bluuebunny/crossref_metadata_2025 huggingface dataset:
Pneumocephalus and pneumorachis after blunt chest trauma without spinal fractures: a case report
Authors: Allard Etienne , Selim Jean , Veber Benoit
Published: October 2019

Background

Pneumocephalus and pneumorachis, presence of air inside the skull and spinal canal, are mostly seen after neurosurgical procedures and neuraxial anesthesia. They have also been described after penetrating trauma, but never after blunt trauma without adjacent bone fractures.

Case description

We present the case of an 85-year-old white male patient admitted to our intensive care unit after a high velocity car accident. On site clinical evaluation showed normal consciousness with 15/15 Glasgow Coma Scale after a short initial loss of consciousness. The patient was first sent to a nearby hospital where a whole-body computed tomography scan revealed pneumocephalus and pneumorachis and an important left hemopneumothorax with pneumomediastinum with extensive subcutaneous emphysema. The state of the patient quickly worsened with hemorrhagic shock. The patient was sent to our intensive care unit; upon neurosurgical evaluation, no surgical indication was retained due to the absence of skull and spine fracture.

A computed tomography scan performed on day 6 showed total regression of the pneumocephalus and pneumorachis. A follow-up computed tomography scan performed on day 30 revealed no intracranial bleeding or stroke, but a left pleural hernia between ribs 5 and 6. Due to respiratory complications, our patient could not be weaned from ventilator support for a proper neurological examination.

Our patient’s state finally worsened with septic shock due to ventilator-acquired pneumonia leading to multiple organ failure and our patient died on day 37.

Conclusions

This is the first case report to describe pneumorachis and pneumocephalus following blunt trauma with pneumothorax, but no spinal or skull fractures. The mechanism that is probably involved here is a migration of air with subcutaneous emphysema and a pleural hernia into the spinal canal. However, in cases of pneumorachis or pneumocephalus, skull fractures need to be investigated as these require surgery and appropriate vaccination to prevent meningitis.
Transmission of wireless backhaul signal in a cellular system with small moving cells
Authors: Kim Hyoung-Keon , Byun Yong-Suk , Jung Geon-Woong , Lee Yong-Hwan
Published: October 2019

Deployment of small moving cells (SMCs) has been considered in advanced cellular systems, where wireless backhaul links are required between base stations and SMCs. In this paper, we consider signal transmission by means of multiuser beamforming in the wireless backhaul link. We generate the beam weight in an eigen-direction of weighted combination of short- and long-term channel information of the backhaul link. The beam weight can maximize the average signal-to-leakage-plus-noise ratio (SLNR), while providing the transmission robust to SMC mobility. We analyze the performance of the proposed scheme in terms of the average signal-to-interference-plus-noise ratio (SINR) and optimize the transmit power by iterative water-filling. Finally, we verify the performance of the proposed scheme by computer simulation.
Some bounds for the Z-eigenpair of nonnegative tensors
Authors: Ma Xiaoyu , Song Yisheng
Published: October 2019

Tensor eigenvalue problem is one of important research topics in tensor theory. In this manuscript, we consider the properties of Z-eigenpair of irreducible nonnegative tensors. By estimating the ratio of the smallest and largest components of a positive Z-eigenvector for a nonnegative tensor, we present some bounds for the eigenvector and Z-spectral radius of an irreducible and weakly symmetric nonnegative tensor. The proposed bounds complement and extend some existing results. Finally, several examples are given to show that such a bound is different from one given in the literature.
On Anderson–Taylor type inequalities for τ-measurable operators
Authors: Shao Jingjing
Published: October 2019

The main purpose of this article is to establish Anderson–Taylor type inequalities for τ-measurable operators. Some related results for M-operators are also obtained.
A conservative numerical scheme for Rosenau-RLW equation based on multiple integral finite volume method
Authors: Guo Cui , Li Fang , Zhang Wenping , Luo Yuesheng
Published: October 2019

A multiple integral finite volume method combined and Lagrange interpolation are applied in this paper to the Rosenau-RLW (RRLW) equation. We construct a two-level implicit fully discrete scheme for the RRLW equation. The numerical scheme has the accuracy of third order in space and second order in time, respectively. The solvability and uniqueness of the numerical solution are shown. We verify that the numerical scheme keeps the original equation characteristic of energy conservation. It is proved that the numerical scheme is convergent in the order of $O(\tau ^{2} + h^{3})$
O
(

τ
2

+

h
3

)
and unconditionally stable. A numerical experiment is given to demonstrate the validity and accuracy of scheme.
From social adversity to sympathy for violent radicalization: the role of depression, religiosity and social support
Authors: Rousseau Cécile , Hassan Ghayda , Miconi Diana , Lecompte Vanessa , Mekki-Berrada Abdelwahed , El Hage Habib , Oulhote Youssef
Published: October 2019

Background

Discrepancies among studies suggest that the relation between social adversity and sympathy for violent radicalization (SVR) is multifaceted and may differ according to social context. This paper examines the role of depression, religiosity and social support in the relation between social adversity (i.e., discrimination and exposure to violence) and SVR among college students in Quebec, Canada.

Methods

A total of 1894 students responded to an online questionnaire posted on the internet of eight colleges. Multilevel analyses were first conducted to account for the clustered nature of the data, followed by mediation and moderation analyses.

Results

First generation migrants reported less SVR than second generation youth and non-immigrants. The mediating and/or moderating role of depression, religiosity and social support was examined through causal inference models. Depression mediated the relation between social adversity and SVR, with depression scores accounting for 47% and 25% of the total effect between discrimination and exposure to violence and SVR scores, respectively. Religiosity and social support moderated the association between social adversity and SVR.

Conclusions

These results suggest that prevention programs should consider violent radicalization as a systemic issue which involves both minorities and the majority, although the specific balance between risk and protective factors may be influenced by local dynamics. They also question intervention measures targeting specifically migrants or ethno-cultural communities because of the risk of increasing profiling and stigmatization. Prevention programs should prioritize decreasing discrimination in colleges, as well as the provision of psychosocial support to depressed youth who experience social adversity.
Correlation analysis of serum thyroid stimulating hormone with acute cerebrovascular disease
Authors: Zhu Jian , Chen Ming , Li Nan , Yang Shaoling , Xu Lu , Wang Yanru , Li Hong
Published: October 2019

Background

Acute cerebrovascular disease (ACVD) could cause abnormal metabolism of thyroid hormones (TH), mostly represented as a euthyroid sick syndrome or low T3 syndrome. However, the changes in serum thyroid-stimulating hormone (TSH) are controversial. The aim of this study is to investigate the clinical significance of TSH alteration in patients with ACVD.

Method

Patients with ACVD admitted in our hospitals between January 2013 and September 2017 were enrolled in this study (n = 245, including 176 cerebral infarctions and 69 cerebral hemorrhages). Their thyroid hormones were measured and compared with healthy individuals (n = 75). The correlation of TSH with severity and prognosis of ACVD were analyzed by receiver operating characteristic curve.

Results

Serum TSH in ACVD group was higher than the control group (1.64 ± 1.08 vs. 1.26 ± 0.36 μIU/mL, P < 0.05). The TSH levels in intermediate and severe patients with ACVD were higher than in mild patients (1.72 ± 1.18 vs. 2.71 ± 0.93 vs. 1.02 ± 0.47 μIU/mL, P < 0.05). Receiver Operating Characteristic curve (ROC) of TSH in determining the severity of patients were 0.863 (Area under the curve, AUC), 1.496 μIU/L (optimal threshold), 76.5% (sensitivity) and 87.3% (specificity). TSH levels in improved and unchanged groups were significantly higher than the primarily healing group (2.27 ± 1.11 vs. 2.88 ± 1.07 vs. 0.86 ± 0.46 μIU/mL, P < 0.05). ROC of TSH in determining the prognosis of patients was 0.910 (AUC), 1.681 mIU/L (optimal threshold), 79.8% (sensitivity) and 90.5% (specificity) correspondingly.

Conclusion

Since elevated TSH in ACVD patients affects the outcome of thyroid function evaluation, it is preferable to re-check after the acute period. A correlation between a high TSH level and the severity and prognosis of ACVD was detected, but the mechanism of this correlation needs to be further studied.
The efficacy and safety of combination of PD-1 and CTLA-4 inhibitors: a meta-analysis
Authors: Wu Kongju , Yi Ming , Qin Shuang , Chu Qian , Zheng Xinhua , Wu Kongming
Published: October 2019

Background

Recently, a series of clinical trials showed that combination of anti-programmed cell death-1 (α-PD-1) and anti-cytotoxic T-lymphocyte-associated protein 4 (α-CTLA-4) could effectively eliminate tumor. However, in comparison with widely adopted mono-immune checkpoint inhibitors, chemotherapy, and targeted therapy, the advantage of combination therapy of α-PD-1 and α-CTLA-4 in response rate and prognosis is controversial especially considering probably increased treatment related adverse event. Thus, we conducted this meta-analysis to explore the efficacy and safety of combination treatment of α-PD-1 and α-CTLA-4.

Methods

This meta-analysis involved 8 clinical trials. In most trials, the primary endpoint was objective response rate (ORR). Thus we calculated risk ratio (RR) and 95% confidence interval (CI) to compare ORR of patients undergoing different treatment strategies. Moreover, the co-primary endpoints in few trials included progression-free survival and overall survival. Hazard ratio (HR) with 95% CI were employed to weigh the influence of different treatments on prognosis of patients. Subgroup analysis was conducted in patients with high and low expression of PD-L1. Lastly, the safety of combination therapy was evaluated by comparing treatment related adverse events among various treatment groups.

Results

Our results showed that ORR was significantly higher in patients receiving α-PD-1 plus α-CTLA-4 compared with α-PD-1 (RR 1.31, 95% CI 1.16–1.48) or α-CTLA-4 monotherapy (RR 2.11, 95% CI 1.84–2.43), chemotherapy and targeted therapy (RR 1.41, 95% CI 1.26–1.58). α-PD-1 plus α-CTLA-4 treated patients had a great advantage on monotherapy, chemotherapy and targeted therapy treated patients in PFS. Notably, no significant alteration in total adverse event rate was observed in α-PD-1 plus α-CTLA-4 treated patients. Results of subgroup analysis showed that combination therapy could enhance anti-tumor response in comparison with other treatments, especially for low PD-L1 expression patients undergoing nivolumab treatment (ORR: RR 1.35, 95% CI 1.11–1.65).

Conclusion

Combination treatment of α-PD-1 and α-CTLA-4 is a feasible strategy with enhanced efficacy and acceptable adverse event. Moreover, for some low PD-L1 expression patients, α-CTLA-4 might decrease the risk of resistance to α-PD-1 and demonstrate the synergistic anti-tumor effect.
Synaptic localization of C9orf72 regulates post-synaptic glutamate receptor 1 levels
Authors: Xiao Shangxi , McKeever Paul M. , Lau Agnes , Robertson Janice
Published: October 2019

A hexanucleotide repeat expansion in a noncoding region of C9orf72 is the most common genetic cause of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). Reduction of select or total C9orf72 transcript and protein levels is observed in postmortem C9-ALS/FTD tissue, and loss of C9orf72 orthologues in zebrafish and C. elegans results in motor deficits. However, how the reduction in C9orf72 in ALS and FTD might contribute to the disease process remains poorly understood. It has been shown that C9orf72 interacts and forms a complex with SMCR8 and WDR41, acting as a guanine exchange factor for Rab GTPases. Given the known synaptosomal compartmentalization of C9orf72-interacting Rab GTPases, we hypothesized that C9orf72 localization to synaptosomes would be required for the regulation of Rab GTPases and receptor trafficking. This study combined synaptosomal and post-synaptic density preparations together with a knockout-confirmed monoclonal antibody for C9orf72 to assess the localization and role of C9orf72 in the synaptosomes of mouse forebrains. Here, we found C9orf72 to be localized to both the pre- and post-synaptic compartment, as confirmed by both post-synaptic immunoprecipitation and immunofluorescence labelling. In C9orf72 knockout (C9-KO) mice, we demonstrated that pre-synaptic Rab3a, Rab5, and Rab11 protein levels remained stable compared with wild-type littermates (C9-WT). Strikingly, post-synaptic preparations from C9-KO mouse forebrains demonstrated a complete loss of Smcr8 protein levels, together with a significant downregulation of Rab39b and a concomitant upregulation of GluR1 compared with C9-WT mice. We confirmed the localization of Rab39b downregulation and GluR1 upregulation to the dorsal hippocampus of C9-KO mice by immunofluorescence. These results indicate that C9orf72 is essential for the regulation of post-synaptic receptor levels, and implicates loss of C9orf72 in contributing to synaptic dysfunction and related excitotoxicity in ALS and FTD.
Eliminating medicine waste in a Finnish university hospital — a qualitative study
Authors: Peltoniemi Teijo , Suomi Reima
Published: October 2019

Background

Medicine waste in hospitals leads to severe economic loss. This waste emerges for a number of reasons. Medicines are often ordered in too large quantities, which leads to stock expiring without being dispensed. Wastage can also be a consequence of poor management practices. Technical aids, such as automatic dispensers, have been suggested to reduce waste, but they too have shortcomings. Information systems can arguably contribute to waste reduction, but this area has not been widely researched.

In this exploratory case study, we scrutinized the management of medicines waste in a hospital from an information systems perspective and examined how information systems are used to manage the medicine supply chain and medicine waste. Our research case was a Finnish university hospital, its central pharmacy, and, more widely, the medicine supply chain within the hospital.

Methods

This is a qualitative case study, based on data gathered through interviews and a survey and a review of other information sources, including annual reports and other relevant collateral. The study participants included pharmacy staff members and other hospital staff involved in medicine supply. The interviews were conducted in two rounds, first capturing the main themes and then exploring them further in the later study stages.

Results

The findings outline a picture of unfit technology and inconsistent and unreliable information. This is compensated for by manual practices and processes that cause an excessive administrative burden and ultimately increased wastage. An infrequent ordering process combined with the lack of recycling practices increase the wastage even more.

Conclusion

Medicine supply and waste management remain a manual administrative task. Inconsistent information and unfit information systems make this task challenging, and the process relies on the medicine supply staff’s experience and assumptions.
Nerves innervating copulatory organs show common FMRFamide, FVRIamide, MIP and serotonin immunoreactivity patterns across Dinophilidae (Annelida) indicating their conserved role in copulatory behaviour
Authors: Kerbl Alexandra , Winther Tolstrup Emilie , Worsaae Katrine
Published: October 2019

Background

Males of the microscopic annelid family Dinophilidae use their prominent glandomuscular copulatory organ (penis) to enzymatically dissolve the female’s epidermis and thereafter inject sperm. In order to test for putative conserved copulatory structures and neural orchestration across three dinophilid species, we reconstructed the reproductive myo- and neuroanatomy and mapped immunoreactivity patterns against two specific neurotransmitter markers with reported roles in invertebrate male mating behaviour (FVRIamide, MIP) and three general neural markers (acetylated α-tubulin, serotonin, FMRFamide).

Results

Seminal vesicles (one or two pairs), surrounded by a thin layer of longitudinal and circular muscles and innervated by neurites, are found between testes and copulatory organ in the larger males ofDinophilus vorticoidesandTrilobodrilus axi, but are missing in the only 0.05 mm longD. gyrociliatusdwarf males. The midventral copulatory organ is in all species composed of an outer muscular penis sheath and an inner penis cone. Neurites encircle the organ equatorially, either as a ring-shaped circumpenial fibre mass or as dorsal and ventral commissures, which are connected to the ventrolateral nerve cords. All three examined dinophilids show similar immunoreactivity patterns against serotonin, FMRFamide, and FVRIamide in the neurons surrounding the penis, supporting the hypotheses about the general involvement of these neurotransmitters in copulatory behaviour in dinophilids. Immunoreactivity against MIP is restricted to the circumpenial fibre mass inD. gyrociliatusand commissures around the penis inT. axi(but not found inD. vorticoides), indicating its role in controlling the copulatory organ.

Conclusions

The overall myo- and neuroanatomy of the reproductive organs is rather similar in the three studied species, suggesting a common ancestry of the unpaired glandomuscular copulatory organ and its innervation in Dinophilidae. This is furthermore supported by the similar immunoreactivity patterns against the tested neurotransmitters around the penis. Smaller differences in the immunoreactivity patterns around the seminal vesicles and spermioducts might account for additional, individual traits. We thus show morphological support for the putatively conserved role of FMRFamide, FVRIamide, MIP and serotonin in dinophilid copulatory behaviour.
Commentary on Interest-Driven Creator theory: a US perspective on fostering interest, creativity, and habit in school
Authors: Roschelle Jeremy , Burke Quinn
Published: October 2019

In this commentary on Interest-Driven Creator (IDC) theory, the authors reflect on the proposed three-step cycles of (i) sparking students’ interest, (ii) fostering individual creativity, and (iii) inculcating lifelong learning habits. Each component of IDC theory pulls together a wide span of prior research and emphasizes active roles for students. Although the context of IDC as a prototype for educational reform is K-12 Asian classrooms, we note that some US schools are also mired in a focus on test scores. This is especially true among the US most struggling, low-income schools, where a lack of electives and afterschool programs correspond to diminished student perceptions about their own autonomy as learners and their future creative potential. Thus, while IDC is an important provocation for curricular reform in Asia, there is also the need to broaden its scope and begin to explore the potential of IDC as a leadership tool beyond Asia. The wider learning sciences community, the commentary concludes, is uniquely suited to support such an extension, and there are many opportunities for productive international collaboration.
An isolated beating pig heart platform for a comprehensive evaluation of intracardiac blood flow with 4D flow MRI: a feasibility study
Authors: Peper Eva S. , Leopaldi Alberto M. , van Tuijl Sjoerd , Coolen Bram F. , Strijkers Gustav J. , Baan Jan , Planken R. Nils , de Weger Arend , Nederveen Aart J. , Marquering Henk A. , van Ooij Pim
Published: October 2019

Background

Cardiac magnetic resonance imaging (MRI) in large animals is cumbersome for various reasons, including ethical considerations, costs of housing and maintenance, and need for anaesthesia. Our primary purpose was to show the feasibility of an isolated beating pig heart model for four-dimensional (4D) flow MRI for investigating intracardiac blood flow patterns and flow parameters using slaughterhouse side products. In addition, the feasibility of evaluating transcatheter aortic valve replacement (TAVR) in the model was investigated.

Methods

Seven slaughterhouse pig hearts were installed in the MRI-compatible isolated beating pig heart platform. First, Langendorff perfusion mode was established; then, the system switched to working mode, in which blood was actively pumped by the left ventricle. A pacemaker ensured a stable HR during 3-T MRI scanning. All hearts were submitted to human physiological conditions of cardiac output and stayed vital for several hours. Aortic flow was measured from which stroke volume, cardiac output, and regurgitation fraction were calculated.

Results

4D flow MRI acquisitions were successfully conducted in all hearts. Stroke volume was 31 ± 6 mL (mean ± standard deviation), cardiac output 3.3 ± 0.9 L/min, and regurgitation fraction 16% ± 9%. With 4D flow, intracardiac and coronary flow patterns could be visualised in all hearts. In addition, we could study valve function and regurgitation in two hearts after TAVR.

Conclusions

The feasibility of 4D flow MRI in an isolated beating pig heart loaded to physiological conditions was demonstrated. The platform is promising for preclinical assessment of cardiac blood flow and function.
Association of Genetic Variants Related to Serum Calcium Levels with Reduced Bone Mineral Density
Authors: Li Gloria Hoi-Yee , Robinson-Cohen Cassianne , Sahni Shivani , Au Philip Chun-Ming , Tan Kathryn Choon-Beng , Kung Annie Wai-Chee , Cheung Ching-Lung
Published: October 2019

Context

The role of serum calcium in bone metabolism is unknown, even though calcium/vitamin D supplementations have been widely used and are expected to improve bone health. We aim to determine the independent role of serum calcium in bone mineral density (BMD).

Design and setting

Two epidemiological analyses with 5478 and 5556 participants from the National Health and Nutrition Examination Survey (NHANES) 2003 to 2006 and the Hong Kong Osteoporosis Study (HKOS) to evaluate the cross-sectional association of serum calcium with BMD. Two-sample Mendelian randomization (MR) studies using genetic variations as instrumental variables to infer causality. Summary statistics of genome-wide association study of serum calcium (N = 39 400) and lifelong whole-body BMD (N = 66 628) were used.

Main outcome measure

BMD measured by dual-energy X-ray absorptiometry

Results

In NHANES 2003–6 and HKOS, each standard deviation (SD) increase in serum calcium was significantly associated with 0.036–0.092 SD decrease in BMD at various sites (all P < .05). In multivariable inverse-variance weighted MR analysis, genetic predisposition to higher serum calcium level was inversely associated with whole-body BMD after adjustment for serum parathyroid hormone, vitamin D, and phosphate (–0.431 SD per SD increase in serum calcium; 95% CI: –0.773 to –0.089, P = .014). Similar estimates were obtained in sensitivity analyses.

Conclusions

Our study reveals that genetic predisposition to higher serum calcium level per se may have a negative impact on bone metabolism. Whether increased serum calcium caused by calcium/vitamin D supplementations would have the same negative effect on bone remains unknown, which warrants further investigation. In addition to other adverse clinical outcomes, careful use of high-dose supplementations is required.
Active Surveillance in Papillary Thyroid Microcarcinomas is Feasible and Safe: Experience at a Single Italian Center
Authors: Molinaro Eleonora , Campopiano Maria Cristina , Pieruzzi Letizia , Matrone Antonio , Agate Laura , Bottici Valeria , Viola David , Cappagli Virginia , Valerio Laura , Giani Carlotta , Puleo Luciana , Lorusso Loredana , Piaggi Paolo , Torregrossa Liborio , Basolo Fulvio , Vitti Paolo , Tuttle R Michael , Elisei Rossella
Published: October 2019

Context

The dramatic rise in the incidence of thyroid cancer over the last 30 years is largely attributable to the increasing diagnosis of papillary microcarcinomas (mPTCs). Current guidelines endorse an observational management approach in properly selected cases.

Objective

To evaluate the feasibility of active surveillance in mPTC in Italy, its impact on real life, and to identify risk factors of progression.

Design and setting

In 2014 we started a prospective–observational study of active surveillance in mPTC patients.

Patients

Included patients demonstrated a single Thy4 or Thy5 thyroid nodule, with largest diameter ≤1.3 cm, and no suspicious laterocervical lymph nodes by neck ultrasonography. Of 185 eligible subjects, 50.3% (93/185) enrolled in the observational management protocol while the others opted for surgery and were excluded from this analysis.

Intervention

Enrolled patients were followed with neck ultrasound at 6- to 12-month intervals. Disease progression was defined as the appearance of abnormal lymph nodes or nodule enlargement during follow-up. In these cases, patients were directed to surgery.

Results

Three patients (3/93, 3%) showed clinical progression and required surgery. Another 19 patients (19/93, 20%) decided to transition to surgical intervention even though there was no evidence of disease progression. All operated patients had excellent response to initial treatment despite the delayed surgery.

Conclusions

Within an Italian medical context, active surveillance appears to be a feasible and safe alternative to immediate surgery in healthy mPTC patients. Only 3% of mPTC demonstrated disease progression during a median follow-up of 19 months (range 6–54) and importantly demonstrated excellent outcomes after surgical intervention in a short-term follow-up.
Assessment of Fluid Responsiveness in Prone Neurosurgical Patients Undergoing Protective Ventilation: Role of Dynamic Indices, Tidal Volume Challenge, and End-Expiratory Occlusion Test
Authors: Messina Antonio , Montagnini Claudia , Cammarota Gianmaria , Giuliani Fabiana , Muratore Lara , Baggiani Marta , Bennett Victoria , Della Corte Francesco , Navalesi Paolo , Cecconi Maurizio
Published: October 2019

BACKGROUND:

In patients in the prone position, the reliability of pulse pressure variation and stroke volume variation (PPV and SVV) and the use of functional hemodynamic tests to predict fluid responsiveness have not previously been established. Perioperatively, in this setting, optimizing fluid management can be challenging, and fluid overload is associated with both intraoperative and postoperative complications. We designed this study to assess the sensitivity and specificity of baseline PPV and SVV, the tidal volume (VT) challenge (VTC) and the end-expiratory occlusion test (EEOT) in predicting fluid responsiveness during elective spinal surgery.

METHODS:

The study protocol was started during a period of intraoperative hemodynamic stability after prone positioning and before the administration of any vasopressor: (1) at baseline, the controlled ventilation was set at 6 mL/kg of predicted body weight (PBW) (T
0); (2) patients underwent the first EEOT (EEOT6) by interrupting the mechanical ventilation for 30 seconds; (3) the ventilation was set again at 6 mL/kg PBW for 1 minute (T
1); (4) the VTC was applied by increasing the VT up to 8 mL/kg PBW for 1 minute; (5) the ventilation was kept at 8 mL/kg PBW for 1 minute (T
2); (6) a second EEOT (EEOT8) was performed; (7) the VT was reduced back to 6 mL/kg PBW for 1 minute (T
3); (8) a fluid challenge of 250 mL of Ringer’s solution was infused over 10 minutes. After each step, a complete set of hemodynamic measurements was recorded.

RESULTS:

Neither PPV and SVV values recorded at T
3 nor the EEOT6 or the EEOT8 predicted fluid responsiveness. The change in PPV after VTC application predicted fluid responsiveness with an area under the curve of 0.96 (95% confidence interval, 0.87–1.00), showing a sensitivity of 95.2% and a specificity of 94.7%, using a cutoff increase of 12.2%. The change in SVV after VTC application predicted fluid responsiveness with an area under the curve 0.96 (95% confidence interval, 0.89–1.00) showing a sensitivity of 95.2% and a specificity of 94.7%, using a cutoff increase of 8.0%. A linear correlation between stroke volume index changes after fluid challenge administration and the changes in PPV and SVV after VTC application was observed (r = 0.71; P < .0001 and r = 0.68; P < .0001, respectively).

CONCLUSIONS:

In prone elective neurosurgical patients, the baseline values of PPV and SVV and the EEOT fail to predict fluid responsiveness, while the VTC is a very reliable functional hemodynamic test and could be helpful in guiding intraoperative fluid therapy.
Antitrans State Terrorism
Authors: Hiner Hillary , Garrido Juan Carlos , Walters Brigette
Published: October 2019

This article analyzes the ways in which trans and travesti women experienced state terrorism during the Chilean military dictatorship (1973–90), a subject that has received little attention in memory and recent history studies in Chile. In particular, the authors propose that the use of the concept of human rights by truth commissions, as well as its inclusion in public policies, has largely excluded trans and travesti women. This text therefore introduces the concept of antitrans state terrorism and, given the limited studies that exist on the subject, encourages more historiographic research of state terrorism and trans and travesti women in Chile.
IL-15Rα membrane anchorage in either cis or trans is required for stabilization of IL-15 and optimal signaling
Authors: Quéméner Agnès , Morisseau Sébastien , Sousa Rui P. , Trillet Kilian , Maillasson Mike , Leray Isabelle , Jacques Yannick , Dion Johann , Barbieux Isabelle , Frutoso Marie , Laurent Adèle D. , Le Questel Jean-Yves , Mortier Erwan
Published: October 2019

Interleukin (IL)-15 plays an important role in the communication between immune cells. It delivers its signal through different modes involving three receptor chains: IL-15Rα, IL-2Rβ and IL-2Rγc. The combination of the different chains result in the formation of IL-15Rα/IL-2Rβ/γc trimeric or IL-2Rβ/γc dimeric receptors. In this study, we have investigated the role of the IL-15Rα chain in stabilizing the cytokine in the IL-2Rβ/γc dimeric receptor. By analyzing the key amino acid residues of IL-15 facing IL-2Rβ, we provide evidence of differential interfaces in the presence or in the absence of membrane-anchored IL-15Rα. Moreover, we found that the anchorage of IL-15Rα to the cell surface regardless its mode of presentation – i.e. cis or trans – is crucial for complete signaling. These observations show how the cells can finely modulate the intensity of cytokine signaling through the quality and the level of expression of the receptor chains.
WORLDWIDE SURVEY OF FITNESS TRENDS FOR 2020
Authors: Thompson Walter R.
Published: October 2019

Apply It!

From this article, the reader should understand the following concepts:

• Articulate the differences between a fad and a trend

• Use the worldwide trends in commercial, corporate, clinical (including medical fitness), and community health fitness industry to further promote physical activity

• Study expert opinions about identified fitness trends for 2020
Increasing Students’ Activity in Physical Education: Results of the Self-determined Exercise and Learning For FITness Trial
Authors: HA AMY S. , LONSDALE CHRIS , LUBANS DAVID R. , NG JOHAN Y. Y.
Published: October 2019

Purpose

To examine the effects of the Self-determined Exercise and Learning For FITness (SELF-FIT) intervention on students’ moderate-to-vigorous physical activity (MVPA) and motivation in physical education (PE).

Methods

In a clustered randomized controlled trial, 667 students (mean age, 14.4 yr; SD, 0.78) from 26 schools (i.e., clusters) were randomized into either an experimental group or a waitlist control group. Students in the experimental group received the SELF-FIT intervention, a school-based intervention designed to infuse fitness and game-like elements into PE using self-determination theory principles, whereas those in the control continued their classes using usual practices. Intervention content was provided by teachers who received training from the research team. The primary outcome was percentage of time spent in MVPA during PE. Secondary outcomes included basic psychological need satisfaction, motivation toward PE, leisure-time MVPA, and mental well-being. Data were analyzed using multilevel regression analyses and prespecified interactions were tested (i.e., group–time–sex).

Results

Positive intervention effects were found on MVPA during PE (B, 4.00; 95% confidence interval, 2.96–5.04; d = 0.36). Regarding the participants’ competence and autonomy need satisfaction, and autonomous motivation, the intervention effects were stronger in girls, compared with boys.

Conclusions

Fitness infusion and game-like elements, used according to self-determination theory principles, can enhance students’ physical activity and motivation toward PE. This low-cost intervention has the potential to be scaled up and disseminated in secondary schools.
Exertional Rhabdomyolysis: A Retrospective Population-based Study
Authors: LUETMER MARIANNE T. , BOETTCHER BRENNAN J. , FRANCO JOHN M. , REISNER JACOB H. , CHEVILLE ANDREA L. , FINNOFF JONATHAN T.
Published: October 2019

Purpose

This study aimed to evaluate the incidence and characteristics of exertional rhabdomyolysis (ER) in a population-based cohort.

Methods

A retrospective cohort study was performed in Olmsted County, Minnesota, from 2003 to 2015. Incident ER cases were ascertained through the Rochester Epidemiology Project medical record linkage system through electronic searches of the International Classification of Diseases, Ninth Revision, codes and clinical note text. Population incidence rate was calculated using the corresponding Rochester Epidemiology Project census populations specific to calendar year and sex. Descriptive statistics were used.

Results

Of the 430 patients, 431 cases met the inclusion criteria for rhabdomyolysis; 4.9% of cases (n = 20; males n = 18; Caucasian n = 17) were ER, with one recurrence. There were no deaths secondary to ER. The age- and sex-adjusted incidence rate of ER was 1.06 ± 0.24 (95% confidence interval = 0.59–1.52) per 100,000 person-years. Endurance activity (n = 7), manual labor (n = 5), and weight lifting (n = 4) were common causes. Complications included kidney injury (n = 5), mild electrolyte abnormalities (n = 10), elevated transaminases (n = 12), and minor electrocardiographic abnormalities (n = 4). A majority of patients were hospitalized (n = 16) for a median of 2 d, had mild abnormalities in renal and liver function and electrolytes, and were discharged without sequelae.

Conclusion

ER in the civilian population occurs at a much lower incidence than the military population. The most common causes were endurance exercise, manual labor, and weight lifting. The majority of cases were treated conservatively with intravenous fluid resuscitation during a brief hospital stay, and all were discharged without sequela. Only one case of recurrence occurred in this cohort, indicating the recurrence rate was low.
Early clinical results of proton spatially fractionated GRID radiation therapy (SFGRT)
Authors: Mohiuddin Majid , Lynch Connor , Gao Mingcheng , Hartsell William
Published: October 2019

Objective:

Approximately 70 patients with large and bulky tumors refractory to prior treatments were treated with photon spatially fractionated GRID radiation (SFGRT). We identified 10 additional patients who clinically needed GRID but could not be treated with photons due to adjacent critical organs. We developed a proton SFGRT technique, and we report treatment of these 10 patients.

Methods:

Subject data were reviewed for clinical results and dosimetric data. 50% of the patients were metastatic at the time of treatment and five had previous photon radiation to the local site but not via GRID. They were treated with 15–20 cobalt Gray equivalent using a single proton GRID field with an average beamlet count of 22.6 (range 7–51). 80% received an average adjuvant radiation dose to the GRID region of 40.8Gy (range 13.7–63.8Gy). Four received subsequent systemic therapy.

Results:

The median follow-up time was 5.9 months (1.1–18.9). At last follow-up, seven patients were alive and three had died. Two patients who had died from metastatic disease had local shrinkage of tumor. Of those alive, four had complete or partial response, two had partial response but later progressed, and one had no response. For all patients, the tumor regression/local symptom improvement rate was 80%. 50% had acute side-effects of grade1/2 only and all were well-tolerated.

Conclusion:

In circumstances where patients cannot receive photon GRID, proton SFGRT is clinically feasible and effective, with a similar side-effect profile.

Advances in knowledge:

Proton GRID should be considered as a treatment option earlier in the disease course for patients who cannot be treated by photon GRID.
Clinico-pathology of newly diagnosed breast cancer with expression of ER, PR, and HER/2neu in cell blocks: An observational prospective study
Authors: Albaldawy Mazin Judy Ibrahim , Mubark Ahmed Abdulshahed
Published: October 2019

Background: Breast cancer is a worldwide problem, and early positive diagnosis is critical for establishing the optimal therapeutic strategy. Following a preliminary diagnosis, fine-needle aspirate cytology (FNAC) may be used to obtain cells for immunohistochemical (IHC) analysis and histopathological examination. This study aimed to assess the FNAC method combined with embedding samples in paraffin blocks (cell blocks) and comparing this with core biopsies (tissue blocks).

Methods: This observational, prospective study was performed at our hospital and involved 50 female participants who presented with breast masses and were subsequently evaluated for high-risk status by FNAC and IHC. Tests for estrogen receptor (ER), progesterone receptor (PR), and human EGF receptor 2 (HER2/neu) were performed and the sensitivity, specificity, and discrepancy rates between methodologies were calculated using correlation analysis and agreement tests.

Results: The correlation analysis between immuno-staining of sections from cell blocks and histopathological examination of sections from tumor-tissue blocks revealed a high concordance for HR and HER2/neu.

Conclusion: IHC of cell-block sections was found to be better for the determination of HR status and HER2/neu levels. It is very important to obtain high-quality cell blocks with strict quality control for their clarification.
Effect of organic manure fertilizer on the growth of Macaranga gigantea
Authors: Susanto Dwi , AULIANA  , RATNA KUSUMA  , RUDIANTO AMIRTA
Published: October 2019

Abstract. Susanto D, Auliana, Kusuma R, Amirta R. 2019. Effect of organic manure fertilizer on the growth of Macaranga gigantea. Nusantara Bioscience 11: 166-171. M. gigantea planting research has been conducted in several habitats such as natural forest gaps, drained peatland and soil with highly degraded land for rehabilitation. This study investigated the effect of organic manure fertilization on soil, tissue chemical properties and growth performance of Macaranga gigantea planted at dense space of 2,5 m x 2,5 m. The experiment used a randomized block design with treatment of fertilization using goat manure with five gradual concentrations namely P0 (0 g), P1 (100 g), P2 (200 g), P3 (300 g) and P4 (400 g) in which each treatment consisted of three groups with 20 replications for each group, totaling 300 seedlings observed. The results showed that organic manure fertilization promoted stem height, stem diameter, leaf number and nutrient concentrations in the leaves of four-month-old M. gigantea. The best growth performance was gained from the treatment of P3 (300 g), followed by P2, P1, P4, and P0. The highest nutrient contained in leave tissue was potassium, followed by calcium, magnesium, nitrogen and available phosphorus.
Ist Angst ein guter Ratgeber?
Authors: Heblich Stephan
Published: October 2019

Eine transparente Kosten-Nutzen-Rechnung kann dazu beitragen, die Unsicherheit über zukünftige Entwicklungen zu reduzieren und gleichzeitig bietet sie auch einen Richtwert für mögliche Kompensationszahlungen and Eigentümer.
La teoría de la carta familiar (siglos XVI-XIX)
Authors: Antón Pelayo Javier
Published: October 2019

Aunque la carta familiar ha estado sometida a pocas reglas, desde la Antigüedad los preceptistas y los epistológrafos no han podido evitar recomendar algunas normas que han contribuido a definir su naturaleza. Este artículo realiza un recorrido histórico de la consideración teórica que ha tenido la carta familiar hasta mediados del siglo XIX y analiza los elementos característicos que la han singularizado: los corresponsales, las temáticas, el estilo y la forma.
El puerto de Alicante y el control del contrabando en tiempos de Antonio Leguey, comandante de su Resguardo entre 1793 y 1799
Authors: Leguey Jiménez Santiago
Published: October 2019

De siempre el contrabando ha constituido una de las lacras que más ha afectado negativamente a la Hacienda Pública. En el Antiguo Régimen, los resguardos, encargados de la persecución del comercio ilícito, percibían, junto a otros funcionarios administrativos y judiciales, una parte de sus comisos, lo que generaba frecuentes enfrentamientos de competencias y por la distribución de sus repartos.Con ese trasfondo, el artículo pretende documentar las disidencias que afloran en el seno de la Junta Provincial de Alicante cuando, en 1793, se incorpora a ella el comandante del Resguardo don Antonio Leguey, antiguo guardia de Corps, que desde el primer momento exige un estricto cumplimiento del reglamento, lo que de inmediato le genera desavenencias con los personajes menos escrupulosos en su ejecución, iniciándose, a partir de ahí, un forcejeo que, con acusaciones y denuncias de por medio, degradaron la convivencia y el servicio.El enrarecido ambiente, plagado de incidencias e intrigas, es extrapolable, con sus matices propios, a cualquier otra parte del territorio nacional, finalizando el caso que nos ocupa a lo largo de 1799 con el fallecimiento de algunos de sus implicados, la jubilación del comandante por orden de S.M. de 8 de marzo, y la remoción de los cargos de la Renta del Tabaco al entrar en vigor una nueva modalidad en la administración de las rentas reales por R.D. de 25 de septiembre.
Ammonia Levels Do Not Guide Clinical Management of Patients With Hepatic Encephalopathy Caused by Cirrhosis
Authors: Haj Mona , Rockey Don C.
Published: October 2019

Introduction:

Ammonia appears to play a major role in the pathophysiology of hepatic encephalopathy (HE), but its role in guiding management is unclear. We aimed to understand the impact of ammonia levels on inpatient HE management, hypothesizing that patients with elevated ammonia levels would receive more aggressive lactulose therapy than patients with normal ammonia or no ammonia level drawn.

METHODS:

We examined patients with cirrhosis older than 18 years admitted for management of HE from 2005 to 2015. We additionally used propensity matching to control for confounding by the severity of underlying disease. Patients with an ammonia level taken at time of HE diagnosis were further separated into those with normal or elevated ammonia levels. The primary endpoint was the total lactulose (mL) amount (or dose) given in the first 48 hours of HE management.

RESULTS:

One thousand two hundred two admissions with HE were identified. Ammonia levels were drawn in 551 (46%) patients; 328 patients (60%) had an abnormal ammonia level (>72 μmol/L). There were no significant differences in the Child-Pugh score, MELD, or Charlson Comorbidity Index in those with and without ammonia levels drawn. The average total lactulose dose over 48 hours was 167 and 171 mL in the no ammonia vs ammonia groups, respectively (P = 0.42). The average lactulose dose in patients with an elevated ammonia level was 161 mL, identical to the lactulose dose in patients with a normal ammonia level. There was no correlation between lactulose dose and ammonia level (R
2 = 0.0026).

DISCUSSION:

Inpatient management of HE with lactulose was not influenced by either the presence or level of ammonia level, suggesting that ammonia levels do not guide therapy in clinical practice.
Increasing Burden of Acute-On-Chronic Liver Failure Among Alcohol-Associated Liver Disease in the Young Population in the United States
Authors: Singal Ashwani K. , Arora Sumant , Wong Robert J. , Satapathy Sanjaya K. , Shah Vijay H. , Kuo Yong-Fang , Kamath Patrick S.
Published: October 2019

OBJECTIVES:

Alcohol-associated liver disease is increasing, especially hospitalizations with acute on chronic liver failure and need for liver transplant. We examined trends in prevalence, inhospital mortality, and resource utilization associated with AALD and ACLF in the young.

METHODS:

The National Inpatient Sample (2006–2014) was queried for hospitalizations with a discharge diagnosis of cirrhosis using the International Classification of Diseases, Ninth Edition, codes. ACLF hospitalization was defined as ≥2 organ failures and stratified by age: young (≤35 years) and older (>35 years).

RESULTS:

Of 447,090 AALD admissions (16,126 in young) between 2006 and 2014, ACLF occurred in 29,599 (6.6%), of which 1,143 (7.1%) were in young. Compared with older, admissions in young had more women (35% vs 29%), were obese (11% vs 7.6%), were Hispanics (29% vs 18%), have alcoholic hepatitis (AH) (41% vs 17%), and have ACLF grades 2 or 3 (34% vs 25%), P < 0.001 for all. Between 2006 and 2014, ACLF in AALD among young increased from 2.8% to 5.2%, with an AH proportion from 24% to 42%, P < 0.0001 for both. Young had more complications requiring ventilation (79% vs 76%) and dialysis (32% vs 28%), P < 0.001 for both. Compared with older, ACLF admission in young had longer hospitalization (12 vs 10 days) with higher hospital charges ($127,915 vs $97,511), P < 0.0001 for both, with 20% reduced inhospital mortality (54%–45%), P < 0.001.

DISCUSSION:

AALD-related hospitalizations are increasing in young in the United States, mainly because of the increasing frequency of AH. Furthermore, this disease burden in young is increasing with a higher frequency of admissions with more severe ACLF and consumption of hospital resources. Studies are needed to develop preventive strategies to reduce burden related to AALD and ACLF in young.
Colonic Polypoid Arteriovenous Malformation Causing Symptomatic Anemia
Authors: Rzepczynski Allison , Kramer Jason , Jakate Shriram , Cheng Lin , Singh Ajaypal
Published: October 2019

Vascular ectasias, which can be classified as angiodysplasias and arteriovenous malformations (AVMs), accounts for approximately 3% of lower gastrointestinal bleeding. Typically, colonic AVMs are solitary, large, and flat or elevated red lesions on endoscopy. We present an interesting case of a polypoid ulcerated AVM in the transverse colon causing symptomatic anemia, which was resected endoscopically with a resolution of symptoms. Polypoid colonic AVMs are rather rare with only 15 other cases described in the literature. This case highlights the approach to endoscopic management of these lesions.