bluuebunny/crossref_metadata_2025 huggingface dataset:
A parallel‐plate waveguide antenna radiating through a perfectly conducting wedge
Authors: Tsalamengas John L. , Vardiambasis Ioannis O.
Published: March 2021

Parallel‐plate waveguide antennas hosted in an electrically perfectly conducting wedge are studied. The analysis relies on an exact singular integral equation formulation. Asymptotic extraction techniques are employed to recast the kernel functions as the sum of two terms: one singular in closed form and another having the form of either a rapidly converging eigenfunctions expansion or a computationally efficient diffraction integral. The obtained integral equation is discretised in the framework of the Nystrom method using rapidly converging quadratures that take into account both the singularities of the kernels and the geometrical singularities at the edges. Numerical examples and case studies demonstrate the high accuracy and efficiency of the proposed algorithms. The analysis covers the canonical problem of a parallel‐plate waveguide antenna backed on a perfectly conducting wedge as a special case.
Automatic pulse repetition pattern reconstruction of conventional radars
Authors: Liu Zhang‐Meng , Kang Shi‐Qian , Chai Xian‐Ming
Published: March 2021

Signals of radars with fixed, stagger and other conventional pulse repetition intervals (PRI) occupy a large proportion in most radar reconnaissance datasets. Automatic and accurate reconstruction of the PRI patterns of these radars is an important task in realizing intelligent processing of radar reconnaissance data. In order to address this problem, this article proposes an automatic method based on the extraction and extension of frequent differential time‐of‐arrival (DTOA) items, which can be combined with other pulse parameters such as pulse width. The values and ordering of the frequent items are determined to reconstruct a complete PRI cycle, and the radar pulses are deinterleaved at the same time as a by‐product. Compared with the commonly used one‐dimensional radar reconnaissance parameters such as framework PRI or typical PRI set, the reconstructed PRI pattern contains more information about radar operational modes and can be applied to realize online and parallel pulse deinterleaving and more accurate radar type classification.
Postoperative Dissoziation nach Totalem Kniegelenkersatz und ihr Einfluss auf den Schmerzverlauf
Authors: Frenzel Lydia , Vogel Matthias , Riediger Christian , Frommer Jörg , Lohmann Christoph , Illiger Sebastian
Published: March 2021

Ziel der Studie Trotz erfolgreicher Operation klagt ungefähr jeder Fünfte Patient nach einem Kniegelenkersatz fortwährend über chronische Schmerzen. Vorangegangene Studien diskutieren in diesem Zusammenhang, dass operative Eingriffe bei einigen Patienten postoperativen traumatischen Stress auslösen. In dieser explorativen Untersuchung soll festgestellt werden, ob nach Totalem Kniegelenkersatz postoperative Dissoziation als Ausdruck von postoperativen traumatischem Stress (neu)auftritt. Außerdem soll untersucht werden, ob diese Patienten nach einem Jahr häufiger chronische postoperative Schmerzen aufweisen und inwiefern sich der Schmerzverlauf zu den anderen Patienten unterscheidet.

Methodik Es wurden 201 Patienten untersucht, die eine primäre Knie-TEP erhielten. Sie beantworteten zu 3 Messzeitpunkten u. a. Fragebögen zu Knie-Schmerzen (WOMAC) und zur Feststellung von Dissoziation (FDS-20): 1 Tag präoperativ (T1), 10 Wochen postoperativ (T2) und 1 Jahr postoperativ (T3).

Ergebnisse In die Analysen wurden 145 Patienten eingeschlossen. Die Inzidenz von postoperativer Dissoziation beträgt 8,3%. Dabei berichten die Patienten mit postoperativer Dissoziation nicht nur häufiger über chronische postoperative Schmerzen nach einem Jahr (p=0,016), sondern der Schmerz reduziert sich postoperativ auch in einem geringerem Maß als bei den Patienten ohne postoperative Dissoziation (p=0,025).

Diskussion Die Befunde liefern Indizien dafür, dass postoperative Dissoziation als Ausdruck von postoperativem traumatischen Stress nach Totalem Kniegelenkersatz neuauftritt. Auch wenn Dissoziation kurzfristig ein Abwehrmechanismus zur Regulation von unerträglichen Affekten zu sein scheint, geht sie langfristig mit mehr chronischen postoperativen Schmerzen einher. Die Patienten mit postoperativer Dissoziation profitieren darüber hinaus weniger in einem 1-jährigen follow up von einem Totalem Kniegelenkersatz hinsichtlich der Schmerzreduktion.

Schlussfolgerung Strategien zur Verringerung der Dissoziation könnten zu stärkerer Schmerzreduktion nach Knie-TEP Implementierung führen und sollten in zukünftigen Interventionsstudien untersucht werden.
Lung Cancer Screening: Evidence, Risks, and Opportunities for Implementation
Authors: Tringali Giulia , Milanese Gianluca , Ledda Roberta Eufrasia , Pastorino Ugo , Sverzellati Nicola , Silva Mario
Published: March 2021

Background Lung cancer is the most common cause of cancer death worldwide. Several trials with different screening approaches have recognized the role of lung cancer screening with low-dose CT for reducing lung cancer mortality. The efficacy of lung cancer screening depends on many factors and implementation is still pending in most European countries.

Methods This review aims to portray current evidence on lung cancer screening with a focus on the potential for opportunities for implementation strategies. Pillars of lung cancer screening practice will be discussed according to the most updated literature (PubMed search until November 16, 2020).

Results and Conclusion The NELSON trial showed reduction of lung cancer mortality, thus confirming previous results of independent European studies, notably by volume of lung nodules. Heterogeneity in patient recruitment could influence screening efficacy, hence the importance of risk models and community-based screening. Recruitment strategies develop and adapt continuously to address the specific needs of the heterogeneous population of potential participants, the most updated evidence comes from the UK. The future of lung cancer screening is a tailored approach with personalized continuous stratification of risk, aimed at reducing costs and risks.

Key Points: 

Citation Format
Accuracy of Chest CT for Differentiating COVID-19 from COVID-19 Mimics
Authors: Sähn Marwin-Jonathan , Yüksel Can , Keil Sebastian , Zeisberger Marcel P. , Post Manuel , Kleines Michael , Brokmann Jörg Christian , Hübel Christian , Kuhl Christiane K. , Isfort Peter , Schulze-Hagen Maximilian Franz
Published: March 2021

Purpose To determine the performance of radiologists with different levels of expertise regarding the differentiation of COVID-19 from other atypical pneumonias. Chest CT to identify patients suffering from COVID-19 has been reported to be limited by its low specificity for distinguishing COVID-19 from other atypical pneumonias (“COVID-19 mimics”). Meanwhile, the understanding of the morphologic patterns of COVID-19 has improved and they appear to be fairly specific.

Materials and Methods Between 02/2020 and 04/2020, 60 patients with COVID-19 pneumonia underwent chest CT in our department. Cases were matched with a comparable control group of 60 patients of similar age, sex, and comorbidities, who underwent chest CT prior to 01/2020 for atypical pneumonia caused by other pathogens. Included were other viral, fungal, and bacterial pathogens. All 120 cases were blinded to patient history and were reviewed independently by two radiologists and two radiology residents. Readers rated the probability of COVID-19 pneumonia according to the COV-RADS classification system. Results were analyzed using Clopper-Pearson 95 % confidence intervals, Youden’s Index for test quality criteria, and Fleiss‘ kappa statistics.

Results Overall, readers were able to correctly identify the presence of COVID-19 pneumonia in 219/240 (sensitivity: 91 %; 95 %-CI; 86.9 %–94.5 %), and to correctly attribute CT findings to COVID-19 mimics in 159/240 ratings (specificity: 66.3 %; 59.9 %–72.2 %), yielding an overall diagnostic accuracy of 78.8 % (378/480; 74.8 %–82.3 %). Individual reader accuracy ranged from 74.2 % (89/120) to 84.2 % (101/120) and did not correlate significantly with reader expertise. Youden’s Index was 0.57. Between-reader agreement was moderate (κ = 0.53).

Conclusion In this enriched cohort, radiologists were able to distinguish COVID-19 from “COVID-19 mimics” with moderate diagnostic accuracy. Accuracy did not correlate with reader expertise.

Key Points: 

Citation Format
Psychoonkologische Versorgung von Menschen mit Migrationshintergrund
und ihren Angehörigen – Ergebnisse aus
leitfadengestützten Einzelinterviews mit Ärztinnen und
Ärzten
Authors: Hempler Isabelle , Riccetti Nicola , Hermes-Moll Kerstin , Heidt Vitali , Singer Susanne
Published: March 2021

Hintergrund Menschen mit Migrationshintergrund stellen eine heterogene
Bevölkerungsgruppe dar mit einer Vielfalt an Ethnien, kulturellen
und religiösen Ansichten und Erfahrungen. Die Diagnose und
anschließende Behandlung einer Krebserkrankung gehen mit
vielfältigen psychosozialen Belastungen einher. Daher war es Ziel
dieser Studie, die aktuelle Perspektive von Ärzt/innen
bezüglich Barrieren bei der psychoonkologischen Versorgung von MMH
zu untersuchen sowie benötigte Hilfestellungen zu analysieren.

Methode Es wurden bundesweit acht niedergelassene
Ärzt/innen aus der hämatologisch-onkologischen
Versorgung in qualitativen Einzelinterviews befragt. Die Interviews wurden
digital aufgezeichnet und transkribiert. Die Auswertung erfolgte nach der
inhaltlich strukturierenden Inhaltsanalyse mithilfe des Softwareprogramms
MAXQDA 2020.

Ergebnisse Identifiziert wurden 255 Codes in den Hauptkategorien
„Definition Menschen mit Migrationshintergrund“,
„Kommunikation“, „Kulturelle Unterschiede“,
„Psychoonkologische Versorgung“, „Koordinierung
& Vermittlung von psychoonkologischen Versorgungsangeboten“
sowie „Optimale psychoonkologische Versorgung“. Die
Ergebnisse geben einen aktuellen Einblick in alltägliche und
praxisrelevante Probleme, die sich in der transkulturellen Kommunikation,
Barrieren hinsichtlich der Identifizierung von Bedürfnissen, in der
psychoonkologischen Weiterversorgung oder auch während der
Übersetzung durch Angehörige erkennen lassen.

Diskussion Bereits die Identifizierung von Bedürfnissen
während der ärztlichen Behandlung ist mit diversen Barrieren
verbunden. Screening-Instrumente für Menschen mit
Migrationshintergrund und Angehörige auf verschiedenen Sprachen und
für unterschiedliche Kulturkreise könnten die
Identifizierung unterstützen. Zudem müssten Netzwerke
geschaffen werden, um Patient/innen anschließend auch
psychoonkologisch versorgen zu können.
Wie erleben Migrantinnen mit Depression den Zugang zu Versorgung in
Deutschland? Eine qualitative Interviewstudie zu Schwierigkeiten und
Wünschen Betroffener
Authors: Eidmann Christine , Siebenhofer Andrea , Güthlin Corina
Published: March 2021

Ziel der Studie Ziel der Studie ist es, mehr darüber zu erfahren,
wie Migrantinnen den Zugang zu Versorgung von Depression erleben und welche
Schwierigkeiten und Verbesserungswünsche sie haben.

Methodik Inhaltsanalytische Auswertung von zwölf
teilstrukturierten qualitativen Einzelinterviews mit Migrantinnen der ersten
Einwanderergeneration, die aufgrund von Depression in Deutschland behandelt
wurden.

Ergebnisse Schwierigkeiten beim Zugang zu Versorgung sind fehlendes
Wissen zu Depressionssymptomen und Behandlungsoptionen, der Umgang mit
Stigmatisierung und Vorurteilen, mangelnde Behandlungskoordination und Beratung
insbesondere beim Zugang zu ambulanter Psychotherapie, lange Wartezeiten sowie
Verständigungsschwierigkeiten. Betroffene wünschen sich
entstigmatisierende öffentliche Informationskampagnen zu Depression,
bessere Informations- und Beratungsmöglichkeiten für Patienten
sowie sprachliche Unterstützung insbesondere zu Beginn der
Behandlung.

Schlussfolgerung Beim Versorgungszugang von Migrantinnen mit Depression
besteht Verbesserungsbedarf. Die beschriebenen Schwierigkeiten sollten bei der
Planung von Versorgungsangeboten und bei der Behandlung von Patienten
stärker berücksichtigt werden.
StäB – Wie bewerten Patientinnen und Patienten die neue Behandlungsform?
Authors: Raschmann Svenja , Götz Eva , Hirschek Denis , Längle Gerhard
Published: March 2021

Vorliegende Arbeit präsentiert erste deskriptive Daten zu selbst eingeschätzter Behandlungszufriedenheit von 100 in 2 südwürttembergischen Kliniken behandelten Patientinnen und Patienten in Stationsäquivalenter Behandlung (StäB). Insgesamt zeichnete sich hohe Zufriedenheit ab. Der Zustimmungsgrad bezüglich erneuter Inanspruchnahme der StäB lag bei 88 % (SD = 26,1). Daneben zeigten sich Unterschiede in den Verteilungen der Gesamtzufriedenheitswerte differenziert nach Klinikstandort (Stadt, Land) und Hauptdiagnose.

Die Ergebnisse deuten auf eine hohe Akzeptanz bei Betroffenen hin und bilden, nach Etablierung dieser Behandlungsform in den letzten 3 Jahren, Ausgangspunkt und methodische Basis für eine umfassendere Evaluation der Behandlungszufriedenheit im Rahmen der AKtiV-Studie des Innovationsfonds 2020–2023.
The Role of Skeletal Muscles in Exertional Heat Stroke Pathophysiology
Authors: Laitano Orlando , Oki Kentaro , Leon Lisa R.
Published: March 2021

The active participation of skeletal muscles is a unique characteristic of exertional heat stroke. Nevertheless, the only well-documented link between skeletal muscle activities and exertional heat stroke pathophysiology is the extensive muscle damage (e. g., rhabdomyolysis) and subsequent leakage of intramuscular content into the circulation of exertional heat stroke victims. Here, we will present and discuss rarely explored roles of skeletal muscles in the context of exertional heat stroke pathophysiology and recovery. This includes an overview of heat production that contributes to severe hyperthermia and the synthesis and secretion of bioactive molecules, such as cytokines, chemokines and acute phase proteins. These molecules can alter the overall inflammatory status from pro- to anti-inflammatory, affecting other organ systems and influencing recovery. The activation of innate immunity can determine whether a victim is ready to return to physical activity or experiences a prolonged convalescence. We also provide a brief discussion on whether heat acclimation can shift skeletal muscle secretory phenotype to prevent or aid recovery from exertional heat stroke. We conclude that skeletal muscles should be considered as a key organ system in exertional heat stroke pathophysiology.
Radical Cyclization of Olefinic Amides through α-C(sp3)–H Functionalization of Ketones under Catalyst-, Ligand-, and Base-Free Conditions
Authors: Ruan Yiping , Liu Hongxin , Wei Wen-Ting , Qin Fu-Hua , Kang Qing-Qing , Zhang Jun-Yao , Hu Sen-Jie , Liu Yi , Zheng Hongxing , Fang Yi-Lin
Published: March 2021

A new, efficient, and practical radical cyclization of olefinic amides with ketones through α-C(sp3)–H functionalization in the presence of tert-butyl peroxybenzoate (TBPB) is described for the first time. This protocol assembles a wide range of pivotal and useful benzoxazines in good to excellent yields under mild, catalyst-free, ligand-free, and base-free conditions with wide functional group tolerance. Moreover, the mechanistic study indicates that the α-carbonyl radical is involved in this transformation.
Manganese-Catalyzed C(sp2)–H Addition to Polar Unsaturated Bonds
Authors: Wang Congyang , Liu Ting
Published: March 2021

Transition-metal-catalyzed nucleophilic C–H addition of hydrocarbons to polar unsaturated bonds could intrinsically avoid prefunctionalization of substrates and formation of waste byproducts, thus featuring high step- and atom-economy. As the third most abundant transition metal, manganese-catalyzed C–H addition to polar unsaturated bonds remains challenging, partially due to the difficulty in building a closed catalytic cycle of manganese. In the past few years, we have developed manganese catalysis to enable the sp2-hydrid C–H addition to polar unsaturated bonds (e.g., imines, aldehydes, nitriles), which will be discussed in this personal account.

1 Introduction

2 Mn-Catalyzed N-Directed C(sp2)–H Addition to Polar Unsaturated Bonds

3 Mn-Catalyzed O-Directed C(sp2)–H Addition to Polar Unsaturated Bonds

4 Conclusion
Fibrinolysis in Patients with Liver Disease
Authors: von Meijenfeldt Fien A. , Lisman Ton
Published: March 2021

Patients with liver disease acquire complex changes in their hemostatic system. Historically, these patients were considered to have a bleeding tendency related, in part, to a hyperfibrinolytic state. However, studies using more modern fibrinolysis tests have questioned the presence of a hyperfibrinolytic state in patients with liver disease and its association with bleeding risk. It may be that the sickest patients with liver disease do have fibrinolytic abnormalities. However, the debate on the fibrinolytic state of patients with (decompensated) cirrhosis or critically ill liver disease is complicated by the fact that hypo- and hyperfibrinolysis have been poorly defined. This could, in part, be explained by the lack of reliable tests that assess a patient's fibrinolytic status. Moreover, large clinical studies on the relationship between bleeding and fibrinolysis in patients with liver disease are scarce. Here, we provide an overview of the current knowledge on fibrinolysis in various types of liver diseases and possible implications as a target for therapeutic strategies in liver disease. As antifibrinolytic therapy has been shown to be safe and effective during liver transplantation, it could potentially be of use in patients with (either laboratory-established or suspected) hyperfibrinolysis-related bleeding.
The Relationship between Mobility and COVID-19 in Germany: Modeling Case Occurrence using Apple's Mobility Trends Data
Authors: Walker Mark David , Sulyok Mihály
Published: March 2021

Background Restrictions on social interaction and movement were implemented by the German government in March 2020 to reduce the transmission of coronavirus disease 2019 (COVID-19). Apple's “Mobility Trends” (AMT) data details levels of community mobility; it is a novel resource of potential use to epidemiologists.

Objective The aim of the study is to use AMT data to examine the relationship between mobility and COVID-19 case occurrence for Germany. Is a change in mobility apparent following COVID-19 and the implementation of social restrictions? Is there a relationship between mobility and COVID-19 occurrence in Germany?

Methods AMT data illustrates mobility levels throughout the epidemic, allowing the relationship between mobility and disease to be examined. Generalized additive models (GAMs) were established for Germany, with mobility categories, and date, as explanatory variables, and case numbers as response.

Results Clear reductions in mobility occurred following the implementation of movement restrictions. There was a negative correlation between mobility and confirmed case numbers. GAM using all three categories of mobility data accounted for case occurrence as well and was favorable (AIC or Akaike Information Criterion: 2504) to models using categories separately (AIC with “driving,” 2511. “transit,” 2513. “walking,” 2508).

Conclusion These results suggest an association between mobility and case occurrence. Further examination of the relationship between movement restrictions and COVID-19 transmission may be pertinent. The study shows how new sources of online data can be used to investigate problems in epidemiology.
Value of Magnetic Resonance Spectroscopy for Diagnosis of Creatine Deficiency Syndrome
Authors: Şimşek Sadullah , Hattapoğlu Salih , Ekici Faysal
Published: March 2021

Creatine deficiency syndromes are congenital metabolic diseases characterized by decreased cerebral creatine levels as a result of disorders in creatine synthesis and transport. Therefore, magnetic resonance spectroscopy is a valuable tool for diagnosis. This disease can be explained by congenital disorders occurring in three forms at different stages of the creatine metabolic pathway. Two of disorders arise autosomal recessively in creatine biosynthesis, arginine-glycine amidinotransferase, and guanidinoacetate methyltransferase enzyme deficiency. The third disorder occurs as a result of an SLC6A8 variant in the form of creatine carrier protein deficiency. In this article, a patient with SLC6A8 carrier deficiency is presented.
SCN2A and Its Related Epileptic Phenotypes
Authors: Praticò Andrea D. , Giallongo Alessandro , Arrabito Marta , D'Amico Silvia , Gauci Maria Cristina , Lombardo Giulia , Polizzi Agata , Falsaperla Raffaele , Ruggieri Martino
Published: March 2021

Epilepsies due to SCN2A mutations can present with a broad range of phenotypes that are still not fully understood. Clinical characteristics of SNC2A-related epilepsy may vary from neonatal benign epilepsy to early-onset epileptic encephalopathy, including Ohtahara syndrome and West syndrome, and epileptic encephalopathies occurring at later ages (usually within the first 10 years of life). Some patient may present with intellectual disability and/or autism or movement disorders and without epilepsy. The heterogeneity of the phenotypes associated to such genetic mutations does not always allow the clinician to address his suspect on this gene. For this reason, diagnosis is usually made after a multiple gene panel examination through next generation sequencing (NGS) or after whole exome sequencing (WES) or whole genome sequencing (WGS). Subsequently, confirmation by Sanger sequencing can be obtained. Mutations in SCN2A are inherited as an autosomal dominant trait. Most individuals diagnosed with SCN2A–benign familial neonatal-infantile seizures (BFNIS) have an affected parent; however, hypothetically, a child may present SCN2A-BNFNIS as the result of a de novo pathogenic variant. Almost all individuals with SCN2A and severe epileptic encephalopathies have a de novo pathogenic variant. SNC2A-related epilepsies have not shown a clear genotype–phenotype correlation; in some cases, a same variant may lead to different presentations even within the same family and this could be due to other genetic factors or to environmental causes. There is no “standardized” treatment for SCN2A-related epilepsy, as it varies in relation to the clinical presentation and the phenotype of the patient, according to its own gene mutation. Treatment is based mainly on antiepileptic drugs, which include classic wide-spectrum drugs, such as valproic acid, levetiracetam, and lamotrigine. However, specific agents, which act directly modulating the sodium channels activity (phenytoin, carbamazepine, oxcarbamazepine, lamotrigine, and zonisamide), have shown positive result, as other sodium channel blockers (lidocaine and mexiletine) or even other drugs with different targets (phenobarbital).
Phragmidium rubi-thunbergii.
Authors:   USDA-ARS
Published: March 2021

There is little published information on this plant pathogenic fungus, which has limited geographic distribution. As hosts exist in other regions of the world with similar environmental conditions, this species may pose a threat to native or agricultural plants if introduced.
Pileolaria pistaciae (Asian pistachio rust).
Authors:   USA, USDA-ARS
Published: March 2021

There is little published information on this plant pathogenic fungus, which is limited to parts of Asia. It infects Pistacia spp. that exist in other regions of the world with similar environmental conditions, therefore this species may pose a threat to native or agricultural plants if introduced.
Boerhavia diffusa (red spiderling).
Authors: Rojas-Sandoval Julissa
Published: March 2021

B. diffusa is a fast-growing weed common in ruderal areas, agricultural land, and pastures. It has been listed as invasive in Argentina, Paraguay, Chile, Trinidad and Tobago, Hawaii, Japan and Cambodia where it is invading principally coastal and ruderal areas (Wagner et al., 1999; Mito and Uesugi, 2004; Zuloaga et al., 2008; PIER, 2015). The sticky fruits of the plant facilitate dispersal.
The effect of different resistance training protocols equalized by time under tension on the force‐position relationship after 10 weeks of training period
Authors: Martins‐Costa Hugo C. , Lanza Marcel B. , Diniz Rodrigo C. R. , Lacerda Lucas T. , Gomes Mateus C. , Lima Fernando V. , Chagas Mauro H.
Published: March 2021

This study investigated the impact of performing two equalized resistance training (RT) protocols for 10 weeks that differ only by repetition duration and number in the force‐position and EMG‐position relationship. Participants performed an equalized (36 s of time under tension; 3–4 sets; 3 min between sets; 50–55% of one‐repetition maximum; 3× week) RT intervention on the bench press and the only different change between protocols was repetition number (RN; 12 vs.6) or duration (RD; 3 s vs. 6 s). Two experimental groups (RN12RD3, n = 12; and RN6RD6, n = 12) performed the RT, while one group was the control (Control, n = 11). Maximal isometric contractions at 10%, 50% and 90% of total bench press range of motion were performed pre‐ and post‐RT, while electromyography was recorded. It demonstrated an increase in isometric force (+14% to 24%, P < 0.001) shifting up the force‐position relationship of the training groups after RT, although no difference was between training groups compared to the Control. Neuromuscular activation from pectoralis major presented an increase after training for both RT groups (+44%; P < 0.001) compared to the Control. However, although not significantly different, triceps brachii also presented an increase depending on the protocol (+25%). In conclusion, 10 weeks of an equalized RT with longer RN and shorter RD (or opposite) similarly increases the ability to produce maximal isometric force during the bench exercise across different angles, while neuromuscular activation of the pectoralis major partially explained the shift‐up of the force‐position relationship after training.
Cultivation and Enabling Effects of Social Support and Self-Efficacy in Parent–Child Dyads
Authors: Banik Anna , Zarychta Karolina , Knoll Nina , Luszczynska Aleksandra
Published: March 2021

Background

There are two alternative mechanisms, elucidating the reciprocal relationship between self-efficacy and social support when explaining health outcomes: self-efficacy beliefs may operate as the establisher of social support (the cultivation model) or social support may enable the formation of self-efficacy beliefs (the enabling model).

Purpose

In line with the cultivation hypothesis, it was tested if self-efficacy (measured in parents and children) would indirectly predict parental and child moderate-to-vigorous physical activity (MVPA), via the mediator, social support (parent-provided, child-received). In line with the enabling hypothesis, it was tested if social support would predict MVPA indirectly, via the mediator, self-efficacy.

Methods

A total of 879 parent–child dyads (1758 individuals; 52.4% girls, aged 5–11 years old, 83.2% mothers) provided self-reports at the baseline (T1) and the 7- to 8-month follow-up (T2). Body weight and height were measured objectively. Manifest path analyses were performed, controlling for the baseline levels of the mediator and dependent variables.

Results

A similar number of significant simple indirect effects was found for the cultivation and the enabling model. Across the models, the indirect effects followed similar patterns: (a) within-individual indirect effects in children; (b) across-individual indirect effects, with the independent variable measured in children and the mediator/dependent variables measured in parents (e.g., child self-efficacy predicted parental support provision and, indirectly, parental MVPA); (c) across-individual indirect effects, accounting for self-efficacy and MVPA measured in children, combined with parental reports of social support.

Conclusions

The findings provide support for both cultivation and enabling models in the context of MVPA among parent–child dyads.
Phentolamine continuous infusion in a pediatric patient with uncontrolled hypertension
Authors: Hatt Andrew
Published: March 2021

Purpose

A case of uncontrolled hypertension nonresponsive to traditional pharmacologic management in a pediatric patient with a ventricular assist device awaiting a heart transplant is reported.

A 4-month-old male in heart failure was experiencing uncontrolled hypertension. Because of a lack of hemodynamic stability, he was unable to be listed as a heart transplant candidate. He received multiple antihypertensive agents (calcium channel blockers, β-blockers, and direct-acting vasodilators) as both intermittent and continuous infusions over the course of several days without achieving normotension. The decision was then made to administer intravenous phentolamine as a continuous infusion to pursue a different mechanism than with traditional antihypertensive agents to achieve hemodynamic stability. Within 8 hours of initiation of the continuous phentolamine infusion, the patient became normotensive and was listed for a heart transplant. The continuous phentolamine infusion was administered over the next 4 days to maintain normotension, and on day 4 the patient underwent successful orthotopic heart transplantation.

Conclusion

A 4-month-old male in heart failure with a ventricular assist device, experiencing uncontrolled hypertension nonresponsive to traditional pharmacologic management, was successfully treated with a continuous intravenous infusion of phentolamine.
Implementation of a pharmacist-provided pharmacogenomics service in an executive health program
Authors: Liko Ina , Corbin Lisa , Tobin Eric , Aquilante Christina L , Lee Yee Ming
Published: March 2021

Purpose

We describe the implementation of a pharmacist-provided pharmacogenomics (PGx) service in an executive health program (EHP) at an academic medical center.

As interest in genomic testing grows, pharmacists have the opportunity to advance the use of PGx in EHPs, in collaboration with other healthcare professionals. In November 2018, a pharmacist-provided PGx service was established in the EHP at the University of Colorado Hospital. The team members included 3 physicians, a pharmacist trained in PGx, a registered dietitian/exercise physiologist, a nurse, and 2 medical assistants. We conducted 4 preimplementation steps: (1) assessment of the patient population, (2) selection of a PGx test, (3) establishment of a visit structure, and (4) selection of a billing model. The PGx consultations involved two 1-hour visits. The first visit encompassed pretest PGx education, review of the patient’s current medications and previous medication intolerances, and DNA sample collection for genotyping. After this visit, the pharmacist developed a therapeutic plan based on the PGx test results, discussed the results and plan with the physician, and created a personalized PGx report. At the second visit, the pharmacist reviewed the PGx test results, personalized the PGx report, and discussed the PGx-guided therapeutic plan with the patient. Overall, the strategy worked well; minor challenges included evaluation of gene-drug pairs with limited PGx evidence, communication of information to non-EHP providers, scheduling issues, and reimbursement.

Conclusion

The addition of a PGx service within an EHP was feasible and provided pharmacists the opportunity to lead PGx efforts and collaborate with physicians to expand the precision medicine footprint at an academic medical center.
Stereotype Threat and Neuropsychological Test Performance in the U.S. African American Population
Authors: Whaley Arthur L
Published: March 2021

Objective

This cross-sectional study tested stereotype threat theory using the Modified-Symbol Digit Modalities Test (M-SDMT), a neurocognitive test, with the African American subsample (N = 3570) of the National Survey of American Life. The primary hypothesis is that those classified as experiencing stereotype threat will achieve the lowest scores.

Method

African American respondents who perceived race as a barrier to life goals and scored above the median in endorsement of negative racial stereotypes were classified as experiencing stereotype threat. M-SDMT scores were regressed on threat group classification with adjustments for gender, age, income, and education. Nonparametric test of the effect sizes for threat group classification versus demographic variables was also conducted.

Results

The stereotype threat group obtained statistically significantly lower M-SDMT scores than the no threat group. However, the stereotype threat effect became nonsignificant in regression analyses adjusted for demographic variables. The nonparametric test revealed a statistically significantly larger average effect size for demographic variables than threat group classification.

Conclusion

The relatively less influential role of stereotype threat than other biological and social factors limit its explanatory power for racial disparities in neuropsychological test performance among African Americans.
Deployment of the Ophthalmic and Facial Angiosomes in the Upper Nose Overlaying the Nasal Bones
Authors: Cai Bing , Yuan Rong , Zhu Guo-Zhang , Zhan Wen-Feng , Luo Cheng-En , Kong Xiang-Xue , Luo Sheng-Kang
Published: March 2021

Background

Nasal filler placement is associated with a high risk of blindness. The arterial supply to the upper nose overlaying the nasal bones is poorly understood.

Objectives

The aim of this study was to visualize and analyze the deployment of the ophthalmic and facial angiosomes in the upper nose to help prevent blindness following nasal filler injections.

Methods

The arterial systems of 62 cadaveric heads were filled with lead oxide contrast agent, and computed tomography (CT) images were acquired and reconstructed in 3 dimensions.

Results

Twenty-six of the cadaveric noses examined demonstrated clear CT images of the facial and ophthalmic angiosomes in the upper nose. The Type 1 upper nose (15.4%) is supplied by 2 independent ophthalmic angiosomes that communicate indirectly through a choke anastomosis. The Type 2 upper nose (38.5%) is supplied by 2 ophthalmic angiosomes with a true anastomosis between them. The Type 3 upper nose (46.1%) is supplied by both ophthalmic and facial angiosomes with true anastomoses across the dorsal midline. These true anastomoses are mediated by the radix arcade in 46% of the noses and involve the dorsal nasal artery in 65% of the cases. The anastomoses all cross the upper dorsal midline and are directly linked to the ophthalmic angiosome.

Conclusions

The deployment and anastomosis of the facial and ophthalmic angiosomes in the upper nose fall into 3 major patterns. About 85% of the noses have true anastomotic arteries that cross the upper dorsal midline and are directly linked to the ophthalmic circulation. Dorsum filler injection poses a significant risk of blindness.
Technical advances in surgery for pancreatic cancer
Authors: Schneider M , Hackert T , Strobel O , Büchler M W
Published: March 2021

Background

Multimodal treatment concepts enhance options for surgery in locally advanced pancreatic ductal adenocarcinoma (PDAC). This review provides an overview of technical advances to facilitate curative-intent resection in PDAC.

Methods

A review of the literature addressing current technical advances in surgery for PDAC was performed, and current state-of-the-art surgical techniques summarized.

Results

Artery-first and uncinate-first approaches, dissection of the anatomical triangle between the coeliac and superior mesenteric arteries and the portomesenteric vein, and radical antegrade modular pancreatosplenectomy were introduced to enhance the completeness of resection and reduce the risk of local recurrence. Elaborated techniques for resection and reconstruction of the mesenteric–portal vein axis and a venous bypass graft-first approach frequently allow resection of PDAC with venous involvement, even in patients with portal venous congestion and cavernous transformation. Arterial involvement does not preclude surgical resection per se, but may become surgically manageable with recent techniques of arterial divestment or arterial resection following neoadjuvant treatment.

Conclusion

Advanced techniques of surgical resection and vessel reconstruction provide a toolkit for curative-intent surgery in borderline resectable and locally advanced PDAC. Effects of these surgical approaches on overall survival remain to be proven with high-level clinical evidence.
Quality-by-Design Approach for Chromatographic Analysis of Metformin, Empagliflozin and Linagliptin
Authors: Gurrala Sunitha , Raj Shiva , CVS Subrahmanyam , Anumolu Panikumar Durga
Published: March 2021

New analytical quality by design-oriented HPLC method with multiple response optimization (Derringer’s desirability function) was demonstrated for simultaneous analysis of three antidiabetic drugs (metformin hydrochloride/empagliflozin/linagliptin) in a fixed-dose combination. Central composite design was employed for systematic optimization of critical method parameters, namely, % organic phase (X1), aqueous phase pH (X2) and flow rate (X3) while resolution, capacity factor and theoretical plate number as critical analytical attributes. Effective chromatographic separation of title analytes was accomplished on Std. Discovery C18 column at 30°C with mobile phase comprising acetonitrile: phosphate buffer pH 5 (38:62% v/v), pumped at a flow rate of 1 mL/min by isocratic elution pattern and UV detection at 222 nm. The model is rectilinear in the range of 1.0–200, 0.2–40 and 0.1–20 μg/mL at retention times of 3.04, 3.93 and 5.99 min for metformin, empagliflozin and linagliptin, respectively. The method obeyed all validation parameters of ICH Q2(R1) guidelines. The proposed HPLC method was highly robust for method transfer, regulatory flexibility within design space and can be used for assay of pharmaceutical dosage forms comprising these analytes. The proposed method was applied for stability studies of drugs under various stress conditions.
Relationships between left ventricular mass and QRS duration in diverse types of left ventricular hypertrophy
Authors: Domain Guillaume , Chouquet Cecile , Réant Patricia , Bongard Vanina , Vedis Theo , Rollin Anne , Mandel Franck , Delasnerie Hubert , Voglimacci-Stephanopoli Quentin , Mondoly Pierre , Beneyto Maxime , Cariou Eve , Fournier Pauline , Delmas Clément , Galinier Michel , Carrié Didier , Lafitte Stéphane , Lairez Olivier , Ferrières Jean , Cochet Hubert , Maury Philippe
Published: March 2021

Aims

Hypertrophic cardiomyopathy (HCM) may be associated with very narrow QRS, while left ventricular hypertrophy (LVH) may increase QRS duration. We investigated the relationships between QRS duration and LV mass (LVM) in subtypes of abnormal LV wall thickness.

Methods and results

Automated measurement of LVM on MRI was correlated to automated measurement of QRS duration on ECG in HCM, left ventricular non compaction (LVNC), left ventricular hypertrophy (LVH), and controls with healthy hearts. Uni and multivariate analyses were performed between groups including explanatory variables expected to influence LVM and QRS duration. The relationships between QRS duration and LVM were further studied within each group. Two hundred and twenty-one HCM, 28 LVNC, 16 LVH, and 40 controls were retrospectively included. Mean QRS duration was 92 ms for HCM, 104 for LVNC, 110 for LVH, and 92 for controls (P < 0.01). Mean LVM was 100, 90, 108, and 68 g/m2 (P < 0.01). QRS duration, LVM, hypertension, maximal wall thickness, and late gadolinium enhancement were significantly linked to HCM in multivariate analysis (w/wo bundle branch block). An independent negative correlation was found between LVM and QRS duration in the HCM group, while the relationship was reverse in LVNC, LVH, and controls.

Conclusion

QRS duration increases with LVM in LVNC, LVH, or in healthy hearts, while reverse relationship is present in HCM. These relationships were independent from other parameters. These results warrant additional investigations for refining diagnosis criteria for HCM in the future.
Transcribed germline-limited coding sequences inOxytricha trifallax
Authors: Miller Richard V , Neme Rafik , Clay Derek M , Pathmanathan Jananan S , Lu Michael W , Yerlici V Talya , Khurana Jaspreet S , Landweber Laura F
Published: March 2021

The germline-soma divide is a fundamental distinction in developmental biology, and different genes are expressed in germline and somatic cells throughout metazoan life cycles. Ciliates, a group of microbial eukaryotes, exhibit germline-somatic nuclear dimorphism within a single cell with two different genomes. The ciliate Oxytricha trifallax undergoes massive RNA-guided DNA elimination and genome rearrangement to produce a new somatic macronucleus (MAC) from a copy of the germline micronucleus (MIC). This process eliminates noncoding DNA sequences that interrupt genes and also deletes hundreds of germline-limited open reading frames (ORFs) that are transcribed during genome rearrangement. Here, we update the set of transcribed germline-limited ORFs (TGLOs) in O. trifallax. We show that TGLOs tend to be expressed during nuclear development and then are absent from the somatic MAC. We also demonstrate that exposure to synthetic RNA can reprogram TGLO retention in the somatic MAC and that TGLO retention leads to transcription outside the normal developmental program. These data suggest that TGLOs represent a group of developmentally regulated protein-coding sequences whose gene expression is terminated by DNA elimination.
Testcrosses are an efficient strategy for identifying cis-regulatory variation: Bayesian analysis of allele-specific expression (BayesASE)
Authors: Miller Brecca R , Morse Alison M , Borgert Jacqueline E , Liu Zihao , Sinclair Kelsey , Gamble Gavin , Zou Fei , Newman Jeremy R B , León-Novelo Luis G , Marroni Fabio , McIntyre Lauren M
Published: March 2021

Allelic imbalance (AI) occurs when alleles in a diploid individual are differentially expressed and indicates cis acting regulatory variation. What is the distribution of allelic effects in a natural population? Are all alleles the same? Are all alleles distinct? The approach described applies to any technology generating allele-specific sequence counts, for example for chromatin accessibility and can be applied generally including to comparisons between tissues or environments for the same genotype. Tests of allelic effect are generally performed by crossing individuals and comparing expression between alleles directly in the F1. However, a crossing scheme that compares alleles pairwise is a prohibitive cost for more than a handful of alleles as the number of crosses is at least (n2-n)/2 where n is the number of alleles. We show here that a testcross design followed by a hypothesis test of AI between testcrosses can be used to infer differences between nontester alleles, allowing n alleles to be compared with n crosses. Using a mouse data set where both testcrosses and direct comparisons have been performed, we show that the predicted differences between nontester alleles are validated at levels of over 90% when a parent-of-origin effect is present and of 60%−80% overall. Power considerations for a testcross, are similar to those in a reciprocal cross. In all applications, the testing for AI involves several complex bioinformatics steps. BayesASE is a complete bioinformatics pipeline that incorporates state-of-the-art error reduction techniques and a flexible Bayesian approach to estimating AI and formally comparing levels of AI between conditions. The modular structure of BayesASE has been packaged in Galaxy, made available in Nextflow and as a collection of scripts for the SLURM workload manager on github (https://github.com/McIntyre-Lab/BayesASE).
Reshaping Liability – The Concept of Undertaking Applied to Private Enforcement of EU Competition Law
Authors: Freund Benedikt
Published: March 2021

It is undeniable that a ‘follow-on damages claim culture’ is on the rise in Europe. The case-law of the Court of Justice of the European Union has been acting as a catalyst to ensure that victims of cartel infringements are in a position to effectively enforce their right to damages. Although the path followed by the Court removed many obstacles for cartel victims it has also departed from traditional concepts of tort law, including liability for civil damages. By extending concepts which were traditionally confined to public enforcement to private enforcement – such as the notion of undertaking – national courts will be faced with new challenges. It is inevitable that questions which were previously of minor importance in public proceedings will carry a different weight in civil litigation. This article focuses on recent developments and explores possible consequences on the imputation of liability in private enforcement of EU competition law.
Persistent Immune Activation in Human Immunodeficiency Virus–Infected Pregnant Women Starting Combination Antiretroviral Therapy After Conception
Authors: Lohman-Payne Barbara , Koster Jacob , Gabriel Benjamin , Chilengi Roma , Forman Leah S , Heeren Tim , Duffy Cassandra R , Herlihy Julie , Crimaldi Steven , Gill Chris , Chavuma Roy , Mwananyanda Lawrence , Thea Donald M
Published: March 2021

This study evaluated the impact of human immunodeficiency virus (HIV) and combination antiretroviral therapy (cART) on immune activation during pregnancy in a Zambian cohort of HIV-exposed but uninfected children followed up from birth. Activated CD8+ T cells (CD38+ and HLA-DR+) were compared among HIV-uninfected (n = 95), cART experienced HIV-infected (n = 111), and cART-naive HIV-infected (n = 21) pregnant women. Immune activation was highest among HIV-infected/cART-naive women but decreased during pregnancy. Immune activation HIV-infected women who started cART during pregnancy was reduced but not to levels similar to those in HIV-uninfected women. The effects of elevated maternal immune activation in pregnancy on subsequent infant health and immunity remain to be determined.
In vitroactivity of dalbavancin against Gram-positive bacteria isolated from diabetic foot osteomyelitis
Authors: Pantel Alix , Nachar Oriane , Boudet Agathe , Loubet Paul , Schuldiner Sophie , Cellier Nicolas , Sotto Albert , Dunyach-Remy Catherine , Lavigne Jean-Philippe
Published: March 2021

Background

Diabetic foot infections (DFIs) represent a serious threat to public health because of their frequency and the severity of their consequences, i.e. osteomyelitis and amputation. The management of diabetic foot osteomyelitis (DFOM) requires prolonged antibiotic therapy. In Western countries, Gram-positive bacteria are the most commonly encountered pathogens.

Objectives

This study evaluated the in vitro activity of dalbavancin, a novel lipoglycopeptide with extended half-life, recently marketed in Europe for acute bacterial skin and skin structure infections, on a panel of Gram-positive bacteria responsible for DFOM.

Methods

Dalbavancin activity was evaluated against a panel of Gram-positive bacterial strains isolated from bone biopsies performed by a trained surgeon among patients with suspected DFOM. MICs were determined using MIC Test Strips (Liofilchem) and confirmed with the EUCAST broth microdilution method. Three other antimicrobial agents (vancomycin, teicoplanin and ceftobiprole) were used as comparators.

Results

Dalbavancin showed excellent activity against all Gram-positive bacterial strains tested, including one teicoplanin-resistant Staphylococcus epidermidis isolate. With MIC50 and MIC90 values of 0.047 and 0.094 mg/L, respectively, dalbavancin showed the most potent in vitro activity among antimicrobial agents tested.

Conclusions

With its efficacy, good tolerability and unique pharmacokinetic properties, dalbavancin appears to be a promising treatment for DFOM involving Gram-positive bacteria.