What is operative? Conceptualizing neuralgia: Neuroma, compression neuropathy, painful hyperalgesia, and phantom nerve pain

Neuralgia, or nerve pain, is a common presenting complaint for the hand surgeon. When the nerve at play is easily localized, and the cause of the pain is clear (eg, carpal tunnel syndrome), the patient may be easily treated with excellent results. However, in more complex cases, the underlying pathophysiology and cause of neuralgia can be more difficult to interpret; if incorrectly managed, this leads to frustration for both the patient and surgeon. Here we offer a way to conceptualize neuralgia into 4 categories-compression neuropathy, neuroma, painful hyperalgesia, and phantom nerve pain-and offer an illustrative clinical vignette and strategies for optimal management of each. Further, we delineate the reasons why compression neuropathy and neuroma are amenable to surgery, while painful hyperalgesia and phantom nerve pain are not

Elevated glutamatergic compounds in pregenual anterior cingulate in pediatric autism spectrum disorder demonstrated by 1H MRS and 1H MRSI.

Recent research in autism spectrum disorder (ASD) has aroused interest in anterior cingulate cortex and in the neurometabolite glutamate. We report two studies of pregenual anterior cingulate cortex (pACC) in pediatric ASD. First, we acquired in vivo single-voxel proton magnetic resonance spectroscopy ((1)H MRS) in 8 children with ASD and 10 typically developing controls who were well matched for age, but with fewer males and higher IQ. In the ASD group in midline pACC, we found mean 17.7% elevation of glutamate + glutamine (Glx) (p<0.05) and 21.2% (p<0.001) decrement in creatine + phosphocreatine (Cr). We then performed a larger (26 subjects with ASD, 16 controls) follow-up study in samples now matched for age, gender, and IQ using proton magnetic resonance spectroscopic imaging ((1)H MRSI). Higher spatial resolution enabled bilateral pACC acquisition. Significant effects were restricted to right pACC where Glx (9.5%, p<0.05), Cr (6.7%, p<0.05), and N-acetyl-aspartate + N-acetyl-aspartyl-glutamate (10.2%, p<0.01) in the ASD sample were elevated above control. These two independent studies suggest hyperglutamatergia and other neurometabolic abnormalities in pACC in ASD, with possible right-lateralization. The hyperglutamatergic state may reflect an imbalance of excitation over inhibition in the brain as proposed in recent neurodevelopmental models of ASD

Planet Candidates from K2 Campaigns 5-8 and Follow-Up Optical Spectroscopy

We present 151 planet candidates orbiting 141 stars from K2 campaigns 5-8 (C5-C8), identified through a systematic search of K2 photometry. In addition, we identify 16 targets as likely eclipsing binaries, based on their light curve morphology. We obtained follow-up optical spectra of 105/141 candidate host stars and 8/16 eclipsing binaries to improve stellar properties and to identify spectroscopic binaries. Importantly, spectroscopy enables measurements of host star radii with $\approx$10% precision, compared to $\approx$40% precision when only broadband photometry is available. The improved stellar radii enable improved planet radii. Our curated catalog of planet candidates provides a starting point for future efforts to confirm and characterize K2 discoveries.Comment: Accepted for publication in the Astronomical Journal; 17 pages, 8 figures, 2 tables, download source for full table

Gene expression profiling to study racial differences after heart transplantation.

BackgroundThe basis for increased mortality after heart transplantation in African Americans and other non-Caucasian racial groups is poorly defined. We hypothesized that increased risk of adverse events is driven by biologic factors. To test this hypothesis in the Invasive Monitoring Attenuation through Gene Expression (IMAGE) study, we determined whether the event rate of the primary outcome of acute rejection, graft dysfunction, death, or retransplantation varied by race as a function of calcineurin inhibitor (CNI) levels and gene expression profile (GEP) scores.MethodsWe determined the event rate of the primary outcome, comparing racial groups, stratified by time after transplant. Logistic regression was used to compute the relative risk across racial groups, and linear modeling was used to measure the dependence of CNI levels and GEP score on race.ResultsIn 580 patients monitored for a median of 19 months, the incidence of the primary end point was 18.3% in African Americans, 22.2% in other non-Caucasians, and 8.5% in Caucasians (p < 0.001). There were small but significant correlations of race and tacrolimus trough levels to the GEP score. Tacrolimus levels were similar among the races. Of patients receiving tacrolimus, other non-Caucasians had higher GEP scores than the other racial groups. African American recipients demonstrated a unique decrease in expression of the FLT3 gene in response to higher tacrolimus levels.ConclusionsAfrican Americans and other non-Caucasian heart transplant recipients were 2.5-times to 3-times more likely than Caucasians to experience outcome events in the Invasive Monitoring Attenuation through Gene Expression study. The increased risk of adverse outcomes may be partly due to the biology of the alloimmune response, which is less effectively inhibited at similar tacrolimus levels in minority racial groups

HAT-P-11: Discovery of a Second Planet and a Clue to Understanding Exoplanet Obliquities

HAT-P-11 is a mid-K dwarf that hosts one of the first Neptune-sized planets found outside the solar system. The orbit of HAT-P-11b is misaligned with the star's spin --- one of the few known cases of a misaligned planet orbiting a star less massive than the Sun. We find an additional planet in the system based on a decade of precision radial velocity (RV) measurements from Keck/HIRES. HAT-P-11c is similar to Jupiter in its mass ($M_P \sin{i} = 1.6\pm0.1$ $M_J$) and orbital period ($P = 9.3^{+1.0}_{-0.5}$ year), but has a much more eccentric orbit ($e=0.60\pm0.03$). In our joint modeling of RV and stellar activity, we found an activity-induced RV signal of $\sim$7 m s$^{-1}$, consistent with other active K dwarfs, but significantly smaller than the 31 m s$^{-1}$ reflex motion due to HAT-P-11c. We investigated the dynamical coupling between HAT-P-11b and c as a possible explanation for HAT-P-11b's misaligned orbit, finding that planet-planet Kozai interactions cannot tilt planet b's orbit due to general relativistic precession; however, nodal precession operating on million year timescales is a viable mechanism to explain HAT-P-11b's high obliquity. This leaves open the question of why HAT-P-11c may have such a tilted orbit. At a distance of 38 pc, the HAT-P-11 system offers rich opportunities for further exoplanet characterization through astrometry and direct imaging.Comment: 16 pages, 11 figures, 4 tables. Accepted to A

Polar bear (Ursus maritimus) Migration from Maternal Dens in Western Hudson Bay

Migration is a common life history strategy among Arctic vertebrates, yet some of its aspects remain poorly described for some species. In February-March, post-parturient polar bears (Ursus maritimus) in western Hudson Bay, Canada, migrate from maternity den sites on land to the sea ice with three- to four-month-old cubs. We investigated this migration using data from 10 adult females fitted with satellite-linked global positioning system collars tracked in 2011 – 16. Directed movement towards the coast began on average on 1 March (range: 31 January to 23 March) and took a mean of 7.8 days to reach the coast. Bears traveled 18 to 100 km from their dens to the coast (mean = 63 km) at a mean rate of 6.7 km/d. Movements were highly directed, with an approximate northeast orientation, but did not follow the shortest path to the coast. Observed migration patterns were broadly similar to those previously documented, although mean departure date from dens was about four days earlier and mean movement rate was only 40% of that from the late 1990s. Given the sensitivity of polar bears to climate change, the phenology of denning may be a meaningful parameter for long-term monitoring.Parmi les vertébrés de l’Arctique, la migration constitue une stratégie de cycle biologique courante et pourtant, pour certaines espèces, certains des aspects de la migration sont toujours mal décrits. En février et en mars, les ours polaires (Ursus maritimus) de post-parturition de l’ouest de la baie d’Hudson, au Canada, migrent depuis leurs aires terrestres de mise bas vers la glace de mer avec leurs oursons de trois à quatre mois. Nous avons étudié cette migration en nous servant des données relatives à dix femelles adultes dotées de colliers satellitaires avec système de localisation GPS, données recueillies de 2011 à 2016. En moyenne, les déplacements dirigés vers la côte commençaient le 1er mars (étendue : du 31 janvier au23 mars) et pour se rendre jusqu’à la côte, il fallait en moyenne 7,8 jours. De leur aire de mise bas jusqu’à la côte, les ours parcouraient de 18 à 100 km (moyenne = 63 km) au taux moyen de 6,7 km/j. Les déplacements étaient fortement dirigés, avec une orientation approximative du nord-est, sans toutefois emprunter le chemin le plus court menant à la côte. Les modèles de migration observés ressemblaient beaucoup aux modèles déjà documentés, quoique la date de départ moyenne des aires de mise bas s’établissait à environ quatre jours plus tôt et que le taux de déplacement moyen ne correspondait qu’à 40 % du taux de la fin des années 1990. Compte tenu de la sensibilité des ours polaires au changement climatique, la phénologie de l’aire de mise bas pourrait constituer un paramètre significatif pour la surveillance à long terme

How to diagnose the cause of sudden cardiac arrest

Sudden cardiac death or sudden cardiac arrest (SCA) is defined as natural death that occurs within an hour of the onset of acute symptoms or during sleep due to a primary cardiac cause. Most cases of SCA are attributable to coronary artery disease, with occult cardiomyopathy or inheritable arrhythmic syndromes accounting for a minority of SCA. Diagnosing the cause of SCA has potential implications for the patient and the family, and demands a comprehensive approach. This review summarizes the potential causes of SCA and outlines a systematic diagnostic approach to the SCA survivor. (Cardiol J 2011; 18, 2: 210-216

A blind test of photometric redshift prediction

Results of a blind test of photometric redshift predictions against spectroscopic galaxy redshifts obtained in the Hubble Deep Field with the Keck Telescope are presented. The best photometric redshift schemes predict spectroscopic redshifts with a redshift accuracy of |Delta-z|<0.1 for more than 68 percent of sources and with |Delta-z|<0.3 for 100 percent, when single-feature spectroscopic redshifts are removed from consideration. This test shows that photometric redshift schemes work well at least when the photometric data are of high quality and when the sources are at moderate redshifts.Comment: 14 pp., accepted for publication in A

Progression to chronic atrial fibrillation after pacing: the Canadian Trial of Physiologic Pacing

AbstractOBJECTIVESThis study examined the effect of physiologic pacing on the development of chronic atrial fibrillation (CAF) in the Canadian Trial Of Physiologic Pacing (CTOPP).BACKGROUNDThe role of physiologic pacing to prevent CAF remains unclear. Small randomized studies have suggested a benefit for patients with sick sinus syndrome. No data from a large randomized trial are available.METHODSThe CTOPP randomized patients undergoing first pacemaker implant to ventricular-based or physiologic pacing (AAI or DDD). Patients who were prospectively found to have persistent atrial fibrillation (AF) lasting greater than or equal to one week were defined as having CAF. Kaplan-Meier plots for the development of CAF were compared by log-rank test. The effect of baseline variables on the benefit of physiologic pacing was evaluated by Cox proportional hazards modeling.RESULTSPhysiologic pacing reduced the development of CAF by 27.1%, from 3.84% per year to 2.8% per year (p = 0.016). Three clinical factors predicted the development of CAF: age ≥74 years (p = 0.057), sinoatrial (SA) node disease (p < 0.001) and prior AF (p < 0.001). Subgroup analysis demonstrated a trend for patients with no history of myocardial infarction or coronary disease (p = 0.09) as well as apparently normal left ventricular function (p = 0.11) to derive greatest benefit.CONCLUSIONSPhysiologic pacing reduces the annual rate of development of chronic AF in patients undergoing first pacemaker implant. Age ≥74 years, SA node disease and prior AF predicted the development of CAF. Patients with structurally normal hearts appear to derive greatest benefits