bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimization on the synthesis of bacterial nano cellulose (BNC) from banana peel waste for water filter membrane applications
Authors: Sijabat Edwin K , Nuruddin Ahmad , Aditiawati Pingkan , Sunendar Purwasasmita Bambang
Published: April 2020

This research reports the optimization of the synthesis of bacterial nano cellulose (BNC) from banana peel waste media of Kepok bananas (Musa paradisiaca L.) using Gluconacetobacter xylinus bacteria in a fermentation process for use in water filter membrane applications. Bacterial nanocellulose (BNC) synthesis was successfully accomplished under conditions of pH 4, 0.5% urea, and varying sucrose contents (5%, 10% and 15% (w/v)). The higher sucrose content causes the pH of the banana peel extract solution to decrease at the end of Day 8 and 10 due to the metabolic activity of bacteria, which produces acetic acid. A bacterial growth pH range of 3.93–4.26 was obtained. The Optical Density (OD) values tend to increase with respect to fermentation time due to the growth of BNC-forming bacteria. The higher the added sucrose content, the higher the total amount of the acid obtained as the G. Xylinus bacteria produces acetic acid in its metabolic processes. BNC thickness is directly proportional to the increase in sucrose level but does not increase proportionally with the increase in sucrose levels from 5%, 10% (two times), and 15% (three times). The sucrose level at 5% (w/v) produces most optimal results. Optimal incubation time was obtained on Day 6, which had the highest rate of increase in thickness in addition to the supporting pH, OD value and total acid factors. The TEM analysis shows that the BNC surface morphology tends to be the same among all sucrose level (5%, 10% and 15% (w/v)). The difference can only be seen in the density of the nanocellulose. The nanocellulor nanofiber produced from banana peels has diameter sizes between 30–50 nm which potentially be used in water filter membrane application.
Efficient microwave frequency conversion mediated by a photonics compatible silicon nitride nanobeam oscillator
Authors: Fink J M , Kalaee M , Norte R , Pitanti A , Painter O
Published: April 2020

Microelectromechanical systems and integrated photonics provide the basis for many reliable and compact circuit elements in modern communication systems. Electro-opto-mechanical devices are currently one of the leading approaches to realize ultra-sensitive, low-loss transducers for an emerging quantum information technology. Here we present an on-chip microwave frequency converter based on a planar aluminum on silicon nitride platform that is compatible with slot-mode coupled photonic crystal cavities. We show efficient frequency conversion between two propagating microwave modes mediated by the radiation pressure interaction with a metalized dielectric nanobeam oscillator. We achieve bidirectional coherent conversion with a total device efficiency of up to ∼60%, a dynamic range of 2 × 109 photons/s and an instantaneous bandwidth of up to 1.7 kHz. A high fidelity quantum state transfer would be possible if the drive dependent output noise of currently ∼14 photons s−1 Hz−1 is further reduced. Such a silicon nitride based transducer is in situ reconfigurable and could be used for on-chip classical and quantum signal routing and filtering, both for microwave and hybrid microwave-optical applications.
Localization of the small amplitude wave in three dimensional granular material
Authors: Peng Jing , Yang Guanghui , Liang Tao , Duan Wen Shan , Yang Lei
Published: April 2020

A general small amplitude wave equations are proposed for the granular material. It is shown that the wave is localized in a certain region which is in agreement with that found in both the analytical and the simulation results. The localization region depends on the wave frequency and the parameters of the granular material such as the bead radius, the magnitude of the initial prestress, the Young’s modulus and the bead mass. Several examples are given which indicate that the attenuation rate of the wave depend on the permutation of the bead. It also depends on whether the wave is longitudinal or tangential.
ISDE guidance statement: management of upper gastrointestinal endoscopy and surgery in COVID-19 outbreak
Authors: Yip Hon Chi , Chiu Philip , Hassan Cesare , Antonelli Giulio , Sharma Prateek
Published: April 2020

This is an official guidance statement of The International Society of the Diseases of the Esophagus (ISDE) to address all the operators involved in management of patients affected by upper gastrointestinal diseases during COVID-19 pandemic. This guidance is based on the best available evidence to date and will be updated as new evidence becomes available.
Haematuria and urinary tract cancers in patients with atrial fibrillation treated with oral anticoagulants
Authors: Rasmussen Peter Vibe , Dalgaard Frederik , Gislason Gunnar Hilmar , Brandes Axel , Johnsen Søren Paaske , Grove Erik Lerkevang , Torp-Pedersen Christian , Münster Anne-Marie Bloch , Erikson Marie Schmidt , Pallisgaard Jannik Langtved , Blanche Paul , Hansen Morten Lock
Published: April 2020

Aims

Patients with atrial fibrillation (AF) treated with oral anticoagulants (OACs) have an increased risk of bleeding including haematuria. In the general population, gross haematuria is associated with urinary tract cancer. Consequently, we aimed to investigate the potential association between gross haematuria and urinary tract cancer in anticoagulated patients with AF.

Methods and results 

Using Danish nationwide registers, we included Danish AF patients treated with OACs between 2001 and 2015. Non-parametric estimation and semi-parametric absolute risk regression were used to estimate the absolute risk of urinary tract cancer in patients with and without gross haematuria. We included 125 063 AF patients with a median age of 74 years (interquartile range 65–80) and a majority of males (57%). The absolute risk of gross haematuria 12 months after treatment initiation increased with age ranging from 0.37% [95% confidence interval (CI) 0.31–0.42] to 0.85% (95% CI 0.75–0.96) in the youngest and oldest age groups of ≤70 and >80 years of age, respectively. The 1-year risk of urinary tract cancer after haematuria ranged from 4.2% (95% CI 2.6–6.6) to 6.5% (95% CI 4.6–9.0) for patients in age group >80 and 71–80 years, respectively. Gross haematuria conferred large risk ratios of urinary tract cancer when comparing patients with and without haematuria across all age groups.

Conclusion 

Gross haematuria was associated with clinically relevant risks of urinary tract cancer in anticoagulated patients with AF. These findings underline the importance of meticulously examining anticoagulated patients with haematuria.
De novo mutations in TOMM70, a receptor of the mitochondrial import translocase, cause neurological impairment
Authors: Dutta Debdeep , Briere Lauren C , Kanca Oguz , Marcogliese Paul C , Walker Melissa A , High Frances A , Vanderver Adeline , Krier Joel , Carmichael Nikkola , Callahan Christine , Taft Ryan J , Simons Cas , Helman Guy , Network Undiagnosed Diseases , Wangler Michael F , Yamamoto Shinya , Sweetser David A , Bellen Hugo J
Published: April 2020

The translocase of outer mitochondrial membrane (TOMM) complex is the entry gate for virtually all mitochondrial proteins and is essential to build the mitochondrial proteome. TOMM70 is a receptor that assists mainly in mitochondrial protein import. Here, we report two individuals with de novo variants in the C-terminal region of TOMM70. While both individuals exhibited shared symptoms including hypotonia, hyper-reflexia, ataxia, dystonia and significant white matter abnormalities, there were differences between the two individuals, most prominently the age of symptom onset. Both individuals were undiagnosed despite extensive genetics workups. Individual 1 was found to have a p.Thr607Ile variant while Individual 2 was found to have a p.Ile554Phe variant in TOMM70. To functionally assess both TOMM70 variants, we replaced the Drosophila Tom70 coding region with a Kozak-mini-GAL4 transgene using CRISPR-Cas9. Homozygous mutant animals die as pupae, but lethality is rescued by the mini-GAL4-driven expression of human UAS-TOMM70 cDNA. Both modeled variants lead to significantly less rescue indicating that they are loss-of-function alleles. Similarly, RNAi-mediated knockdown of Tom70 in the developing eye causes roughening and synaptic transmission defect, common findings in neurodegenerative and mitochondrial disorders. These phenotypes were rescued by the reference, but not the variants, of TOMM70. Altogether, our data indicate that de novo loss-of-function variants in TOMM70 result in variable white matter disease and neurological phenotypes in affected individuals.
Liability in Joint Military Operations—The Green Desert Case
Authors: Kessing Peter Vedel
Published: April 2020

Almost all international military operations today are joint military operations where several states collaborate to carry out concrete operations, such as combat or arrest operations. This raises pertinent and difficult questions in relation to state responsibility if international law obligations are breached during the operation, not least: Which state or states are responsible? In June 2018, a Danish High Court found Denmark responsible in its complicity for Iraqi ill-treatment of 18 Iraqis who were detained by the Iraqi military in a joint Danish–Iraqi military operation in Iraq in November 2004. Danish soldiers did not exercise control over the Iraqi troops; the detainees were not captured by Danish soldiers or at any time subject to their control or jurisdiction; and Danish forces did not participate in or witness any ill-treatment during the operation. Nevertheless, the Danish High Court found that the Danish defence forces were liable to pay compensation to the 18 Iraqi detainees because Danish defence forces ‘should have known’ that there was a real risk of Iraqi ill-treatment of detainees and paid to little attention to the risk when planning and participating in the operation. The article discusses the Danish High Court judgment. Is it a problem that the High Court decided the case on the basis of Danish compensation law and largely ignores international law standards? And would the Danish defence forces have been responsible if assessed on the basis of State responsibility standards in international law?
SNP Markers as a Successful Molecular Tool for Assessing Species Identity and Geographic Origin of Trees in the Economically Important South American Legume GenusDipteryx
Authors: Honorio Coronado Eurídice N , Blanc-Jolivet Céline , Mader Malte , García-Dávila Carmen R , Aldana Gomero David , del Castillo Torres Dennis , Flores Llampazo Gerardo , Hidalgo Pizango Gabriel , Sebbenn Alexandre M , Meyer-Sand Barbara R V , Paredes-Villanueva Kathelyn , Tysklind Niklas , Troispoux Valerie , Massot Marie , Carvalho Catarina , de Lima Haroldo C , Cardoso Domingos , Degen Bernd
Published: April 2020

Dipteryx timber has been heavily exploited in South America since 2000s due to the increasing international demand for hardwood. Developing tools for the genetic identification of Dipteryx species and their geographical origin can help to promote legal trading of timber. A collection of 800 individual trees, belonging to 6 different Dipteryx species, was genotyped based on 171 molecular markers. After the exclusion of markers out of Hardy–Weinberg equilibrium or with no polymorphism or low amplification, 83 nuclear, 29 chloroplast, 13 mitochondrial single nucleotide polymorphisms (SNPs), and 2 chloroplast and 5 mitochondrial INDELS remained. Six genetic groups were identified using Bayesian Structure analyses of the nuclear SNPs, which corresponded to the different Dipteryx species collected in the field. Seventeen highly informative markers were identified as suitable for species identification and obtained self-assignment success rates to species level of 78–96%. An additional set of 15 molecular markers was selected to determine the different genetic clusters found in Dipteryx odorata and Dipteryx ferrea, obtaining self-assignment success rates of 91–100%. The success to assign samples to the correct country of origin using all or only the informative markers improved when using the nearest neighbor approach (69–92%) compared to the Bayesian approach (33–80%). While nuclear and chloroplast SNPs were more suitable for differentiating the different Dipteryx species, mitochondrial SNPs were ideal for determining the genetic clusters of D. odorata and D. ferrea. These 32 selected SNPs will be invaluable genetic tools for the accurate identification of species and country of origin of Dipteryx timber.
Visions of Peace Amidst a Human Rights Crisis: War on Drugs in Colombia and the Philippines
Authors: Regilme Salvador Santino F
Published: April 2020

Peace is one of most widely used yet highly contested concepts in contemporary politics. What constitutes peace? That broad analytic inquiry motivates this article, which focuses on the contentious discourses of peace within a society besieged by widespread trafficking and use of illegal drugs. Focusing on the illegal drug problem in Colombia and the Philippines, the central puzzle of this paper constitutes two fundamental questions: How do state leaders justify their respective “war on drugs”? How do they construct and discursively articulate ideals of peace in the context of the illegal drug problem? This paper compares the post-9/11 Colombian war on drugs (2002–2010) vis-à-vis the Philippine war on drugs under the Duterte administration (2016–2019), particularly in terms of how their presidential administrations articulate “peace” in the context of resolving the drug problem. The paper examines the varying discourses of peace, investigates how those local discourses relate to global discourses on peace and illegal drugs, and underscores how and under which conditions those peace discourses portray the material distributive conflicts in those societies. The core argument states that the Uribe and Duterte administrations primarily deployed the notion of peace as a justificatory discourse for increased state repression, intensified criminalization of the drug problem, and the reluctance of the state in embracing a public health approach to the proliferation of illegal drugs.
Can Reminders and Incentives Improve Implementation Within Government? Evidence from a Field Experiment
Authors: Andersen Simon Calmar , Hvidman Ulrik
Published: April 2020

Existing research demonstrates how governments can use insights from behavioral science to design policy and alter residents’ behavior. This article proposes that the effect of behavioral interventions may be different in hierarchical organizations where the decision to change behavior and the execution of that decision are split between different individuals. We examine the effect of two small-scale interventions—personal reminders and financial incentives—in a large-scale field experiment with public schools in Denmark. The Ministry of Education invited a representative sample of public schools to adopt a program that provides information on students’ socio-emotional competencies. Results show that small financial incentives increased managers’ adoption of the program by 7 percentage points. Frontline workers’ subsequent data generation and performance information acquisition were also increased in the incentive treatment groups, even though the latter was not incentivized. Reminders paired with incentives had an impact on the managers’ adoption, but the reminder effect disappeared during the implementation phase. These findings demonstrate both the potentials and limitations of applying behavioral research on individual residents to hierarchical organizations.
Atomic Charge Calculator II: web-based tool for the calculation of partial atomic charges
Authors: Raček Tomáš , Schindler Ondřej , Toušek Dominik , Horský Vladimír , Berka Karel , Koča Jaroslav , Svobodová Radka
Published: April 2020

Partial atomic charges serve as a simple model for the electrostatic distribution of a molecule that drives its interactions with its surroundings. Since partial atomic charges are frequently used in computational chemistry, chemoinformatics and bioinformatics, many computational approaches for calculating them have been introduced. The most applicable are fast and reasonably accurate empirical charge calculation approaches. Here, we introduce Atomic Charge Calculator II (ACC II), a web application that enables the calculation of partial atomic charges via all the main empirical approaches and for all types of molecules. ACC II implements 17 empirical charge calculation methods, including the highly cited (QEq, EEM), the recently published (EQeq, EQeq+C), and the old but still often used (PEOE). ACC II enables the fast calculation of charges even for large macromolecular structures. The web server also offers charge visualization, courtesy of the powerful LiteMol viewer. The calculation setup of ACC II is very straightforward and enables the quick calculation of high-quality partial charges. The application is available at https://acc2.ncbr.muni.cz.
Why does caloric restriction increase life and healthspan? The ‘clean cupboards’ hypothesis
Authors: Speakman John R
Published: April 2020

The disposable soma hypothesis explanation of the effects of caloric restriction (CR) on lifespan fails to explain why CR generates negative impacts alongside the positive effects and does not work in all species. I propose here a novel idea called the clean cupboards hypothesis which overcomes these problems.
Comparative Metabolome and Transcriptome Analyses of Susceptible Asparagus officinalis and Resistant Wild A. kiusianus Reveal Insights into Stem Blight Disease Resistance
Authors: Abdelrahman Mostafa , Nakabayashi Ryo , Mori Tetsuya , Ikeuchi Takao , Mori Mitsutaka , Murakami Kyoko , Ozaki Yukio , Matsumoto Masaru , Uragami Atsuko , Tsujimoto Hisashi , Tran Lam-Son Phan , Kanno Akira
Published: April 2020

Phomopsis asparagi is one of the most serious fungal pathogens, which causes stem blight disease in Asparagus officinalis (AO), adversely affecting its production worldwide. Recently, the development of novel asparagus varieties using wild Asparagus genetic resources with natural P. asparagi resistance has become a priority in Japan due to the lack of resistant commercial AO cultivars. In this study, comparative metabolome and transcriptome analyses of susceptible AO and resistant wild Asparagus kiusianus (AK) 24 and 48 h postinoculated (AOI_24 hpi, AOI_48 hpi, AKI_24 hpi and AKI_48 hpi, respectively) with P. asparagi were conducted to gain insights into metabolic and expression changes associated with AK species. Following infection, the resistant wild AK showed rapid metabolic changes with increased levels of flavonoids and steroidal saponins and decreased asparagusic acid glucose ester content, compared with the susceptible AO plants. Transcriptome data revealed a total of 21  differentially expressed genes (DEGs) as the core gene set that displayed upregulation in the resistant AK versus susceptible AO after infection with P. asparagi. Kyoto Encyclopedia of Genes and Genomes pathway analysis of these DEGs identified 11 significantly enriched pathways, including flavonoid biosynthesis and primary metabolite metabolism, in addition to plant signaling and defense-related pathways. In addition, comparative single-nucleotide polymorphism and Indel distributions in susceptible AO and resistant AK plants were evaluated using the latest AO reference genome Aspof.V1. The data generated in this study are important resources for advancing Asparagus breeding programs and for investigations of genetic linkage mapping, phylogenetic diversity and plant defense-related genes.
Vortex motion of a continuous medium depending on the pressure change
Authors: Braginsky Alexander
Published: April 2020

In this paper, we study the vortex motion of a continuous medium, which is described by forces obtained from the principle of least action. It is shown that in a continuous medium the vortex force components are proportional to the velocity and pressure gradient components. This article gives a description of the 2D vortex motion of air in zones of high and low pressure. If the pressure decreases, the angular velocity of rotation of the continuous medium increases, whereas if the pressure increases, the angular velocity fades. The lifting force is obtained due to the vortex movement of air in the form of a funnel. It is shown that the vortex force contains a vortex term of the Euler hydrodynamic equations with a relative factor equal to the velocity of the continuous medium squared divided by the sound velocity squared. To describe the motion of a continuous medium correctly it is necessary to replace the forces obtained by Euler with the forces obtained from the minimum of action in the equations of motion. It is concluded that vortex motions and turbulence are described by the obtained equations of motion, and not by the Navier–Stokes equations. Most likely, this is related to the Problem of the Millennium description of turbulence announced at the International Congress of Mathematics in 2000.
Remembering and Dismembering Henry Howard: Blazon and Beheading in Sir John Cheke’s Elegy on the Earl of Surrey
Authors: Grossman Joel
Published: April 2020

Sir John Cheke’s poem ‘What natures worke is this’ constitutes the earliest extant elegy to the early Tudor poet and courtier Henry Howard, Earl of Surrey. If the renaissance elegy typically sought to praise or blame its subject, Surrey posed a peculiar problem: executed as a traitor and enemy to the Edwardian succession, Surrey was fast becoming revered as the greatest English poet since Chaucer. Unable to reconcile these two positions in the single figure of Surrey, Cheke’s poem produces a fragmented image of its subject, an image foregrounded by the figurative dismemberment of Surrey through anatomical blazons. Yet, Cheke’s poem itself becomes fragmented in this process. From the grammar and versification, to the elegist’s self-representation, the poem succumbs to the loss of structural integrity attributed to its subject. This essay understands this fragmentation as a reflection of Cheke’s own fractured relationship to his subject. Cheke’s divided loyalties of literary admiration and political animosity necessitated the construction of a divided and incomprehensible elegiac subject. Ultimately, the process of remembering Surrey becomes one of re-membering him: creating a version of Surrey from his fragmented remains.
Seasonal Variation in the Volume of Posterior Spinal Arthrodesis Procedures for Pediatric Scoliosis
Authors: Marrache Majd , Harris Andrew B. , Puvanesarajah Varun , Sponseller Paul D.
Published: April 2020

Study Design.

Retrospective review of the Healthcare Cost and Utilization Project's Kids’ Inpatient Database.

Objective.

The aim of this study was to investigate variations in surgical case volume in the US for spinal arthrodesis for pediatric patients with scoliosis.

Summary of Background Data.

Approximately 38,000 spinal arthrodesis procedures are performed each year in the United States for pediatric patients with scoliosis. Anecdotally, pediatric spine surgeons report performing more scoliosis procedures during summer months and before national holidays than during other periods, but this has not been reported in the literature. A thorough understanding of seasonal variations in surgical volume may guide the allocation of health care resources.

Methods.

Using the Healthcare Cost and Utilization Project's Kids’ Inpatient Database, we identified 32,563 patients aged <21 years with adolescent idiopathic scoliosis (54%), neuromuscular scoliosis (19%), congenital scoliosis (12%), early-onset scoliosis (12%), or scoliosis from other causes (5%) who underwent primary spinal arthrodesis from 2000 through 2016. χ
2 goodness-of-fit tests were used to evaluate seasonal differences in the number of spinal arthrodesis procedures performed. A negative binomial distribution model was used to compare surgical volume by month. Alpha = 0.05.

Results.

We found significant seasonal variation in the volume of spinal arthrodesis procedures performed, which persisted after stratifying by type of scoliosis (all, P < 0.001). For all types of scoliosis, surgical volume was highest during the summer. The 3 months with the highest surgical volumes were June, July, and December.

Conclusion.

The number of spinal arthrodesis procedures performed in the United States for pediatric scoliosis peaked significantly during the summer, with the highest volume of surgeries performed during June, July, and December. An understanding of these variations can help hospitals and providers allocate resources appropriately throughout the year according to predictable changes in surgical volume.

Level of Evidence: 4
The Impact of Geometrical Spinal Shape on Fresh Vertebral Fractures in Elderly Volunteers
Authors: Yamada Tomohiro , Yamato Yu , Sato Yoshihiro , Togawa Daisuke , Hasegawa Tomohiko , Yoshida Go , Yasuda Tatsuya , Arima Hideyuki , Banno Tomohiro , Oe Shin , Ushirozako Hiroki , Ide Koichiro , Watanabe Yuh , Matsuyama Yukihiro
Published: April 2020

Study Design.

Four-year, longitudinal cohort study.

Objective.

The aim of this study was to investigate the effect of original spinal shape on incidental vertebral fractures (VFs) and to identify the influence of changes in pre- and post-fracture geometrical spinal shape.

Summary of Background Data.

Clinical evidence demonstrates that VFs cause spinal kyphosis, morbidities, and deteriorating quality of life in elderly people. However, knowledge of geometrical spinal shapes that affect incidental VFs is limited.

Methods.

Three hundred seventeen volunteers underwent whole spine radiography as part of a health screening in both 2012 and 2016. We extracted volunteers with incidental VF in 2016. Sex- and age-matched volunteers without VF were enrolled as controls. Baseline demographic variables, geometrical spinal shape, and spinopelvic parameters were compared between the two groups. In volunteers with incidental VF, we investigated the association between baseline spinal shape and post-fracture shape.

Results.

Twenty-seven volunteers (12 men; mean age 75.4 ± 5.4 and 15 women; mean age 71.6 ± 7.9) with VF were enrolled, and 175 volunteers (48 men, 127 women) without VF were selected as controls. In men with VF, the thoracic kyphosis apex was located significantly more posteriorly and caudally than in those without VF. In women with VF, the lordosis apex was located significantly more posteriorly and caudally than in those without VF. After fractures occurring above the inflexion vertebra, the low anterior apex spine (L5) changed its geometrical shape in that the posterior apex and the inflexion vertebra shifted significantly more posteriorly compared to the high anterior apex spine (L4/5).

Conclusion.

Original geometrical spinal shape affected the occurrence of VF, and post-fracture spinal shape depended on the positional relationship between the inflexion vertebra and fractured vertebra. Our study helps to understand the influence of geometrical spinal shape on the risks of VF.

Level of Evidence: 3
Patient-reported Quality of Life Following Posterior Lumbar Interbody Fusion or Indirect Decompression Using Lateral Lumbar Interbody Fusion
Authors: Nakashima Hiroaki , Kanemura Tokumi , Satake Kotaro , Ito Kenyu , Tanaka Satoshi , Ouchida Jun , Segi Naoki , Kobayashi Kazuyoshi , Ando Kei , Ishiguro Naoki , Imagama Shiro
Published: April 2020

Study design.

A retrospective review of prospectively collected data.

Objective.

The aim of this study was to compare quality of life (QOL) outcomes of posterior lumbar interbody fusion (PLIF) with lateral lumbar interbody fusion (LLIF) using reports from patients obtained at the 2-year postoperative follow-up.

Summary of Background Data.

Indirect decompression with LLIF is used to treat degenerative lumbar diseases that require neural decompression. However, the difference in improvement in QOL following indirect decompression compared with direct neural decompression using PLIF is unclear.

Methods.

We enrolled 284 consecutive patients with degenerative lumbar spondylolisthesis in the present study, 203 who underwent PLIF and 81 who underwent LLIF. All patients completed a minimum of 2 years of follow-up. We evaluated the effectiveness of surgery in each category of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ).

Results.

The results of preoperative JOABPEQ and the severity of thecal sac stenosis were not significantly different between PLIF and LLIF, neither was the rate of perioperative complications (14.8% and 15.4% for the PLIF and LLIF groups, respectively; P = 0.91). The effectiveness at 2 years postoperatively was almost the same for all five domains of the JOABPEQ: 62.6% and 68.9% for pain-related disorders (P = 0.34), 38.3% and 42.7% for lumbar spine dysfunction (P = 0.51), 65.8% and 67.5% for gait disturbance (P = 0.79), 53.5% and 48.8% for social life dysfunction (P = 0.47), and 29.1% and 33.3% for psychological disorders (P = 0.48) following PLIF and LLIF, respectively. Visual analogue scale results for back and lower-limb pain and numbness of the lower limbs were almost the same for both groups. No significant differences were observed in terms of perioperative complications and radiographical outcomes.

Conclusion.

Indirect decompression using LLIF improves QOL and radiographical outcomes to a comparable degree as direct decompression via PLIF.

Level of Evidence: 4
Readmission Rate After 2-level Lumbar Decompression
Authors: Elsharydah Ahmad , Duncan Katherine L. , Rosero Eric B. , Minhajuddin Abu , Somasundaram Alwin , Joshi Girish P.
Published: April 2020

Study Design:

Retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database years 2012–2015.

Objective:

Compare the 30-day readmission and postoperative major complications rates of 2-level lumbar decompression performed in the ambulatory and the inpatient settings.

Summary of Background Data:

In recent years, there is an increasing trend toward ambulatory spine surgery. However, there remains a concern regarding risks of readmission and postoperative morbidity after discharge.

Methods:

The ACS-NSQIP database from 2012 to 2015 was queried for adult patients who underwent elective 2-level lumbar decompression (CPT code 63047 accompanied with code 63048). A cohort of ambulatory lumbar decompression cases was matched 1:1 with an inpatient cohort after controlling for patient demographics, comorbidities, and complexity of the procedure. The primary outcome was the 30-day readmission rate. Secondary outcomes included a composite of 30-day postoperative major complications and hospital length of stay for hospitalized patients.

Results:

A total of 7505 patients met our study criteria. The ambulatory 2-level lumbar decompression surgery rate increased significantly over the study period from 28% in 2012 to 49% in 2015 (P<0.001). In the matched sample, there was no statistically significant difference in the 30-day readmission rate (odds ratio, 0.82; 95% confidence interval, 0.64–1.04; P=0.097) between the two cohorts; however, the ambulatory cohort had a lower 30-day postoperative major complication rate (odds ratio, 0.55; 95% confidence interval, 0.38–0.79; P=0.002).

Conclusions:

After 2-level lumbar decompression performed on inpatient versus outpatient basis, the 30-day readmission rate is similar. However, the 30-day postoperative complication rate is significantly lower in the ambulatory setting. The reasons for these differences need further exploration.

Level of Evidence:

Level III.
Clinical Distancing and Mitigation of Coronavirus Disease 2019
Authors: Scott Benjamin K. , Hravnak Marilyn , Pamplin Jeremy C.
Published: April 2020

Social distancing as a technique to limit transmission of infectious disease has come into common parlance following the arrival and rapid spread of a novel coronavirus disease around the world in 2019 and 2020. But in the face of an emerging pandemic threat, it is crucial that we start to apply these principles to the clinic, the emergency department, and the hospital ward. We propose that this dynamic situation calls for a parallel “Clinical Distancing” in which we as a medical culture go against many of our fundamental instincts and, at least in the short term, begin to reduce unnecessary patient-care contacts for the benefit of our patients and our ability to continue to provide care to those who need it most. In this commentary, we provide specific recommendations for the rapid implementation of clinical distancing techniques.
Peking University Third Hospital score: a comprehensive system to predict intra-operative blood loss in radical nephrectomy and thrombectomy
Authors: Liu Zhuo , Zhao Xun , Zhang Hong-Xian , Ma Run-Zhuo , Li Li-Wei , Tang Shi-Ying , Wang Guo-Liang , Zhang Shu-Dong , Wang Shu-Min , Tian Xiao-Jun , Ma Lu-Lin
Published: April 2020

Background

Radical nephrectomy and thrombectomy is the standard surgical procedure for the treatment of renal cell carcinoma (RCC) with tumor thrombus (TT). But the estimation of intra-operative blood loss is only based on the surgeon's experience. Therefore, our study aimed to develop Peking University Third Hospital score (PKUTH score) for the prediction of intra-operative blood loss volume in radical nephrectomy and thrombectomy.

Methods

The clinical data of 153 cases of renal mass with renal vein (RV) or inferior vena cava tumor thrombus admitted to Department of Urology, Peking University Third Hospital from January 2015 to May 2018 were retrospectively analyzed. The total amount of blood loss during operation is equal to the amount of blood sucked out by the aspirator plus the amount of blood in the blood-soaked gauze. Univariate linear analysis was used to analyze risk factors for intra-operative blood loss, then significant factors were included in subsequent multivariable linear regression analysis.

Results

The final multivariable model included the following three factors: open operative approach (P < 0.001), Neves classification IV (P < 0.001), inferior vena cava resection (P = 0.001). The PKUTH score (0–3) was calculated according to the number of aforementioned risk factors. A significant increase of blood loss was noticed along with higher risk score. The estimated median blood loss from PKUTH score 0 to 3 was 280 mL (interquartile range [IQR] 100–600 mL), 1250 mL (IQR 575–2700 mL), 2000 mL (IQR 1250–2900 mL), and 5000 mL (IQR 4250–8000 mL), respectively. Meanwhile, the higher PKUTH score was, the more chance of post-operative complications (P = 0.004) occurred. A tendency but not significant overall survival difference was found between PKUTH risk score 0 vs. 1 to 3 (P = 0.098).

Conclusion

We present a structured and quantitative scoring system, PKUTH score, to predict intra-operative blood loss volume in radical nephrectomy and thrombectomy.
Detection and Analysis of Uncharged Particles Using Consumer-grade CCDs
Authors: Cummings John A. , Deaton James W. , Hess Charles T. , Hess Samuel T.
Published: April 2020

In the current climate of increased global terrorism, the threat of a radiological incident is becoming more realistic than ever, and as such, the necessity of early-warning detection is paramount to national security. To assist with this need, we have investigated the detection of uncharged particle emissions from radiological sources using charged-coupled devices (CCDs), which are contained within a variety of products, including consumer cellphones and traffic cameras. Because the CCD is intrinsically sensitive to charge accumulation as a result of linear energy transfer by the incident particles, each event can be counted and quantified using video-image processing and an estimated energy band assessed by the properties of the pixels. In an effort to make this process applicable to the widest possible range of CCDs available, this experiment was conducted using low-quality CCDs contained within consumer-grade, budget web cameras. Within a 239Pu-Be neutron howitzer, particles were detected using several camera models: Gigaware X76, Z76 and Logitech C170, C270. Particle detection events were counted by post-processing with Matlab, and an efficiency for each CCD was determined relative to both a theoretical flux model and a calibrated 3He tube detector. The relative detection efficiencies for the cameras tested fell within the range 14–18% and showed a linear correlation between incident energy and pixel response.
Post-LASIK Ectasia Versus Keratoconus: An In Vivo Confocal Microscopy Study
Authors: Alvani Azam , Hashemi Hassan , Pakravan Mohammad , Mahbod Mirgholamreza , Seyedian Mohammad Amin , Amanzadeh Kazem , Khabazkhoob Mehdi , Jafarzadehpur Ebrahim , Fotouhi Akbar
Published: April 2020

Purpose:

To examine and compare corneal cellular and subbasal nerve (SBN) characteristics in post–laser-assisted in situ keratomileusis ectasia (PLE) corneas, normal post–laser-assisted in situ keratomileusis corneas (PLC), keratoconus (KC) corneas, and normal virgin corneas (NC).

Methods:

In this cross-sectional comparative study, 18 PLE eyes of 11 patients, 18 PLC of 15 cases, 32 KC eyes of 32 patients, and 29 NC of 29 subjects were assessed using in vivo confocal microscopy. The density of the basal epithelial cell (BEC), anterior keratocyte, posterior keratocyte, and endothelial cell layers, as well as the characteristics of SBN fibers, was compared between the 4 groups.

Results:

The density of the BEC and anterior and posterior keratocyte layers was significantly lower in KC compared with NC (−650 ± 190, P = 0.013; −181 ± 39, P < 0.001; and −36 ± 11, P = 0.021, respectively). However, there was no significant difference between PLE and PLC regarding these parameters (all Ps ≥ 0.6). Mean SBN parameters, including central corneal nerve branch density, nerve fiber length, total branch density, and nerve fiber area, were significantly lower in KC compared with NC and in PLE compared with PLC (all Ps ≤ 0.021).

Conclusions:

The pathophysiology of PLE seems to differ from KC. Apparent changes in the BEC and anterior and posterior keratocytes associated with KC were not observed in PLE. However, SBNs seem to be involved in both conditions.
Results 5 to 10 years after cataract surgery with primary IOL implantation in juvenile idiopathic arthritis–related uveitis
Authors: Leinonen Sanna , Kotaniemi Kaisu M. , Kivelä Tero T. , Krootila Kari
Published: April 2020

Purpose:

To evaluate the results of cataract extraction with primary intraocular lens (IOL) implantation in patients with juvenile idiopathic arthritis (JIA) and uveitis-related cataract.

Setting:

Department of Ophthalmology, Helsinki University Hospital, Finland.

Design:

Retrospective case series.

Methods:

All consecutive patients younger than 20 years with JIA-uveitis–related cataract undergoing cataract extraction with primary IOL implantation in 1 or both eyes at the Department of Ophthalmology, Helsinki University Hospital, Finland, from February 2000 to April 2012 were included. Twenty eligible patients with 26 operated eyes were identified; 14 were girls and 6 were boys. All patients had a follow-up of 5 years and 13 patients (16 eyes [65%]) reached 10 years of follow-up.

Results:

Twenty-six eyes of 20 patients were studied. Preoperative median corrected distance visual acuity (CDVA) was 0.05 in decimal notation. Median CDVA was 1.0 at 5 years and 0.9 at 10 years of follow-up. Two eyes did not reach CDVA 0.5 with the operation, and in 2 eyes, CDVA decreased below 0.5 over the period of 3 to 5 years after the operation. Active uveitis during 3 and 12 months preoperatively was a risk indicator for postoperative CDVA <0.5 at 5 years (P = .005 and P = .007, respectively).

Conclusions:

Cataract extraction with primary IOL implantation provides long-standing good visual acuity for young patients with well-controlled JIA-related uveitis.
Role of real-time shear-wave elastogarphy in differentiating hepatocellular carcinoma from other hepatic focal lesions
Authors: Gad Magdy A. Mawgood , Eraky Tamer E. , Omar Hazem M. , Abosheaishaa Hazem Maarouf
Published: April 2020

Background:

Hepatocellular carcinoma (HCC) has an increasing incidence worldwide, and is considered the second cause of cancer-related death.

Aim:

The aim of the study is to assess the usefulness of real-time shear-wave elastography in differentiating HCC from other hepatic focal lesions.

Patients and methods:

The current study was conducted on 110 patients in addition to 10 healthy subjects, divided into four groups as follows: liver cirrhosis, HCC, hepatic focal lesions other than HCC, and control. Demographic, laboratory and imaging data were collected and then elastographic assessment of the hepatic focal lesions and the surrounding liver parenchyma using elastograph point quantification (ElastPQ) (iU22x MATRIX, Philips) was done.

Results:

ElastPQ (iU22x MATRIX, Philips) has shown its ability to differentiate between HCC and cystic focal lesions, HCC and cholangiocarcinoma, and HCC and focal nodular hyperplasia (FNH). Cystic lesions demonstrated lower stiffness in comparison to HCC; however, cholangiocarcinoma and FNH demonstrated higher stiffness in comparison to HCC. ElastPQ was unable to differentiate between stiffness in both ‘HCC and hemangioma’ and ‘HCC and metastatic focal lesions’. ElastPQ showed that HCC, cystic focal lesions, and cholangiocarcinoma had lower stiffness in comparison to their surrounding liver parenchyma, whereas FNH had higher stiffness in comparison to the surrounding liver parenchyma. ElastPQ showed that the surrounding liver parenchyma of the HCC group has the highest stiffness amongst all studied hepatic focal lesions surrounding liver parenchyma.

Conclusion:

‘Point’ shear-waves elastography (ElastPQ; Philips iU22x MATRIX, Philips) is a noninvasive, quantitative and nonradiating method for evaluation of tissue elasticity, and is helpful in differentiating HCC from other hepatic focal lesions.
Changing paradigms in the treatment of residual/recurrent head and neck cancer: implications for dysphagia management
Authors: Brady Grainne C. , Hardman John C. , Paleri Vinidh , Harrington Kevin J. , Roe Justin W.G.
Published: April 2020

Purpose of review

Despite advances in head and neck cancer treatment provision, recurrence rates remain high with the added risk of successfully treated patients developing a second primary. We report on the management of dysphagia in the context of residual/recurrent or new disease in a preirradiated field and make suggestions for future research.

Recent findings

There have been numerous developments in treatment options for people with residual/recurrent head and neck cancer. This is because of improved surgical interventions including microvascular reconstruction techniques and transoral robotic surgery. In the era of highly conformal radiotherapy techniques, such as intensity-modulated radiotherapy (IMRT), there may be opportunities for re-irradiation. These advancements are now increasingly employed in the context of locoregionally recurrent disease. With results being reported from an increasing number of clinical trials, systemic therapies, including treatment with immunotherapy, offer the potential for increased survival with less treatment-related toxicity.

Dysphagia is recognized as a significant toxicity following radical surgical and radiation-based approaches, particularly when multimodal treatment is required. Increasingly, late radiation-associated dysphagia is gaining greater attention in the literature. Many patients presenting with residual and recurrent disease do so against a background of comorbidities as well as persistent and late treatment-related toxicity.
Preresection Radiologic Assessment and Imaging Features of 156 Pathologically Proven Adrenal Adenomas
Authors: Elsherif Sherif B. , Javadi Sanaz , Blair Katherine J. , Morshid Ali I. , Hui Ling , Khalaf Ahmed M. , Elbanan Mohamed G. , Zhang Miao , Habra Mouhammed A. , Elsayes Khaled M.
Published: April 2020

Purpose

The aims of the study were to assess the typical and atypical radiologic features of pathologically proven adrenal adenomas and to determine the relationship between the radiologic and histopathologic classification.

Methods

We retrospectively studied 156 pathologically proven adrenal adenomas in 154 patients from our institutional databases who have computed tomography (CT) and/or magnetic resonance imaging (MRI) examinations before intervention. We determined the histopathologic diagnosis (typical or atypical) using Weiss scoring and classified the adenomas radiologically into typical, atypical, or indeterminate based on lesion size, precontrast CT attenuation, absolute percentage washout, calcification, and necrosis. The κ statistic was used to assess the agreement between radiologists. The Fisher exact test was used to compare the radiologic and pathological classifications.

Results

In consensus, there were 83 typical, 42 atypical, and 31 indeterminate adrenal lesions. Logistic regression model showed that radiologically atypical adenoma was significantly associated with larger size, lobulated shape, higher unenhanced CT attenuation, heterogeneous appearance, nonfunctioning status, absolute percentage washout of less than 60%, and a signal intensity index of less than 16.5%.

Pathologically, 147 adenomas were pathologically typical (Weiss 0), and 9 adenomas were pathologically atypical (Weiss 1–2). Radiologically, there was substantial agreement between both readers, with Cohen κ at 0.71. Approximately 98% of radiologically typical adenomas were pathologically typical. Only 17% of radiologically atypical adenomas were pathologically atypical. All radiologically indeterminate adenomas were pathologically typical. However, some of the radiologically indeterminate and typical adenomas still had an atypical component on pathologic analysis, such as necrosis, nuclear atypia, or oncocytic features.

Conclusions

Radiologically atypical lesion was significantly associated with larger size and higher unenhanced CT attenuation. Approximately 27% of the cases demonstrated atypical features on imaging. Most radiologically atypical adrenal adenomas are pathologically typical.