bluuebunny/crossref_metadata_2025 huggingface dataset:
Who is a high-risk surgical patient?
Authors: Bose Somnath , Talmor Daniel
Published: October 2018

Purpose of review

Timely identification of high-risk surgical candidates facilitate surgical decision-making and allows appropriate tailoring of perioperative management strategies. This review aims to summarize the recent advances in perioperative risk stratification.

Recent findings

Use of indices which include various combinations of preoperative and postoperative variables remain the most commonly used risk-stratification strategy. Incorporation of biomarkers (troponin and natriuretic peptides), comprehensive objective assessment of functional capacity, and frailty into the current framework enhance perioperative risk estimation. Intraoperative hemodynamic parameters can provide further signals towards identifying patients at risk of adverse postoperative outcomes. Implementation of machine-learning algorithms is showing promising results in real-time forecasting of perioperative outcomes.

Perioperative risk estimation is multidimensional including validated indices, biomarkers, functional capacity estimation, and intraoperative hemodynamics. Identification and implementation of targeted strategies which mitigate predicted risk remains a greater challenge.
Left main coronary artery atresia with concomitant mitral regurgitation in an adult
Authors: Tian Meice , Wang Xianqiang , Gao Huawei , Wang Liqing , Hu Shengshou
Published: October 2018

Introduction:

Left main coronary artery (LMCA) atresia is a quite rare congenital malformation, which may present with various symptoms. Past literatures were sporadic without recent summary of world-wide cases. We hereby report an adult case of LMCA atresia with concomitant mitral regurgitation and also summarize all cases found in published literatures.

Case presentation:

A 48-year old female presented with sudden dyspnea. Preliminary impression was acute heart failure caused by mitral regurgitation. Preoperative coronary angiography demonstrated that there was no left coronary ostium and multiple collateral vessels arising from right coronary artery. The diagnosis of left main coronary atresia was made and the patient received successful valvuloplasty and coronary artery bypass grafting with left internal mammary artery anastomosed to the left anterior descending (LAD) artery. She recovered well and 3-month follow-up showed the graft was patent.

Conclusion:

This case highlights the importance of angiography for diagnosis of LMCA and performance of CABG once diagnosed.
The prognostic value of decreased NDRG1 expression in patients with digestive system cancers
Authors: Chen Kang , Liu Xiao-Hong , Wang Fu-Rong , Liu Hai-Peng , Huang Ze-Ping , Chen Xiao
Published: October 2018

Background:

Digestive system cancers are recognized as associated with high morbidity and mortality. It is generally accepted that N-myc downstream-regulated gene 1 (NDRG1) is aberrantly overexpressed or downregulated in digestive system cancers, and its prognostic value remains controversial. Accordingly, we herein conducted a meta-analysis to explore whether NDRG1 expression is correlated with overall survival (OS) and clinicopathological characteristics of patients with digestive system cancers.

Methods:

We systematically searched PubMed, EMBASE, and Web of Science for eligible studies up to June 6, 2017. In all, 19 publications with 21 studies, were included.

Results:

The pooled results showed that low NDRG1 expression was significantly associated with worse OS in colorectal cancer (pooled HR = 1.67, 95% CI: 1.22–2.28, P < .001) and pancreatic cancer (pooled HR = 1.87, 95% CI: 1–3.5, P < .0001). Moreover, the relationships between low NDRG1 expression and higher OS ratio of patients with liver cancer (pooled HR = 0.44, 95% CI: 0.32–0.62, P = .009) and gallbladder cancer (pooled HR = 0.56, 95% CI: 0.23–1.38, P = .01) were observed. Nevertheless, no significant association was observed between low NDRG1 expression and OS in gastric cancer (pooled HR = 0.81, 95% CI: 0.45–1.43, P = .46) or esophageal cancer (pooled HR = 0.76, 95% CI: 0.26–2.24, P = .62).

Conclusion:

The prognostic significance of NDRG1 expression varies according to cancer type in patients with DSCs. Considering that several limitations existed in this meta-analysis, more studies are required to further assess the prognostic value of NDRG1 expression in patients with DSCs and relevant mechanisms.
Oral health condition and occurrence of depression in the elderly
Authors: Skośkiewicz-Malinowska Katarzyna , Malicka Barbara , Ziętek Marek , Kaczmarek Urszula
Published: October 2018

Depression is a common disorder among the elderly; however, it is not a standard element of the ageing process. Depression can affect oral health as a result of neglecting oral hygiene procedures, cariogenic nutrition, avoidance of necessary dental care which leads to an increased risk of dental caries and periodontal disease.

Assessment of the relationship of oral health parameters with depression.

500 subjects aged ≥65 (mean 74.4 ± 7.4) were involved in the study. Dental condition (decay-missing-filled index [DMFT], number of missing teeth [MT], removable denture wearing, teeth mobility), periodontal condition (bleeding on probing [BoP], pocket depth [PD], loss of attachment), oral dryness (the Challacombe Scale) and depression according to the Patient Health Questionnaire-9 (PHQ-9) scale were assessed.

Depression on a minimal level was detected in 60.2% of the subjects, mild—in 22.2%, moderate—in 6.0% and moderately—in 2.6%. The mean of the PHQ-9 scale was 3.56 ± 4.07. Regression analysis showed a positive relationship of the PHQ-9 value with DMFT, the number of MT, oral dryness and with age. No correlation was observed between other examined oral health indicators, such as periodontal condition (BoP, PD, clinical attachment level), periodontitis, removable denture wearing a PHQ-9.

The results of our study have shown that among people aged 65 and over, the severity of depression increases with a higher number of MT, the number of decayed teeth, as well as prevalence of oral dryness.
Percutaneous versus open pedicle screw instrumentation in treatment of thoracic and lumbar spine fractures
Authors: Tian Feng , Tu Lai-Yong , Gu Wen-Fei , Zhang En-Feng , Wang Zhen-Bin , Chu Ge , Ka Haer , Zhao Jiang
Published: October 2018

Background:

To assess the safety and efficacy of percutaneous short-segment pedicle instrumentation compared with conventionally open short-segment pedicle instrumentation and provide recommendations for using these procedures to treat thoracolumbar fractures.

Methods:

The Medline database, Cochrane database of Systematic Reviews, Cochrane Clinical Trial Register, and Embase were searched for articles published. The randomized controlled trials (RCTs) and non-RCTs that compared percutaneous short-segment pedicle instrumentation to open short-segment pedicle instrumentation and provided data on safety and clinical effects were included. Demographic characteristics, clinical outcomes, radiological outcomes, and adverse events were manually extracted from all of the selected studies. Methodological quality of included studies using Methodological Index for Non-Randomized Studies scale and Cochrane collaboration's tool for assessing the risk of bias by 2 reviewers independently.

Results:

Nine studies encompassing 433 patients met the inclusion criteria. Subgroup meta-analyses were performed according to the study design. The pooled results showed there were significant differences between the 2 techniques in short- and long-term visual analog scale, intraoperative blood loss, operative time, postoperative draining loss, hospital stay, and incision size, although there were no significant differences in postoperative radiological outcomes, Oswestry Disability Index, hospitalization cost, intraoperative fluoroscopy time, and adverse events.

Conclusion:

Percutaneous short-segment pedicle instrumentation in cases with achieve satisfactory results, could replace in many cases extensive open surgery and not increased related complications. However, further high-quality RCTs are needed to assess the long-term outcome of patients between 2 techniques.
Diffuse optical spectroscopy for monitoring the responses of patients with breast cancer to neoadjuvant chemotherapy
Authors: Liu Yong Hong , Xue Ling Bo , Yang Yan Fang , Zhao Tian Jiao , Bai Yang , Zhang Bu Yong , Li Jie
Published: October 2018

Background:

This study aimed to investigate the potential of diffuse optical spectroscopy (DOT) for monitoring the responses of patients with breast cancer to neoadjuvant chemotherapy (NAC).

Methods:

We searched PubMed, EMBASE, Cochrane Database of Systematic Reviews, and Web of Science for relevant studies. Data were extracted for pooled analysis, heterogeneity testing, threshold effect testing, sensitivity analysis, publication bias analysis, and subgroup analysis.

Results:

The pooled meta-analysis of the 10 eligible studies that included 422 patients indicated the high performance of DOT for monitoring total patient responses to NAC (OR = 14.78, 95% CI: 8.23–26.54, P < .001), with low significant heterogeneity (I
2 = 7.2%, P = .375). DOT possessed an area under the curve of 0.84 (95% CI: 0.81–0.87) to distinguish total patient responses to NAC. Subgroup analysis showed that the pooled sensitivity of DOT for monitoring pathologic complete response to NAC was 87%, and the pooled specificity was 70%. Meanwhile, the pooled sensitivity of DOT for monitoring pathologic complete and partial responses to NAC was 82%, and the pooled specificity was 82%. Although Begg's funnel plot (P = .049) indicated the presence of publication bias among the included studies, trim-and-fill method verified the stability of the pooled outcomes.

Conclusion:

Our meta-analysis of available published data indicated that DOT can be potentially used to predict and monitor patient responses to NAC. A larger study population is needed to fully assess the use of DOT for guiding therapies and predicting responses of individual subjects to NAC.
Granulomatous lymphadenitis mimicking metastatic lymphadenopathy in the neck after lymphatic embolization of chyle leakage
Authors: Ryu Kyeong Hwa , Baek Hye Jin , Cho Soo Buem , An Hyo Jung , Kim Jin Pyeong
Published: October 2018

Rationale:

Lymphatic embolization is a minimally invasive treatment option for managing chyle leakage after nodal dissection in the neck. After the procedure, the embolic material may cause foreign body granulomatous lymphadenitis and can be a diagnostic challenge for radiologists because of sonographic similarity to metastatic lymph node. Herein, we describe a clinical case of granulomatous lymphadenitis due to embolic material mimicking nodal metastasis detected on ultrasonography (US) with cytologic findings in a patient with thyroid cancer who underwent lymphatic embolization to treat chyle leakage after total thyroidectomy and neck dissection. We also review the relevant literature regarding this disease with technical background of the procedure and suggest the importance of clinical suspicion in diagnosing the granulomatous lymphadenitis in patients with a history of lymphatic embolization.

Patient concerns:

A 40-year-old man who underwent total thyroidectomy and bilateral modified radical neck dissection due to papillary thyroid carcinoma had suspicious cervical lymph node on US after lymphatic embolization of chyle leakage.

Diagnoses:

The suspicious cervical lymph node proved to be foreign body granulomatous lymphadenitis due to embolic material by US-guided fine-needle aspiration.

Interventions:

The patient did not undergone additional surgery because the pathologic cervical lymph node was confirmed to be foreign body granulomatous lymphadenitis.

Outcomes:

The patient is being followed up regularly at the outpatient department.

Lessons:

Clinical awareness of the technical background of lymphatic embolization and possible sonographic features of granulomatous lymphadenitis is important for an accurate diagnosis and the appropriate management in patients who underwent lymphatic embolization.
Three-dimensional scan of the uterine cavity of infertile women before assisted reproductive technology use
Authors: Pleş Liana , Alexandrescu Cătălina , Ionescu Cringu Antoniu , Arvătescu Cristian Andrei , Vladareanu Simona , Moga Marius Alexandru
Published: October 2018

The primary objective was to assess the utility of routine 3-dimensional (3D) ultrasound in the evaluation of infertile women and to estimate the prevalence of uterine anomalies before the use of assisted reproductive technology (ART), using the European Society of Human Reproduction and Embryology and the European Society for Gynaecological Endoscopy classification system. A second objective was to assess the effect of uterine anomalies on the pregnancy rate in patients who underwent assisted reproductive techniques.

We retrospectively studied 668 patients treated in the Department Obstetrics Gynecology and Neonatology “Sf Ioan” Clinical Emergency Hospital and in the Department of Medical and Surgical Specialties, Faculty of Medicine “’Transilvania” University of Brasov between July 2016 and February 2017 for subfertility. Patients were examined using 2-dimensional (2D) and 3-dimensional (3D) transvaginal ultrasound. Müllerian duct anomalies were present in 6.13% of patients, with the most common anomaly being a dysmorphic uterus (class U1c in 42.68% of patients), 17 patients (20.73%) with incompletely septate uterus (class U2a), 12 patients (14.63%) with a completely septate uterus (classU2b), 8 patients (9.75%) with a partly bicorporeal uterus (classU3a), and 6 patients (7.31%) with a completely bicorporeal uterus (class U3b). Only 1 (1.21%) patient had an aplastic uterus without a rudimentary cavity (class U5b). The pregnancy rate in the presence of uterine anomalies was 55% and the pregnancy rate in control group patients was 39.8%. The incidence of pregnancy in the group with uterine anomalies was statistically similar with the control group of normal uterus (P < .11). For ongoing pregnancy rate and live birth rate, our data indicated a slightly elevated rate for both of those indexes in the anomalies group. The incidence of miscarriage in the presence of uterine anomalies was 24% and 6.7% in the control group, which is statistically significant (P = .05).

3D ultrasound evaluation of the uterus should be considered before ART in order to make an accurate diagnosis of the uterine congenital anomaly and improve ART results.
The use of SAPS 3, SOFA, and Glasgow Coma Scale to predict mortality in patients with subarachnoid hemorrhage
Authors: Basile-Filho Anibal , Lago Alessandra Fabiane , Menegueti Mayra Gonçalves , Nicolini Edson Antonio , Nunes Roosevelt Santos , Lima Silas Lucena de , Ferreira João Paulo Uvera , Feres Marcus Antonio
Published: October 2018

Guidelines for patients with subarachnoid hemorrhage (SAH) management and several grading systems or prognostic indices have been used not only to improve the quality of care but to predict also the outcome of these patients. Among them, the gold standards Fisher radiological grading scale, Hunt-Hess and the World Federation of Neurological Surgeons (WFNS) are the most employed. The objective of this study is to compare the predictive values of simplified acute physiology score (SAPS) 3, sequential organ failure assessment (SOFA), and Glasgow Coma Scale (GCS) in the outcome of patients with aneurysmal SAH.

Fifty-one SAH patients (33% males and 67% females; mean age of 54.1 ± 10.3 years) admitted to the intensive care units (ICU) in the post-operative phase were retrospectively studied. The patients were divided into survivors (n=37) and nonsurvivors (n = 14). SAPS 3, Fischer scale, WFNS, SOFA, and GCS were recorded on ICU admission (day 1 – D1), and 72-hours (day 3 – D3) SOFA, and GCS. The capability of each index SAPS 3, SOFA, and GCS (D1 and D3) to predict mortality was analyzed by receiver operating characteristic (ROC) curves. The area under the ROC curve (AUC) and the respective confidence interval (CI) were used to measure the index accuracy. The level of significance was set at P < .05.

The mean SAPS 3, SOFA, and GCS on D1 were 13.5 ± 12.7, 3.1 ± 2.4, and 13.7 ± 2.8 for survivors and 32.5 ± 28.0, 5.6 ± 4.9, and 13.5 ± 1.9 for nonsurvivors, respectively. The AUC and 95% CI for SAPS 3, SOFA, and GCS on D1 were 0.735 (0.592–0.848), 0.623 (0.476–0.754), 0.565 (0.419–0.703), respectively. The AUC and 95% CI for SOFA and GCS on D3 were 0.768 (0.629–0.875) and 0.708 (0.563–0.826), respectively. The overall mortality was 37.8%.

Even though SAPS 3 and Fischer scale predicted mortality better on admission (D1), both indices SOFA and GCS performed similarly to predict outcome in SAH patients on D3.
The association between IUGR and maternal inherited thrombophilias
Authors: Dugalić Stefan , Petronijevic Milos , Stefanovic Aleksandar , Jeremic Katarina , Petronijevic Svetlana Vrzic , Soldatovic Ivan , Pantic Igor , Djunic Irena , Jokic Zoran , Djokovic Filip , Dotlic Jelena , Zaric Milica , Todorovic Jovana
Published: October 2018

One of the risk factors for vascular obstetric complications, such as intrauterine growth restriction (IUGR), is inherited thrombophilias. Nevertheless, routine screening for thrombophilias is not endorsed in pregnant women due to their low prevalence and conflicting results of published studies regarding the usefulness of screening in these patients. The cause of IUGR remains unknown in almost 1 quarter of cases. There are no published studies evaluating the association of inherited thrombophilias and IUGR in patients with IUGR of unknown origin. Understanding and preventing IUGR is an important public health concern, as IUGR has been associated with fetal mortality and neonatal morbidity, as well as adverse long-standing consequences. This study aimed to evaluate the prevalence of inherited thrombophilias in IUGR of unknown cause and to test the association between the inherited thrombophilias and IUGR of unknown cause.

This study included 33 cases of IUGR of unknown cause tested for inherited thrombophilias and 66 controls individually matched for age, ethnicity, and smoking status.

Patients with plasminogen activator inhibitor 1 (PAI-1) and methylenetetrahydrofolate reductase (MTHFR) had significantly higher odds for IUGR of unknown cause (P < .001 and P = .002, respectively) with OR 13.546 (CI 95% 3.79–48.37) and 8.139 (CI 95% 2.20–30.10), respectively. A positive association between other inherited thrombophilias (homozygous 20210 prothrombin gene mutation and homozygous factor V Leiden) and IUGR of unknown cause was also found, P = .096, OR 6.106 (CI 95% 0.72–51.30), although it was not statistically significant (P = .096, OR = 6.106, CI 95% 0.72–51.30).

Our results indicate that PAI-1 and MTHFR thrombophilias represent risk factors for IUGR of otherwise unidentified cause.
Blunt traumatic diaphragmatic rupture
Authors: Lim Kyoung Hoon , Park Jinyoung
Published: October 2018

Blunt traumatic diaphragmatic rupture (BTDR) is uncommon, but is associated with high rates of morbidity and mortality. The purpose of this study was to present our experience with management of this injury. Medical records of 38 patients with BTDR who were treated in our hospital from January 2001 to June 2016 were analyzed retrospectively. The sex, age, cause of injury, location of rupture, mode of diagnosis, time to diagnosis, the presence of herniation and bowel perforation, the presence of preoperative shock and intubation, Injury Severity Score (ISS), associated injuries, comorbidity, the operative procedure, morbidity and mortality, and the predictive factors affecting the outcome of BTDR were evaluated. There were 32 men (84.2%) and 6 women (15.8%) with a mean age of 51.2 years (range 18–84 years). The diagnosis could be preoperatively established in 28 patients (73.7%) with a plain chest X-ray or computed tomography scan. Rupture of diaphragm was left-sided in 31 patients (81.6%), right-sided in 6 (15.8%), and bilateral in 1 (2.6%). Sixteen patients had preoperative shock (systolic blood pressure <90 mm Hg, heart rate >120/min). Initial operative approaches were laparotomy in 22 patients (57.9%) and thoracotomy in 16 (42.1%). Eleven required additional exploration. The rate of additional exploration was higher in patients who initially underwent thoracotomy than laparotomy (56.2% vs 9.1%, P = .003). Patients who underwent additional exploration had a significantly longer operation time (330 minutes vs 237.5 minutes, P = .012), and a significantly higher morbidity rate (72.7% vs 22.2%, P =.008). Overall mortality was observed in 6 patients (15.8%). The mortality was associated with right-sided TDR (P = .042) and preoperative shock (P = .003). Neither ISS nor delay in diagnosis posed a statistically significant risk to the outcome of patients. Intra-abdominal organ injuries are more common than intrathoracic injuries in patients with BTDR, indicating that laparotomy should be the initial approach in these patients. Preoperative shock and right-sided TDR are predictive of mortality after BTDR.
Imaging and Cytopathological Criteria Indicating Malignancy in Mucin-Producing Pancreatic Neoplasms
Authors: Salla Charitini , Karvouni Eleni , Nikas Ilias , Ikonomakis Aristidis , Konstantinou Panagiotis , Karoumpalis Ioannis , Sepsa Athanasia , Papaparaskeva Kleio , Tsopanomichalou Maria , Georgiadou Despoina , Kostopoulou Akrivi , Tsiotos Gregory , Theocharis Stamatios , Sergentanis Theodoros N. , Politi Ekaterini
Published: October 2018

Objectives

This study aims to evaluate the performance of clinical, imaging, and cytopathological criteria in the identification of high-grade dysplasia/carcinoma (HGD/Ca) in pancreatic mucin-producing cystic neoplasms.

Methods

Sixty-eight consecutive, histopathologically confirmed mucin-producing cystic neoplasms, evaluated by endoscopic ultrasound-guided fine-needle aspiration, were enrolled; specifically, 39 branch duct intraductal papillary mucinous neoplasms (BD-IPMNs), 21 main duct IPMNs, and 8 mucinous cystic neoplasms. The associations between HGD/Ca in histopathology and findings of endoscopic ultrasound and cytology, demographic, lifestyle, and clinical parameters were evaluated, separately in IPMNs and mucinous cystic neoplasms.

Results

Age 65 years or more was associated with HGD/Ca in IPMNs. In BD-IPMNs, cyst diameter 3 cm or greater (sensitivity, 68.8%; specificity, 65.2%), a mural nodule (sensitivity, 56.3%; specificity, 78.3%), main pancreatic duct diameter 5 to 9 mm (sensitivity, 50.0%; specificity, 87.0%), and suspicious cytology (sensitivity, 81.3%; specificity, 100%) signaled the presence of HGD/Ca. Similarly, in main duct IPMNs, suspicious cytology predicted HGD/Ca with high sensitivity (88.9%) and excellent specificity (100%). Regarding cytopathological criteria, in BD-IPMNs, HGD/Ca was associated with a high nuclear/cytoplasmic ratio, background necrosis, presence of papillary structures, hypochromatic nuclei, hyperchromatic nuclei, and major nuclear membrane irregularities (thickening and/or indentations).

Conclusions

Clinical, imaging, and cytopathological criteria are useful in the identification of HGD/Ca in IPMNs.
Prelicensure Nursing Students' Attitudes and Perceptions of End-of-Life Care
Authors: Smothers Angel , Young Stephanie , Dai Zheng
Published: October 2018

Background

It is important that education on palliative care begin early in prelicensure nursing education because of the complex care needs of patients requiring end-of-life care.

Problem

Nursing students often lack confidence and skills in providing quality care for these patients.

Approach

Nursing students’ attitudes on end-of-life care were assessed using the Frommelt Attitudes Toward Care of the Dying scale. Students were tested as sophomores, then again as seniors, in a nursing program where the End-of-Life Nursing Education Consortium (ELNEC) curriculum had previously been integrated.

Outcomes

Seniors reported improved comfort levels providing end-of-life care.

Conclusion

Assessing for improved comfort levels among nursing students who receive ELNEC training could help support ongoing efforts to integrate this education in all nursing programs. Students who had formal education in end-of-life care were more comfortable caring for patients at end of life and had a better understanding of their role.
Preoperative Biliary Stenting and Major Morbidity After Pancreatoduodenectomy: Does Elapsed Time Matter?
Authors: Sandini Marta , Honselmann Kim C. , Birnbaum David J. , Gavazzi Francesca , Chirica Mircea , Wellner Ulrich , Guilbaud Théophile , Bolm Louisa , Angrisani Marco , Moutardier Vincent , Cereda Marco , Girard Édouard , Montorsi Marco , Keck Tobias , Zerbi Alessandro , Gianotti Luca
Published: October 2018

Objective:

To analyze possible associations between the duration of stent placement before surgery and the occurrence and severity of postoperative complications after pancreatoduodenectomy (PD).

Background:

The effect of preoperative stent duration on postoperative outcomes after PD has not been investigated.

Methods:

From 2013 to 2016, patients who underwent PD for any reasons after biliary stent placement at 5 European academic centers were analyzed from prospectively maintained databases. The primary aim was to investigate the association between the duration of preoperative biliary stenting and postoperative morbidity. Patients were stratified by stent duration into 3 groups: short (<4 weeks), intermediate (4–8 weeks), and long (≥8 weeks).

Results:

In all, 312 patients were analyzed. The median time from stent placement to surgery was 37 days (2–559 days), and most operations were performed for pancreatic cancer (67.6%). Morbidity and mortality rates were 56.0% and 2.6%, respectively. Patients in the short group (n = 106) experienced a higher rate of major morbidity (43.4% vs 20.0% vs 24.2%; P < 0.001), biliary fistulae (13.2% vs 4.3% vs 5.5%; P = 0.031), and length of hospital stay [16 (10–52) days vs 12 (8–35) days vs 12 (8–43) days; P = 0.025]. A multivariate adjusted model identified the short stent duration as an independent risk factor for major complications (odds ratio 2.64, 95% confidence interval 1.23–5.67, P = 0.013).

Conclusions:

When jaundice treatment cannot be avoided, delaying surgery up to 1 month after biliary stenting may reduce major morbidity, procedure-related complications, and length of hospital stay.
Mutations of RAS/RAF Proto-oncogenes Impair Survival After Cytoreductive Surgery and HIPEC for Peritoneal Metastasis of Colorectal Origin
Authors: Schneider Marcel André , Eden Janina , Pache Basile , Laminger Felix , Lopez-Lopez Victor , Steffen Thomas , Hübner Martin , Kober Friedrich , Roka Sebastian , Campos Pedro Cascales , Roth Lilian , Gupta Anurag , Siebenhüner Alexander , Kepenekian Vahan , Passot Guillaume , Gertsch Philippe , Glehen Olivier , Lehmann Kuno
Published: October 2018

Background:

Adequate selection of patients with peritoneal metastasis (PM) for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) remains critical for successful long-term outcomes. Factors reflecting tumor biology are currently poorly represented in the selection process. The prognostic relevance of RAS/RAF mutations in patients with PM remains unclear.

Methods:

Survival data of patients with colorectal PM operated in 6 European tertiary centers were retrospectively collected and predictive factors for survival identified by Cox regression analyses. A simple point-based risk score was developed to allow patient selection and outcome prediction.

Results:

Data of 524 patients with a median age of 59 years and a median peritoneal cancer index of 7 (interquartile range: 3–12) were collected. A complete resection was possible in 505 patients; overall morbidity and 90-day mortality were 50.9% and 2.1%, respectively. PCI [hazard ratio (HR): 1.08], N1 stage (HR: 2.15), N2 stage (HR: 2.57), G3 stage (HR: 1.80) as well as KRAS (HR: 1.46) and BRAF (HR: 3.97) mutations were found to significantly impair survival after CRS/HIPEC on multivariate analyses. Mutations of RAS/RAF impaired survival independently of targeted treatment against EGFR. Consequently, a simple point-based risk score termed BIOSCOPE (BIOlogical Score of COlorectal PEritoneal metastasis) based on PCI, N-, G-, and RAS/RAF status was developed, which showed good discrimination [development area under the curve (AUC) = 0.72, validation AUC = 0.70], calibration (P = 0.401) and allowed categorization of patients into 4 groups with strongly divergent survival outcomes.

Conclusion:

RAS/RAF mutations impair survival after CRS/HIPEC. The novel BIOSCOPE score reflects tumor biology, adequately stratifies long-term outcomes, and improves patient assessment and selection.
Environmental heterogeneity promotes spatial resilience of phototrophic biofilms in streambeds
Authors: Dzubakova Katharine , Peter Hannes , Bertuzzo Enrico , Juez Carmelo , Franca Mário J. , Rinaldo Andrea , Battin Tom J.
Published: October 2018

The loss of environmental heterogeneity threatens biodiversity and ecosystem functioning. It is therefore important to understand the relationship between environmental heterogeneity and spatial resilience as the capacity of ecological communities embedded in a landscape matrix to reorganize following disturbance. We experimented with phototrophic biofilms colonizing streambed landscapes differing in spatial heterogeneity and exposed to flow-induced disturbance. We show how streambed roughness and related features promote growth-related trait diversity and the recovery of biofilms towards carrying capacity (CC) and spatial resilience. At the scale of streambed landscapes, roughness and exposure to water flow promoted biofilm CC and growth trait diversity. Structural equation modelling identified roughness, post-disturbance biomass and a ‘neighbourhood effect’ to drive biofilm CC. Our findings suggest that the environment selecting for adaptive capacities prior to disturbance (that is, memory effects) and biofilm connectivity into spatial networks (that is, mobile links) contribute to the spatial resilience of biofilms in streambed landscapes. These findings are critical given the key functions biofilms fulfil in streams, now increasingly experiencing shifts in sedimentary and hydrological regimes.
Use of daily Internet search query data improves real-time projections of influenza epidemics
Authors: Zimmer Christoph , Leuba Sequoia I. , Yaesoubi Reza , Cohen Ted
Published: October 2018

Seasonal influenza causes millions of illnesses and tens of thousands of deaths per year in the USA alone. While the morbidity and mortality associated with influenza is substantial each year, the timing and magnitude of epidemics are highly variable which complicates efforts to anticipate demands on the healthcare system. Better methods to forecast influenza activity would help policymakers anticipate such stressors. The US Centers for Disease Control and Prevention (CDC) has recognized the importance of improving influenza forecasting and hosts an annual challenge for predicting influenza-like illness (ILI) activity in the USA. The CDC data serve as the reference for ILI in the USA, but this information is aggregated by epidemiological week and reported after a one-week delay (and may be subject to correction even after this reporting lag). Therefore, there has been substantial interest in whether real-time Internet search data, such as Google, Twitter or Wikipedia could be used to improve influenza forecasting. In this study, we combine a previously developed calibration and prediction framework with an established humidity-based transmission dynamic model to forecast influenza. We then compare predictions based on only CDC ILI data with predictions that leverage the earlier availability and finer temporal resolution of Wikipedia search data. We find that both the earlier availability and the finer temporal resolution are important for increasing forecasting performance. Using daily Wikipedia search data leads to a marked improvement in prediction performance compared to weekly data especially for a three- to four-week forecasting horizon.
Chordwise wing flexibility may passively stabilize hovering insects
Authors: Bluman James E. , Sridhar Madhu K. , Kang Chang-kwon
Published: October 2018

Insect wings are flexible, and the dynamically deforming wing shape influences the resulting aerodynamics and power consumption. However, the influence of wing flexibility on the flight dynamics of insects is unknown. Most stability studies in the literature consider rigid wings and conclude that the hover equilibrium condition is unstable. The rigid wings possess an unstable oscillatory mode mainly due to their pitch sensitivity to horizontal velocity perturbations. Here, we show that a flapping wing flyer with flexible wings exhibits stable hover equilibria. The free-flight insect flight dynamics are simulated at the fruit fly scale in the longitudinal plane. The chordwise wing flexibility is modelled as a linear beam. The two-dimensional Navier–Stokes equations are solved in a tight fluid–structure integration scheme. For a range of wing flexibilities similar to live insects, all eigenvalues of the system matrix about the hover equilibrium have negative real parts. Flexible wings appear to stabilize the unstable mode by passively deforming their wing shape in the presence of perturbations, generating significantly more horizontal velocity damping and pitch rate damping. These results suggest that insects may passively stabilize their hover flight via wing flexibility, which can inform designs of synthetic flapping wing robots.
Pore pressure evolution and mass loss of broken gangue during the seepage
Authors: Zhang Jixiong , Liu Yu , Zhou Nan , Li Meng
Published: October 2018

Broken gangue consists of different particles, and it has more complicated seepage characteristics than intact rock sample. Using the self-designed instrument, the permeability, mass loss and pore pressure of crushed gangue during the seepage are tested. The result shows that permeability parameter
k
of crushed rock has a polynomial relationship with effective stress
σ
′ in inverse proportion, and permeability parameter
β
of crushed gangue has power exponent relationship with effective stress
σ
′ increasing in direct proportion. The particle size of 8.0–10.0 mm has a good support effect. The inner pressure of crushed rock is mostly linear distribution along the tube wall. After the seepage, mass loss of broken gangue mainly increases with large particle size out of proportion.
Multiscale entropy rate analysis of complex mobile agents
Authors: Paul Tuhin , Stanley Kevin G. , Osgood Nathaniel D.
Published: October 2018

Accurate prediction of the motion of objects is a central scientific goal. For deterministic or stochastic processes, models exist which characterize motion with a high degree of reliability. For complex systems, or those where objects have a degree of agency, characterizing motion is far more challenging. The information entropy rate of motion through a discrete space can place a limit on the predictability of even the most complex or history-dependent actor, but the variability in measured encountered locations is inexorably tied to the spatial and temporal resolutions of those measurements. This relation depends on the path of the actor in ways that can be used to derive a general law in closed form relating the mobility entropy rate to different spatial and temporal resolutions, and the path properties within each cell along the path. Correcting for spatial and temporal effects through regression yields the path properties and a measure of mobility entropy rate robust to changes in dimension, allowing comparison of mobility entropy rates between datasets. Employing this measure on empirical datasets yields novel findings, from the similarity of taxicabs to drifters, to the predictable motions of undergraduates, to the browsing habits of Canadian moose.
Two pulses of morphological diversification in Pacific pelagic fishes following the Cretaceous–Palaeogene mass extinction
Authors: Sibert Elizabeth , Friedman Matt , Hull Pincelli , Hunt Gene , Norris Richard
Published: October 2018

Molecular phylogenies suggest some major radiations of open-ocean fish clades occurred roughly coincident with the Cretaceous–Palaeogene (K/Pg) boundary, however the timing and nature of this diversification is poorly constrained. Here, we investigate evolutionary patterns in ray-finned fishes across the K/Pg mass extinction 66 million years ago (Ma), using microfossils (isolated teeth) preserved in a South Pacific sediment core spanning 72–43 Ma. Our record does not show significant turnover of fish tooth morphotypes at the K/Pg boundary: only two of 48 Cretaceous tooth morphotypes disappear at the event in the South Pacific, a rate no different from background extinction. Capture–mark–recapture analysis finds two pulses of origination in fish tooth morphotypes following the mass extinction. The first pulse, at approximately 64 Ma, included short-lived teeth, as well as forms that contribute to an expansion into novel morphospace. A second pulse, centred at approximately 58 Ma, produced morphotype novelty in a different region of morphospace from the first pulse, and contributed significantly to Eocene tooth morphospace occupation. There was no significant increase in origination rates or expansion into novel morphospace during the early or middle Eocene, despite a near 10-fold increase in tooth abundance during that interval. Our results suggest that while the K/Pg event had a minor impact on fish diversity in terms of extinction, the removal of the few dominant Cretaceous morphotypes triggered a sequence of origination events allowing fishes to rapidly diversify morphologically, setting the stage for exceptional levels of ray-finned fish diversity in the Cenozoic.
DIAlignR provides precise retention time alignment across distant runs in DIA and targeted proteomics
Authors: Gupta Shubham , Ahadi Sara , Zhou Wenyu , Röst Hannes
Published: October 2018

SWATH-MS has been widely used for proteomics analysis given its high-throughput and reproducibility but ensuring consistent quantification of analytes across large-scale studies of heterogeneous samples such as human-plasma remains challenging. Heterogeneity in large-scale studies can be caused by large time intervals between data-acquisition, acquisition by different operators or instruments, intermittent repair or replacement of parts, such as the liquid chromatography column, all of which affect retention time (RT) reproducibility and successively performance of SWATH-MS data analysis. Here, we present a novel algorithm for retention time alignment of SWATH-MS data based on direct alignment of raw MS2 chromatograms using a hybrid dynamic programming approach. The algorithm does not impose a chronological order of elution and allows for alignment of elution-order swapped peaks. Furthermore, allowing RT-mapping in a certain window around coarse global fit makes it robust against noise. On a manually validated dataset, this strategy outperforms the current state-of-the-art approaches. In addition, on a real-world clinical data, our approach outperforms global alignment methods by mapping 98% of peaks compared to 67% cumulatively and DIAlignR can reduce alignment error up to 30-fold for extremely distant runs. The robustness of technical parameters used in this pairwise alignment strategy has also been demonstrated. The source code is released under the BSD license at https://github.com/Roestlab/DIAlignR.

Abbreviations:

AUC

Area Under the Curve

DIA

Data-independent acquisition

LC

Liquid chromatography

LOESS

Local weighted regression

RSE

Residual Standard Error

RT

Retention time

XIC

Extracted ion chromatograms

Data Availability:

Raw chromatograms and features extracted by OpenSWATH are available on PeptideAtlas.

Servername: ftp.peptideatlas.org

Username: PASS01280

Password: KQ2592b
Modular modeling improves the predictions of genetic variant effects on splicing
Authors: Cheng Jun , Nguyen Thi Yen Duong , Cygan Kamil J , Çelik Muhammed Hasan , Fairbrother William G , Avsec Žiga , Gagneur Julien
Published: October 2018

Predicting the effects of genetic variants on splicing is highly relevant for human genetics. We describe the framework MMSplice (modular modeling of splicing) with which we built the winning model of the CAGI 2018 exon skipping prediction challenge. The MMSplice modules are neural networks scoring exon, intron, and splice sites, trained on distinct large-scale genomics datasets. These modules are combined to predict effects of variants on exon skipping, alternative donor and acceptor sites, splicing efficiency, and pathogenicity, with matched or higher performance than state-of-the-art. Our models, available in the repository Kipoi, apply to variants including indels directly from VCF files.
Pupil responses to hidden photoreceptor–specific modulations in movies
Authors: Spitschan Manuel , Gardasevic Marina , Martial Franck P. , Lucas Robert J. , Allen Annette E.
Published: October 2018

Under typical daytime light levels, the human pupillary light response (PLR) is driven by the activity of the L, M, and S cones, and melanopsin expressed in the so-called intrinsically photosensitive retinal ganglion cells (ipRGCs). However, the importance of each of these photoreceptive mechanisms in defining pupil size under real-world viewing conditions remains to be established. To address this question, we embedded photoreceptor-specific modulations in a movie displayed using a novel projector-based five-primary spatial stimulation system, which allowed for the precise control of photoreceptor activations in time and space. We measured the pupillary light response in eleven observers, who viewed short cartoon movies which contained hidden low-frequency (0.25 Hz) silent-substitution modulations of the L, M and S cones (no stimulation of melanopsin), melanopsin (no stimulation of L, M and S cones), both L, M, and S cones and melanopsin or no modulation at all. We find that all photoreceptors active at photopic light levels regulate pupil size under this condition. Our data imply that embedding modulations in photoreceptor contrast could provide a method to manipulate key adaptive aspects of the human visual system in everyday, real-world activities such as watching a movie.
Board nationality and educational background diversity and corporate social performance
Authors: Harjoto Maretno Agus , Laksmana Indrarini , Yang Ya wen
Published: October 2018

Purpose

This paper aims to examine the relationship between the nationality and educational background diversity of directors serving on corporate boards and the firms’ corporate social performance (CSP).

Design/methodology/approach

This study measures nationality diversity by directors’ national citizenship and measures educational background diversity by countries from which they earned their undergraduate and post undergraduate degrees. It measures firms’ CSP using the MSCI ESG ratings. The study uses both univariate and multivariate analyses to empirically test the hypotheses.

Findings

Using a sample of US firms, the authors find that board nationality diversity and educational background diversity are positively associated with CSP. The findings suggest that improving director nationality diversity and educational background diversity could improve firms’ social performance.

Originality/value

This study shows that the increasing trend of foreign nationals in the US boards could shift the focus of US corporations to be more stakeholder-oriented.
Determinants of audience demand for the televised professional baseball matches in Korea
Authors: Ryu Yoonji , Kim Kihan , Paik Jong Won , Cheong Yunjae
Published: October 2018

Purpose

The purpose of this paper is to examine factors influencing the audience demand for televised post-season games of the Korean professional baseball league.

Design/methodology/approach

The data were collected from a total of 129 games – the entire post-season games from 2008 to 2016. Two dependent variables representing audience demand for televised baseball matches, obtained from the third-party television audit company AGB Nielsen, were regressed on a series of match-related and unrelated antecedent factors associated with each match. Pooled OLS regression with wild bootstrap standard errors with 100,000 replications was applied in the analysis.

Findings

Regarding match-related factors, higher television ratings and the greater numbers of television viewers were associated with matches with greater significance, outcome uncertainty and score sum. In terms of the match-unrelated factors, the broadcast platform appeared to be the most powerful predictor of both television ratings and the numbers of viewers. Other than the broadcast platform, night matches, matches with full stadium occupancy and team values showed positive impacts on both the television ratings and the numbers of viewers.

Practical implications

The sales of media rights and sponsorships are the major sources of revenues for professional sports leagues, and the size of these two streams of revenues is in proportion to the size of the audience demand for television and other media. This study provides valuable insights to the sports marketers of professional sports clubs and leagues by establishing proper understanding of the determinants of the audience demand for televised sports.

Originality/value

The characteristics specific to each professional league and country play unique roles in determining the antecedent factors of audience demand for televised sports; this study is one of the few attempts to examine Koran professional baseball league.
Analysis of the drivers and benefits of BIM incorporation into quantity surveying profession
Authors: Babatunde Solomon Olusola , Ekundayo Damilola , Babalola Olubola , Jimoh Jumoke Aduramigba
Published: October 2018

Purpose

Building information modeling (BIM) inclusion in education pedagogy is crucial in preparing skilled graduates for employment in the construction industry. Against this backdrop, studies on BIM education abound in architecture, engineering and construction (AEC) programmes in higher education institutions (HEIs). However, there are limited empirical studies on BIM potentials in the quantity surveying (QS) profession in HEIs, particularly in developing countries. The purpose of this study is to identify and assess the BIM drivers and benefits as important to the QS profession using an empirical approach.

Design/methodology/approach

A comprehensive literature review was conducted to identify the BIM drivers and benefits in relation to the QS profession, which was used to design a questionnaire. To capture a broad perception, a questionnaire survey was carried out which targeted the academia and final year undergraduate students from two selected universities offering QS honour degree programmes in Nigeria. Data collected were analysed using mean score, standard deviation and Mann–Whitney test.

Findings

The study identified 12 BIM drivers in relation to the QS profession and the analysis of the ranking revealed that almost all the identified BIM drivers are considered by respondents as important. The study further identified 14 BIM benefits and the analysis of the ranking indicated that all the identified BIM benefits are considered as important. The results of the Mann–Whitney test indicated a slight statistically significant difference, particularly in one of the selected universities on the ranking of the BIM drivers and benefits as important to the QS profession.

Practical implication

The findings of the study provide empirical evidence on the current perceptions of the drivers and benefits of BIM to QS academia and students as they explore the concept for the advancement of QS profession.

Originality/value

This study would provide practical insights to use BIM for QS practice. Also, this study would contribute to improving the QS graduates and professional quantity surveyors understanding of the BIM knowledge applicable to QS profession.