bluuebunny/crossref_metadata_2025 huggingface dataset:
Twenty-nine years of the BIR Annual Survey part 1: Technological change
Authors: Tredinnick Luke
Published: September 2019

This article is the first part of a review of the Business Information Review Annual Survey, which has been published annually since 1991. The article explores technological change as it has been revealed by the surveys. It uses a combination of content and thematic analysis to develop six key themes, which are discussed by reference to the original surveys: the telling case of CD-ROMs; the Internet and the World Wide Web; changing information formats; the impact of digital technologies on information work; intranets and knowledge management (KM); and newer technologies. The article aims to summarise and consolidate longitudinal trends revealed by the survey, act as a guide to the rich data contained within the surveys themselves and provide a testament to the wealth of professional experience captured in the BIR Annual Surveys. Its findings relate to the nature of technological change and the incorporation of new technologies by the information and KM profession.
Examining Self-Reported Physical Contact With Minors Among Pedophile Support Forum Users
Authors: Holt Karen , Liggett Roberta , Holt Thomas J. , Lee Jin R.
Published: September 2019

Minimal research has considered the extent to which pedophile social support forum users disclose physical relationships with minors in the course of their posts. As these forums cater to those who express sexual interests in minors, the users may be at higher risk for contact offenses and require unique treatment and supervision. To address this gap in the literature, this study utilized a quantitative analysis of the posts from 806 users from four separate pedophile support forums to identify the correlates of self-disclosed contact with minors. The findings demonstrated that although most users do not disclose physical contact, those who do share several common traits, specifically fantasies of minors, mentions of relationships with minors, and a sexually suggestive username. The implications of this analysis for our understanding of the role of online forums and potential clinical treatment are discussed in detail.
From the archive: Two early 20th-century books on the physical geography of beaver landscapes
Authors: Butler David R
Published: September 2019

The recent publication of several books on the history and ecology of beavers ( Castor canadensis and Castor fiber) illustrates a renewed interest in the construction activities of beavers and their impacts on landscapes. Over one hundred years ago, two popular books on these same topics were published, In Beaver World and The Romance of the Beaver. These books, their authors, and their legacies can still inform today’s readers interested in beavers, ecosystem engineering, and zoogeomorphology.
Total Factor Productivity Growth: Evidence from West African Economies
Authors: Abekah-Koomson Isaac , Loon Pang Wei , Premaratne Gamini , Yean Teo Siew
Published: September 2019

Since the 1990s, the economic growth of the West African region has been remarkable, with average GDP growth of 5 per cent annually. In view of that, this article investigates the Total Factor Productivity (TFP) performance for the Economic Community of West African States (ECOWAS) region, which takes into account the recent development on political stability and trade openness. There were also periods when TFP fell sharply, the most significant happened in the late 1990s and 2000s where TFP dropped significantly which might be attributed to the spillover effect of the Asian and global financial crises. Our results showed that TFP was performing well for the region as well as for each member countries for the period of the study. We acknowledged that the estimated TFP in our model captures other factors such as human capital, health and other institutional factors that could affect economic growth. We also estimated the Technical Efficiency (TE) for the ECOWAS region using the Stochastic Frontier Modelling and the result indicates that the TE performance is well below the optimal level of production.
Effect of transcranial direct current stimulation combined with a virtual reality exercise on balance in a patient with multiple sclerosis: a case report
Authors: Costa Glaucio Carneiro , Kunitake André Issao , Fonseca Junior Paulo Roberto , Ledur Ângela Cristina , Elord Júlio Cíntia , Pereira Gabriela Santos , Corrêa João Carlos Ferrari , Correa Fernanda Ishida
Published: September 2019

To investigate the effects of training with videogame (VG) combined with transcranial direct current (tDCS) stimulation on balance, fatigue, and quality of life in an individual with multiple sclerosis.

A 51-year-old male patient reported a history of progressive loss of muscle strength in the left lower limb from 37 years of age. Equilibrium, fatigue, and quality of life were evaluated before and after two treatment protocols, with the 14-day interval between them: Protocol 1: VG + sham tDCS (five consecutive sessions) and Protocol 2: VG + tDCS active (five consecutive sessions). Each session lasted 20 min, with 2 mA intensity.

After Protocol 1, the patient presented improvement in balance, fatigue, and quality of life, but these improvements were not maintained in the follow-up evaluation. After Protocol 2, an improvement in balance was not clinically important and the results of the low post-intervention and follow-up were found in relation to fatigue and quality of life.

The most promising clinical changes were found when the VG was combined with the sham tDCS compared to the combination of VG and active tDCS.
The Targeted Therapies Era Beyond the Surgical Point of View: What Spine Surgeons Should Know Before Approaching Spinal Metastases
Authors: Cofano Fabio , Monticelli Matteo , Ajello Marco , Zenga Francesco , Marengo Nicola , Di Perna Giuseppe , Altieri Roberto , Cassoni Paola , Bertero Luca , Melcarne Antonio , Tartara Fulvio , Ducati Alessandro , Garbossa Diego
Published: September 2019

In the last few years, the treatment of spinal metastases has significantly changed. This is due to the advancements in surgical technique, radiotherapy, and chemotherapy which have enriched the multidisciplinary management. Above all, the field of molecular biology of tumors is in continuous and prosperous evolution. In this review, the molecular markers and new approaches that have radically modified the chemotherapeutic strategy of the most common metastatic neoplasms will be examined together with clinical and surgical implications. The experience and skills of several different medical professionals are mandatory: an interdisciplinary oncology team represents the winning strategy in the treatment of patients with spinal metastases
Zinc Finger-Homeodomain Genes: Evolution, Functional Differentiation, and Expression Profiling Under Flowering-Related Treatments and Abiotic Stresses in Plants
Authors: Shalmani Abdullah , Muhammad Izhar , Sharif Rahat , Zhao CaiPing , Ullah Uzair , Zhang Dong , Jing Xiu-Qing , Amin Bakht , Jia Peng , Mobeen Tahir Muhammad , Xu Ze , Chen Kun-Ming , An Na
Published: September 2019

Zinc finger-homeodomain (ZHD) proteins constitute a plant-specific transcription factor family that play important roles in plant growth, development, and stress responses. In this study, we investigated a total of 10, 17, and 31 ZHD gene members in the peach, Arabidopsis, and apple genome, respectively. The phylogenetic tree divided the identified ZHD genes into 4 subfamilies based on their domain organization, gene structure, and motif distribution with minor variations. The ZHD gene family members were unevenly distributed throughout in apple, peach, and Arabidopsis genomes. Segmental duplication was observed for 14 pairs of genes in apple. Transcript analysis found that ZHD genes mostly expressed in various tissues, particularly in leaves and flowers. Moreover, the transcript of most ZHD genes was significantly affected at different time points in response to various flowering-related exogenous hormones (sugar, gibberellin [GA], and 6-benzylaminopurine [6-BA]), signifying their possible role in the flowering induction in apple. Furthermore, the transcripts of CaZHD6, CaZHD7, CaZHD3, and CaZHD8 have induced in response to abiotic stresses including heat, drought, salt, and cold, indicating their possible involvement in response to abiotic stresses. Our research work systemically presents the different roles of ZHD genes. We believe that this study will provide a platform for future functional characterization of ZHD genes and to deeply unfold their roles in the regulation of flowering induction in plants.
Reliability and Accuracy of MRI in Orthopedics: A Survey of Its Use and Perceived Limitations
Authors: Hong Andrew , Liu Joseph N , Gowd Anirudh K , Dhawan Aman , Amin Nirav H
Published: September 2019

Over the past decade, the use of magnetic resonance imaging (MRI) as a diagnostic tool has been increasing significantly in various fields of medicine due to its wide array of applications. As a result, its diagnostic efficacy and reliability come into question. Specifically, in the field of orthopedics, there has been little discussion on the problems many physicians face while using MRIs in practice. To gauge the perceived limitations of MRI, we designed a decision analysis to analyze the utility of MRIs and estimate the number of inconclusive MRIs ordered within an orthopedic practice to explore potential alternative avenues of diagnosis. A survey of 100 board-certified practicing orthopedic surgeons given at 2 national conferences was designed to assess the value, reliability, and diagnostic utility of MRIs in preoperative planning in shoulder and knee surgery. Of those surveyed, 93% reported that there was believed to be a problem with the accuracy of an MRI in the setting of a prior surgery and/or if previous hardware was present specifically pertaining to the knee or shoulder. The most common indications of concern regarding knee or shoulder MRI reliability among this sample group were previous patient hardware (19%), a previous surgery (16%), and a chondral defect (11%). In addition, when asked how many MRIs were believed to be inconclusive based on previous surgery/hardware alone in the last 6 months of practice, an average of 19 inconclusive MRIs was reported. This study summarizes some of the concerns of MRI use in the orthopedic community and attempts to add a unique perspective on the attitudes, decision-making, and apparent economic problems that they face as well as uncover specific instances where MRIs were determined to be unreliable and incomplete in aiding the diagnosis and treatment algorithm.
Speciesism, generalized prejudice, and perceptions of prejudiced others
Authors: Everett Jim A. C. , Caviola Lucius , Savulescu Julian , Faber Nadira S.
Published: September 2019

Philosophers have argued there is a normative relationship between our attitudes towards animals (“speciesism”) and other prejudices, and psychological work suggests speciesism relies on similar psychological processes and motivations as those underlying other prejudices. But do laypeople perceive such a connection? We compared perceptions of a target who is high or low on speciesism with those of a target who is high or low on racism (Studies 1–2), sexism (Study 2), or homophobia (Study 3). We find that just like racists, sexists, and homophobes, speciesists were both evaluated more negatively and expected to hold more general prejudicial attitudes and ideologies (e.g., thought to be higher on SDO and more prejudiced in other ways). Our results suggest that laypeople seem intuitively aware of the connection between speciesism and “traditional” forms of prejudice, inferring similar personality traits and general prejudicial attitudes from a speciesist just as they do from a racist, sexist, or homophobe.
Power Analysis, p Values, and Bayesian Techniques: How Bayesian Techniques Can Be Used in HRD Literature
Authors: Baker Rose , Hirudayaraj Malar
Published: September 2019

The Problem

Researchers have described challenges and problems in reporting research that uses only p values and power to make decisions to reject the null hypothesis. Confusion about how to interpret null hypothesis statistical tests has resulted from mixed information presented in statistics articles and textbooks.

The Solution

Combining evidence from data with initial beliefs, Bayesian inference techniques help to provide uncontroversial support of a null hypothesis or alternative hypothesis. An overview of the limitations associated with only using p values and power to make decisions to reject or retain the null hypothesis are presented. Analyses across multiple studies with common parameters can be pooled using Bayesian techniques as a means for conducting meta-analysis. Examples using Bayesian techniques are given.

The Stakeholders

When designing a research study, researchers often use external elements and likelihood to make powerful inferences using Bayesian techniques. Those performing research in populations requiring sampling.
SecureSurgiNET: A framework for ensuring security in telesurgery
Authors: Iqbal Sohail , Farooq Shahzad , Shahzad Khuram , Malik Asad Waqar , Hamayun Mian M , Hasan Osman
Published: September 2019

The notion of surgical robotics is actively being extended to enable telesurgery, where both the surgeon and patient are remotely located and connected via a public network, which leads to many security risks. Being a safety-critical application, it is highly important to make telesurgery robust and secure against active and passive attacks. In this article, we propose the first complete framework, called SecureSurgiNET, for ensuring security in telesurgery environments. SecureSurgiNET is primarily based on a set of well-established protocols to provide a fool-proof telesurgical robotic system. For increasing the efficiency of secured telesurgery environments, the idea of a telesurgical authority is introduced that ensures the integrity, identity management, authentication policy implementation, and postoperative data security. An analysis is provided describing the security and throughput of Advanced Encryption Standard during the intraoperative phase of SecureSurgiNET. Moreover, we have tabulated the possible attacks on SecureSurgiNET along with the devised defensive measures. Finally, we also present a time complexity analysis of the SecureSurgiNET through simulations.
Pore structure and strength of waste fiber recycled concrete
Authors: Zhou Jinghai , Kang Tianbei , Wang Fengchi
Published: September 2019

The pore structure is one of the major factors affecting the mechanical properties of waste fiber recycled concrete. In this article, the pore structure and strength performance of waste fiber recycled concrete are experimentally studied. The design variables are water–cement ratio, recycled aggregate replacement rate, waste fiber length, and volume fraction of waste fibers. The pore structure characteristic parameters of waste fiber recycled concrete are investigated using mercury intrusion porosimetry test and fractal theory. The complex distribution of pore structure in space is quantitatively described by fractal dimension, and the pore structure is comprehensively evaluated. The results show that the water–cement ratio has the largest influence on the pore structure, and the fiber length has the least influence. The optimum volume fraction of waste fibers is 0.12%. There is an obvious linear relationship between the pore volume fractal dimension and strength. With the increase in the fractal dimensions, the compressive and splitting tensile strengths increase. Macroscopic mechanical properties of waste fiber recycled concrete can be predicted by the pore structure.
Awareness and Current Therapeutics of Asthma
Authors: Zainab Rida , Akram Muhammad , Daniyal Muhammad , Riaz Muhammad
Published: September 2019

Introduction:

Asthma is a serious allergic disorder of the respiratory system. It affects about 300 million people worldwide. This has a great burden on medical treatment. Several medicines are available, but they have many serious side effects. Therefore, there is a need to search for a new therapeutic agent with no or minimal side effects while most economical for patients. In folk medicine, antiasthmatics herbal medicine has been used and showed potential therapeutic antiasthmatic efficacy due to the presence of potential bioactive compounds.

Methods:

Different databases were searched (ie, Embase, PubMed, CBM, AMED, and CINAHL). We have reviewed the published data of the last 20 years. We used MeSH terms “asthma” herbal treatment of asthma, allopathic treatment of asthma, and treatment strategies for asthma. The traditional medicine was compared with modern medicine and the same pharmacotherapies alone or with placebo. The methodology was evaluated by using the GRADE summary of Finding tables and Cochrane Risk of Bias Tool.

Results:

There have been some clear-cut indications toward the recognition of further molecular and cellular mechanisms of asthma. Most of them recommend a further target for treatment. The novel procedures, biologics, and pharmaceuticals are evaluated. Both allopathic and herbal treatments of asthma are effective. Due to none or lesser side effects, herbal medicines are safer than conventional medicine.

Conclusion:

The preliminary documentation of the plants discussed in the review show the presence of several secondary metabolites that are responsible for the management of asthma and its relevant complications. Further research studies are needed to identify the bioactive compounds from these plants that have potential efficacy to cure asthma, and clinically based studies are needed to search for a complete cure for this disease.
Trastuzumab-Coated Nanoparticles Loaded With Docetaxel for Breast Cancer Therapy
Authors: Zhang Xueyan , Liu Jiaxin , Li Xiangyu , Li Fang , Lee Robert J. , Sun Fengying , Li Youxin , Liu Zongyu , Teng Lesheng
Published: September 2019

Docetaxel (DTX) is commonly used for breast cancer treatment. Tween 80 used for DTX dissolution in its clinical formulation causes severe hypersensitivity and other adverse reactions. In this study, trastuzumab (Tmab)-coated lipid-polymer hybrid nanoparticles (PLNs) were prepared, composed of poly (d, l-lactide- co-glycolide), PLGA; polyethylenimine (PEI); and lipids. The PLGA/PEI/lipid formed a hydrophobic core, while Tmab was electrostatically adsorbed on the surface of the PLNs as a ligand that targets human epidermal growth factor receptor 2 (HER2)-positive breast cancer cells. The resulting PLNs, electrostatically adsorbed Tmab-bearing PLGA/PEI/lipid nanoparticles (eTmab-PPLNs), had a mean particle size of 217.4 ± 13.36 nm, a ζ potential of 0.056 ± 0.315 mV, and good stability. In vitro, the eTmab-PPLNs showed increased cytotoxicity in HER2-postive BT474 cells but not in HER2-negative MCF7 cells. Studies of the ability of eTmab-PPLNs to target HER2 were performed. The uptake of eTmab-PPLNs was shown to be dependent on HER2 expression level. Therefore, eTmab-PPLNs provide a promising therapeutic for the treatment of breast cancer.
The Use of Autoscopy From the Epistemological Perspective of Action Research for Self-Analysis and Reflection of Teacher Practice
Authors: de Souza Daniela Maysa , Backes Vânia Marli Schubert , do Prado Marta Lenise , Martini Jussara Gue , Medina Moya José Luis
Published: September 2019

The video recording of lessons allows the analysis results to provide data about the teaching practice. Analyzing the pedagogical practice itself allows the teacher an exercise of self-reflection, as they become aware of their behavior in the classroom, leading to the revitalization of their teaching model. This study aims to present the use of autoscopy as a stimulus to reflection, to a new understanding of the pedagogical practice of teachers, in an action research. This is a case study, with a qualitative and descriptive approach, performed with a new nursing teacher. The data were initially collected through a semistructured biographical interview and subsequent video recording of the classes, characterizing nonparticipant observations. The application of autoscopy followed the proposal of action research, with its phases: exploratory phase, in-depth research, action phase, and evaluation phase. The autoscopy was a useful strategy to stimulate teacher reflection because during the projection of the sketches selected for the video of the autoscopy session, the teacher can see himself or herself in action and self-analyze and discuss the selected pedagogical moments, stimulating reflection and generating a new understanding about his or her teaching practice. In this way, the use of autoscopy under the epistemological perspective of action research stimulates the self-analysis and reflection of the teaching practice.
And whatsoever I shall see or hear …I will never divulge. Confidentiality and disclosure for intensivists
Authors: D’Sa Aaron , O’Leary Ronan
Published: September 2019

Police requests to provide information about unconscious patients frequently cause difficulty for intensivists. This article reviews the circumstances where an intensive care doctor may and should disclose information about unconscious patients to the police. It first considers what constitutes private and confidential information and explains why this information should be protected. The relevant laws and regulations are then examined to identify circumstances in which a disclosure to the police is compulsory and when it is discretionary. It considers the required and permitted extent of the disclosures, and any requirements that must be fulfilled for the disclosure to be lawful. The role of the General Data Protection Regulations in governing all disclosures is reviewed, and a framework is provided which may be adopted to aid decision-making for disclosures to the police.
Using probabilistic patient flow modelling helps generate individualised intensive care unit operational predictions and improved understanding of current organisational behaviours
Authors: Hadjipavlou George , Titchell Jill , Heath Christina , Siviter Richard , Madder Hilary
Published: September 2019

Purpose

We sought a bespoke, stochastic model for our specific, and complex ICU to understand its organisational behaviour and how best to focus our resources in order to optimise our intensive care unit’s function.

Methods

Using 12 months of ICU data from 2017, we simulated different referral rates to find the threshold between occupancy and failed admissions and unsafe days. We also modelled the outcomes of four change options.

Results

Ninety-two percent bed occupancy is our threshold between practical unit function and optimal resource use. All change options reduced occupancy, and less predictably unsafe days and failed admissions. They were ranked by magnitude and direction of change.

Conclusions

This approach goes one step further from past models by examining efficiency limits first, and then allowing change options to be quantitatively compared. The model can be adapted by any intensive care unit in order to predict optimal strategies for improving ICU efficiency.
The classification of employment relationships in Belgium
Authors: Wouters Mathias
Published: September 2019

This chapter provides an overview of the characteristics of the Belgian employment contract and, in particular, of the concept of ‘subordination’. After having painted a picture of what differentiates an employment contract from a contract for services, it, subsequently, assesses the classification of certain specific examples, such as self-employed persons with only one client. The role of economic dependency in the classification of working relationships is discussed by using these examples. The chapter furthermore emphasises the strong binary divide between employment and self-employment. It goes into more detail on the country’s collective bargaining mechanisms for false and genuine self-employed workers. After having described the Belgian take on identifying the ‘employing entity’, the chapter finishes off by outlining the contemporary debate on the reform of the Belgian classification mechanisms.
A Case of Acute Lymphocytic Leukaemia with t(3;13) and Central Nervous System Leukemia after Allogenic Cord Blood Transplantation
Authors: Li Xiaofan , Hong Yaqun , Huang Jiafu , Li Nainong
Published: September 2019

Background:

Acute lymphoblastic leukemia (ALL) is a neoplastic cancer characterized by clonal expansion of leukemic cells in lymph organs and bone marrow. Lots of kinds of different chromosomal translocations can be found in those leukemic cells. However, the role of abnormal chromosomes and genes in leukemogenesis is not yet fully understood. Identifying new chromosomal translocations can facilitate a better understanding of pathogenesis of this disease.

Case presentation:

We report a rare case of acute lymphocytic leukaemia with t(3;13)(q29, q21). The patient was diagnosed pre-B-ALL with no abnormal chromosomal or gene fusion and achieved complete remission (CR) after induction chemotherapy; 10 months later, she relapsed in the consolidation, with cytogenetics tests showing 46, XX, t(3;13)(q29, q21). Given no CR after two chemotherapy regimens, the patient received salvage cord blood transplantation. Regular intrathecal methotrexate was applied to prevent central nervous system leukemia. Good graft versus leukemia was induced by daily injection of a low dose of IL-2 2 months post-transplantation. Minimal residual disease negativity was maintained until central nervous system (CNS) leukemia was found 8 months after transplantation. A whole exome sequencing was performed. Nine driver mutation genes and seven tumor genes were found.

Conclusions:

We highly suspect that the relapse in the CNS after transplantation is associated with a rare chromosomal translocation.
Language-Independent Hearing Screening Based on Masked Recognition of Ecological Sounds
Authors: Denys Sam , De Laat Jan , Dreschler Wouter , Hofmann Michael , van Wieringen Astrid , Wouters Jan
Published: September 2019

A language-independent automated self-test on tablet based on masked recognition of ecological sounds, the Sound Ear Check (SEC), was developed. In this test, 24 trials of eight different sounds are randomly presented in a noise that was spectrally shaped according to the average frequency spectra of the stimulus sounds, using a 1-up 2-down adaptive procedure. The test was evaluated in adults with normal hearing and hearing loss, and its feasibility was investigated in young children, who are the target population of this test. Following equalization of perceptual difficulty across sounds by applying level adjustments to the individual tokens, a reference curve with a steep slope of 18%/dB was obtained, resulting in a test with a high test–retest reliability of 1 dB. The SEC sound reception threshold was significantly associated with the averaged pure tone threshold ( r = .70), as well as with the speech reception threshold for the Digit Triplet Test ( r = .79), indicating that the SEC is susceptible to both audibility and signal-to-noise ratio loss. Sensitivity and specificity values on the order of magnitude of ∼70% and ∼80% to detect individuals with mild and moderate hearing loss, respectively, and ∼80% to detect individuals with slight speech-in-noise recognition difficulties were obtained. Homogeneity among sounds was verified in children. Psychometric functions fitted to the data indicated a steep slope of 16%/dB, and test–retest reliability of sound reception threshold estimates was 1.3 dB. A reference value of −9 dB signal-to-noise ratio was obtained. Test duration was around 6 minutes, including training and acclimatization.
Value of endometrial echo pattern transformation after hCG trigger in predicting IVF pregnancy outcome: a prospective cohort study
Authors: Hou Zhaojuan , Zhang Qiong , Zhao Jing , Xu Aizhuang , He Aihua , Huang Xi , Xie Shi , Fu Jing , Xiao Lan , Li Yanping
Published: September 2019

Background

There is much value in identifying non-invasive ways of measuring endometrial receptivity, as it has the potential to improve outcomes following in vitro fertilization (IVF). It has been suggested that endometrial echogenicity on the day of hCG administration was a good marker of endometrial receptivity. In the daily practice, we notice that patients with non-homogeneous hyperechoic endometrium on the embryo transfer day usually have lower pregnancy rates. We therefore extended the research onward transformation of echo pattern after hCG trigger to analyze the relationship between endometrial echogenicity transformation and IVF outcomes.

Methods

A total of 146 infertile women undergoing their first IVF cycle were recruited in the prospective cohort study from August 2017 through August 2018. A series of endometrial echo pattern monitoring was carried out in these patients after hCG trigger: hCG day, from 1 through 3 days after ovum pick-up (OPU + 1, OPU + 2, OPU + 3).

Results

The endometrial echogenicity value was calculated as the ratio of the hyperechogenic endometrial area over the whole endometrial area. Clinical pregnancy rate and embryo implantation rate had positive relationship with echogenicity value. The ROC curve analysis of endometrial echogenicity showed the area under curve was greatest on the second day after oocyte retrieval (OPU + 1, 2, 3 were 0.738, 0.765, 0.714 respectively) versus pregnancy. Endometrial echogenicity value on OPU + 2 had a higher predictive efficiency, and the cutoff value was 76.5%. The sensitivity was 61.3% and specificity was 82.0%. When putting the cut-off at <60%, the sensitivity was 93.8% and the specificity was 23.1%.

Conclusions

The endometrial echogenicity value on OPU + 2 was recommended to evaluate endometrial receptivity. It seemed appropriate for clinicians to provide a ‘freeze all’ IVF cycle and transfer in a subsequent frozen-thawed embryos cycle when echogenicity value <60% on OPU + 2.

Trial registration

The registration number wasChiCTR-OOC-17012214and the registration date was August 1st, 2017.
Supplemental Intraoperative Oxygen Does Not Promote Acute Kidney Injury or Cardiovascular Complications After Noncardiac Surgery: Subanalysis of an Alternating Intervention Trial
Authors: Ruetzler Kurt , Cohen Barak , Leung Steve , Mascha Edward J. , Knotzer Johann , Kurz Andrea , Sessler Daniel I. , Turan Alparslan
Published: September 2019

BACKGROUND:

Perioperative hyperoxia has been recommended by the World Health Organization and the Centers for Disease Control and Prevention for the prevention of surgical site infections. Based on animal studies and physiological concerns, the kidneys and heart may be at risk from hyperoxia. We therefore conducted 2 unplanned subanalyses of a previous alternating cohort trial in which patients having colorectal surgery were assigned to either 30% or 80% inspired intraoperative oxygen. Specifically, we tested 2 coprimary hypotheses: (1) hyperoxia increases the incidence of acute kidney injury (AKI) within 7 postoperative days (PODs); and (2) hyperoxia worsens a composite of myocardial injury, in-hospital cardiac arrest, and 30-day mortality.

METHODS:

The underlying controlled trial included 5749 colorectal surgeries in 4481 patients, with the exposure alternating between 30% and 80% fraction of inspired oxygen (Fio
2) during general anesthesia at 2-week intervals over a period of 39 months. AKI was defined as a 1.5-fold increase in creatinine from the preoperative level to the highest value measured during the initial 7 PODs. Myocardial injury was defined by fourth-generation troponin-T level >0.03 ng/mL. We assessed the effect of 80% vs 30% oxygen on the outcomes using generalized estimating equation (GEE) logistic models that adjusted for the possible within-patient correlation across multiple potential operations for a patient on different visits.

RESULTS:

For the AKI outcome, 2522 surgeries were allocated to 80% oxygen and 2552 to 30% oxygen. Hyperoxia had no effect on the primary outcome of postoperative AKI, with an incidence of 7.7% in the 80% oxygen group and 7.7% in the 30% oxygen group (relative risk = 0.99; 95% confidence interval [CI], 0.82–1.2; P = .95). One thousand six hundred forty-seven surgeries (all with scheduled troponin monitoring) were analyzed for the composite cardiovascular outcome. Hyperoxia had no effect on the collapsed composite of myocardial injury, cardiac arrest, and 30-day mortality, nor on any of its components (estimated relative risk = 0.71; 95% CI, 0.44–1.16; P = .17).

CONCLUSIONS:

We found no evidence that intraoperative hyperoxia causes AKI or cardiovascular complications in adults undergoing colorectal surgery. Consequently, we suggest that clinicians select intraoperative inspired oxygen fraction based on other considerations.
Tranexamic Acid for Acute Hemorrhage: A Narrative Review of Landmark Studies and a Critical Reappraisal of Its Use Over the Last Decade
Authors: Lier Heiko , Maegele Marc , Shander Aryeh
Published: September 2019

The publication of the Clinical Randomization of an Antifibrinolytic in Significant Hemorrhage-2 (CRASH-2) study and its intense dissemination prompted a renaissance for the use of the antifibrinolytic agent tranexamic acid (TXA) in acute trauma hemorrhage. Subsequent studies led to its widespread use as a therapeutic as well as prophylactic agent across different clinical scenarios involving bleeding, such as trauma, postpartum, and orthopedic surgery. However, results from the existing studies are confounded by methodological and statistical ambiguities and are open to varied interpretations. Substantial knowledge gaps remain on dosing, pharmacokinetics, mechanism of action, and clinical applications for TXA. The risk for potential thromboembolic complications with the use of TXA must be balanced against its clinical benefits. The present article aims to provide a critical reappraisal of TXA use over the last decade and a “thought exercise” in the potential downsides of TXA. A more selective and individualized use of TXA, guided by extended and functional coagulation assays, is advocated in the context of the evolving concept of precision medicine.
Intravenous Lidocaine for the Prevention of Postoperative Catheter-Related Bladder Discomfort in Male Patients Undergoing Transurethral Resection of Bladder Tumors: A Randomized, Double-Blind, Controlled Trial
Authors: Kim Doo-Hwan , Park Jun-Young , Yu Jihion , Lee Sang-A , Park Sooin , Hwang Jai-Hyun , Koh Gi-Ho , Kim Young-Kug
Published: September 2019

BACKGROUND:

Male patients undergoing transurethral resection of bladder tumors (TURBT) are prone to suffer from catheter-related bladder discomfort (CRBD). Lidocaine administration has been widely performed to reduce postoperative pain. Here, the effect of intravenous lidocaine administration on moderate-to-severe CRBD was evaluated in male patients undergoing TURBT.

METHODS:

Patients were randomly allocated to receive intravenous lidocaine (1.5 mg/kg bolus dose followed by a 2 mg/kg/h continuous infusion during the intraoperative period, which was continued for 1 hour postsurgery; group L) or placebo (normal saline; group C). The primary outcome was moderate-to-severe CRBD at 0 hour postsurgery (on admission to the postanesthetic care unit), analyzed using the χ2 test. The secondary outcome was opioid requirement during the 24-hour postoperative period. None, mild, and moderate-to-severe CRBD at 1, 2, and 6 hours postsurgery, postoperative pain, patient satisfaction, side effects of lidocaine and rescue medications (tramadol and fentanyl), and surgical complications were also assessed.

RESULTS:

A total of 132 patients were included in the study (66 patients in each group). The incidence of moderate-to-severe CRBD at 0 hour postsurgery was significantly lower in group L than in group C (25.8% vs 66.7%, P < .001, relative risk: 0.386, 95% confidence interval: 0.248–0.602). Opioid requirements during the 24-hour postoperative period were significantly lower in group L than in group C (10.0 mg [interquartile range (IQR), 5.0–15.0 mg] vs 13.8 mg [IQR, 10.0–20.0 mg], P = .005). At 1 and 2 hours postsurgery (but not at 6 hours), the incidence of moderate-to-severe CRBD was significantly lower in group L than in group C (1 hour: 10.6% vs 27.3%, P = .026; 2 hours: 0.0% vs 15.2%, P = .003). Patient satisfaction was significantly greater in group L than in group C (5.0 [IQR, 4.8–6.0] vs 4.0 [IQR, 4.0–5.0], P < .001). No lidocaine-related side effects were reported. Rescue medication-related side effects and surgical complications did not differ significantly between the 2 groups.

CONCLUSIONS:

Intravenous lidocaine administration resulted in lower incidence of moderate-to-severe CRBD, lower opioid requirement, and higher patient satisfaction in male patients undergoing TURBT without evidence of significant side effects.
CD40 forward signaling is a physiological regulator of early sensory axon growth
Authors: Howard Laura , McWilliams Thomas G. , Wyatt Sean , Davies Alun M.
Published: September 2019

Multiple members of the tumor necrosis factor superfamily (TNFSF) regulate the growth and branching of neural processes late in development when neurons are establishing and refining connections. Here we present the first evidence that a TNFSF member acts much earlier in development when axons are growing to their targets. CD40L transiently enhanced axon growth from embryonic mouse DRG neurons cultured at this early stage. Early spinal nerves of embryos lacking the CD40L receptor (Cd40−/− mice) were significantly shorter in vivo than those of Cd40+/+ littermates. CD40L was synthesized in early DRG targets and was co-expressed with CD40 in early DRG neurons. Whereas CD40L enhanced early axon growth independently of neurotrophins, disruption of a CD40L/CD40 autocrine loop impaired early neurotrophin-promoted axon growth. In marked contrast to the widespread regulation of axon and dendrite growth by CD40L reverse signaling later in development, CD40-Fc, which activates reverse signaling, had no effect on early sensory axon growth. These results suggest that CD40 forward signaling is a novel physiological regulator of early axon growth that acts by target-derived and autocrine mechanisms.
Genomic architecture of Shh dependent cochlear morphogenesis
Authors: Muthu Victor , Rohacek Alex. M. , Yao Yao , Rakowiecki Staci M. , Brown Alexander S. , Zhao Ying-Tao , Meyers James , Won Kyoung-Jae , Ramdas Shweta , Brown Christopher D. , Peterson Kevin A. , Epstein Douglas J.
Published: September 2019

The mammalian cochlea develops from a ventral outgrowth of the otic vesicle in response to Shh signaling. Mouse embryos lacking Shh or its essential signal transduction components display cochlear agenesis, however, a detailed understanding of the transcriptional network mediating this process is unclear. Here, we describe an integrated genomic approach to identify Shh dependent genes and associated regulatory sequences that promote cochlear duct morphogenesis. A comparative transcriptome analysis of otic vesicles from mouse mutants exhibiting loss (Smoecko) and gain (Shh-P1) of Shh signaling reveal a set of Shh responsive genes partitioned into four expression categories in the ventral half of the otic vesicle. This target gene classification scheme provides novel insight into several unanticipated roles for Shh, including priming the cochlear epithelium for subsequent sensory development. We also mapped regions of open chromatin in the inner ear by ATAC-seq that, in combination with Gli2 ChIP-seq, identified inner ear enhancers in the vicinity of Shh responsive genes. These datasets are useful entry points for deciphering Shh dependent regulatory mechanisms involved in cochlear duct morphogenesis and establishment of its constituent cell types.
Planar cell polarity signaling regulates polarized second heart field morphogenesis to promote both arterial and venous pole septation
Authors: Li Ding , Angermeier Allyson , Wang Jianbo
Published: September 2019

Second heart field (SHF) harbors progenitors important for heart formation, but little is known about its morphogenesis. We show that SHF population in the splanchnic mesoderm (SpM-SHF) undergoes polarized morphogenesis to preferentially elongate anteroposteriorly. Loss of Wnt5, a putative ligand of the planar cell polarity (PCP) pathway, cause the SpM-SHF to expand isotropically. Temporal tracking reveals that Wnt5a lineage is a unique subpopulation specified as early as E7.5, and undergoes bi-directional deployment to form specifically the pulmonary trunk and the dorsal mesenchymal protrusion (DMP). In Wnt5a-/- mutants, Wnt5a lineage fails to extend into the arterial and venous poles, leading to both outflow tract and atrial septation defects that can be rescued by an activated form of PCP effector Daam1. We identify oriented actomyosin cable in the medial SpM-SHF as a potential Wnt5a-mediated mechanism to promote SpM-SHF lengthening and restrict its widening. Finally, Wnt5a lineage also contributes to the pulmonary mesenchyme, suggesting that Wnt5a/ PCP is a molecular circuit recruited by the recently identified cardiopulmonary progenitors to coordinate morphogenesis of the pulmonary airways and the cardiac septations necessary for pulmonary circulation.
Muscle myonuclear domain, but not oxidative stress, decreases with age in a long-lived seabird with high activity costs
Authors: Jimenez Ana Gabriela , O'Connor Erin S. , Elliott Kyle H.
Published: September 2019

In birds, many physiological parameters appear to remain constant with increasing age, showing no deterioration until ‘catastrophic’ mortality sets in. Given their high whole-organism metabolic rate and the importance of flight in foraging and predator avoidance, flight muscle deterioration and accumulated oxidative stress and tissue deterioration may be an important contributor to physiological senescence in wild birds. As a by-product of aerobic respiration, reactive oxygen species are produced and can cause structural damage within cells. The anti-oxidant system deters oxidative damage to macromolecules. We examined oxidative stress and muscle ultrastructure in thick-billed murres aged 8 to 37 years (N=50) in pectoralis muscle biopsies. When considered in general linear models with body mass, body size and sex, no oxidative stress parameter varied with age. In contrast, there was a decrease in myonuclear domain similar to that seen in human muscle aging. We conclude that for wild birds with very high flight activity levels, muscle ultrastructural changes may be an important contributor to demographic senescence. Such gradual, linear declines in muscle morphology may eventually contribute to ‘catastrophic’ failure in foraging or predator avoidance abilities, leading to demographic senescence.
The Role for the Weak Interaction on the Stabilization of Copper-Containing Complex: DFT Investigation of Noncovalent Interactions in Ternary-Cu(II) (DA)(AA) Complexes (DA = Diamine and AA = Amino Acids) as a Model of Metalloprotein
Authors: Taborosi Attila , Yamaguchi Takahide , Odani Akira , Yamauchi Osamu , Kohzuma Takamitsu
Published: September 2019

In view of the key roles played by noncovalent or weak interactions in biological processes, it is important to understand them at the molecular level. Based on the results of the thermodynamic, spectroscopic and X-ray structural studies on ternary Cu(II) complexes, as platform molecules for ligand-ligand interactions, the presence of π-π interactions between aromatic rings (phenyl, phenol and indole) of amino acids and aromatic rings of imidazole, diamines have been shown. We carried out systematic theoretical studies using different DFT functionals (pure-GGA, meta-GGA, hybrid-GGA and meta-hybrid-GGA) with triple-ζ (def2TZVP) basis set for the experimentally determined structure of [Cu(hista)(Phe)]ClO4, to obtain the most suitable method. We gained reliable insight into the geometry, electronic structure and noncovalent interactions for different ternary complexes, [Cu(hista)(AA)]ClO4 (AA = Phe, Tyr, Trp, Leu, Ile, Ala, Met, Val) by applying the most accurate method (PW91/def2TZVP/CPCM). The calculated stability constants (logK) were in good agreement with the experimental results. We obtained knowledge of the differences in noncovalent interactions and excited states among the ternary Cu(II) complexes containing Phe, Tyr, and Trp by the Non-Covalent Interaction (NCI) and TDDFT methods.
Can thoracic nodes oligometastases be safely treated with image guided hypofractionated radiation therapy?
Authors: Franceschini Davide , Bianciardi Federico , Mazzola Rosario , De Rose Fiorenza , Gentile Piercarlo , Alongi Filippo , Scorsetti Marta
Published: September 2019

Objective:

To evaluate safety and efficacy of image guided-hypofractionated radiation therapy (IG-HRT) in patients with thoracic nodes oligometastases

Methods:

The present study is a multicenter analysis. Oligometastatic patients, affected by a maximum of five active lesions in three or less different organs, treated with IG-HRT to thoracic nodes metastases between 2012 and 2017 were included in the analysis. Primary end point was local control (LC), secondary end points were overall survival (OS), progression-free survival, acute and late toxicity. Univariate and multivariate analysis were performed to identify possible prognostic factors for the survival end points.

Results:

76 patients were included in the analysis. Different RT dose and fractionation schedules were prescribed according to site, number, size of the lymph node(s) and to respect dose constraints for relevant organs at risk. Median biologically effective dose delivered was 75 Gy (interquartile range: 59–86 Gy). Treatment was optimal; one G1 acute toxicity and seven G1 late toxicities of any grade were recorded. Median follow-up time was 23.16 months. 16 patients (21.05%) had a local progression, while 52 patients progressed in distant sites (68.42 %). Median local relapse free survival was not reached, LC at 6, 12 and 24 months was 96.05% [confidence interval (CI) 88.26–98.71%], 86.68% (CI 75.86–92.87) and 68.21% (CI 51.89–80.00%), respectively. Median OS was 28.3 months (interquartile range 16.1–47.2). Median progression-freesurvival was 9.2 months (interquartile range 4.1–17.93). At multivariate analysis, RT dose, colorectal histology, systemic therapies were correlated with LC. Performance status and the presence of metastatic sites other than the thoracic nodes were correlated with OS. Local response was a predictor of OS.

Conclusion:

IG-HRT for thoracic nodes was safe and feasible. Higher RT doses were correlated to better LC and should be taken in consideration at least in patients with isolated nodal metastases and colorectal histology.

Advances in knowledge:

Radiotherapy is safe and effective treatment for thoracic nodes metastases, higher radiotherapy doses are correlated to better LC. Oligometastatic patients can receive IG-HRT also for thoracic nodes metastases.
The evolving role of radiotherapy in non-small cell lung cancer
Authors: Brown Sean , Banfill Kathryn , Aznar Marianne C. , Whitehurst Philip , Faivre Finn Corinne
Published: September 2019

Lung cancer is the most commonly diagnosed cancer and biggest cause of cancer mortality worldwide with non-small cell lung cancer (NSCLC) accounting for most cases. Radiotherapy (RT) plays a key role in its management and is used at least once in over half of patients in both curative and palliative treatments. This narrative review will demonstrate how the evolution of RT for NSCLC has been underpinned by improvements in RT technology. These improvements have facilitated geometric individualization, increasingly accurate treatment and now offer the ability to deliver truly individualized RT. In this review, we summarize and discuss recent developments in the field of advanced RT in early stage, locally advanced and metastatic NSCLC. We highlight limitations in current approaches and discuss future potential treatment strategies for patients with NSCLC.