bluuebunny/crossref_metadata_2025 huggingface dataset:
One step versus two step screening for gestational diabetes mellitus
Authors: Hematbhai Satodiya Mohit
Published: February 2021

Objective: To compare the incidence, maternal and fetal outcomes of gestational diabetes mellitus using one step vs. two step as a screening procedure.

Methodology: A prospective randomized trial involving screening of 1000 pregnant women for gestational diabetes mellitus was conducted. Women were divided in two groups (500 each). Group A comprised of patients screened with two step approach (ACOG recommendation), Group B comprised of women screened by one step method (IADPSG criteria). Women diagnosed with ‘gestational diabetes’ were followed in antenatal clinic and incidence of GDM, maternal and fetal outcome between two groups were analyzed using SPSS.

Results: The incidence of GDM was almost double using one step approach versus two step which was 19.2% and 11.8% respectively. Maternal outcomes were comparable in both the groups except the risk of preterm delivery which was 2.5 times more in group A than group B (odds ratio = 2.43 95% CI = 1.01-5.79). Further fetal outcomes were also comparable except neonatal hypoglycemia which was seen in 29.31% in group A vs. 7.4% in group B. In the group B 15 patients (15.8%) patients with GDM (based on FBS ≥92 mg/dl at 1st ANC visit) showed clinical symptoms & blood sugars in hypoglycemic range on MNT requiring resumption of normal diet.

Conclusion: The incidence of GDM using IADPSG criteria was almost double versus ACOG criteria. Maternal and fetal outcomes were comparable except in 15.8% women diagnosed as GDM (using FBS ≥92 mg/dl at 1st ANC visit as per IADPSG) suffered from hypoglycemia. A large trial is being proposed before these criteria are adopted.
Paget’s disease of the vulva in postmenopausal women: A case report
Authors: Shrestha Eliza , Shekon Rupinder , Giri Shveta , Rawal Sudhir
Published: February 2021

Vulvar Paget’s disease is an extremely rare neoplasm that accounts for less than 1% of vulvar malignancies. We present a case of a 66 year old woman, who had an ulcerated lesion involving the labia majora bilaterally; lymph nodes were not palpable in the inguinal region bilaterally. A biopsy of the Vulva showed Paget’s disease. She underwent radical Vulvectomy with Bilateral inguinal lymph node dissection. The specimens resected were reviewed with respect to involvement of the margins with Paget cells and the margin was negative. The patient remained disease free at 2 years follow up.
Synchronous primary ovarian sex cord tumor and endometrial cancer
Authors: Iqbal S. A. , Shukla H. , Jain V. , Giri S. , Sekhon R. , Rawal S.
Published: February 2021

Synchronous primary tumors of female genital tract are rare with a rate of about 0.7-1.8% of all gynaecological tumours. Most common primary tumours presenting as synchronous lesions are ovary and endometrium. However, sex cord stromal tumors are rare variety of primary ovarian tumor and synchronous with endometrium is even much rarer. These tumors are detected usually in younger, overweight, nulliparous and perimenopausal female. Synchronous primary tumors of endometrium and ovary have a better prognosis than the either of above alone because these are usually low grade and diagnosed at early stage. We present a report of four cases of synchronous endometrial and sex cord stromal tumors of ovary.
R-veil in carcinoma vulva
Authors: Jain Vandana , Sekhon Rupinder , Giri Shveta , Rawal Sudhir
Published: February 2021

Background: Vulvar cancer accounts for about 3-5% of gynaecologic malignancies. Prognosis is strongly dependent on presence of inguinofemoral lymph node metastases. Effective management of regional lymph nodes is the most important factor in the curative management of early vulvar cancer. Despite careful dissection and maintaining vascularity of skin, surgical morbidity is seen in 50% cases. Video – endoscopic inguinofemoral lymphadenectomy was developed by Bishoff in 2003 by dissecting two cadaveric models and in one patient with stage T3N1M0 penile carcinoma. VEIL is an alternative to reduce the morbidity without compromising the oncologic outcomes. VEIL has continued to evolve into single site and robotic variants. R-VEIL is a minimally invasive procedure duplicating the standard open procedure with less morbidity.

Aims and Objectives: A video presentation to describe the technique of R-VEIL in vulvar cancer and discuss the advantages and outcome.

Conclusions: R–VEIL is an attractive minimally invasive technique to do inguinal block dissection in a single sitting in patients with vulvar carcinoma as the surgeon does not get tired as happens in VEIL technique. R-VEIL allows the removal of inguinal lymph nodes within the same limits as in open procedure and potentially reduces surgical morbidity. It is better accepted cosmetically and reduces hospital stay. Long term oncological results are not available. Randomized multi-institutional studies are required to prove its efficacy over open counterpart.
Radical excision of a massive vulvo-vaginal mass
Authors: Meena J. , Parthasarathy A. , Vatsa R. , Singh N. , Kumar S. , Roy K. K. , Singhal S.
Published: February 2021

Background: Vulvo-vaginal masses has a varied presentation and causes. The most common differential diagnosis are condylomata acuminata, vulvular abscess, vulvular/vaginal cysts, vulval carcinoma, vulval lipoma, angiomyofibroblastoma and aggressive angiomyxoma. Surgical excision of the mass is the main method of treatment and the outcome differs with the histological diagnosis. We present a video of excision of a massive Vulvo vaginal mass in toto.

Case: A 45 year old P3 L3 female, presented with complaint of mass in perineal area and discharge per vaginum for 2 years. The mass was growing progressively and reached the present size. On examination there was a 9 × 8 cm irregular firm to cystic mass, arising from posterior wall of vagina and protruding out of introitus with bossellated surface. The mass also extended into right ischiorectal fossa, 10 × 10 cm mass with cystic, smooth surface that was irreducible with no cough impulse. CECT abdomen and pelvis revealed a well-defined 12 × 10 × 8 cm mass in right perineum arising from right lower lateral vaginal wall with ischiorectal fossa extension. There was no extension into cervix, bladder or rectum. Biopsy taken from the mass was inconclusive. A wide local excision was done under general anesthesia wherein an ischiorectal and vaginal mass of size 30 × 10 cm with irregular margin was excised in toto. Histopathology was suggestive of aggressive angiomyxoma. The patient is under follow up.

Discussion: Aggressive Angiomyxoma is a rare slow growing locally invasive mesenchymal tumor and has a substantial potential for recurrence. It is often misdiagnosed. Pre-operative diagnosis is difficult due to rarity of this entity and absence of diagnostic features, but it should be considered in case of masses in genital, perianal and pelvic region in a woman of reproductive age. Radical surgical excision is the first line of management. A long term follow up of the case is necessary and MRI is preferred method for detecting recurrences.
Radical excision of a massive vulvo-vaginal mass
Authors: Meena J. , Parthasarathy A. , Vatsa R. , Singh N. , Kumar S. , Roy K. K. , Singhal S.
Published: February 2021

Background: Vulvo-vaginal masses has a varied presentation and causes. The most common differential diagnosis are Condylomata acuminata, Vulvular abscess, Vulvular/vaginal cysts, Vulval carcinoma, Vulval lipoma, Angiomyofibroblastoma and Aggressive Angiomyxoma. Surgical excision of the mass is the main method of treatment and the outcome differs with the histological diagnosis. We present a video of excision of a massiveVulvo vaginal mass in toto.

Case: A 45 year old P3 L3female, presented with complaint of mass in perineal area & discharge per vaginum for 2 years. The mass was growing progressively and reached the present size. On examination there was a 9 X 8 cm irregular firm to cystic mass, arising from posterior wall of vagina and protruding out of introitus with bossellated surface. The mass also extended into right ischiorectal fossa, 10 X 10 cm mass with cystic, smooth surface that was irreducible with no cough impulse. CECT abdomen and pelvis revealed a well-defined 12 X 10 X 8 cm mass in right perineum arising from right lower lateral vaginal wall with ischiorectal fossa extension. There was no extension into cervix, bladder or rectum. Biopsy taken from the mass was inconclusive. A wide local excision was done under general anesthesia wherein an ischiorectal and vaginal mass of size 30 X 10 cm with irregular margin was excised in toto. Histopathology was suggestive of Aggressive Angiomyxoma. The patient is under follow up.

Discussion: Aggressive Angiomyxoma is a rare slow growing locally invasive mesenchymal tumor and has a substantial potential for recurrence. It is often misdiagnosed. Pre-operative diagnosis is difficult due to rarity of this entity and absence of diagnostic features, but it should be considered in case of masses in genital, perianal and pelvic region in a woman of reproductive age. Radical surgical excision is the first line of management. A long term follow up of the case is necessary and MRI is preferred method for detecting recurrences.
Laparoscopic radical hysterectomy: Results, recovery, recurrence – Our experience
Authors: Bhardwaj Punita , Das T. K. , Batra S. ,   Roman
Published: February 2021

Gynaecology Oncology is a beneficiary of Minimally Invasive Approach. We present our experience. The laparoscopic approach is associated with less surgical morbidity, per operative bleeding and shorter hospital stay though the duration of operation might be longer. It has a longer learning curve. Laparoscopic radical hysterectomy with pelvic lymphadenectomy is a safe surgical option for treatment of Gynaecological cancers taking into account amount of bleeding, complications recovery and recurrence.
Dosimetric evaluation of sigmoidal and bowel doses in the treatment of carcinoma of cervix using CT based volumetric imaging technique
Authors: Bisht Jyoti , Kant Ravi , Gupta Meenu , Nautiyal Vipul , Bansal Saurabh , Saini Sunil , Ahmad Mushtaq
Published: February 2021

Purpose: Radiation therapy is the main stray for the treatment of the cervical cancer. Normal organs such as bladder, rectum, sigmoid colon and bowel loops also get significant dose during treatment of carcinoma of cervix which often results late toxicity. The purpose of this study is evaluate CT image based volumetric doses of organ at risk and correlate the doses with the toxicity profile observed in cancer patients.

Materials and Methods: Sixty high dose rate intracavitary brachytherapy applications were performed in thirty patients of carcinoma of cervix. External beam therapy was planned for 46 Gy in 23 fractions followed by two brachytherapy sessions of 9 Gy/session. External beam radiotherapy was given by four field box technique to each patient. CT based treatment planning was done for each intracavitary brachytherapy application. Dose volume histogram was used for analysis of volumetric dose parameters and correlated with the RTOG defined normal organ toxicity profile of the patients.

Results: In the follow up of two years 2 (6.66%) patient had died, 12 (40%) patients had reported no significant problem, 3 (10%) patient got bladder toxicity of grade 2, 10 (33.33%) patients had reported small intestine toxicity of grade 1 and grade 2 while no information could be available for 3 (10%) patients. The average volume of rectum, sigmoid colon and bowel loops were 60.34 cc, 22.19 cc and 270.82 cc. The average, median and 2 cc volume doses for rectum 289 ± 121 cGy, 263 ± 113 cGy and 884 ± 444 cGy for sigmoid colon 409 ± 211 cGy, 366 ± 185 cGy and 693 ± 371 cGy resp. and for bowel loops 240 ± 169 cGy, 153 ± 59 cGy and 870 ± 222 cGy. The average and median sigmoid colon point doses were higher than rectum average (p= 0.000) and median doses (p =0.001) but 2cc volumetric doses of sigmoid colon are less than rectum 2cc volumetric doses (p = 0.013). For bowel loops the 2cc volumetric doses were much higher than average doses (p = 0.000) due to its large volume. The recto-sigmoidal toxicity profile were evaluated for sigmoidal max doses and rectum 2 cc volumetric dose profile. There was a poor correlation between rectum 2 cc volumetric dose and sigmoid 2 cc volumetric doses.

Conclusion: According to dose toxicity profile, sigmoidal doses represent an important role for dose constrains but till now no protocol has been formed for reporting the sigmoidal doses. This study attracts the attention for reporting the sigmoidal and bowl loop doses. This study demonstrates the possibility and role of volumetric imaging and dosimetry for improvement in dose constraints.
Granulosa cell tumour of ovary in a benign looking adnexal mass: A rare occurrence and its management
Authors: Hena Kausar , Rahul Manchanda , Anshika Lekhi , Sravani Chitra C. H. , Nidhi Jain
Published: February 2021

Granulosa cell tumours are sex cord stromal tumours of the ovary which accounts for 1-2% of all ovarian malignancies. We present a case of a 22 yrs old unmarried girl with chief complaints of dysmenorrhoea for last 4 months. There were no other symptoms and her general physical examination revealed no abnormality. Ultrasonography showed a simple ovarian cyst of 7 x 8 cm in right adnexa with normal Doppler flow and no ascites. Her tumour markers were negative. Per-operative uterus and left sided ovary and upper abdomen was normal. Right ovary showed a simple unilocular cyst of around 8 x 8 cm and right ovarian cystectomy done. Surprisingly histopathological examination of cyst wall revealed granulosa cell tumour. Immunohistochemical staining was found to be positive especially with inhibin. Staging laparoscopy with peritoneal wash, multiple peritoneal biopsy with right sided salpingo-oopherectomy, left sided ovarian biopsy and dilatation and curettage was done. Cytological and histopathlogical examination were found to be normal. Post operatively patient received chemotherapy because cyst wall was ruptured per-operatively and patient is doing fine and disease free till now.
Development of nasal HPV vaccine formulations
Authors: Krishnakumar D. , Jaganathan K. S.
Published: February 2021

Cervical cancer is the second most cancer in women worldwide with over 500000 new cases and 275000 deaths being registered every year. With nearly 73000 women dying every year, India now tops the world in cervical cancer deaths. India represents 26.4% of all women dying of cervical cancer globally. Cervical cancer estimated to be responsible for about 5% of human cancers worldwide. Currently available vaccines may not provide complete protection against all HPV types as the protection is primarily type specific. Furthermore, the available vaccines are delivered via intramuscular route and require three doses and require cold chain supply which increases the cost of vaccine. Therefore a single dose vaccine delivered via non-invasive route (nasal) that protects against multiple HPV types would be a cost effective and better alternative to the currently available HPV vaccines. The main objective of this study was to prepare HPV antigen loaded poly (lactic-co-glycolic acid) (PLGA) and Tri Methyl Chitosan (TMC) coated PLGA microparticles and compare their efficacy as nasal vaccine. The developed formulations were characterized for size, zeta potential, entrapment efficiency, mucin adsorption ability, in vitro and in vivo studies. PLGA microparticles demonstrated negative zeta potential whereas PLGA-TMC microparticles showed higher positive zeta potential. The protein loading efficiency was found as above 80%. Results indicated that PLGA-TMC microparticles demonstrated substantially higher mucin adsorption when compared to PLGA microparticles. HPV antigen encapsulated in PLGA-TMC particles elicited a significantly higher secretory (IgA) immune response compared to that encapsulated in PLGA particles. Present study demonstrates that PLGA-TMC microparticles with specific size range can be a better carrier adjuvant for nasal subunit vaccines. Surface modified PLGA microparticles proved great potential as a nasal delivery system for HPV infections where systemic and mucosal responses are necessary particularly in conditions after viral pathogens invade the host through the mucosal surface.
Primary signet ring cell mucinous carcinoma ovary: A very rare neoplasm
Authors: Mishra Amita , Pandit Archit , Kalra Namit , Narula Bhawna
Published: February 2021

Introduction: Mucinous ovarian carcinomas are less common than serous and endometriod type, and are more frequently confined to the ovary at the time of diagnosis. But primary signet ring cell mucinous carcinomas of the ovary are extremely rare.

Case Presentation: A 40 yr old patient presented with extremely rare primary signet cell mucinous carcinoma of ovary. She presented with abdominal distension and frequency of urination for one month. She was evaluated and CECT whole abdomen was s/o large left ovarian mass. All the tumor markers were with in normal range. Laparotomy frozen section of left adnexal mass was done and was reported as malignant with sheets of signet ring cells seen. Hence complete staging laparotomy including TAH with RSO with bilateral pelvic lymph node dissection with total omentectomy with para aortic lymph node dissection. Final histopathology with IHC markers were S/O primary signet ring cell carcinoma of ovary with no extracapsular invasion, no lymph nodal involvement & no metastatic spread.

Conclusion: We present a very rare case of primary signet ring cell of ovary, confined to ovary itself. On literature review only 14 cases have been reported and of them very few are malignant.
Clinical presentation and management of malignant germ cell ovarian tumours in BPKMCH
Authors: Pariyar Jitendra , Shrestha Binuma
Published: February 2021

Background: Germ cell malignancies account for about 5% of all ovarian cancers. These tumours grow rapidly and often produce symptoms quicker than the slow growing epithelial tumour. Commonly seen in the first two decades of life germ cell malignancies are highly chemosensitive and are potentially curable with surgery and chemotherapy. This study is the first of its kind regarding the epidemiology, management and outcome of patients with malignant germ cell tumour in Nepal.

Objective: To analyze the clinical presentation and management outcomes of malignant germ cell tumours managed in B.P. Koirala Memorial Cancer Hospital, Nepal.

Methodology: Descriptive study conducted in B.P. Koirala Memorial Cancer Hospital, Nepal. Case records of malignant germ cell tumours attending the hospital from January 1999 to December 2009 were analyzed regarding their illness history, clinical examination, investigations, treatment, follow-up and outcomes measured.

Observations: Total 65 cases of malignant germ cell tumours with age range from 2 to 58 years (mean 21.7 years) were received. 42% cases were Tibeto-Burmese; 30% were Indo-Aryans. There were 15 cases (23%) of dysgeminoma, 21 endodermal sinus tumor (32%), 16 Immature Cystic Teratoma (24.5%), 9 (14%) Mixed Germ Cell, 2 unclassified GCT (3.5%) and 2 malignant transformation in teratoma (3.5%). 33 (49.5%) patients had early stage disease, 37 (57%) underwent fertility preserving surgery. 4 cases (9%) due to disseminated disease, underwent neoadjuvant chemotherapy followed by debulking surgery. 51 cases (78.5%) received adjuvant chemotherapy (BEP or EP regimen). The overall survival was 70%.

Conclusion: Early stage germ cell malignancies can be safely managed by fertility preserving surgery followed by, chemotherapy if indicated. For advanced diseases, neoadjuvant chemotherapy followed by surgery can be undertaken with curable intent.
Clinicopathological correlates and need for adjuvant radiotherapy in early stage carcinoma cervix
Authors: Reddy Apoorva , Rajaram Shalini , Gupta Bindiya , Garg Shipra , Mishra Kiran , Goel Neerja , Radhakrishnan Gita , Vaid N. B.
Published: February 2021

Objective: To analyse clinical-pathological findings in women undergoing surgery for early stage carcinoma cervix and to determine the need for adjuvant radiotherapy.

Methods: The study was a retrospective one done to analyse data of women who had been operated for carcinoma cervix in the last 10 years at a tertiary hospital in Delhi. Type II/III radical hysterectomy with pelvic lymphadenectomy was done depending on stage. Histopathological findings and need for adjuvant therapy based on presence of clinical and pathological criteria were studied.

Results: A total of 93 eligible patient records were included in the study. Mean age and parity was 48.09 ± 22.36 years and 4.29 ± 3.9 respectively. 47.31% (44) of the women had stage 1B1 carcinoma cervix; 31.18% (29) had stage 1B2 and 19.35% (18) had stage 2A disease. Average size of the tumour growth was 3.25 ± 2.46 cm with the largest being 7 cm. Keratinising squamous cell carcinoma was seen in 48.38% (45) of patients whereas the non-keratinising one was seen in 33.33% (31). Large cell variant was seen in 6.45% (6) whereas micro invasive cancer was seen in 4 women. Adenocarcinoma constituted only 3.2% (3) of the study group. Vaginal cuff involvement was present in 9.67% (9) of patients and an equal number had occult parametrial invasion. A significant number of these had stage 2A disease (16.66% and 22.22% respectively). Between 1B1 and 1B2 there was no significant difference in the incidence of vaginal cuff involvement and occult parametrial invasion (P equals to 0.206 and 1 respectively). Lymph nodes were positive in 24.73% with the obturator lymph node being the commonest involved (17). In stage 1b1 25% (11) had positive lymph nodes; in stage 1B2 34.48% (10) and in 2A only one woman had positive pelvic lymph nodes. This difference was also not significant (P = 0.434). About 50% (47) of patients were referred for adjuvant radiotherapy on the basis of the pathological findings. 61% (11) of patients with stage 2A disease, 51.7% (15) of patients with stage 1b2 and 45.45% (20) with stage 1B1 disease required adjuvant radiotherapy.

Conclusion: There was no significant difference in the pathological findings in patients of 1B1 and 1B2. Also the need for radiotherapy in both the groups was similar. Hence similar surgical approach to women with both 1B1 and 1B2 disease appears appropriate.
Cervical cancer management in Rural India: Are we really living in 21st century or need to focus on health education of our doctors
Authors: Mittal Sujata
Published: February 2021

Objectives: To study cases of cervical cancer managed/unmanaged in rural India and to analyze the reasons for poor outcome.

Methods: This is a retrospective study of 218 cases of cervical cancers between 2008-2013 with resultant outcome in terms of treatment or absence of treatment in spite of diagnosis. Reasons for not taking the treatment have been analyzed. Also, analysis of 21 cases of simple hysterectomy with resultant complications like VVF, RVF has been done. Indications of surgery, operating surgeon, availability of preoperative/postoperative HPR, slides/blocks, discharge summary and disease status at the time of referral was done.

Results: 44% refused to take treatment in spite of stage III diagnosis citing financial constraints, distance to be traveled daily for RT and apathetic attitude of family towards females. 20.65% opted for other hospitals. 29.8% took complete treatment. 80% of females were illiterate and dependent. 9.7% had simple hysterectomy for invasive disease. 95% of simple hysterectomies were performed by general surgeons in private setups resulting in 19% of complications like VVF, RVF. 100% cases of simple Hysterectomy did not have pre-operative biopsy. Only 50% cases had post-operative biopsy report and in none of the cases were slide/blocks available for review as trained pathologists were not available. General surgeons who had performed surgery were neither trained in doing P/V examinations nor aware of staging of cervical cancer.

Conclusion: Illiteracy, poverty and absence of implementation of cancer control programs are the major hurdles in control of cervical cancer. The study highlights the absence of Government’s will to control cervical cancer in rural India. It emphasizes on the need of intensive training and health education of gynaecologists and surgeons at district/rural level, lack of which is a primary factor for violation of medical ethics by the doctors.
Effects of a 1-Year Physical Activity Intervention on Markers of Hemostasis among Breast Cancer Survivors: A Randomized Controlled Trial
Authors: Bøhn Siv Kjølsrud , Thune Inger , Flote Vidar Gordon , Frydenberg Hanne , Bertheussen Gro Falkenér , Husøy Anders , Fjeldheim Frøydis , Brunvoll Sonja Hjellegjerde , Hjartåker Anette , Mowinckel Marie-Christine , Sandset Per Morten , Iversen Per Ole
Published: February 2021

Introduction Physical activity may reduce the development of breast cancer. Whereas hypercoagulability has been linked to adverse outcomes in breast cancer patients, the effects of physical activity on their hemostatic factors are unknown. The study aimed to assess whether long-term (1 year) physical activity can affect hemostatic factors in breast cancer patients.

Methods Fifty-five women (35–75 years) with invasive breast cancer stage I/II were randomized to a physical activity intervention (n = 29) lasting 1 year or to a control group (n = 26), and analyzed as intention to treat. Fibrinogen, factor VII antigen, tissue factor pathway inhibitor, and von Willebrand factor (VWF) antigen as well as prothrombin fragment 1 + 2, the endogenous thrombin potential and D-dimer, were measured in plasma before intervention (baseline), and then after 6 and 12 months.

Results Maximal oxygen uptake (measure of cardiorespiratory fitness) decreased the first 6 months among the controls, but remained stable in the intervention group. We found no significant differences between the two study groups regarding any of the hemostatic factors, except a significantly higher increase in factor VII antigen in the intervention group. The effect of the intervention on VWF was, however, significantly affected by menopausal stage, and a significant effect of the intervention was found on VWF among postmenopausal women, even after adjustment for dietary intake.

Conclusion Long-term physical activity had no effect on the majority of the hemostatic factors measured, but led to increased plasma concentrations of factor VII antigen and prevented an increase in VWF concentration after breast cancer treatment in postmenopausal women. The clinical impact of these findings for risk of vascular thrombosis warrants further studies.
Evaluating the Right Ventricle in Acute and Chronic Pulmonary Embolism: Current and Future Considerations
Authors: Singh Siddharth , Lewis Michael I.
Published: February 2021

The right ventricle (RV), due to its morphologic and physiologic differences, is susceptible to sudden increase in RV afterload, as noted in patients with acute pulmonary embolism (PE). Functional impairment of RV function is a stronger presage of adverse outcomes in acute PE than the location or burden of emboli. While current iterations of most clinical prognostic scores do not incorporate RV dysfunction, advancements in imaging have enabled more granular and accurate assessment of RV dysfunction in acute PE. RV enlargement and dysfunction on imaging is noted only in a subset of patients with acute PE and is dependent on underlying cardiopulmonary reserve and clot burden. Specific signs like McConnell's and “60/60” sign are noted in less than 20% of patients with acute PE. About 2% of patients with acute PE develop chronic thromboembolic pulmonary hypertension, characterized by continued deterioration in RV function in a subset of patients with a continuum of RV function from preserved to overt right heart failure. Advances in molecular and other imaging will help better characterize RV dysfunction in this population and evaluate the response to therapies.
Risk Stratification in Acute Pulmonary Embolism: The Latest Algorithms
Authors: Triantafyllou Georgios A. , O'Corragain Oisin , Rivera-Lebron Belinda , Rali Parth
Published: February 2021

Pulmonary embolism (PE) is a common clinical entity, which most clinicians will encounter. Appropriate risk stratification of patients is key to identify those who may benefit from reperfusion therapy. The first step in risk assessment should be the identification of hemodynamic instability and, if present, urgent patient consideration for systemic thrombolytics. In the absence of shock, there is a plethora of imaging studies, biochemical markers, and clinical scores that can be used to further assess the patients' short-term mortality risk. Integrated prediction models incorporate more information toward an individualized and precise mortality prediction. Additionally, bleeding risk scores should be utilized prior to initiation of anticoagulation and/or reperfusion therapy administration. Here, we review the latest algorithms for a comprehensive risk stratification of the patient with acute PE.
Determinants and Management of the Post–Pulmonary Embolism Syndrome
Authors: Boon Gudula J.A.M. , Huisman Menno V. , Klok Frederikus A.
Published: February 2021

Acute pulmonary embolism (PE) is not only a serious and potentially life-threatening disease in the acute phase, in recent years it has become evident that it may also have a major impact on a patient's daily life in the long run. Persistent dyspnea and impaired functional status are common, occurring in up to 50% of PE survivors, and have been termed the post-PE syndrome (PPES). Chronic thromboembolic pulmonary hypertension is the most feared cause of post-PE dyspnea. When pulmonary hypertension is ruled out, cardiopulmonary exercise testing can play a central role in investigating the potential causes of persistent symptoms, including chronic thromboembolic pulmonary disease or other cardiopulmonary conditions. Alternatively, it is important to realize that post-PE cardiac impairment or post-PE functional limitations, including deconditioning, are present in a large proportion of patients. Health-related quality of life is strongly influenced by PPES, which emphasizes the importance of persistent limitations after an episode of acute PE. In this review, physiological determinants and the diagnostic management of persistent dyspnea after acute PE are elucidated.
Prevention of Venous Thromboembolism in Acutely Ill Medical Patients: A New Era
Authors: MacDougall Kira , Spyropoulos Alex C.
Published: February 2021

Venous thromboembolism (VTE) is the leading preventable cause of death in hospitalized patients and data consistently show that acutely ill medical patients remain at increased risk for VTE-related morbidity and mortality in the post-hospital discharge period. Prescribing extended thromboprophylaxis for up to 45 days following an acute hospitalization in key patient subgroups that include more than one-quarter of hospitalized medically-ill patients represents a paradigm shift in the way hospital-based physicians think about VTE prevention. Advances in the field of primary thromboprophylaxis in acutely-ill medical patients using validated VTE and bleeding risk assessment models have established key patient subgroups at high risk of VTE and low risk of bleeding that may benefit from both in-hospital and extended thromboprophylaxis. The direct oral anticoagulants betrixaban and rivaroxaban are now U.S. Food and Drug Administration-approved for in-hospital and extended thromboprophylaxis in medically ill patients and provide net clinical benefit in these key subgroups. Coronavirus disease-2019 may predispose patients to VTE due to excessive inflammation, platelet activation, endothelial dysfunction, and hemostasis. The optimum preventive strategy for these patients requires further investigation. This article aims to review the latest concepts in predicting and preventing VTE and discuss the new era of extended thromboprophylaxis in hospitalized medically ill patients.
Optical filters based on fixed length Thue–Morse plasma-dielectric photonic band multilayers: Comparing two, three, and four materials systems
Authors: Solaimani M. , Ghalandari M. , Nejati Malihe
Published: February 2021

In this paper, we study the optical filtering properties of plasma-dielectric photonic crystals based on Thue–Morse multilayers. The method of generating the Thue–Morse sequence used in the current paper is different from that used in the available literature. We fix the total multi-material system length and use two, three, and four alternative layers of materials with different refractive indices to study the optical transmission properties of a few proposed structures. We also use plasma layers to have more tunable bandgaps. We employ the transfer matrix method to do our numerical calculations. We change the geometrical parameters, the number of layers, the arrangement of the layers, material refractive indices, and plasma properties and extract their effects on the bandgap behavior. We determine the tunability of the proposed structures to facilitate the selection of the one with desired filtering properties. However, understanding the tunability of our systems can facilitate the devising of optical devices such as an optical filter.
Jahn–Teller distortions in (Co1–xCux)Cr2O4 (x = 0.5, 0.25) nanoparticles: Structural, magnetic and electronic properties
Authors: Mohanty P. , Sheppard C. J. , Doyle B. P. , Carleschi E. , Prinsloo A. R. E.
Published: February 2021

The spinel ferrimagnetic compound CoCr2O4 demonstrates a spin spiral (TS) ordering at 25 K, as well as an anomaly at 15 K termed as lock-in transition (TL). From crystallographic perspective CoCr2O4 retains the cubic phase down to 11 K. On the other hand, the normal spinel CuCr2O4 crystallizes into the cubic phase above 850 K, below which Jahn-Teller (J-T) activity of the Cu reduces the crystal symmetry by transforming it to a tetragonal phase. Contraction of CuO4 tetrahedra towards the formation of a square planar structure accounts for the tetragonal to orthorhombic structural transition at ∼ 130 K associated with the ferrimagnetic Curie temperature (TC). Considering the differences in crystal structure and magnetism of these two compounds, the current work investigates the modification in crystal structure and magnetic behaviour by mixing Co site with Cu in CoCr2O4. To achieve this, (Co1–xCux)Cr2O4 (x = 0.5, 0.25 and 0.75) nanoparticles were prepared by chemical routes. X-ray diffraction (XRD) revealed the retention of cubic structure for the samples calcined at a temperature of 600 °C for x = 0.25 and 0.5. On the other hand, J-T distortion becomes prominent for x = 0.75. Hence, only the compositions with x = 0.25 and 0.5 were studied in detail as unusual cubic phase retention is observed in these compounds. The temperature dependent magnetization studies revealed that the TC values of both the samples, 103 K for (Co0.5Cu0.5)Cr2O4 and 99 K for (Co0.75Cu0.25)Cr2O4, compare well with the value reported for CoCr2O4. However, the feature related to TS is quite prominent for x = 0.25, whereas it is suppressed for x = 0.5. The electronic properties of the cations associated with these compounds, probed using X-ray photoelectron spectroscopy (XPS), indicate that Cu and Co mostly has a 2+ oxidation state whereas that of Cr is 3+.
Refining China’s grassland policies: an interdisciplinary and ex-ante analysis
Authors: Brown Colin , Behrendt Karl , Ping Li , Guanghua Qiao , Bennett Jeff , Bao Zhang , Addison Jane , Kemp David , Guodong Han , Jing Zhang
Published: February 2021

China is about to embark on a new round of grassland policies as part of its 14th Five-Year-Plan. Although current grassland policies have generally been perceived positively in arresting widespread grassland degradation, concerns have arisen that the current policies may not be effective in achieving the desired reduction in livestock numbers. Furthermore, there are concerns the incentive-based payments that are part of these policy programs may not reflect herder opportunity costs or the marginal environmental benefits of the program, with associated issues of herder satisfaction and compliance. Changes to current policy settings are being considered in response to these concerns. This paper reports on an interdisciplinary and ex-ante analysis of alternative policy settings affecting grazing and livestock management in terms of their environmental impacts, net social benefits and other impacts. The analysis finds that a bundle of instruments involving both positive and negative herder incentives is needed if desired stocking rates are to be achieved. The impact on herder incomes, both positive and negative depending on the grassland biome, along with transaction costs of implementing the policies, have the most influence on net social benefits.
Reductions in NO
2
burden over north equatorial Africa from decline in biomass burning in spite of growing fossil fuel use, 2005 to 2017
Authors: Hickman Jonathan E. , Andela Niels , Tsigaridis Kostas , Galy-Lacaux Corinne , Ossohou Money , Bauer Susanne E.
Published: February 2021

Significance

Socioeconomic development in low- and middle-income countries is thought to increase emissions of air pollutants, such as nitrogen dioxide (NO
2
). In Africa, fossil fuel use has nearly doubled since 2000, but vegetation fires—which cause substantial NO
2
pollution—have declined, partly as a result of human activity. Satellite observations show that during the biomass burning season, NO
2
concentrations in Africa’s northern fire region declined by 4.5% between 2005 and 2017, potentially benefitting hundreds of millions of people. Statistical modeling suggests that this decline is associated with declining vegetation fires. During the biomass burning season, higher levels of economic productivity are associated with lower NO
2
concentrations, suggesting that socioeconomic development in this region is resulting in net improvements to air quality.
Neural correlates of goal-directed and non–goal-directed movements
Authors: Sendhilnathan Naveen , Basu Debaleena , Goldberg Michael E. , Schall Jeffrey D. , Murthy Aditya
Published: February 2021

Significance

Although the monkey frontal eye field is implicated in the voluntary control of saccades, we found that only for during goal-directed saccades the variability in spike rate across trials decreased and had a concurrent reduction of LFP beta-band power, and the neural activity increased earlier. These data indicate the presence of additional constraints and computations that distinguish goal-directed movements from non–goal-directed movements.
Collective dynamics in entangled worm and robot blobs
Authors: Ozkan-Aydin Yasemin , Goldman Daniel I. , Bhamla M. Saad
Published: February 2021

Significance

Living organisms form collectives across all scales, enabling biological functions not accessible by individuals alone. In a few cases, the individuals are physically connected to each other, forming an additional class of entangled active matter systems with emergent mechanofunctionalities of the collective. Here, we describe the dynamics of macroscopic aquatic worms that braid their long, soft bodies to form large entangled worm blobs. We discover that the worm blob behaves as a living material to undergo dynamic shape transformations to reduce evaporation or break-symmetry and locomote to safety against thermal stresses. We validate our biological hypotheses in robophysical swarming blobs, which pave the way for additional classes of mechanofunctional active matter systems and collective emergent robotics.
Ancient DNA and multimethod dating confirm the late arrival of anatomically modern humans in southern China
Authors: Sun Xue-feng , Wen Shao-qing , Lu Cheng-qiu , Zhou Bo-yan , Curnoe Darren , Lu Hua-yu , Li Hong-chun , Wang Wei , Cheng Hai , Yi Shuang-wen , Jia Xin , Du Pan-xin , Xu Xing-hua , Lu Yi-ming , Lu Ying , Zheng Hong-xiang , Zhang Hong , Sun Chang , Wei Lan-hai , Han Fei , Huang Juan , Edwards R. Lawrence , Jin Li , Li Hui
Published: February 2021

Significance

Genetic studies show the founders of all living non-African populations expanded from Africa ca. 65 to 45 ka. This “late dispersal” model has been challenged by the discovery of isolated AMHs at caves in southern China suggested as early as ca. 120 ka. We assessed the age of early AMH fossils from five caves in this region using ancient DNA analysis and a multimethod geological dating strategy. We found they were much younger than previously suggested, with some remains dating to the Holocene owing to the complex depositional history at these subtropical caves. Current evidence shows AMHs settled southern China within the timeframe set by molecular data of less than ca. 50 to 45 ka and no earlier.
Another argument for the differences among
wa-marked phrases
Authors: Nakamura Koichiro
Published: February 2021

The aim of this paper is to argue that the focal
stress and structural position determine the interpretation of
wa-marked phrases in a Japanese sentence.
Namely, our argument is, based on, and extended out of Nakamura
(2017: 356–359), that in sentence initial position,
wa-marked phrases denote Thematic Topic
(tt) or Contrastive Topic (ct). Besides, our
claim is that within vP domain, focally-stressed
wa-marked phrase, denoted here as
wa-marked phrase, signals Contrastive Focus (cf).
In (1a),
wa-marked phrase denotes exhaustivity. On the other
hand, wa-marked phrase in (1b), which occurs below the VP
adverb majimeni (=seriously), signals contrast.

(1)

Iya,
demo
ano-ronbun-wa

Taro-ga
yon-da
(yo).

no,

but

that paper-ei Focus

T-Nom

read-Past

Par

‘Not, but Taro read that
paper, and he read nothing more.’

Majimeni
Taro-wa
hon-4-satu-wa

yon-da

seriously

t-tt

book-4-cl-cf

read-Past

‘Taro seriously read the
four books (, opposed to four papers).

Through the examples of the scopal interactions
between negation, verbs and focus particles and wa-marked
phrases, we demonstrate that the wa-marked phrase in
vP domain denotes contrastive focus
(cf). We go on to propose the following elaborated left
peripheries for both CP and vP territories.

(2)

[TopP
[FocP [TopP [TP [
vP [VP ….]]]]]:
CP periphery

[TopP
[FocP [TopP [
vP [VP ….]]]]:
vP periphery
Properties of child-directed speech in bilingual parents
Authors: Li Yezhou , Onnis Luca
Published: February 2021

How parents talk to young children matters to language and cognitive development. In the early years the quantity,
quality, and diversity inherent in language from parents in the home predict differences in vocabulary knowledge, school
readiness, and later academic achievement. However, most of what is known about child-directed speech (CDS) comes from studies of
monolingual parents, and little is known about features of speech from bilingual parents. Here, we asked whether degree of
bilingualism assessed within a single parent might be positively associated with CDS features that are known to facilitate
children’s lexical and grammatical structures across languages – parental partial repetitions. During unscripted narrations
(n = 91) of a picture book to their toddlers in English, mothers who reported being more bilingually balanced
used a higher proportion of self-repetitions (both single words and 2-word combinations) within a brief time-frame. At the same
time, more bilingual mothers preserved the same degree of lexical diversity as more monolingual mothers. The results obtained even
accounting for differences in socio-economic status. These findings are discussed in terms of adaptive strategies that bilingual
parents may consciously or unconsciously adopt in bilingual language development
Change and continuity in Hurstville’s Chinese restaurants
Authors: Xu Samantha Zhan , Wang Wei
Published: February 2021

This paper investigates the Linguistic Landscape of Chinese restaurants in Hurstville, a Chinese-concentrated suburb in Sydney, Australia. It draws on Blommaert and Maly’s (2016) Ethnographic Linguistic Landscape Analysis (ELLA) and Scollon and Scollon’s geosemiotics (2003). Our data set consists of photographs, Google Street View archives, and ethnographic fieldwork, in particular in-depth interviews with restaurant owners. This paper adopts a diachronic perspective to compare the restaurant scape between 2009 and 2019 and presents an ELLA case study of a long-standing Chinese restaurant. It aims to unveil the temporal and spatial relationships between signs, agents, and place, that demonstrate how a social and historical perspective in Linguistic Landscape studies of diasporic communities can shed light on the changes in the broader social context.
The thymoproteasome hardwires the TCR repertoire of CD8+ T cells in the cortex independent of negative selection
Authors: Ohigashi Izumi , Frantzeskakis Melina , Jacques Alison , Fujimori Sayumi , Ushio Aya , Yamashita Fusano , Ishimaru Naozumi , Yin Da , Cam Margaret , Kelly Michael C. , Awasthi Parirokh , Takada Kensuke , Takahama Yousuke
Published: February 2021

The thymoproteasome expressed specifically in thymic cortical epithelium optimizes the generation of CD8+ T cells; however, how the thymoproteasome contributes to CD8+ T cell development is unclear. Here, we show that the thymoproteasome shapes the TCR repertoire directly in cortical thymocytes before migration to the thymic medulla. We further show that the thymoproteasome optimizes CD8+ T cell production independent of the thymic medulla; independent of additional antigen-presenting cells, including medullary thymic epithelial cells and dendritic cells; and independent of apoptosis-mediated negative selection. These results indicate that the thymoproteasome hardwires the TCR repertoire of CD8+ T cells with cortical positive selection independent of negative selection in the thymus.
Auto-antibodies to type I IFNs can underlie adverse reactions to yellow fever live attenuated vaccine
Authors: Bastard Paul , Michailidis Eleftherios , Hoffmann Hans-Heinrich , Chbihi Marwa , Le Voyer Tom , Rosain Jérémie , Philippot Quentin , Seeleuthner Yoann , Gervais Adrian , Materna Marie , de Oliveira Patricia Mouta Nunes , Maia Maria de Lourdes S. , Dinis Ano Bom Ana Paula , Azamor Tamiris , Araújo da Conceição Deborah , Goudouris Ekaterini , Homma Akira , Slesak Günther , Schäfer Johannes , Pulendran Bali , Miller Joseph D. , Huits Ralph , Yang Rui , Rosen Lindsey B. , Bizien Lucy , Lorenzo Lazaro , Chrabieh Maya , Erazo Lucia V. , Rozenberg Flore , Jeljeli Mohamed Maxime , Béziat Vivien , Holland Steven M. , Cobat Aurélie , Notarangelo Luigi D. , Su Helen C. , Ahmed Rafi , Puel Anne , Zhang Shen-Ying , Abel Laurent , Seligman Stephen J. , Zhang Qian , MacDonald Margaret R. , Jouanguy Emmanuelle , Rice Charles M. , Casanova Jean-Laurent
Published: February 2021

Yellow fever virus (YFV) live attenuated vaccine can, in rare cases, cause life-threatening disease, typically in patients with no previous history of severe viral illness. Autosomal recessive (AR) complete IFNAR1 deficiency was reported in one 12-yr-old patient. Here, we studied seven other previously healthy patients aged 13 to 80 yr with unexplained life-threatening YFV vaccine–associated disease. One 13-yr-old patient had AR complete IFNAR2 deficiency. Three other patients vaccinated at the ages of 47, 57, and 64 yr had high titers of circulating auto-Abs against at least 14 of the 17 individual type I IFNs. These antibodies were recently shown to underlie at least 10% of cases of life-threatening COVID-19 pneumonia. The auto-Abs were neutralizing in vitro, blocking the protective effect of IFN-α2 against YFV vaccine strains. AR IFNAR1 or IFNAR2 deficiency and neutralizing auto-Abs against type I IFNs thus accounted for more than half the cases of life-threatening YFV vaccine-associated disease studied here. Previously healthy subjects could be tested for both predispositions before anti-YFV vaccination.