bluuebunny/crossref_metadata_2025 huggingface dataset:
Suppression of Complex Hysteretic Resonances in Varying Compliance Vibration of a Ball Bearing
Authors: Zhang Zhiyong , Sattel Thomas , Tan Aditya Suryadi , Rui Xiaoting , Yang Shaopu , Yang Rui , Ying Yongheng , Li Xuan
Published: September 2020

It is traditionally considered that, due to the Hertzian contact force-deformation relationship, the stiffness of rolling bearings has stiffening characteristics, and gradually researchers find that the supporting characteristics of the system may stiffen, soften, and even coexist from them. The resonant hysteresis affects the stability and safety of the system, and its jumping effect can make an impact on the system. However, the ball bearing contains many nonlinearities such as the Hertzian contact between the rolling elements and raceways, bearing clearance, and time-varying compliances (VC), leading great difficulties to clarify the dynamical mechanism of resonant hysteresis of the system. With the aid of the harmonic balance and alternating frequency/time domain (HB-AFT) method and Floquet theory, this paper will investigate the hysteretic characteristics of the Hertzian contact resonances of a ball bearing system under VC excitations. Moreover, the linearized dynamic bearing stiffness of the system will be presented for assessing the locations of VC resonances, and the nonlinear characteristics of bearing stiffness will also be discussed in depth. Our analysis indicates that the system possesses many types of VC resonances such as the primary, internal, superharmonic, and even combination resonances, and the evolutions of these resonances are presented. Finally, the suppression of resonances and hysteresis of the system will be proposed by adjusting the bearing clearance.
Endometriosis of the Inguinal Canal Mimicking a Hydrocele of the Canal of Nuck
Authors: Basnayake Oshan , Jayarajah Umesh , Seneviratne Sanjeewa Anuruddha
Published: September 2020

Isolated presentation of endometriosis of the inguinal canal is infrequent, and the clinical and imaging findings may be misleading in such patients. We describe an otherwise healthy female with isolated inguinal endometriosis presenting as a hydrocele of the canal of Nuck. Surgeons should consider such unusual presentations and obtain imaging and histological evaluations in doubtful instances. Complete excision was curative in our patient with no evidence of recurrence.
Synthesis of Pectiniform Polyurethane‐Modified Polycarboxylate and Its Preliminary Application in Ultrahigh‐Performance Concrete
Authors: Xiang Shuncheng , Gao Yingli
Published: September 2020

In this paper, modified polyurethane prepolymer was synthesized by the segmental synthesis method using isophorone diisocyanate (IPDI), hydroxyl‐terminated silicone, and polyether glycol dimethylolpropionic acid as raw materials. After that, pectiniform polycarboxylate, of which side chains were in roughly the same polymerization degree and main chains were in different lengths, was synthesized at normal temperature in the complex initiation system of H2O2, APS, sodium bisulfite, and Vc. Then, compared with commercial Sika polycarboxylate, their applications in ultrahigh‐performance concrete (HUPC), including flowability, strength, drying shrinkage, and autogenous shrinkage, were investigated. The results showed that, due to the molecular structure of polyorganosiloxane, the synthesized polycarboxylate could be better dispersed. Dosage of silica fume could effectively improve the compressive strength of UHPC, while slag had a certain negative impact on its strength. Incorporation of slag and silica fume could effectively reduce the dry shrinkage of UHPC.
Prevalence and Determinants of Intestinal Parasitic Infections among Pregnant Women Receiving Antenatal Care in Kasoa Polyclinic, Ghana
Authors: Abaka-Yawson Albert , Sosu Solomon Quarshie , Kwadzokpui Precious Kwablah , Afari Salomey , Adusei Samuel , Arko-Mensah John
Published: September 2020

Background. Intestinal parasitic infections affect pregnant women worldwide. The infection has been implicated in causing life-threatening conditions in both gravid women and their developing foetus. Sub-Saharan Africa is known to harbor the greatest proportion of intestinal parasitic infections largely due to socioeconomic and environmental factors. In Kasoa, Southern Ghana, there is paucity of data on the prevalence and associated factors of intestinal parasitic infections among pregnant women. Objective. The aim of the study was to determine the prevalence of intestinal parasitic infections and associated factors among pregnant women attending antenatal care in Kasoa Polyclinic. Methods. A hospital based analytical cross-sectional study was carried out among three hundred (300) conveniently sampled pregnant women receiving antenatal care services at the Kasoa Polyclinic. Structured questionnaires were administered to the study participants to assess sociodemographic and other possible factors. Stool samples were collected from each pregnant woman and examined for the presence of intestinal parasites by microscopy using direct wet mount as well as formol-ether sedimentation techniques. Results. Overall prevalence of intestinal parasites was 14.3% (95% CI 11–19%). Entamoeba histolytica (5.0%) was the most predominant parasite species identified followed by Ascaris lumbricoides (4.3%), Giardia lamblia (2.3%), Trichuris trichiura (1.3%), Schistosoma mansoni (0.3%), Hookworm (0.3%), Hymenolepis nana (0.3%), and Isospora belli (0.3%). Age > 30 years (AOR = 0.17, 95% CI = 0.06–0.48; p=0.001), multigravidity (AOR = 0.43, 95% CI = 0.19–0.97; p=0.043), and 2nd and 3rd trimesters (AOR = 4.73, 95% CI = 1.36–16.49; p=0.015) were independently associated with intestinal parasitic infections among pregnant women. Conclusions. A prevalence of 14.3% pregnant women compared to previous studies in Ghana is relatively low. It however suggests that intestinal parasitic infection is still a problem. The major factors noted were age, gravidity, and gestational age. Routine stool examination and provision of public health education are recommended to prevent infection of pregnant mothers and their unborn babies.
Hesitant Fuzzy Decision-Making Method Based on Correlation Coefficient under Confidence Levels with Application to Multisensor Electronic Reconnaissance
Authors: Ruan Chuan-Yang
Published: September 2020

In this paper, we focus on the hesitant fuzzy decision-making method based on correlation coefficient under confidence levels. Firstly, we propose several correlation coefficients based on confidence levels, and based on the correlation coefficient between attribute-evaluated values and the ideal values, several optimal attribute weights models are constructed. Secondly, we have defined the concepts of module, weight module, projection, and weighted projection in hesitant fuzzy sets on account of the projection theory. Finally, on the strength of our research results above, we construct a hesitant fuzzy multiattribute decision-making method and apply it to the multiattribute decision-making problem in multisensor electronic reconnaissance. Comparative analyses are made via simulation to test the rationality and validity of the proposed method.
Clinical Evaluation of the Diagnostic Role of MicroRNA-155 in Breast Cancer
Authors: Hosseini Mojahed Fatemeh , Aalami Amir Hossein , Pouresmaeil Vahid , Amirabadi Amir , Qasemi Rad Mahdi , Sahebkar Amirhossein
Published: September 2020

Aim. Biochemical markers, including microRNAs (miRs), may facilitate the diagnosis and prognosis of breast cancer. This study was aimed at assessing serum miR-155 expression in patients with breast cancer and receptors. Methods. This case-control study was conducted on 36 patients with breast cancer and 36 healthy individuals. After RNA extraction from the patient’s serum, cDNA was synthesized. The expression of miR-155 was measured using RT-qPCR. Demographic and histochemical data were extracted from patient documents. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software. Results. The mean age of subjects in breast cancer and control groups was 47.64±8.19 and 47.36±7.52 years, respectively. The serum miR-155 expression was higher in the cancer group (1.68±0.66) compared to the control group (p<0.0001). There was a significant relationship between serum miR-155 expression and the tumor grade (p<0.001), tumor stage (p<0.001), and tumor size (p<0.001) of the patients. However, no relationship between miR-155 expression and the presence of lymph node involvement (p=0.15), HER2 (p=0.79), Ki-67 (p=0.9), progesterone receptor (p=0.54), and estrogen receptors (p=0.84) was found. The ROC curve analysis showed that the AUC was 0.89 (77.78% sensitivity and 88.89% specificity), and the cutoff was 1.4 (Youden index: 0.6667) for detecting breast cancer. Conclusion. The findings of this study revealed that serum miR-155 may serve as a potential noninvasive molecular biomarker for breast cancer diagnosis and can help predict the grade of the disease.
Collision Tumor in the Pituitary, Concurrent Pituitary Adenoma, and Craniopharyngioma
Authors: Shareef Zaid , Kerndt Connor , Nessel Trevor , Mistry Devin , Figueroa Bryan
Published: September 2020

Collision tumors are two independent, distinct tumors occupying the same anatomical space. This case presents a pituitary adenoma-craniopharyngioma collision tumor presenting with hemianopsia. A 60-year-old with a past history of a nonsecretory pituitary adenoma presented with progressive headaches, bitemporal hemianopsia, and nausea. Previously, in 2008, his adenoma was effectively treated with nasal septal flap and transsphenoidal pituitary resection. A magnetic resonance imaging (MRI) was ordered for concern of recurrence, given his history and neurologic complaints. The MRI revealed a suprasellar mass extending into the third ventricle with displacement of the hypothalamus and optic chiasm. Laboratory testing revealed no indicators of endocrinopathy. The neurosurgical and otolaryngologic teams were elected to perform tumor resection given the ongoing symptoms. An image-guided transsphenoidal tumor resection with abdominal fat graft harvest and septal mucosal flap CSF leak repair was performed. Histopathological examination revealed two tumor components within the resection including an adamantinomatous craniopharyngioma and recurrent pituitary adenoma.
An In Vitro Pilot Study Comparing the Novel HemoClear Gravity-Driven Microfiltration Cell Salvage System with the Conventional Centrifugal XTRA™ Autotransfusion Device
Authors: Hoetink Anneloes , Scherphof Sabine F. , Mooi Frederik J. , Westers Paul , van Dijk Jack , van de Leur Sjef J. , Nierich Arno P.
Published: September 2020

Background. In 2013, the World Health Organization reported a shortage of 17 million red blood cell units, a number that remains growing. Acts to relieve this shortage have primarily focused on allogeneic blood collection. Nevertheless, autologous transfusion can partially alleviate the current pressure and dependence on blood banking systems. To achieve this, current gold standard autotransfusion devices should be complemented with widely available, cost-efficient, and time-efficient devices. The novel HemoClear cell salvage device (HemoClear BV, Zwolle, Netherlands), a gravity-driven microfilter, potentially is widely employable. We evaluated its performance in the cardiac postoperative setting compared to the centrifugal XTRA™ autotransfusion device.Methods. In a split-unit study (n = 18), shed blood collected 18 hours after cardiothoracic surgery was divided into two equal volumes. One-half was processed by the XTRA™ device and the other with the HemoClear blood separation system. In this paired set-up, equal washing volumes were used for both methods. Washing effectivity and cellular recovery were determined by measuring of complete blood count, free hemoglobin, complement C3, complement C4, and D-dimer in both concentrate as filtrate. Also, processing times and volumes were evaluated.Results. The HemoClear and XTRA™ devices showed equal effectiveness in concentrating erythrocytes and leucocytes. Both methods reduced complement C3, complement C4, and D-dimer by ≥90%. The centrifugal device reduced solutes more significantly by up to 99%. Free hemoglobin load was reduced to 12.9% and 15.5% by the XTRA™ and HemoClear, respectively.Conclusion. The HemoClear device effectively produced washed concentrated red blood cells comparably to the conventional centrifugal XTRA™ autotransfusion device. Although the centrifugal XTRA™ device achieved a significantly higher reduction in contaminants, the HemoClear device achieved acceptable blood quality and seems promising in settings where gold standard cell savers are unaffordable or unpractical.
Visualization of Activated T Cells by OX40-ImmunoPET as a Strategy for Diagnosis of Acute Graft-versus-Host Disease
Authors: Alam Israt S. , Simonetta Federico , Scheller Lukas , Mayer Aaron T. , Murty Surya , Vermesh Ophir , Nobashi Tomomi W. , Lohmeyer Juliane K. , Hirai Toshihito , Baker Jeanette , Lau Kenneth H. , Negrin Robert , Gambhir Sanjiv S.
Published: September 2020

Graft-versus-host disease (GvHD) is a major complication of allogeneic hematopoietic cell transplantation (HCT), mediated primarily by donor T cells that become activated and attack host tissues. Noninvasive strategies detecting T-cell activation would allow for early diagnosis and possibly more effective management of HCT recipients. PET imaging is a sensitive and clinically relevant modality ideal for GvHD diagnosis, and there is a strong rationale for the use of PET tracers that can monitor T-cell activation and expansion with high specificity. The TNF receptor superfamily member OX40 (CD134) is a cell surface marker that is highly specific for activated T cells, is upregulated during GvHD, and mediates disease pathogenesis. We recently reported the development of an antibody-based activated T-cell imaging agent targeting OX40. In the present study, we visualize the dynamics of OX40 expression in an MHC-mismatch mouse model of acute GvHD using OX40-immunoPET. This approach enabled visualization of T-cell activation at early stages of disease, prior to overt clinical symptoms with high sensitivity and specificity. This study highlights the potential utility of the OX40 PET imaging as a new strategy for GvHD diagnosis and therapy monitoring.

Significance:

OX40-immunoPET imaging is a promising noninvasive strategy for early detection of GvHD, capable of detecting signs of GvHD pathology even prior to the development of overt clinical symptoms.
Multimodal CEA-Targeted Image-Guided Colorectal Cancer Surgery using 111In-Labeled SGM-101
Authors: de Gooyer Jan Marie , Elekonawo Fortuné M.K. , Bos Desirée L. , van der Post Rachel S. , Pèlegrin André , Framery Bérénice , Cailler Françoise , Vahrmeijer Alexander L. , de Wilt Johannes H.W. , Rijpkema Mark
Published: September 2020

Purpose:

Intraoperative image guidance may aid in clinical decision-making during surgical treatment of colorectal cancer. We developed the dual-labeled carcinoembryonic antigen–targeting tracer, [111In]In-DTPA-SGM-101, for pre- and intraoperative imaging of colorectal cancer. Subsequently, we investigated the tracer in preclinical biodistribution and multimodal image-guided surgery studies, and assessed the clinical feasibility on patient-derived colorectal cancer samples, paving the way for rapid clinical translation.

Experimental Design:

SGM-101 was conjugated with p-isothiocyanatobenzyl–diethylenetriaminepentaacetic acid (DTPA) and labeled with Indium-111 (111In). The biodistribution of 3, 10, 30, and 100 μg [111In]In-DTPA-SGM-101 was assessed in a dose escalation study in BALB/c nude mice with subcutaneous LS174T human colonic tumors, followed by a study to determine the optimal timepoint for imaging. Mice with intraperitoneal LS174T tumors underwent micro-SPECT/CT imaging and fluorescence image–guided resection. In a final translational experiment, we incubated freshly resected human tumor specimens with the tracer and assessed the tumor-to-adjacent tissue ratio of both signals.

Results:

The optimal protein dose of  [111In]In-DTPA-SGM-101 was 30 μg (tumor-to-blood ratio, 5.8 ± 1.1) and the optimal timepoint for imaging was 72 hours after injection (tumor-to-blood ratio, 5.1 ± 1.0). In mice with intraperitoneal tumors, [111In]In-DTPA-SGM-101 enabled preoperative SPECT/CT imaging and fluorescence image–guided resection. After incubation of human tumor samples, overall fluorescence and radiosignal intensities were higher in tumor areas compared with adjacent nontumor tissue (P < 0.001).

Conclusions:

[111In]In-DTPA-SGM-101 showed specific accumulation in colorectal tumors, and enabled micro-SPECT/CT imaging and fluorescence image–guided tumor resection. Thus, [111In]In-DTPA-SGM-101 could be a valuable tool for preoperative SPECT/CT imaging and intraoperative radio-guided localization and fluorescence image–guided resection of colorectal cancer.
How Does Behavioural Activation Work? A Systematic Review of the Evidence on Potential Mediators
Authors: Janssen Noortje P. , Hendriks Gert-Jan , Baranelli Céline T. , Lucassen Peter , Oude Voshaar Richard , Spijker Jan , Huibers Marcus J.H.
Published: September 2020

Introduction: Behavioural activation is an effective treatment for depression, but little is known about its working mechanisms. Theoretically, its effect is thought to rely on an interplay between activation and environmental reward. Objective: The present systematic review examines the mediators of behavioural activation for depression. Methods: A systematic literature search without time restrictions in Medline, EMBASE, PsycINFO, The Cochrane Library, and CINAHL resulted in 14 relevant controlled and uncontrolled prospective treatment studies that also performed formal mediation analyses to investigate their working mechanisms. After categorising the mediators investigated, we systematically compared the studies’ methodological quality and performed a narrative synthesis of the findings. Results: Most studies focused on activation or environmental reward, with 21 different mediators being investigated using questionnaires that focused on psychological processes or beliefs. The evidence for both activation and environmental reward as mediators was weak. Conclusions: Non-significant results, poor methodological quality of some of the studies, and differences in questionnaires employed precluded any firm conclusions as to the significance of any of the mediators. Future research should exploit knowledge from fundamental research, such as reward motivation from neurobiology. Furthermore, the use of experience sampling methods and idiographic analyses in bigger samples is recommended to investigate potential causal pathways in individual patients.
Pulmonary Vein Isolation With Single Pulse Irreversible Electroporation
Authors: Loh Peter , van Es René , Groen Marijn H.A. , Neven Kars , Kassenberg Wil , Wittkampf Fred H.M. , Doevendans Pieter A.
Published: September 2020

Background:

Irreversible electroporation (IRE) is a promising new nonthermal ablation technology for pulmonary vein (PV) isolation in patients with atrial fibrillation. Experimental data suggest that IRE ablation produces large enough lesions without the risk of PV stenosis, artery, nerve, or esophageal damage. This study aimed to investigate the feasibility and safety of single pulse IRE PV isolation in patients with atrial fibrillation.

Methods:

Ten patients with symptomatic paroxysmal or persistent atrial fibrillation underwent single pulse IRE PV isolation under general anesthesia. Three-dimensional reconstruction and electroanatomical voltage mapping (EnSite Precision, Abbott) of left atrium and PVs were performed using a conventional circular mapping catheter. PV isolation was performed by delivering nonarcing, nonbarotraumatic 6 ms, 200 J direct current IRE applications via a custom nondeflectable 14-polar circular IRE ablation catheter with a variable hoop diameter (16–27 mm). A deflectable sheath (Agilis, Abbott) was used to maneuver the ablation catheter. A minimum of 2 IRE applications with slightly different catheter positions were delivered per vein to achieve circular tissue contact, even if PV potentials were abolished after the first application. Bidirectional PV isolation was confirmed with the circular mapping catheter and a post ablation voltage map. After a 30-minute waiting period, adenosine testing (30 mg) was used to reveal dormant PV conduction.

Results:

All 40 PVs could be successfully isolated with a mean of 2.4±0.4 IRE applications per PV. Mean delivered peak voltage and peak current were 2154±59 V and 33.9±1.6 A, respectively. No PV reconnections occurred during the waiting period and adenosine testing. No periprocedural complications were observed.

Conclusions:

In the 10 patients of this first-in-human study, acute bidirectional electrical PV isolation could be achieved safely by single pulse IRE ablation.
Power, Lesion Size Index and Oesophageal Temperature Alerts During Atrial Fibrillation Ablation
Authors: Leo Milena , Pedersen Michala , Rajappan Kim , Ginks Matthew R. , Hunter Ross J. , Bowers Robert , Kalla Manish , Bashir Yaver , Betts Timothy R.
Published: September 2020

Background:

Low radiofrequency powers are commonly used on the posterior wall of the left atrium for atrial fibrillation ablation to prevent esophageal damage. Compared with higher powers, they require longer ablation durations to achieve a target lesion size index (LSI). Esophageal heating during ablation is the result of a time-dependent process of conductive heating produced by nearby radiofrequency delivery. This randomized study was conducted to compare risk of esophageal heating and acute procedure success of different LSI-guided ablation protocols combining higher or lower radiofrequency power and different target LSI values.

Methods:

Eighty consecutive patients were prospectively enrolled and randomized to one of 4 combinations of radiofrequency power and target LSI for ablation on the left atrium posterior wall (20 W/LSI 4, 20 W/LSI 5, 40 W/LSI 4, and 40 W/LSI 5). The primary end point of the study was the occurrence and number of esophageal temperature alerts per patient during ablation. Acute indicators of procedure success were considered as secondary end points. Long-term follow-up data were also collected for all patients.

Results:

Esophageal temperature alerts occurred in a similar proportion of patients in all groups. Significantly, shorter radiofrequency durations were required to achieve the target LSI in the 40 W groups. Less than 50% of the radiofrequency lesions reached the target LSI of 5 when using 20 W despite a longer radiofrequency duration. A lower rate of first-pass pulmonary vein isolation and a higher rate of acute pulmonary vein reconnection were recorded in the group 20 W/LSI 5. A lower atrial fibrillation recurrence rate was observed in the 40 W groups compared with the 20 W groups at 29 months follow-up.

Conclusions:

When guided by LSI, posterior wall ablation with 40 W is associated with a similar rate of esophageal temperature alerts and a lower atrial fibrillation recurrence rate at follow-up if compared with 20 W. These data will provide a basis to plan future randomized trials.

Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02619396.
Prognostic Impact of Residual Anatomic Disease Burden After Functionally Complete Revascularization
Authors: Lee Joo Myung , Hwang Doyeon , Choi Ki Hong , Lee Hyun-Jong , Song Young Bin , Cho Yun-Kyeong , Nam Chang-Wook , Hahn Joo-Yong , Shin Eun-Seok , Doh Joon-Hyung , Hoshino Masahiro , Hamaya Rikuta , Kanaji Yoshihisa , Murai Tadashi , Zhang Jun-Jie , Ye Fei , Li Xiaobo , Ge Zhen , Chen Shao-Liang , Kakuta Tsunekazu , Koo Bon-Kwon
Published: September 2020

Background:

Prognostic impact of residual anatomic disease burden after functionally complete percutaneous coronary intervention (PCI), defined by post-PCI fractional flow reserve (FFR) >0.80 would be a clinically relevant question. The current study evaluated clinical outcomes at 2 years according to residual Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score (RSS) in patients who underwent functionally complete revascularization.

Methods:

A total of 1910 patients (2095 revascularized vessels) with post-PCI FFR >0.80 were selected from the International Post-PCI FFR Registry. RSS was defined as the SYNTAX score recalculated after PCI, SYNTAX revascularization index was calculated as 100×(1−RSS/pre-PCI SYNTAX score), and post-PCI FFR was measured after completion of PCI. The primary outcome was target vessel failure (TVF; a composite of cardiac death, target vessel–related myocardial infarction, and clinically driven target vessel revascularization) at 2 years, and risk of TVF was compared according to tertile classification of RSS (0, 1–5, and >5) and post-PCI FFR (≥0.94, 0.87–0.93, and ≤0.86).

Results:

After PCI, SYNTAX score was changed from 10.0 (Q1–Q3, 7.0–16.0) to 0.0 (Q1–Q3, 0.0–5.0) and FFR changed from 0.70±0.12 to 0.90±0.05. TVF at 2 years occurred in 4.9%, and patients with TVF showed higher pre-PCI SYNTAX score and lower post-PCI FFR than those without. However, there were no significant differences in SYNTAX revascularization index and RSS. The risk of TVF was not different according to tertile of RSS (log-rank
P
=0.851). Conversely, risk of TVF was different according to tertile of post-PCI FFR (log-rank
P
=0.009). Multivariable model showed the risk of TVF was significantly associated with post-PCI FFR (hazard ratio, 1.091 [95% CI, 1.032–1.153];
P
=0.002) but not with RSS (hazard ratio, 0.969 [95% CI, 0.898–1.045];
P
=0.417).

Conclusions:

Among patients who underwent functionally complete revascularization, residual anatomic disease burden assessed by RSS was not related with occurrence of TVF at 2 years. These results support the importance of functionally complete revascularization rather than angiographic complete revascularization.

Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT04012281.
Biometric and Psychometric Remote Monitoring and Cardiovascular Risk Biomarkers in Ischemic Heart Disease
Authors: Shufelt Chrisandra L. , Kim Andy , Joung Sandy , Barsky Lili , Arnold Corey , Cheng Susan , Dhawan Shivani , Fuller Garth , Speier William , Lopez Mayra , Mastali Mitra , Mouapi Kelly , van den Broek Irene , Wei Janet , Spiegel Brennan , Van Eyk Jennifer E. , Bairey-Merz C. Noel
Published: September 2020

Background

Patients with stable ischemic heart disease represent a heterogeneous population at variable risk for major adverse cardiac events (MACE). Because MACE typically occurs outside the hospital, we studied whether biometric and psychometric remote patient monitoring are associated with MACE risk biomarkers.

Methods and Results

In 198 patients with stable ischemic heart disease (mean age 65±11 years, 60% women), we evaluated baseline measures, including biometric (FitBit 2) and psychometric (acquired via smartphone‐administered patient‐reported outcomes) remote monitoring, in the PRE‐MACE (Prediction, Risk, and Evaluation of Major Adverse Cardiac Events) study. In multivariable adjusted regression analyses, we examined the association of these measures with biomarkers of MACE risk, including NT‐proBNP (N‐terminal pro‐b‐type natriuretic peptide), u‐hs‐cTnI (ultra‐high sensitivity cardiac‐specific troponin I), and hs‐CRP (high‐sensitivity C‐reactive) protein. Both biometric and psychometric measures were associated with NT‐proBNP. Specifically, step count, heart rate, physical activity, global health score, and physical function score were all inversely related, whereas physical limitation score was directly related (
P
≤0.05 for all). However, only biometric measures (step count and heart rate) were associated with u‐hs‐cTnI (inversely related,
P
<0.05), while only the psychometric measures of physical limitation were associated with hs‐CRP (directly related,
P
≤0.05).

Conclusions

In stable ischemic heart disease patients, remotely monitored measures were associated with MACE risk biomarkers. Both biometric and psychometric measures were related to NT‐proBNP. In contrast, biometric measures were uniquely related to u‐hs‐cTnI, while psychometric indices were uniquely related to hs‐CRP. Further investigation could assess the predictive value of these metrics for MACE in ischemic heart disease.
Practice Pattern, Diagnostic Yield, and Long‐Term Prognostic Impact of Coronary Computed Tomographic Angiography
Authors: Cho Min Soo , Roh Jae‐Hyung , Park Hanbit , Cho Sang‐Cheol , Kang Do‐Yoon , Lee Pil Hyung , Ahn Jung‐Min , Koo Hyun Jung , Yang Dong Hyun , Kang Joon‐Won , Park Seung‐Jung , Patel Manesh R. , Park Duk‐Woo
Published: September 2020

Background

Although guidelines recommend the use of coronary computed tomographic angiography (CTA) in patients with stable pain syndromes, the clinical benefits of the use of coronary CTA in a broad spectrum of patients is unknown. We evaluated the contemporary practice pattern and diagnostic yield of coronary CTA and their impact on the subsequent diagnostic‐therapeutic cascade and clinical outcomes.

Methods and Results

We identified 39 906 patients without known coronary artery disease (CAD) who underwent coronary CTA between January 2007 and December 2013. The patients' demographic characteristics, risk factors, symptoms, results of coronary CTA, the appropriateness of downstream diagnostic and therapeutic interventions, and long‐term outcomes (death or myocardial infarction) were evaluated. The number of coronary CTAs had increased over time, especially in asymptomatic patients. Coronary CTA revealed that 6108 patients (15.3%) had obstructive CAD (23.7% of symptomatic and 9.3% of asymptomatic patients). Subsequent cardiac catheterization was performed in 19.2% of symptomatic patients (appropriate, 80.6%) and in 3.9% of asymptomatic patients (appropriate, 7.9%). The 5‐year rate of death or myocardial infarction was significantly higher in patients with obstructive CAD on CTA than those without (7.2% versus 3.0%;
P
<0.001; adjusted hazard ratio [95% CI], 1.34 [1.17–1.54]). However, obstructive CAD on CTA had limited added value over conventional risk factors for predicting death or myocardial infarction.

Conclusions

Although the use of coronary CTA had substantially increased, CTA had a low diagnostic yield for obstructive CAD, especially in asymptomatic patients. The use of CTA in asymptomatic patients seemed to have led to inappropriate subsequent diagnostic or therapeutic interventions without clinical benefit.
E‐cigarette or Vaping Product Use–Associated Lung Injury Produced in an Animal Model From Electronic Cigarette Vapor Exposure Without Tetrahydrocannabinol or Vitamin E Oil
Authors: Kleinman Michael T. , Arechavala Rebecca Johnson , Herman David , Shi Jianru , Hasen Irene , Ting Amanda , Dai Wangde , Carreno Juan , Chavez Jesus , Zhao Lifu , Kloner Robert A.
Published: September 2020

E‐cigarette or vaping product use–associated lung injury was recognized in the United States in the summer of 2019 and is typified by acute respiratory distress, shortness of breath, chest pain, cough, and fever, associated with vaping. It can mimic many of the manifestations of coronavirus disease 2019 (COVID‐19). Some investigators have suggested that E‐cigarette or vaping product use–associated lung injury was due to tetrahydrocannabinol or vitamin E acetate oil mixed with the electronic cigarette liquid. In experimental rodent studies initially designed to study the effect of electronic cigarette use on the cardiovascular system, we observed an E‐cigarette or vaping product use–associated lung injury‐like condition that occurred acutely after use of a nichrome heating element at high power, without the use of tetrahydrocannabinol, vitamin E, or nicotine. Lung lesions included thickening of the alveolar wall with foci of inflammation, red blood cell congestion, obliteration of alveolar spaces, and pneumonitis in some cases; bronchi showed accumulation of fibrin, inflammatory cells, and mucus plugs. Electronic cigarette users should be cautioned about the potential danger of operating electronic cigarette units at high settings; the possibility that certain heating elements may be deleterious; and that E‐cigarette or vaping product use–associated lung injury may not be dependent upon tetrahydrocannabinol, vitamin E, or nicotine.
Infection as a Stroke Risk Factor and Determinant of Outcome After Stroke
Authors: Elkind Mitchell S.V. , Boehme Amelia K. , Smith Craig J. , Meisel Andreas , Buckwalter Marion S.
Published: September 2020

Understanding the relationship between infection and stroke has taken on new urgency in the era of the coronavirus disease 2019 (COVID-19) pandemic. This association is not a new concept, as several infections have long been recognized to contribute to stroke risk. The association of infection and stroke is also bidirectional. Although infection can lead to stroke, stroke also induces immune suppression which increases risk of infection. Apart from their short-term effects, emerging evidence suggests that poststroke immune changes may also adversely affect long-term cognitive outcomes in patients with stroke, increasing the risk of poststroke neurodegeneration and dementia. Infections at the time of stroke may also increase immune dysregulation after the stroke, further exacerbating the risk of cognitive decline. This review will cover the role of acute infections, including respiratory infections such as COVID-19, as a trigger for stroke; the role of infectious burden, or the cumulative number of infections throughout life, as a contributor to long-term risk of atherosclerotic disease and stroke; immune dysregulation after stroke and its effect on the risk of stroke-associated infection; and the impact of infection at the time of a stroke on the immune reaction to brain injury and subsequent long-term cognitive and functional outcomes. Finally, we will present a model to conceptualize the many relationships among chronic and acute infections and their short- and long-term neurological consequences. This model will suggest several directions for future research.
A new approach for estimating research impact: An application to French cancer research
Authors: Chevalier Gérard , Chomienne Christine , Jeanrenaud Nicolas Guetta , Lane Julia , Ross Matthew
Published: September 2020

Much attention has been paid to estimating the impact of investments in scientific research. Historically, those efforts have been largely ad hoc, burdensome, and error prone. In addition, the focus has been largely mechanical—drawing a direct line between funding and outputs—rather than focusing on the scientists that do the work. Here, we provide an illustrative application of a new approach that examines the impact of research funding on individuals and their scientific output in terms of publications, citations, collaborations, and international activity, controlling for both observed and unobserved factors. We argue that full engagement between scientific funders and the research community is needed if we are to expand the data infrastructure to enable a more scientific assessment of scientific investments.
Studies on Parmulariaceae II. Re-examination of Hysterostomella, Mintera, Rhipidocarpon and Viegasella

Authors: DAI DONG-QIN , WIJAYAWARDENE NALIN N. , TANG LI-ZHOU , TIAN YE , PROMPUTTHA ITTHAYAKORN , BHAT D. JAYARAMA , HYDE KEVIN D.
Published: September 2020

This is the second in a series of papers in which we examine the type species of genera in Parmulariaceae. Specimens of type species of Hysterostomella, Mintera, Rhipidocarpon and Viegasella are re-examined and their descriptions and illustrations are provided. Hysterostomella is characterized by large, black, circular or elliptical ascostromata, later becoming irregular, rather flat and opening by irregular fissures. Asci are subglobose, obovoid and bitunicate and ascospores are dark brown, ellipsoidal with a single septum. Mintera is similar to Viegasella in having radiating, loculate ascostromata forming on leaf surfaces. However, Mintera is distinguished by its appressoriate mycelium. Rhipidocarpon has carbonaceous, flattened ascostromata with ridges, irregularly radiating from centre to the outer rim, becoming a fan-shape, ridges containing elongated locules, which open by a longitudinal slit and contain numerous asci. Based on their morphological characters, the placement of the genera in Parmulariaceae is confirmed.
Pollen grain micromorphology in some genera of Ornithogaleae (Asparagaceae, Scilloideae) and its relative significance

Authors: HEIDARIAN MEHDI , HAMDI SEYED MOHAMMAD MAHDI , DEHSHIRI MOHAMMAD MEHDI , NEJADSATTARI TAHER , MASOUMI SEYED MOHAMMAD
Published: September 2020

In this research, the pollen micromorphology of nine species belonging to Honorius, Loncomelos, Ornithogalum and Stellarioides are observed by LM (Light Microscopy), SEM (Scanning Electron Microscopy) and two species by TEM (Transmission Electron Microscopy). Lately, the phylogenetic studies have determined nineteen monophyletic genera in subfamily Ornithogaloideae (=tribe Ornithogaleae). Our results show that the pollen grains characters such as shape, size, exine ornamentation on equatorial surface, sulcus margin exine ornamentation, sulcus membrane ornamentation and lumina number on exine surface are varied among all studied genera. The dendrogram of palynological characters analyzed on LM and SEM observation by MVSP (Multi Variate Statistical Package) software partly supports the monophyletic genera. According to the obtained palynological dendrogram, Loncomelos arcuatum and Ornithogalum sintenisii are placed in one subtype. Based on the sporoderm structure (exine thickness and the endexine type), L. arcuatum differs from O. sintenisii. Finally, the palynological characters can be useful for clarifying the taxonomic relationship in this subfamily.
Right-wing populism and feminist politics: The case of Law and Justice in Poland
Authors: Gwiazda Anna
Published: September 2020

This article disentangles the complexity of right-wing populism and feminist politics using an original framework based on inputs (representative claims) and outputs (policies) to examine a Polish case. In 2015, the right-wing populist Law and Justice party (PiS) formed a single-party majority government led by a female prime minister after winning the elections. PiS is ideologically conservative, promotes traditional and national values and is supported by the Catholic Church. Additionally, it is hostile towards what it calls ‘gender-ideology’ and is reluctant to implement feminist policies. This article also reveals that PiS represents conservative women’s interests and advocates an aspect of conservative feminism, therefore possessing a duality in its claims and policies. Overall, this article draws inferences about the nexus between social conservatism, populism and feminism, and thus seeks to contribute to the scholarly literature by examining a timely issue against the backdrop of rising populism, illiberalism and anti-gender campaigns.
Patterns of Nodal Metastases and Predictors of Occult Disease in HPV‐Associated Oropharynx Cancer
Authors: Stanford‐Moore Gaelen Britton , Ochoa Edgar , Larson Andrew , Han Mary , Hoppe Kathryn , Ryan William R.
Published: September 2020

Objective

For human papilloma virus–associated oropharynx squamous cell carcinoma (HPV+ OPSCC), we evaluated the distribution of neck‐level lymph node (LN) metastasis, based on postsurgical histopathology, and the incidence of and risk factors for occult LN metastases, as these patterns need clarification for this newer cancer subset.

Study Design

Retrospective cohort study.

Setting

National Cancer Database (NCDB).

Methods

We analyzed 2358 patients in the NCDB with HPV+ OPSCC who underwent neck dissection (ND) from 2010 to 2015. Incidence and distribution of LN metastases were calculated for neck levels I to V. Variables associated with occult LN metastasis were assessed by multivariate logistic regression.

Results

In therapeutic NDs (n = 1935), the following proportions of positive LNs were found: level I, 9.0% (n = 175); level II, 81.0% (n = 1568); level III, 29.6% (n = 573); level IV, 11.9% (n = 230); and level V, 4.9% (n = 95). In elective NDs (n = 423), occult‐positive LNs were found in 35.8% (n = 152), with the following proportions by level: level I, 3.3% (n = 14); level II, 26.9% (n = 114); level III, 8.7% (n = 37); level IV, 4.0% (n = 17); and level V, 0.2% (n = 1). The presence of occult LNs was independently associated with a Charlson‐Deyo score of 1 (odds ratio, 2.26; 95% CI, 1.18‐4.31; P =. 014) and lymphovascular invasion (odds ratio, 5.91; 95% CI, 3.21‐11.18; P <. 001). Occult LN metastases were not significantly associated with pT classification, primary site, or number of LNs resected.

Conclusion

For HPV+ OPSCC, occult nodal disease is common. Therapeutic NDs should encompass at least levels II, III, and IV and possibly I, whereas elective NDs could possibly encompass levels II and III.

Level of Evidence

4.
Preoperative Gabapentin Administration and Its Impact on Postoperative Opioid Requirement and Pain in Sinonasal Surgery
Authors: Gill Amarbir S. , Virani Farrukh R. , Hwang Joshua C. , Wilson Machelle D. , Beliveau Angela M. , Strong E. Bradley , Steele Toby O.
Published: September 2020

Objective

To determine the efficacy of preoperative gabapentin on patient‐reported pain levels and postoperative opioid requirements following sinonasal surgery.

Study Design

Retrospective review.

Setting

Academic institution.

Methods

Patients undergoing sinonasal surgery between July 2019 and January 2020 were followed. Groups were divided into those that received 600 mg of oral gabapentin 1 hour preoperatively (gabapentin) and those that did not (control). Postoperatively, each patient was counseled to use acetaminophen, ibuprofen, and oxycodone as needed for pain control. Patients completed a daily postoperative pain and medication log. Pain was measured by the visual analog scale (VAS) and opioid use by morphine equivalent dose (MED). Chi‐square test and Wilcoxon test were used for data analysis.

Results

Fifty‐seven patients were included (control, n = 28; gabapentin, n = 29). There was no significant difference in age, sex, or baseline Sinonasal Outcome Test–22 scores between the groups. The total MED, postoperative day (POD) 1‐2 MED, POD 3‐4 MED, and POD 5‐6 MED did not differ significantly between the control (17.9, 12.2, 4.6, 1.5) and gabapentin (19.0, 8.9, 7.2, 3.5) groups (P =. 98,. 25,. 16,. 44). The mean daily VAS score did not differ significantly between the control (3.1) and gabapentin (2.8) groups (P =. 81). The mean daily VAS score decreased significantly in both groups with each successive POD (P =. 004).

Conclusion

Preoperative gabapentin did not significantly reduce postoperative pain or opioid use. Postoperative discomfort following sinonasal surgery is mild, and opioid intake is minimal.
Implications of Obesity on Endoscopic Sinus Surgery Postoperative Complications: An Analysis of the NSQIP Database
Authors: Wardlow Robert D. , Bernstein Isaac A. , Orlov Cinthia P. , Rowan Nicholas R.
Published: September 2020

Objective

To evaluate the influence of body mass index on postoperative adverse events in adult patients undergoing endoscopic sinus surgery.

Study Design

Retrospective cohort study.

Setting

Database of the American College of Surgeons NSQIP (National Surgical Quality Improvement Program) from 2006 to 2018.

Methods

The NSQIP database was queried for adult patients undergoing endoscopic sinus surgery. The total sample (N = 1546) was stratified by nonobese (18.5 kg/m2≤ body mass index <30 kg/m2) and obese (≥30 kg/m2). Demographics, comorbidities, intraoperative variables, and postoperative adverse events were compared via chi‐square analysis and multivariable logistic regression.

Results

Obese patients accounted for 49.7% (n = 768) of the cohort. Obese patients had a higher American Society of Anesthesiologists classification (class III, 45.1% vs 29.5%; P <. 001), rate of diabetes (18.2% vs 7.2%, P <. 001), and rate of hypertension requiring medication (43.1% vs 23.0%, P <. 001). Nonobese patients were more likely to be >58 years of age (23.4% vs 29.0%, P =. 02) and have disseminated cancer (<1% vs 3.2%, P <. 001). The obese cohort had a lower frequency of surgical complications (3.0% vs 5.4%, P =. 027), driven by frequency of perioperative bleeding (1.8% vs 3.7%, P =. 022). There was no statistical difference in medical complications (P =. 775), unplanned readmissions (P =. 286), unplanned reoperations (P =. 053), or 30‐day mortality (P >. 999). After multivariable adjustment, obese subjects had decreased odds of any surgical complication (adjusted odds ratio [aOR], 0.567; 95% CI, 0.329‐0.979), perioperative bleeding (aOR, 0.474; 95% CI, 0.239‐0.942), and any adverse postoperative event (aOR, 0.740; 95% CI, 0.566‐0.968).

Conclusion

Obesity does not increase the risk of 30‐day adverse outcomes following endoscopic sinus surgery and may even be protective against perioperative bleeding.
Four Risk Factors for Arthrofibrosis in Tibial Spine Fractures: A National 10-Site Multicenter Study
Authors: Bram Joshua T. , Aoyama Julien T. , Mistovich R. Justin , Ellis Henry B. , Schmale Gregory A. , Yen Yi-Meng , McKay Scott D. , Fabricant Peter D. , Green Daniel W. , Lee R. Jay , Cruz Aristides I. , Kushare Indranil V. , Shea Kevin G. , Ganley Theodore J.
Published: September 2020

Background:

Tibial spine fractures (TSFs) are relatively rare pediatric injuries. Postoperative arthrofibrosis remains the most common complication, with few studies having examined factors associated with its development.

Purpose:

To identify risk factors for arthrofibrosis and required MUA or lysis of adhesions in the largest known cohort of patients with TSFs.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

This was a multicenter study of 249 patients ≤18 years old who had a TSF between January 2000 and February 2019. Patients were separated into cohorts based on whether they developed arthrofibrosis, defined as a 10° deficit in extension and/or 25° deficit in flexion at postoperative 3 months or a return to the operating room for manipulation under anesthesia (MUA) and/or lysis of adhesions.

Results:

A total of 58 (23.3%) patients developed postoperative arthrofibrosis, with 19 (7.6%) requiring a return to the operating room for MUA. Patients with arthrofibrosis were younger (mean ± SD, 11.3 ± 2.7 vs 12.3 ± 2.8 years; P = .029). They were more likely to have a nonsport, trauma-related injury (65.4% vs 32.1%; P < .001) and a concomitant ACL injury (10.3% vs 1.1%; P = .003). Those with arthrofibrosis had longer operative times (135.0 vs 114.8 minutes; P = .006) and were more likely to have been immobilized in a cast postoperatively (30.4% vs 16.6%; P = .043). In multivariate regression, concomitant anterior cruciate ligament (ACL) injury (odds ratio [OR], 20.0; P = .001), traumatic injury (OR, 3.8; P < .001), age <10 years (OR, 2.2; P = .049), and cast immobilization (OR, 2.4; P = .047) remained significant predictors of arthrofibrosis. Concomitant ACL injury (OR, 7.5; P = .030) was additionally predictive of a required return to the operating room for MUA.

Conclusion:

Surgeons should be cognizant of arthrofibrosis risk in younger patients with concomitant ACL tears and traumatic injuries not resulting from athletics. Furthermore, postoperative immobilization in a cast should be avoided given the high risk of arthrofibrosis. Concomitant ACL injury is associated with a higher return to the operating room for MUA.