Citations

AbstractTwo‐wing flyingfish (Exocoetus spp.) are widely distributed, epipelagic, mid‐trophic organisms that feed on zooplankton and are preyed upon by numerous predators (e.g., tunas, dolphinfish, tropical seabirds), yet an understanding of their speciation and systematics is lacking. As a model of epipelagic fish speciation and to investigate mechanisms that increase biodiversity, we studied the phylogeny and biogeography of Exocoetus, a highly abundant holoepipelagic fish taxon of the tropical open ocean. Morphological and molecular data were used to evaluate the phylogenetic relationships, species boundaries, and biogeographic patterns of the five putative Exocoetus species. We show that the most widespread species (E. volitans) is sister to all other species, and we find no evidence for cryptic species in this taxon. Sister relationship between E. monocirrhus (Indo‐Pacific) and E. obtusirostris (Atlantic) indicates the Isthmus of Panama and/or Benguela Barrier may have played a role in their divergence via allopatric speciation. The sister species E. peruvianus and E. gibbosus are found in different regions of the Pacific Ocean; however, our molecular results do not show a clear distinction between these species, indicating recent divergence or ongoing gene flow. Overall, our phylogeny reveals that the most spatially restricted species are more recently derived, suggesting that allopatric barriers may drive speciation, but subsequent dispersal and range expansion may affect the distributions of species.

Blast traumatic brain injury (bTBI) may happen due to sudden blast and high-frequency loads. Due to the moral issues and the burden of experimental approaches, using computational methods such as finite element analysis (FEA) can be effective. Several finite element studies have focused on the effects of TBI to anticipate and understand the brain dynamic response. One of the most important factors in every FEA study of bTBI is the accurate modeling of brain tissue material properties. The main goal of this study is a comparison of different brain tissue constitutive models to understand the dynamic response of brain under an identical blast load. The multi-material FE modeling of the human head has several limitations such as its complexity and consequently high computational costs. Therefore, a spherical head model is modeled which suggests more straightforward observation/understanding of the FE modeling of skull (solid), CSF (fluid), and the brain tissue. Three different material models are considered for the brain tissue, namely hyperelastic, viscoelastic, and hyperviscoelastic. Brain dynamic responses are studied in terms of the head kinematics (linear acceleration), intracranial pressure (ICP), shear stress, and maximum mechanical strain. Our results showed that the hyperelastic model predicts larger ICP and shear than other constitutive brain tissue models. However, all material models predicted similar shear strain and head accelerations.

Skull deformation and vibration has been hypothesized to be an injury mechanism when the human head undergoes an impact scenario. The extent that skull deformation may increase the risk of traumatic brain injury, however, is not well understood. This computational study explains whether skull deformation has any impact on the variation of intracranial pressure (ICP). To this end, a finite element head model including major anatomical components of the human head was employed. The head model has been validated against ICP variations on the brain. The impact simulations were carried out using a rigid cylindrical impactor. The scenarios were frontal impacts with the impactor hitting the forehead of the head model at two impact severity levels. In order to examine the effect of skull elasticity on the stress wave propagation inside the cranium under an external applied force, the skull was also taken as a rigid body with the same density as the elastic one, and the result were compared with those obtained with the deformable skull. For the two cases, the variation of ICPs at the coup and countercoup sites were recorded and compared. The results of the study showed that, for the case studies presented here, the deformation of skull didn’t increase the level of ICP inside the brain. It was concluded that the skull rapid body motion might be responsible for brain injuries.

Blast-induced traumatic brain injury (bTBI), is defined as a type of acquired brain injury that occurs upon the interaction of the human head with blast-generated high-pressure shockwaves. Lack of experimental studies due to moral issues, have motivated the researchers to employ computational methods to study the bTBI mechanisms. Accordingly, a nonlinear finite element (FE) analysis was employed to study the interaction of both unprotected and protected head models with explosion pressure waves. The head was exposed to the incoming shockwaves from front, back, and side directions. The main goal was to examine the effects of head protection tools and the direction of blast waves on the tissue and kinematical responses of the brain. Generation, propagation, and interactions of blast waves with the head were modeled using an arbitrary Lagrangian-Eulerian (ALE) method and a fluid-structure interaction (FSI) coupling algorithm. The FE simulations were performed using Ls-Dyna, a transient, nonlinear FE code. Side blast predicted the highest mechanical responses for the brain. Moreover, the protection assemblies showed to significantly alter the blast flow mechanics. Use of faceshield was also observed to be highly effective in the front blast due to hindering of shockwaves.

Background: Surgical indications for Scheuermann kyphosis are variable. We sought to evaluate the characteristics of patients undergoing operative versus nonoperative treatment of Scheuermann kyphosis to better understand current practices and the factors which contribute to the decision for surgical management. Methods: Multicenter prospective cohort study. We evaluated consecutive patients presenting with Scheuermann kyphosis. Patients underwent either surgical or nonoperative management according to surgeon and patient discretion. Preoperative patient-reported outcome measures (Scoliosis Research Society and Spinal Appearance Questionnaire scores), demographics, and radiographic characteristics were assessed. Results: Overall, 150 patients with Scheuermann kyphosis were enrolled, with 77 choosing nonoperative treatment and 73 treated operatively. Compared with the nonoperative cohort, patients treated operatively were older (16.3±2.0 vs. 15.1±2.2, P=0.0004), and had higher body mass index (26.3±7.2 vs. 22.7±6.5, P=0.003), had greater T2-T12 kyphosis (71±14 degrees vs. 61±12 degrees, P<0.001), increased pelvic incidence (46 vs. 41 degrees, P=0.03) and pelvic tilt (10 vs. 3 degrees, P=0.03). There was no detected difference in maximal sagittal Cobb angle in the operative versus nonoperative patients (73±11 vs. 70±12 degrees, P=0.11). Functionally, the operative patients had worse Scoliosis Research Society pain scores (3.7±0.9 vs. 4.1±0.7, P=0.0027) and appearance scores (2.9±0.7 vs. 3.4±0.8, P <0.0001). Conclusions: Patients undergoing surgical management of Scheuermann disease were more likely to have large body mass index and worse pain scores. Other factors beyond radiographic measurement likely contribute to the decision for surgical management of Scheuermann kyphosis. Level of Evidence: Level II.

AbstractDisease OverviewRing sideroblasts (RS) are erythroid precursors with abnormal perinuclear mitochondrial iron accumulation. Two myeloid neoplasms defined by the presence of RS, include refractory anemia with ring sideroblasts (RARS), now classified under myelodysplastic syndromes with RS (MDS‐RS) and RARS with thrombocytosis (RARS‐T); now called myelodysplastic/myeloproliferative neoplasm with RS and thrombocytosis (MDS/MPN‐RS‐T).DiagnosisMDS‐RS is a lower risk MDS, with single or multilineage dysplasia (SLD/MLD), <5% bone marrow (BM) blasts and ≥15% BM RS (≥5% in the presence of SF3B1 mutations). MDS/MPN‐RS‐T, now a formal entity in the MDS/MPN overlap syndromes, has diagnostic features of MDS‐RS‐SLD, along with a platelet count ≥ 450 × 10(9)/L and large atypical megakaryocytes (similar to BCR‐ABL1 negative MPN).Mutations and KaryotypeMutations in SF3B1 are seen in ≥80% of patients with MDS‐RS‐SLD and MDS/MPN‐RS‐T, and strongly correlate with the presence of BM RS; MDS/MPN‐RS‐T patients also demonstrate JAK2V617F, ASXL1, DNMT3A, SETBP1, and TET2 mutations; with ASXL1/SETBP1 mutations adversely impacting survival. Cytogenetic abnormalities are uncommon in both diseases.Risk stratificationMost patients with MDS‐RS‐SLD are stratified into lower risk groups by the revised‐International Prognostic Scoring System (R‐IPSS). Disease outcome in MDS/MPN‐RS‐T is better than that of MDS‐RS‐SLD, but worse than that of essential thrombocythemia. Both diseases have a low risk of leukemicTreatmentAnemia and iron overload are complications seen in both and are managed similar to lower risk MDS and MPN. Aspirin therapy is reasonable in MDS/MPN‐RS‐T, especially in the presence of JAK2V617F, but the value of platelet‐lowering drugs is uncertain.

BACKGROUND: Critically ill patients frequently receive plasma transfusion under the assumptions that abnormal coagulation test results confer increased risk of bleeding and that plasma transfusion will decrease this risk. However, the effect of prophylactic plasma transfusion remains poorly understood. The objective of this study was to determine the relationship between prophylactic plasma transfusion and bleeding complications in critically ill patients. METHODS: This is a retrospective cohort study of adults admitted to the intensive care unit (ICU) at a single academic institution between January 1, 2009 and December 31, 2013. Inclusion criteria included age ≥18 years and an international normalized ratio measured during ICU admission. Multivariable propensity-matched analyses were used to evaluate associations between prophylactic plasma transfusion and outcomes of interest with a primary outcome of red blood cell transfusion in the ensuing 24 hours and secondary outcomes of hospital- and ICU-free days and mortality within 30 days of ICU discharge. RESULTS: A total of 27,561 patients were included in the investigation with 2472 (9.0%) receiving plasma therapy and 1105 (44.7%) for which plasma transfusion was prophylactic in nature. In multivariable propensity-matched analyses, patients receiving plasma had higher rates of red blood cell transfusion (odds ratio: 4.3 [95% confidence interval: 3.3–5.7], P < .001) and fewer hospital-free days (estimated % increase: −11.0% [95% confidence interval: −11.4, −10.6%], P < .001). There were no significant differences in ICU-free days or mortality. These findings appeared robust, persisting in multiple predefined sensitivity analyses. CONCLUSIONS: Prophylactic administration of plasma in the critically ill was not associated with improved clinical outcomes. Further investigation examining the utility of plasma transfusion in this population is warranted.