<p_{T}<50  GeV/c, within a pseudorapidity acceptance of |η|<0.3. The nuclear-modification factor (R_{dAu}) values for 0%-100% d+Au events are found to be consistent with unity, constraining the role of initial state effects on jet production. However, the centrality-selected R_{dAu} values and central-to-peripheral ratios (R_{CP}) show large, p_{T}-dependent deviations from unity, challenging the conventional models that relate hard-process rates and soft-particle production in collisions involving nuclei.

Outcomes of Clostridium difficile infection in pediatric solid organ transplant recipients

BACKGROUND

The incidence of Clostridium difficile infection (CDI) is increasing in the pediatric population. Pediatric recipients of solid organ transplantation (SOT) may be at a higher risk for CDI in part because of chemotherapy and prolonged hospitalization.

METHODS

We utilized data from the Healthcare Cost and Utilization Project Kids' Inpatient Database to study the incidence and outcomes related to CDI as a complicating factor in pediatric recipients of SOT.

RESULTS

Our results demonstrate that hospitalized children with SOT have increased rates of infection, with the greatest risk for younger children with additional comorbidities and severe illness. The type of transplanted organ affects the risk for CDI, with the lowest incidence observed in renal transplant patients.

CONCLUSION

The occurrence of CDI in the pediatric SOT population contributes to a greater length of stay and higher hospital charges. However, CDI is not an independent predictor of increased in- hospital mortality in these patients.

Identification and Successful Negotiation of a Metabolic Checkpoint in Direct Neuronal Reprogramming

Despite the widespread interest in direct neuronal reprogramming, the mechanisms underpinning fate conversion remain largely unknown. Our study revealed a critical time point after which cells either successfully convert into neurons or succumb to cell death. Co-transduction with Bcl-2 greatly improved negotiation of this critical point by faster neuronal differentiation. Surprisingly, mutants with reduced or no affinity for Bax demonstrated that Bcl-2 exerts this effect by an apoptosis-independent mechanism. Consistent with a caspase-independent role, ferroptosis inhibitors potently increased neuronal reprogramming by inhibiting lipid peroxidation occurring during fate conversion. Genome-wide expression analysis confirmed that treatments promoting neuronal reprogramming elicit an anti-oxidative stress response. Importantly, co-expression of Bcl-2 and anti-oxidative treatments leads to an unprecedented improvement in glial-to-neuron conversion after traumatic brain injury in vivo, underscoring the relevance of these pathways in cellular reprograming irrespective of cell type in vitro and in vivo.

Hepatorenal syndrome in hospitalized patients with chronic liver disease: results from the Nationwide Inpatient Sample 2002–2012

Hepatorenal syndrome (HRS) is one of the leading causes of hospitalizations in patients with chronic liver disease (CLD). We conducted a retrospective national database study to determine the epidemiology of HRS in hospitalized patients with CLD. Data from a Nationwide Inpatient Sample were extracted from 2002 to 2012 using ICD-9-CM codes related to CLD and HRS. The following outcomes were examined: in-hospital mortality, total charges, length of stay (LOS), patient demographics, procedures, complications, and comorbidities. Statistical analysis including regression was performed to examine factors associated with HRS. During 2002–2012, hospital discharges related to CLD increased from 407,246 to 836,475 with an increase of 37.9% for HRS as a complication in this population. Patients with CLD and HRS had worse outcomes compared with patients with CLD without HRS. This was manifested as a higher mortality rate (32.0% vs 10.3%), increased LOS (median 7 vs 5 days), and increased hospital costs (median $16,000 vs $11,000). Logistic regression demonstrated that HIV/AIDS (adjusted OR 2.9, 95% CI 2.2 to 3.9), pneumonia (aOR 2.8, 95% CI 2.3 to 3.2), and esophageal variceal bleeding (aOR 1.9, 95% CI 1.7 to 2.0) were associated with higher mortality in patients with HRS. Conversely, liver transplantation (aOR 0.1, 95% CI 0.1 to 0.1), transjugular intrahepatic portosystemic shunt (aOR 0.5, 95% CI 0.4 to 0.6), and hospitalization in the Midwest region of the USA (aOR 0.7, 95% CI 0.6 to 0.7) were associated with reduced mortality. The incidence of HRS in hospitalized patients with CLD increased during 2002–2012. HRS is associated with significant mortality and morbidity in these patients.

Measurements of Elliptic and Triangular Flow in High-Multiplicity 3He+Au Collisions at √(s(NN))=200 GeV

We present the first measurement of elliptic (v(2)) and triangular (v(3)) flow in high-multiplicity (3)He+Au collisions at √(s(NN))=200  GeV. Two-particle correlations, where the particles have a large separation in pseudorapidity, are compared in (3)He+Au and in p+p collisions and indicate that collective effects dominate the second and third Fourier components for the correlations observed in the (3)He+Au system. The collective behavior is quantified in terms of elliptic v(2) and triangular v(3) anisotropy coefficients measured with respect to their corresponding event planes. The v(2) values are comparable to those previously measured in d+Au collisions at the same nucleon-nucleon center-of-mass energy. Comparisons with various theoretical predictions are made, including to models where the hot spots created by the impact of the three (3)He nucleons on the Au nucleus expand hydrodynamically to generate the triangular flow. The agreement of these models with data may indicate the formation of low-viscosity quark-gluon plasma even in these small collision systems.

Incorporating advanced language models into the P300 speller using particle filtering

OBJECTIVE

The P300 speller is a common brain-computer interface (BCI) application designed to communicate language by detecting event related potentials in a subject's electroencephalogram signal. Information about the structure of natural language can be valuable for BCI communication, but attempts to use this information have thus far been limited to rudimentary n-gram models. While more sophisticated language models are prevalent in natural language processing literature, current BCI analysis methods based on dynamic programming cannot handle their complexity.

APPROACH

Sampling methods can overcome this complexity by estimating the posterior distribution without searching the entire state space of the model. In this study, we implement sequential importance resampling, a commonly used particle filtering (PF) algorithm, to integrate a probabilistic automaton language model.

MAIN RESULT

This method was first evaluated offline on a dataset of 15 healthy subjects, which showed significant increases in speed and accuracy when compared to standard classification methods as well as a recently published approach using a hidden Markov model (HMM). An online pilot study verified these results as the average speed and accuracy achieved using the PF method was significantly higher than that using the HMM method.

SIGNIFICANCE

These findings strongly support the integration of domain-specific knowledge into BCI classification to improve system performance.

Measurement of Long-Range Angular Correlation and Quadrupole Anisotropy of Pions and (Anti)Protons in Central d+Au Collisions at sqrt[s_{NN}]=200 GeV

We present azimuthal angular correlations between charged hadrons and energy deposited in calorimeter towers in central d+Au and minimum bias p+p collisions at sqrt[s_{NN}]=200 GeV. The charged hadron is measured at midrapidity |η|<0.35, and the energy is measured at large rapidity (-3.7<η<-3.1, Au-going direction). An enhanced near-side angular correlation across |Δη|>2.75 is observed in d+Au collisions. Using the event plane method applied to the Au-going energy distribution, we extract the anisotropy strength v_{2} for inclusive charged hadrons at midrapidity up to p_{T}=4.5 GeV/c. We also present the measurement of v_{2} for identified π^{±} and (anti)protons in central d+Au collisions, and observe a mass-ordering pattern similar to that seen in heavy-ion collisions. These results are compared with viscous hydrodynamic calculations and measurements from p+Pb at sqrt[s_{NN}]=5.02 TeV. The magnitude of the mass ordering in d+Au is found to be smaller than that in p+Pb collisions, which may indicate smaller radial flow in lower energy d+Au collisions.

Biofouling of surgical power tools during routine use

Surgical power tools (SPTs) are frequently used in many surgical specialties such as dentistry, orthopaedics, ophthalmology, neurology, and podiatry. They have complex designs that may restrict access to cleaning and sterilization agents and frequently become contaminated with microbial and tissue residues following use. Due to these challenges, surgical power tools can be considered the weak link in the decontamination cycle and present a potential for iatrogenic transmission of infection. We aimed to review the existing literature on the decontamination of surgical power tools and associated iatrogenic transmission of infection. A search of the medical literature was performed using Ovid online using the following databases: Ovid Medline 1950-2014, Embase 1980-2014, and EBM Reviews Full Text--Cochrane DSR, ACP Journal Club, and Dare. Despite challenges to decontamination processes, reported episodes of iatrogenic infection directly linked to SPTs appear rare. This may reflect a true picture but more likely represents incomplete reporting, failure to investigate power tools, or lack of surveillance linking surgical site infections (SSIs) to power tools. Healthcare professionals should be aware of the complexities associated with the decontamination of different SPTs, and should review manufacturers' reprocessing instructions prior to purchase. More clarity is required in the manufacturers' validation of these reprocessing instructions. This particularly applies to the emerging surgical robot systems that present extreme challenges to decontamination between uses. Investigation of cross-infection incidents or SSI surveillance should include an element of assessment of SPT decontamination to further elucidate the contribution of SPTs to skin and soft tissue infections.

Trends of vulvar cancer

Vulvar cancer is an uncommon malignancy of the female genital tract in developing countries, accounting for 3% of gynaecological cancers. Here, cervical cancer is an everyday problem; ovarian cancer is the second commonest gynaecological cancer; endometrial is less common and vulvar cancer is rare. It is advanced at admission, though is a visible cancer. Records of women who had histopathologically proven vulvar cancer over 24 years were analysed for epidemiological status and preventive possibilities. During the analysis period, 9,419 total cancer cases were diagnosed; 4,726 (50.17%) were in women. A total of 39.52% (1,868 of 4,726) were gynaecological; 18 cases were vulvar (0.38% of the 4,726 women with cancer) and 0.96% of the 1,868 gynaecological cancer cases. Decreasing trends were 2.25% between 1984 and 1988, down to 0.33% between 2004 and 2008. Leading presenting complaints were: dyspareunia, 88.88% (16 of 18 patients); pruritus 13; ulcers 14; vulvar swelling 12 and urinary problems 13. Dystrophy was present in 8 of 18 cases. Overall, four had stage I, one stage II, three stage III and four stage IV disease at admission; all at labia majora or minora, some too advanced to know origin. Four women with metastasis in the lungs, liver and bones could only be given palliation. While vulvar cancer is uncommon, advanced disease at admission is a concern. Awareness is essential. Research is needed as to why cervical cancer is common and vulvar uncommon, as HPV plays a major aetiological role, so that cervical cancer can be prevented, with early diagnosis, management of vulvar cancer should also be available.

Cold-nuclear-matter effects on heavy-quark production at forward and backward rapidity in d + Au collisions at √sNN = 200 GeV

The PHENIX experiment has measured open heavy-flavor production via semileptonic decay over the transverse momentum range 1 < p(T) < 6  GeV/c at forward and backward rapidity (1.4 < |y| < 2.0) in d+Au and p + p collisions at √sNN = 200  GeV. In central d+Au collisions, relative to the yield in p + p collisions scaled by the number of binary nucleon-nucleon collisions, a suppression is observed at forward rapidity (in the d-going direction) and an enhancement at backward rapidity (in the Au-going direction). Predictions using nuclear-modified-parton-distribution functions, even with additional nuclear-p(T) broadening, cannot simultaneously reproduce the data at both rapidity ranges, which implies that these models are incomplete and suggests the possible importance of final-state interactions in the asymmetric d + Au collision system. These results can be used to probe cold-nuclear-matter effects, which may significantly affect heavy-quark production, in addition to helping constrain the magnitude of charmonia-breakup effects in nuclear matter.

Azimuthal-angle dependence of charged-pion-interferometry measurements with respect to second- and third-order event planes in Au+Au collisions at √[S(NN)]=200 GeV

Charged-pion-interferometry measurements were made with respect to the second- and third-order event plane for Au+Au collisions at sqrt[s_{NN}]=200  GeV. A strong azimuthal-angle dependence of the extracted Gaussian-source radii was observed with respect to both the second- and third-order event planes. The results for the second-order dependence indicate that the initial eccentricity is reduced during the medium evolution, which is consistent with previous results. In contrast, the results for the third-order dependence indicate that the initial triangular shape is significantly reduced and potentially reversed by the end of the medium evolution, and that the third-order oscillations are largely dominated by the dynamical effects from triangular flow.