bluuebunny/crossref_metadata_2025 huggingface dataset:
Vallecular cyst with coexisting laryngomalacia: Successful diagnosis and laser therapy by flexible endoscopy with a novel noninvasive ventilation support in infants
Authors: Soong Wen‐Jue , Yang Chia‐Feng , Lee Yu‐Sheng , Tsao Pei‐Jeng , Lin Chien‐Heng , Chen Chieh‐Ho
Published: April 2020

Objective

Vallecular cyst coexisting with laryngomalacia (VC‐LM) can cause significant pharyngolaryngeal obstruction. Traditionally, it is diagnosed with flexible endoscopy (FE) and treated by rigid endoscopy. This study evaluates the effectiveness of solely using FE with novel noninvasive ventilation (NIV) of sustained pharyngeal inflation (SPI) support for both diagnosis and treatment in such infants.

Methods

A retrospective review of consecutive infants who were diagnosed and treated for VC‐LM in the 12‐year period, 2007 to 2018, was conducted. Clinical variables, techniques, and outcomes were analyzed and reported.

Results

Eighteen infants (10 males) were included. The mean age was 3.0 ± 0.6 months and the mean body weight was 4.6 ± 1.3 kg. Before FE, 14 infants were supported with bi‐nasal prongs NIV (BN‐NIV) and four infants with tracheal intubation. During diagnostic and therapeutic FE, all infants supported with a nasopharyngeal NIV (NP‐NIV) only. All diagnoses were made in the first FE inspection of 3.5 ± 1.2 minutes. Thirteen lesions were immediately treated with FE laser therapy in 18.1 ± 1.7 minutes in the same FE course. Total FE time was 24.6 ± 2.8 minutes. Three infants needed revision laser therapy 4 days later. There was no desaturation (<90%), bradycardia (<100/min), or pneumothorax. After FE therapy, all infants were supported with BN‐NIV only with significantly (<0.01) lower pressure and completely weaned off before being discharged 8.4 ± 1.5 days later. All infants, followed up for a 6‐month period, showed many clinical improvements.

Conclusions

FE, with this NP‐NIV and SPI supports, could offer accurate diagnosis and successful laser therapy of the VC‐LM with procedural sedation in the same session in infants.
Enhancing data acquisition for the analysis of complex organic matter in direct‐infusion Orbitrap mass spectrometry using micro‐scans
Authors: Wolters Cédric , Flandinet Laurène , He Chao , Isa Junko , Orthous‐Daunay François‐Régis , Thissen Roland , Hörst Sarah , Vuitton Véronique
Published: April 2020

Rationale

Acquisition quality in analytical science is key to obtaining optimal data from a sample. In very high‐resolution mass spectrometry, quality is driven by the optimization of multiple parameters, including the use of scans and micro‐scans (or transients) for performing a Fourier transformation.

Methods

Thirty‐nine mass spectra of a single synthesized complex sample were acquired using various numbers of scans and micro‐scans determined through a simple experimental design. An electrospray ionization source coupled with an LTQ Orbitrap XL™ mass spectrometer was used, and acquisition was performed using a single mass range. All the resulting spectra were treated in the same way to enable comparisons of assigned stoichiometric formulae between acquisitions.

Results

Converting the number of scans into micro‐scans enhances signal quality by lowering noise and reducing artifacts. This modification also increases the number of attributed stoichiometric formulae for an equivalent acquisition time, giving access to a larger molecular diversity for the analyzed complex sample.

Conclusions

For complex samples, the use of long acquisition times leads to optimal data quality, and the use of micro‐scans instead of scans‐only maximizes the number of attributed stoichiometric formulae.
Nitrogen‐Doped Graphene Oxide as a Sustainable Carbonaceous Catalyst for Greener Synthesis: Benign and Solvent‐free Synthesis of Pyranopyrazoles
Authors: Saravana Ganesan Nagappan , Suresh Palaniswamy
Published: April 2020

The development of benign strategies using the greener catalytic system is one of the prime tasks to improvise the greenness and sustainability in the synthesis of bioactive molecules. In the present work, a straightforward and sustainable methodology for the one‐pot synthesis of dihydropyrano[2,3‐c] pyrazole has been developed using nitrogen‐doped graphene oxide (NGO) as a solid carbocatalyst under neat condition. The presence of high‐density different types of nitrogen on the basal plane and the edges of the graphitic surface renders excellent active alkali sites and make it as a carbonaceous catalyst for the synthesis of a wide range of pyranopyrazoles with excellent yield. Present carbonaceous NGO catalysis the formation of pyranopyrazoles from diverse aldehydes and ketones under a solvent‐free simple grinding condition that avoids chromatographic purifications. In this benign multicomponent synthesis, the NGO is highly stable and reusable without any loss in its catalytic activity even after eight successive reuses, which strongly enlighten the sustainable nature of the catalyst. Further analytical studies of the reused catalyst confirm the stability of the catalyst even after several reuses. The NGO catalyst paves a path for the development of sustainable nitrogen‐based carbocatalyst for the benign multicomponent synthesis of bioactive molecules.
Thermodynamics of Phase Transformation and Microstructure Evolution of 18Cr2Ni4WA Carburized Steel during High‐Temperature Tempering
Authors: Wang Bin , He Yanping , Liu Ye , Tian Yong , You Jinglin , Misra Raja Devesh Kumar , Wang Zhaodong , Wang Guodong
Published: April 2020

The microstructural evolution and phase transformation mechanism in 18Cr2Ni4WA carburized steel during high‐temperature tempering is investigated using a thermodynamic model. The experimental results demonstrate that the retained austenite in the matrix decreases from the surface to the core, and martensite transform from acicular to lath‐type. Furthermore, the hardness distribution of the carburized layer increase initially, and then decrease. Based on thermodynamic calculations, the driving forces for the decomposition of martensite decomposition and nucleation of cementite in martensite are larger than those for the decomposition of austenite during tempering. Furthermore, cementite preferentially precipitate in martensite. The driving force for the overall phase transformation of the decomposition of the retained austenite is negative, and the driving force for the nucleation of cementite in the low‐carbon retained austenite is positive, indicating that cementite can nucleate only in high‐carbon retained austenite. The low‐carbon retained austenite transform into secondary martensite on cooling after the tempering process while the driving force gradually increase. The decomposition of the initial quenched martensite during the tempering process leads to a decrease in the overall hardness of the carburized layer. The secondary martensite obtained from the retained austenite contribute to the increase in the surface hardness.
fib models for modeling of chloride ion ingress and concrete carbonation: Levels of assessment of input parameters
Authors: Šomodíková Martina , Strauss Alfred , Zambon Ivan
Published: April 2020

Degradation processes affecting structural materials, such as chloride ion ingress, concrete carbonation, and the subsequent corrosion of reinforcement, are limiting factors for the service life of reinforced concrete structures and/or structural elements. The objective of a structural condition assessment is to determine the current state and estimate the future performance of a structure with a maximum degree of accuracy and a minimum of effort. There is therefore a need for advanced methodologies and predictive deterioration models for the assessment of structures/structural elements over time. In the paper, the focus is on the widely accepted models for modeling of chloride ion ingress into concrete and concrete carbonation process incorporated in the fib Model Code 2010. Three levels of assessment of input parameters are presented, starting with simple quantification based on codes/literature recommendations and progressing to higher levels of assessment using design documentation and visual inspection data, additional on‐site measurements, and/or laboratory tests.
Effect of Poly(Styrene‐Ethylene‐Butylene‐Styrene) Block Copolymer on Thermomechanical Properties and Morphology of Polypropylene/Poly(Styrene‐Ethylene‐Butylene‐Styrene)/Polycarbonate Ternary Blends
Authors: Soltanolkottabi Fariba , Moini Jazani Omid , Shokoohi Shirin
Published: April 2020

Ternary polymer blends based on polypropylene (PP)/poly(styrene‐ethylene‐butylene‐styrene) (SEBS)/polycarbonate (PC) compatibilized through maleic anhydride‐grafted SEBS were prepared using a twin‐screw extruder. Four different compositions in which the weight ratio of SEBS constituent was varied from 5% up to 30% were formulated in order to assess the relation between morphology and mechanical properties and SEBS/SEBS‐g‐MA weight ratio was set to be 1. Samples were characterized using scanning electron microscopy (SEM), differential scanning calorimetry (DSC), dynamic mechanical thermal analysis (DMTA), and mechanical properties measurements. Microscopic observation confirmed the formation of core‐shell droplets dispersed in the PP matrix in which the rubbery phase encapsulated PC droplets. Individual fibril‐like PC rods were also observed beside the encapsulations. Accordingly, impact resistance progressively improved (28.57‐fold at 30 wt% of SEBS) compared to neat PP while only 6.8% decrease was detected in the yield strength of this sample. SEM micrographs also showed that the population and size of the individual PC particles are higher in the samples containing 5 and 10 wt% of SEBS compared to those containing 20 and 30 wt%, which endow the former with higher chance of heterogeneous nucleation and correspondingly higher crystallization temperature confirmed by DSC results. Introduction of SEBS rubber phase intensified the elastic behavior of the blends supported by DMTA thermograms.
How animals collaborate: Underlying proximate mechanisms
Authors: Duguid Shona , Melis Alicia P.
Published: April 2020

Collaboration or social interactions in which two or more individuals coordinate their behavior to produce outcomes from which both individuals benefit are common in nature. Individuals from many species hunt together, defend their territory, and form coalitions in intragroup competition. However, we still know very little about the proximate mechanisms underlying these behaviors. Recent theories of human cognitive evolution have emphasized the role collaboration may have played in the selection of socio‐cognitive skills. It has been argued that the capacity to form shared goals and joint intentions with others, is what allows humans to collaborate so flexibly and efficiently. Although there is no evidence that nonhuman animals are capable of shared intentionality, there is conceivably a wide range of proximate mechanisms that support forms of, potentially flexible, collaboration in other species. We review the experimental literature with the aim of evaluating what we know about how other species achieve collaboration; with a particular focus on chimpanzees. We structure the review with a new categorization of collaborative behavior that focuses on whether individuals intentionally coordinate actions with others. We conclude that for a wider comparative perspective we need more data from other species but the findings so far suggest that chimpanzees, and possibly other great apes, are capable of understanding the causal role of a partner in collaboration.

This article is categorized under:

Cognitive Biology > Evolutionary Roots of Cognition

Psychology > Comparative Psychology
What do practicing lawyers need to know about technology?
Authors: Trammell Rebecca S.
Published: April 2020

Continuing advances in technology and the many ways technologies are used involve both legal issues and ethical concerns impacting today's lawyers and the practice of law. What laws apply to existing technology? If current technology is used in new ways will existing laws apply to these new uses? Will new technology require new laws? How will existing ethical rules apply to today's technology? What are the technology related ethical issues that practicing lawyers must consider? How can lawyers keep up with advances in technology including electronically stored information and the artificial intelligence necessary to understand and use this technology? What resources are available to attorneys to assist in meeting these challenges? How can practicing lawyers successfully meet today's tech‐driven changes?

This article is categorized under:

Jurisprudence and Regulatory Oversight > Digital Courtroom

Jurisprudence and Regulatory Oversight > Communication Across Science and Law
Instanton corrections and Emergent Strings
Authors: Baume Florent , Marchesano Fernando , Wiesner Max
Published: April 2020

Abstract

We study limits of infinite distance in the moduli space of 4d

$$ \mathcal{N} $$

N

= 2 string compactifications, in which instanton effects dominate. We first consider trajectories in the hypermultiplet moduli space of type IIB Calabi-Yau compactifications. We observe a correspondence between towers of D-brane instantons and D-brane 4d strings, such that the lighter the string the more relevant the instanton effects are. The dominant instantons modify the classical trajectory such that the lightest D-brane string becomes tensionless even faster, while the other strings are prevented to go below the fundamental string tension. This lightest string is dual to a fundamental type IIB string and realises the Emergent String Conjecture. We also consider the vector multiplet moduli space of type I string theory on K3 ×
T
2, where quantum corrections can also become significant. Naively, we only find trajectories that correspond to decompactification limits, in apparent contradiction with the picture obtained in some dual setup.
CP violation and circular polarisation in neutrino radiative decay
Authors: Balaji Shyam , Ramirez-Quezada Maura , Zhou Ye-Ling
Published: April 2020

Abstract

The radiative decay of neutral fermions has been studied for decades but CP violation induced within such a paradigm has evaded attention. CP violation in these processes can produce an asymmetry between circularly polarised directions of the radiated photons and produces an important source of net circular polarisation in particle and astroparticle physics observables. The results presented in this work outlines the general connection between CP violation and circular polarisation for both Dirac and Majorana fermions and can be used for any class of models that produce such radiative decays. The total CP violation is calculated based on a widely studied Yukawa interaction considered in both active and sterile neutrino radiative decay scenarios as well as searches for dark matter via direct detection and collider signatures. Finally, the phenomenological implications of the formalism on keV sterile neutrino decay, leptogenesis-induced right-handed neutrino radiative decay and IceCube-driven heavy dark matter decay are discussed.
Diagnostik von psychischen Faktoren bei chronischem Pruritus
Authors: Schneider G.
Published: April 2020

Hintergrund

Pruritus ist ein häufiges und quälendes Symptom in der Bevölkerung sowie in ärztlichen Praxen.

Ziel der Arbeit

Der vorliegende Beitrag gibt einen Überblick über die Systematik psychischer Faktoren in Entstehung bzw. Verlauf des Pruritus sowie Hinweise zu ihrer jeweiligen Diagnostik

Material und Methode

Es handelt sich um eine Überblicksarbeit.

Ergebnisse

Psychische Beeinträchtigungen/Störungen können als Reaktion auf chronischen Pruritus auftreten, z. B. als Anpassungsstörungen, depressive Störungen, Angststörungen. Psychische Faktoren können auch in Entstehung und Verlauf eines chronischen Pruritus eine Rolle spielen, entweder im Zusammenspiel mit organischen Ursachen oder bei deren Fehlen als somatoformer Pruritus oder Pruritus bei coenästhetischer Schizophrenie. Ferner können selbstinduzierte Kratzartefakte mit oder ohne Pruritus im Rahmen von Störungen der Impulskontrolle, Zwangsstörungen oder Artefaktstörungen auftreten. Auch eine primär unabhängige Komorbidität mit einer sonstigen psychischen oder psychosomatischen Störung kann das Management des Pruritus erschweren und den Krankheitsverlauf beeinflussen. Es werden Hinweise zur Diagnostik der genannten Faktoren gegeben.

Diskussion

Die Diagnostik psychischer Einflussfaktoren und psychischer Aspekte des chronischen Pruritus ist komplex. Das wichtigste diagnostische Werkzeug ist die gründliche Anamneseerhebung auch bezüglich psychischer Aspekte. Zusätzlich können psychometrische Instrumente zum Einsatz kommen, die das ärztliche Gespräch jedoch nicht ersetzen.
Entwicklung einer Entscheidungshilfe für partizipative Vorausplanungen für Menschen mit Demenz und deren Angehörige
Authors: Bronner Katharina , Bodner Lea , Jox Ralf J. , Marckmann Georg , Diehl-Schmid Janine , Hamann Johannes
Published: April 2020

Hintergrund

Eine Demenzdiagnose konfrontiert Betroffene mit vielen gesundheitlichen und sozialen Entscheidungen. Aufgrund der Progression der Demenz ist für eine aktive Teilnahme am Entscheidungsprozess eine rechtzeitige Auseinandersetzung mit diesen Themen ratsam. Eine professionelle Unterstützung kann dabei helfen, frühzeitig gemäß den eigenen Wünschen und Möglichkeiten vorauszuplanen.

Material und Methoden

In einem mehrstufigen Prozess wurde eine Entscheidungshilfe basierend auf „advance care planning“ und „shared decision making“ entwickelt. Der Prototyp wurde an 8 Patient-Angehörigen-Dyaden aus einer Spezialambulanz für Früherkennung vorgetestet und für deren Bedürfnisse bestmöglich angepasst. In einer Pilotstudie wurde anschließend die Anwendbarkeit der Entscheidungshilfe bei weiteren 19 Patient-Angehörigen-Dyaden (Diagnose einer Alzheimer-Demenz bzw. gemischte Form; MMSE (Mini-Mental-State-Test-Summenwert) >20 und <27) mit ausgebildeten Gesprächsbegleitern als Intervention getestet.

Ergebnis

Das Ergebnis ist eine schriftliche Entscheidungshilfe für Menschen mit Demenz im Frühstadium und deren Angehörige, welche den Entscheidungsprozess bei wichtigen Themen (Vorsorgevollmacht, Patientenverfügung, Wohnen, Autofahren) unterstützt. Erste Ergebnisse weisen auf eine gute Akzeptanz und Handhabung hin. Patienten und Angehörige beschäftigten sich in hohem Maße mit den Themen und sprachen ihnen hohe Relevanz zu.

Diskussion

Trotz positiver Rückmeldung der Teilnehmer hinsichtlich Akzeptanz und Anwendbarkeit gab es größere Schwierigkeiten bei der Rekrutierung. Perspektivisch könnte der systematisierte Einsatz einer Entscheidungshilfe als Teil der Routineversorgung dazu beitragen, Entscheidungsprozesse dieser Patientengruppe zu unterstützen.
Urologische Forschung in Deutschland
Authors: Neuberger M. , Weiß C. , Westhoff N. , Worst T. S. , Michel M. S. , von Hardenberg J.
Published: April 2020

Hintergrund und Ziel der Arbeit

Der Jahreskongress der Deutschen Gesellschaft für Urologie (DGU) spiegelt die urologische Forschungslandschaft im deutschsprachigen Raum wider. Ziel war es, durch die longitudinale Analyse der Kongressabstracts und hervorgehenden Vollpublikationen Trends aufzudecken.

Material und Methoden

Es erfolgte die systematische Analyse der Kongressabstracts des Jahreskongresses 2016 auf Inhalt, Studiendesign, Kooperationen, hervorgehenden Vollpublikationen sowie der veröffentlichenden Journalen. Hiernach erfolgte der Vergleich mit den Kongressen 2002 und 2009. Statistische Berechnungen erfolgten per χ2-, Mann-Whitney-U-, Cochran-Armitage- und Kruskal-Wallis-Test.

Ergebnisse

Auf den Kongressen 2002, 2009 und 2016 wurden 1073 Abstracts präsentiert. Abstracts zu Prostataerkrankungen (24,2 %, 29,7 %, 34,0 %; p = 0,0043), onkologische Abstracts (50,6 %, 57,9 %, 61,7 %; p = 0,003), multizentrische Studien (18,3 %, 28,6 %, 34,3 %; p < 0,0001) und Kooperationsprojekte (55,6 %, 62,9 %, 70,5 %, p < 0,0001) nahmen zu, experimentelle (29,0 %, 33,2 %, 22,8 %; p = 0,009) und prospektive Arbeiten (62,1 %, 42,0 %, 36,0 %; p < 0,0001) ab. Statistische Analysen (18,4 %, 14,7 %, 41,2 %; p < 0,0001) und der „impact factor“ nachfolgender Vollpublikationen (2,08, 3,42, 4,42; p < 0,0001) stiegen. 2016 erfolgten 11,2 % dieser Vollpublikationen „open access“. Die Rate veröffentlichter Abstracts betrug 49,1 %, 56,3 % und 52,3 % (p = 0,15).

Schlussfolgerung

Die nationale und internationale Vernetzung der urologischen Forschungsgemeinschaft nimmt zu, prospektive Studien werden weniger präsentiert. Die Rate aus DGU-Abstracts hervorgehender Vollpublikationen zeigt sich über die drei Kongresse auf hohem Niveau. Die Veröffentlichungsrate in Open-access-Journalen ist bisher gering.
Absence of the highly expressed small carbohydrate-binding protein Cgt improves the acarbose formation in Actinoplanes sp. SE50/110
Authors: Schaffert Lena , Schneiker-Bekel Susanne , Gierhake Jessica , Droste Julian , Persicke Marcus , Rosen Winfried , Pühler Alfred , Kalinowski Jörn
Published: April 2020

Actinoplanes sp. SE50/110 (ATCC 31044) is the wild type of industrial producer strains of acarbose. Acarbose has been used since the early 1990s as an inhibitor of intestinal human α-glucosidases in the medical treatment of type II diabetes mellitus. The small secreted protein Cgt, which consists of a single carbohydrate-binding module (CBM) 20-domain, was found to be highly expressed in Actinoplanes sp. SE50/110 in previous studies, but neither its function nor a possible role in the acarbose formation was explored, yet. Here, we demonstrated the starch-binding function of the Cgt protein in a binding assay. Transcription analysis showed that the cgt gene was strongly repressed in the presence of glucose or lactose. Due to this and its high abundance in the extracellular proteome of Actinoplanes, a functional role within the sugar metabolism or in the environmental stress protection was assumed. However, the gene deletion mutant ∆cgt, constructed by CRISPR/Cas9 technology, displayed no apparent phenotype in screening experiments testing for pH and osmolality stress, limited carbon source starch, and the excess of seven different sugars in liquid culture and further 97 carbon sources in the Omnilog Phenotypic Microarray System of Biolog. Therefore, a protective function as a surface protein or a function within the retainment and the utilization of carbon sources could not be experimentally validated. Remarkably, enhanced production of acarbose was determined yielding into 8–16% higher product titers when grown in maltose-containing medium.
Intraindividual comparison between 68Ga-PSMA-PET/CT and mpMRI for intraprostatic tumor delineation in patients with primary prostate cancer: a retrospective analysis in 101 patients
Authors: Spohn Simon , Jaegle Chiara , Fassbender Thomas F. , Sprave Tanja , Gkika Eleni , Nicolay Nils H. , Bock Michael , Ruf Juri , Benndorf Matthias , Gratzke Christian , Grosu Anca L. , Zamboglou Constantinos
Published: April 2020

Purpose

Accurate delineation of intraprostatic gross tumor volume (GTV) is mandatory for successful fusion biopsy guidance and focal therapy planning of prostate cancer (PCa). Multiparametric magnetic resonance imaging (mpMRI) is the current gold standard for GTV delineation; however, prostate-specific membrane antigen positron emission tomography (PSMA-PET) is emerging as a promising alternative. This study compares GTV delineation between mpMRI and 68Ga-PSMA-PET in a large number of patients using validated contouring approaches.

Methods

One hundred one patients with biopsy-proven primary PCa who underwent mpMRI and 68Ga-PSMA-PET within 3 months before primary treatment were retrospectively enrolled. Clinical parameters (age, PSA, Gleason score in biopsy) were documented. GTV based on MRI and PET images were delineated; volumes measured and laterality determined. Additionally, biopsy data from 77 patients was analyzed. Univariate and multivariate binary logistic regression analyses were performed using concordance in laterality as the endpoint.

Results

In total mpMRI and 68Ga-PSMA-PET detected 151 and 159 lesions, respectively. Median GTV-MRI (2.8 ml, 95% CI 2.31–3.38 ml) was significantly (p < 0.0001) smaller than median GTV-PET (4.9 ml, 95% CI 3.9–6.6 ml). 68Ga-PSMA-PET detected significantly more bilateral lesions than mpMRI (71 vs 57, p = 0.03). Analysis of patients with bilateral lesions in biopsy showed a significant higher concordance of laterality in 68Ga-PSMA-PET (p = 0.03). In univariate analysis, PSA level and volume of GTV-MRI had an impact on concordance in laterality (p = 0.02 and p = 0.01), whereas in multivariate analysis, only GTV-MRI volume remained significant (p = 0.04).

Conclusion

MpMRI and 68Ga-PSMA-PET detect a similar amount of PCa lesions. However, GTV-PET had approximately twice the volume (median 4.9 ml vs 2.8 ml) and detected significantly more bilateral lesions than mpMRI. Thus, 68Ga-PSMA-PET gives highly important complementary information. Since we could not find any strong evidence for parameters to guide when 68Ga-PSMA-PET is dispensable, it should be performed additionally to MRI in patients with intermediate and high-risk PCa according to D’Amico classification to improve GTV delineation.
Failure after proximal humeral fracture osteosynthesis: a one year analysis of hospital-related healthcare cost
Authors: Dauwe Jan , Walters Gregory , Holzer Lukas A. , Vanhaecht Kris , Nijs Stefaan
Published: April 2020

Purpose

The issue of rising healthcare costs and limited resources is a topic of worldwide discussion over the last several decades. We hypothesized that failure of proximal humeral fracture osteosynthesis is presumed to be an important determinant in healthcare resources and related costs. The aim of this study was to calculate the total hospital-related healthcare cost of proximal humeral fracture osteosynthesis over one  year focusing on failure.

Methods

A total of 121 patients with a proximal humeral fracture treated by angular stable osteosynthesis were included in this retrospective study. All hospital-related healthcare costs were investigated. Five main hospital-related cost categories were defined: hospitalization cost, honoraria, day care admission, materials, and pharmaceuticals.

Results

A total healthcare cost of € 1,139,448 was calculated for the whole patient group. Twelve patients needed revision surgery due to complications or fixation-related failure. This failure rate alone costed € 190,809 of the healthcare resources. In other words, failure after proximal humeral fracture osteosynthesis costed 17% of the total healthcare expenditure inone year.

Conclusion

This study demonstrates that a high amount of hospital-related healthcare resources is spent because of failure after proximal humeral fracture osteosynthesis. Further research is necessary and should investigate on how to prevent failure. This is not only in the patient’s interest, but it is also of great importance for maintaining a healthy healthcare system.
Outcomes of computer-assisted peri-acetabular osteotomy compared with conventional osteotomy in hip dysplasia
Authors: Imai Hiroshi , Kamada Tomomi , Miyawaki Joji , Maruishi Akira , Mashima Naohiko , Miura Hiromasa
Published: April 2020

Aim of the study

To compare the outcomes after computer-assisted peri-acetabular osteotomy (PAO) and conventional PAO performed for hip dysplasia (DDH).

Methods

Ninety-one patients (98 hips) were enrolled in this study. In each case, DDH was treated with either conventional PAO, in which the angle and direction of the osteotomy was determined by intra-operative X-ray examination, or with computer-assisted PAO, which used the 3D navigation system. Forty hips underwent conventional PAO and 58 hips underwent computer-assisted PAO.

Results

Japanese Orthopaedic Association hip scores improved significantly from 70.0 points pre-operatively to 90.7 points post-operatively in patients with conventional PAO, and from 74.5 points pre-operatively to 94.2 points post-operatively in patients with computer-assisted PAO. In all patients with computer-assisted PAO, the post-operative AHI and VCA angle were within the radiographic target zone. Some patients with conventional PAO had post-operative AHI and VCA angle outside of the target zone. We performed total hip arthroplasty (THA) on five of the 98 PAO hips (5.1%) after an average follow-up period of 5.4 years. None of 58 hips (0%) with computer-assisted PAO was revised.

Discussion

Computer-assisted PAO enabled intra-operative confirmation of osteotomy sites, and the position of the osteotomized bone fragment could be confirmed in real time. Adequate anterior and lateral coverage of the femoral head in patients with computer-assisted PAO resulted in no need for early conversion to THA, in contrast to conventional PAO.

Conclusion

Computer-assisted PAO not only improved accuracy and safety but also achieved sufficient anterior and lateral displacement to prevent the progression of DDH.
BRAFV600E Mutation is Associated with an Increased Risk of Papillary Thyroid Cancer Recurrence
Authors: Enumah Samuel , Fingeret Abbey , Parangi Sareh , Dias‐Santagata Dora , Sadow Peter M. , Lubitz Carrie C.
Published: April 2020

Background

Papillary thyroid carcinoma is the most common endocrine malignancy and one of the most common cancers worldwide. However, the optimal timing and frequency of surveillance to assess for recurrence remain undetermined. As the incidence of thyroid cancer continues to rise worldwide, identifying risk factors for recurrence and investigating intervals and durations of surveillance are paramount to adapt treatment and follow‐up plans to high‐risk individuals and to reduce interventions for low‐risk patients.

Methods

Our dataset included an unselected cohort of papillary thyroid carcinoma (PTC) patients who underwent a total thyroidectomy (or unilateral then completion thyroidectomy) at a single institution from 2000 to 2007. BRAF genotyping was performed on available specimens by a validated PCR‐based assay. Pathologic structural recurrence was the primary outcome. We performed univariate and multivariable analyses to identify predictors of cancer recurrence.

Results

In total, 599 patients underwent complete resection of the thyroid gland for PTC. The cohort was young (mean age 45.0 years), predominately female (n = 462, 76.9%), and median follow‐up was 10.3 years (IQR 5.4–12.2). Recurrence occurred more commonly in the BRAFV600E group (18.6 vs. 9.9%, p = 0.02). BRAF independently predicted PTC recurrence (HR 2.81, p = 0.006).

Conclusions

BRAF mutation is an independent predictor of papillary thyroid carcinoma long‐term recurrence. Understanding molecular characteristics of individual thyroid cancers may help risk‐stratify patients and direct them toward more appropriate initial care and long‐term surveillance strategies.
Deadly injuries through recoilless anti-tank weapons while military shooting practice—two case studies from Germany and Switzerland
Authors: Jellinghaus Katharina , Scherer Charlotte , Stauffer Edouard , Urban Petra , Bohnert Michael , Kneubuehl Beat P.
Published: April 2020

In this casuistry, two accidents from Germany and Switzerland are presented that happened during the shot of recoilless anti-tank weapons. In both cases, the injuries led to the death of two soldiers: A 22-year-old soldier in Germany was struck by the counter mass of a so-called Davis gun which had been fired by a comrade during a firing exercise; he died from his severe injuries, especially in the abdominal part of the body. As a peculiarity of the wound morphology, it was found to be a thick-layered, metallic, gray material in the wound cavity, which corresponded to the material of the counter mass that was ejected opposite to the shooting direction. The other case took place in Switzerland, where a 24-year-old soldier was seriously injured during an exercise with portable anti-tank rockets. At the time the shot was fired, he stood behind the launcher and was hit by the propulsion jet of the rocket motor. He died as well from his severe injuries, which were located at the chest done by the gas jet and by the very high pressure. In both cases, two different causes of death were present: massive blunt violence in the first case versus a jet of hot gases of very high speed and temperature in the second case.
Bone marrow mesenchymal stem cells combine with normothermic machine perfusion to improve rat donor liver quality—the important role of hepatic microcirculation in donation after circulatory death
Authors: Yang Liu , Cao Huan , Sun Dong , Hou Bin , Lin Ling , Shen Zhong-Yang , Song Hong-Li
Published: April 2020

Donation after circulatory death (DCD) can expand the donor pool effectively. A gap remains in outcome between DCD livers and living donor livers, warranting improved DCD liver quality and urgent resolution. Bone marrow mesenchymal stem cells (BMMSCs) can regulate immunity, participate in the anti-inflammatory response, and secrete cytokines. We investigated the effect of BMMSCs combined with normothermic machine perfusion (NMP) on DCD liver quality, and the role of microcirculation therein. Rat thoracic aortas were clipped to obtain DCD livers, and a rat NMP system was established. The DCD livers were grouped by preservation method: normal, static cold storage (SCS), NMP (P), and BMMSCs plus NMP (BP); storage time was up to 8 h. Liver function in outflow perfusate was detected by biochemical methods; liver tissue histopathology was observed by hematoxylin–eosin staining; hepatocyte ultrastructure was observed by transmission electron microscopy; hepatocyte apoptosis was detected by terminal deoxynucleotidyl transferase dUTP nick end labeling; liver microcirculation–related indicators were detected by immunofluorescence, immunohistochemistry, Western blotting, and enzyme-linked immunosorbent assay. Compared with SCS, P and BP significantly improved liver function and liver histological damage, reduced hepatocyte apoptosis, and repaired hepatocyte mitochondrial damage after 6 h in vitro. BP also significantly inhibited intrahepatic macrophage activation and intercellular adhesion, improved endothelial damage, and significantly improved endothelin 1–nitric oxide balance and microcirculation perfusion. In conclusion, BP can improve DCD liver microcirculation and quality. The mechanism may be the improvement of improve hepatic sinusoidal endothelial injury and microcirculation perfusion by inhibiting macrophage activation and intercellular adhesion.
Importance of stem photosynthesis in plant carbon allocation of Clusia minor
Authors: Kocurek Maciej , Kornas Andrzej , Wierzchnicki Ryszard , Lüttge Ulrich , Miszalski Zbigniew
Published: April 2020

Key message

Restricted access of light for stems reduced carbon acquisition there and limited the biomass growth of the roots.

Light access can affect the microatmosphere within stems, creating favourable conditions for photosynthesis. We tested the hypothesis that stem photosynthesis modifies carbon allocation within plants and also can affect root growth. To verify this hypothesis, parts ofClusia minorL.stems were covered with dark material for 8 months to block light access to stems, and then, we compared morphological traits, biomass increment, photosynthetic activity and carbon isotopic signature (δ13C) in plants with dark- and light-exposed stems.Clusia minorstems were characterized by chlorophyll presence from pith to cortex, active photosystem II and 79% re-assimilation of respired CO2. We also revealed 24-h changes in the δ13C of carbohydrates exported from leaves. Keeping stems in darkness led to a significant lowering in root biomass and shoot-to-root weight index (Iw). Moreover, reductions in stem CO2efflux and the δ13C in the roots and stems were also observed. Our results indicate that the lack of stem photosynthesis affects photosynthate flux to heterotrophic organs, such as roots, stems and probably expanding leaves.
Sensitivity of magnetic resonance tomographic angiography for detecting the degree of neurovascular compression in trigeminal neuralgia
Authors: Hao Yun-bo , Zhang Wei-jie , Chen Min-jie , Chai Ying , Zhang Wen-hao , Wei Wen-bin
Published: April 2020

Purpose

Neurovascular compression (NVC) is hypothesized to be the main pathogenic factor of trigeminal neuralgia (TN). Microvascular decompression (MVD) has become a popular surgery for TN, and the success rate depends on the degree of NVC. As the routine examination before MVD, magnetic resonance tomographic angiography (MRTA) shows high sensitivity for detecting NVC. However, there are no reports on the sensitivity of MRTA for assessing the degree of NVC.

Methods

This study aimed to evaluate the sensitivity of MRTA for determining the degree of NVC by comparing preoperative MRTA and intraoperative endoscopy findings. A total of 480 patients who suffered from TN and underwent MVD were included. Their preoperative MRTA and intraoperative endoscopy findings were reviewed. The kappa test was used to identify similarities between the MRTA and endoscopy findings.

Results

The degree of NVC on preoperative MRTA was similar to that on endoscopy (kappa = 0.770). The number of offending vessels according to preoperative MRTA was coincident with that according to endoscopy (kappa = 0.722).

Conclusion

MRTA had high sensitivity for detecting not only the presence of NVC but also the degree of NVC.
Breast sensibility in bilateral autologous breast reconstruction with unilateral sensory nerve coaptation
Authors: Bijkerk Ennie , van Kuijk Sander M. J. , Lataster Arno , van der Hulst René R. W. J. , Tuinder Stefania M. H.
Published: April 2020

Background

Patient satisfaction after breast reconstruction is dependent on both esthetics and functional outcomes. In an attempt to improve breast sensibility, a sensory nerve coaptation can be performed. The aim of this study was to objectify the sensory recovery in patients who, by chance, underwent bilateral autologous breast reconstruction with one innervated and one non-innervated flap. It must be emphasized that the intention was to coaptate the sensory nerves on both sides.

Methods

The cohort study was carried out in the Maastricht University Medical Center between August 2016 and August 2018. Patients were eligible if they underwent bilateral non-complex, autologous breast reconstruction with unilateral sensory nerve coaptation and underwent sensory measurements using Semmes–Weinstein monofilaments at 12 months of follow-up. Sensory outcomes were compared using t tests.

Results

A total of 15 patients were included, all contributing one innervated and one non-innervated flap. All patients had a follow-up of at least 12 months, but were measured at different follow-up points with a mean follow-up of 19 months. Sensory nerve coaptation was significantly associated with better sensation in the innervated breasts and showed better sensory recovery over time, compared to non-innervated breasts. Moreover, the protective sensation of the skin can be restored by sensory nerve coaptation.

Conclusions

The study demonstrated that sensory nerve coaptation leads to better sensation in the autologous reconstructed breast in patients who underwent bilateral breast reconstruction and, by chance, received unilateral sensory nerve coaptation.
ETM: Enrichment by topic modeling for automated clinical sentence classification to detect patients’ disease history
Authors: Bagheri Ayoub , Sammani Arjan , van der Heijden Peter G. M. , Asselbergs Folkert W. , Oberski Daniel L.
Published: April 2020

Given the rapid rate at which text data are being digitally gathered in the medical domain, there is growing need for automated tools that can analyze clinical notes and classify their sentences in electronic health records (EHRs). This study uses EHR texts to detect patients’ disease history from clinical sentences. However, in EHRs, sentences are less topic-focused and shorter than that in general domain, which leads to the sparsity of co-occurrence patterns and the lack of semantic features. To tackle this challenge, current approaches for clinical sentence classification are dependent on external information to improve classification performance. However, this is implausible owing to a lack of universal medical dictionaries. This study proposes the ETM (enrichment by topic modeling) algorithm, based on latent Dirichlet allocation, to smoothen the semantic representations of short sentences. The ETM enriches text representation by incorporating probability distributions generated by an unsupervised algorithm into it. It considers the length of the original texts to enhance representation by using an internal knowledge acquisition procedure. When it comes to clinical predictive modeling, interpretability improves the acceptance of the model. Thus, for clinical sentence classification, the ETM approach employs an initial TFiDF (term frequency inverse document frequency) representation, where we use the support vector machine and neural network algorithms for the classification task. We conducted three sets of experiments on a data set consisting of clinical cardiovascular notes from the Netherlands to test the sentence classification performance of the proposed method in comparison with prevalent approaches. The results show that the proposed ETM approach outperformed state-of-the-art baselines.
Predicting disruptions and their passenger delay impacts for public transport stops
Authors: Yap Menno , Cats Oded
Published: April 2020

Disruptions in public transport can have major implications for passengers and service providers. Our study objective is to develop a generic approach to predict how often different disruption types occur at different stations of a public transport network, and to predict the impact related to these disruptions as measured in terms of passenger delays. We propose a supervised learning approach to perform these predictions, as this allows for predictions for individual stations for each time period, without the requirement of having sufficient empirical disruption observations available for each location and time period. This approach also enables a fast prediction of disruption impacts for a large number of disruption instances, hence addressing the computational challenges that rise when typical public transport assignment or simulation models would be used for real-world public transport networks. To improve transferability of our study results, we cluster stations based on their contribution to network vulnerability using unsupervised learning. This supports public transport agencies to apply the appropriate type of measure aimed to reduce disruptions or to mitigate disruption impacts for each station type. Applied to the Washington metro network, we predict a yearly passenger delay of 5.9 million hours for the total metro network. Based on the clustering, five different types of station are distinguished. Stations with high train frequencies and high passenger volumes located at central trunk sections of the network show to be most critical, along with start/terminal and transfer stations. Intermediate stations located at branches of a line are least critical.
Hyperbolic Green Function Estimates
Authors: Ryznar M. , Serafin G. , Żak T.
Published: April 2020

For a hyperbolic Brownian motion in the hyperbolic space $\mathbb {H}^{n}, n\ge 3$

ℍ

n

,
n
≥
3
, we prove a representation of a Green function and a Poisson kernel for bounded and smooth sets in terms of the corresponding objects for an ordinary Euclidean Brownian motion and a conditional gauge functional. Using this representation we prove bounds for the Green functions and Poisson kernels for smooth sets. In particular, we provide a two sided sharp estimate of the Green function of a hyperbolic ball of any radius. By usual isomorphism argument the same estimate holds in any other model of a real hyperbolic space.
Large Deviation Principle for Fractional Brownian Motion with Respect to Capacity
Authors: Li Jiawei , Qian Zhongmin
Published: April 2020

We show that the fractional Brownian motion (fBM) defined via the Volterra integral representation with Hurst parameter $H\geq \frac {1}{2}$
H
≥

1

2

is a quasi-surely defined Wiener functional on the classical Wiener space, and we establish the large deviation principle (LDP) for such an fBM with respect to (p,r)-capacity on the classical Wiener space in Malliavin’s sense.
Agreement Among Paper and Electronic Modes of the EQ-5D-5L
Authors:   the ePRO Consortium, Lundy J. Jason , Coons Stephen Joel , Flood Emuella , Patel Mira J.
Published: April 2020

Introduction

While the EQ-5D-5L has been migrated to several electronic modes, evidence supporting the measurement equivalence of the original paper-based instrument to the electronic modes is limited.

Objectives

This study was designed to comprehensively examine the equivalence of the paper and electronic modes (i.e., handheld, tablet, interactive voice response [IVR], and web).

Methods

As part of the foundational work for this study, the test–retest reliability of the paper-based, UK English format of the EQ-5D-5L was assessed using a single-group, single-visit, two-period, repeated-measures design. To compare paper and electronic modes, three independent samples were recruited into a three-period crossover study. Each participant was assigned to one of six groups to account for order effects. Descriptive statistics, mean differences (i.e., split-plot analysis of variance [ANOVA]), and intraclass correlation coefficients (ICCs) were calculated.

Results

The test–retest results showed mean differences near zero and ICC values > 0.90 for both the index and the EQ VAS scores. For the electronic comparisons, mean difference confidence intervals (CIs) for the EQ-5D index scores and EQ VAS scores reflected equivalence of the means across all modes, as the CIs were wholly contained inside the equivalence interval. Further, the ICC 95% lower CIs for the index and EQ VAS scores showed values above the thresholds for denoting equivalence across all comparisons in each sample. No significant mode-by-order interactions were present in any ANOVA model.

Conclusions

Overall, our comparisons of the paper, screen-based, and phone-based formats of the EQ-5D-5L provided substantial evidence to support the measurement equivalence of these modes of data collection.
Stress Distribution of the Tibiofemoral Joint in a Healthy Versus Osteoarthritis Knee Model Using Image-Based Three-Dimensional Finite Element Analysis
Authors: Thienkarochanakul Kulchamai , Javadi Akbar A. , Akrami Mohammad , Charnley Joseph Robert , Benattayallah Abdelmalek
Published: April 2020

Purpose

Osteoarthritis (OA) is one of the most common pathological conditions to affect the human knee joint. In order to analyse the biomechanical causes and effects of OA, accessing the internal structures such as cartilage or the menisci directly is not possible. Therefore, computational models can be used to study the effects of OA on the stresses and strains in the joint and the susceptibility to deformations within the knee joint.

Methods

In this study, a three-dimensional finite element model of a knee complex was constructed using MRI scans. Medical image processing software was used to create accurate geometries of bones, articular cartilages, menisci, patella, patella tendon and all the relevant ligaments. Finally, a 3D model of OA knee joint was created with a few changes to the cartilage. The cartilage was thinned, and the material properties were altered in order to simulate OA in the joint. 3D gait measurements were analysed to define loading and boundary conditions.

Results

The developed model analysed the possibility of osteoarthritis. It was shown that the medial regions of cartilage layers and menisci in the knee joint sustain higher values of stress for OA conditions, while for the healthy knee, the stresses are more evenly distributed across the cartilage in the medial and lateral regions.

Conclusion

The results suggest that any treatment for knee osteoarthritis should focus more on the medial region of the tibiofemoral cartilage in order not to cause degradation.