bluuebunny/crossref_metadata_2025 huggingface dataset:
Genome sequence of the agarwood tree Aquilaria sinensis (Lour.) Spreng: the first chromosome-level draft genome in the Thymelaeceae family
Authors: Ding Xupo , Mei Wenli , Lin Qiang , Wang Hao , Wang Jun , Peng Shiqing , Li Huiliang , Zhu Jiahong , Li Wei , Wang Pei , Chen Huiqin , Dong Wenhua , Guo Dong , Cai Caihong , Huang Shengzhuo , Cui Peng , Dai Haofu
Published: March 2020

Backgroud

Aquilaria sinensis (Lour.) Spreng is one of the important plant resources involved in the production of agarwood in China. The agarwood resin collected from wounded Aquilaria trees has been used in Asia for aromatic or medicinal purposes from ancient times, although the mechanism underlying the formation of agarwood still remains poorly understood owing to a lack of accurate and high-quality genetic information.

Findings

We report the genomic architecture of A. sinensis by using an integrated strategy combining Nanopore, Illumina, and Hi-C sequencing. The final genome was ~726.5 Mb in size, which reached a high level of continuity and a contig N50 of 1.1 Mb. We combined Hi-C data with the genome assembly to generate chromosome-level scaffolds. Eight super-scaffolds corresponding to the 8 chromosomes were assembled to a final size of 716.6 Mb, with a scaffold N50 of 88.78 Mb using 1,862 contigs. BUSCO evaluation reveals that the genome completeness reached 95.27%. The repeat sequences accounted for 59.13%, and 29,203 protein-coding genes were annotated in the genome. According to phylogenetic analysis using single-copy orthologous genes, we found that A. sinensis is closely related to Gossypium hirsutum and Theobroma cacao from the Malvales order, and A. sinensis diverged from their common ancestor ~53.18–84.37 million years ago.

Conclusions

Here, we present the first chromosome-level genome assembly and gene annotation of A. sinensis. This study should contribute to valuable genetic resources for further research on the agarwood formation mechanism, genome-assisted improvement, and conservation biology of Aquilaria species.
Transcatheter aortic root replacement with chimney grafts for coronary perfusion: a preliminary test in a three-dimensional-printed root model
Authors: Ferrari Enrico , Scoglio Martin , Piazza Giulia , Maisano Francesco , von Segesser Ludwig Karl , Berdajs Denis
Published: March 2020

OBJECTIVES

Transcatheter aortic root repair is still not available because of the technical challenge of coronary perfusion. The use of chimney grafts for coronary ostia can be an option and we tested the flow-through coronary chimney grafts deployed in a 3-dimensional-printed root model as part of a transcatheter aortic root repair system.

METHODS

A 3-dimensional-printed root was used to test the coronary flow after the deployment of 1 root endograft (28 mm diameter) and two 6-mm diameter 10-cm long coronary chimney grafts. Continuous coronary flows were measured in a bench test at different pressure levels (60, 80 and 100 mmHg) and compared to target coronary flows (250 ml/min at rest for the left and 150 ml/min at rest for the right coronary artery).

RESULTS

The computed tomography scan-based root was modified with two 5-mm diameter coronary conduits to overcome the limits of the original 3-dimensional-printed coronary ostia. The root was placed in the hydrodynamic system: adjusted coronary free flow at 60, 80 and 100 mmHg of pressure was 1913, 2200 and 2480 ml/min for left coronary and 1633, 2026 and 2366 ml/min for right coronary, respectively. After endografts deployment, mean chimney graft flow at 60, 80 and 100 mmHg of pressure was 1053 ml/min (−45%), 1306 ml/min (−41%) and 1502 ml/min (−40%) for the left coronary and 1100 ml/min (−33%), 1460 ml/min (−28%) and 1626 ml/min (−31%) for the right coronary, respectively.

CONCLUSIONS

In this preliminary study, chimney grafts for transcatheter aortic root repair provided 830% of target flow in the right coronary (−31% of free flow) and 414% of target flow in the left coronary (−42% of free flow) which is more than sufficient for both coronaries in real-life conditions. The potential of this approach should be further explored with specifically designed endografts.
Re-repair after previous mitral valve reconstruction: handle with care!
Authors: Trumello Cinzia , Giambuzzi Ilaria , Del Forno Benedetto , Bargagna Marta , Blasio Andrea , Ruggeri Stefania , Meneghin Roberta , Schiavi Davide , Nascimbene Simona , Castiglioni Alessandro , Alfieri Ottavio , De Bonis Michele
Published: March 2020

OBJECTIVES

Patients with recurrent mitral regurgitation after surgical repair are currently treated with a re-repair procedure or valve replacement. The aim of this study was to compare outcomes of our series of patients who underwent re-repair versus replacement in this setting.

METHODS

From 2003 to 2017, a total of 79 patients with recurrent mitral regurgitation underwent re-repair, group A (39), or replacement, group B (40). Mean follow-up was 7.4 ± 3.27 years (max 14.4). Inverse Probability of Treatment Weighting was used to create comparable distributions of the covariates; the Kaplan–Meier method was used for survival and competing risk analysis for time to cardiac death, time to recurrence of MR ≥3+ and MR ≥2+.

RESULTS

A re-repair was possible in 49.4% of patients (39/79). At hospital discharge, residual MR ≥2+ was present in 5 patients in group A, and none in group B (P < 0.001). The paired overall survival at 8 years was 100% in the re-repair group and 96.5 ± 2.34% in the replacement group (P = 0.069). The cumulative incidence function of cardiac death, with non-cardiac death as competitive event, at 8 years was 0% in group A and 3.5 ± 2.34% in group B (P = 0.077). The cumulative incidence function of MR ≥3+ at 8 years was 29.2 ± 8.81% in group A and 0% in group B (P < 0.001).

CONCLUSIONS

Recurrent significant mitral regurgitation after re-repair is not rare already at 8 years, but the survival tends to be worse after replacement. This finding calls for a very selective approach in pursuing a re-repair only when the intraoperative findings and the immediate results are very reassuring as far as long-term durability is concerned.
The hybrid smart contract agreement challenge to European electronic signature regulation
Authors: Veerpalu Anne , Jürgen Liisi , Rodrigues e Silva Eduardo da Cruz , Norta Alex
Published: March 2020

The article investigates the smart contract used in the Initial Coin Offering (ICO) process and its qualification under the typology of form of contract and the EU electronic signature regulation eIDAS.1 ICOs took the globe by storm in 2017 and created a lot of turmoil among the regulators due to a new form of raising funds globally. In addition to their effect on the capital market, another phenomenon that saw a rise in popularity was the smart contract. The smart contract is usually built into the ICO process as a protocol to execute the issue of a token. The article suggests that the contract in the ICO process does not only refer to the smart/contract code in silos but should be considered in the larger context as the so-called hybrid smart contract agreement with the smart contract protocol being merely the execution motor for the issuance of the token. The article qualifies the contract concluded during the ICO process under the general typology of forms of contract with the aim to identify whether the hybrid smart/contract agreement is in electronic form of contract. Some states in the USA and a few Member States in the EU have also introduced smart contract-specific regulation clearly stating that smart contracts are contracts either in electronic or written form. Still, as this is not prevalent in the EU law, the principle of functional equivalence is used to assess whether the signature on a smart contract used in an ICO process is functionally equivalent to the qualified electronic signature under eIDAS. The existence of a qualified electronic signature allows the contract to be qualified as a contract in electronic form equivalent to a paper-form agreement with hand-written signatures. Furthermore, the article investigates whether the centralized trust system of the eIDAS creates an infrastructural bias against the source of trust in case of distributed ledger technology that in itself could be non-compliant with the principle of technology neutrality.
Selling Out or Standing Firm? Explaining the Design of Civil War Peace Agreements
Authors: Cil Deniz , Prorok Alyssa K
Published: March 2020

When do rebel leaders “sell out” their constituents in the terms of peace by signing agreements that benefit group elites over the rebel constituency, and when do they instead “stand firm,” pushing for settlement terms that benefit the public they claim to represent? This article examines variation in the design of civil war settlement agreements. It argues that constituents, fighters, and rebel elites have different preferences over the terms of peace, and that rebel leaders will push for settlements that reflect the preferences of whichever audience they are most reliant on and accountable to. In particular, leaders of groups that are more civilian-reliant for their military and political power are more likely to sign agreements that favor broad benefits for civilian constituents, while leaders who do not depend on civilian support for their political and military power will sign agreements with fewer public benefits. We test this argument using original data on the design of all final peace agreements reached between 1989 and 2009, and several proxies for the group's level of reliance on civilian supporters. Using a variety of statistical tests and accounting for nonrandom selection into peace agreements, we find strong support for our hypothesis.
Who Wants to Be a Suicide Bomber? Evidence from Islamic State Recruits
Authors: Morris Andrea Michelle
Published: March 2020

Suicide attackers are frequently educated and economically well-off. These findings are widely taken as evidence that highly competent individuals predominately volunteer to conduct suicide operations. I evaluate this theory using a novel dataset on the personnel records of members of the Islamic State of Iraq and Syria (ISIS). The dataset contains information on the characteristics of individuals who volunteer for suicide attacks as opposed to normal combat missions. The results reject the self-selection hypothesis, as education and religious knowledge are negatively associated with volunteering for suicide attacks. Instead, the findings are consistent with an alternative explanation for why high-quality individuals commit suicide attacks: leaders of terrorist organizations carefully screen recruits and select high-quality individuals to commit these attacks. The results highlight the importance of leader demand rather than soldier supply of suicide bombers.
Multiple Identities and Scholarship in International Studies: 2019 ISA Presidential Address
Authors: Thies Cameron G
Published: March 2020

The International Studies Association (ISA) has gone through a variety of internal changes as a result of growth in our membership. Such growth transformed the association from a regional American enterprise into a global organization, diversified our disciplinary profile away from the dominance of political science, and incorporated individuals represented by a wide array of cultural identities into the membership. These changes have had huge effects on ISA's organizational identity and our attempts to manage it. I describe various options available for organizations to manage identity, including ISA's traditional strategy for identity management, and conclude with a plea for an aggregation strategy that refocuses attention on international studies as our master identity. I argue that such a strategy allows us to embrace and enhance the diversity of the association to pursue the major challenges facing the globe today.
Dose-Dependent Retention of Omega-3 Fatty Acids by Black Soldier Fly Larvae (Diptera: Stratiomyidae)
Authors: Erbland Patrick , Alyokhin Andrei , Perkins L Brian , Peterson Michael
Published: March 2020

Black soldier fly larvae, Hermetia illucens (L.), are used to convert organic waste streams into insect-based animal feeds. We tested their ability to retain alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) from feeding substrates, which has important implications for their use in aquaculture. When supplementing a chicken feed diet with increasing concentrations of salmon oil (0–42%) over an increasing number of days (0–8), the concentrations of the three omega-3 acids in larvae increased significantly. Larval survival and biomass accumulation were not affected. Supplementing a chicken feed diet with increasing concentrations (0–14%) of Tetraselmis chui Butcher (Chlorodendrales: Chlorodendraceae) microalgae paste also significantly increased ALA and EPA contents of the harvested larvae. However, microalgae also decreased survival, harvested biomass, and individual growth of larvae feeding on the diet with the highest supplement concentration (14%). DHA was not detected in any microalgae diet or subsequent larval tissue samples. All three omega-3 polyunsaturated fatty acids tested in this study were accumulated in dose-dependent manner, with quadratic, and occasionally linear, equations providing the best description of the observed relationships. There were significant negative correlations between several fatty acids, indicating that they may replace one another in living larvae. Our findings confirm that black soldier fly larvae can retain ingested fatty acids and change fatty acid profiles in their tissues accordingly. However, optimizing nutrient content of harvestable larvae is likely to be more complicated than simply enriching their diets with omega-3 fatty acids.
Exploring Adoption of the Wildland Fire Decision Support System: End User Perspectives
Authors: Noble Peter , Paveglio Travis B
Published: March 2020

Abstract

The increasing complexity of wildland fire management highlights the importance of sound decision making. Numerous fire management decision support systems (FMDSS) are designed to enhance science and technology delivery or assist fire managers with decision-making tasks. However, few scientific efforts have explored the adoption and use of FMDSS by fire managers. This research couples existing decision support system research and in-depth interviews with US Forest Service fire managers to explore perspectives surrounding the Wildland Fire Decision Support System (WFDSS). Results indicate that fire managers appreciate many WFDSS components but view it primarily as a means to document fire management decisions. They describe on-the-ground actions that can be disconnected with decisions developed in WFDSS, which they attribute to the timeliness of WFDSS outputs, the complexity of the WFDSS design, and how it was introduced to managers. We conclude by discussing how FMDSS development could address concerns raised by managers.
Legitimizing a practice across fields: microprocesses of theorization of Design Thinking
Authors: Jha Harsh Kumar , Jacob Dimitry
Published: March 2020

Legitimizing a practice is a challenging task because it has to be constantly made understandable and meaningful to prospective users. Garnering such legitimacy is critical for successful practice diffusion and potential institutionalization. The process of theorization—rendering of ideas into understandable and compelling formats—is considered central to legitimacy construction. However, we still have a limited understanding of the specific mechanisms through which theorization happens. In this article, we address this issue by examining the microprocesses through which the practice of Design Thinking (DT) was theorized by its proponents in the field of business management. We undertook qualitative analysis, using grounded theory, of archival data. Our analysis revealed three key microprocesses: appropriation (presenting DT as a solution to abstract field-level problems), assimilation (integrating DT with current vocabularies and legacy practices within user organizations), and adaptation (redefining DT in order to resolve contradictions with legacy practices within organizations). This study makes two contributions. First, to the literature on theorization by explicating key microprocesses underlying theorization and providing a nuanced understanding of how legitimacy and theorization may be linked. Second, to the literature on management knowledge production, by showing how management practices and concepts may be contextualized and interlinked.
“A Very Bad Presidente in the House”: Workhouse Masters, Care, and Discipline in the Eighteenth-Century Workhouse
Authors: Ottaway Susannah
Published: March 2020

Although they linger in historical memory as “Pauper Bastilles,” in the long eighteenth century, English workhouses functioned in many ways as institutions of care, as well as places of discipline. This article uses an unusual set of source materials—including a Master’s Query Book—to examine the nature of workhouse discipline in the Leeds township workhouse in the mid-eighteenth century. A close analysis of this remarkable source allows us a clear view of both the structures of authority and the agency of poor inmates in this institution. Poor Law officials monitored material conditions in the workhouse—the provision of food, clothing, and medical care—with great attentiveness, ensuring inmates were kept in good health, while leaving records that reveal intensive surveillance of the material objects inside the house. The workhouse committee also, however, kept an eagle eye on the workhouse master, allowing inmates a direct line of complaint. Workhouse inmates responded to these conditions by vigorously resisting rules that restricted their freedom of movement inside and outside the institution. Masters in such institutions were intermediaries between parish governors and the poor, rather than “technicians of discipline.” At the same time, workhouse records show that children were far more vulnerable, subjected to discipline at the discretion of master and mistress; we must disaggregate their experiences from the general population of inmates. These findings conform well to a widening strand in the historiography that reveals Old Poor Law workhouses as complex, hybrid institutions.
Anterior Sensorimotor Subthalamic Nucleus Stimulation Is Associated With Improved Voice Function
Authors: Jorge Ahmed , Dastolfo-Hromack Christina , Lipski Witold J , Kratter Ian H , Smith Libby J , Gartner-Schmidt Jackie L , Richardson R Mark
Published: March 2020

Background

Despite the impact of Parkinson disease (PD) on speech communication, there is no consensus regarding the effect of lead location on voice-related outcomes in subthalamic nucleus (STN) deep brain stimulation (DBS).

Objective

To determine the relationship of stimulation location to changes in cepstral analyses of voice following STN DBS.

Methods

Speech pathology evaluations were obtained from 14 PD subjects, before and after STN DBS, including audio-perceptual voice ratings (overall severity, loudness, hoarseness changes), measured indices of dysphonia (cepstral peak prominence and cepstral spectral index of dysphonia), and phonatory aerodynamics. The contact locations used for active stimulation at the time of postoperative voice evaluations were determined and assessed in relation to voice outcomes.

Results

Voice outcomes remained relatively unchanged on average. Stimulation locations in the anterior portion of the sensorimotor region of the left STN, however, were associated with improvements in voice severity scores, cepstral spectral index of dysphonia, shortness of breath, and phonatory airflow during connected speech. Posterior locations were associated with worsening of these outcomes. Variation in the medial-lateral or dorsal-ventral position on the left, and in any direction on the right, did not correlate with any voice outcome.

Conclusion

Active contact placement within the anterior sensorimotor STN was associated with improved perceptual and acoustic-aerodynamic voice-related outcomes. These findings suggest an STN topography for improving airflow for speech, in turn improving how PD patients’ voices sound.
CasRx-mediated RNA targeting prevents choroidal neovascularization in a mouse model of age-related macular degeneration
Authors: Zhou Changyang , Hu Xinde , Tang Cheng , Liu Wenjia , Wang Shaoran , Zhou Yingsi , Zhao Qimeng , Bo Qiyu , Shi Linyu , Sun Xiaodong , Zhou Haibo , Yang Hui
Published: March 2020

RNA-targeting CRISPR system Cas13 offers an efficient approach for manipulating RNA transcripts in vitro. In this perspective, we provide a proof-of-concept demonstration that Cas13-mediated Vegfa knockdown in vivo could prevent the development of laser-induced CNV in mouse model of Age-related macular degeneration.
TESS photometry of the eclipsing δ Scuti star AI Hydrae
Authors: Lee Jae Woo , Hong Kyeongsoo , Kristiansen Martti H
Published: March 2020

AI Hya has been known as an eclipsing binary with a monoperiodic $\delta$ Sct pulsator. We present the results from its TESS (Transiting Exoplanet Survey Satellite) photometry observed during Sector 7. Including our five minimum epochs, the eclipse timing diagram displays the apsidal motion with a rate of $\dot{\omega } = 0.075 \pm 0.031\:$deg$\:$yr$^{-1}$, which corresponds to an apsidal period of $U = 4800\pm 2000\:$yr. The binary star model represents that the smaller, less massive primary component is $427\:$K hotter than the pulsating secondary, and our distance of $612\pm 36\:$pc is in good agreement with the Gaia distance of $644\pm 26\:$pc. We subtracted the binary effects from the observed TESS data and applied a multifrequency analysis to these residuals. The result reveals that AI Hya is multiperiodic in its pulsation. Of 14 signals detected, four ($f_1$, $f_2$, $f_3$, $f_6$) may be considered independent pulsation frequencies. The period ratios of $P_{\rm pul}/P_{\rm orb} = 0.012$–0.021 and the pulsation constants of $Q = 0.30$–0.52 d correspond to $\delta$ Sct pulsations in binaries. We found that the secondary component of AI Hya pulsates in both radial fundamental $F$ modes ($f_2$ and $f_3$) and non-radial $g_1$ modes with a low degree of $\ell = 2$ ($f_1$ and $f_6$).
A quantum hydrodynamical model of skyrmions with electrical dipole moments and novel magneto-electric skyrmion Hall effect
Authors: Trukhanova Mariya Iv. , Andreev Pavel
Published: March 2020

To introduce novel ways of manipulating the skyrmion dynamics we need to develop new fundamental models. Many-particle quantum hydrodynamics allows us to study inter-skyrmion interactions in the approximation of point-particle skyrmions, which were discovered in multiferroic insulators, where the spiral magnetic structure is accompanied by a finite electric dipole moment. We propose a new model of many-particle quantum hydrodynamics for dipolar skyrmions with dipole–dipole interaction, in the presence of electric and magnetic field gradients. Based on the developed model we find a new way to control the positions of skyrmions, using the crossed gradients of magnetic and electric fields or a novel magneto-electric Hall effect. We have shown that the influence of non-uniform magnetic field provides circular motion of the dipolar skyrmion in the plane with the frequency determined by the derivative of the external magnetic field and the amplitude of the dipole moment. We study the wave processes in the system of skyrmions. We investigate hydrodynamic waves in a skyrmion gas in crossed non-uniform electric and magnetic fields, and predict the generation of a new type of hydrodynamic waves and instabilities. Also, we predict a new type of polarization waves in a rigid skyrmion gas with the dipole–dipole interaction.
Possible existence of a third fundamental long-range force
Authors: Nakanishi Noboru , Yoshida Ritsu
Published: March 2020

It is inferred that, in addition to the Coulomb and Newtonian forces, there should exist a third fundamental long-range force, which acts between intrinsic angular momenta. This inference is based on the quantum Einstein gravity, that is, the manifestly-covariant, BRS-invariant, canonically quantized theory of general relativity. The form of the potential of the third fundamental long-range force is determined by calculating the non-relativistic limit of the Bethe–Salpeter kernel in the lowest-order perturbation theory. The observability of this force is also discussed.
Interactional synchrony: signals, mechanisms and benefits
Authors: Hoehl Stefanie , Fairhurst Merle , Schirmer Annett
Published: March 2020

Many group-living animals, humans included, occasionally synchronize their behavior with that of conspecifics. Social psychology and neuroscience have attempted to explain this phenomenon. Here we sought to integrate results around three themes: the stimuli, the mechanisms and the benefits of interactional synchrony. As regards stimuli, we asked what characteristics, apart from temporal regularity, prompt synchronization and found that stimulus modality and complexity are important. The high temporal resolution of the auditory system and the relevance of socio-emotional information endow auditory, multimodal, emotional and somewhat variable and adaptive sequences with particular synchronizing power. Looking at the mechanisms revealed that traditional perspectives emphasizing beat-based representations of others’ signals conflict with more recent work investigating the perception of temporal regularity. Timing processes supported by striato-cortical loops represent any kind of repetitive interval sequence fairly automatically. Additionally, socio-emotional processes supported by posterior superior temporal cortex help endow such sequences with value motivating the extent of synchronizing. Synchronizing benefits arise from an increased predictability of incoming signals and include many positive outcomes ranging from basic information processing at the individual level to the bonding of dyads and larger groups.
A Systematic Review of the Potential Use of Neurofeedback in Patients With Schizophrenia
Authors: Gandara Veronica , Pineda Jaime A , Shu I-Wei , Singh Fiza
Published: March 2020

Schizophrenia (SCZ) is a neurodevelopmental disorder characterized by positive symptoms (hallucinations and delusions), negative symptoms (anhedonia, social withdrawal) and marked cognitive deficits (memory, executive function, and attention). Current mainstays of treatment, including medications and psychotherapy, do not adequately address cognitive symptoms, which are essential for everyday functioning. However, recent advances in computational neurobiology have rekindled interest in neurofeedback (NF), a form of self-regulation or neuromodulation, in potentially alleviating cognitive symptoms in patients with SCZ. Therefore, we conducted a systematic review of the literature for NF studies in SCZ to identify lessons learned and to identify steps to move the field forward. Our findings reveal that NF studies to date consist mostly of case studies and small sample, single-group studies. Despite few randomized clinical trials, the results suggest that NF is feasible and that it leads to measurable changes in brain function. These findings indicate early proof-of-concept data that needs to be followed up by larger, randomized clinical trials, testing the efficacy of NF compared to well thought out placebos. We hope that such an undertaking by the field will lead to innovative solutions that address refractory symptoms and improve everyday functioning in patients with SCZ.
Evaluation of Foliar Diseases for Soybean Entries in the Pan-African Trials in Malawi and Zambia
Authors: Nachilima Christabell , Chigeza Godfree , Chibanda Mwila , Mushoriwa Hapson , Diers Brian D. , Murithi Harun M. , Hartman Glen L.
Published: March 2020

Soybean production has expanded worldwide including countries in sub-Saharan Africa. Several national and international agencies and research groups have partnered to improve overall performance of soybean breeding stocks and have introduced new germplasm from Brazil and the United States with the goal of developing new high-yielding cultivars. Part of this effort has been to test improved soybean lines/cultivars accumulated from private and public sources in multilocational trials in sub-Saharan Africa. These trials are known as the Pan-African Soybean Variety Trials, and the entries come from both private and public breeding programs. The objective of this research was to evaluate entries in the trials that include commercial cultivars or advanced experimental lines for the incidence and severity of foliar diseases. All trials were planted in December 2018 with six located in Zambia and one in Malawi. Plants were evaluated during the reproductive growth stages using a visual pretransformed severity rating scale. Foliar disease ratings were recorded for three bacterial diseases, six fungal diseases, one oomycete, and viruses. The overall occurrence of most of the diseases was high except for soybean rust and target spot, which were only found at two and one location, respectively. However, disease severity was generally low, although there were differences in disease severity ratings among the entries at some of the locations for brown spot, downy mildew, frogeye leaf spot, red leaf blotch, and soybean rust.
A Comparison of 3 Fixation Strategies in the Treatment of Neer Type IIB Distal Clavicle Fractures
Authors: Garlich John , Little Milton T. M. , Nelson Trevor J. , Eberlein Sam A. , Monfiston Carl-Henri , Kremen Thomas , Metzger Melodie F.
Published: March 2020

Objectives:

To compare the stability of NT2B clavicle fractures fixed with either a hook plating (HP), Superior Plating with Suture Augmentation (SPSA), or dual orthogonal plating (DP) with the hypothesis that DP would provide increased multiplanar stability across NT2B fractures.

Methods:

NT2B distal clavicle fractures were created in cadaveric specimens and fixed using (1) HP, (2) SPSA, or (3) DP. Specimens were cyclically loaded in 3 different planes of motion: (1) anteroposterior (AP), (2) superior–inferior, and (3) axial rotation while displacement was continually recorded. Afterward, a superiorly directed load was applied to the clavicle. Load to failure, stiffness, and mode of failure were recorded.

Results:

During AP loading, clavicles fixed with a DP had significantly lower mean posterior displacement compared to those fixed with SPSA at every 100-cycle interval of testing, P < 0.01. During inferior–superior loading, specimens fixed with a DP had less superior displacement than specimens fixed with an HP and SPSA, reaching significance at the 500–700 cycles of testing. There was no significant difference in axial rotation stability or load to failure between the 3 fixation techniques.

Conclusions:

Orthogonally placed minifragment plates provide improved stability against anterior displacement with no significant difference in superior stability, axial rotational stability, stiffness, or load to failure. Further clinical studies are needed to confirm the long-term stability of dual plating and determine the risks and benefits of this novel method of distal clavicle fixation.
Handgrip Strength as a Predictor of Exercise Capacity in Coronary Heart Disease
Authors: Kim Woohyeun , Park Se-Hyun , Kim Woo-Sub , Jang Won Young , Park Eun Jin , Kang Dong Oh , Park Yoonjee , Na Jin Oh , Kim Jin Won , Kim Eung Ju , Rha Seung-Woon , Park Chang Gyu , Seo Hong Seog , Choi Cheol Ung
Published: March 2020

Purpose:

A recent study has shown that quadriceps strength can be used to predict the level of exercise capacity in patients with coronary heart disease. We investigated whether the relationship between muscular strength and exercise capacity is also observed with handgrip strength (HGS).

Methods:

We studied 443 participants (61.8 ± 11.2 yr; 78% male) who underwent coronary intervention and participated in cardiac rehabilitation between 2015 and 2018. Logistic regression was used to assess the relationship between various clinical measures (HGS, age, sex, etc) with the distance walked on a 6-minute walk test (6MWT) and maximal oxygen uptake (

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2max).

Results:

Handgrip strength was related to distance walked on the 6MWT (r = 0.435, P < .001). It was the only predictor of all exercise capacity categories, and one of the strongest predictors of each exercise capacity category. An HGS of 26% of body weight predicted an achievement of a 200-m walk on the 6MWT (positive predictive value = 0.95). However, HGS <36% of body weight predicted that 500 m could not be done in 6 min (negative predictive value = 0.97). This trend was also observed in the subgroups in which

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o
2max was measured.

Conclusion:

This study demonstrates that HGS is associated with exercise capacity in coronary heart disease and can be used to predict the level of exercise capacity. These findings may contribute to setting the recommended level of daily activity as well as the level of cardiac rehabilitation in coronary heart disease.
Ventilatory and Near-Infrared Spectroscopy Responses Similarly Determine Anaerobic Threshold in Patients With Heart Failure
Authors: Reis Michel Silva , Nasser Igor , Barroco Adriano , Berton Danilo Cortozi , Neder José Alberto , Arena Ross , Borghi-Silva Audrey
Published: March 2020

Purpose:

The present study compared the level of agreement of anaerobic threshold (AT) between ventilatory and near-infrared spectroscopy (NIRS) techniques in patients with chronic heart failure (CHF) and healthy subjects.

Methods:

Patients with CHF (n = 9) and a control group (CG; n = 14) underwent cardiopulmonary exercise testing on a cycle ergometer until physical exhaustion. Determination of AT was performed visually by (1) ventilatory-expired gas analysis curves and (2) oxyhemoglobin (O2Hb) and deoxyhemoglobin (HHb) curves assessed by NIRS.

Results:

The CHF group presented significantly lower oxygen consumption (O2), heart rate, and workload at AT when compared with the CG measured by NIRS (P < .05). However, the effect size, measured by the Cohen d, revealed large magnitude (>0.80) in both techniques when compared between CHF patients and the CG. In addition, ventilatory and NIRS techniques demonstrated significant and very strong/strong correlations for relative O2 (r = 0.91) and heart rate (r = 0.85) in the detection of AT in the CHF group.

Conclusion:

Both ventilatory and NIRS assessments are correlated and there are no differences in the responses between CHF patients and healthy subjects in the determination of AT. These findings indicate both approaches may have utility in the assessment of submaximal exercise performance in patients with CHF.
Survey of Exercise Prescription in US Pulmonary Rehabilitation Programs
Authors: Garvey Chris , Casaburi Richard , Spruit Martijn A. , De Brandt Jana
Published: March 2020

Purpose:

Pulmonary rehabilitation (PR) is the standard of care for chronic, symptomatic lung disease. Current scientific and clinical guidelines recommend PR to improve dyspnea, functional capacity, and quality of life. Several PR guidelines provide recommendations about the mode, intensity, duration, frequency, and progression of exercise-based interventions. There are variations in the components of PR exercise prescription that may influence the response to PR, as well as variations in how the exercise prescription and its components are determined and monitored. Therefore, the purpose of this investigation was to identify current PR exercise prescription practices via survey sent to 1758 PR programs in the United States.

Methods:

The American Association of Cardiovascular and Pulmonary Rehabilitation administered surveys in 2013 and 2016 to US-based PR providers.

Results:

Responses were returned from 371 PR providers (vs 380 in 2013). There was an increase in responses for all options describing exercise prescription methodology in the 2016 survey, with each element (frequency, intensity, time [duration], and type [mode]; FITT) demonstrating significant increase in use. There was a significant increase in 3 methods of determining exercise goals in 2016 versus 2013: duration (P = .017), distance (P = .010), and metabolic equivalents of task (P ≤ .001).

Conclusions:

The 2016 survey responses show a greater use of guideline-based exercise prescription methodology, with an increase in use of FITT methodology for exercise prescription.
Stromal Keratitis After Varicella in Children
Authors: Denier Margot , Gabison Eric , Sahyoun Marwan , Labetoulle Marc , Dureau Pascal , Cochereau Isabelle , Doan Serge
Published: March 2020

Purpose:

We describe here a case series of patients with stromal keratitis of chronic course, a potential manifestation after chickenpox in children.

Methods:

This is a retrospective review of 8 eyes (7 children) with stromal keratitis after varicella seen in our referral cornea center. All patients received a systemic antiviral treatment with oral acyclovir and topical steroid eye drops. Topical cyclosporine eye drops were associated with steroids in case of steroid dependence or steroid-related side effects. Both antiinflammatory treatments were slowly tapered over time.

Results:

Median age at diagnosis was 3 years and 4 months. Stromal keratitis was unilateral in 6 children (85.7%) and consisted of superficial nummular keratitis in 4 cases and deep stromal diffuse keratitis in 3 cases. During the median follow-up of 31 months (range, 13–59 months), 6 children had 1 to 6 episodes of relapse. The median duration of topical steroid eye drop was 26 months (range, 2–59 months). Topical cyclosporine eye drops were used with steroids in 3 patients (42.9%). Three patients stopped topical steroids after 2, 5, and 8 months, without recurrence. Four patients were still undergoing treatment after a median of 43 months (range, 26–59 months). All patients regained a best-corrected visual acuity of 20/20 at the end of the follow-up.

Conclusions:

Stromal keratitis after varicella is an entity with a potential chronic course lasting 3 months or more. Steroid dependence and relapses during tapering are 2 major challenges for the management.
Novel Duplex Polymerase Chain Reaction for the Rapid Detection of Pythium insidiosum Directly From Corneal Specimens of Patients With Ocular Pythiosis
Authors: Kulandai Lily Therese , Lakshmipathy Dhanurekha , Sargunam Janaki
Published: March 2020

Purpose:

To standardize a novel duplex polymerase chain reaction (PCR) targeting 18S rRNA gene and internal transcribed spacer region for the identification of Pythium insidiosum isolates and also to detect P. insidiosum genome directly from corneal specimens of patients with suspected ocular pythiosis.

Methods:

A total of 42 nonsporulating molds culturally and morphologically resembling suspected unidentified fungal isolates (corneal buttons 33 and corneal scrapings 9) and 14 clinical specimens (corneal buttons 7 and corneal scrapings 7) clinically suspected to be ocular pythiosis were included in the present study. Standardization of uniplex PCRs and duplex PCRs targeting 18S rRNA gene and internal transcribed spacer region and further application of the standardized PCRs on both clinical isolates and clinical specimens suspected to have fungal keratitis. The sensitivity and specificity of the standardized duplex PCR were calculated using Medcal.net software.

Results:

The standardized uniplex and duplex PCRs were found specific for the detection of only P. insidiosum DNA, and the analytical sensitivities of the primers were 1.36 Zg. Of the 14 clinical specimens analyzed, 13 were positive in both corneal specimens and their respective P. insidiosum isolates. The specificity of the novel duplex PCR was 100% when applied on corneal specimens and clinical isolates, but the sensitivity was 92.8% (13/14) and 100% (42/42), respectively, for the clinical specimens and fungal isolates from suspected ocular pythiosis patients included in the study.

Conclusions:

The novel duplex PCR developed in this study will aid in rapid identification of P. insidiosum clinical isolates and clinical specimens from suspected ocular pythiosis specimens, which in turn will help the ophthalmologists to initiate appropriate treatment.
Nasolacrimal Lymphangioma Presenting With Hemolacria
Authors: Li Emily , Yoda Rebecca A. , Keene C. Dirk , Moe Kristen S. , Chambers Christopher , Zhang Matthew M.
Published: March 2020

A 22-year-old male presented with spontaneous unilateral hemolacria and was found to have complete opacification of the ipsilateral nasolacrimal sac and duct. Endoscopic biopsy with histopathologic analysis revealed the diagnosis of nasolacrimal lymphangioma. Additional management included nasolacrimal stenting, and there was no hemolacria recurrence or epiphora. This is the first report of a nasolacrimal lymphangioma and describes the vascular malformation as a potential cause of bloody tearing.
Intranasal dexmedetomidine versus oral chloral hydrate for diagnostic procedures sedation in infants and toddlers
Authors: Li Linji , Zhou Jiaojiao , Yu Deshui , Hao Xuechao , Xie Ying , Zhu Tao
Published: March 2020

Background:

Intranasal dexmedetomidine is a relatively new way to sedate young children undergoing nonpainful diagnostic procedures. We performed a meta-analysis to compare the efficacy and safety of intranasal dexmedetomidine in young children with those of oral chloral hydrate, which has been a commonly used method for decades.

Methods:

We searched PubMed, Embase, and the Cochrane Library for all randomized controlled trials that compared intranasal dexmedetomidine with oral chloral hydrate in children undergoing diagnostic procedures. Data on success rate of sedation, onset time, recovery time, and adverse effects were extracted and respectively analyzed.

Results:

Five studies with a total of 720 patients met the inclusion criteria. Intranasal dexmedetomidine provided significant higher success rate of sedation (relative risk [RR], 1.12; 95% confidence interval [CI], 1.02 to 1.24; P = .02; I
2 = 74%) than oral chloral hydrate. Furthermore, it experienced significantly shorter onset time (weight mean difference [WMD], −1.79; 95% CI, −3.23 to −0.34; P = .02; I
2 = 69%). Nevertheless, there were no statistically differences in recovery time (WMD, −10.53; 95% CI, −24.17 to 3.11; P = .13; I
2 = 92%) and the proportion of patients back to normal activities (RR, 1.11; 95% CI, 0.77–1.60; P = .57; I
2 = 0%). Intranasal dexmedetomidine was associated with a significantly lower incidence of nausea and vomiting (RR, 0.05; 95% CI, 0.01–0.22; P < .0001; I
2 = 0%) than oral chloral hydrate. Although adverse events such as bradycardia, hypotension and hypoxia were not synthetized due to lack of data, no clinical interventions except oxygen supplementation were required in any patients.

Conclusion:

Our meta-analysis revealed that intranasal dexmedetomidine is possibly a more effective and acceptable sedation method for infants and toddlers undergoing diagnostic procedures than oral chloral hydrate. Additionally, it shows similar safety profile and could be a potential alternative to oral chloral hydrate.
Comparative efficacy of nonpharmaceutical therapy in the treatment of dysphagia after stroke
Authors: Qin Weixun , Wang Zhijie , Zhong Yue , Yuan Qing , Jiang Xin , Gao Jing , Wu Junyan , Zhang Yu
Published: March 2020

Background:

Dysphagia is one of the major post-stroke complications that can severely damage a patient's quality of life. An increasing number of studies have demonstrated that many kinds of nonpharmacological treatments can be used for post-stroke dysphagia. However, there is not enough evidence evaluating the effectiveness and safety of these interventions. This study will conduct a systematic review, and Bayesian network meta-analysis, of nonpharmacological treatments in order to provide evidence for a future study investigating more options for post-stroke dysphagia.

Methods:

Randomized controlled trials (RCTs) of adult patients aged >18 years old who meet the criteria for a diagnosis of post-stroke dysphagia will be included, regardless of gender, nationality, or education level. Four Chinese databases (CNKI, SinoMed, Wanfang Database, and the Chinese Scientific Journal Database) and four English databases (Web of Science, MEDLINE, Embase, and the Cochrane Library) will be searched. Two independent reviewers will evaluate the title summary for each RCT. Disagreements will be discussed with a third commentator. Standard pairwise meta-analysis, including heterogeneity analysis, subgroup analysis, and sensitivity analysis, will be performed using the RevMan 5.3 software, and the risk of bias assessment will be conducted based on the methodological quality of the included trials recommended by the Cochrane Handbook 5.1. The Bayesian network meta-analysis will be performed using R-3.3.2 software. The quality evaluation of this study will be completed using the World Health Organization's Grading of Recommendations, Assessment, Development, and Evaluation.

Results:

This study will summarize all the selected trials aimed at estimating the effectiveness, as well as safety, of applying nonpharmacological treatments to post-stroke dysphagia.

Conclusion:

This systematic review will provide evidence to assess the validity and safety of applying different types of nonpharmacological treatments for post-stroke dysphagia, which may provide clinicians with more choices in the treatment of this disease.

PROSPERO registration number:

CRD42019119368.
Guizhi Gancao Longgu Muli decoction for insomnia
Authors: Chen Fangying , Chen Guoming , Chen Ziyin , Zhang Zhaoping , Zhang Peng , Luo Dongqiang , Li Keyi , Hou Yingyue , Xing Wanli , Shi Peiyu , Yuan Xueya
Published: March 2020

Background:

Insomnia is a prevalent and bothersome disorder of sleep initiation and maintenance. Although efficacious treatments for insomnia have been available for decades, they all have their own limitations. Guizhi Gancao Longgu Muli Decoction (GGLMD), a popular complementary and alternative therapy, has been widely applied to treat insomnia in some Asian countries for centuries. Yet no systematic reviews have comprehensively assessed the efficacy and safety of GGLMD as a treatment for insomnia.

Methods:

A comprehensive search up to November, 2019 will be conducted in the following electronic databases: the Cochrane Library, Embase, PubMed, Web of Science, the Chinese National Knowledge Infrastructure (CNKI), the Chinese Biomedical Literature Database (CBM), the Chinese Scientific Journal Database (VIP), and the Wanfang Database. The primary outcomes will be sleep quality including Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG). Stata 15 will be used for data analysis as well.

Results:

This study will provide the current evidence of insomnia treated with GGLMD from the several points including PSQI and PSG.

Conclusion:

The consequence of this summary will furnish proof to evaluate if GGLMD is effective in the treatment of insomnia.

Ethics and dissemination:

Without personal information involved, ethical approval and informed consent form is no need. The review will be submitted to a peer-reviewed journal prospectively to spread our findings.

PROSPERO registration number:

PROSPERO CRD42018118336.