bluuebunny/crossref_metadata_2025 huggingface dataset:
Chaotic dynamics of a delayed tumor–immune interaction model
Authors: Khajanchi Subhas
Published: November 2019

Due to the unpredictable growth of tumor cells, the tumor–immune interactive dynamics continues to draw attention from both applied mathematicians and oncologists. Mathematical modeling is a powerful tool to improve our understanding of the complicated biological system for tumor growth. With this goal, we report a mathematical model which describes how tumor cells evolve and survive the brief encounter with the immune system mediated by immune effector cells and host cells which includes discrete time delay. We analyze the basic mathematical properties of the considered model such as positivity of the system and the boundedness of the solutions. By analyzing the distribution of eigenvalues, local stability analysis of the biologically feasible equilibria and the existence of Hopf bifurcation are obtained in which discrete time delay is used as a bifurcation parameter. Based on the normal form theory and center manifold theorem, we obtain explicit expressions to determine the direction of Hopf bifurcation and the stability of Hopf bifurcating periodic solutions. Numerical simulations are carried out to illustrate the rich dynamical behavior of the delayed tumor model. Our model simulations demonstrate that the delayed tumor model exhibits regular and irregular periodic oscillations or chaotic behaviors, which indicate the scenario of long-term tumor relapse.
A secure data protection technique for healthcare data in the cloud using homomorphic encryption and Jaya–Whale optimization algorithm
Authors: Sudha I. , Nedunchelian R.
Published: November 2019

Cloud computing has become a powerful mechanism for initiating secure communication among users. The advancements in the technology lead to provide various services, like accessing network, resources, and platform. However, handling large datasets and security are major issues in the cloud systems. Hence, this paper proposes a technique, namely, Jaya–Whale Optimization (JWO), which is the integration of Jaya algorithm and Whale optimization algorithm (WOA) and adapts homomorphic encryption for initiating secure data transmission in the cloud. The original data are preserved by generating Data Protection (DP) coefficient using the proposed JWO algorithm. In the proposed algorithm, the fitness is calculated based on privacy and utility parameters for selecting the optimal solution. Also, the sanitized data are generated by EXORing the Key Information Product (KIP) matrix and key vector. Finally, the data owner provides the key to the users for retrieving the original data from the sanitized data. The experimentation is carried out using Cleveland, Hungarian, and Switzerland datasets in terms of BD, accuracy, and fitness and the analysis shows that the proposed JWO provides superior performance in terms of BD, accuracy, and fitness parameters with values 0.720, 0.822, and 0.722.
Promoting Bilateral People-to-People Exchange Amid Rising China-U.S. Strategic Competition
Authors: Pan Yaling
Published: November 2019

Amid the escalating trade war and a growing Washington consensus on a hardline China policy, the China-U.S. relationship has entered a prolonged period of strategic competition and uncertainty. Strengthening cultural and people-to-people exchange at the sub-national level may serve as an important means of stabilizing the increasingly unpredictable bilateral relationship. Yet, while economic ties continue to expand between Chinese provinces and cities and their American counterparts, bilateral cultural and people-to-people exchange has lagged far behind, partly due to a lack of understanding of Chinese provincial and local governments about how American society is changing, especially with regard to political and electoral realignments that underpin the Trump presidency. To mitigate the mentality of rising strategic competition on both sides and build a solid ground for a more durable China-U.S. relationship, the Chinese central, provincial and local governments need to foster a better understanding of American society and improve the institutions and approaches that support enhancement of the bilateral cultural and people-to-people exchange.
A Game-Theoretic Analysis of Energy-Depleting Jamming Attacks with a Learning Counterstrategy
Authors: Chiariotti Federico , Pielli Chiara , Laurenti Nicola , Zanella Andrea , Zorzi Michele
Published: November 2019

Jamming may become a serious threat in Internet of Things networks of battery-powered nodes, as attackers can disrupt packet delivery and significantly reduce the lifetime of the nodes. In this work, we model an active defense scenario in which an energy-limited node uses power control to defend itself from a malicious attacker, whose energy constraints may not be known to the defender. The interaction between the two nodes is modeled as an asymmetric Bayesian game where the victim has incomplete information about the attacker. We show how to derive the optimal Bayesian strategies for both the defender and the attacker, which may then serve as guidelines to develop and gauge efficient heuristics that are less computationally expensive than the optimal strategies. For example, we propose a neural-network-based learning method that allows the node to effectively defend itself from the jamming with a significantly reduced computational load. The outcomes of the ideal strategies highlight the tradeoff between node lifetime and communication reliability and the importance of an intelligent defense from jamming attacks.
Don't write short texts, write concise ones
Authors: Yaffe Philip
Published: November 2019

Each "Communication Corner" essay is self-contained; however, they build on each other. For best results, before reading this essay and doing the exercise, go to the first essay "How an Ugly Duckling Became a Swan," then read each succeeding essay.

Applying specific communication techniques can only be achieved by first understanding the fundamental principles. In this article, Phil Yaffe shares a new one: Your writing should be as long as necessary, and as short as possible.
Current Approaches to Germline Cancer Genetic Testing
Authors: Stoffel Elena M. , Carethers John M.
Published: November 2019

The prevalence of genetic predisposition to cancer is greater than initially appreciated, yet most affected individuals remain undiagnosed. Deleterious germline variants in cancer predisposition genes are implicated in 1 in 10 cases of advanced cancer. Next-generation sequencing technologies have made germline and tumor DNA sequencing more accessible and less expensive. Expanded access to clinical genetic testing will improve identification of individuals with genetic predisposition to cancer and provide opportunities to effectively reduce morbidity through precision cancer therapies and surveillance. Cross-disciplinary clinical education in genomic medicine is needed to translate advances in genomic medicine into improved health outcomes.
Molecular Mechanism of Matrine fromSophora alopecuroidesin the Reversing Effect of Multi-Anticancer Drug Resistance in K562/ADR Cells
Authors: Chen Zhi , Nishimura Nobuhiro , Okamoto Takayuki , Wada Koichiro , Naora Kohji
Published: November 2019

Multidrug resistance is the main obstacle to current chemotherapies. In this study, we evaluated the reversing effect of matrine, the principal alkaloid derived fromSophora alopecuroides, on chemoresistant leukemia K562/ADR cells. Matrine in a range of the nontoxic concentration was employed in the whole study. IC50s of cancer medicines were tested using WST-8 assay. Drug export and apoptotic rates were examined using flow cytometry. The mRNA and protein expressions were quantified by quantitative real-time PCR and western blotting, respectively. Our data indicated that matrine had potent reversal properties augmenting cytotoxicity of cancer medicines on K562/ADR cells as well as apoptotic rates induced by doxorubicin. Moreover, matrine inhibited drug-exporting activity and expression of ATP-binding cassette subfamily B member 1 (ABCB1) on both mRNA and protein levels. That might result from inhibited NF-kappa B activation, which also led to restored intrinsic apoptosis. These findings suggest that matrine in the nontoxic concentration can suppress ABCB1 drug transport and facilitate the intrinsic apoptosis pathway through the inhibiting effect on NF-kappa B and has the potential to become an efficient sensitizer for anticancer drug resistance.
Tumor Suppressive Function of NQO1 in Cutaneous Squamous Cell Carcinoma (SCC) Cells
Authors: Zhang Qing-Ling , Li Xue Mei , Lian De-De , Zhu Ming Ji , Yim Su-Hyuk , Lee Jeung-Hoon , Jiang Ri-Hua , Kim Chang-Deok
Published: November 2019

Cutaneous squamous cell carcinoma (SCC) is a common cancer that significantly decreases the quality of life. It is known that external stimulus such as ultraviolet (UV) radiation induces cutaneous SCC via provoking oxidative stress. NAD(P)H dehydrogenase 1 (NQO1) is a ubiquitous flavoenzyme that functions as a guardian against oxidative stress. However, the effect of NQO1 on cutaneous SCC is not clearly elucidated. In this study, we investigated the effect of NQO1 on cutaneous SCC cells using the recombinant adenoviruses that can upregulate and/or downregulate NQO1 expression. Overexpression of NQO1 resulted in significant decrease of cell proliferation and colony forming activity of SCC lines (SCC12 and SCC13 cells). By contrast, knockdown of NQO1 increased the cell proliferation and colony forming activity. Accordingly, the levels of proliferation-related regulators, such as Cyclin D1, Cyclin E, PCNA, SOX2, and p63, were decreased by the overexpression of NQO1, while those were increased by knockdown of NQO1. In addition, NQO1 affected the invasion and migration of SCC cells in a very similar way, with the regulation of epithelial-mesenchymal transition- (EMT-) related molecules, including E-cadherin, N-cadherin, Vimentin, Snail, and Slug. Finally, the overexpression of NQO1 decreased the level of phosphorylated AKT, JNK, and p38 MAPK, while the knockdown of NQO1 increased the level of phosphorylated signaling molecules. Based on these data, NQO1 has tumor suppressive function in cutaneous SCC cells.
Effectiveness of Exercise Programs on Patients with Dementia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Li Xudong , Guo Rui , Wei Zhenhong , Jia Jing , Wei Chaojun
Published: November 2019

Exercise programs have been introduced to improve cognitive function, whereas studies showed inconsistent results regarding the effectiveness of exercise programs on patients with dementia. This study aimed to summarize randomized controlled trials (RCTs) to assess the effect of exercise programs on cognition, activities of daily living (ADL), and depression in elderly with dementia. We systematically screened PubMed, Embase, and the Cochrane library for relevant studies throughout November 21, 2018. The pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were employed to calculate cognition, ADL, and depression by using random-effects model. A total of 20 RCTs with 2,051 dementia patients were included in final quantitative meta-analysis. There were no significant differences between exercise programs and control regarding cognition (SMD: 0.44; 95% CI: −0.21–1.09; P=0.183), ADL (SMD: 0.50; 95% CI: −0.03–1.02; P=0.066), and depression (SMD: −0.43; 95% CI: −0.90–0.05; P=0.077). Sensitivity analysis results indicated that exercise programs might play an important role in cognition and ADL, whereas the depression level was unaltered by the exclusion of any particular study. Subgroup analyses indicated that exercise programs were associated with increased cognitive levels if the mean age of patients was <80.0 years when compared with usual care and studies with low quality. Moreover, the ADL level was significantly increased in patients receiving exercise programs versus usual care. These results suggested that exercise programs might play an important role in cognition and ADL in patients with dementia. These results required further verification by large-scale RCTs, especially for depression outcomes.
Histogram Analysis and Visual Heterogeneity of Diffusion-Weighted Imaging with Apparent Diffusion Coefficient Mapping in the Prediction of Molecular Subtypes of Invasive Breast Cancers
Authors: Horvat Joao V. , Iyer Aditi , Morris Elizabeth A. , Apte Aditya , Bernard-Davila Blanca , Martinez Danny F. , Leithner Doris , Sutton Olivia M. , Ochoa-Albiztegui R. Elena , Giri Dilip , Pinker Katja , Thakur Sunitha B.
Published: November 2019

Objective. To investigate if histogram analysis and visually assessed heterogeneity of diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping can predict molecular subtypes of invasive breast cancers. Materials and Methods. In this retrospective study, 91 patients with invasive breast carcinoma who underwent preoperative magnetic resonance imaging (MRI) with DWI at our institution were included. Two radiologists delineated a 2-D region of interest (ROI) on ADC maps in consensus. Tumors were also independently classified into low and high heterogeneity based on visual assessment of DWI. First-order statistics extracted through histogram analysis within the ROI of the ADC maps (mean, 10th percentile, 50th percentile, 90th percentile, standard deviation, kurtosis, and skewness) and visually assessed heterogeneity were evaluated for associations with tumor receptor status (ER, PR, and HER2 status) as well as molecular subtype. Results. HER2-positive lesions demonstrated significantly higher mean (p=0.034), Perc50 (p=0.046), and Perc90 (p=0.040), with AUCs of 0.605, 0.592, and 0.652, respectively, than HER2-negative lesions. No significant differences were found in the histogram values for ER and PR statuses. Neither quantitative histogram analysis based on ADC maps nor qualitative visual heterogeneity assessment of DWI images was able to significantly differentiate between molecular subtypes, i.e., luminal A versus all other subtypes (luminal B, HER2-enriched, and triple negative) combined, luminal A and B combined versus HER2-enriched and triple negative combined, and triple negative versus all other types combined. Conclusion. Histogram analysis and visual heterogeneity assessment cannot be used to differentiate molecular subtypes of invasive breast cancer.
Compilation and Application of UMAT for Mechanical Properties of Heterogeneous Metal Welded Joints in Nuclear Power Materials
Authors: Xue He , Bi Yueqi , Wang Shuai , Zhang Jianlong , Gou Siyu
Published: November 2019

For the problem of mechanical properties of heterogeneous dissimilar metal welded joints, when analyzed by the finite element method, it is usually simplified into a “sandwich” material structure model. However, the mechanical properties of materials in different regions of the “sandwich” material mechanics model are different, and there will be mutations at the material interface. In order to accurately describe the mechanical properties of welded joints, the constitutive equations of dissimilar metal welded joint materials were compiled, and the constitutive equations of inhomogeneous materials whose material mechanical properties were continuously changed with space coordinates were established. The ABAQUS software was used to establish the “sandwich” model and the continuous transition model. The model is used to compare and analyze the crack tip stress distribution of different yield strength mismatch coefficients. The results show that the continuous transition material model eliminates the mutation of the “sandwich” model at the material interface and achieves the continuous change of the mechanical properties of the material. For the longitudinal crack, under the influence of different mismatch coefficients, the crack tip stress field of the transitional material model is deflected toward the low yield strength side. The compilation of constitutive equations for continuous transition materials of dissimilar metal welded joints provides a basis for the safety evaluation of dissimilar metal welded joints.
Hopf Bifurcation Analysis of a Synthetic Drug Transmission Model with Time Delays
Authors: Zhang Zizhen , Yang Fangfang , Xia Wanjun
Published: November 2019

This paper is concerned with the Hopf bifurcation of a synthetic drug transmission model with two delays. Firstly, some sufficient conditions of delay‐induced bifurcation for such a model are captured by using different combinations of the two delays as the bifurcation parameter. Secondly, based on the center manifold theorem and normal form theory, some sufficient conditions determining properties of the Hopf bifurcation such as the direction and the stability are established. Finally, to underline the effectiveness of the obtained results, some numerical simulations are ultimately addressed.
Motivational Strategies to Prevent Frailty in Older Adults with Diabetes: A Focused Review
Authors: Vaccaro J. A. , Gaillard T. , Huffman F. G. , Vieira E. R.
Published: November 2019

The prevalence of diabetes among Americans aged 65 years and older is greater than 25%. Medical expenditures for persons with diabetes are more than twice as high as those for patients without diabetes. Diabetes in older adults often times coexists with frailty, resulting in reduced quality of life and increased health-care use. Many older adults with type 2 diabetes have mobility impairments and experience falls, which contributes to increased frailty. Exercise has a protective effect for frailty and falls, yet less than half of persons with diabetes exercise and approximately one-quarter meet exercise recommendations. In addition to exercise, nutrition may help reduce the risk for falls; however, nutritional interventions have not been tested as a fall-prevention intervention. According to a review, there is insufficient evidence to create nutritional guidelines specific for frail older adults with type 2 diabetes. There is a need to motivate and empower older adults with type 2 diabetes to make lifestyle changes to prevent frailty. The purpose of this review was to identify and integrate what is known and what still needs to be done for this population to be successful in making health behavior changes to reduce frailty. There is some evidence that motivational approaches have worked for older adults with various chronic disease conditions. However, studies applying motivational strategies are lacking for frail older adults with type 2 diabetes. A novel motivational approach was described; it combines aspects of the Health Belief Model and Motivational Interviewing. Intervention studies incorporating this model are needed to determine whether this client-driven strategy can help various racial/ethnic populations make the sustainable health behavior changes of increasing exercise and healthy eating while taking into consideration physiological, psychological, and economic barriers.
Improving Faster R‐CNN Framework for Fast Vehicle Detection
Authors: Nguyen Hoanh
Published: November 2019

Vision‐based vehicle detection plays an important role in intelligent transportation systems. With the fast development of deep convolutional neural networks (CNNs), vision‐based vehicle detection approaches have achieved significant improvements compared to traditional approaches. However, due to large vehicle scale variation, heavy occlusion, or truncation of the vehicle in an image, recent deep CNN‐based object detectors still showed a limited performance. This paper proposes an improved framework based on Faster R‐CNN for fast vehicle detection. Firstly, MobileNet architecture is adopted to build the base convolution layer in Faster R‐CNN. Then, NMS algorithm after the region proposal network in the original Faster R‐CNN is replaced by the soft‐NMS algorithm to solve the issue of duplicate proposals. Next, context‐aware RoI pooling layer is adopted to adjust the proposals to the specified size without sacrificing important contextual information. Finally, the structure of depthwise separable convolution in MobileNet architecture is adopted to build the classifier at the final stage of the Faster R‐CNN framework to classify proposals and adjust the bounding box for each of the detected vehicle. Experimental results on the KITTI vehicle dataset and LSVH dataset show that the proposed approach achieved better performance compared to original Faster R‐CNN in both detection accuracy and inference time. More specific, the performance of the proposed method is improved comparing with the original Faster R‐CNN framework by 4% on the KITTI test set and 24.5% on the LSVH test set.
Strontium Promotes the Proliferation and Osteogenic Differentiation of Human Placental Decidual Basalis- and Bone Marrow-Derived MSCs in a Dose-Dependent Manner
Authors: Huang Yi-Zhou , Wu Cheng-Guang , Xie Hui-Qi , Li Zhao-Yang , Silini Antonietta , Parolini Ornella , Wu Yi , Deng Li , Huang Yong-Can
Published: November 2019

The osteogenic potential of mesenchymal stromal cells (MSCs) varies among different tissue sources. Strontium enhances the osteogenic differentiation of bone marrow-derived MSCs (BM-MSCs), but whether it exerts similar effects on placental decidual basalis-derived MSCs (PDB-MSCs) remains unknown. Here, we compared the influence of strontium on the proliferation and osteogenic differentiation of human PDB- and BM-MSCs in vitro. We found that 1 mM and 10 mM strontium, but not 0.1 mM strontium, evidently promoted the proliferation of human PDB- and BM-MSCs. These doses of strontium showed a comparable alkaline phosphatase activity in both cell types, but their osteogenic gene expressions were promoted in a dose-dependent manner. Strontium at doses of 0.1 mM and 1 mM elevated several osteogenic gene expressions of PDB-MSCs, but not those of BM-MSCs at an early stage. Nevertheless, they failed to enhance the mineralization of either cell type. By contrast, 10 mM strontium facilitated the osteogenic gene expression as well as the mineralization of human PDB- and BM-MSCs. Collectively, this study demonstrated that human PDB- and BM-MSCs shared a great similarity in response to strontium, which promoted their proliferation and osteogenic differentiation in a dose-dependent manner.
Strategies to Enhance Mesenchymal Stem Cell-Based Therapies for Acute Respiratory Distress Syndrome
Authors: Han Jibin , Li Yanmin , Li Yuanyuan
Published: November 2019

Acute respiratory distress syndrome (ARDS) is a multifaced disease characterized by the acute onset of hypoxemia, worsened pulmonary compliance, and noncardiogenic pulmonary edema. Despite over five decades of research, specific treatments for established ARDS are still lacking. MSC-based therapies have the advantage of targeting nearly all pathophysiological components of ARDS by means of a variety of secreted trophic factors, exerting anti-inflammatory, antioxidative, immunomodulatory, antiapoptotic, and proangiogenic effects, resulting in significant structural and functional recovery following ARDS in various preclinical models. However, the therapeutic efficacy of transplanted MSCs is limited by their poor engraftment and low survival rate in the injured tissues, major barriers to clinical translation. Accordingly, several strategies have been explored to improve MSC retention in the lung and enhance the innate properties of MSCs in preclinical models of ARDS. To provide a comprehensive and updated view, we summarize a large body of experimental evidence for a variety of strategies directed towards strengthening the therapeutic potential of MSCs in ARDS.
The Role of Peer Support Education Model in Management of Glucose and Lipid Levels in Patients with Type 2 Diabetes Mellitus in Chinese Adults
Authors: Zhao Xin , Yu Xiaofeng , Zhang Xiaomei
Published: November 2019

Aims. To investigate the effect of peer support education model on the levels of glucose and lipids in patients with type 2 diabetes mellitus in China. Methods. 120 type 2 diabetes mellitus patients (T2DM) were assigned to two groups randomly from December 2016 to October 2017. Group 1 was trained on basic diabetic medical knowledge by a professional medical staff. After 8 weeks of studying, these specially trained patients then trained the patients of Group 2. Results. It was found that after 3 months of intervention, the levels of fasting blood glucose, triglycerides, glycosylated hemoglobin, total cholesterol, and low-density lipoprotein cholesterol were significantly decreased for the two groups (p<0.05). However, with the prolongation of time, there were no significant changes in the two groups in the above indices (p>0.05) after 6 months, and the result was the same after strafing sex, age, and education level. Meanwhile, there was no significant difference in decreasing glucose and lipid level between the two groups’ participants (p>0.05). Conclusion. It was found that both the peer support education model and medical staff education model have a better short-term effect on blood glucose and lipid levels in patients with type 2 diabetes. As there is no difference of effect between the two methods of training, the peer support education model can be widely used in diabetes education.
Research on the Feature Selection of Rolling Bearings’ Degradation Features
Authors: Li Yaolong , Li Hongru , Wang Bing , Yu He , Wang Weiguo
Published: November 2019

The bearings’ degradation features are crucial to assess the performance degradation and predict the remaining useful life of rolling bearings. So far, numerous degradation features have been proposed. Many researchers have devoted to use dimensionality reduction methods to reduce the redundancy of those features. However, they have not considered the properties and similarity of those features. In this paper, we present a simple way to reduce dimensionality by classifying different features based on their trends. And the degradation features can be classified into two subdivisions, namely, uptrends and downtrends. In each subdivision, there exists visible trend similarity, and we have introduced two indexes to measure this similarity. By selecting the representative features of the subdivision, the multifeatures can be dimensionality reduced. Through the comparison, the root mean square and sample entropy are two good representatives of uptrend and downtrend features. This method gives an alternative way for dimensionality reduction of the rolling bearings’ degradation features.
Robust Optimization Solution to Emergency Mobile Facility Fleet Size and Location
Authors: Li Jianxun , Lai Kin Keung , Lin Qiuping
Published: November 2019

Allocation of emergency mobile facility is the key problem of the emergency response system, which affects the cost and the satisfaction of services for emergency so as to rapidly respond to disasters, contagions, etc. In order to seek a reasonable fleet size and locations of emergency mobile facilities, we propose a two‐stage programming model with the objective function of minimizing the total cost. With uncertain characteristics of emergency event, the model conforms to the requirement for noninterruptible service and tries to satisfy all emergency demands. For overcoming the computational difficulty of emergency mobile facility fleet size and location problem, a robust optimization approach and modified ant colony algorithm are employed to obtain solutions. The illustrative example shows that the model can provide a reasonable solution to the determination of the fleet size and locations of emergency mobile facilities and that the risk recognition factor of the model can further guide decision‐making.
Inadequate Nutrition Coverage in Outpatient Cancer Centers: Results of a National Survey
Authors: Trujillo Elaine B. , Claghorn Katrina , Dixon Suzanne W. , Hill Emily B. , Braun Ashlea , Lipinski Elizabeth , Platek Mary E. , Vergo Maxwell T. , Spees Colleen
Published: November 2019

Cancer-related malnutrition is associated with poor health outcomes, including decreased tolerance to cancer therapy, greater treatment toxicities, and increased mortality. Medical nutrition therapy (MNT) optimizes clinical outcomes, yet registered dietitian nutritionists (RDNs), the healthcare professionals specifically trained in MNT, are not routinely employed in outpatient cancer centers where over 90% of all cancer patients are treated. The objective of this study was to evaluate RDN staffing patterns, nutrition services provided in ambulatory oncology settings, malnutrition screening practices, and referral and reimbursement practices across the nation in outpatient cancer centers. An online questionnaire was developed by the Oncology Nutrition Dietetic Practice Group (ON DPG) of the Academy of Nutrition and Dietetics and distributed via the ON DPG electronic mailing list. Complete data were summarized for 215 cancer centers. The mean RDN full-time equivalent (FTE) for all centers was 1.7 ± 2.0. After stratifying by type of center, National Cancer Institute-Designated Cancer Centers (NCI CCs) employed a mean of 3.1 ± 3.0 RDN FTEs compared to 1.3 ± 1.4 amongst non-NCI CCs. The RDN-to-patient ratio, based on reported analytic cases, was 1 : 2,308. Per day, RDNs evaluated and counseled an average of 7.4 ± 4.3 oncology patients. Approximately half (53.1%) of the centers screened for malnutrition, and 64.9% of these facilities used a validated malnutrition screening tool. The majority (76.8%) of centers do not bill for nutrition services. This is the first national study to evaluate RDN staffing patterns, provider-to-patient ratios, and reimbursement practices in outpatient cancer centers. These data indicate there is a significant gap in RDN access for oncology patients in need of nutritional care.
Frequency of Gestational Diabetes Mellitus Reappearance or Absence during the Second Pregnancy of Women Treated at Mayo Clinic between 2013 and 2018
Authors: Enninga Elizabeth Ann L. , Egan Aoife M. , Alrahmani Layan , Leontovich Alexey A. , Ruano Rodrigo , Sarras Michael P.
Published: November 2019

The Center for Disease Control and Prevention ranks diabetes mellitus (DM) as the seventh leading cause of death in the USA. The most prevalent forms of DM include Type 2 DM, Type 1 DM, and gestational diabetes mellitus (GDM). While the acute problem of diabetic hyperglycemia can be clinically managed through dietary control and lifestyle changes or pharmacological intervention with oral medications or insulin, long-term complications of the disease are associated with significant morbidity and mortality. These long-term complications involve nearly all organ systems of the body and share common pathologies associated with endothelial cell abnormalities. To better understand the molecular mechanisms underlying DM as related to future long-term complications following hyperglycemia, we have undertaken a study to determine the frequency that GDM did or did not occur in the second pregnancy of women who experienced GDM in their first pregnancy between 2013 and 2018 at Mayo Clinic, Rochester, MN. Within the five-year period of the study, the results indicate that 7,330 women received obstetrical care for pregnancy during the study period. Of these, 150 developed GDM in their first pregnancy and of these, 42 (28%) had a second pregnancy. Of these 42 women, 20 again developed GDM and 22 did not develop GDM in their second pregnancy within the study period. Following the occurrence of GDM in the first pregnancy, the study (1) established the number of women with and without GDM in the second pregnancy and (2) confirmed the feasibility to study diabetic metabolic memory using maternal placental tissue from GDM women. These studies represent Phase I of a larger research project whose goal is to analyze epigenetic mechanisms underlying true diabetic metabolic memory using endothelial cells isolated from the maternal placenta of women with and without GDM as described in this article.
Whole-Slide Image Analysis Reveals Quantitative Landscape of Tumor–Immune Microenvironment in Colorectal Cancers
Authors: Yoo Seung-Yeon , Park Hye Eun , Kim Jung Ho , Wen Xianyu , Jeong Seorin , Cho Nam-Yun , Gwon Hwang Gwan , Kim Kwangsoo , Lee Hye Seung , Jeong Seung-Yong , Park Kyu Joo , Han Sae-Won , Kim Tae-You , Bae Jeong Mo , Kang Gyeong Hoon
Published: November 2019

Purpose:

Despite the well-known prognostic value of the tumor–immune microenvironment (TIME) in colorectal cancers, objective and readily applicable methods for quantifying tumor-infiltrating lymphocytes (TIL) and the tumor–stroma ratio (TSR) are not yet available.

Experimental Design:

We established an open-source software-based analytic pipeline for quantifying TILs and the TSR from whole-slide images obtained after CD3 and CD8 IHC staining. Using a random forest classifier, the method separately quantified intraepithelial TILs (iTIL) and stromal TILs (sTIL). We applied this method to discovery and validation cohorts of 578 and 283 stage III or high-risk stage II colorectal cancers patients, respectively, who were subjected to curative surgical resection and oxlaliplatin-based adjuvant chemotherapy.

Results:

Automatic quantification of iTILs and sTILs showed a moderate concordance with that obtained after visual inspection by a pathologist. The K-means–based consensus clustering of 197 TIME parameters that showed robustness against interobserver variations caused colorectal cancers to be grouped into five distinctive subgroups, reminiscent of those for consensus molecular subtypes (CMS1-4 and mixed/intermediate group). In accordance with the original CMS report, the CMS4-like subgroup (cluster 4) was significantly associated with a worse 5-year relapse-free survival and proved to be an independent prognostic factor. The clinicopathologic and prognostic features of the TIME subgroups have been validated in an independent validation cohort.

Conclusions:

Machine-learning–based image analysis can be useful for extracting quantitative information about the TIME, using whole-slide histopathologic images. This information can classify colorectal cancers into clinicopathologically relevant subgroups without performing a molecular analysis of the tumors.
Comparison of Retinal Layer Thickness in Eyes with Resolved Diabetic Macular Edema Receiving Ranibizumab with Normal Eyes
Authors: Rentiya Zubir S. , Kherani Saleema , Usmani Bushra , Qazi Manneha A. , Sadiq Mohammad Ali , Iftikhar Mustafa , Nguyen Quan Dong , Shah Syed M. , Sepah Yasir J. ,   on behalf of the Read-3 study group
Published: November 2019

Purpose: To evaluate the thickness of individual retinal layers in eyes with resolved diabetic macular edema (DME) after treatment with ranibizumab (RBZ). Methods: Spectral-domain optical coherence tomography (OCT) scans of 25 eyes (25 patients) with DME that had been treated with RBZ (and shown resolution of edema as evident by the absence of fluid in a high-resolution grid placed on the fovea) were acquired using Spectralis HRA + OCTTM. Thickness measurements of individual layers were calculated using papillomacular bundle (PMB), central subfield, and inner- and outer-ring Early Treatment Diabetic Retinopathy Study (ETDRS) grids. Measurements were compared to 45 normal eyes with no known retinal disease. A post-hoc analysis was done correlating visual acuity (VA) with individual retinal layer thickness. Results: Full retinal thickness (FRT) was thinner than normal individuals across all 4 grids. There were similarities and differences among the 4 grids; however, PMB and inner-ring ETDRS grids displayed the most resemblance. The VA significantly correlated with the FRT measured in PMB (p = 0.004), central subfield (p = 0.02), and inner-ring (p = 0.006) ETDRS. Conclusions: Segmentation of OCT scans revealed significant differences in the overall thickness of the retina and of individual retinal layers in patients with resolved DME. PMB grid showed a stronger correlation between affected retinal layers and VA compared to ETDRS. PMB also showed significance with VA in layers that were shown to be not significant in ETDRS grid.
Blended Psychotherapy: Treatment Concept and Case Report for the Integration of Internet- and Mobile-Based Interventions into Brief Psychotherapy of Depressive Disorders
Authors: Titzler Ingrid , Egle Viktoria , Berking Matthias , Gumbmann Corinna , Ebert David Daniel
Published: November 2019

Background: Blended psychotherapy (bPT) is a treatment that integrates internet- and mobile-based interventions into out-/inpatient psychotherapy. It can enrich the therapy by using online-based treatment modules as therapeutic extension that patients use time- and location-independently between face-to-face sessions. It could potentially improve the efficacy of psychotherapy and increase the number of treated persons through saved therapist time. The case report aims to facilitate the understanding of the blended treatment components. Case Report: A 4-month short-time depression treatment with six face-to-face therapy sessions, six online lessons, and app ratings of a 48-year-old female patient is presented based on the CARE guidelines and quantitative and qualitative measures (treatment documentation). Depressive symptoms were clinically significantly reduced (PHQ-9, 0–27: T0 = 17; T1 = 7) from a moderately severe to a subclinical-mild degree, and no diagnostic criteria were met in the 12-month follow-up diagnostic interview. The patient showed a maximum treatment satisfaction (ZUF-8, 8–32: T1 = 32) and adherence and rated the therapeutic working alliance (WAI, 12–60: T1 = 57) highly positive. Conclusion: bPT reduced depressive symptoms for this patient. Strengths of the treatment were the facilitated use of the internet-based elements with a full-time job and the individualization within the face-to-face sessions through the therapist. Treatment success was limited by the predetermined six sessions, which hindered addressing all topics and conducting relapse prevention.
Recanalization of Emergent Large Intracranial Vessel Occlusion through Intravenous Thrombolysis: Frequency, Clinical Outcome, and Reperfusion Pattern
Authors: Serna Candel Carmen , Aguilar Pérez Marta , Hellstern Victoria , AlMatter Muhammad , Bäzner Hansjörg , Henkes Hans
Published: November 2019

Background: According to a recent meta-analysis, 1 out of 10 patients with emergent large intracranial vessel occlusion (ELVO) causing stroke have recanalization after intravenous thrombolysis (IVT) alone. However, rate, clinical outcome, and recanalization pattern of this phenomenon are poorly understood. Objectives and Methods: Patients with ELVO recanalized only by IVT were analyzed, and frequency of recanalization, clinical outcome, safety variables, and reperfusion pattern were assessed. These patients were compared to a group of patients with ELVO who underwent endovascular thrombectomy with or without prior IVT. Results: Successful or sufficient recanalization after IVT alone occurred in 81 of 760 patients (10.6%) with ELVO who had been referred for endovascular thrombectomy. These 81 patients (group 1) were compared to a group of patients receiving endovascular thrombectomy with prior IVT (group 2) or without (group 3). A good clinical outcome at 90 days was seen in 61.7% of patients in group 1, 32.2% in group 2, and 34.5% in group 3 (p < 0.001). The 3 groups had no significant differences in intracranial hemorrhage. IVT was not independently associated with symptomatic intracranial hemorrhage, parenchymal hematoma, or subarachnoid hemorrhage. Mortality at 90 days was 9.9% in group 1, 20.7% in group 2, and 29.6% in group 3 (p < 0.001). After adjusting for all relevant variables, outcome and mortality differences were nonsignificant. No difference in the rate of successful reperfusion (modified treatment in cerebral ischemia [mTICI] 2b/3) was found. A reperfusion mTICI 3 was achieved in 18.5% in group 1, 60.7% in group 2, and 57.1% in group 3 (p < 0.001). Patients in group 1 had lower chance of achieving a complete recanalization (mTICI 3) compared to patients in group 2, OR 0.15 (95% CI 0.08–0.29) and in group 3, OR 0.17 (95% CI 0.09–0.32; p < 0.001). Conclusions: Primary IVT in ELVO caused a recanalization rate of 10.6%, making endovascular treatment either unnecessary or impossible. Early recanalization of ELVO with only IVT is associated with a 61.7% independence rate at 90 days and similar successful reperfusion rates (mTICI2b/3) compared to ELVO treated with endovascular treatment, with or without previous IVT. However, recanalization only through IVT achieves a lower rate of mTICI 3 reperfusion when compared to endovascular treatment.
Androgen Deprivation Therapy and the Risk of Stroke in Patients with Prostate Cancer: An Updated Systematic Review and Meta-Analysis
Authors: Liu Ranlu , Zhou Jiatong , Xia Shuai , Li Tao
Published: November 2019

Background: The aim of this article was to review the association between androgen deprivation therapy (ADT) and the risk of stroke in patients with prostate cancer (PC). Thus, we performed this study to understand the impact of ADT on the incidence of stroke in PC patients. Methods: A comprehensive literature search was performed in June 2019 based on PubMed, EMBASE, and Web of science databases. Pooled rate ratio (RR), hazard ratio (HR), and their 95% confidence intervals (95% CIs) were calculated with a DerSimonian and Laird random effects. Result: A total of 239,099 patients from 10 studies were included in this analysis. There was no significant association in pooled RR analysis. Pooled HR analysis showed that ADT treatment increased the risk of stroke (HR = 1.129, 95% CI: 1.019–1.251, p = 0.02). In a subgroup analysis of RR results, we found that different ADT treatments had no significant effect on increasing the risk of stroke. And in the subgroup analysis of HR results, only PC patients treated with gonadotropin-releasing hormone (GnRH) agonists, orchiectomy, or oral antiandrogen had significantly higher risk of stroke. In addition, we observed the result from another comparison that PC patients treated with GnRH agonists combined with oral antiandrogens might have a lower risk of stroke compared with using GnRH agonists alone. Conclusion: Our results showed that GnRH agonists, orchiectomy, or oral antiandrogen might play an important role in the incidence of stroke. We still need further studies to clarify the role of ADT in the increased risk of stroke.
Characterization of VvSPL18 and Its Expression in Response to Exogenous Hormones during Grape Berry Development and Ripening
Authors: Xie Zhenqiang , Su Ziwen , Wang Wenran , Guan Le , Bai Yunhe , Zhu Xudong , Wang Xicheng , Jia Haifeng , Fang Jinggui , Wang Chen
Published: November 2019

The sequence and structure of grape SBP-box-like18 (VvSPL18) were identified and characterized to explore its regulatory roles during grape berry development and ripening. Homologous conservation across diverse plant species was observed, and its potential function and modulated roles in grapes were investigated. The results showed that VvSPL18 has an ORF sequence of 1,137 bp, encodes 378 amino acids, and is located on chromosome 14 of grapevine. VvSPL18 has the closest relationship with its homolog in soybeans. The promoter of VvSPL18 contains cis-elements responsive to gibberellins (GA) and salicylic acid (SA), indicating that this gene might respond to these hormones involved in the modulation of grape berry. VvSPL18 is mainly distributed in the nucleus. Expression profiles showed that VvSPL18 is highly expressed only at the veraison stage of the grape berry and is slightly expressed in other phases. RNA-seq data also revealed that VvSPL18 might participate in the modulation of grape berry development and ripening. Treatment with diverse hormones demonstrated that abscisic acid (ABA) had almost no effect on its expression, whereas naphthalene acetic acid (NAA) significantly upregulated its expression at the veraison stage. We also found that VvSPL18 has a GA-responsive cis-element but no NAA-responsive cis-element. GA could promote the expression of VvSPL18 with a peak at an earlier stage than NAA, suggesting that VvSPL18 responds faster to GA than to NAA. This result indicates that VvSPL18 might modulate berry development at this phase through an ABA-independent pathway, and it might directly respond to GA, but indirectly to NAA. Our findings provide insights into the functions of VvSPL18 in mediating grape berry development and ripening.
Selecting the Best Elements from Previous Kidney Tumor Scoring Systems to Restructure Efficient Predictive Models for Surgery Type
Authors: Zhang Huijiang , Xu Zhaoyu , Chen Xuedong , Li Yongchun , Li Peng , Zhang Weili , Ye Junjie
Published: November 2019

Objective: The aim of this work was to select the best elements from previous scoring systems to restructure efficient predictive models for surgery type. Methods: Sixteen elements were selected from 7 systems (RENAL, PADUA, DAP, ZS, NephRO, ABC, and CI). They were divided into 6 categories (tumor max. size, exophytic/endophytic, correlation with collecting system or sinus, tumor location, contact situation with the parenchyma, invasion depth). Three elements, selected from 3 different categories, were integrated to establish a total of 320 new models. According to AUC rank, optimized models were developed, and these models were divided into 3 sections. An analysis of the distribution of the 6 categories was made to explore the predictive capacities of the models. Results: A total of 166 consecutive patients were included. Seventy-five patients underwent radical nephrectomy operations. The AUC of the 7 systems ranged from 0.81 to 0.844. Three optimized models (AUC 0.88) were developed to predict surgery type. These optimized models were composed of DAP (D), PADUA, (sinus), and ABC; DAP (D), RENAL (N), and ABC; NePhRO (O), PADUA (UCS), and ABC. Two categories (“exophytic/endophytic,” p < 0.001; “correlation with collecting system or sinus,” p = 0.001) were nonuniformly distributed. Conclusions: Seven systems held good predictive power for surgery type. Three optimized models were developed. “Correlation with collecting system or sinus” is a critical factor for predicting surgery type.