bluuebunny/crossref_metadata_2025 huggingface dataset:
Constitutive Characteristics, Microstructure, and Texture Evolution of As‐Cast 42CrMo Alloy in Nonisothermal Multipass Compression
Authors: Qin Fangcheng , Qi Huiping , Liu Chongyu , Qi Haiquan , Meng Zhengbing
Published: January 2021

The nonisothermal multipass deformation behavior of as‐cast 42CrMo alloy was studied with declining temperature, constant pass strain, varying strain rate, and interval time. The stresses are used to develop the constitutive model. As the finishing temperature increases from 990°C to 1070°C, the stress decreases gradually and the softening effect increases, which results in a large grain size and inhomogeneous microstructure. The low angle grain boundaries transform into high angle grain boundaries through absorbing dislocations. The noticeable stress softening in a high strain rate is attributed to the thermal softening, dynamic recovery, and dynamic recrystallization. The thermal softening is no longer considered to be the main interpass softening mechanism at a low strain rate. The interval time has a negligible effect on the stress, but the significant changes in grain size and texture component are caused by the interpass softening. The average grain size is approximately 40 μm, and the distorted grain boundaries and small fine grains are found in the interval times of 0.5–5 s, implying the dynamic recovery and grain growth. The near {001}<110> and {110}<112> orientation exerts an important influence on the grain refinement.
Quantum Image Processing: Opportunities and Challenges
Authors: Ruan Yue , Xue Xiling , Shen Yuanxia
Published: January 2021

Quantum image processing (QIP) is a research branch of quantum information and quantum computing. It studies how to take advantage of quantum mechanics’ properties to represent images in a quantum computer and then, based on that image format, implement various image operations. Due to the quantum parallel computing derived from quantum state superposition and entanglement, QIP has natural advantages over classical image processing. But some related works misuse the notion of quantum superiority and mislead the research of QIP, which leads to a big controversy. In this paper, after describing this field’s research status, we list and analyze the doubts about QIP and argue “quantum image classification and recognition” would be the most significant opportunity to exhibit the real quantum superiority. We present the reasons for this judgment and dwell on the challenges for this opportunity in the era of NISQ (Noisy Intermediate-Scale Quantum).
The Effect of Accessory Pathway Location on Cardiac Function in Adult Patients with Wolff–Parkinson–White Syndrome
Authors: Zhang Ying , Xin Mei , Liu Tongbao , Song Shangming , Wang Wenxin , Li Jun , Xu Bo , Hou Xiaoyang , Dong Bo
Published: January 2021

Introduction. The relationship between ventricular pre-excitation and left ventricular dysfunction has been described in the absence of sustained supraventricular tachycardia in a series of case reports. However, there have been no systematic studies about the effect of ventricular pre-excitation on cardiac function in adult patients with different accessory pathway locations. Methods and Results. Patients were divided into four groups based on the type and location of their accessory pathway: septal, right free wall, left free wall, and concealed. N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, electrocardiogram recordings, electrophysiological properties, and transthoracic echocardiographic data (septal-to-posterior wall motion delay (SPWMD) and interventricular mechanical delay (IVMD) indicating intraventricular and interventricular dyssynchrony) were compared before and after successful ablation. Before radiofrequency catheter ablation, left ventricular ejection fraction (LVEF) was significantly lower in patients with septal and right free wall accessory pathways. Within three months after radiofrequency catheter ablation, NT-proBNP levels decreased, left ventricular function improved, and intraventricular left ventricular dyssynchrony disappeared. There was a negative correlation between initial LVEF with initial QRS duration and initial SPWMD. Notably, SPWMD had a stronger correlation with LVEF than initial QRS duration. Conclusions. Anterograde conduction with a septal or right free wall accessory pathway may cause left ventricular dyssynchrony and impair left ventricular function. Intraventricular left ventricular dyssynchrony seems to be responsible for the pathogenesis of left ventricular dysfunction. Radiofrequency catheter ablation results in decreased NT-proBNP levels, normalized QRS duration, mechanical resynchronization, and improved left ventricular function.
Diarylalkanoids as Potent Tyrosinase Inhibitors from the Stems of Semecarpus caudata
Authors: Dang Phu H. , Le Tho H. , Do Truong N. V. , Nguyen Hai X. , Nguyen Mai T. T. , Nguyen Nhan T.
Published: January 2021

From a CHCl3-soluble extract of the stems of Semecarpus caudata (Anacardiaceae), two new diarylalkanoids, semedienone (1) and semetrienone (2), were isolated. Their structures were elucidated based on NMR spectroscopic data interpretation. These compounds possess strong tyrosinase inhibitory activity with the IC50 values of 0.033 and 0.11 μM, respectively. Docking studies of 1 and 2 with oxy-tyrosinase were carried out to analyze their interactions. Accordingly, semedienone (1) showed good interactions with the peroxide group and amino acid residues. The biosynthesis of the isolated diarylalkanoids was proposed.
Performance of Integrated Emergency Surgical Officers at Mizan-Tepi University Teaching Hospital, Mizan-Aman, Ethiopia: A Retrospective Cohort Study
Authors: Harrison Margo S. , Kirub Ephrem , Liyew Tewodros , Teshome Biruk , Jimenez-Zambrano Andrea , Muldrow Margaret , Yarinbab Teklemariam
Published: January 2021

Introduction. Surgical physician extenders are used in Ethiopia and sub-Saharan Africa where there is a lack of surgical providers. Methods. We tested characteristics associated with and outcomes of births attended by an integrated emergency surgical officers (IESOs) as compared to midwives and physician providers. Results. Of 1,000 women in our convenience sample, data on birth attendant was missing on 5 women (0.5%). Of the remaining women, almost three-fourths (73.6%, n = 732) of women were attended by a midwife, almost a quarter were attended by an IESO (24.4%, n = 243), 10 women were attended by a physician with a General Practitioner level of training (1.0%), 5 women were delivered by an Ob/Gyn resident (0.5%), and 5 women were attended by an Ob/Gyn (0.5%). Women had a higher likelihood of being attended by an IESO than a midwife if they underwent forceps-assisted (RR 88.4,

p
<
0.05

), vacuum-assisted (RR 45.2,

p
<
0.05

), or cesarean birth (RR 161.8,

p
<
0.05

) as compared to an unassisted vaginal birth. IESOs are performing more operative vaginal and cesarean births than other delivery providers. Outcomes of their deliveries are worse than those of midwives, but this is likely due to the acuity level of the patients and not the provider type.
Hemodynamic Characteristics of Mechanically Ventilated COVID-19 Patients: A Cohort Analysis
Authors: Boerma E. Christiaan , Bethlehem Carina , Stellingwerf Franciena , de Lange Fellery , Streng Koen W. , Koetsier Peter M. , Bootsma Inge T.
Published: January 2021

Background. Solid data on cardiovascular derangements in critically ill COVID-19 patients remain scarce. The aim of this study is to describe hemodynamic characteristics in a cohort of COVID-19-related critically ill patients. Methods. A retrospective observational cohort study in twenty-eight consecutive mechanically ventilated COVID-19 patients. Pulse contour analysis-derived data were obtained from all patients, using the PiCCO® system. Results. The mean arterial pressure increased from 77 ± 10 mmHg on day 1 to 84 ± 9 mmHg on day 21 (

p
=
0.04

), in combination with the rapid tapering and cessation of norepinephrine and the gradual use of antihypertensive drugs in the vast majority of patients. The cardiac index increased significantly from 2.8 ± 0.7 L/min/m2 on day 1 to 4.0 ± 0.8 L/min/m2 on day 21 (

p
<
0.001

). Dobutamine was administered in only two patients. Mean markers of left ventricular contractility and peripheral perfusion, as well as lactate levels, remained within the normal range. Despite a constant fluid balance, extravascular lung water index decreased significantly from 17 ± 7 mL/kg on day 1 to 11 ± 4 mL/kg on day 21 (

p
<
0.001

). Simultaneously, intrapulmonary right-to-left shunt fraction (Qs/Qt) decreased significantly from 27 ± 10% in week 1 to 15 ± 9% in week 3 (

p
=
0.007

). PaO2/FiO2 ratio improved from 159 ± 53 mmHg to 319 ± 53 mmHg (

p
<
0.001

), but static lung compliance remained unchanged. Conclusions. In general, this cohort of patients with COVID-19 respiratory failure showed a marked rise in blood pressure over time, not accompanied by distinctive markers of circulatory failure. Characteristically, increased extravascular lung water, vascular permeability, and intrapulmonary shunt diminished over time, concomitant with an improvement in gas exchange.
Technical Innovation for Visual Assessment of Preterm Newborns in a Neonatal Intensive Care Unit: Exploratory Study
Authors: Moran C. A. , Alves V. L. , Pereira S. A. , Costa M. F.
Published: January 2021

Objective. The present study is aimed at assessing heart rate variability (HRV) and its correlation with visual acuity (VA) assessment of preterm newborns (PTNB) in neonatal intensive care units. Method. Cross-sectional study analyzing HRV during assessment of VA with the aid of a Polar RS800CX heart rate monitor (Polar Electro Oy, Finland). HRV was analyzed according to time and frequency domains and the chaos domain used the autocorrelation coefficient and entropy. The sample consisted of hospitalized PTNB, and static analysis included simple regression diagnosis. Results. A total of 14 PTNB were included in the sample. VA varied between 0.23 and 1.60 cpd, and only five PTNB obtained below-expected values for age. Statistical analysis demonstrated a negative correlation between VA and time domain (SDDN and SD2) and a positive correlation between frequency domain (heart rate and hertz), but in simple linear regression analysis, these variables did not influence VA. Conclusion. The results of the study demonstrate that visual acuity was inversely correlated with SDNN and SD2 and during stimulation, showing that the higher the visual performance, the lower the autonomic modulation response.
Salting the Soil: Targeting the Microenvironment of Brain Metastases
Authors: Srinivasan Ethan S. , Tan Aaron C. , Anders Carey K. , Pendergast Ann Marie , Sipkins Dorothy A. , Ashley David M. , Fecci Peter E. , Khasraw Mustafa
Published: January 2021

Paget's “seed and soil” hypothesis of metastatic spread has acted as a foundation of the field for over a century, with continued evolution as mechanisms of the process have been elucidated. The central nervous system (CNS) presents a unique soil through this lens, relatively isolated from peripheral circulation and immune surveillance with distinct cellular and structural composition. Research in primary and metastatic brain tumors has demonstrated that this tumor microenvironment (TME) plays an essential role in the growth of CNS tumors. In each case, the cancerous cells develop complex and bidirectional relationships that reorganize the local TME and reprogram the CNS cells, including endothelial cells, pericytes, astrocytes, microglia, infiltrating monocytes, and lymphocytes. These interactions create a structurally and immunologically permissive TME with malignant processes promoting positive feedback loops and systemic consequences. Strategies to interrupt interactions with the native CNS components, on “salting the soil,” to create an inhospitable environment are promising in the preclinical setting. This review aims to examine the general and specific pathways thus far investigated in brain metastases and related work in glioma to identify targetable mechanisms that may have general application across the spectrum of intracranial tumors.
Anti-Biofilm Effect of Octenidine and Polyhexanide on Uropathogenic Biofilm-Producing Bacteria
Authors: Loose Maria , Naber Kurt G. , Purcell Larry , Wirth Manfred P. , Wagenlehner Florian M.E.
Published: January 2021

Background: A catheter allowing a release of antibacterial substances such as antiseptics into the bladder could be a new way of preventing biofilm formation and subsequent catheter-associated urinary tract infections. Methods: Minimal inhibitory and bactericidal concentration (MIC/MBC) determinations in cation-adjusted Mueller-Hinton broth and artificial urine were performed for 4 antiseptics against 3 uropathogenic biofilm producers, Escherichia coli, Pseudomonas aeruginosa, and Proteus mirabilis. Furthermore, effects of octenidine and polyhexanide against catheter biofilm formation were determined by quantification of biofilm-producing bacteria. Results: Sodium hypochlorite showed MIC/MBC values between 200 and 800 mg/L for all strains tested. Triclosan was efficient against E. coli and P. mirabilis (MIC ≤2.98 mg/L) but ineffective against P. aeruginosa. Octenidine and polyhexanide showed antibacterial activity against all 3 species tested (MIC 1.95–7.8 and 3.9–31.25 mg/L). Both octenidine and polyhexanide were able to prevent biofilm formation on catheter segments in a concentration dependent manner. Furthermore, adding 250 mg/L of each biocide disrupted biofilms formed by E. coli and P. mirabilis, whereas even 500 mg/L was not sufficient to completely destroy P. aeruginosa biofilms. Conclusion: Octenidine- and polyhexanide-containing antiseptics showed a broad effect against typical uropathogenic biofilm producers even in high dilutions. This study provides a basis for further investigation of the potential of octenidine and polyhexanide as prophylaxis or treatment of catheter biofilms.
A Short Cycle of Narrow-Band UVB Phototherapy in the Early Phase of Dupilumab Therapy Can Provide a Quicker Improvement of Severe Atopic Dermatitis
Authors: Rossi Mariateresa , Rovati Chiara , Arisi Mariachiara , Tomasi Cesare , Calzavara-Pinton Irene , Venturini Marina , Calzavara-Pinton Piergiacomo
Published: January 2021

Background: Since the best clinical response to dupilumab is achieved after 12–16 weeks, a combination therapy at the beginning of the treatment could be a helpful strategy to reach a faster response in patients with severe atopic dermatitis (AD). Objectives: To quantify the benefit of a combination of dupilumab treatment with a short course of narrow-band ultraviolet B (NB-UVB) phototherapy. Methods: In the present pilot study adult patients suffering from severe AD were enrolled with a 2:1 ratio to receive treatment with dupilumab alone or dupilumab plus NB-UVB phototherapy, for 12 weeks. After the twelfth week, all patients received dupilumab only. A follow-up visit took place after 16 weeks. Both clinician-oriented and patient-oriented scores were assessed at baseline (T0) and after 4 (T1), 12 (T2) and 16 (T3) weeks. Results: Forty-five adult patients were enrolled in the study. Both treatment regimens were well tolerated and very effective on all measured scores (EASI, SCORAD, BSA, NRS of itching, NRS of sleep loss, DLQI, POEM and HADS), but the combined regimen led to a more robust clinical improvement of lesions and relief of symptoms after 4 weeks. However, after 12 and 16 weeks, the additional therapeutic effect of phototherapy weakened. Conclusion: NB-UVB phototherapy can provide a faster remission of severe AD in the first few weeks of dupilumab therapy.
Staphylococcus aureus Carriage in Hidradenitis Suppurativa: Impact on Response to Adalimumab
Authors: Stergianou Dimitra , Tzanetakou Vassiliki , Argyropoulou Maria , Kanni Theodora , Bagos Pantelis G. , Giamarellos-Bourboulis Evangelos J.
Published: January 2021

Background: Several patients with hidradenitis suppurativa (HS) present flare-ups during treatment with adalimumab (ADA), the cause of which is not clear. ADA is the only FDA-approved biologic for the therapy of moderate-to-severe HS. A previous study of our group has shown that Staphylococcus aureus stimulation of whole blood affects the production of human β-defensin 2 and modulates HS severity. It is, therefore, hypothesized, that carriage of S. aureus may drive HS flare-ups. Objective: To explore the association between carriage of S. aureus and loss of response to ADA. Patients and Methods: Among patients with moderate-to-severe HS without carriage of S. aureus at start of treatment with ADA, we investigated for carriage of S. aureus from the nares when flare-ups occurred. Flare-ups were pre-defined as at least 25% increase of inflammatory lesions (sum of inflammatory nodules and abscesses) from baseline. Samplings were also done after completion of 12 weeks of ADA treatment from all patients who did not present flare-ups. Clinical response to ADA was assessed by the HS Clinical Response score (HiSCR). Results: Thirty-nine patients were studied; 24 with Hurley II stage HS and 15 with Hurley III stage HS. Twenty-nine patients achieved HiSCR after 12 weeks of treatment without any flare-ups; 10 patients had flare-ups and failed HiSCR. Three (10.3%) and 5 (50%) patients, respectively, had nasal carriage of S. aureus (odds ratio 8.67; 95% CI 1.54–48.49; p = 0.014). Among 32 patients reaching follow-up week 48, 20 patients achieved HiSCR and 12 had flare-ups leading to ADA failure; 2 (10%) and 5 (41.7%) patients, respectively, had positive culture for S. aureus (odds ratio 6.42; 95% CI 1.00–41.20; p = 0.05). Conclusion: Nasal carriage of S. aureus may be associated with loss of response to ADA. Findings need confirmation in larger series of patients.
Ethical Issues and Management of Fetal Hemolytic Anemia Caused by Anti-Rh17 in a Multipara with Rare –D– Phenotype
Authors: Torreiter Patrick P. , Macher Susanne , Matzhold Eva-Maria , Resch Bernhard , Klaritsch Philipp , Körmöczi Günther F. , Polin Helene , Neuhold Leopold , Schönbacher Marlies , Schlenke Peter , Wagner Thomas
Published: January 2021

Background: The development of allo-anti-Rh17 (anti-Hr0) in a –D– phenotype whose red blood cells (RBCs) lack CcEe antigens is most likely triggered by transfusion, transplantation, or pregnancy. Gene conversion is the predominating factor in generating RHD-CE-D and RHCE-D-CE hybrids like –D–. Methods: We report here immunohematological and obstetrical data from 2 of the 5 pregnancies of a 24-year-old woman presenting with the –D– phenotype with anti-Rh17. Blood group typing, antibody screening, antibody differentiation, direct antiglobulin test (DAT), and antibody titers were performed by routine gel technology and tube testing. Additionally, molecular genetic analysis was performed. Fetal surveillance was done by sonographic evaluation of the fetal middle cerebral artery peak systolic velocity (MCA-PSV). Results: Blood group typing showed O, C-c-D+E-e- and the DAT was negative. DNA sequencing revealed homozygosity for an RHCE-D(3–9)-CE null allele. Anti-Rh17 titers in the fourth pregnancy remained between 1:8 and 1:128, and no signs for a fetal anemia were observed. However, in the fifth pregnancy, the antibody titers increased up to 1:4,096. Signs of moderate fetal anemia were detected and cesarean section was performed at 34 + 6 weeks of gestation. The newborn presented with hemolytic anemia (cord blood hemoglobin [Hb] = 8.5 mg/dL). She received 2 compatible (small) packed RBC concentrates, phototherapy, and intravenous immunoglobulins. Conclusion: Our case shows that the risk for hemolytic complications increases with the number of pregnancies of sensitized women. Only people who also lack CcEe antigens are compatible as donors. The role of such rare donors as lifesavers, their freedom, and voluntariness conflict with the urgent need for compatible blood.
Determinants of Morbidity and Mortality Associated With Isolated Tricuspid Valve Surgery
Authors: Kawsara Akram , Alqahtani Fahad , Nkomo Vuyisile T. , Eleid Mackram F. , Pislaru Sorin V. , Rihal Charanjit S. , Nishimura Rick A. , Schaff Hartzell V. , Crestanello Juan A. , Alkhouli Mohamad
Published: January 2021

Background

Whether the poor outcomes of isolated tricuspid valve surgery are related to the operation itself or to certain patient characteristics including late referral is unknown.

Methods and Results

Adult patients who underwent isolated tricuspid valve surgery were identified in the Nationwide Readmissions Database (2016–2017). Patients who had redo tricuspid valve surgery, endocarditis, or congenital heart disease were excluded. Multivariable logistic regression was performed to identify contributors to postoperative mortality. A total of 1513 patients were included (mean age 55.7±16.6 years, 49.6% women). Surrogates of late referral were frequent: 41% of patients were admitted with decompensated heart failure, 44.3% had a nonelective surgery status, 16.8% had advanced liver disease, and 31% had an unplanned hospitalization in the prior 90 days. The operation was performed on day 0 to 1 of the hospitalization in only 50% of patients, and beyond day 10 in 22% of patients. In‐hospital mortality occurred in 8.7% of patients. Median length of stay was 14 days (7–35 days), and median cost was $87 223 ($43 122–$200 872). In multivariable logistic regression analysis, surrogates for late referrals (acute heart failure decompensation, nonelective surgery status, or advanced liver disease) were the strongest predictors of in‐hospital mortality (odds ratio [OR], 4.75; 95% CI, 2.74–8.25 [
P
<0.001]). This was also consistent in a second model incorporating unplanned hospitalizations in the 90 days before surgery as a surrogate for late referral (OR, 5.50; 95% CI, 2.28–10.71 [
P
<0.001]).

Conclusions

The poor outcomes of isolated tricuspid valve surgery may be largely explained by the late referral for intervention. Studies are needed to determine the role of early intervention for severe isolated tricuspid regurgitation.
Losing Track of Time
Authors: Greenberg Jonathan
Published: January 2021

Ottessa Moshfegh's My Year of Rest and Relaxation tells a story of doing nothing; it is an antinovel whose heroine attempts to sleep for a year in order to lose track of time. This desire to lose track of time constitutes a refusal of plot, a satiric and passive-aggressive rejection of the kinds of narrative sequences that novels typically employ but that, Moshfegh implies, offer nothing but accommodation to an unhealthy late capitalist society. Yet the effort to stifle plot is revealed, paradoxically, as an ambition to be achieved through plot, and so in resisting what novels do, My Year of Rest and Relaxation ends up showing us what novels do. Being an antinovel turns out to be just another way of being a novel; in seeking to lose track of time, the novel attunes us to our being in time.
Campaigning for the Prize: The Quests by Sweden and the Kingdom of the Netherlands for Security Council Membership, 2017–2018
Authors: Ekengren Ann-Marie , Möller Ulrika
Published: January 2021

Competition for a non-permanent seat in the UN Security Council is getting tougher, not the least between candidates within the Western European and Others Group. This empirical study compares the campaigns carried out by Sweden and the Kingdom of the Netherlands, in order to explain the Swedish victory in the first round of the elections in 2016. A theoretical framework identifies three logics of campaigning: contributions, commitment and competence. The study maps out the features of the campaigns, including organisation, key participants, activities and message. It includes interviews with diplomats and public officials involved in the campaigns, as well as available campaign documentation and concluding reports. A main difference detected between the candidatures is the more active political involvement in the Swedish campaign, which shows the Swedish commitment and competence to serve on the Council. Further use of this theoretical framework on additional cases of international campaigning is encouraged.
REVISION OF THE TYPE MATERIALS OF STAURONEIS SCHINZII VAR. ARGENTINA FRENGUELLI AND S. SCHINZII VAR. MAXIMA FRENGUELLI (BACILLARIOPHYCEAE)

Authors: VOUILLOUD A.A. , GUERRERO J.M. , PALLADINO M.B. , LAMARO A.A.
Published: January 2021

Stauroneis schinzii var. argentina and S. schinzii var. maxima were first described from Esteros del Iberá, a large subtropical wetland located in northeast Argentina. The type materials of these varieties were examined with light and scanning electron microscopy and compared to S. schinzii var. schinzii and other infraspecific taxa. As a result of this study the taxonomic validity of both varieties was confirmed, their diagnosis were emended based on the new morphological information derived, and lectotypes and isolectotypes were designated.
Barotropic and Baroclinic Inverse Kinetic Energy Cascade in the Antarctic Circumpolar Current
Authors: Li Hongjie , Xu Yongsheng
Published: January 2021

Stratified geostrophic turbulence theory predicts an inverse energy cascade for the barotropic (BT) mode. Satellite altimetry has revealed a net inverse cascade in the baroclinic (BC) mode. Here the spatial variabilities of BT and BC kinetic energy fluxes in the Antarctic Circumpolar Current (ACC) were investigated using ECCO2 data, which synthesize satellite data and in situ measurements with an eddy-permitting general circulation model containing realistic bathymetry and wind forcing. The BT and BC inverse kinetic energy cascades both reveal complex spatial variations that could not be explained fully by classical arguments. For example, the BC injection scales match better with most unstable scales than with the first-mode deformation scales, but the opposite is true for the BT mode. In addition, the BT and BC arrest scales do not follow the Rhines scale well in terms of spatial variation, but show better consistency with their own energy-containing scales. The reverse cascade of the BT and BC modes was found related to their EKE, and better correlation was found between the BT inverse cascade and barotropization. Speculations of the findings were proposed; however, further observations and modeling experiments are needed to test these interpretations. Spectral flux anisotropy exhibits a feature associated with oceanic jets that is consistent with classical expectations. Specifically, the spectral flux along the along-stream direction remains negative at scales up to that of the studied domain (~2000 km), while that in the perpendicular direction becomes positive close to the scale of the width of a typical jet.
Imaging of pulmonary hypertension in adults: a position paper from the Fleischner Society
Authors: Remy-Jardin Martine , Ryerson Christopher J. , Schiebler Mark L. , Leung Ann N.C. , Wild James M. , Hoeper Marius M. , Alderson Philip O. , Goodman Lawrence R. , Mayo John , Haramati Linda B. , Ohno Yoshiharu , Thistlethwaite Patricia , van Beek Edwin J.R. , Knight Shandra Lee , Lynch David A. , Rubin Geoffrey D. , Humbert Marc
Published: January 2021

Pulmonary hypertension (PH) is defined by a mean pulmonary artery pressure greater than 20 mmHg and classified into five different groups sharing similar pathophysiologic mechanisms, haemodynamic characteristics, and therapeutic management. Radiologists play a key role in the multidisciplinary assessment and management of PH. A working group was formed from within the Fleischner Society based on expertise in the imaging and/or management of patients with PH, as well as experience with methodologies of systematic reviews. The working group identified key questions focusing on the utility of CT, MRI, and nuclear medicine in the evaluation of PH:a)Is noninvasive imaging capable of identifying PH?b)What is the role of imaging in establishing the cause of PH?c)How does imaging determine the severity and complications of PH?d)How should imaging be used to assess chronic thromboembolic PH before treatment?e)Should imaging be performed after treatment of PH? This systematic review and position paper highlights the key role of imaging in the recognition, work-up, treatment planning, and follow-up of PH.
Cylinder Pressure Prediction of An HCCI Engine Using Deep Learning
Authors: Yaşar Halit , Çağıl Gültekin , Torkul Orhan , Şişci Merve
Published: January 2021

Engine tests are both costly and time consuming in developing a new internal combustion engine. Therefore, it is of great importance to predict engine characteristics with high accuracy using artificial intelligence. Thus, it is possible to reduce engine testing costs and speed up the engine development process. Deep Learning is an effective artificial intelligence method that shows high performance in many research areas through its ability to learn high-level hidden features in data samples. The present paper describes a method to predict the cylinder pressure of a Homogeneous Charge Compression Ignition (HCCI) engine for various excess air coefficients by using Deep Neural Network, which is one of the Deep Learning methods and is based on the Artificial Neural Network (ANN). The Deep Learning results were compared with the ANN and experimental results. The results show that the difference between experimental and the Deep Neural Network (DNN) results were less than 1%. The best results were obtained by Deep Learning method. The cylinder pressure was predicted with a maximum accuracy of 97.83% of the experimental value by using ANN. On the other hand, the accuracy value was increased up to 99.84% using DNN. These results show that the DNN method can be used effectively to predict cylinder pressures of internal combustion engines.
Arthrofibrosis after total knee arthroplasty: patients with keloids at risk
Authors: Flick Travis R. , Wang Cindy X. , Patel Akshar H. , Hodo Thomas W. , Sherman William F. , Sanchez Fernando L.
Published: January 2021

Background

Arthrofibrosis remains one of the leading causes for revision in primary total knee arthroplasty (TKA). Similar in nature to arthrofibrosis, hypertrophic scars and keloid formation are a result of excessive collagen formation. There is paucity in the literature on whether there is an association between keloid formation and the development of arthrofibrosis following TKA. Therefore, the purpose of this study was to utilize a large nationwide database to identify and compare the rates of postoperative complications related to arthrofibrosis after primary TKA in patients with history of hypertrophic scar and keloid disorders versus those without.

Methods

Patient records from 2010 to the second quarter of 2016 were queried from an administrative claims database, comparing rates of arthrofibrosis, manipulation under anesthesia (MUA), lysis of adhesions (LOA), and revision TKA in patients with chart diagnosis of keloids versus those without in patients who underwent primary TKA. Data analysis was performed using R statistical software (R Project for Statistical Computing, Vienna, Austria) utilizing multivariate logistic regression, chi square analysis, or Welch’s t- test where appropriate with p values < 0.05 being considered statistically significant.

Results

Of 545,875 primary TKAs, 11,461 (2.1%) had a keloid diagnosis at any time point in their record, while 534,414 (97.9%) had not. Patients in the keloid cohort had a significantly higher association with ankylosis within 30 days (OR, 1.7), 90 days (OR, 1.2), 6 months (OR, 1.2), and 1 year (OR, 1.3) following primary TKA. The keloid cohort also had a significantly greater risk of MUA (90-day OR, 1.1; 6-month OR, 1.1; 1-year OR, 1.2) and LOA (90-day OR, 2.2; 6-month OR, 2.0; 1-year OR, 1.9).

Conclusion

Patients with keloids have increased odds risk of arthrofibrosis following primary TKA. These patients are subsequently at a higher odds risk of undergoing the procedures necessary to treat arthrofibrosis, such as MUA and LOA. Future studies investigating confounding factors such as race, prior surgery, range of motion, and postoperative recovery are needed to confirm the association of keloid diagnosis and arthrofibrosis following primary TKA demonstrated in this study.

Level of Evidence

Level III retrospective comparative study.
Microbiology of secondary infections in Buruli ulcer lesions; implications for therapeutic interventions
Authors: Gyamfi Elizabeth , Narh Charles A , Quaye Charles , Abbass Adiza , Dzudzor Bartholomew , Mosi Lydia
Published: January 2021

Background

Buruli ulcer (BU) is a skin disease caused by Mycobacterium ulcerans and is the second most common mycobacterial disease after tuberculosis in Ghana and Côte d’Ivoire. M. ulcerans produces mycolactone, an immunosuppressant macrolide toxin, responsible for the characteristic painless nature of the infection. Secondary infection of ulcers before, during and after treatment has been associated with delayed wound healing and resistance to streptomycin and rifampicin. However, not much is known of the bacteria causing these infections as well as antimicrobial drugs for treating the secondary microorganism. This study sought to identify secondary microbial infections in BU lesions and to determine their levels of antibiotic resistance due to the prolonged antibiotic therapy required for Buruli ulcer.

Results

Swabs from fifty-one suspected BU cases were sampled in the Amansie Central District from St. Peters Hospital (Jacobu) and through an active case surveillance. Forty of the samples were M. ulcerans (BU) positive. Secondary bacteria were identified in all sampled lesions (N = 51). The predominant bacteria identified in both BU and Non-BU groups were Staphylococci spp and Bacilli spp. The most diverse secondary bacteria were detected among BU patients who were not yet on antibiotic treatment. Fungal species identified were Candida spp, Penicillium spp and Trichodema spp. Selected secondary bacteria isolates were all susceptible to clarithromycin and amikacin among both BU and Non-BU patients. Majority, however, had high resistance to streptomycin.

Conclusions

Microorganisms other than M. ulcerans colonize and proliferate on BU lesions. Secondary microorganisms of BU wounds were mainly Staphylococcus spp, Bacillus spp and Pseudomonas spp. These secondary microorganisms were less predominant in BU patients under treatment compared to those without treatment. The delay in healing that are experienced by some BU patients could be as a result of these bacteria and fungi colonizing and proliferating in BU lesions. Clarithromycin and amikacin are likely suitable drugs for clearance of secondary infection of Buruli ulcer.
Comparative efficacy and safety of adjuvant nivolumab versus other treatments in adults with resected melanoma: a systematic literature review and network meta-analysis
Authors: Toor Kabirraaj , Middleton Mark R. , Chan Keith , Amadi Adenike , Moshyk Andriy , Kotapati Srividya
Published: January 2021

Background

Immune checkpoint inhibitors and targeted therapies are approved for adjuvant treatment of patients with resected melanoma; however, they have not been compared in randomized controlled trials (RCTs). We compared the efficacy and safety of adjuvant nivolumab with other approved treatments using available evidence from RCTs in a Bayesian network meta-analysis (NMA).

Methods

A systematic literature review was conducted through May 2019 to identify relevant RCTs evaluating approved adjuvant treatments. Outcomes of interest included recurrence-free survival (RFS)/disease-free survival (DFS), distant metastasis-free survival (DMFS), all-cause grade 3/4 adverse events (AEs), discontinuations, and discontinuations due to AEs. Time-to-event outcomes (RFS/DFS and DMFS) were analyzed both assuming that hazard ratios (HRs) are constant over time and that they vary.

Results

Of 26 identified RCTs, 19 were included in the NMA following a feasibility assessment. Based on HRs for RFS/DFS, the risk of recurrence with nivolumab was similar to that of pembrolizumab and lower than that of ipilimumab 3 mg/kg, ipilimumab 10 mg/kg, or interferon. Risk of recurrence with nivolumab was similar to that of dabrafenib plus trametinib at 12 months, however, was lower beyond 12 months (HR [95% credible interval] at 24 months, 0.46 [0.27–0.78]; at 36 months, 0.28 [0.14–0.59]). Based on HRs for DMFS, the risk of developing distant metastases was lower with nivolumab than with ipilimumab 10 mg/kg or interferon and was similar to dabrafenib plus trametinib.

Conclusion

Adjuvant therapy with nivolumab provides an effective treatment option with a promising risk–benefit profile.
The implications of clinical risk factors, CAR index, and compositional changes of immune cells on hyperprogressive disease in non-small cell lung cancer patients receiving immunotherapy
Authors: Kim Seo Ree , Chun Sang Hoon , Kim Joo Ri , Kim Sang-Yeob , Seo Jun Young , Jung Chan Kwon , Gil Bo-Mi , Kim Jeong-Oh , Ko Yoon Ho , Woo In Sook , Shim Byoung Yong , Hong Sook-Hee , Kang Jin Hyoung
Published: January 2021

Background

Immune checkpoint blockades (ICBs) are characterized by a durable clinical response and better tolerability in patients with a variety of advanced solid tumors. However, we not infrequently encounter patients with hyperprogressive disease (HPD) exhibiting paradoxically accelerated tumor growth with poor clinical outcomes. This study aimed to investigate implications of clinical factors and immune cell composition on different tumor responses to immunotherapy in patients with non-small cell lung cancer (NSCLC).

Methods

This study evaluated 231 NSCLC patients receiving ICBs between January 2014 and May 2018. HPD was defined as a > 2-fold tumor growth kinetics ratio during ICB therapy and time-to-treatment failure of ≤2 months. We analyzed clinical data, imaging studies, periodic serologic indexes, and immune cell compositions in tumors and stromata using multiplex immunohistochemistry.

Results

Of 231 NSCLC patients, PR/CR and SD were observed in 50 (21.6%) and 79 (34.2%) patients, respectively and 26 (11.3%) patients met the criteria for HPD. Median overall survival in poor response groups (HPD and non-HPD PD) was extremely shorter than disease-controlled group (SD and PR/CR) (5.5 and 6.1 months vs. 16.2 and 18.3 months, respectively, P = 0.000). In multivariate analysis, HPD were significantly associated with heavy smoker (p = 0.0072), PD-L1 expression ≤1% (p = 0.0355), and number of metastatic site ≥3 (p = 0.0297). Among the serologic indexes including NLR, PLR, CAR, and LDH, only CAR had constantly significant correlations with HPD at the beginning of prior treatment and immunotherapy, and at the 1st tumor assessment. The number of CD4+ effector T cells and CD8+ cytotoxic T cells, and CD8+/PD-1+ tumor-infiltrating lymphocytes (TIL) tended to be smaller, especially in stromata of HPD group. More M2-type macrophages expressing CD14, CD68 and CD163 in the stromal area and markedly fewer CD56+ NK cells in the intratumoral area were observed in HPD group.

Conclusions

Our study suggests that not only clinical factors including heavy smoker, very low PD-L1 expression, multiple metastasis, and CAR index, but also fewer CD8+/PD-1+ TIL and more M2 macrophages in the tumor microenvironment are significantly associated with the occurrence of HPD in the patients with advanced/metastatic NSCLC receiving immunotherapy.
Advance directives and end-of-life care: knowledge and preferences of patients with brain Tumours from Anhui, China
Authors: Wang Yixin , Zhang Yongkang , Hong Yang , Zeng Ping , Hu Zongtao , Xu Xiuli , Wang Hongzhi
Published: January 2021

Background

In Mainland China, advance directives (ADs) and end-of-life care for patients with tumours, especially patients with brain tumours who may have lost consciousness or the ability to speak at the early stage of their illness, have been poorly acknowledged. Thus, this study aimed to clarify the knowledge and preferences of ADs and end-of-life care in patients with brain tumours and to investigate predictors of patient preferences.

Methods

This was a population-based cross-sectional survey that was conducted via face-to-face interviews. Information on sociodemographic factors, brain tumour illness, knowledge and preferences of the advanced decisions and end-of-life care of the patients was collected.

Results

A total of 88.61% of participants had never heard of ADs, but 65.18% reported that they would like to make ADs. Knowledge of ADs, receiving surgical treatment or radiotherapy, being younger than 70 years old, being male, having educational qualifications of college or beyond, being childless, having medical insurance for nonworking or working urban residents and self-paying medical expenses were predictors of preference for making ADs. A total of 79.43% of participants wanted to discuss end-of-life arrangements with medical staff, and 63.29% of participants were willing to receive end-of-life care, even though it would not delay death. A total of 65.82% of patients with brain tumours wanted resuscitation, and as many as 45.45% of the patients thought that they did not need life support if they were in a persistent vegetative state. Brain primary tumours, being younger than 70 years old, male sex, educational qualification of junior middle school or below, having children, having new rural cooperative medical insurance and having medical expenses paid by children or spouses were predictors of choosing appropriate palliative care.

Conclusions

ADs and end-of-life care have been poorly acknowledged among patients with brain tumours in mainland China. Additional efforts should be encouraged amongst patients with primary brain tumours, those who are undergoing surgery and radiotherapy and those who have low socioeconomic status. A longitudinal and comprehensive study is encouraged to promote disease-specific ADs among Chinese patients with brain tumours.
Correction to: Treatment strategy for atypical ulnar fracture due to severely suppressed bone turnover caused by long-term bisphosphonate therapy: a case report and literature review
Authors: Abe Kensaku , Kimura Hiroaki , Yamamoto Norio , Shimozaki Shingo , Higuchi Takashi , Taniguchi Yuta , Uto Takaaki , Tsuchiya Hiroyuki
Published: January 2021

An amendment to this paper has been published and can be accessed via the original article.
Comparison of antimicrobial prescription patterns in calves in Switzerland before and after the launch of online guidelines for prudent antimicrobial use
Authors: Hubbuch Alina , Peter Ruth , Willi Barbara , Hartnack Sonja , Müntener Cedric , Naegeli Hanspeter , Gerspach Christian
Published: January 2021

Background

The increasing threat of bacterial resistance promotes the need for antibiotic stewardship programs to foster responsible antimicrobial use. Therefore, guidelines for prudent use supported by an online stewardship tool (AntibioticScout.ch) were introduced in Switzerland in December 2016. They recommend (with decreasing preference) a first, second or third line antimicrobial for treatment. The objective of this study was to evaluate antimicrobial prescriptions for Swiss calves before (2016) and after (2018) the launch of these guidelines. Cases of calves with pneumonia, diarrhea and otitis from a university hospital and eight private practices in Switzerland were included. Data on anamnesis, clinical findings, diagnostic work-up and treatment were collected. Type and percentages [95% confidence interval] of antimicrobial prescriptions were compared between 2016 and 2018.

Results

Of the total number of calves, 88.2% [85.4–90.6] in 2016 (n = 625) and 88.4% [85.7–90.7] in 2018 (n = 655) were treated with antibiotics. The use of highest priority critically important antimicrobials (HPCIAs) decreased from 52.7% [48.6–56.9] in 2016 to 38.0% [34.2–41.9] in 2018; this decrease was found at the university hospital and in private practice and in cases with pneumonia and diarrhea. Particularly the use of fluoroquinolones decreased (2016: 43.1% [39.2–47.2]; 2018: 31.1% [27.6–34.8]). Overall, the number of first line treatments increased from 12.8% [10.4–15.6] in 2016 to 20.2% [17.3–23.4] in 2018. In cases of pneumonia, first line treatments increased (2016: 15.3% [11.6–19.9]; 2018: 26.5% [21.8–31.9]) and third line treatments decreased (2016: 43.5% [38.0–49.3]; 2018: 27.9% [23.1–33.3]); this was seen at the university hospital, whereas in private practice only a decrease of third line treatments was observed. In cases of diarrhea, more second line at the expense of unlisted antimicrobials were prescribed at the university hospital in 2018. Antimicrobial treatment of calves with otitis did not change from 2016 to 2018.

Conclusions

After the introduction of AntibioticScout.ch, more prudent use was observed in the treatment of calves with pneumonia and diarrhea as less HPCIAs, particularly fluoroquinolones, and more first line antimicrobials were prescribed. However, the overall frequency of antimicrobial treatment did not change and the use of HPCIAs was still common in 2018, especially in private practices. Therefore, further antimicrobial stewardship activities are necessary.
Association between the Mediterranean lifestyle, metabolic syndrome and mortality: a whole-country cohort in Spain
Authors: Sotos-Prieto Mercedes , Ortolá Rosario , Ruiz-Canela Miguel , Garcia-Esquinas Esther , Martínez-Gómez David , Lopez-Garcia Esther , Martínez-González Miguel Ángel , Rodriguez-Artalejo Fernando
Published: January 2021

Background

Evidence is limited about the joint health effects of the Mediterranean lifestyle on cardiometabolic health and mortality. The aim of this study was to evaluate the association of the Mediterranean lifestyle with the frequency of the metabolic syndrome (MS) and the risk of all-cause and cardiovascular mortality in Spain.

Methods

Data were taken from ENRICA study, a prospective cohort of 11,090 individuals aged 18+ years, representative of the population of Spain, who were free of cardiovascular disease (CVD) and diabetes at 2008–2010 and were followed-up to 2017. The Mediterranean lifestyle was assessed at baseline with the 27-item MEDLIFE index (with higher score representing better adherence).

Results

Compared to participants in the lowest quartile of MEDLIFE, those in the highest quartile had a multivariable-adjusted odds ratio 0.73 (95% confidence interval (CI) 0.5, 0.93) for MS, 0.63. (0.51, 0.80) for abdominal obesity, and 0.76 (0.63, 0.90) for low HDL-cholesterol. Similarly, a higher MELDIFE score was associated with lower HOMA-IR and highly-sensitivity C-reactive protein (P-trend < 0.001). During a mean follow-up of 8.7 years, 330 total deaths (74 CVD deaths) were ascertained. When comparing those in highest vs. lowest quartile of MEDLIFE, the multivariable-adjusted hazard ratio (95% CI) was 0.58 (0.37, 0.90) for total mortality and 0.33 (0.11, 1.02) for cardiovascular mortality.

Conclusions

The Mediterranean lifestyle was associated with lower frequency of MS and reduced all-cause mortality in Spain. Future studies should determine if this also applies to other Mediterranean countries, and also improve cardiovascular health outside the Mediterranean basin.