bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigation of indoor total volatile organic compound concentrations in densely occupied university buildings under natural ventilation: Temporal variation, correlation and source contribution
Authors: Jia Yabin , Zheng Xu , Guan Jun , Tan Xue , Chen Shuqin , Qi Bing , Zheng Huiyan
Published: April 2020

Human activities have been proven to be one of the most important sources of indoor volatile organic compound (VOC) emissions, especially in densely occupied environments. However, characterization of temporal variation and its impact analysis of indoor total volatile organic compounds (TVOC) have not been presented adequately. In this study, indoor concentrations and temporal variation of TVOC concentrations were investigated using a continuous monitoring instrument in 20 densely occupied education buildings randomly selected at one university in Nanjing, China, including nine lecture halls and 11 classrooms. Indoor and outdoor CO2 concentration, temperature and relative humidity were monitored to analyse the correlation and contribution rates of TVOC from indoor and outdoor sources. Results show that the variation in the indoor TVOC concentration was similar to the indoor CO2 concentration in densely occupied education buildings with the exception of sudden indoor sources, such as food service. Further analysis indicates that a strong positive correlation was observed between the number of occupants and TVOC concentrations. The average contribution rate could reach 69.2% from indoor sources and 30.8% from outdoors. This study provided a better understanding of the status quo and could help in developing control strategies of indoor air quality in densely occupied education buildings.
Joining by forming of polymer-metal sheet-tube connections
Authors: Alves Luis M , Afonso Rafael M , Martins Paulo AF
Published: April 2020

This paper focuses on the mechanical joining of sheets to tubes made from dissimilar materials. The objective is to investigate the applicability of deformation-assisted joining by annular sheet squeezing to hybrid polymer-metal connections in order to understand how this new process can be used as an alternative to conventional fastening and adhesive bonding. The presentation draws from identification of the main operating parameters and modes of deformation to characterisation of the process workability limits. Selected test cases retrieved from experimentation and finite element simulation are included. The work is an extension of the previous work of the authors on metallic materials, and results show that joining by annular sheet squeezing is an easy and effective solution to connect a metal sheet to a polymer tube away from its end.
The Matthew Effect in social media news use: Assessing inequalities in news exposure and news engagement on social network sites (SNS)
Authors: Kümpel Anna Sophie
Published: April 2020

Social network sites such as Facebook and Twitter have become a key part of online users’ news diets. On social network sites, even individuals who are not motivated to seek out news are believed to be exposed to news posts due to the sharing activities of friends or inadvertently witnessing discussions about current events. Research on this incidental news exposure (INE) has largely focused on its potential for positive effects on information gain or political participation, while simultaneously turning a blind eye to the inequalities in news exposure and engagement. This article aims to address this issue by proposing and explicating the existence of a ‘Matthew Effect’ in social media news use. It is argued that INE research needs to consider the unequal chances to both be exposed to news on social network sites and to actually engage (i.e. read and interact) with ‘accidentally’ encountered news content.
Producing legibility through ritual: The Inka expansion in Huarochirí (Lima, Peru)
Authors: Hernández Garavito Carla
Published: April 2020

This article builds a framework for the analysis of the Inka Empire’s (1400–1532 CE) expansion in the Peruvian highlands. Drawing from recent archaeological excavations at the site of Canchaje (Huarochirí), I propose that the Inka built upon cultural familiarities between them and their subjects by using ritual emplacements (rock outcrops and plazas) as arenas of mediation. At the same time, the construction of mutual legibility enabled subjected communities to maintain and redefine their cultural practices in ways that survived the Inka Empire. By recasting the Inka from foreign conqueror to new kin within local ritual systems, the people of Huarochirí reinvented their traditions to garner political agency. Using archaeological data and colonial-period documents, I show that local agency informed empire-building, leading to the reinvention of local traditions. Ultimately, my work shows how mutual legibility was built on the ground while exploring specific instances of negotiation through ritual.
Parenting Programs That Address Physical Abuse in Childhood for Families of Children With Developmental Disabilities in Mainland China: Systematic Review and Meta-Regression
Authors: Fang Zuyi , Barlow Jane , Zhang Cheng
Published: April 2020

Millions of children in China are diagnosed with developmental disabilities (DD), many of whom are subject to physical abuse. While a significant body of research suggests that parenting interventions can reduce the incidence and risk of such abuse, there is currently limited evidence of their effectiveness for this population or from non-English-speaking countries. This review involved searches in both English and Chinese databases to identify randomized controlled trials and quasi-experimental studies of parenting interventions for families of children with DD in mainland China. Multilevel meta-analyses were undertaken to examine the effectiveness of parenting programs. Subgroup analyses and meta-regression were conducted to investigate heterogeneity and identify potential moderators with a focus on intervention and delivery components. Risk of bias was assessed for each study. Thirty-one studies were included. The results showed that parenting interventions could reduce child emotional and behavioral problems (CEBP) and improve the parent–child relationship, although only one study directly measured the actual incidence of abuse. Programs for autism and epilepsy had stronger treatment effects. Teaching knowledge about CEBP, skills to improve parental mental health, and techniques to cultivate empathy were associated with program success; however, positive reinforcement was associated with more problems. The results also supported the delivery of programs with longer duration, a combination of group and individual sessions, efforts to build rapport, ongoing communication outside the programs, and delivery in hospitals or service agencies. Further research is needed, however, in addition to improvements in the quality of research and reporting.
Enhanced flexural and tribological properties of basalt fiber-epoxy composite using nano-zirconia/graphene oxide hybrid system
Authors: Toorchi Davood , Tohidlou Esmaeil , Khosravi Hamed
Published: April 2020

In this work, the synergistic effect of graphene oxide and nanozirconia on the flexural and tribological properties of basalt fiber/epoxy composites was investigated. At the first step, the nanofillers were surface-modified to improve their compatibility with the epoxy matrix. Then, several laminates were fabricated by varying the filler loading. The results revealed that the multiscale composite filled with 0.1 wt.% graphene oxide + 1 wt.% nanozirconia exhibited the maximum flexural strength and wear resistance. Compared to the neat basalt fiber/epoxy composite, the wear rate and friction coefficient of the 0.1 wt.% graphene oxide + 1 wt.% nanozirconia-filled specimen were decreased by 67 and 62%, respectively, whereas the flexural strength was enhanced by 50%. Scanning electron microscopy analysis clearly showed an enhanced fiber-matrix interfacial bonding for the multiscale composite containing hybrid fillers in the matrix.
β-Oscillations Reflect Recovery of the Paretic Upper Limb in Subacute Stroke
Authors: Tang Chih-Wei , Hsiao Fu-Jung , Lee Po-Lei , Tsai Yun-An , Hsu Ya-Fang , Chen Wei-Ta , Lin Yung-Yang , Stagg Charlotte J. , Lee I-Hui
Published: April 2020

Background. Recovery of upper limb function post-stroke can be partly predicted by initial motor function, but the mechanisms underpinning these improvements have yet to be determined. Here, we sought to identify neural correlates of post-stroke recovery using longitudinal magnetoencephalography (MEG) assessments in subacute stroke survivors. Methods. First-ever, subcortical ischemic stroke survivors with unilateral mild to moderate hand paresis were evaluated at 3, 5, and 12 weeks after stroke using a finger-lifting task in the MEG. Cortical activity patterns in the β-band (16-30 Hz) were compared with matched healthy controls. Results. All stroke survivors (n=22; 17 males) had improvements in action research arm test (ARAT) and Fugl-Meyer upper extremity (FM-UE) scores between 3 and 12 weeks. At 3 weeks post-stroke the peak amplitudes of the movement-related ipsilesional β-band event-related desynchronization (β-ERD) and synchronization (β-ERS) in primary motor cortex (M1) were significantly lower than the healthy controls (p<0.001) and were correlated with both the FM-UE and ARAT scores (r=0.51-0.69, p<0.017). The decreased β-ERS peak amplitudes were observed both in paretic and non-paretic hand movement particularly at 3 weeks post-stroke, suggesting a generalized disinhibition status. The peak amplitudes of ipsilesional β-ERS at week 3 post-stroke correlated with the FM-UE score at 12 weeks (r=0.54, p=0.03) but no longer significant when controlling for the FM-UE score at 3 weeks post-stroke. Conclusions. Although early β-band activity does not independently predict outcome at 3 months after stroke, it mirrors functional changes, giving a potential insight into the mechanisms underpinning recovery of motor function in subacute stroke.
Lipidomic Profiling for Serum Biomarkers in Mice Exposed to Ionizing Radiation
Authors: Huang Jinfeng , Wang Qi , Qi Zhenhua , Zhou Shixiang , Zhou Meijuan , Wang Zhidong
Published: April 2020

Radiation biodosimeters are required urgently for fast and accurate evaluation of absorbed dose for irradiated individuals. Lipidomics has appeared as a credible technique for identification and quantification of lipid for researching biomarker of diseases. We performed a lipidomic profile on mice serum at time points of 6, 24, and 72 hours after 0, 2, 5.5, 7, and 8 Gy irradiation to select radiation-responsive lipids and conducted Kyoto Encyclopedia of Genes and Genome pathway enrichment analysis to recognize the pathways and network changes. Then, Pearson correlation analysis was performed to evaluate the feasibility of radiation-responsive lipids to estimate radiation dose. Seven radiation-responsive lipids including PC (18:2/18:2), PC (18:0/18:2), Lyso PC 18:1, PC (18:0/20:4), SM (D18:0/24:1), PC (16:0/18:1), and Lyso PC 18:2 were identified in which glycerophospholipid metabolism presented as the most significant pathway, and they all presented good linear correlation with the irradiated dose. This study identified 7 radiation-responsive lipids in mice serum and certificate their feasibility of dose estimation as biodosimeters.
Exercise Is Medicine
Authors: Thompson Walter R. , Sallis Robert , Joy Elizabeth , Jaworski Carrie A. , Stuhr Robyn M. , Trilk Jennifer L.
Published: April 2020

There is overwhelming evidence in the scientific and medical literature that physical inactivity is a major public health problem with a wide array of harmful effects. Over 50% of health status can be attributed to unhealthy behaviors with smoking, diet, and physical inactivity as the main contributors. Exercise has been used in both the treatment and prevention of a variety of chronic conditions such as heart disease, pulmonary disease, diabetes, and obesity. While the negative effects of physical inactivity are widely known, there is a gap between what physicians tell their patients and exercise compliance. Exercise is Medicine was established in 2007 by the American College of Sports Medicine to inform and educate physicians and other health care providers about exercise as well as bridge the widening gap between health care and health fitness. Physicians have many competing demands at the point of care, which often translates into limited time spent counseling patients. The consistent message from all health care providers to their patients should be to start or to continue a regular exercise program. Exercise is Medicine is a solution that enables physicians to support their patients in implementing exercise as part of their disease prevention and treatment strategies.
Leadership, management and command in the time of the Coronavirus
Authors: Grint Keith
Published: April 2020

The Covid-19 pandemic that swept through the world in late 2019 and through 2020 provides a test not just for all societies and their leadership, but for leadership theory. In a world turned upside down, when many conventions are disposed of, it is clear that things will not return to the status quo ante any time soon, if ever. In the light of these challenges, this short paper suggests we might reconsider the way governments and their leaders act against the frame of societal problems, originally established by Rittell and Webber in 1973. I suggest that all three modes of decision-making (Leadership, management and command) are necessary because of the complex and complicated nature of the problem and conclude that while Command is appropriate for certain times and issues, it also poses long-term threats, especially if the context is ignored.
Exploring Balloon Sinuplasty Adverse Events With the Innovative OpenFDA Database
Authors: Wright Alex E. , Davis Erik D. , Khan Mashfee , Chaaban Mohamad R.
Published: April 2020

Background

Balloon sinuplasty (BSP) has become a common, minimally invasive treatment for chronic sinusitis. Like any surgical procedure, there are definite risks when using it as a stand-alone procedure or in conjunction with other revision procedures.

Objective

To explore the adverse events of BSP using the openFDA cloud with regard to malfunction and injury following surgery.

Methods

Between January 2015 and December 2018, the Food and Drug Administration’s (FDA) openFDA database was queried for adverse event use. Reports were further categorized by procedure location, injury type, device malfunction, procedure (stand-alone BSP vs hybrid), and source of complication (anatomical or surgeon related).

Results

Seventy-eight events were reported to the FDA in the study period. Majority of cases consisted of device malfunctions (64.1%), while patient injuries consisted of 43.5%. Frontal sinus procedures had the greatest presence of adverse events (47.4%) with the majority reporting significant cerebrospinal fluid (CSF) leaks ( P < .001) and device retention ( P = .021). Orbital complications ( P = .004) were found to be significantly associated with dilation of the maxillary sinus. Skull-based injuries were the only factor incident in which surgeon-reported anatomical complications were significant ( P = .018).

Conclusions

As balloon dilation procedure continues to rise in the United States, significant adverse events continue to occur. Frontal sinus BSP leads to the highest number of complications and a 4.75 reported CSF leaks yearly. Based on real data, surgeons performing the procedure should be acquainted with common BSP-related injuries so they can prepare for those circumstances and share informed consent with their patients.
All evidence is equal, but electronic evidence is more equal than any other: The relationship between the European Investigation Order and the European Production Order
Authors: Tosza Stanislaw
Published: April 2020

The European Investigation Order (EIO) was supposed to offer a comprehensive solution to cross-border gathering of evidence within the area of freedom, security and justice replacing a patchwork of instruments and providing for one single standardised order for all types of evidence. However, not even a year since the deadline for its implementation had passed, the Commission proposed an instrument that would be applicable for electronic evidence: European Production Order (EPO). This initiative was born from an increasing frustration in gathering this type of evidence and the conviction that the EIO is not suitable for that purpose. The need for digital evidence (according to the estimate of the EU Commission, 85% of criminal investigations require electronic evidence) is a direct consequence of the place information and communication technology has taken in everyday life. However, electronic evidence differs in a number of ways from ‘real-life’ evidence rendering current legal framework extremely impractical for law enforcement. One of the major obstacles that law enforcement authorities encounter is the fact that the data they need are often stored abroad or by a foreign service provider. Both instruments were conceived because of the need to gather evidence across borders; however, the transnational component is different (evidence being abroad vs. service provider being foreign). Both instruments subject ‘European citizens to the investigative machinery of any other Member State’, however, in a different way. If the e-evidence package is adopted, it will create a dual system of cross-border gathering of evidence, with different philosophy, procedure, enforcement and protective framework. The goal of this article is to analyse and compare two different models of acquiring evidence that these two instruments offer as well as to delimitate their (non-exclusive) scope. The concluding part will provide a reflection on the systemic consequences of this duality of instruments and of introducing the EPO model in particular.
Improvements in exercise capacity of older adults during cardiac rehabilitation
Authors: Bierbauer Walter , Scholz Urte , Bermudez Tania , Debeer Dries , Coch Michael , Fleisch-Silvestri Ruth , Nacht Claude-Alain , Tschanz Hansueli , Schmid Jean-Paul , Hermann Matthias
Published: April 2020

Aims

Cardiac rehabilitation plays a vital role in secondary prevention of cardiovascular patients. Female sex and higher age, however, are associated with non-referral to cardiac rehabilitation. Improving exercise capacity during cardiac rehabilitation is essential to reduce morbidity and mortality risks. The objective of this study was to closely examine the beneficial changes in exercise capacity of older patients of both sexes during cardiac rehabilitation and to identify the most important predictors of the change in exercise capacity.

Method

A sample of 13,612 patients (mean age = 69.10 ± 11.8 years, 63.7% men, 19% > 80 years) was analysed. Data were prospectively assessed from 2012–2018 in six Swiss in-patient cardiovascular rehabilitation clinics. Improvement in exercise capacity measured with the six-minute walking test represents the outcome variable. Univariate and multivariate analyses, as well as the random forest method were used to estimate variable importance.

Results

Mean improvement in the six-minute walking test was 113.5 ± 90.5 m (men = 118.7 ± 110.0; women = 104.4 ± 93.0, Cohen’s d = 0.16). The presence of heart failure, diabetes mellitus and psychiatric diagnoses was related to reduced but nonetheless clinically relevant six-minute walking test improvement. Random forest analysis suggests that baseline exercise capacity, age, time in rehabilitation and heart failure were the most important predictors for improvement in exercise capacity. Clinically relevant improvements in exercise capacity (>45 m) were also present into old age (85 years) and for both sexes.

Conclusion

As indicated by these results, efforts need to be increased to refer eligible patients to structured rehabilitation programmes, irrespective of patients’ age and sex.
Incidence, predictors and prognosis of respiratory support in non-ST segment elevation myocardial infarction
Authors: Metkus Thomas , Miller P Elliott , Alviar Carlos L , Jentzer Jacob C , van Diepen Sean , Katz Jason N , Morrow David A , Schulman Steven , Eid Shaker
Published: April 2020

Background

The incidences of invasive mechanical ventilation and non-invasive ventilation among patients with non-ST segment elevation myocardial infarction and associated prognosis are not well characterized.

Methods

We conducted a retrospective cohort study of patients with admission diagnosis of non-ST segment elevation myocardial infarction using the US National Inpatient Sample database between 2002–2014. The exposure variable was invasive mechanical ventilation or non-invasive ventilation within 24 h of admission, compared to no respiratory support. The primary outcome was in-hospital mortality. We determined the association between respiratory support and mortality using Cox proportional hazard models.

Results

A total of 4,152,421 non-ST segment elevation myocardial infarction hospitalizations were identified, among whom 1.3% required non-invasive ventilation and 1.9% required invasive mechanical ventilation. Non-invasive ventilation use increased over time (0.4% in 2002 to 2.4% in 2014, p<0.001) while there was no definite trend in invasive mechanical ventilation use. Revascularization was lower for non-ST segment elevation myocardial infarction hospitalizations including invasive mechanical ventilation (23.9%) and non-invasive ventilation (14.5%) compared to 36.5% of those without respiratory support (p<0.001). In-hospital mortality was 3.1% for non-ST segment elevation myocardial infarction without respiratory support compared to 9.2% with non-invasive ventilation (adjusted hazard ratio 1.86, 95% confidence interval 1.74–1.98) and 37.2% with invasive mechanical ventilation (adjusted hazard ratio 3.03, 95% confidence interval 2.88–3.19). Mortality for non-ST segment elevation myocardial infarction-non-invasive ventilation is improving over time while mortality for non-ST segment elevation myocardial infarction-invasive mechanical ventilation is increasing over time.

Conclusion

Mechanical respiratory support in non-ST segment elevation myocardial infarction is used in an important minority of cases, is increasing and is independently associated with mortality. Studies of the optimal management of acute coronary syndrome complicated by respiratory failure are needed to improve outcomes.
Personal Goals and Identity of Czech University Students
Authors: Kvasková Lucia , Širůček Jan , Ježek Stanislav , Hrubá Lucie , Lacinová Lenka , Macek Petr
Published: April 2020

This study aimed to examine personal goal setting and identity processes in Czech university students. A total of 1,347 Czech emerging adults completed the questionnaires on goal setting, identity commitment, and identity exploration in various life domains (romantic relationship, education, and work). First, our study showed that in our sample, goals related to education were the most prominent. Second, higher identity commitment or exploration in one domain predicted setting the goal in the same domain, supporting the notion of the interrelatedness of identity formation and goal pursuit. Additionally, those who set work-related goals reported fewer goals associated with romantic partnership, marriage, and family, suggesting individual differences in goal preferences. Our study adds to the knowledge of European emerging adults’ identity processes and goal selection processes. Furthermore, our findings stress the holistic approach when investigating personal goals.
COVID-19 and Spine Surgery: A Review and Evolving Recommendations
Authors: Jain Nickul S. , Alluri Ram K. , Schopler Steven S. , Hah Raymond , Wang Jeffrey C.
Published: April 2020

Coronavirus-19 (COVID-19) has disrupted the normal delivery of healthcare for spine surgeons across the world. In this review, we will provide an overview of COVID-19's clinical features, and discuss the optimization and treatment of spine pathology during the ongoing global pandemic.
In Vivo Randomized Controlled Study of the Bone Response of All-Suture Anchors and Biocomposite Anchors
Authors: Stewart Christopher M.B. , Raja Haseem , Torrance Emma , Funk Lennard
Published: April 2020

Background:

Suture anchors are widely used for labral reconstruction surgery. However, there has been some concern over the development of osteolysis around the anchor. This has been reported for both biocomposite and all-suture anchors, but they have not been compared directly in vivo.

Purpose:

To compare the bone response to 2 common suture anchors: a traditional biocomposite push-fit anchor and an all-suture anchor.

Study Design:

Randomized controlled trial; Level of evidence, 2.

Methods:

Included in this study were 17 patients with a total of 37 unique suture anchors. Magnetic resonance imaging scans were performed at 3 weeks and 6 months postoperatively. A total of 38 senior radiologists and shoulder surgeons evaluated the images using a previously validated system for grading the bone response around suture anchors. The mean difference in grading at 3 weeks and 6 months was calculated using unpaired t tests, and the interrater reliability was evaluated with an intraclass correlation coefficient (ICC).

Results:

At 3 weeks, there was no statistically significant difference in the degree of osteolysis surrounding each suture anchor type ( P = .258), with little bone response. However, on the 6-month scans, there was a significantly lower level of osteolysis seen in the all-suture anchors compared with the biocomposite anchors ( P = .040). Interrater reliability was excellent, with an ICC value of 0.975 (95% CI, 0.962-0.985).

Conclusion:

All-suture anchors cause significantly less osteolysis in glenoid bone at 6 months compared with biocomposite anchors.
Localization Performance in a Binaural Real-Time Auralization System Extended to Research Hearing Aids
Authors: Pausch Florian , Fels Janina
Published: April 2020

Auralization systems for auditory research should ideally be validated by perceptual experiments, as well as objective measures. This study employed perceptual tests to evaluate a recently proposed binaural real-time auralization system for hearing aid (HA) users. The dynamic localization of real sound sources was compared with that of virtualized ones, reproduced binaurally over headphones, loudspeakers with crosstalk cancellation (CTC) filters, research HAs, or combined via loudspeakers with CTC filters and research HAs under free-field conditions. System-inherent properties affecting localization cues were identified and their effects on overall horizontal localization, reversal rates, and angular error metrics were assessed. The general localization performance in combined reproduction was found to fall between what was measured for loudspeakers with CTC filters and research HAs alone. Reproduction via research HAs alone resulted in the highest reversal rates and angular errors. While combined reproduction helped decrease the reversal rates, no significant effect was observed on the angular error metrics. However, combined reproduction resulted in the same overall horizontal source localization performance as measured for real sound sources, while improving localization compared with reproduction over research HAs alone. Collectively, the results with respect to combined reproduction can be considered a performance indicator for future experiments involving HA users.
Energy Market Integration in Northeast Region of India: Efficiencies, Vulnerabilities and Strategic Implications for Asia
Authors: Anbumozhi Venkatachalam , Kutani Ichiro , Singh Bhupendra Kumar
Published: April 2020

Energy is a common thread that connects multiple economic domains of countries and sub-regions in Asia. In the drive to trigger and consolidate energy market integration, the North Eastern Region (NER) of India offers great potential as electricity trading hub. This article analyses multiple potentials of energy markers of NER with neighbouring countries through cross-border trade. Supply and demand analysis under different connectivity scenarios shows that not only the eight states of NER of India may be able to fully utilise the economic benefits of energy market integration, but also the neighbouring countries like Bangladesh, Bhutan and Myanmar should keep their carbon emissions in check by importing reliable cost effective energy sources. However, lack of infrastructure for the transfer of power to a common transmission system increases the vulnerability of energy market integration. Given the region’s diverse hydro-geography and wide range of clean energy portfolios, energy market integration perspective offers a way forward for strategic energy security planning and climate mitigation strategy for NER and neighbouring Asian countries.
Giant Intrathoracic Goiter of Atypical Presentation: A Case Report
Authors: Iriarte María B. , Morales Eliana I. , Velásquez Mauricio , Zúñiga Valeria , Sua Luz F. , Fernández-Trujillo Liliana
Published: April 2020

Background:

The term goiter is used to describe any abnormal growth of the thyroid gland, which can be diffuse or nodular, and can be associated with normal, diminished, or increased thyroid function. Multinodular goiter is a common disease whose prevalence increases at age 50. Clinical manifestations can be due to thyroid function impairment or related to size and location of the gland with compressive symptoms. Intrathoracic location is less frequent, can be mistaken with pulmonary lesions and usually implies a difficult surgical approach.

Case presentation:

A 66-year-old woman with a history of subtotal thyroidectomy presented with 7-month dyspnea, dry cough. There was no evidence of neck masses, or jugular engorgement. Physical examination was normal. Chest x-ray showed an 11 cm mass in the upper right hemithorax. Computed tomography (CT)-scan, showed calcifications, and compression of the superior vena cava without infiltration, the right subclavian vein and left displacement of the trachea. Distinction between intrapulmonary or mediastinal location was not clear. Biopsy showed thyroid origin, and bilateral thoracotomy was performed with confirmation of a giant multinodular goiter.

Conclusions:

Intrathoracic goiter should undergo surgical or ablative management if compressive symptoms of the airway and cervical or thoracic vessels are present. The large size of the tumor along with the presentation after thyroidectomy and the seeming location in the right upper lobe made this particular case striking. Specially in the elderly, multidisciplinary perioperative management is key for a successful recovery.
A phase 1 trial of itacitinib, a selective JAK1 inhibitor, in patients with acute graft-versus-host disease
Authors: Schroeder Mark A. , Khoury H. Jean , Jagasia Madan , Ali Haris , Schiller Gary J. , Staser Karl , Choi Jaebok , Gehrs Leah , Arbushites Michael C. , Yan Ying , Langmuir Peter , Srinivas Nithya , Pratta Michael , Perales Miguel-Angel , Chen Yi-Bin , Meyers Gabrielle , DiPersio John F.
Published: April 2020

Acute graft-versus-host disease (aGVHD) following allogeneic hematopoietic cell transplantation (HCT) is a primary cause of nonrelapse mortality and a major barrier to successful transplant outcomes. Itacitinib is a Janus kinase (JAK)1–selective inhibitor that has demonstrated efficacy in preclinical models of aGVHD. We report results from the first registered study of a JAK inhibitor in patients with aGVHD. This was an open-label phase 1 study enrolling patients aged ≥18 years with first HCT from any source who developed grade IIB to IVD aGVHD. Patients with steroid-naive or steroid-refractory aGVHD were randomized 1:1 to itacitinib 200 mg or 300 mg once daily plus corticosteroids. The primary endpoint was safety and tolerability; day 28 overall response rate (ORR) was the main secondary endpoint. Twenty-nine patients (200 mg, n = 14; 300 mg, n = 15) received ≥1 dose of itacitinib and were included in safety and efficacy assessments. One dose-limiting toxicity was reported (grade 3 thrombocytopenia attributed to GVHD progression in a patient receiving 300 mg itacitinib with preexisting thrombocytopenia). The most common nonhematologic treatment-emergent adverse event was diarrhea (48.3%, n = 14); anemia occurred in 11 patients (38%). ORR on day 28 for all patients in the 200-mg and 300-mg groups was 78.6% and 66.7%, respectively. Day 28 ORR was 75.0% for patients with treatment-naive aGVHD and 70.6% in those with steroid-refractory aGVHD. All patients receiving itacitinib decreased corticosteroid use over time. In summary, itacitinib was well tolerated and demonstrated encouraging efficacy in patients with steroid-naive or steroid-refractory aGVHD, warranting continued clinical investigations. This trial was registered at www.clinicaltrials.gov as #NCT02614612.
On Sackin’s original proposal: the variance of the leaves’ depths as a phylogenetic balance index
Authors: M. Coronado Tomás , Mir Arnau , Rosselló Francesc , Rotger Lucía
Published: April 2020

Background

The Sackin indexS of a rooted phylogenetic tree, defined as the sum of its leaves’ depths, is one of the most popular balance indices in phylogenetics, and Sackin’s paper (Syst Zool 21:225–6, 1972) is usually cited as the source for this index. However, what Sackin actually proposed in his paper as a measure of the imbalance of a rooted tree was not the sum of its leaves’ depths, but their “variation”. This proposal was later implemented as the variance of the leaves’ depths by Kirkpatrick and Slatkin in (Evolution 47:1171–81, 1993), where they also posed the problem of finding a closed formula for its expected value under the Yule model. Nowadays, Sackin’s original proposal seems to have passed into oblivion in the phylogenetics literature, replaced by the index bearing his name, which, in fact, was introduced a decade later by Sokal.

Results

In this paper we study the properties of the variance of the leaves’ depths, V, as a balance index. Firstly, we prove that the rooted trees with n leaves and maximum V value are exactly the combs with n leaves. But although V achieves its minimum value on every space $\mathcal {BT}_{n}$ℬTn of bifurcating rooted phylogenetic trees with n≤183 leaves at the so-called “maximally balanced trees” with n leaves, this property fails for almost every n≥184. We provide then an algorithm that finds the trees in $\mathcal {BT}_{n}$ℬTn with minimum V value in time O(n log(n)). Secondly, we obtain closed formulas for the expected V value of a bifurcating rooted tree with any number n of leaves under the Yule and the uniform models and, as a by-product of the computations leading to these formulas, we also obtain closed formulas for the variance under the uniform model of the Sackin index and the total cophenetic index (Mir et al., Math Biosci 241:125–36, 2013) of a bifurcating rooted tree, as well as of their covariance, thus filling this gap in the literature.

Conclusion

The phylogenetics community has been wise in preferring the sum S(T) of the leaves’ depths of a phylogenetic tree T over their variance V(T) as a balance index, because the latter does not seem to capture correctly the notion of balance of large bifurcating rooted trees. But it is still a valid and useful shape index.
Early detection of left atrial and bi-ventricular myocardial strain abnormalities by MRI feature tracking in normotensive or hypertensive T2DM patients with preserved LV function
Authors: Shao Guozhu , Cao Yukun , Cui Yue , Han Xiaoyu , Liu Jia , Li Yumin , Li Na , Liu Tong , Yu Jie , Shi Heshui
Published: April 2020

Background

Previous studies have found that impaired global myocardial systolic strain is associated with cardiovascular events in T2DM patients. However, the effect of hypertension (HT) on left atrial (LA), right ventricular (RV) and left ventricular (LV) myocardial deformation in hypertensive T2DM patients has not been fully studied by cardiac magnetic resonance feature tracking (CMR-FT). Our aim was to assess LA, RV and LV strain in T2DM patients with T2DM-HT and without hypertension using CMR-FT and to determine the underlying relationships with clinical parameters.

Methods

A total of 27 T2DM patients, 23 T2DM-HT patients and 31 controls were studied. LA, LV and RV strain was evaluated using CMR-FT. The clinical and biochemical parameters of the patients were collected.

Results

The T2DM patients had reduced LA global circumferential strain (LAGCS), radial strain (LAGRS), longitudinal strain (LAGLS) and right ventricular longitudinal strain (RVGLS) compared with the controls (LAGCS: 27.2 ± 2.1% vs 33.5 ± 2.4%; LAGRS: − 28.6 ± 1.1% vs − 31.9 ± 1.3%; LAGLS: 24.3 ± 1.3% vs 31.4 ± 1.5; RVGLS: − 21.4 ± 1.2% vs − 26.3 ± 1.1%, p < 0.05 for all). The T2DM-HT patients had greater LAGCS, LAGRS and LAGLS than the T2DM patients (LAGCS: 40.4 ± 3.8% vs 27.2 ± 2.1%; LAGRS: − 36.8 ± 2.0% vs − 28.6 ± 1.1%; LAGLS: 32.3 ± 2.4% vs 24.3 ± 1.3%, p < 0.05 for all). In the diabetic patients, LAGCS was associated with microalbuminuria levels (standardized ß = − 0.289, p = 0.021), and LAGCS, LAGRS and LAGLS were correlated with diuretic treatment (standardized ß =0.440, − 0.442, and 0.643, p < 0.05 for all).

Conclusions

CMR-FT may be considered a promising tool for the early detection of abnormal LA and RV myocardial strain. LA and RV strain values are impaired in T2DM patients. The amelioration of LA strain might be associated with hypertensive compensation or antihypertensive treatment, which requires to be confirmed in larger trials.
Image diagnosis: Eisenmenger’s syndrome in patients with simple congenital heart disease
Authors: Bu Haisong , Gong Xueyang , Zhao Tianli
Published: April 2020

Background

Early identification of congenital heart disease (CHD) allows detection of the pulmonary arteriopathy in an early stage, and timely shunt closure can permanently reverse pulmonary arterial hypertension (PAH). However, surgical correction is not recommended in patients with irreversible PAH. Herein we report our experience about Eisenmenger’s syndrome in simple CHD.

Case presentation

From January 2017 to November 2018, a total of 8 CHD patients (3 ventricular septal defects (VSD), 2 atrial septal defects (ASD), and 3 patent ductus arteriosus (PDA), median age, 15.5 years [range, 3–18 years]) with PAH were detected by chest X-ray, electrocardiogram, transthoracic echocardiography (TTE), computed tomographic angiography (CTA) and cardiac catheterization. The median defect diameter, pulmonary artery pressure (PAP), pulmonary vascular resistance (PVR) were 16.5 mm (range, 3–30 mm), 75 mmHg (range, 60–86 mmHg), and 16 Woods units (range, 12–19 Woods units), respectively. Here, we report the representative cases of three types of simple CHD with irreversible PAH. The surgical correction was not performed in all patients who had fixed PAH and were referred to medical treatment.

Conclusions

PAH in CHD can be reversed by early shunt closure, but this potential is lost beyond a certain point of no return. This article highlights the essence of enhancing the level of healthcare and services in Chinese rural areas. Failure to accurately and timely assess PAH will delay effective treatment past optimal treatment time, and even lead to death.
Reduced risk of post ERCP pancreatitis in statin users
Authors: Hadi Yousaf Bashir , Naqvi Syeda Fatima , Abdelqader Abdelhai , Kupec Justin , Nasr John
Published: April 2020

Background

One of the most feared complications of endoscopic retrograde cholangiopancreatography (ERCP), with an incidence of 3.5 to 15%, is post ERCP pancreatitis (PEP). Given the role of statins in the reduction of systemic and pancreatic intraluminal inflammation, we hypothesized that the use of statins may lower the risk of PEP.

Methods

A retrospective cohort study of all patients undergoing ERCP at West Virginia University during the years 2016 and 2017 was performed. Possible association of collected variables with PEP was assessed with Univariate tests and multivariable logistic regression analyses.

Results

A total of 1162 ERCPs were included. Mean age was 60.12 years (SD: 17.5). 51.3% of the participants were female. Two hundred and sixty-three participants underwent more than one ERCP during the study period.

Seven hundred and ninety-nine ERCPs (78.8%) were conducted in participants who were not taking a statin medication at the time of ERCP, while 363 participants were on statin medications at the time of ERCP; 118 and 245 participants were taking high dose statins (atorvastatin 40–80 mg or rosuvastatin 20 mg), and low/medium dose statins (all other statin regimens) at the time of the procedure, respectively.

The overall incidence of PEP in the cohort was 7.3%. In the non-statin and statin groups, 9.5 and 3.4% of participants developed PEP, respectively. On univariate analysis, young age, no statin use, history of PEP, and endoscopic sphincterotomy were found to be significantly associated with the development of PEP. In a binary logistic regression model, young age (P = 0.033), history of PEP (P = 0.0001, OR 2.41, 95% CI: 1.05–5.51) and endoscopic sphincterotomy (P = 0.038, OR 2.85, 95% CI: 1.7–4.78) were found to be associated with increased risk of PEP. Statin usage was found to be protective against PEP, (OR 0.35, 95% CI: 0.18–0.69).

Conclusion

Chronic statin usage is protective against post ERCP pancreatitis, and our findings suggest a potential role of these drugs as prophylactic agents. Randomized controlled trials are needed to establish any potential clinical application.
Cerebrospinal fluid leak presented with the C1-C2 sign caused by spinal canal stenosis: a case report
Authors: Akiba Chihiro , Bandai Hideki , Ito Yoshitaka , Maeda Tsuyoshi , Yamaguchi Keisuke , Nakajima Madoka , Miyajima Masakazu
Published: April 2020

Background

Intracranial hypotension is a disorder characterized by low cerebrospinal fluid (CSF) pressure typically caused by loss of CSF. Although some mechanisms account for the CSF leakage have been elucidated, spinal canal stenosis has never been reported as a pathological cause of intracranial hypotension.

C1-C2 sign is a characteristic imaging feature, which indicates CSF collection between the spinous processes of C1 and C2, occasionally observed on magnetic resonance imaging (MRI) in patients with intracranial hypotension.

Case presentation

A 58-year-old man was presented to our institute with complaints of posterior cervical pain persisting for 3 months, along with numbness and muscle weakness of extremities. A fat suppression T2-weighted image of MRI illustrated fluid collection in the retrospinal region at C1-C2 level, and an 111In-DTPA cisternoscintigram clearly revealed the presence of CSF leakage into the same region. The MRI also showed stenosis in spinal canal at C3/4 level, and a computed tomography (CT) myelogram suggested a blockage at the same level. We gave a diagnosis as intracranial hypotension due to the CSF leakage, which might be caused by the spinal canal stenosis at C3/4 level. Despite 72 h of conservative therapy, a brain CT showed the development of bilateral subdural hematomas. We, therefore, performed burr-hole drainage of the subdural hematoma, blood-patch therapy at C1/2 level, and laminoplasty at C3–4 at the same time. Improvement of symptoms and imaging features which suggested the CSF leak and subdural hematoma were obtained post-operatively.

Conclusion

The present case suggested the mechanism where the CSF leakage was revealed as fluid collection in the retrospinal region at C1-C2 level. Increased intradural pressure due to the spinal canal stenosis resulted in dural tear. CSF leaked into the epidural space and subsequently to the retrospinal region at C1-C2 level, due to the presence of spinal canal stenosis caudally as well as the vulnerability of the tissue structure in the retrospinal region at C1-C2 level. Thus, our theory supports the mechanisms of previously reported CSF dynamics associated to C1-C2 sign, and also, we suggest spinal canal stenosis as a novel etiology of intracranial hypotension.
Different associations of tumor PIK3CA mutations and clinical outcomes according to aspirin use among women with metastatic hormone receptor positive breast cancer
Authors: McCarthy Anne Marie , Kumar Nitya Pradeep , He Wei , Regan Susan , Welch Michaela , Moy Beverly , Iafrate A. John , Chan Andrew T. , Bardia Aditya , Armstrong Katrina
Published: April 2020

Introduction

The relationships among PIK3CA mutations, medication use and tumor progression remains poorly understood. Aspirin use post-diagnosis may modify components of the PI3K pathway, including AKT and mTOR, and has been associated with lower risk of breast cancer recurrence and mortality. We assessed time to metastasis (TTM) and survival with respect to aspirin use and tumor PIK3CA mutations among women with metastatic breast cancer.

Methods

Patients with hormone receptor positive, HER2 negative (HR+/HER2-) metastatic breast cancer treated in 2009–2016 who received tumor genotyping were included. Aspirin use between primary and metastatic diagnosis was extracted from electronic medical records. TTM and survival were estimated using Cox proportional hazards regression.

Results

Among 267 women with metastatic breast cancer, women with PIK3CA mutated tumors had longer TTM than women with PIK3CA wildtype tumors (7.1 vs. 4.7 years, p = 0.008). There was a significant interaction between PIK3CA mutations and aspirin use on TTM (p = 0.006) and survival (p = 0.026). PIK3CA mutations were associated with longer TTM among aspirin non-users (HR = 0.60 95% CI:0.44–0.82 p = 0.001) but not among aspirin users (HR = 1.57 0.86–2.84 p = 0.139). Similarly, PIK3CA mutations were associated with reduced mortality among aspirin non-users (HR = 0.70 95% CI:0.48–1.02 p = 0.066) but not among aspirin users (HR = 1.75 95% CI:0.88–3.49 p = 0.110).

Conclusions

Among women who develop metastatic breast cancer, tumor PIK3CA mutations are associated with slower time to progression and mortality only among aspirin non-users. Larger studies are needed to confirm this finding and examine the relationship among aspirin use, tumor mutation profile, and the overall risk of breast cancer progression.
Influence of Nodal signalling on pluripotency factor expression, tumour cell proliferation and cisplatin-sensitivity in testicular germ cell tumours
Authors: Harpelunde Poulsen K. , Nielsen J. E. , Grønkær Toft B. , Joensen U. N. , Rasmussen L. J. , Blomberg Jensen M. , Mitchell R. T. , Juul A. , Rajpert-De Meyts E. , Jørgensen A.
Published: April 2020

Background

Testicular germ cell tumours (TGCTs) are characterised by an overall high cisplatin-sensitivity which has been linked to their continued expression of pluripotency factors. Recently, the Nodal signalling pathway has been implicated in the regulation of pluripotency factor expression in fetal germ cells, and the pathway could therefore also be involved in regulating expression of pluripotency factors in malignant germ cells, and hence cisplatin-sensitivity in TGCTs.

Methods

We used in vitro culture of the TGCT-derived cell line NTera2, ex vivo tissue culture of primary TGCT specimens and xenografting of NTera2 cells into nude mice in order to investigate the consequences of manipulating Nodal and Activin signalling on pluripotency factor expression, apoptosis, proliferation and cisplatin-sensitivity.

Results

The Nodal signalling factors were markedly expressed concomitantly with the pluripotency factor OCT4 in GCNIS cells, seminomas and embryonal carcinomas. Despite this, inhibition of Nodal and Activin signalling either alone or simultaneously did not affect proliferation or apoptosis in malignant germ cells in vitro or ex vivo. Interestingly, inhibition of Nodal signalling in vitro reduced the expression of pluripotency factors and Nodal pathway genes, while stimulation of the pathway increased their expression. However, cisplatin-sensitivity was not affected following pharmacological inhibition of Nodal/Activin signalling or siRNA-mediated knockdown of the obligate co-receptor CRIPTO in NTera2 cells in vitro or in a xenograft model.

Conclusion

Our findings suggest that the Nodal signalling pathway may be involved in regulating pluripotency factor expression in malignant germ cells, but manipulation of the pathway does not appear to affect cisplatin-sensitivity or tumour cell proliferation.