bluuebunny/crossref_metadata_2025 huggingface dataset:
Finding Oil Is Really Hard, Making Money Even Harder
Authors: Rassenfoss Stephen
Published: April 2020

As ExxonMobil announced discovery after discovery offshore Guyana, it sounded easy.

Beginning with the Liza-1 discovery well, the giant oil company announced 16 successful exploration wells. There were four or five successful wells per year from 2017 through 2019, ending with news of its 16th find in January—pushing its estimated oil in the ground to 8 billion bbl.

For those who found the oil, the evidence they used to pick those drilling targets was hardly clear cut, and it took more than 90 years to get to that point.

“In retrospect it wasn’t obvious, and that was why it took so long,” said Maria Guedez, exploration manager for Guyana and Suriname for ExxonMobil.

While a timeline of the Guyana project includes “initiated oil and gas exploration activities in Guyana in 2008,” the story ExxonMobil presented at the recent AAPG SuperBasins 2020 conference covered exploration starts and stops going back to 1928 by the company’s predecessor, Standard Oil Co.

One slide showed a typewritten report from the 1930s noting the test wells were “salted,” giving the impression of a rich reservoir, even though “there is no evidence of oil.”

But ExxonMobil and other oil companies kept coming back. There were dry holes in the 1970s off nearby Suriname—the eastern extension of the play. They saw some positive signs, but the source rock was judged to be not mature enough to fill the conventional oil deposits needed to justify development.

Finally, in the 1990s ExxonMobil geoscientists looking for new exploration opportunities used what had been learned, plus advanced seismic imaging, a better understanding of the movements of tectonic plates, and some simple analysis to outline a plan that ultimately led to the discovery.

Guedez showed a picture of a simple chart evaluating the pros and cons of the basin with handwritten notes, and a geologic cross section in which a geologist hand-counted layers in shallow and deep waters to identify the elements of a productive play.

“New data and technologies often trigger key insights, but you need to ask the right questions,” Guedez said. “Sometimes you don’t need massive amounts of data to make a difference.”

Executing the concept required developing the ability to drill wells in water 8,000 ft deep and high resolution to seismic that allowed interpreters to see the subtle signs of hydrocarbon-rich stratigraphic traps.

“The places where you have structure, it was hard [to spot anomalies]. Stratigraphic traps are normally just really difficult to explore. It was going to be difficult to hit without having some sort of high-resolution 3D seismic,” Guedez said.

These anomalies are never easy to spot, but she said that compared to her experience in offshore Africa, signs of traps off Guyana were “remarkably subtle.”

So far, they have hit on 89% of the wells drilled. “Once the eyes of the team got fine-tuned to that, they did a good job spotting them,” Guedez said.
Technology Focus: Deepwater Fields (May 2020)
Authors: Iversen Morten
Published: April 2020

The collapse in upstream investment has wreaked havoc on the deepwater market, leading to rationalization and consolidation. Many of the operators and rig/vessel owners left have been clinging on by their fingertips. The number of rigs operating under contract is still at slump levels of less than 200, down by plus minus 30% from the heyday.

Prophets of doom have argued that there will be no cyclical upturn this time, that conventional offshore oil and gas developments, with the odd exception, have been squeezed out of the cost curve by the rise of tight oil. Yet there are signs of recovery that might breathe life back into the sector.

Deepwater is the only segment expected to grow above 5% next year, spelling a positive uplift for the industry in general.

On a regional level, only Africa, Russia, and South America are expected to see growth or flat development in investments next year, with key players such as Mozambique, Libya, and Mauritania pushing the largest continent’s growth to the highest worldwide at greater than 10%. Unsurprisingly, Brazil, thanks to the Marlim and Mero projects, likely will prop South America up to a predicted almost 6% of growth next year.

However, development of deepwater projects presents a series of challenges, even for the most experienced players. While the industry has gone through a long learning curve and technology advancements, which have helped drive down the costs of deepwater production, players still face a myriad of challenges resulting in lengthy development times for deepwater projects. Therefore, the associated offshore-project risks are expected to hinder the growth of the market studied. The other third of offshore wells drilled are exploration.

There are signs that the rig market will tighten. More brand-new high-spec Generation VI and VII rigs are coming onto the market, but these are replacing retirals or forcing lower-spec rigs into cold stack; net available supply looks set to stay flat. Usage rates for Generation VI and VII rigs could climb from 70% currently to greater than 90% inside 4 years.

Finally, pricing power is set for a return. Rates for new contracts are languishing near the lows reached in 2017.
A Look at the Aasta Hansteen Norwegian Deepwater Spar FPSO
Authors: Feder Judy
Published: April 2020

This article, written by JPT Technology Editor Judy Feder, contains highlights of paper OTC 29222, “Aasta Hansteen Spar FPSO—A Pioneer in Norwegian Deepwater,” by Torolf Christensen, Stig Arne Witsøe, and Helge Hagen, Equinor, et al., prepared for the 2019 Offshore Technology Conference, Houston, 6–9 May. The paper has not been peer reviewed. Copyright 2019 Offshore Technology Conference. Reproduced by permission.

The complete paper describes the overall project execution of the Aasta Hansteen field development on the Norwegian Continental Shelf (NCS) north of the Arctic Circle. It is the deepest field yet developed on the NCS in 1300 m of water. In a harsh environment, with no other offshore installations in the area, the field is being developed with a spar floating, production, storage, and offloading (FPSO) structure using steel catenary risers and polyester mooring lines.

Business Case

The field is 300 km off the coast of northern Norway and 140 km from the nearest offshore installation. The field was discovered in 1997, with investment decision taken in December 2012 and production begun in December 2018. Total investment in facilities and infrastructure (including pipeline and modifications at Nyhamna) is approximately $7 billion. Equinor operates the field on behalf of its partners, Wintershall (24%), OMV (15%), and ConocoPhillips (10%).

The field’s rich gas is exported through a 482-km-long, 36-in. pipeline to an on-shore processing plant at Nyhamna for further processing to sales gas. From there, the gas is exported to the European market. Stabilized condensate is stored in the spar FPSO and offloaded to shuttle tankers.

The development of the field with the platform facilities and the Polarled pipeline was a strategic decision to open a new gas region in the Norwegian Sea and connect it to Europe by the NCS gas infrastructure. The development solution will serve as a gas hub enabling tie-in of future production from discoveries and prospects in the area. The objective of the Aasta Hansteen development is to maximize the recovery of the Aasta Hansteen reserves and to achieve maximum value creation in the value chain.

Estimated recoverable reserves are 51 billion scm rich gas and 0.6 million scm condensate. The reserves consist of three separate discoveries—Luva, Haklang, and Snefrid Sør—all in the Nise formation and within the same production license.

The development of Aasta Hansteen has been executed as a parallel development of the Polarled pipeline project to establish a new gas transport pipeline from Aasta Hansteen to Nyhamna. The pipeline has several tie-in points from Aasta Hansteen to the Nyhamna gas-processing plant. Snefrid Nord, the first subsea tieback development, is already being developed. The complete paper provides a brief description of the Polarled project.
Genome-wide identification and comparison of differentially expressed profiles of miRNAs and lncRNAs with associated ceRNA networks in the gonads of Chinese soft-shelled turtle, Pelodiscus sinensis
Authors: Ma Xiao , Cen Shuangshuang , Wang Luming , Zhang Chao , Wu Limin , Tian Xue , Wu Qisheng , Li Xuejun , Wang Xiaoqing
Published: April 2020

Background: The gonad is the major factor affecting animal reproduction. The regulatory mechanism of the expression of protein-coding genes involved in reproduction still remains to be elucidated. Increasing evidence has shown that ncRNAs play key regulatory roles in gene expression in many life processes. The roles of microRNAs (miRNAs) and long non-coding RNAs (lncRNAs) in reproduction have been investigated in some species. However, the regulatory patterns of miRNA and lncRNA in the sex biased expression of protein coding genes remains to be elucidated. In this study, we performed an integrated analysis of miRNA, messenger RNA (mRNA), and lncRNA expression profiles to explore their regulatory patterns in the female ovary and male testis of Pelodiscus sinensis.Results: We identified 10 446 mature miRNAs, 20 414 mRNAs and 28 500 lncRNAs in the ovaries and testes, and 633 miRNAs, 11 319 mRNAs, and 10 495 lncRNAs showed differential expression. A total of 2 814 target genes were identified for miRNAs. The predicted target genes of these differentially expressed (DE) miRNAs and lncRNAs included abundant genes related to reproductive regulation. Furthermore, we found that 189 DEmiRNAs and 5 408 DElncRNAs showed sex-specific expression. Of these, 3 DEmiRNAs and 917 DElncRNAs were testis-specific, and 186 DEmiRNAs and 4 491 DElncRNAs were ovary-specific. We further constructed complete endogenous lncRNA-miRNA-mRNA networks using bioinformatics, including 103 DEmiRNAs, 636 DEmRNAs, and 1 622 DElncRNAs. The target genes for the differentially expressed miRNAs and lncRNAs included abundant genes involved in gonadal development, including Wt1, Creb3l2, Gata4, Wnt2, Nr5a1, Hsd17, Igf2r, H2afz, Lin52, Trim71, Zar1, and Jazf1.Conclusions: In animals, miRNA and lncRNA as master regulators regulate reproductive processes by controlling the expression of mRNAs. Considering their importance, the identified miRNAs, lncRNAs, and their targets in P. sinensis might be useful for studying the molecular processes involved in sexual reproduction and genome editing to produce higher quality aquaculture animals. A thorough understanding of ncRNA-based cellular regulatory networks will aid in the improvement of P. sinensis reproductive traits for aquaculture.
Survival and prognostic factor analyses in malignant giant cell tumour of bone
Authors: Zhang Jin , Wang Xin , Lin Feng , Xu Guijun , Wu Haixiao , Duan Jincai , Mao Min , Zhang Chao
Published: May 2020

Background: The characteristics and survival of patients with malignant giant cell tumour of bone (GCTB) have not been investigated thoroughly due to the rarity of the disease. We evaluated these factors in a large cohort in the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database.Methods: Data from patients who were diagnosed with malignant GCTB from 1975 to 2016 were extracted from the SEER database. The overall survival (OS) was calculated by Kaplan–Meier analysis, and intergroup differences were tested by the log-rank test. Univariate and multivariate Cox proportional hazard regression analyses were conducted to identify the independent survival factors.Results: A total of 325 patients with malignant GCTB were included. The overall 1-, 5-, and 10-year survival rates were 94.3% (95% CI: 91.7-96.8), 82.3% (95% CI: 77.9-86.6), and 80.1% (95% CI: 75.4-84.7), respectively. A potential non-linear J-shaped dose–response relationship between the age or diagnosis year and survival were found. Multivariate Cox regression showed poor survival in patients with age from 35 to 60 years (hazard ratio (HR) =9.99, 95% CI: 1.34-74.80, P=0.025), age older than 60 years (HR=62.03, 95% CI: 7.94-484.38, P<0.001), with stage T2 disease (HR=4.85, 95% CI: 1.52-15.47, P=0.008), with stage T3 disease (HR=6.09, 95% CI: 1.03-36.23, P=0.047), and with distant tumours (HR=2.76, 95% CI: 1.14-6.65, P=0.024), and extraskeletal sites (HR=3.33, 95% CI: 1.02-10.85, P=0.046).Conclusions: This large population-based series described the clinical characteristics of malignant GCTB. Patients with stage T2/3disease, distant disease and extra-skeletal sites had more odds to be with worse survival. The elder age than 34 years had a gradually increased risk for survival.
Primary surgery versus no surgery in synchronous metastatic breast cancer: Patient-reported Quality-of-Life outcomes of the prospective randomized multicenter ABCSG-28 Posytive Trial
Authors: Bjelic-Radisic Vesna , Fitzal Florian , Knauer Michael , Steger Guenther , Egle Daniel , Greil Richard , Schrenk Peter , Balic Marija , Singer Christian , Exner Ruth , Soelkner Lidija , Gnant Michael
Published: April 2020

Background: The ABCSG-28 trial compared primary surgery followed by systemic therapy versus primary systemic therapy without surgery in patients with de novo stage IV BC. The present report describes QoL results of this trial. Methods: 90 patients with primary operable MBC were randomised to surgery of the primary tumor followed by systemic therapy or to primary systemic therapy without surgery. QoL analyses covering the results at baseline, 6,12,18 and 24 months follow up of 79 (88%) patients, was assessed with the EORTC QLQ-C30 and QLQ-BR23 questionnaires. Results: There were no statistically significant differences in any of the scales of the QLQ-C30 and QLQ-BR23 questionnaires between the two groups over the time. Baseline global health status and physical functioning were predictors for OS (patients with a higher score lived longer (p=0.0250, p=0.0225; p=0.0355, p=0.0355)). Global health status, social functioning scale, breast symptoms and future perspective were predictors for longer TTPd (p=0.0244; p=0.0140, p=0.020; p=0.0438, p=0.0123). Patients in both arms reported significant improvement on the emotional functioning scale. Cognitive functioning decreased over time in both groups. Younger women had clinically relevant better physical and sexual functioning scores (p=0.039 and 0.024). Conclusion: Primary surgery does not improve nor alter QoL of patients with de novo stage IV BC. Global health status and physical functioning were predictors for OS and could be use as additional marker for prediction of OS and TTTd in patients with de novo stage IV BC. Trial registration: The trial is listed on clinicaltrial.gov (NCT01015625)
Development of the Prototype Concise Safe Systems Checklist Tool for General Practice
Authors: Litchfield Ian J , Spencer Rachel , Bell Brian , Avery Anthony , Perryman Katherine , Marsden Kate , Greenfield Sheila , Campbell Stephen
Published: April 2020

Background In the course of producing a patient safety toolkit for primary care, we identified the need for a concise safe-systems checklist designed to address areas of patient safety which are under-represented in mandatory requirements and existing tools. This paper describes the development of a prototype checklist designed to be used in busy general practice environments to provide an overview of key patient safety related processes and prompt practice wide-discussion. Methods An extensive narrative review and a survey of world-wide general practice organisations were used to identify existing primary care patient safety issues and tools. A RAND panel of international experts rated the results, summarising the findings for importance and relevance. The checklist was created to include areas that are not part of established patient safety tools or mandatory and legal requirements. Four main themes were identified: information flow, practice safety information, prescribing, and use of IT systems from which a 13 item checklist was trialled in 16 practices resulting in a nine item prototype checklist, which was tested in eight practices. Qualitative data on the utility and usability of the prototype was collected through a series of semi-structured interviews.Results In testing the prototype four of nine items on the checklist were achieved by all eight practices. Three items were achieved by seven of eight practices and two items by six of eight practices. Participants welcomed the brevity and ease of use of the prototype, that it might be used within time scales at their discretion and its ability to engage a range of practice staff in relevant discussions on the safety of existing processes. The items relating to prescribing safety were considered particularly useful. Conclusions As a result of this work the concise patient safety checklist tool, specifically designed for general practice, has now been made available as part of an online Patient Safety Toolkit hosted by the Royal College of General Practitioners. Senior practice staff such as practice managers and GP partners should find it a useful tool to understand the safety of less explored yet important safety processes within the practice.
A univariable and multivariable analysis of right censored time-to-event data based on restricted mean survival time: A combination with traditional survival methods.
Authors: Huang Qiao , Lyv Jun , Li Bing-hui , Ma Lin-lu , Deng Tong , Zeng Xian-Tao
Published: April 2020

Background Hazard ratio is considered as an appropriate effect measure of time-to-event data. However, hazard ratio is only valid when proportional hazards (PH) assumption is met. The use of the restricted mean survival time (RMST) is proposed and recommended without limitation of PH assumption. Method 4405 osteosarcomas were captured from Surveillance, Epidemiology and End Results Program Database. Traditional survival analyses and RMST-based analyses were integrated into a flowchart and applied for univariable and multivariable analyses, using hazard ratio (HR) and difference in RMST (survival time lost or gain, STL or STG) as effect measures. The relationship between difference in RMST and HR were explored when PH assumption was and was not met, respectively. Results In group comparison and univariable regressions, using difference in RMST calculated by Kaplan-Meier methods as reference, pseudo-value regressions (R2=0.99) and inverse probability of censoring probability (IPCW) regressions with group-specific weights (R2=1.00) provided more consistent estimation on difference in RMST than IPCW with individual weights (R2=0.09). In multivariable analysis, age (HR:1.03, STL: 3.86 months), diagnosis in 1970~1980s (HR:1.39 STL:27.49 months), metastasis (HR:4.47, STL: 202 months), surgery (HR:0.58, SLG:35.55 months) and radiation (HR:1.46, SLT:44.65 months) met PH assumption and were main independent factors for overall survival. In both univariable and multivariable variables, a robust negative logarithmic linear relationship between HRs estimated by Cox regression and differences in RMST by pseudo-value regressions was only observed when PH assumption was hold. Conclusion The flowchart will be intuitive and helpful to instruct appropriate use of RMST based and traditional methods. RMST-based methods provided an absolute effect measure to inspect effects of covariates on survival time and promote evidence communication with HR. Difference in RMST should be reported with hazard ratio routinely.
Delta Neutrophil Index as a Predictive and Prognostic Factor for Candidemia patients: A Matched Case-Control Study
Authors: Park So Yeon , LEE JIN SEO , Oh Jihyu , Park Ji-Young
Published: April 2020

Background: Delayed antifungal therapy for candidemia leads to increased mortality. Differentiating bacterial infection from candidemia in systemic inflammatory response syndrome (SIRS) patients is complex and difficult. The Delta Neutrophil Index (DNI) has recently been considered a new factor to distinguish infections from non-infections and predict the severity of sepsis. We aimed to assess if the DNI can predict and provide a prognosis for candidemia in SIRS patients. Methods: A matched case-control study was conducted from July 2016 to June 2017 at Kangdong Sacred Heart Hospital. Among patients with a comorbidity of SIRS, those with candidemia were classified as the case group, whereas those with negative blood culture results were classified as the control group. The matching conditions included age, blood culture date, and SIRS onset location. Multivariate logistic regression was performed to evaluate DNI as a predictive and prognostic factor for candidemia.Results: The 140 included patients were assigned to each group in a 1:1 ratio. The DNI_D1 values measured on the blood culture date were higher in the case group than in the control group (p<0.001). The results of multivariate analyses confirmed DNI_D1 (odds ratio [ORs] 2.138, 95% confidential interval [CI] 1.421-3.217, p<0.001) and Candida colonization as predictive factors for candidemia. The cutoff value of DNI for predicting candidemia was 2.75%. The area under the curve for the DNI value was 0.804 (95% CI, 0.719-0.890, p<0.001), with a sensitivity and specificity of 72.9% and 78.6%, respectively. Analysis of 14-day mortality in patients with candidemia showed significantly higher DNI_D1 and DNI_48 in the non-survivor group than in the survivor group.Conclusions: DNI was identified as a predictive factor for candidemia in patients with SIRS and a prognostic factor in predicting 14-day mortality in candidemia patients. DNI, along with clinical patient characteristics, was useful in determining the occurrence of candidemia in patients with SIRS.
Defining Clusters of Young Autistic and Typically-Developing Children Based on Loudness-Dependent Auditory Electrophysiological Responses
Authors: Dwyer Patrick , Wang Xiaodong , De Meo-Monteil Rosanna , Hsieh Fushing , Saron Clifford D. , Rivera Susan M.
Published: April 2020

Background: Autistic individuals exhibit atypical patterns of sensory processing that are known to be related to quality of life, but which are also highly heterogeneous. Previous investigations of this heterogeneity have ordinarily used questionnaires and have rarely investigated sensory processing in Typical Development (TD) alongside Autism Spectrum Development (ASD). Methods: The present study used hierarchical clustering in a large sample to identify subgroups of young autistic and typically-developing children based the normalized global field power (GFP) of their event-related potentials (ERPs) to auditory stimuli of four different loudness intensities (50, 60, 70, 80 dB SPL): that is, based on an index of the relative strengths of their neural responses across these loudness conditions. Results: Four clusters of participants were defined. Normalized GFP responses to sounds of different intensities differed strongly across clusters. There was considerable overlap in cluster assignments of autistic and typically-developing participants, but autistic participants were more likely to display a pattern of relatively linear increases in response strength accompanied by a disproportionately strong response to 70 dB stimuli. Autistic participants displaying this pattern trended towards obtaining higher scores on assessments of cognitive abilities. There was also a trend for typically-developing participants to disproportionately fall into a cluster characterized by disproportionately/nonlinearly strong 60 dB responses. Greater auditory distractibility was reported among autistic participants in a cluster characterized by disproportionately strong responses to the loudest (80 dB) sounds, and furthermore, relatively strong responses to loud sounds were correlated with both auditory distractibility and noise distress. This appears to provide evidence of coinciding behavioural and neural sensory atypicalities. Limitations : Replication may be needed to verify exploratory results. This analysis may ignore some variability related to classical ERP latencies and topographies. The sensory questionnaire employed was not specifically designed for use in autism. Variability in sensory responses unrelated to loudness is ignored, leaving much room for additional research. Conclusions: Taken together, these data demonstrate the broader benefits of using electrophysiology to explore individual differences. They illuminate different neural response patterns and suggest relationships between sensory neural responses and sensory behaviours, cognitive abilities, and autism diagnostic status.
Clinical outcomes of early gastric cardiac cancer treated with endoscopic submucosal dissection in patients with different indications
Authors: Fan Ting , Sun Qi , Cao Shouli , Fan Xiangshan , Huang Qin , Zhang Shu , Lv Ying , Zhang Xiaoqi , Ling Tingsheng , Wang Lei , Xu Guifang , Zou Xiaoping
Published: April 2020

Background: Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment for early gastric cardiac cancer (EGCC). Here, we investigate the clinical outcomes of the EGCC patients who underwent ESD in different indications. Methods: From January 2011 to October 2019, we enrolled 502 EGCC lesions from 495 patients which were resected by ESD at our center. We retrospectively analyzed the short-term and long-term clinical outcomes among different indication groups. Results: The number of the patients in the absolute indication (AI), expanded indication (EI) and beyond the expanded indication (BEI) groups was 265, 137 and 93, respectively. The en bloc resection rate was 100%, 100% and 98.9% ( P =0.185). The complete resection rate was 99.3%, 98.5% and 74.5%, respectively ( P <0.001). During a median follow-up of 48.1 months, the lymph node metastasis rate was 0%, 0% and 2.3% ( P <0.001). The distant metastasis rate was 0.4%, 0% and 2.3% ( P =0.150). The five-year disease-specific survival rate in the BEI group was 96.6% ( P =0.016), compared to 99.6% in the AI group and 100% in the EI group. Conclusion: The efficacy for ESD patients in EI group was almost equal to the AI group. Patients in the BEI group showed generally favorable clinical outcomes and needed to be carefully checked after ESD. ESD may be an optional treatment for patients unsuitable for gastrectomy.
Comparison of Antimicrobial Resistance in Patients with Obstructive Pyelonephritis Associated with Ureteral Stones and Uncomplicated Pyelonephritis
Authors: Oh Ji-sun , Ahn Su Joa , Won Jeongyeon , Han Jung , Eom Joong Sik , Chung Wookyung , Cho Yong Kyun , Jang Young-Rock
Published: April 2020

Background

This study aimed to investigate the clinical outcomes and antibiotic susceptibilities of causative microorganisms in patients with obstructive pyelonephritis associated with ureteral stones (OPU).
Methods

This retrospective cohort study included female patients diagnosed with community-acquired acute pyelonephritis (APN) at a tertiary care hospital from 2008 to 2017. Cases of APN associated with obstruction of the upper urinary tract due to the presence of ureteral stones and cases of APN without complications were compared. Propensity score matching was used to adjust for heterogeneity within each group.
Results

Of the 588 female patients with community-acquired APN, 107 patients were diagnosed with OPU and 481 patients were diagnosed with uncomplicated APN. Propensity score matching revealed that Enterobacteriaceae strains isolated from OPU cases were more resistant to fluoroquinolones (51.9% vs. 16.0%, p < 0.001). Extended-spectrum β-lactamase was detected in 22.2% and 21.0% of the Enterobacteriaceae strains isolated from OPU cases and uncomplicated APN cases, respectively (p = 1.000). The treatment failure rate was similar in the OPU and uncomplicated APN groups (16.0% vs. 21.0%, p = 0.545).
Conclusions

Antibiotic treatment for patients with OPU may be empirically selected in accordance with the treatment protocol for general pyelonephritis. Clinicians should exercise caution before prescribing fluoroquinolones for the treatment of OPU.
Estimation of the Ideal Correction of Lumbar Lordosis to Prevent Reoperation for Symptomatic Adjacent Segment Disease After Lumbar Fusion in Older People
Authors: Wang Shan-Jin , Zhang Shu-Bao , Yi Yu-Yang , Xu Hao-Wei , Wu De-Sheng
Published: April 2020

Background
Symptomatic adjacent segment disease (ASDis) is a major complication following spinal fusion. Sagittal spinopelvic imbalance may contribute to the development of ASDis. However, the exact ideal correction of LL is unknown for different ages of people to prevent ASDis. The purpose of this study was to estimate the ideal correction of lumbar lordosis (LL) required to prevent symptomatic ASDis requiring revision surgery in patients of various ages, and to determine the radiographic risk factors for ASDis.
Method
468 patients who underwent lumbar fusion between January 2014 and December 2016, were enrolled in the present study. The patients were classified into the ASDis and N-ASD group. These two matched groups were compared regarding surgery-related factors and radiographic features. Multivariate logistic regression analysis was used to evaluate the risk factors for ASDis.
Results
Sixty-two patients (13.25%) underwent reoperation for ASDis during a mean follow-up duration of 38.07 months. Receiver operating characteristic curve analysis showed that the postoperative LL - preoperative LL (△LL) cutoff value was 11.7°for the development of ASDis. Logistic regression analysis revealed that the risk factors for symptomatic ASDis were a smaller LL angle, △LL > 12°, and PI-LL > 10° (p < 0.05). For patients > 60 years, the incidence of ASDis was higher in patients with a LL correction of ≥ 10° and a lumbar-pelvic mismatch (PI-LL) of > 20°.
Conclusions
The significant predictors of the occurrence of ASD were a smaller LL angle, △LL > 12°, and PI-LL > 10°. However, in patients older than 60 years, the incidence of ASD after lumbar fusion was higher in those with a LL correction of ≥ 10° and PI-LL of > 20°. More attention should be paid to patient age and the angle of correction of LL before lumbar fusion.
Predictors for the development of preoperative oxygenation impairment in acute aortic dissection in hypertensive patients
Authors: Zhao Xuemin , Bie Mengjun
Published: April 2020

Background
Acute aortic dissection (AAD) is an acute life-threatening cardiovascular disease, which is frequently complicated with oxygenation impairment (OI).
Objective
We aim to investigate predictors of the development of OI in the patients with AAD.
Methods
We retrospectively collected clinical data of AAD in hypertensive patients from July 2012 to March 2020. The patients included in this study were divided into OI (+) group (oxygenation index ≤ 200) and OI (-) group (oxygenation index > 200). Both groups were compared according to demographic and clinical characteristics, and laboratory findings. Characteristics of hypertension in the patients with AAD were described. Predictors for the development of OI were assessed. And cutoff values were determined by receiver operating characteristics (ROC) curve.
Results
A total of 208 patients were included in this study and the incidence of OI was 32.2%. In OI (+) group, patients had significantly higher peak body temperature (37.85 ± 0.60 vs 37.64 ± 0.44℃, P = .005), higher levels of CRP (42.70 ± 28.27 vs 13.90 ± 18.70 mg/L, P = .000) and procalcitonin (1.07 ± 3.92 vs 0.31 ± 0.77ug/L, P = .027), and lower levels of albumin (34.21 ± 5.65 vs 37.73 ± 4.70 g/L, P = .000). Spearman’s rank correlation test showed that the minimum oxygenation index was positively correlated with albumin, and was negatively correlated with the peak body temperature, serum CRP, procalcitonin, BNP and troponin. The stepwise multiple linear regression analysis showed that the peak body temperature, serum CRP and albumin were independently associated with development of OI. An optimal cutoff value for CRP for predicting OI was ≥ 9.20 mg/L, with a sensitivity of 91.0% and a specificity of 61.0%.
Conclusions
The peak body temperature, serum CRP and albumin were independent predictors of OI development in the patients with AAD. The serum CRP on admission ≥ 9.20 mg/L might be a valuable and reliable indicator in predicting the development of OI.
Tubeless versus common minimally invasive percutaneous nephrolithotomy for renal stones under local anesthesia: analysis of clinical outcomes
Authors: Qu GenYi , Xu Yong , Tang Cheng , Liu JinGe , Nie HaiBo , Jiang XiuFang , Huang WenLin , Yang Guang
Published: April 2020

Background: To compare the clinical outcomes of tubeless minimally invasive percutaneous nephrolithotomy（mPCNL）and common minimally invasive percutaneous nephrolithotomy under local anesthesia, and to explore the feasibility, safety and clinical efficacy of tubeless mPCNL under local anesthesia. Methods: Patients with PCNL who underwent local anesthesia from January 1, 2018 to November 30, 2018. The patients were divided into Group 1 (tubeless mPCNL: indwelling double J tube, no indwelling nephrostomy tube) and group 2 (common mPCNL: indwelling double J tube and nephrostomy tube). The intraoperative and postoperative parameters of the two groups were compared, including operation time, average postoperative hospital stay, puncture position, postoperative hemoglobin decline, postoperative visual analogue scale (VAS), analgesic use, postoperative fever and stone removal rate. Results: In group1,the VAS scores of 6 hours after surgery was 4.07±1.79 significantly lower than that for group 2 (4.07±1.79 vs 6.24±1.33, P<0.05). and There was a statistically significant difference in the use of analgesics between the two groups（P<0.05）. The VAS scores of day 1 after surgery (2.50±1.76 vs 3.83±2.22 in group1 and group2) was significantly lower in the tubeless mPCNL (P<0.05). The hospital stay for group 1 was significantly shorter than group 2(3.15±1.42 vs 6.48±1.88 days, P<0.01)). There were no significant differences in the operation time, puncture position, postoperative hemoglobin decline rate, VAS score on the day of discharge, postoperative fever, and stone removal rate between the two groups (P>0.05). Conclusion: Tubeless mPCNL is a simple, safe and effective technique under local anesthesia. It is worthy of clinical application. Tubeless mPCNL treatment for renal stones can significantly reduce postoperative pain and shorten hospital stays compared with common m PCNL.
Combined support mechanism of rock bolt and anchor cable for adjacent roadways in the external staggered split-level panel layout
Authors: Batugin Adrian , Zhiqiang Wang , Zehua Su , Sidikovna Shermatova Sayyora
Published: April 2020

Utilizing the spatial structure characteristics of the external staggered split-level panel layout, the combined support technology of adjacent roadways is proposed, and combined support mechanism of rock bolt and anchor cable were analyzed. The influence of the side rock bolt and anchor cable parameters respectively on the mechanical properties of the anchorage body and support stress distribution of lateral coal body was revealed through FLAC3D software. The optimal support parameters of side rock bolt and anchor cable were determined subsequently. And the support effect of the gob-side entry under mining influence was verified. Result shows that the support effect of side rock bolt and anchor cable can improve the mechanical properties and the stress state of the anchorage body, which has a good protective effect on the coal body of the air-intake entry roof and side wall. It is beneficial to the stability of the side wall and the realization of the suspension effect for the roof rock bolt and anchor cable, which makes the surrounding rock maintenance of the gob-side entry of the thick coal seam more favorable.
A prospective feasibility study of one-year administration of adjuvant S-1 therapy for resected biliary tract cancer in a multi-institutional trial (Tokyo Study Group for Biliary Cancer: TOSBIC01)
Authors: Itano Osamu , Takemura Yusuke , Kishida Norihiro , Tamagawa Eiji , Shinozaki Hiroharu , Ikeda Ken , Urakami Hidejiro , Ei Shigenori , Hayatsu Shigeo , Suzuki Keiichi , Sakuragawa Tadayuki , Ishii Masatsugu , Shito Masaya , Aiura Koichi , Fujisaki Hiroto , Takano Kiminori , Matsui Junichi , Minagawa Takuya , Shinoda Masahiro , Kitago Minoru , Abe Yuta , Yagi Hiroshi , Oshima Go , Hori Shutaro , Kitagawa Yuko
Published: April 2020

Background: Although surgery is the definitive curative treatment for biliary tract cancer (BTC), outcomes after surgery alone have not been satisfactory. Adjuvant therapy with S-1 may improve survival in patients with BTC. This study examined the safety and efficacy of 1 year adjuvant S-1 therapy for BTC in a multi-institutional trial.Methods: The inclusion criteria were as follows: histologically proven BTC, ECOG performance status 0 or 1, R0 or R1 surgery performed, cancer classified as Stage IB to III. Within 10 weeks post-surgery, a 42-day cycle of treatment with S-1 (80 mg/m2/day orally twice daily on days 1–28 of each cycle) was initiated and continued up to 1 year post surgery. The primary endpoint was adjuvant therapy completion rate. The secondary endpoints were toxicities, disease-free survival (DFS) and overall survival (OS).Results: Overall, 46 patients met the inclusion criteria of whom 19 had extrahepatic cholangiocarcinoma, 10 had gallbladder carcinoma, 9 had ampullary carcinoma, and 8 had intrahepatic cholangiocarcinoma. Overall, 25 patients completed adjuvant chemotherapy, with a 54.3% completion rate while the completion rate without recurrence during the 1 year administration was 62.5%. Seven patients (15%) experienced adverse events (grade 3/4). The median number of courses administered was 7.5. Thirteen patients needed dose reduction or temporal therapy withdrawal. OS and DFS rates at 1/2 years were 91.2/80.0% and 84.3/77.2%, respectively. Among patients who were administered S-1 more than 3 courses, only one case discontinued due to adverse events.Conclusions: One-year administration of adjuvant S-1 therapy for resected BTC was feasible and may be a promising treatment for those with resected BTC. Now, a randomized trial to determine the optimal duration of S-1 is ongoing.Trial registration: UMIN-CTR, UMIN000009029. Registered 5 October 2012-Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000009347)
What Parents Expect when Requesting an Autism Spectrum Disorder Assessment of their Young Child: an In-Depth Interview Study
Authors: Jacobs Delphine , Steyaert Jean , Dierickx Kris , Hens Kristien
Published: April 2020

Background
Parents are valued stakeholders in research, clinical practice and policy development concerning autism spectrum disorder (ASD). Little is known, however, about what drives and moves parents when they request a diagnostic ASD assessment of their child.
Methods
Seventeen Flemish parents of 11 young children participated in a longitudinal study consisting of three in-depth interviews before and after their child’s diagnostic ASD assessment. Data were analysed in Nvivo 11 according to the procedures of Interpretative Phenomenological Analysis.
Results
In this paper we report the results of the first series of interviews which were conducted after parents had asked for an ASD assessment of their young child, and before this assessment started. The pre-assessment experiences of the parents were dominated by the anticipation of various implications of an ASD diagnosis, comprising both positive and negative expectations. The theme of positive expectations consisted of two equally prominent subthemes: treatment-related implications but also psycho-relational expectations.
Conclusions
This study suggests important issues for clinicians to bear in mind during a consultation with parents who request an ASD assessment of their young child. We argue that attending to and communicating about parents’ expectations prior to their child’s ASD assessment may help clinicians to better understand parents’ requests for help, and to address their needs more effectively.
Assessment and associated factors of suicidal behaviour among cancer patients visiting the oncology outpatient unit in Mekelle oncologic clinics, Tigray, Ethiopia: a cross−sectional study
Authors: Gebreselassie abreha Tsegay , metekiya workua mekonen , beyene birhane gebrehiwot
Published: April 2020

Background

Cancer is a group of diseases characterized by the uncontrolled growth and spread of abnormal cells. According to estimates from the International Agency for Research on Cancer, there will be 17.0 million new cancer cases in 2018 worldwide. Depression, age, sex, divorced, and hopelessness are of most factors can patient with cancer result in suicidal behaviour. The purpose of this study is to identify and associated factors of suicidal behaviour among cancer patients in Mekelle, Ethiopia.
Methods

The cross-sectional study design was employed with a total of 345 study subjects in Mekelle, Ethiopia. Suicidal behaviour was measured by the Suicidal Behavior Questionnaire-Revised (SBQ-R) scale. Bivariate and multiple logistic regression analyses were performed to determine between the explanatory and outcome variables.
Results

The magnitude of suicidal behaviour was 20%. Previously suicidal attempt [AOR = 31.466, 95% CI (14.552, 68.042), P < 0.0001] was associated factor whereas no comorbid physical illness [AOR = .0.363, 95% (0. 164, 0.806)] and current treatment regimen (surgery, radiotherapy and palliative care) were significantly protective factors for suicidal behavior.
Conclusion

No comorbid physical illness, suicide attempt and current treatment regimen were significant factors of suicidal behaviour. Oncologic professionals should assess patient suicidal risk assessment routinely and every professional focuses on management besides the medication.
Functional Status of Hypothalamic-pituitary-thyroid axis and Prolactin level in Patients with First-episode of Bipolar Disorder in Mania State
Authors: Wang Fang , Zhang Huaihui , Wang Jun , Zhao Dongmei , Zhu Yuncheng
Published: April 2020

Background

Bipolar disorder (BD)-mania symptoms are stimulated by disease of the thyroid.
Methods

This study included 70 patients diagnosed with first-episode BD-mania and 70 healthy controls (HC) matched for age and sex. We aimed to determine upstream thyroid hormone interactions on the anterior pituitary, and find differences between thyroid-stimulating-hormone (TSH) and Prolactin (PRL) in the patients with first-episode of BD-mania. There were significant changes in triiodothyronine (TT3), total thyroxin (TT4), and free thyroxine (FT4) concentrations between the BD-mania and HC groups (p < 0.0167 with Bonferroni correction).
Results

After being grouped by sex, higher PRL in the male and female BD-mania subgroup were observed compared to each isosexual HC (p’s < 0.01). Higher FT4 in the male BD-mania group was observed compared to the HC males (p < 0.01) while the female BD-mania group showed lower TT3 and TT4 compared to the HC females (p’s < 0.01). In the female BD-mania group, correlation analysis established an inverse relationship between PRL and TSH (r2 = 0.25, F = 11.11, p < 0.01).
Conclusions

The findings demonstrate that sex impacts the concentration of hormones secreted by the anterior pituitary of patients with first-episode BD-mania. The increased PRL may be a putative mechanism that underlies the onset in female patients with a moderate inverse relationship between TSH and PRL.
Nomogram for predicting cancer-specific survival of patients with buccal squamous cell carcinoma: a population-based study
Authors: Wang Wei-Ming , chu xiuhong , yang sisi , wang ying , hu chuanyu
Published: April 2020

Background

The use of the traditional American Joint Committee on Cancer (AJCC) staging system alone has limitations in predicting the survival of buccal squamous cell carcinoma (BSCC) patients. We aimed to establish a comprehensive prognostic nomogram whose prognostic value compared with AJCC system.
Methods

Patients were obtained from the SEER (Surveillance, Epidemiology, and End Result) database. The Cox regression model was used to select variables using a backward stepwise selection method. Based on the predictive model for determining prognostic factors, a nomogram was developed to predict the cancer-specific survival rates of BSCC patients at 3, 5 and 8 years. We used several standard model validation methods to evaluate the performance of the survival model: concordance index (C-index), area under the time-dependent receiver operating characteristic curve (AUC), net reclassification improvement (NRI), calibration plots, decision curve analyses (DCAs), and integrated discrimination improvement (IDI).
Results

Multivariate analysis showed that age, AJCC stage, N stage, M stage, pathological grade, and surgical status were risk factors for survival. The c-index chart, the AUC chart, and the calibration chart show that the performance of the nomogram is better, and the NRI and IDI values show that the performance of the nomogram is better than that of the AJCC staging system. The 3-year, 5-year and 8-year DCA curves of nomogram show that it has more net benefit than traditional AJCC staging system, both in terms of training and validation queues.
Conclusion

We developed and validated the first BSCC prognosis nomogram, which has a better prognostic value than the separate AJCC staging system. Our BSCC prognosis nomogram is a valuable tool for explaining the risks of the next 3, 5 and 8 years in clinical practice.
Hypoxia-inducible factor 2α but not hypoxia-inducible factor-1α increases iron traffic in astrocytes
Authors: Xu Manman , Chen Zhiqiang , Ma Xizhen , Xu Hangrui , Fan Changsheng , Wang Jun , Xie Junxia
Published: April 2020

Background

Disrupted iron homeostasis in the substantia nigra (SN) is an important mechanism in Parkinson’s disease (PD). In our previous studies using cultured neurons, we showed that 6-hydroxydopamine (6-OHDA) treatment increased the expression of divalent metal transporter-1 (DMT1) gating iron influx and decreased the expression of ferroportin 1 (FPN1) gating iron efflux, leading to increased iron deposition. In astrocytes, 6-OHDA increased both DMT1 and FPN1 expressions and iron traffic. However, the underlying mechanisms mediating these processes remain elusive. Hypoxia-inducible factors (HIFs) are important regulators of iron homeostasis.
Methods

Using western blots, we observed HIFs, DMT1 and FPN1 expressions in primary cultured astrocytes and ventral mesencephalic (VM) treated with 6-OHDA, inhibitors of HIF-1α and HIF-2α, protein kinase C (PKC) inhibitor and PKC activator, radical scavenger and inducible NO synthase (iNOS) inhibitor. The ferrous iron traffic of astrocytes was determined by measuring the quenching or reversing of calcein fluorescence.
Results

Using primary rat cell cultures, we observed that 6-OHDA treatment significantly increased the expressions of HIF-1α and HIF-2α in cultured astrocytes but not in VM neurons. Moreover, we observed that HIF-2α inhibitor, but not HIF-1α inhibitor reversed the 6-OHDA-induced upregulation of DMT1 and FPN1 and ferrous iron traffic. Blocking protein kinase C (PKC) pathway by bisindolylmaleimide I hydrochloride (Bisl) or N-acetyl-l-cysteine (NAC) or Nω-Nitro-L-arginine methyl ester hydrochloride (L-NAME) inhibits Phorbol 12-myristate 13-acetate (PMA) or 6-OHDA induced activation of HIF-2α, whereas activating by PMA or 6-OHDA was sufficient to activate HIF-2α. Notably, blocking of PKC delta (PKC δ) phosphorylation by NAC, or L-NAME inhibits 6-OHDA induced activation of HIF-2α.
Conclusion

Our data indicate that astrocytic HIF-2α, but not HIF-1α, may be an important regulator of DMT1 and FPN1 expressions by activating the PKC -dependent pathway.