bluuebunny/crossref_metadata_2025 huggingface dataset:
From the Soil to the Soul: Fragments of a Theory of Economic Conflicts
Authors: Gerber Julien-François
Published: March 2023

This chapter intends to strengthen the institutional and psychological dimensions of the Barcelona School’s analysis of environmental conflicts. It does so by embedding environmental conflicts into other kinds of struggles over the economy, defined as the various ways by which humans organize their sustenance. It asks: What are the key triggers behind economic conflicts? What kinds of radical ideologies emerge from them? How are they able (or not) to sustain their radical projects? I suggest that the main conflicting points of today’s neoliberal capitalism are related to its metabolism (ecological), its debts (institutional), and to the widespread alienation it is creating (psychological). I argue that these particular points of contention are giving rise to a new blend of radical ideas around ‘degrowth’ and related movements. On one hand, this is so because degrowth confronts growthism and its unparalleled levels of ecological destruction and debt. On the other hand, degrowth seeks to address the problem of alienation by reconnecting economies to the conditions for flourishing. Collective flourishing requires, among other things, to work on one’s awareness. Such ‘inner work’ is necessary in any social movement, but it has received much less attention than the ‘outer work’ of changing the immediate or the structural triggers behind conflicts. I suggest that this disregard contributes to explaining why radical movements have so rarely been successful. I conclude that subjectivity and alienation are important frontiers of research for the Barcelona School.
Contribution of Global Cities to Climate Change Mitigation Overrated
Authors: van den Bergh Jeroen C. J. M.
Published: March 2023

Local solutions to global environment challenges form part of the Martinez-Alier style of ecological economics in Barcelona. This tends to involve an optimistic assessment of the role of cities. Here, I consider this role for the case of urban policies aimed at reducing carbon emissions. There is indeed considerable optimism about the role of cities in global reduction of greenhouse gas (GHG) emissions. I appraise recent studies and conclude that they (1) do not account for the limited reach of urban policies; (2) overplay voluntary action and underplay the importance of effective regulation; (3) disregard free riding and systemic effects like carbon leakage; and (4) lack quantitative estimates of the overall contribution of cities to emissions reduction, at best providing empirical indicators that do not connect well with urban policies. I provide an initial, tentative estimate of the upper bound to the contribution of city policies worldwide to global emissions reduction as equal to 16.8%, while realistic policies are assessed to control no more than 2%. These numbers underpin that the major part of emissions generated within city borders is outside the control of local policies, instead depending on policies set by national governments.
Synopsis: Strategic Opportunism – Vision, Passion and Pragmatism
Authors: Huntley Brian John
Published: March 2023

Strategic opportunism is adaptive management writ large. It seeks to transform problems into solutions. It recognises serendipity and embraces unexpected opportunities and the political moment. The development and application of the concept is based on experience drawn from multiple projects, across ten countries, within biomes ranging from hyper-arid desert, to tropical savanna, and to sub-Antarctic tundra, and within dynamic socio-political landscapes. The thesis of this book is that success depends on a clear and shared vision, within a flexible approach to project design and implementation, free of the straight-jacket of development agency project formats and short-term funding horizons.
Seizing the Moment While Imagining the Future
Authors: Huntley Brian John
Published: March 2023

The concept of strategic opportunism can be succinctly defined as ‘seizing the moment while imagining the future’. The development and application of the approach is based on many decades of experience in fragile socio-economic landscapes where adaptation to uncertainty and change is essential. It exploits unpredictable opportunities and serendipity – a mix of good luck and good timing. It combines paying attention to frequent minor crises, but yet never losing sight of the long-term vision.
Angolan Giant Sable: Rediscovery, Rescue and Recovery
Authors: Huntley Brian John
Published: March 2023

By the end of Angola’s 30-year civil war, the country’s national icon, the giant sable antelope, was believed to be extinct. The remarkable story of one man’s commitment to the re-discovery, rescue and recovery of the ‘finest antelope in Africa’ is described. Following twenty years of indefatigable effort, the long-term future of this magnificent antelope has been secured.
Marion Island: Birds, Cats, Mice and Men
Authors: Huntley Brian John
Published: March 2023

Marion and Prince Edward Islands, 2 300 km off the southern tip of Africa, are home to several million breeding seabirds. But five domestic cats were introduced as pets to the meteorological station on Marion Island in 1948. By the mid-1980s, the feral cat population, by then over 2 000 strong, were estimated to be killing over 455 000 ground-nesting petrels and prions per year. A seven-phase campaign, combining the use of trapping, the release of feline panleucopaenia virus, and intensive hunting, across more than twenty years, led to the total extermination of cats on the island, the largest project of its kind undertaken to that date.
Gorongosa National Park: Wilderness, War and Wildlife Recovery
Authors: Huntley Brian John
Published: March 2023

Gorongosa National Park provides a model of hope for conservation in Africa. In the 1960s and ‘70s it was the pride of Mozambique, a wildlife paradise of extraordinarily rich biodiversity and stunning landscapes. But by the end of the century, the civil war that followed independence in 1975 left it with less than 15% of its wildlife population, and with several species locally extirpated. A chance meeting between an American philanthropist and the Mozambican president in 2004 led to an ambitious plan to restore the Park. The Gorongosa Restoration Project was based on the long view on conservation. The Park has become the nexus of a regional human development engine. The wildlife populations have rapidly increased, and many species have been reintroduced, restoring the mix of herbivores and predators.
Translating Legal Terms at International Organisations: Do Institutional Term Banks Meet Translators’ Needs?
Authors: Prieto Ramos Fernando , Guzmán Diego
Published: March 2023

Institutional term banks (ITBs), such as Inter-Active Terminology for Europe (IATE) in the European Union (EU) institutions and UNTERM in the United Nations, are key sources for the language services of these institutions, and are also used by many other translators and language professionals. These resources are considered authoritative in the translation of institution-specific terminology. However, previous studies have revealed reliability gaps in the content of ITB records, particularly for terms borrowed from specific legal traditions that are used in international legal settings and terms designating singular concepts of national legal systems. This chapter reports further research into the potential causes for such issues and the extent to which terminological records meet institutional translators’ needs. To this end, data were collected through several methods as part of the LETRINT project on legal translation in international institutional settings: (1) interviews with institutional terminologists on the approaches applied to build legal term records for IATE, UNTERM and CuriaTerm (which was initially developed for the needs of the Court of Justice of the EU and later migrated into IATE); (2) an evaluation of ITB relevance and reliability by institutional translators through a survey of 190 respondents; and (3) an assessment of 79 IATE and UNTERM records for 30 terms (of three degrees of legal singularity) from the perspective of translation-oriented legal lexicography. The triangulated results provide evidence of the benefits of applying a systematic legal lexicography approach in the case of CuriaTerm. They also point to significant correlations between translators’ evaluation of IATE and UNTERM for legal translation and the reliability and completeness variations detected in the analysis of illustrative records for each ITB and degree of legal singularity.
On the representation of ordered semigroups by transformations of ordered sets
Authors: Tsingelis Michael
Published: March 2023

A transformation of an ordered set M is an isotone mapping of M into M. By a representation of an ordered semigroup S by transformations of an ordered set M we mean a homomorphism of S into the set of transformations of M, i.e. (since the set of transformations of M is an ordered semigroup) an isotone mapping from S into the set of transformations of M preserving the operations. We prove that this type of representation leads to an “action” of S on M and so we introduce the notion of a left operand of M over S. Also we introduce the notions of a left operator pseudoorder on a left operand over S and a left operator homomorphism between left operands over S. We show that the concept of left operator pseudoorders on left operands over S plays an important role in the study of left operator homomorphisms of left operands over S. In the case of right operands over S dually definitions and results hold.
Dual-Energy Computed Tomography in Stroke Imaging
Authors: Grkovski Risto , Acu Leyla , Ahmadli Uzeyir , Nakhostin Dominik , Thurner Patrick , Wacht Lorenz , Kulcsár Zsolt , Alkadhi Hatem , Winklhofer Sebastian
Published: March 2023

Objective

To assess if a new dual-energy computed tomography (DECT) technique enables an improved visualization of ischemic brain tissue after mechanical thrombectomy in acute stroke patients.

Material and Methods

The DECT head scans with a new sequential technique (TwinSpiral DECT) were performed in 41 patients with ischemic stroke after endovascular thrombectomy and were retrospectively included. Standard mixed and virtual non-contrast (VNC) images were reconstructed. Infarct visibility and image noise were assessed qualitatively by two readers using a 4-point Likert scale. Quantitative Hounsfield units (HU) were used to assess density differences of ischemic brain tissue versus healthy tissue on the non-affected contralateral hemisphere.

Results

Infarct visibility was significantly better in VNC compared to mixed images for both readers R1 (VNC: median 1 (range 1–3), mixed: median 2 (range 1–4), p < 0.05) and R2 (VNC: median 2 (range 1–3), mixed: 2 (range 1–4), p < 0.05). Qualitative image noise was significantly higher in VNC compared to mixed images for both readers R1 (VNC: median 3, mixed: 2) and R2 (VNC: median 2, mixed: 1, p < 0.05, each). Mean HU were significantly different between the infarcted tissue and the reference healthy brain tissue on the contralateral hemisphere in VNC (infarct 24 ± 3) and mixed images (infarct 33 ± 5, p < 0.05, each). The mean HU difference between ischemia and reference in VNC images (mean 8 ± 3) was significantly higher (p < 0.05) compared to the mean HU difference in mixed images (mean 5 ± 4).

Conclusion

TwinSpiral DECT allows an improved qualitative and quantitative visualization of ischemic brain tissue in ischemic stroke patients after endovascular treatment.
Computed Tomography of the Head
Authors: Dieckmeyer Michael , Sollmann Nico , Kupfer Karina , Löffler Maximilian T. , Paprottka Karolin J. , Kirschke Jan S. , Baum Thomas
Published: March 2023

In 1971, the first computed tomography (CT) scan was performed on a patient’s brain. Clinical CT systems were introduced in 1974 and dedicated to head imaging only. New technological developments, broader availability, and the clinical success of CT led to a steady growth in examination numbers. Most frequent indications for non-contrast CT (NCCT) of the head include the assessment of ischemia and stroke, intracranial hemorrhage and trauma, while CT angiography (CTA) has become the standard for first-line cerebrovascular evaluation; however, resulting improvements in patient management and clinical outcomes come at the cost of radiation exposure, increasing the risk for secondary morbidity. Therefore, radiation dose optimization should always be part of technical advancements in CT imaging but how can the dose be optimized? What dose reduction can be achieved without compromising diagnostic value, and what is the potential of the upcoming technologies artificial intelligence and photon counting CT? In this article, we look for answers to these questions by reviewing dose reduction techniques with respect to the major clinical indications of NCCT and CTA of the head, including a brief perspective on what to expect from current and future developments in CT technology with respect to radiation dose optimization.
Impact of dose escalation on colostomy-free survival and treatment outcome in squamous cell anal carcinoma
Authors: Untiedt Sebastian , Rolf Daniel , Scobioala Sergiu , Wolters Heidi , Elsayad Khaled , Oertel Michael , Kittel Christopher , Pascher Andreas , Rijcken Emile , Ullerich Hansjörg , Glasbrenner Bernhard , Eich Hans Theodor
Published: March 2023

Purpose

Primary radiochemotherapy (RCT) constitutes the standard of care for early- and advanced-stage anal carcinoma. This retrospective study investigates the impact of dose escalation on colostomy-free survival (CFS), overall survival (OS), locoregional control (LRC), progression-free survival (PFS), and acute and late toxicities in patients with squamous cell anal cancer.

Methods

Considered were the outcomes of 87 patients with anal cancer treated with radiation/RCT between May 2004 and January 2020 at our institution. Toxicities were evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE version 5.0).

Results

The 87 patients received treatment with a median boost of 63 Gy to the primary tumor. With a median follow-up of 32 months, the 3‑year CFS, OS, LRC, and PFS were 79.5%, 71.4%, 83.9%, and 78.5%, respectively. Tumor relapse occurred in 13 patients (14.9%). Dose escalation to > 63 Gy (maximum 66.6 Gy) to the primary tumor in 38/87 patients revealed a nonsignificant trend for improved 3‑year CFS (82.4% vs. 97%, P = 0.092), a significantly improved CFS for T2/T3 tumors (72.6% vs. 100%, P = 0.008), and a significantly improved 3‑year PFS for T1/T2 tumors (76.7% vs. 100%, P = 0.035). While acute toxicities did not differ, dose escalation > 63 Gy led to a higher rate of chronic skin toxicities (43.8% vs. 69%, P = 0.042). Treatment with intensity-modulated radiotherapy (IMRT) showed a significant improvement in 3‑year OS (75.4% vs. 53.8%, P = 0.048). In multivariate analysis, significant improvements for T1/T2 tumors (CFS, OS, LRC, PFS), G1/2 tumors (PFS), and IMRT (OS) were shown. The nonsignificant trend for CFS improvement with dose escalation > 63 Gy was also apparent in multivariate analysis (P = 0.067).

Conclusion

Dose escalation > 63 Gy (maximum 66.6 Gy) may improve CFS and PFS for certain subgroups, with a concomitant increase in chronic skin toxicities. Modern IMRT seems to be associated with an improvement in OS.
Endovascular treatment of spinal AVM: report of two cases with transvenous approach in combination with retrograde pressure cooker technique
Authors: Stracke Christian Paul , Schwindt Wolfram , Meyer Lukas , Fiehler Jens , Chapot René
Published: March 2023

Purpose

Endovascular treatment of spinal AVMs is limited by low complete cure rates. Transarterial extensive treatment with liquid embolics carries the risk of clinically relevant ischemic complications. We report two cases of symptomatic spinal AVMs treated by a transvenous approach with retrograde pressure cooker technique.

Methods

In two selected cases, transvenous navigation aimed at retrograde pressure cooker embolization.

Results

Retrograde venous navigation was possible with two parallel microcatheters, and the pressure cooker technique with ethylenvinylalcohol-polymer was applicable in both cases. One AVM was occluded completely, and one subtotally due to a second draining vein. No clinical complications occurred.

Conclusion

A transvenous approach for embolization with liquid embolics may offer advantages in treating certain spinal AVMs.
89Zr-immuno-PET using the anti-LAG-3 tracer [89Zr]Zr-BI 754111: demonstrating target specific binding in NSCLC and HNSCC
Authors: Miedema Iris H.C. , Huisman Marc C. , Zwezerijnen Gerben J.C. , Grempler Rolf , Pitarch Alejandro Perez , Thiele Andrea , Hesse Raphael , Elgadi Mabrouk , Peltzer Alexander , Vugts Danielle J. , van Dongen Guus A.M.S. , de Gruijl Tanja D. , Menke-van der Houven van Oordt C. Willemien , Bahce Idris
Published: March 2023

Purpose

Although lymphocyte activation gene-3 (LAG-3) directed therapies demonstrate promising clinical anti-cancer activity, only a subset of patients seems to benefit and predictive biomarkers are lacking. Here, we explored the potential use of the anti-LAG-3 antibody tracer [89Zr]Zr-BI 754111 as a predictive imaging biomarker and investigated its target specific uptake as well as the correlation of its tumor uptake and the tumor immune infiltration.

Methods

Patients with head and neck (N = 2) or lung cancer (N = 4) were included in an imaging substudy of a phase 1 trial with BI 754091 (anti-PD-1) and BI 754111 (anti-LAG-3). After baseline tumor biopsy and [18F]FDG-PET, patients were given 240 mg of BI 754091, followed 8 days later by administration of [89Zr]Zr-BI 754111 (37 MBq, 4 mg). PET scans were performed 2 h, 96 h, and 144 h post-injection. To investigate target specificity, a second tracer administration was given two weeks later, this time with pre-administration of 40 (N = 3) or 600 mg (N = 3) unlabeled BI 754111, followed by PET scans at 96 h and 144 h post-injection. Tumor immune cell infiltration was assessed by immunohistochemistry and RNA sequencing.

Results

Tracer uptake in tumors was clearly visible at the 4-mg mass dose (tumor-to-plasma ratio 1.63 [IQR 0.37-2.89]) and could be saturated by increasing mass doses (44 mg: 0.67 [IQR 0.50–0.85]; 604 mg: 0.56 [IQR 0.42–0.75]), demonstrating target specificity. Tumor uptake correlated to immune cell-derived RNA signatures.

Conclusions

[89Zr]Zr-BI-754111 PET imaging shows favorable technical and biological characteristics for developing a potential predictive imaging biomarker for LAG-3-directed therapies.

Trial registration

ClinicalTrials.gov, NCT03780725. Registered 19 December 2018
Multitrip vehicle routing with delivery options: a data-driven application to the parcel industry
Authors: Janinhoff Lukas , Klein Robert , Scholz Daniel
Published: March 2023

To make the last mile of parcel delivery more efficient, service providers offer an increasing number of modes of delivery as alternatives to the traditional and often cost-intensive home delivery service. Parcel lockers and pickup stations can be utilized to reduce the number of stops and avoid costly detours. To design smart delivery networks, service providers must evaluate different business models. In this context, a multitrip vehicle routing problem with delivery options and location-dependent costs arises. We present a data-driven framework to evaluate alternative delivery strategies, formulate a corresponding model and solve the problem heuristically using adaptive large neighborhood search. By examining large, real-life instances from a major European parcel service, we determine the potential and benefits of different delivery options. Specifically, we show that delivery costs can be mitigated by consolidating orders in pickup stations and illustrate how pricing can be applied to steer customer demand toward profitable, eco-friendly products.
Si–Ge–Sn alloys grown by chemical vapour deposition: a versatile material for photonics, electronics, and thermoelectrics
Authors: Grützmacher D. , Concepción O. , Zhao Q.-T. , Buca D.
Published: March 2023

Si–Ge–Sn alloys are offering unusual material properties with a strong potential to add a variety of functionalities to advanced CMOS technology. Being a group IV alloy, SiGeSn can be monolithically integrated on Si. The discovery of a direct band gap at Sn concentration above 8%, the extremely small effective mass for electrons and holes as well as the pronounced phonon scattering are opening new opportunities for Si photonics, high frequency devices and thermoelectrics. Si–Ge–Sn alloys with Sn concentration far beyond the solid solubility limit are metastable, artificial materials, which request challenging growth conditions. In this paper the epitaxial conditions for Si–Ge–Sn alloys to achieve precise control of the Sn content, to manage the lattice mismatch and defects, as well as to fabricate doped layers are discussed. The applied process control allows for epitaxy of group-IV heterostructures, required for typical devices for photonic and electronic applications. In this context, lasers and nanowires MOSFETs are discussed in this paper. In additions, the thermal conductivity is investigated as a critical material parameter to obtain a high thermoelectric figure of merit in GeSn alloys.
Downstream development during ridging South Atlantic Ocean anticyclones
Authors: Ndarana Thando , Lekoloane Lesetja E. , Rammopo Tsholanang S. , Reason Chris J. C. , Bopape Mary-Jane M. , Chikoore Hector , Engelbrecht Francois A.
Published: March 2023

Ridging South Atlantic high pressure systems (ridging highs) are often accompanied by cut-off low (COL) pressure systems aloft, but may also occur without them, in which case a linear baroclinic wave would be observed propagating across the South African domain in the upper troposphere. Using 41 years of ERA-5 reanalysis data, this study documents differences between the characteristics of the prevailing dynamical processes and associated local eddy kinetic energy generation, its downstream transfer and dissipation during these two scenarios. The study shows that when COLs are present then baroclinic conversion is strong and it is confined east of the Greenwich Meridian, whereas it is located downstream of South Africa and it is much weaker, when ridging occurs without COLs. The differences in strength and locations of the baroclinic conversion are associated with the differing jet streak configurations between the two scenarios; which lead to Rossby wave breaking and the absence thereof when there are COLs and when ridging occurs without COLs, respectively. The presence of breaking during COLs leads to trans-ridge downstream development that facilitates energy transfer from the midlatitudes into the South African domain. When there are no COLs present, the trans-trough downstream development is stronger than it is across the upstream ridge. Barotropic conversion from eddy kinetic energy to mean kinetic energy occurs in the South African domain during COLs, but occurs much further downstream when there are no COLs during ridging highs. The difference in the characteristics identified in this study can be traced back to the differences in the potential vorticity anomaly structures, which are largely due to whether the waves break or do not during the evolution of ridging events in the South African domain.
Long-term supplementation with 3200 to 4000 IU of vitamin D daily and adverse events: a systematic review and meta-analysis of randomized controlled trials
Authors: Zittermann Armin , Trummer Christian , Theiler-Schwetz Verena , Pilz Stefan
Published: March 2023

Purpose

The upper tolerable intake level for vitamin D in the general population has been set at 4000 international units (IU) daily, but considerable uncertainty remains. We summarized reported harmful effects of a daily vitamin D supplement of 3200–4000 IU in trials lasting ≥ 6 months.

Methods

We performed a systematic review and meta-analysis of randomized controlled trials in several databases and identified 22 trials reporting safety data. Parameters of calcium metabolism, falls, hospitalization, and mortality were assessed.

Results

The selected trials comprised a total number of 12,952 participants. All trials used supplemental vitamin D3. The relative risk (RR) of hypercalcemia in the vitamin D vs. control arm was 2.21 (95%CI: 1.26–3.87; 10 studies), with a vitamin D-induced frequency of hypercalcemia of 4 cases per 1000 individuals. Subgroup analysis in trials with > 100 and ≤ 100 study participants revealed an RR of 2.63 (95%CI: 1.30–5.30; 7 studies) and 0.80 (95%CI: 0.24–2.62; 3 studies), respectively (Pinteraction = 0.06). Risks of falls and hospitalization were also significantly increased in the vitamin D arm with an RR of 1.25 (95%CI: 1.01–1.55; 4 studies) and 1.16 (95%CI: 1.01–1.33; 7 studies), respectively. Risks of hypercalciuria, kidney stones, and mortality did not differ significantly between study arms. Quality assessment revealed high risk of incomplete reporting of safety-related outcome data.

Conclusion

Supplemental vitamin D doses of 3200–4000 IU/d appear to increase the risk of hypercalcemia and some other adverse events in a small proportion of individuals, indicating that this dose is not completely safe. In future studies, rigorous reporting of safety-related outcomes is needed when using moderately high doses of vitamin D.
Ploidy-stratified single cardiomyocyte transcriptomics map Zinc Finger E-Box Binding Homeobox 1 to underly cardiomyocyte proliferation before birth
Authors: Bak Sara Thornby , Harvald Eva Bang , Ellman Ditte Gry , Mathiesen Sabrina Bech , Chen Ting , Fang Shu , Andersen Kristian Skriver , Fenger Christina Dühring , Burton Mark , Thomassen Mads , Andersen Ditte Caroline
Published: March 2023

Whereas cardiomyocytes (CMs) in the fetal heart divide, postnatal CMs fail to undergo karyokinesis and/or cytokinesis and therefore become polyploid or binucleated, a key process in terminal CM differentiation. This switch from a diploid proliferative CM to a terminally differentiated polyploid CM remains an enigma and seems an obstacle for heart regeneration. Here, we set out to identify the transcriptional landscape of CMs around birth using single cell RNA sequencing (scRNA-seq) to predict transcription factors (TFs) involved in CM proliferation and terminal differentiation. To this end, we established an approach combining fluorescence activated cell sorting (FACS) with scRNA-seq of fixed CMs from developing (E16.5, P1, and P5) mouse hearts, and generated high-resolution single-cell transcriptomic maps of in vivo diploid and tetraploid CMs, increasing the CM resolution. We identified TF-networks regulating the G2/M phases of developing CMs around birth. ZEB1 (Zinc Finger E-Box Binding Homeobox 1), a hereto unknown TF in CM cell cycling, was found to regulate the highest number of cell cycle genes in cycling CMs at E16.5 but was downregulated around birth. CM ZEB1-knockdown reduced proliferation of E16.5 CMs, while ZEB1 overexpression at P0 after birth resulted in CM endoreplication. These data thus provide a ploidy stratified transcriptomic map of developing CMs and bring new insight to CM proliferation and endoreplication identifying ZEB1 as a key player in these processes.
Lower limb cutaneous melanoma surgery: location matters
Authors: Piñero-Madrona Antonio , Cerezuela-Fuentes Pablo , Ruiz-Merino Guadalupe , Martínez-Barba Enrique , Ortiz-Reina Sebastián , Martínez-Ortiz María José , López-Ávila Angel , Frías-Iniesta José F. , Viney Alice , Cabezas-Herrera Juan
Published: March 2023

The anatomical location of cutaneous melanoma is a relevant independent prognostic factor in melanoma. The aim of the study is to know the prognosis of lower limb cutaneous melanoma related to their location within the limb, regardless of the histological type, and if there are any other influencing variables. A real-world data observational study was developed. The lesions were divided depending on the location of the melanoma (thigh, leg and foot). Bivariate and multivariate analysis were performed, and melanoma-specific survival and disease-free survival rates were calculated. When these analysis were done, the results showed that, in melanomas of the lower limb, location on the foot presented a lower melanoma-specific survival rate compared to more proximal locations, and only the anatomical location presents statistical significance to discriminate cases with a higher mortality risk and a lower disease-free survival rate among distal melanomas (mainly on the foot). In conclusion, this study confirms that a more distal location of lower limb cutaneous melanoma is a relevant prognostic factor.

Trial registration number NCT04625491 retrospectively registered.
Altered parasympathetic activity during sleep and emotionally arousing wakefulness in frequent nightmare recallers
Authors: Tomacsek Vivien , Blaskovich Borbála , Király Anna , Reichardt Richárd , Simor Péter
Published: March 2023

Nightmare disorder is characterized by dysfunctional emotion regulation and poor subjective sleep quality reflected in pathophysiological features such as abnormal arousal processes and sympathetic influences. Dysfunctional parasympathetic regulation, especially before and during rapid eye movement (REM) phases, is assumed to alter heart rate (HR) and its variability (HRV) of frequent nightmare recallers (NM). We hypothesized that cardiac variability is attenuated in NMs as opposed to healthy controls (CTL) during sleep, pre-sleep wakefulness and under an emotion-evoking picture-rating task. Based on the polysomnographic recordings of 24 NM and 30 CTL participants, we examined HRV during pre-REM, REM, post-REM and slow wave sleep, separately. Additionally, electrocardiographic recordings of resting state before sleep onset and under an emotionally challenging picture-rating task were also analyzed. Applying repeated measures analysis of variance (rmANOVA), a significant difference was found in the HR of NMs and CTLs during nocturnal segments but not during resting wakefulness, suggesting autonomic dysregulation, specifically during sleep in NMs. As opposed to the HR, the HRV values were not significantly different in the rmANOVA in the two groups, implying that the extent of parasympathetic dysregulation on a trait level might depend on the severeness of dysphoric dreaming. Nonetheless, in the group comparisons, the NM group showed increased HR and reduced HRV during the emotion-evoking picture-rating task, which aimed to model the nightmare experience in the daytime, indicating disrupted emotion regulation in NMs under acute distress. In conclusion, trait-like autonomic changes during sleep and state-like autonomic responses to emotion-evoking pictures indicate parasympathetic dysregulation in NMs.
Understanding the burden of unidentified bodies: a systematic review
Authors: Reid Kate Megan , Martin Lorna J. , Heathfield Laura Jane
Published: March 2023

While human identification is a crucial aspect of medico-legal investigations, many individuals remain unidentified each year across the world. The burden of unidentified bodies is often referred to when motivating for improved methods of identification, and anatomical teaching, yet the actual burden is somewhat unclear. A systematic literature review was undertaken to identify articles that empirically investigate the number of unidentified bodies experienced. Despite the large number of articles returned, an alarmingly low number (24 articles) provided specific and empirical details on the number of unidentified bodies, demographics and trends thereof. It is possible that this lack of data is due to the variable definition of ‘unidentified’ bodies and the use of alternative terminology such as ‘homelessness’ or ‘unclaimed’ bodies. Nevertheless, the 24 articles provided data for 15 forensic facilities across ten countries of both developed and developing statuses. On average, developing countries experienced more than double (9.56%) the number of unidentified bodies when compared to developed nations (4.40%). While facilities were mandated under different legislations and infrastructures available varied greatly, the most common issue faced is the lack of standardised procedures for forensic human identification. Further to this, the need for investigative databases was highlighted. Through addressing the standardisation of identification procedures and terminology, alongside the appropriate utilisation of existing infrastructure and database creation, the number of unidentified bodies could be significantly reduced globally.
The clinical and genetic spectrum of primary familial brain calcification
Authors: Carecchio Miryam , Mainardi Michele , Bonato Giulia
Published: March 2023

Primary familial brain calcification (PFBC), formerly known as Fahr’s disease, is a rare neurodegenerative disease characterized by bilateral progressive calcification of the microvessels of the basal ganglia and other cerebral and cerebellar structures. PFBC is thought to be due to an altered function of the Neurovascular Unit (NVU), where abnormal calcium-phosphorus metabolism, functional and microanatomical alterations of pericytes and mitochondrial alterations cause a dysfunction of the blood–brain barrier (BBB) and the generation of an osteogenic environment with surrounding astrocyte activation and progressive neurodegeneration. Seven causative genes have been discovered so far, of which four with dominant (SLC20A2, PDGFB, PDGFRB, XPR1) and three with recessive inheritance (MYORG, JAM2, CMPK2). Clinical presentation ranges from asymptomatic subjects to movement disorders, cognitive decline and psychiatric disturbances alone or in various combinations. Radiological patterns of calcium deposition are similar in all known genetic forms, but central pontine calcification and cerebellar atrophy are highly suggestive of MYORG mutations and extensive cortical calcification has been associated with JAM2 mutations. Currently, no disease-modifying drugs or calcium-chelating agents are available and only symptomatic treatments can be offered.
Application of optical coherence tomography and keratograph in the measurements of lower lid margin thickness
Authors: Wang Da-Hu , Tang Jian-Cen , Hao Xiao-Jun , Zhang Yin-Jian , Liu Xin-Quan
Published: March 2023

Purpose

This study aims to investigate the applicability of lower lid margin thickness (LLMT) measurements in adults with and without meibomian gland dysfunction (MGD) by optical coherence tomography (OCT) and keratograph.

Methods

This is a cross-sectional, observational study. A hundred and eight volunteers aged 20 to 79, including 68 MGD patients and 40 normal subjects, were recruited. Using OCT and keratograph to measure the LLMT from the posterior lash line to anterior edge or outer edge of the tear meniscus was separately performed two times by the same person.

Results

The mean age of normal and MGD subjects was 50.5 ± 14.2 years and 55.8 ± 15.5 years, respectively. The LLMT with OCT and keratograph in MGD patients was significantly greater than that in normal subjects (1.06 ± 0.27 and 1.03 ± 0.25 mm vs. 0.90 ± 0.20 and 0.86 ± 0.16 mm, respectively). In both normal and MGD subjects, the tear meniscus height and LLMT with OCT were both greater than that with keratograph (P < 0.05), and intraclass correlation coefficient (ICC) demonstrated a good agreement in the LLMT measurements between two devices (ICC = 0.83 and 0.79, respectively). Additionally, the LLMT in MGD patients was appeared to be positively correlated with meiboscore (rs = 0.37, P = 0.002).

Conclusions

The OCT and keratograph were two reliable tools in the LLMT measurements, which may have potential applications for diagnosis and evaluation of MGD. Furthermore, we found that the LLMT measured by OCT was greater than that measured by keratograph.
The relation between clinically diagnosed and parent-reported feeding difficulties in children with and without clefts
Authors: de Vries Iris A. C. , Guillaume Camille H. A. L. , Penris Wouter M. , Eligh Anne Merijn , Eijkemans Rene M. J. C. , Kon Moshe , Breugem Corstiaan C. , van Dijk Marijn W. G.
Published: March 2023

A cleft lip and/or palate (CL/P) is one of the most common craniofacial malformations, occurring worldwide in about one in 600–1000 newborn infants. CL/P is known to influence the feeding process negatively, causing feeding difficulties in 25–73% of all children with CL/P. Because there is a risk for serious complications in these children regarding feeding difficulties, there is often a need for intensive medical counseling and treatment. At this moment, adequate diagnosis and measurement remain a challenge and often lead to a delayed referral for professional help. Since parents play a big part in reporting feeding difficulties, it is important to help objectify parents’ experiences, as well as the use of a frontline screening instrument for routine check-ups during medical appointments. The aim of this study is to investigate the relationship between parent perspective and standardized observation by medical professionals on feeding difficulties in 60 children with and without clefts at the age of 17 months. We focus on the information from parents and health professionals by comparing the Observation List Spoon Feeding and the Schedule for Oral Motor Assessment with the validated Dutch translation of the Montreal Children’s Hospital Feeding Scale.

  Conclusion: There is a need for timely and adequate diagnosis and referral when it comes to feeding difficulties in children with CL/P. This study underscores the importance of combining both parental observations and measurements of oral motor skills by healthcare professionals to enable this.

What is Known:

• Early identification of feeding difficulties can prevent adversely affected growth and development.

• Clefts increase the probability of feeding difficulties; however, the diagnostic trajectory is unclear.

• The Observation List Spoon Feeding (OSF) and Schedule for Oral Motor Assessment (SOMA) are validated to measure oral motor skills. The Montreal Children’s Hospital Feeding Scale Dutch version (MCH-FSD) has been validated for the parental perception of infant feeding difficulties.

What is New:

• Parents of children with CL/P experience relatively few feeding problems in their child on average.

• Oral motor skills for spoon feeding are associated with oral motor skills for solid foods in children with CL/P.

• The extent of the cleft is associated with experiencing more feeding difficulties in children with CL/P.
Managing severe hypertension in children
Authors: Coulthard Malcolm G.
Published: March 2023

Severe childhood hypertension is uncommon and frequently not recognised and is best defined as a systolic blood pressure (SBP) above the stage 2 threshold of the 95th centile + 12 mmHg. If no signs of end-organ damage are present, this is urgent hypertension which can be managed by the slow introduction of oral or sublingual medication, but if signs are present, the child has emergency hypertension (or hypertensive encephalopathy if they include irritability, visual impairment, fits, coma, or facial palsy), and treatment must be started promptly to prevent progression to permanent neurological damage or death. However, detailed evidence from case series shows that the SBP must be lowered in a controlled manner over about 2 days by infusing short-acting intravenous hypotensive agents, with saline boluses ready in case of overshoot, unless the child had documented normotension within the last day. This is because sustained hypertension may increase pressure thresholds of cerebrovascular autoregulation which take time to reverse. A recent PICU study that suggested otherwise was significantly flawed. The target is to reduce the admission SBP by its excess, to just above the 95th centile, in three equal steps lasting about ≥ 6 h, 12 h, and finally ≥ 24 h, before introducing oral therapy. Few of the current clinical guidelines are comprehensive, and some advise reducing the SBP by a fixed percentage, which may be dangerous and has no evidence base. This review suggests criteria for future guidelines and argues that these should be evaluated by establishing prospective national or international databases.
Early skeletal muscle mass decline is a prognostic factor in patients receiving gemcitabine plus nab-paclitaxel for unresectable pancreatic cancer: a retrospective observational study
Authors: Suzuki Yukari , Saito Kei , Nakai Yousuke , Oyama Hiroki , Kanai Sachiko , Suzuki Tatsunori , Sato Tatsuya , Hakuta Ryunosuke , Ishigaki Kazunaga , Saito Tomotaka , Hamada Tsuyoshi , Takahara Naminatsu , Tateishi Ryosuke , Fujishiro Mitsuhiro
Published: March 2023

Purpose

Patients with pancreatic cancer often have cancer cachexia at diagnosis. Recent studies suggested that loss of skeletal muscle mass was related to cancer cachexia, which hindered continuance of chemotherapy and could be one of prognostic factors in pancreatic cancer, however the association remains unclear in patients receiving gemcitabine and nab-paclitaxel (GnP).

Methods

We retrospectively studied 138 patients with unresectable pancreatic cancer receiving first-line GnP at the University of Tokyo from January 2015 to September 2020. We calculated body composition in CT images before chemotherapy and at initial evaluation, and evaluated the association of both body composition before chemotherapy and its changes at initial evaluation.

Results

Compared by skeletal muscle mass index (SMI) change rate between pre-chemotherapy and initial evaluation, there were statistically significantly differences in the median OS: 16.3 months (95%CI 12.3–22.7) and 10.3 months (95%CI 8.3–18.1) between SMI change rate ≥ -3.5% and < -3.5% groups (P = 0.01). By multivariate analysis for OS, CA19-9 (HR 3.34, 95%CI 2.00–5.57, P < 0.01), PLR (HR 1.68, 95%CI 1.01–2.78, P = 0.04), mGPS (HR 2.32, 95%CI 1.47–3.65, P < 0.01) and relative dose intensity (HR 2.21, 95%CI 1.42–3.46, P < 0.01) were significantly poor prognostic factors. SMI change rate (HR 1.47, 95%CI 0.95–2.28, P = 0.08) showed a trend to poor prognosis. Sarcopenia before chemotherapy was not significantly associated with PFS or OS.

Conclusion

Early skeletal muscle mass decline was associated with poor OS. Further investigation is warranted whether the maintenance of skeletal muscle mass by nutritional support would improve prognosis.
A Hybrid Methodology of Rock Support Design for Poor Ground Conditions in Hard Rock Tunnelling
Authors: Terron-Almenara Jorge , Holter Karl Gunnar , Høien Are Håvard
Published: March 2023

The design of rock support in hard rock tunnelling is often assisted by the use of empirical engineering rock mass classification systems. This has involved support design in a wide variety of geological- and rock mechanical-conditions, including poor ground conditions like fault zones and weak rocks. For most of the encountered situations, the empirical support designs have performed well. However, the empirical classification systems pose several limitations to describe ground behavior and derive optimal rock support design in poor ground conditions as discussed in several publications during the last decades. In the present study, an analysis of 118 case records, mostly from monitored Norwegian tunnel sites, has been undertaken to investigate the performance of the current empirical design practice with the Q-system when exposed to poor ground conditions. The results have revealed significant improvement possibilities which relate to a wide variety of ground conditions. Among others, weak rocks, anisotropic rock, and rock mass conditions in the transition from self-bearing rock masses to rock masses requiring load-bearing support in the tunnel, and typically with rock mass quality Q < 1. As a result, a set of improvements and design recommendations have been developed and an integrated or hybrid design methodology specific for poor ground conditions proposed. The hybrid approach combines the main components and advantages of different design methodologies and provides guidance for design optimization where the empirical approach presents limitations.
Personalized surgical informed consent with stereoscopic visualization in neurosurgery—real benefit for the patient or unnecessary gimmick?
Authors: Hertzsprung Nicolas , Krantchev Kiril , Picht Thomas , Roethe Anna L. , Rubarth Kerstin , Fuellhase Josch , Vajkoczy Peter , Acker Güliz
Published: March 2023

Background

Informed consent of the patient prior to surgical procedures is obligatory. A good and informative communication improves patients’ understanding and confidence, thus may strengthen the patient-doctor relationship. The aim of our study was to investigate the usefulness of additional stereoscopic visualization of patient-specific imaging during informed consent conversation.

Methods

Patients scheduled for a brain tumor surgery were screened for this study prospectively. The primary exclusion criteria were cognitive or visual impairments. The participants were randomized into two groups. The first group underwent a conventional surgical informed consent performed by a neurosurgeon including a demonstration of the individual MRI on a 2D computer screen. The second group received an additional stereoscopic visualization of the same imaging to explain the pathology more in-depth. The patients were then asked to fill in a questionnaire after each part. This questionnaire was designed to assess the potential information gained from the patients with details on the anatomical location of the tumor as well as the surgical procedure and possible complications. Patients’ subjective impression about the informed consent was assessed using a 5-point Likert scale.

Results

A total of 27 patients were included in this study. After additional stereoscopic visualization, no significant increase in patient understanding was found for either objective criteria or subjective assessment. Participants’ anxiety was not increased by stereoscopic visualization. Overall, patients perceived stereoscopic imaging as helpful from a subjective perspective. Confidence in the department was high in both groups.

Conclusion

Stereoscopic visualization of MRI images within informed consent conversation did not improve the objective understanding of the patients in our series. Although no objective anatomical knowledge gain was noted in this series, patients felt that the addition of stereoscopic visualization improved their overall understanding. It therefore potentially increases patient confidence in treatment decisions.