bluuebunny/crossref_metadata_2025 huggingface dataset:
Safety and Antitumor Activity of Pembrolizumab in Patients with Estrogen Receptor–Positive/Human Epidermal Growth Factor Receptor 2–Negative Advanced Breast Cancer
Authors: Rugo Hope S. , Delord Jean-Pierre , Im Seock-Ah , Ott Patrick A. , Piha-Paul Sarina A. , Bedard Philippe L. , Sachdev Jasgit , Tourneau Christophe Le , van Brummelen Emilie M.J. , Varga Andrea , Salgado Roberto , Loi Sherene , Saraf Sanatan , Pietrangelo Dina , Karantza Vassiliki , Tan Antoinette R.
Published: March 2018

Purpose: We investigated the safety and antitumor activity of the anti–programmed death 1 monoclonal antibody pembrolizumab in patients with estrogen receptor–positive (ER+)/human epidermal growth factor receptor 2–negative (HER2−) advanced breast cancer with programmed death ligand 1–positive (PD-L1–positive) tumors in the phase Ib open-label, multicohort KEYNOTE-028 (NCT02054806) study.

Patients and Methods: Patients with ER+/HER2− advanced breast cancer with PD-L1–positive tumors (combined positive score ≥1) received pembrolizumab (10 mg/kg every 2 weeks) up to 2 years or until confirmed progression/intolerable toxicity. Primary endpoints were safety and overall response rate (ORR), based on Response Evaluation Criteria in Solid Tumors, version 1 (RECIST v1.1) as assessed by investigator review.

Results: Between April 2014 and January 2015, 25 patients were enrolled. Median number of prior therapies for breast cancer, including endocrine agents, was 9 (range, 3–15). Median follow-up was 9.7 months (range, 0.7–31.8 months). Three patients experienced partial response (PR) and none experienced complete response (CR), resulting in an ORR of 12.0% (95% CI, 2.5%–31.2%); 16% of patients had stable disease (SD) and clinical benefit rate (CR + PR + [SD for ≥24 weeks]) was 20% (95% CI, 7–41). Median duration of response was 12.0 months (range, 7.4–15.9 months). The incidence of treatment-related adverse events was 64%; nausea (20%) and fatigue (12%) were most common and were predominantly grade 1/2. No treatment-related discontinuations or deaths occurred.

Conclusions: Pembrolizumab was well tolerated with modest but durable overall response in certain patients with previously treated, advanced, PD-L1–positive, ER+/HER2− breast cancer. Clin Cancer Res; 24(12); 2804–11. ©2018 AACR.
Ginsenoside 20(S)-Rg3 Inhibits the Warburg Effect Via Modulating DNMT3A/ MiR-532-3p/HK2 Pathway in Ovarian Cancer Cells
Authors: Zhou Yuanyuan , Zheng Xia , Lu Jiaojiao , Chen Wei , Li Xu , Zhao Le
Published: March 2018

Background/Aims: The Warburg effect is one of the main energy metabolism features supporting cancer cell growth. 20(S)-Rg3 exerts anti-tumor effect on ovarian cancer partly by inhibiting the Warburg effect. microRNAs are important regulators of the Warburg effect. However, the microRNA regulatory network mediating the anti-Warburg effect of 20(S)-Rg3 was largely unknown. Methods: microRNA deep sequencing was performed to identify the 20(S)-Rg3-influenced microRNAs in SKOV3 ovarian cancer cells. miR-532-3p was overexpressed by mimic532-3p transfection in SKOV3 and A2780 cells or inhibited by inhibitor532-3p transfection in 20(S)-Rg3-treated cells to examine the changes in HK2 and PKM2 expression, glucose consumption, lactate production and cell growth. Dual-luciferase reporter assay was conducted to verify the direct binding of miR-532-3p to HK2. The methylation status in the promoter region of pre-miR-532-3p gene was examined by methylation-specific PCR. Expression changes of key molecules controlling DNA methylation including DNMT1, DNMT3A, DNMT3B, and TET1-3 were examined in 20(S)-Rg3-treated cells. DNMT3A was overexpressed in 20(S)-Rg3-treated cells to examine its influence on miR-532-3p level, HK2 and PKM2 expression, glucose consumption and lactate production. Results: Deep sequencing results showed that 11 microRNAs were increased and 9 microRNAs were decreased by 20(S)-Rg3 in SKOV3 cells, which were verified by qPCR. More than 2-fold increase of miR-532-3p was found in 20(S)-Rg3-treated SKOV3 cells. Forced expression of miR-532-3p reduced HK2 and PKM2 expression, glucose consumption and lactate production in SKOV3 and A2780 ovarian cancer cells. Inhibition of miR-532-3p antagonized the suppressive effect of 20(S)-Rg3 on HK2 and PKM2 expression, glucose consumption and lactate production in ovarian cancer cells. Dual-luciferase reporter assay showed that miR-532-3p directly suppressed HK2 rather than PKM2. miR-532-3p level was controlled by the methylation in the promoter region of its host gene. 20(S)-Rg3 inhibited DNMT3A expression while exerted insignificant effect on DNMT1, DNMT3B and TET1-3. 20(S)-Rg3 reversed DNMT3A-mediated methylation in the promoter of the host gene of miR-532-3p, and thus elevated miR-532-3p level followed by suppression of HK2 and PKM2 expression, glucose consumption and lactate production. Conclusions: 20(S)-Rg3 modulated microRNAs to exert the anti-tumor effect in ovarian cancer. 20(S)-Rg3 lessened the DNMT3A-mediated methylation and promoted the suppression of miR-532-3p on HK2 to antagonize the Warburg effect of ovarian cancer cells.
De que trata o texto? Leitores e críticos na pesquisa sobre literatura
Authors: Mata Anderson Da
Published: March 2018

A indagação que se faz neste artigo é sobre como o trabalho de formação na pesquisa em literatura pode impactar o processo de letramento de um jovem estudante na linguagem específica do campo. Cinco pesquisadores que participaram de um projeto de pesquisa sobre a crítica literária brasileira contemporânea publicada em periódicos foram entrevistados sobre o impacto da pesquisa nas suas formações como leitores. Essas entrevistas são entrecruzadas com os resultados da própria pesquisa, que auxiliam na compreensão desse processo de formação de leitores, uma vez que trata da crítica literária, que pode ser, ela própria uma forma de mediação de leituras.
Mean Platelet Volume as a Predictor for Restenosis After Carotid Angioplasty and Stenting
Authors: Dai Zhengze , Gao Jie , Li Shun , Li Rongrong , Chen Zhaoyao , Liang Meng , Liu Xinfeng , Xu Gelin
Published: March 2018

Background and Purpose—

Platelet aggregation plays a vital role in the development of in-stent restenosis (ISR) after carotid angioplasty and stenting (CAS). Mean platelet volume (MPV) has been suggested as an index of platelet reactivity. This study aimed to investigate the association between MPV and ISR in CAS patients.

Methods—

A total of 261 patients with CAS were enrolled. MPV was measured before CAS procedure. Digital subtraction angiography, computed tomographic angiography, or duplex ultrasonography was performed at 6 months and annually after the procedure. ISR was defined as ≥50% stenosis in the treated lesion. Cox regression was used to identify predictors of ISR after CAS.

Results—

Of the 261 patients with CAS, 46 (17.6%) were determined with ISR during a mean follow-up of 12.1±16.1 months (range, 2.1–120.7). On multivariate analysis, baseline MPV >10.1 fL (hazard ratio, 3.20; 95% confidence interval, 1.28–8.03), lesion length (hazard ratio, 1.05; 95% confidence interval, 1.02–1.08), residual stenosis (hazard ratio, 1.07; 95% confidence interval, 1.05–1.10), and baseline glucose (hazard ratio, 1.01; 95% confidence interval, 1.00–1.02) were associated with ISR.

Conclusions—

Elevated MPV may be associated with ISR after CAS. Patients with high preprocedural MPV may benefit from an intensified antiplatelet therapy after CAS.
Spring Arctic Atmospheric Preconditioning: Do Not Rule Out Shortwave Radiation Just Yet
Authors: Sedlar Joseph
Published: March 2018

Springtime atmospheric preconditioning of Arctic sea ice for enhanced or buffered sea ice melt during the subsequent melt year has received considerable research focus. Studies have identified enhanced poleward atmospheric transport of moisture and heat during spring, leading to increased emission of longwave radiation to the surface. Simultaneously, these studies ruled out the role of shortwave radiation as an effective preconditioning mechanism because of relatively weak incident solar radiation, high surface albedo from sea ice and snow, and increased clouds during spring. These conclusions are derived primarily from atmospheric reanalysis, which may not always accurately represent the Arctic climate system. Here, top-of-atmosphere shortwave radiation observations from a state-of-the-art satellite sensor are compared with ERA-Interim reanalysis to examine similarities and differences in the springtime absorbed shortwave radiation (ASR) over the Arctic Ocean. Distinct biases in regional location and absolute magnitude of ASR anomalies are found between satellite-based measurements and reanalysis. Observations indicate separability between ASR anomalies in spring corresponding to anomalously low and high ice extents in September; the reanalysis fails to capture the full extent of this separability. The causes for the difference in ASR anomalies between observations and reanalysis are considered in terms of the variability in surface albedo and cloud presence. Additionally, biases in reanalysis cloud water during spring are presented and are considered for their impact on overestimating spring downwelling longwave anomalies. Taken together, shortwave radiation should not be overlooked as a contributing mechanism to springtime Arctic atmospheric preconditioning.
Homogenization and Trend Analysis of the 1958–2016 In Situ Surface Solar Radiation Records in China
Authors: Yang Su , Wang Xiaolan L. , Wild Martin
Published: March 2018

This paper presents a method to homogenize China’s surface solar radiation (SSR) data and uses the resulting homogenized SSR data to assess the SSR trend over the period 1958–2016. Neighboring surface sunshine duration (SSD) data are used as reference data to assess the SSR data homogeneity. A principal component analysis is applied to build a reference series, which is proven to be less sensitive to occasional data issues than using the arithmetic mean of data from adjacent stations. A relative or absolute test is applied to detect changepoints, depending on whether or not a suitable reference series is available. A quantile-matching method is used to adjust the data to diminish the inhomogeneities. As a result, 60 out of the 119 SSR stations were found to have inhomogeneity issues. These were mainly caused by changes in instrument and observation schedule. The nonclimatic changes exaggerated the SSR change rates in 1991–93 and resulted in a sudden rise in the national average SSR series, causing an unrealistically drastic trend reversal in the 1990s. This was diminished by the data homogenization. The homogenized data show that the national average SSR has been declining significantly over the period 1958–90; this dimming trend mostly diminished over the period 1991–2005 and was replaced by a brightening trend in the recent decade. From the homogenized SSR data, the 1958–90 and 1958–2005 dimming rate is estimated to be −6.13 ± 0.47 and −5.08 ± 0.27 W m−2 decade−1, respectively, and the 2005–16 brightening rate is 6.13 ± 1.77 W m−2 decade−1.
Observed Energy Exchange between Low-Frequency Flows and Internal Waves in the Gulf of Mexico
Authors: Jing Zhao , Chang Ping , DiMarco S. F. , Wu Lixin
Published: March 2018

A long-term mooring array deployed in the northern Gulf of Mexico is used to analyze energy exchange between internal waves and low-frequency flows. In the subthermocline (245–450 m), there is a noticeable net energy transfer from low-frequency flows, defined as having a period longer than six inertial periods, to internal waves. The magnitude of energy transfer rate depends on the Okubo–Weiss parameter of low-frequency flows. A permanent energy exchange occurs only when the Okubo–Weiss parameter is positive. The near-inertial internal waves (NIWs) make major contribution to the energy exchange owing to their energetic wave stress and relatively stronger interaction with low-frequency flows compared to the high-frequency internal waves. There is some evidence that the permanent energy exchange between low-frequency flows and NIWs is attributed to the partial realization of the wave capture mechanism. In the periods favoring the occurrence of the wave capture mechanism, the horizontal propagation direction of NIWs becomes anisotropic and exhibits evident tendency toward that predicted from the wave capture mechanism, leading to pronounced energy transfer from low-frequency flows to NIWs.
Scale-Invariant Formulation of Momentum Diffusion for High-Resolution Atmospheric Circulation Models
Authors: Schaefer-Rolffs Urs , Becker Erich
Published: March 2018

A new version of the dynamic Smagorinsky model is presented that applies for nonisotropic momentum diffusion in high-resolution atmospheric circulation models. While the horizontal mixing length is computed in accordance with scale invariance in the mesoscale regime of the horizontal energy cascade, the associated dynamic vertical mixing length (DVML) is based on a recently developed scale invariance criterion and represents an application of the scaling laws of stratified macroturbulence. The DVML is validated in high-resolution simulations with the Kühlungsborn mechanistic general circulation model, using triangular spectral truncation at wavenumber 330 and a vertical level spacing of about 200 m in the upper troposphere. For a proper choice of the test filter, the model simulates a realistic horizontal kinetic energy spectrum in the troposphere along with a realistic intensity of the Lorenz energy cycle. This result is obtained without any hyperdiffusion, and it depends only little on whether the vertical mixing length is prescribed or set to the DVML. The globally averaged Smagorinsky parameter is about c S ≅ 0.53. The latitude–height cross sections show that c S maximizes in regions of strong mesoscale kinetic energy.
High-speed infrared thermal imaging during ballistic impact of triaxially braided composites
Authors: Johnston Joel P , Pereira J Michael , Ruggeri Charles R , Roberts Gary D
Published: March 2018

Ballistic impact experiments were performed on triaxially braided polymer matrix composites to study the heat generated in the material due to projectile velocity and penetration damage. Triaxially braided (0/+60/−60) composite panels were manufactured with T700S standard modulus carbon fiber and two epoxy resins. The PR520 (toughened) and 3502 (untoughened) resin systems were used to make different panels to study the effects of resin properties on temperature rise. The ballistic impact tests were conducted using a single stage gas gun, and different projectile velocities were applied to study the effect on the temperature results. Temperature contours were obtained from the back surface of the panel during the test through a high speed, infrared thermal imaging system. The contours show that high temperatures were locally generated and more pronounced along the axial tows for the T700S/PR520 composite panels; whereas, tests performed on T700S/3502 composite panels, using similar impact velocities, demonstrated a widespread area of lower temperature rises. Nondestructive, ultrasonic C-scan analyses were performed to observe the failure patterns in the impacted composite panels and correlate the C-scan results with the temperature contours. Overall, the impact experimentation showed temperatures exceeding 252℃ (485°F) in both composites which is well above the respective glass transition temperatures for the polymer constituents. This expresses the need for further high strain rate testing with measurement of the temperature and deformation fields in order to fully understand the complex behavior and failure of the material and to improve the confidence in designing aerospace components with these materials.
Book Review: Gayatri Bhattacharyya. The First Indian Social Theorist: Ideas of Bhudev Chandra Mukhopadhyay
Authors: Vivek P. S.
Published: March 2018

Gayatri Bhattacharyya. The First Indian Social Theorist: Ideas of Bhudev Chandra Mukhopadhyay. Kolkata: University of Calcutta, 2012, 528 pp., ₹500 (paperback).
Career–family strategies and spatial mobility among South Korean women scholars
Authors: Yoon Hyejin , Kim Hyosun
Published: March 2018

This paper examines the mobility of female South Korean scholars and their career–family strategies for negotiating their relationships. Despite the importance of the relations and social capital of workers, previous studies on the mobility of highly skilled professionals have overlooked their social and personal relationships. South Korean women scholars consider not only career opportunities but also familial relations in the process of migration decision-making. To negotiate their relationships, they adopt strategies to build and maintain their relations at various geographic levels. Their strategies for making networks are complex and vary according to career, personal and familial goals.
Effect of Intranasal Insulin on Olfactory Recovery in Patients with Hyposmia: A Randomized Clinical Trial
Authors: Rezaeian Ahmad
Published: March 2018

Objective

Hyposmia is a sensorial disorder in which patients have a reduced sense of smell. However, there are no effective regimens for the management of this disorder. Therefore, the aim of this study is to evaluate the therapeutic effect of intranasal insulin on olfactory recovery in patients with hyposmia.

Study Design

This is a double‐blinded, randomized controlled trial.

Setting

Intervention.

Subjects and Methods

This study was administered on 38 patients with hyposmia according to the inclusion and exclusion criteria. Patients were randomly divided into 2 parallel groups. The intervention and placebo groups underwent endoscopic placement of intranasal insulin gel foam (40 IU) and saline‐soaked gel foam into the olfactory cleft, respectively. The procedure was performed twice a week for 4 weeks with butanol threshold testing initially and 4 weeks after treatment.

Results

The Connecticut Chemosensory Clinical Research Center score in the intervention group was significantly higher compared to that of the placebo group after 4 weeks (P =. 01). Moreover, no adverse effects were reported in both groups.

Conclusion

Our findings indicated that intranasal insulin (40 IU) administration may trigger the improvement in the olfactory sense and also appears to be free of significant adverse events in this small cohort. However, due to limited research regarding this topic, further studies using a larger population are required.
Prognostic Role of Neutrophil‐to‐Lymphocyte Ratio in Patients with Human Papillomavirus–Positive Oropharyngeal Cancer
Authors: So Yoon Kyoung , Lee GilJoon , Oh Dongryul , Byeon Sunju , Park Woori , Chung Man Ki
Published: March 2018

Objective

To investigate the prognostic impact of the neutrophil‐to‐lymphocyte ratio (NLR) for human papillomavirus–positive oropharyngeal cancer (HPV+ OPC).

Study Design

Retrospective institutional database analysis.

Setting

Tertiary referral medical center.

Material and Methods

In total, 104 patients with HPV+ OPC were enrolled. From the blood laboratory data checked within 4 weeks before initiation of primary treatment, NLR was calculated. The association between clinicopathological characteristics and NLR was analyzed, and the prognostic role was evaluated based on overall survival (OS) and disease‐free survival (DFS).

Results

According to the cutoff value (2.42) for NLR, the patients were classified into the low NLR group (n = 61) or the high NLR group (n = 43). High NLR was associated with a higher rate of advanced T classification (P =. 007) and diabetes mellitus (P =. 01). The proportion of surgery‐based treatment was lower in the high NLR group (20.9% vs 42.6%, P =. 02). The high NLR group showed a lower 5‐year OS rate (85.3% vs 96.3%, P =. 09) and a lower 5‐year DFS rate (68.1% vs 94.7%, P =. 01) than those in the low NLR group. Multivariate analysis showed that advanced N classification was a significant predictor for worse 5‐year OS (hazard ratio [HR], 17.40; 95% confidence interval [CI], 2.36‐128.29) and that both advanced N classification (HR, 7.78; 95% CI, 2.33‐25.93) and high NLR (HR, 4.16; 95% CI, 1.24‐13.95) were important prognosticators for worse 5‐year DFS.

Conclusion

Elevated pretreatment NLR was associated with poor DFS in patients with HPV+ OPC.
Opioids and the Otolaryngologist: An Ambulatory Assessment
Authors: Mohan Suresh , Bhattacharyya Neil
Published: March 2018

Objectives

To recognize current opioid prescription patterns in otolaryngology and determine changes in rates of outpatient opioid prescribing over time.

Study Design

Cross‐sectional analysis of national survey database.

Setting

Ambulatory care settings in the United States.

Subjects and Methods

The National Ambulatory Medical Care Survey from 2006 to 2013 was analyzed for outpatient otolaryngology visits. The rate of opioid medication prescribing was determined with patient and visit characteristics associated with an opioid prescription, including corresponding diagnoses. Calendar trends for the rate of opioid prescribing were determined and compared biennially.

Results

Among 19.2 ± 1.7 million otolaryngology visits annually (raw N = 11,905), there were 728,000 ± 96,000 visits with an opioid prescription (3.8% ± 0.4%). Adults were more likely than children to receive a narcotic (4.3% vs 1.9%, P <. 001); there was no significant difference according to sex (3.9% female vs 3.7% male, P =. 567). With respect to calendar trend, the opioid prescription rate increased significantly from 2.3% in 2006‐2007 to 4.6% in 2008‐2011 and then decreased to 3.5% in 2012‐2013 (P <. 031). The most common visit diagnosis categories associated with opioid prescribing were as follows: postoperative care (19.7% of prescriptions), adenotonsillitis (13.9%), chronic otitis media (8.7%), otitis externa (6.2%), and nasal obstruction (5.6%).

Conclusion

Despite the opioid epidemic in the United States, only a small portion of otolaryngology visits were associated with opioid prescription. However, given the significant increase in prescribing from 2008 to 2011, continued surveillance of prescribing patterns is warranted.
Integrative Medicine as a Bridge to Physician Wellness
Authors: Nguyen Chau T.
Published: March 2018

Burnout is increasingly recognized as an issue of major importance affecting physicians of all ages and disciplines and thereby patients, systems, and health care in general. At the 2017 American Academy of Otolaryngology—Head and Neck Surgery Foundation Annual Meeting, the scope of burnout in medicine was addressed, along with systematic issues that remain. While changing the culture of medicine and health systems to address this is needed, what strategies can health care providers use in their everyday lives to lessen the impact of burnout? Integrative medicine with its focus on wholeness of patient care, including the emotional, mental, social, and spiritual domains of health, is uniquely positioned in arming physicians with sets of tools to help them navigate patients to better health and healing. These very same methods are invaluable for personal self‐care, as we are all potential patients. Integrative medicine is a pathway to improving one's own self‐care and, thereby, improving patient care.
Delivering quality along with quantity: The challenge of teaching a large and heterogeneous engineering class
Authors: Chronopoulos D
Published: March 2018

The challenges faced by a lecturer teaching large multidisciplinary engineering classes are identified. These are principally related to the size of the class, the extensive mathematical knowledge that is considered as prerequisite, as well as the heterogeneity of the class due to the diversity of students’ academic background and interests. In order to improve students’ engagement and retention in class, active learning techniques are employed and their impact on the performance of the class is captured through a questionnaire designed for this purpose. The statistics demonstrate that good teaching facilities and a well-prepared lecturer do not suffice for maximising students’ satisfaction, attention and retention. In order to engage the students in a large class setting, it is important to involve them in the lecture process. The employed active learning methods comprising quizzes, in class demonstration and muddiest-point cards induce a remarkably positive impact at almost no additional teaching resources.
On mooring line tension and fatigue prediction for offshore vertical axis wind turbines: A comparison of lumped mass and quasi-static approaches
Authors: Cevasco D , Collu M , Rizzo CM , Hall M
Published: March 2018

Despite several potential advantages, relatively few studies and design support tools have been developed for floating vertical axis wind turbines. Due to the substantial aerodynamics differences, the analyses of vertical axis wind turbine on floating structures cannot be easily extended from what have been already done for horizontal axis wind turbines. Therefore, the main aim of the present work is to compare the dynamic response of the floating offshore wind turbine system adopting two different mooring dynamics approaches. Two versions of the in-house aero-hydro-mooring coupled model of dynamics for floating vertical axis wind turbine (FloVAWT) have been used, employing a mooring quasi-static model, which solves the equations using an energetic approach, and a modified version of floating vertical axis wind turbine, which instead couples with the lumped mass mooring line model MoorDyn. The results, in terms of mooring line tension, fatigue and response in frequency have been obtained and analysed, based on a 5 MW Darrieus type rotor supported by the OC4-DeepCwind semisubmersible.
Enhanced one-step-ahead adaptive control technique for wind systems
Authors: Dambrosio Lorenzo
Published: March 2018

This article proposes an enhanced version of the one-step-ahead control algorithm applied to a wind system. The wind system is considered as an isolate source of power and it is composed of a horizontal-axis wind turbine connected to an induction generator: consistent mathematical models for the horizontal-axis wind turbine and the induction generator will be introduced. Although the main strength of the one-step-ahead control technique is its adaptivity, nevertheless its convergence rate reduces very quickly. This aspect shows the primary algorithm weakness and is the reason for the proposed enhancement. Finally, the results of control problems will prove the reliability of the suggested enhanced control technique.
Variable pitch control for vertical-axis wind turbines
Authors: Horb S , Fuchs R , Immas A , Silvert F , Deglaire P
Published: March 2018

NENUPHAR aims at developing the next generation of large-scale floating offshore vertical-axis wind turbine. To challenge the horizontal-axis wind turbine, the variable blade pitch control appears to be a promising solution. This article focuses on blade pitch law optimization and resulting power and thrust gain depending on the operational conditions. The aerodynamics resulting from the implementation of a variable blade pitch control are studied through numerical simulations, either with a three-dimensional vortex code or with two-dimensional Navier-stokes simulations (two-dimensional computational fluid dynamics). Results showed that the three-dimensional vortex code used as quasi-two-dimensional succeeded to give aerodynamic loads in very good agreement with two-dimensional computational fluid dynamics simulation results. The three-dimensional-vortex code was then used in three-dimensional configuration, highlighting that the variable pitch can enhance the vertical-axis wind turbine power coefficient ( Cp) by more than 15% in maximum power point tracking mode and decrease it by more than 75% in power limitation mode while keeping the thrust below its rated value.
Valve Replacement for Chronic Mitral Insufficiency; Long-term Follow up Using Technetium Pertechnetate Scintigraphy
Authors: Reichart B. , Schad N. , Bougioukas G. , Kemkes B.M. , Kreuzer E.
Published: March 2018

Technetium Pertechnetate Scintigraphy was performed in 12 patients (9 men and 3 women, average age 48 ± 13 years) on an average 19.8 ± 11 months after valve replacement for chronic mitral insufficiency.

Preoperative conventional ventriculography had revealed increased enddiastolic and endsystolic volumes (230.9 ± 66 resp. 73.5 ± 26 ml). 59.4 ± 9% of the stroke volume (157.5 ± 47 ml) regurgitated into the left atrium. Ejection-fraction (67.7 ± 6%) was normal in all cases.

Postoperative first pass technique was employed using a fast multicrystal camera (Baird Atomic, system 77). Volumes were assessed measuring normalized total count rate (count integral of the left ventricle divided by the maximum count density). 19.8 ± 11 months after valve replacement enddiastolic and endsystolic volumes revealed normal at rest (121.8 ± 38 resp. 52.8 ± 35 ml) and after maximum exercise (122.0 ± 29 resp. 37.6 ± 22 ml). Ejection fraction responded physiologically to exercise by rising from 57.7 ± 12 to 69.7 ± 10%.
Tc-99m-DTPA - a new Test Substance for Detoxification Devices
Authors: Ahrenholz P. , Falkenhagen D. , Roy T. , Esther G. , Klinkmann H.
Published: March 2018

Tc99m labeled diethylenetriaminepentaacetic acid (Tc-99m-DTPA) is an appropriate in vivo test solute for all extracorporeal detoxification procedures. The molecular weight of the Tc-99m-DTPA complex is within the biologically relevant middle molecular range of 400 to 700 daltons. Tc-99m-DTPA is distributed in the extracellular space in the same way as inulin. Regarding its localization in the gel filtration spectra and plasma clearance, Tc-99m-DTPA corresponds to middle molecule peak 2.

The evaluation of elimination rate and plasma clearance CP of Tc-99m-DTPA is possible by measuring the pulse rates before and after the detoxification device. Taking into account the corrections for Ht and UFR, the Tc-99m-DTPA plasma clearances were calculated for different dialyzers, high flux dialyzers, hemofilters and a hemoperfusion device.

The continuous measurement of pulse rates and the use of a UFR-controller (A2008) allow an exact tracking of CP vs. time, the estimation of CP(QB), CP(UFR) and of the sieving coefficient. Examples are given for these cases.

It was shown that an increase in plasma clearance to more than about 100 ml/min does not greatly increase the Tc-99m-DTPA elimination rate.
The Influence of Fine Surface Structures on the Osseo-integration of Implants
Authors: Heimke G. , Schulte W. , d'Hoedt B. , Griss P. , Büsing C.M. , Stock D.
Published: March 2018

The availability of inert materials like dense, pure Al-2O3-ceramic or titanium allows the study of purely biomechanical influences of surface modulations or lacune on the osseo-integration of implants at different locations of the skeleton. The discovery of the «load-line-shadow» phenomenon in lacune of dental implants and the observation of the same effect in the grooves of hip sockets (Lindenhof type) indicate the general validity of the rules controlling the remodelling ability of bony tissue. Their application to the problems concerned with load transmission via surfaces which are mainly loaded by shear can contribute to achieve a well defined anchorage of implants.
Characteristics of the Cellulose Triacetate Membrane for Hemofiltration
Authors: Sato H. , Kidaka T.
Published: March 2018

The Permeation characteristics of the cellulose triacetate membrane used for hemofiltration were studied and compared with other commercially available sheet type membranes. The critical solute fractionation profile of the cellulose triacetate membrane was very similar to that of a glomerular basement membrane. The cellulose triacetate membrane showed a typical gel concentration polarization with a protein solution; however, the surface of the membrane is considered to be relatively homogeneous for permeation based on the relation between fluxes of the protein solution and saline: the flux of the protein solution is not much less than that of saline. This result differs from that observed with other membranes. Because of these desirable characteristics the cellulose triacetate membrane is considered to be suitable as a membrane for a hemofiltration system.
Complete Extracorporeal Removal of Metabolic Carbon Dioxide by Alkali Administration and Dialysis in Apnea
Authors: Chang B.S. , Garella S.
Published: March 2018

The high mortality rate of patients afflicted with adult respiratory distress syndrome (ARDS) may be due, in part, to the hemodynamic changes and the barotrauma accompanying mechanical ventilation, especially when high positive pressure and oxygen tension are used. Recent experimental evidence suggests that prognosis may be improved by suspending ventilation: in the apneic condition, oxygenation can be maintained by trans-alveolar oxygen diffusion, while extracorporeal carbon dioxide removal (ECCO2R), achieved with membrane lungs, assures CO2 homeostasis. This technology, however, requires high blood flow rates, and is available only to very few specially equipped centers. We report results of experiments in dogs using an alternative approach to ECCO2R during apnea. Dissolved CO2 was converted to bicarbonate by the systemic infusion of NaOH at the rate of 0.15 mM/kg/min; the generated bicarbonate was then removed by hemodialysis against a bicarbonate-free dialysate, at a blood flow rate of 200 ml/min. Sodium and fluid balance were maintained by ultrafiltration. Observations in five dogs confirm that systemic pCO2, TCO2, and pH can be maintained well within physiologic ranges, and that prolonged apnea followed by full recovery can be achieved with this methodology. Mecause of the wide availability of dialysis equipment and expertise, and of lowerr extracorporeal blood flow requirements, ECCO2R by alkali administration and hemodialysis offers a potentially attractive alternative approach to the use of membrane lungs in the apneic therapy of ARDS.
Cascade filtration: Clinical Application in 26 Patients with Immune Complex and Igm Mediated Diseases
Authors: Valbonesi M. , Mosconi L. , Montani F. , Florio G. , Rossi U.
Published: March 2018

A new technique which allows lymphocytapheresis to be combined with cascade filtration (CF) is described in this paper. This therapeutical approach was applied for the treatment of patients affected by necrotizing vasculitis (1), inflammatory myopathies (5), Cryoglobulinemia (5), immune complex polyneuropathies (7), rheumatoid arthritis (3) and psoriasis (3 patients). Two cases of Waldenstrom's macroglobulinemia were also treated after the onset of the hyperviscosity syndrome. 78 procedures have been performed without any untoward effect. From a clinical point of view all patients had some improvement following treatment, thereby confirming not only the clinical safety of this therapeutical approach but also its effectiveness at least in the management of diseases which usually respond to plasma exchange treatment. Laboratory investigations showed that with CF it is possible to selectively remove IgM, immune complexes, fibrinogen, lipoproteins and high molecular weight plasma components, sparing most albumin and IgG globulins (85 and 71%, respectively).
The Efficacy of Large Volume Plasma Exchange in Chemotherapy Resistant Malignancies
Authors: Beyer J.H. , Werner P.S. , Kaboth U. , Krieger G. , Nagel G.A.
Published: March 2018

Chemotherapy resistance in cancer patients may be due to serum blocking factors, which can be deminished or eliminated by large volume plasma exchange (PE). This procedure was performed with the IBM blood cell separator in 69 patients resistant to chemotherapy. Immediately after PE the chemotherapy was given but it failed to produce remission. The combined treatment was reinstituted, if clinical evaluation revealed partial remission, minor response or no change. 37 out of 69 patients (53.6%) responded again, 32 (46.4%) did not. Response duration ranged from 2 to 45 weeks. Best clinical results were obtained in patients with colorectal cancer, 15 out of 23 showed improvement between 4 to 45 weeks. Serum blocking activity was measured using a modified mixed lymphocyte culture assay (MLC). There was a 80% positive correlation between clinical course of patients and MLC levels, if basic activity before the first PE was compared to MLC inhibition before the following PE's.
Evaluation of interfacial disbonding using finite element-based resonance ultrasonic spectroscopy
Authors: Sodagar Sina , Pourshab Reza
Published: March 2018

In this paper, application of resonance scattering theory for nondestructive evaluation of embedded elastic cylindrical targets is investigated. For this purpose, an FE-based short-pulse method of isolation and identification of resonances is used to investigate the effects of cylinder-matrix interfacial disbonding involving the frequency effects of measurement system. Insonification of ultrasonic plane wave from an emitting transducer and the resulting scattered wave field from the embedded cylinder is simulated using commercial software ABAQUS/Explicit. The proposed FE-based method of isolation and identification of resonances is employed to investigate the effects of cylinder-matrix interfacial disbonding on the resonance modes using far-field backscattered frequency spectrum. It is observed that, compared to the whispering gallery resonance modes, the Rayleigh modes have higher sensitivity to the presence of side-wall interfacial disbonding which significantly decreases for back-wall defects.
Dark and white lesions observed in central serous chorioretinopathy on optical coherence tomography angiography
Authors: De Bats Flore , Cornut Pierre-Loïc , Wolff Benjamin , Kodjikian Laurent , Mauget-Faÿsse Martine
Published: March 2018

Purpose:

To describe abnormal dark (hyposignal) and white (hypersignal) lesions observed on optical coherence tomography angiography in central serous chorioretinopathy.

Methods:

Prospective, multicenter, and descriptive study including patients with active or quiescent central serous chorioretinopathy. All patients had undergone a complete ophthalmic examination.

Results:

Abnormal dark lesions were detected as “dark spots” and “dark areas” on optical coherence tomography angiography. A “dark spot” could correspond to six different abnormalities: pigment epithelium detachment, subretinal deposit, “Lucency” within surrounding subretinal fibrin, choroidal cavitation, choroidal excavation, and choroidal fluid. A “dark area” could be related to a serous retinal detachment or choriocapillary compression. Abnormal white lesions were also detected: A “white spot” could correspond with the leaking point on fluorescein angiography or with hyper-reflective dots; A “white filamentous pattern” at the Brüch’s membrane level corresponded to abnormal choroidal neovascular vessels.

Conclusion:

A semiology is described using optical coherence tomography angiography in central serous chorioretinopathy as abnormal dark and white lesions. Multimodal imaging is mandatory in addition to optical coherence tomography angiography to diagnose non-neovascular retinal and choroidal central serous chorioretinopathy lesions. However, optical coherence tomography angiography alone is helpful in detecting choroidal neovascular membrane in central serous chorioretinopathy.
Non-linear dynamic response analysis of cylindrical roller bearings due to rotational speed
Authors: Patra Pravajyoti , Saran V Huzur , Harsha SP
Published: March 2018

The dynamic behaviour of cylindrical roller bearings is presented, in both balanced and unbalanced conditions as a function of speed. The stiffness and damping non-linearities at the contact points (due to Hertzian contact force between rollers and races), radial internal clearance and unbalanced rotor force make the bearing system non-linear. Presently, the differential equations representing the dynamics of the cylindrical roller bearings have been obtained using Lagrange’s equation and solved numerically using modified Newmark-β method. The results of the analyses of various motion behaviours are presented as time–displacement responses, orbit plots, phase portraits, Poincaré maps and Fast Fourier Transform plots. The obtained responses revealed the sensitive behaviour of the system from periodic to quasi-periodic and chaotic with speed variations for both balanced and unbalanced rotor conditions. Also, intermittent chaotic behaviour has been observed. A pattern of the interaction between rotational and variable compliance vibration is observed with speed variations. The frequency pattern analysis (with different techniques used like phase/orbit plots and Poincaré plots) for healthy cylindrical bearing and different rotor conditions under different applied non-linearity consideration is a new attempt to analyse dynamic behaviour of the bearing. This analysis is helpful for online monitoring of fault-free cylindrical roller bearings and for studying the impact of speed on system’s dynamical behaviour.
Badiou, Haussmann and Saint-Simon: Opening spaces for the state and planning between ‘post-politics’ and urban insurgencies
Authors: Paccoud Antoine
Published: March 2018

The post-political literature – which equates ‘the political’ with insurgencies directed against the state – has only limited relevance for planning, focused as it is on the ways in which conflict is displaced from the functioning of the state apparatus. The post-political literature has however neglected a significant change in Alain Badiou’s conceptualisation of the relation between the political and the state: the introduction of a political subject which acts from the within the state – what he calls the state revolutionary. This figure, which makes ‘evental’ planning possible, is fleshed out through a Saint-Simonian reading of Haussmann’s planning practice in his first years as Prefect of the Seine.
Aortic Graft Infection Secondary to Iatrogenic Transcolonic Graft Malposition
Authors: Blank Jacqueline J. , Rothstein Abby E. , Lee Cheong Jun , Malinowski Michael J. , Lewis Brian D. , Ridolfi Timothy J. , Otterson Mary F.
Published: March 2018

Aortic graft infections are a rare but devastating complication of aortic revascularization. Often infections occur due to contamination at the time of surgery. Iatrogenic misplacement of the limbs of an aortobifemoral graft is exceedingly rare, and principles of evaluation and treatment are not well defined. We report 2 cases of aortobifemoral bypass graft malposition through the colon.

Case Report:

Case 1 is a 54-year-old male who underwent aortobifemoral bypass grafting for acute limb ischemia. He had previously undergone a partial sigmoid colectomy for diverticulitis. Approximately 6 months after vascular surgery, he presented with an occult graft infection. Preoperative imaging and intraoperative findings were consistent with graft placement through the sigmoid colon. Case 2 is a 60-year-old male who underwent aortobifemoral bypass grafting due to a nonhealing wound after toe amputation. His postoperative course was complicated by pneumonia, bacteremia thought to be secondary to the pneumonia, general malaise, and persistent fevers. Approximately 10 weeks after the vascular surgery, he presented with imaging and intraoperative findings of graft malposition through the cecum.

Conclusions:

Aortic graft infection is usually caused by surgical contamination and presents as an indolent infection. Case 1 presented as such; Case 2 presented more acutely. Both grafts were iatrogenically misplaced through the colon at the index operation. The patients underwent extra-anatomic bypass and graft explantation and subsequently recovered.
Unilateral Acute Renal Artery Embolism: An Index Case of Successful Mechanical Aspiration Thrombectomy With Use of Penumbra Indigo Aspiration System and a Review of the Literature
Authors: Yousif Ali , Samannan Rajesh , Abu-Fadel Mazen
Published: March 2018

Acute renal artery embolism (RAE) is a rare condition associated with significant morbidity and mortality. The treatment strategy for RAE includes anticoagulation with or without thrombolysis or surgical or endovascular embolectomy. We describe here a case presentation of acute RAE secondary to atrial fibrillation treated successfully with Penumbra Indigo Aspiration System, a novel device in peripheral endovascular interventions. Our patient had ongoing symptoms and acute renal failure on presentation with contraindication to thrombolysis given hypertensive emergency. A 6F Penumbra Aspiration catheter was used to aspirate large amounts of thrombus from segmental renal arteries with restoration of flow. Patient’s symptoms and renal function returned to baseline after intervention. Penumbra system is used routinely in cerebral endovascular intervention, yet here we describe its potential use in peripheral vascular interventions in addition to a literature review of all available evidence for the different treatment modalities of acute RAE.
Pseudoaneurysm of the Radial Artery After a Bicycle Fall
Authors: Ratschiller Thomas , Müller Hannes , Schachner Thomas , Zierer Andreas
Published: March 2018

We report a case of a 64-year-old man who developed a painful pulsatile mass in the distal forearm after a bicycle fall with fracture of the wrist. Ultrasonography confirmed a 2.5-cm large pseudoaneurysm of the radial artery. The patient underwent surgical exploration. The pseudoaneurysm was resected and the defect in the arterial wall was reconstructed with an autologous saphenous vein patch. We suggest that the double arterial supply of the hand should be preserved whenever possible.
Development of a Model for the Acquisition and Assessment of Advanced Laparoscopic Suturing Skills Using an Automated Device
Authors: Bilgic Elif , Takao Madoka , Kaneva Pepa , Endo Satoshi , Takao Toshitatsu , Watanabe Yusuke , McKendy Katherine M. , Feldman Liane S. , Vassiliou Melina C.
Published: March 2018

Background. Needs assessment identified a gap regarding laparoscopic suturing skills targeted in simulation. This study collected validity evidence for an advanced laparoscopic suturing task using an Endo StitchTM device. Methods. Experienced (ES) and novice surgeons (NS) performed continuous suturing after watching an instructional video. Scores were based on time and accuracy, and Global Operative Assessment of Laparoscopic Surgery. Data are shown as medians [25th-75th percentiles] (ES vs NS). Interrater reliability was calculated using intraclass correlation coefficients (confidence interval). Results. Seventeen participants were enrolled. Experienced surgeons had significantly greater task (980 [964-999] vs 666 [391-711], P = .0035) and Global Operative Assessment of Laparoscopic Surgery scores (25 [24-25] vs 14 [12-17], P = .0029). Interrater reliability for time and accuracy were 1.0 and 0.9 (0.74-0.96), respectively. All experienced surgeons agreed that the task was relevant to practice. Conclusion. This study provides validity evidence for the task as a measure of laparoscopic suturing skill using an automated suturing device. It could help trainees acquire the skills they need to better prepare for clinical learning.