bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term Clinical Results of Vitrectomy and Scleral Buckling in Treatment of Rhegmatogenous Retinal Detachment
Authors: Schmidt I. , Plange N. , Rößler G. , Schellhase H. , Koutsonas A. , Walter P. , Mazinani B.
Published: March 2019

Purpose. Most studies about retinal detachment cover a limited follow-up period. The purpose of this research is to assess the long-term results after pars plana vitrectomy (PPV) and scleral buckle (SB) surgery in patients with rhegmatogenous retinal detachment (RRD). Methods. 155 patients with RRD are treated either with SB or PPV with a mean follow-up of more than 5 years. Retrospective analysis of patient data with RRD was performed between January 2006 and June 2008 at a tertiary eye clinic. Results. Overall primary success rate was 85.2% (PPV: 84.6%, SB: 89.5%; p=0.57). 90.5% of redetachments appeared within the first 124 days. No significant different success rate was found for vitrectomy with and without additional encircling band (p=0.09). No advantage of a supplemental encircling band in cases of preoperative inferior breaks was seen (p=0.81). Patients of SB group were treated more frequently in follow-up time because of epiretinal membrane (ERM) (SB: 15.5% versus PPV: 7.3%). No patient of the PPV group without intraoperative use of endolaser cerclage (14.7%) had any peeling surgery postoperatively. Conclusion. Redetachment rates of both methods are comparable in a clinical setting where PPV is considered a suitable method for pseudophakic patients and in complex cases and SB was performed in younger phakic patients with clearly identified retinal tears. PPV seems to show a more heterogenous pattern of complications. No advantage of a supplemental encircling band could be found in these case series of patients with primary RRD. No relevant long-term risk of redetachment was seen after SB.
Analysis of Contact Position for Subthalamic Nucleus Deep Brain Stimulation-Induced Hyperhidrosis
Authors: Yang Chunhui , Qiu Yiqing , Wu Xi , Wang Jiali , Wu Yina , Hu Xiaowu
Published: March 2019

Objectives. To analyze the hyperhidrosis neural network structure induced by subthalamic nucleus (STN) - deep brain stimulation (DBS). Materials and Methods. Patients with Parkinson’s disease treated with STN-DBS in Changhai Hospital between July 1, 2015, and December 1, 2016, were analyzed retrospectively. Using records of side effects of the intraoperative macrostimulation test, patients with skin sweats were selected as the sweating group. Based on the number of cases in the sweating group, the same number of patients was randomly selected from other STN-DBS patients without sweating to form the control group. The study standardized electrode position with Lead-DBS software to Montreal Neurological Institute (MNI) standard stereotactic space to compare the differences in three-dimensional coordinates of activated contacts between groups. Results. Of 355 patients, 11 patients had sweats during intraoperative macrostimulation tests. There was no significant difference in the preoperative baseline information and the postoperative UPDRS-III improvement rate (Med-off, IPG-on) between groups. Contacts inducing sweat were more medial (X-axis) (11.02 ± 0.69 mm vs 11.98 ± 0.84 mm, P=0.00057) and more upward (Z-axis) (−7.15 ± 1.06 mm VS −7.98 ± 1.21 mm, P=0.032) than those of the control group. The straight-line distance between the center of the sweat contact and the nearest voxel of the red nucleus was closer than that of the control group (2.72 ± 0.65 mm VS 3.76 ± 0.85 mm, P=0.00012). Conclusions. STN-DBS-induced sweat indicated that the contact was at superior medial of STN.
Locating the Site of Neuropathic Pain In Vivo Using MMP-12-Targeted Magnetic Nanoparticles
Authors: Husain Syeda Fabeha , Lam Raymond W. M. , Hu Tao , Ng Michael W. F. , Liau Z. Q. G. , Nagata Keiji , Khanna Sanjay , Lam Yulin , Bhakoo Kishore , Ho Roger C. M. , Wong Hee-Kit
Published: March 2019

Neuropathic pain remains underrecognised and ineffectively treated in chronic pain sufferers. Consequently, their quality of life is considerably reduced, and substantial healthcare costs are incurred. The anatomical location of pain must be identified for definitive diagnosis, but current neuropsychological tools cannot do so. Matrix metalloproteinases (MMP) are thought to maintain peripheral neuroinflammation, and MMP-12 is elevated particularly in such pathological conditions. Magnetic resonance imaging (MRI) of the peripheral nervous system has made headway, owing to its high-contrast resolution and multiplanar features. We sought to improve MRI specificity of neural lesions, by constructing an MMP-12-targeted magnetic iron oxide nanoparticle (IONP). Its in vivo efficiency was evaluated in a rodent model of neuropathic pain, where the left lumbar 5 (L5) spinal nerve was tightly ligated. Spinal nerve ligation (SNL) successfully induced mechanical allodynia, and thermal hyperalgesia, in the left hind paw throughout the study duration. These neuropathy characteristics were absent in animals that underwent sham surgery. MMP-12 upregulation with concomitant macrophage infiltration, demyelination, and elastin fibre loss was observed at the site of ligation. This was not observed in spinal nerves contralateral and ipsilateral to the ligated spinal nerve or uninjured left L5 spinal nerves. The synthesised MMP-12-targeted magnetic IONP was stable and nontoxic in vitro. It was administered onto the left L5 spinal nerve by intrathecal injection, and decreased magnetic resonance (MR) signal was observed at the site of ligation. Histology analysis confirmed the presence of iron in ligated spinal nerves, whereas iron was not detected in uninjured left L5 spinal nerves. Therefore, MMP-12 is a potential biomarker of neuropathic pain. Its detection in vivo, using IONP-enhanced MRI, may be further developed as a tool for neuropathic pain diagnosis and management.
The Diagnostic Value of Quantitative CT Analysis of Ground-Glass Volume Percentage in Differentiating Epidermal Growth Factor Receptor Mutation and Subtypes in Lung Adenocarcinoma
Authors: Wang Hexiang , Guo Hongwei , Wang Zeguo , Shan Bao , Lin Jizheng
Published: March 2019

Objective. To retrospectively investigate computed tomographic (CT) quantitative analysis of ground-glass opacity (GGO) volume percentage and morphologic features of resected lung adenocarcinomas according to epidermal growth factor receptor (EGFR) mutation status and subtypes. Methods. Amplification refractory mutation system was used to detect mutations in the EGFR gene. Distribution of demographics and GGO volume percentage were performed according to EGFR mutation status and subtypes. Results. EGFR mutations were significantly more frequent in women (55.2% vs. 37.0%, p=0.001) and in never-smokers (59.5% vs. 38.4%, p < 0.001) than those without EGFR mutation. GGO volume percentage was significantly higher in tumors with EGFR mutation than in tumors without EGFR mutation (52.8±25.7% vs. 29.0±20.7%, p < 0.001). The GGO volume percentages in tumors with exon 21 mutation and EGFR mutation showed a significant difference compared with those without EGFR mutation (p < 0.001, area under the curve=0.871, sensitivity=94.6%, specificity=73.8%, and p < 0.001, area under the curve=0.783, sensitivity=69.9%, specificity=75.4%, resp.), with cut-off values of 37.7% and 34.3% in receiver operating characteristic curve analysis. Conclusion. GGO volume percentage in adenocarcinomas with EGFR mutation was significantly higher than that in tumors without EGFR mutation, and adenocarcinomas with exon 21 mutation showed significantly higher GGO volume percentage than in tumors with exon 19 mutation and those without EGFR mutation. Our results indicate that GGO volume percentage cut-off values of more than 37.7% and 34.3% were predictors of positive exon 21 mutation and EGFR mutation, respectively.
Disparities in Systemic Treatment Use in Advanced-stage Non–Small Cell Lung Cancer by Source of Health Insurance
Authors: Maguire Frances B. , Morris Cyllene R. , Parikh-Patel Arti , Cress Rosemary D. , Keegan Theresa H.M. , Li Chin-Shang , Lin Patrick S. , Kizer Kenneth W.
Published: March 2019

Background:

Management of advanced-stage non–small cell lung cancer (NSCLC) has changed significantly over the past two decades with the development of numerous systemic treatments, including targeted therapies. However, a high proportion of advanced-stage patients are untreated. The role that health insurance plays in receipt of systemic treatments is unclear.

Methods:

Using California Cancer Registry data (2012–2014), we developed multivariable Poisson regression models to assess the independent effect of health insurance type on systemic treatment utilization among patients with stage IV NSCLC. Systemic treatment information was manually abstracted from treatment text fields.

Results:

A total of 17,310 patients were evaluated. Patients with Medicaid/other public insurance were significantly less likely to receive any systemic treatments [risk ratio (RR), 0.78; 95% confidence interval (CI), 0.75–0.82], bevacizumab combinations (RR, 0.57; 95% CI, 0.45–0.71), or tyrosine kinase inhibitors (RR, 0.70; 95% CI, 0.60–0.82) compared with the privately insured. Patients with Medicare or dual Medicare–Medicaid insurance were not significantly different from the privately insured in their likelihood of receiving systemic treatments.

Conclusions:

Substantial disparities in the use of systemic treatments for stage IV NSCLC exist by source of health insurance in California. Patients with Medicaid/other public insurance were significantly less likely to receive systemic treatments compared with their privately insured counterparts.

Impact:

Source of health insurance influences care received. Further research is warranted to better understand barriers to treatment that patients with Medicaid face.
Finasteride Use and Risk of Male Breast Cancer: A Case–Control Study Using Individual-Level Registry Data from Denmark, Finland, and Sweden
Authors: Kjærulff Thora M. , Ersbøll Annette K. , Green Anders , Emneus Martha , Brasso Klaus , Iversen Peter , Pukkala Eero , Bolin Kristian , Thygesen Lau C.
Published: March 2019

Background:

In case reports, concerns have been raised as to whether finasteride use increases the risk of male breast cancer. Previous epidemiologic evidence on the potential link is conflicting. This study aimed to assess whether an association between finasteride use and male breast cancer exists after accounting for potential confounders.

Methods:

The source population consisted of all men (≥35 years) from Denmark (1995–2014), Finland (1997–2013), and Sweden (2005–2014). Cases with incident male breast cancer were identified in the cancer registries and matched with 50 density-sampled, age, and country-matched male population controls per case. Exposure information on finasteride use was derived from the prescription registries. Potential confounders were identified using the directed acyclic graph methodology and measured by use of information from nation-wide registries.

Results:

The study population comprised 1,005 male breast cancer cases and 43,058 controls. Confounder-adjusted odds of finasteride exposure were not statistically significantly increased [OR, 1.09; 95% confidence interval (CI), 0.77–1.54] in breast cancer cases relative to controls. There was no evidence of a dose–response relationship, as the group with greatest exposure to finasteride was associated with lowest OR of male breast cancer [OR, 0.72 (95% CI, 0.40–1.30)]. Sensitivity analyses did not reveal marked changes in results with different exposure definitions or for specific subgroups.

Conclusions:

Results from this study provided no evidence that finasteride use was associated with male breast cancer.

Impact:

This large confounder-adjusted study supports the view that exposure to finasteride is not associated materially with male breast cancer risk.
Acrolein Is Involved in the Synergistic Potential of Cigarette Smoking– and Betel Quid Chewing–Related Human Oral Cancer
Authors: Tsou Han-Hsing , Hu Chih-Hung , Liu Jin-Hui , Liu Chung-Ji , Lee Chien-Hung , Liu Tsung-Yun , Wang Hsiang-Tsui
Published: March 2019

Background:

Cigarette smoking (CS) and betel quid (BQ) chewing are two known risk factors and have synergistic potential for the development of oral squamous cell carcinoma (OSCC) in Taiwan. The p53 mutation characteristics in OSCC (G to A or G to T mutations) are similar to that of acrolein-induced DNA damage. Acrolein is a major cigarette-related carcinogen that preferentially causes p53 mutations and inhibits DNA repair function in lung cancer. We hypothesize that acrolein is associated with OSCC carcinogenesis.

Methods:

A total of 97 patients with OSCC and 230 healthy subjects with CS and/or BQ chewing histories were recruited. Slot blot analysis of Acr-dG adducts, an indicator of acrolein-induced DNA damage in buccal DNA, and LC/MS-MS analysis of 3-HPMA levels, urinary Acr metabolites, were performed.

Results:

Our results showed that the level of Acr-dG adducts in buccal cells was 1.4-fold higher in patients with OSCC than in healthy subjects with CS and/or BQ chewing histories (P < 0.001). In addition, in healthy subjects, CS and BQ chewing were associated with significantly higher levels of 3-HPMA, indicating that CS and BQ chewing promotes acrolein absorption. However, 3-HPMA levels in patients with OSCC were significantly lower than those in healthy subjects, indicating impaired acrolein metabolism.

Conclusions:

In this study, we provide a novel mechanism by which increased acrolein uptake and impaired metabolism may contribute to the synergistic potential of CS and BQ-induced OSCC.

Impact:

Elevated acrolein-induced DNA damage (Acr-dG adducts) detected in buccal swabs may serve as an early indicator to identify patients at risk of developing OSCC.
Shift Work Patterns, Chronotype, and Epithelial Ovarian Cancer Risk
Authors: Leung Lisa , Grundy Anne , Siemiatycki Jack , Arseneau Jocelyne , Gilbert Lucy , Gotlieb Walter H. , Provencher Diane M. , Aronson Kristan J. , Koushik Anita
Published: March 2019

Background:

Shift work causing circadian disruption is classified as a “probable carcinogen” and may contribute to the pathogenesis of hormone-sensitive cancers. This study investigated shift work exposure in relation to epithelial ovarian cancer (EOC) risk.

Methods:

In a population-based case–control study with 496 EOC cases and 906 controls, lifetime occupational histories were collected and used to calculate cumulative years of shift work exposure, average number of night shifts per month, and average number of consecutive night shifts per month. ORs and 95% confidence intervals (CI) for associations with EOC risk were estimated using logistic regression. Associations were also examined according to chronotype and menopausal status.

Results:

More than half of the cases (53.4%) and controls (51.7%) worked evening and/or night shifts. There was no clear pattern of increasing EOC risk with increasing years of shift work; the adjusted OR of EOC comparing the highest shift work category versus never working shift work was 1.20 (95% CI, 0.89–1.63). This association was more pronounced among those self-identified as having a “morning” chronotype (OR, 1.64; 95% CI, 1.01–2.65). Associations did not greatly differ by menopausal status.

Conclusions:

These results do not strongly demonstrate a relationship between shift work and EOC risk.

Impact:

This study collected detailed shift work information and examined shift work patterns according to shift times and schedules. The findings highlight that chronotype should be considered in studies of shift work as an exposure.
Calculated Serum Osmolality, Acute Kidney Injury, and Relationship to Mortality after Percutaneous Coronary Intervention
Authors: Farhan Serdar , Vogel Birgit , Baber Usman , Sartori Samantha , Aquino Melissa , Chandrasekhar Jaya , Sorrentino Sabato , Giustino Gennaro , Sharma Madhav , Guedeney Paul , Rohla Miklos , Bhandari Reyna , Barman Nitin , Sweeny Joseph , Dangas George , Mehran Roxana , Kini Annapoorna , Sharma Samin
Published: March 2019

Background: Data on the associations between serum osmolality (sOsmo) and acute kidney injury (AKI) as well as short- and long-term mortality in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) are limited. Objectives: To investigate the association between sOsmo and development of AKI and clinical outcomes in patients undergoing PCI. Methods: We investigated 1,927 consecutive patients undergoing PCI from the registry of a single center. Patients were divided into quartiles according to sOsmo at admission (Q1–Q4). sOsmo was calculated using the following equation: (1.86 × serum sodium [mmol/L]) + (glucose [mg/dL] / 18) + (blood urea nitrogen [mg/dL] / 2.8) + 9. The primary endpoint was AKI, per Kidney Disease: Improving Global Outcomes (KDIGO) definition. The secondary endpoints were 30-day and 1-year all-cause mortality. Results: Patients with the highest sOsmo (Q4) were older and more likely female, with significantly more cardiovascular risk factors and comorbidities compared to those with lower sOsmo (Q1–Q3). Incidence of AKI was highest in Q4 and lowest in Q2. In the multivariate logistic regression model, high sOsmo independently predicted the development of AKI (OR 2.00, 95% CI 1.26–3.19, p = 0.003). Patients with Q4 had a higher risk of 1-year mortality compared to patients with Q2 (HR 2.11, 95% CI 1.10–4.15; p = 0.031), but not after adding AKI to the multivariate model (HR 1.71, 95% CI 0.87–3.39; p = 0.12). Conclusion: sOsmo is a valid and easily obtainable predictor of AKI after PCI. High sOsmo is associated with increased risk of AKI and 1-year mortality in patients undergoing PCI. Further research is warranted to clarify whether the use of an sOsmo-directed hydration protocol might reduce the incidence of AKI in patients undergoing PCI.
Grading of Left Ventricular Diastolic Dysfunction with Preserved Systolic Function by the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging Recommendations Contributes to Predicting Cardiovascular Events in Hemodialysis Patients
Authors: Toida Tatsunori , Toida Reiko , Yamashita Risa , Komiya Norihiro , Uezono Shigehiro , Komatsu Hiroyuki , Ishikawa Tetsunori , Kitamura Kazuo , Sato Yuji , Fujimoto Shouichi
Published: March 2019

Background: Left ventricular diastolic dysfunction (LVDD) causes heart failure with a preserved left ventricular ejection fraction (LVEF) in the general population. Objective: To examine the relationships between the LVDD grades of the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) recommendations and several arteriosclerotic parameters and major cardiovascular events (MACE) in hemodialysis patients with preserved LVEF. Method: Sixty-three prevalent hemodialysis patients (median age [interquartile range], 69 [64–75] years, 31.7% female) with normal systolic function (LVEF > 50%) were enrolled. LVDD evaluated by echocardiography at baseline was divided into three groups according to ASE/EACVI recommendations (normal diastolic function [ND], n = 24; intermediate, n = 19; diastolic dysfunction [DD], n = 20). All patients underwent analyses of several arteriosclerotic parameters (carotid intima-media thickness [CIMT], plaque score [PS], ankle brachial index [ABI], and brachial-ankle pulse wave velocity [baPWV]). The presence or absence of postdialysis orthostatic hypotension was assessed in each dialysis session. MACE during the 1-year follow-up period was obtained from medical records. Kaplan-Meier and Cox’s regression analyses were used to investigate the relationship between LVDD grades and MACE. Results: Postdialysis orthostatic hypotension and PS, but not CIMT, ABI, or baPWV, increased proportionally with LVDD grades. Eleven patients developed MACE, including 2 cardiovascular deaths. The Kaplan-Meier analysis showed that MACE frequently occurred in the DD grade (p = 0.002 by the log-rank test). Cox’s regression analysis adjusted for potential confounders (age, sex, diabetes, systolic blood pressure, and body mass index) revealed that the DD grade was associated with MACE when the ND grade was set as a reference. Conclusions: In maintenance hemodialysis patients with normal ventricular systolic function, a classification of LVDD by the 2016 ASE/EACVI recommendations may be a useful tool for predicting cardiovascular events.
The Effect of Antenatal Betamethasone on White Matter Inflammation and Injury in Fetal Sheep and Ventilated Preterm Lambs
Authors: Stojanovska Vanesa , Barton Samantha K. , Tolcos Mary , Gill Andrew W. , Kluckow Martin , Miller Suzanne L. , Zahra Valerie , Hooper Stuart B. , Galinsky Robert , Polglase Graeme R.
Published: March 2019

Antenatal administration of betamethasone (BM) is a common antecedent of preterm birth, but there is limited information about its impact on the acute evolution of preterm neonatal brain injury. We aimed to compare the effects of maternal BM in combination with mechanical ventilation on the white matter (WM) of late preterm sheep. At 0.85 of gestation, pregnant ewes were randomly assigned to receive intra-muscular (i.m.) saline (n = 9) or i.m. BM (n = 13). Lambs were delivered and unventilated controls (UVCSal, n = 4; UVCBM, n = 6) were humanely killed without intervention; ventilated lambs (VentSal, n = 5; VentBM, n = 7) were injuriously ventilated for 15 min, followed by conventional ventilation for 75 min. Cardiovascular and cerebral haemodynamics and oxygenation were measured continuously. The cerebral WM underwent assessment of inflammation and injury, and oxidative stress was measured in the cerebrospinal fluid (CSF). In the periventricular and subcortical WM tracts, the proportion of amoeboid (activated) microglia, the density of astrocytes, and the number of blood vessels with protein extravasation were higher in UVCBM than in UVCSal (p < 0.05 for all). During ventilation, tidal volume, mean arterial pressure, carotid blood flow, and oxygen delivery were higher in ­VentBM lambs (p < 0.05 vs. VentSal). In the subcortical WM, microglial infiltration was increased in the VentSal group compared to UVCSal. The proportion of activated microglia and protein extravasation was higher in the VentBM group compared to VentSal within the periventricular and subcortical WM tracts (p < 0.05). CSF oxidative stress was increased in the VentBM group compared to UVCSal, UVCBM, and VentSal groups (p < 0.05). Antenatal BM was associated with inflammation and vascular permeability in the WM of late preterm fetal sheep. During the immediate neonatal period, the increased carotid perfusion and oxygen delivery in BM-treated lambs was associated with increased oxidative stress, microglial activation and microvascular injury.
Pathologic Study of Supernumerary Orbital Band in Type I Duane Syndrome
Authors: Ali Muhammad Hassaan , Pineles Stacy L. , Velez Federico G. , Tandon Anika K. , Glasgow Ben J.
Published: March 2019

Background/Aims: Accessory orbital bands are relatively rare and very few reports detail histopathology. Cases in the literature describe the composition of the bands as muscular and/or fibrous. The composition of the supernumerary band lying deep in the medial rectus muscle in a patient with type I Duane syndrome was investigated. Methods: Histochemical stains were used in conjunction with polarized light for differentiating compressed collagen from muscle. Immunohistochemistry was used for verification of the presence of muscle. Results: Compressed collagen appeared red using Masson trichrome staining. Collagen was positively identified by illumination with polarized light on several stains including the underutilized Sirius red dye. Conclusions: The findings of dense collagen fibers in the fibrotic band with focal striated muscle correlated with the restrictive strabismus. In concert with other cases in the literature, it is proposed that the fibrous bands are generally associated with restrictive strabismus. Bands that are muscular may or may not be associated with strabismus. Special techniques are needed to positively identify compressed collagen.
Esophageal Stenosis in a Patient with Lichen Planus
Authors: Rosic Despalatovic Bruna  , Bratanic Andre , Puljiz Zeljko , Bozikovic Jasminka
Published: March 2019

Lichen planus is a chronic, idiopathic disorder which usually affects skin and mucosal surfaces. While oral mucosa is frequently involved, esophageal localization is uncommon, and it usually manifests with dysphagia. It has also been associated with squamous cell carcinoma. Underdiagnosing of esophageal lichen planus often leads to a delay in treatment. There are also no clear recommendations for treatment of this disorder. Systemic corticosteroids are usually the first-line therapy, but different other therapeutic approaches are also used, with a various rate of response. We present the case of a patient with esophageal lichen planus complicated with esophageal stenosis, who was rather resistant to treatment.
Impacted Bullet in the Sphenoid Sinus: A Case Report
Authors: Padiyar B. Vageesh , Vats Ankur , Dhiman Akanksha , Rai A.K.
Published: March 2019

A bullet encountered as a foreign body in the sphenoid sinus is a rare occurrence. We report a case of a bullet impacted in the sphenoid sinus following a firing assault from point blank range. The bullet was safely removed with the assistance of an endoscope preserving the structures around the sphenoid sinus. Adequate knowledge of the anatomical variations with regard to the sphenoid sinus is essential to ensure safe removal of foreign bodies, thereby avoiding catastrophic complications. We believe that endoscopic foreign body removal should be advocated more often, rather than open approaches, for foreign bodies impacted beyond the sphenoid sinus involving the anterior skull base.
Abstract P119: Gap Between Need and Supply for Hypertension Care in Low- and Middle-Income Countries
Authors: Neupane Dinesh , Feng Yijing , Matsushita Kunihiro , Appel Lawrence J
Published: March 2019

Background:
The ‘Resolve to Saves Lives’ initiative aims to save 100 millions lives, in part by improving hypertension control. Since only physicians can prescribe antihypertensive medication in most countries, the scalability of such an initiative will depend on physician capacity. We estimated the # of physician visits needed by hypertensive patients and available capacity in the 20 LMICs with the highest # of hypertensive patients.

Methods:
Total # of physicians and hypertensive patients were estimated using data from World Bank and World Health Organization (WHO). We estimated a) 3 visits/patient/yr; b) total available visits by physicians in a lower capacity scenario (5000 visits/physician/year) and higher capacity scenario (10000 visits/physician/year); c) physicians could spend 10% of total visits on hypertension care.

Results:
The Table summarizes need and supply (capacity) of physician visits for hypertension care. In the lower and higher capacity scenarios, 50% and 25% of those countries have a deficit of visits for hypertension care, respectively. Indonesia, Bangladesh, Ethiopia, Thailand, and Congo have a deficit in both scenarios. India has the highest deficit in lower capacity scenario. Indonesia has the highest deficit in higher capacity scenario.

Conclusion:
The gap between supply and need for physician visits to manage hypertension is substantial in several large LMICs. Even in countries without national-level deficit, substantial intra-country deficits may exist due to patient-physician mismatch in urban-rural areas. Options to fill this gap include increasing # of physicians, increasing fraction of physician time for hypertension care, or task sharing with, e.g., nurses and community health workers. Of these, task sharing seems most practical.
Use of Emergency Medical Services and Timely Treatment Among Ischemic Stroke
Authors: Gu Hong-Qiu , Rao Zhen-Zhen , Yang Xin , Wang Chun-Juan , Zhao Xing-Quan , Wang Yi-Long , Liu Li-Ping , Wang Cai-Yun , Liu Chelsea , Li Hao , Li Zi-Xiao , Xiao Rui-Ping , Wang Yong-Jun ,   on behalf of the Chinese Stroke Center Alliance Investigators
Published: March 2019

Background and Purpose—

Emergency medical services (EMSs) are critical for early treatment of patients with ischemic stroke, yet data on EMS utilization and its association with timely treatment in China are still limited.

Methods—

We examined data from the Chinese Stroke Center Alliance for patients with ischemic stroke from June 2015 to June 2018. Absolute standardized difference was used for covariates’ balance assessments. We used multivariable logistic models with the generalized estimating equations to account for intrahospital clustering in identifying demographic and clinical factors associated with EMS use as well as in evaluating the association of EMS use with timely treatment.

Results—

Of the 560 447 patients with ischemic stroke analyzed, only 69 841 (12.5%) were transported by EMS. Multivariable-adjusted results indicated that those with younger age, lower levels of education, less insurance coverage, lower income, lower stroke severity, hypertension, diabetes mellitus, and peripheral vascular disease were less likely to use EMS. However, a history of cardiovascular diseases was associated with increased EMS usage. Compared with self-transport, EMS transport was associated with significantly shorter onset-to-door time, door-to-needle time (if prenotification was sent), earlier arrival (adjusted odds ratio [95% CIs] were 2.07 [1.95–2.20] for onset-to-door time ≤2 hours, 2.32 [2.18–2.47] for onset-to-door time ≤3.5 hours), and more rapid treatment (2.96 [2.88–3.05] for IV-tPA [intravenous recombinant tissue-type plasminogen activator] in eligible patients, 1.70 [1.62–1.77] for treatment with IV-tPA by 3 hours if onset-to-door time ≤2 hours, and 1.76 [1.70–1.83] for treatment with IV-tPA by 4.5 hours if onset-to-door time ≤3.5 hours).

Conclusions—

Although EMS transportation is associated with substantial reductions in prehospital delay and improved likelihood of early arrival and timely treatment, rate of utilization is currently low among Chinese patients with ischemic stroke. Developing an efficient EMS system and promoting culture-adapted education efforts are necessary for improving EMS activation.
Nepeta azadkouhensis (Lamiaceae), a new alpine-subnival species from the Central Alborz of Iran
Authors: SABERAMOLI SIROOS , BALALI GHOLAM REZA , ASRI YOUNES , AFSHARZADEH SAEED
Published: March 2019

Nepeta azadkouhensis (Lamiaceae), a new species from Mazandaran province in northern Iran is described and illustrated. This taxon is similar to N. natanzensis and N. monocephala with terminal capitate inflorescences, tubular and curved corolla tubes as well as tubular calyces glabrous inside. It differs from N. natanzensis in corollas pink-purple, bracts and bracteoles smaller, as well as calyx with shorter teeth and a regular throat. It differs from N. monocephala in tall stems, procumbent to ascending and leaves arranged all along the stem. The new species is found in the alpine-subnival zone on scree at an elevation of 3700 to 3800 m.
Male description and generic review of Agyrtolasia Szymczakowski, with key to genera of Agyrtodini (Coleoptera: Leiodidae: Camiarinae: Agyrtodini)
Authors: SEAGO AINSLEY E.
Published: March 2019

The male of Agyrtolasia calliptera Szymczakowski is described and new collecting records are provided. The range and habitat of Agyrtolasia resemble those of Australian Agyrtodes Portevin, with A. calliptera found in fungus and forest leaf litter from New South Wales to Southeast Queensland. Pertinent diagnostic and systematic characters are discussed for adult Agyrtodini. The probable phylogenetic placement of Agyrtolasia is very close to Agyrtodes; adult morphology suggests the former is either within or sister to the latter. An illustrated key to world agyrtodine genera is provided.
A new Andean species of Liolaemus of the darwinii Complex (Reptilia: Iguanidae)
Authors: CABRER MARIO R. , MONGUILLOT JULIO C.
Published: March 2019

A new species of Iguanidae Liolaeminae from the Parque Nacional San Guillermo, San Juan province in western Argentina, is described. The new species is member of the Liolaemus darwinii complex within the monophyletic boulengeri species group. It is characterized by small body size, long tail, relatively low number of scales around midbody, dorsal scales keeled, precloacal pores only in male, bulged patch of enlarged scales on the proximal posterior surface of the thigh in both sexes, and a dorsal color pattern in the male of 12–13 pairs of dark paravertebral spots and irregularly scattered light blue and white scales “speckled” on reddish brown ground. Both sexes lack of light vertebral or dorsolateral stripes. Liolaemus sp. nov. is terrestrial, dwelling on rocky gravel and sandy soil in a Monte landscape with sparse vegetation, and seems to have low population density.
Tonlesapia amnica, a new species of dragonet (Teleostei: Callionymidae) from the Mekong delta HEOK HEE NG (Singapore) & WALTER J. RAINBOTH (USA)
Authors: NG HEOK HEE , RAINBOTH WALTER J.
Published: March 2019

Tonlesapia amnica, a new species of dragonet lacking a first dorsal fin, is described from the Mekong River delta in southern Vietnam. It can be distinguished from its sole congener, T. tsukawakii, in having the infraorbital canal extending beyond (vs. not reaching) ventral margin of orbit, a more slender body (7.2–13.5% SL vs. 14.3–15.0) and caudal peduncle (4.4–5.2% SL vs. 5.1–6.3), a smaller eye (6.5–8.3% SL vs. 8.7–9.2) and more dorsal-fin rays (9–10 vs. 8).
Revision of Prosyntexis from the Lower Cretaceous Crato Formation of Brazil (Hymenoptera: Sepulcidae: Trematothoracinae)
Authors: JATTIOT ROMAIN , KROGMANN LARS , NEL ANDRÉ
Published: March 2019

The fossil Prosyntexis species from the Lower Cretaceous Crato Formation of Brazil are revised. The examination of three new specimens of the sepulcid species Prosyntexis gouleti Sharkey, 1990 allows amending its species diagnosis by adding new morphological characters, especially from the wing venation and from the hitherto unknown antenna. A close comparison with Prosyntexis legitima Martins-Neto et al., 2007 demonstrates that this species is a junior synonym of P. gouleti (syn. nov.). The taxonomic position of the genus Prosyntexis within Sepulcidae: Trematothoracinae and of the enigmatic Prosyntexis montsecensis Rasnitsyn and Ansorge, 2000 are discussed on the basis of the new morphological data.
Systematics of Guajirolus ektrapeloglossa Flowers 1985 (Ephemeroptera: Baetidae)
Authors: KLUGE NIKITA J.
Published: March 2019

Larva, subimago, imago and eggs of Guajirolus ektrapeloglossa Flowers 1985 are described based on reared males and females from the type locality in Panama and a reared female from Peru. Structure and development of male genitals testify that the Neotropical taxon Guajirolus/g1 (incl. Chane) does not belong to Labiobaetini Kluge & Novikova 2016 and, therefore, is not related to the Afrotropical genus Pseudopannota Waltz & McCafferty 1987. At the same time, larvae of Guajirolus have striking similarity with that of Pseudopannota. The existent descriptions of Guajirolus nanus Lugo-Ortiz & McCafferty 1995, G. queremba Nieto 2003 and G. flowersi Thomas & Dominique (in Thomas, Dominique & Orth) 2005 do not contain characters allowing to distinguish them from G. ektrapeloglossa. Thus, new synonymy is proposed: G. ektrapeloglossa (= G. nanus syn. n.; G. queremba syn. n.; G. flowersi syn. n.). Among the characters described as species-specific for Guajirolus rondoni Salles 2007, only the shape of labial palps allows to distinguish it from G. ektrapeloglossa.
The Neotropical species of Clistopyga (Hymenoptera, Ichneumonidae, Pimplinae). Part IV: the C. eldae species group, with the description of three new species
Authors: BORDERA SANTIAGO , PALACIO EDGARD
Published: March 2019

The Neotropical Clistopyga eldae species-group is revised. Three species, C. catarina, C. marcapatensis and C. polita, are described as new. The species C. eldae Gauld, 1991 is redescribed, and an illustrated identification key to all species of the group is provided.
Two new species and new records of terrestrial isopods (Crustacea, Isopoda, Oniscidea) from Brazilian caves
Authors: CAMPOS-FILHO IVANKLIN SOARES , FERNANDES CAMILE SORBO , CARDOSO GIOVANNA MONTICELLI , BICHUETTE MARIA ELINA , AGUIAR JOSÉ OTÁVIO , TAITI STEFANO
Published: March 2019

To date, approximately 190 species of terrestrial isopods are known from Brazil and only 14 are considered troglobiotic. After the examination of a large collection from caves in Bambuí and Una geomorphological areas, along the states of Bahia, Minas Gerais and Goiás, two new troglobiotic species were recognized. Pectenoniscus liliae Campos-Filho, Bichuette & Taiti sp. n. (Styloniscidae) is described from Serra do Ramalho karst area, and Benthana xiquinhoi Campos-Filho, Bichuette & Taiti sp. n. (Philosciidae) from sandstone caves of Chapada Diamantina region. The latter constitutes the second troglomorphic species of the genus. Xangoniscus aganju (Styloniscidae) is also recorded from two caves in the Serra do Ramalho karst area. The systematic position of Iuiuniscus iuiuensis is briefly discussed and Venezillo congener (Armadillidae) is redescribed from São Domingos karst area.
Ultrastructure and morphometry of the egg of Coquillettidia albifera (Prado) with illustrations of male genitalia (Diptera: Culicidae)
Authors: ALENCAR JERONIMO , GIL-SANTANA HÉLCIO REINALDO , DE MELLO CECILIA FERREIRA , MARCONDES CARLOS BRISOLA , SANTOS-MALLET JACENIR REIS DOS
Published: March 2019

The ultrastructure and morphometry of the egg of Coquillettidia albifera (Prado) (Diptera: Culicidae) studied under scanning electronic microscopy is presented for the first time. The identification of the species was confirmed by examination of the genitalia of males collected with females. The male genitalia are redescribed and digital photographs are provided. The eggs are elliptical with the anterior region elongate and tubuliform, length 661 ± 2.59 µm and width 183 ± 2.59 µm (ratio length/width 3.61 ± 0.08). The dorsal surface is covered by a hexagonal, pentagonal and rectangular chorionic network with randomly distributed tubercles. The micropylar disc has a diameter of 18.91 ± 0.65 µm, surrounded by a continuous protuberant collar with a thickness of 4.4 ± 0.3 µm. No structure or vestige of cement related to egg attachment was observed.
Two new species of Oxytrechus Jeannel, 1927 (Coleoptera, Carabidae, Trechini) from Peru
Authors: DELGADO PEDRO , RUIZ-TAPIADOR ILDEFONSO
Published: March 2019

O. juani n. sp. and O. alexei n. sp. are described as new species of the genus Oxytrechus Jeannel, 1927, from the southeastern Peruvian Andes, at altitudes between 4,646 and 4,888 m.
Protaetia (Potosia) jelineki (Coleoptera: Scarabaeidae: Cetoniinae: Cetoniini): preimaginal stages, biology, intrapopulation variability and taxonomy
Authors: ULIANA MARCO , VAS’KO BOGDAN , POLAT ALPER
Published: March 2019

Protaetia (Potosia) jelineki (Petrovitz, 1981) is a little-known flower beetle from north-eastern Turkey whose taxonomy and nomenclature have been recently treated by different authors, coming to opposite conclusions. Following the opportunity to observe and sample a dense population from the outskirts of Erzurum, we add different contributions to the knowledge of this taxon. Larva and pupa are described and illustrated. An account on the intrapopulation variation of adults is provided, thus adding relevant information to the problematic diagnosis from close taxa: presence or absence of white dorsal pattern and of pygidial impressions are not to be considered diagnostic towards P. hajastanica Ghrejyan & Kalashian, 2017; and the usually peculiar elytral sculpture may show considerable variation. We discuss the uncertain identity of the only known syntype of Cetonia floricola fausti Kraatz, 1891, which is involved in the taxonomic and nomenclatorial debate, and we consider it conspecific with P. splendidula (Faldermann, 1835), following also the introduction of a new morphometric character allowing to diagnose P. jelineki from P. splendidula based on the shape of anterior tibiae. We provide information about the natural history of P. jelineki based on observation in nature and captivity. Adults are often associated to flowering plants of Crambe orientalis and can be active during at least two seasons.
Persistent Spring Shortwave Cloud Radiative Effect and the Associated Circulations over Southeastern China
Authors: Li Jiandong , Wang Wei-Chyung , Mao Jiangyu , Wang Ziqian , Zeng Gang , Chen Guoxing
Published: March 2019

Clouds strongly modulate regional radiation balance and their evolution is profoundly influenced by circulations. This study uses 2001–16 satellite and reanalysis data together with regional model simulations to investigate the spring shortwave cloud radiative effect (SWCRE) and the associated circulations over southeastern China (SEC). Strong SWCRE, up to −110 W m−2, persists throughout springtime in this region and its spring mean is the largest among the same latitudes of the Northern Hemisphere. SWCRE exhibits pronounced subseasonal variation and is closely associated with persistent regional ascending motion and moisture convergence, which favor large amounts of cloud liquid water and resultant strong SWCRE. Around pentad 12 (late February), SWCRE abruptly increases and afterward remains stable between 22° and 32°N. The thermal and dynamic effects of Tibetan Plateau and westerly jet provide appropriate settings for the maintenance of ascending motion, while water vapor, as cloud water supply, stably comes from the southern flank of the Tibetan Plateau and South China Sea. During pentads 25–36 (early May to late June), SWCRE is further enhanced by the increased water vapor transport caused by the march of East Asian monsoon systems, particularly after the onset of the South China Sea monsoon. After pentad 36, these circulations quickly weaken and the SWCRE decreases accordingly. Individual years with spring strong and weak rainfall are chosen to highlight the importance of the strength of the ascending motion. The simulation broadly reproduced the observed results, although biases exist. Finally, the model biases in SWCRE–circulation associations are discussed.
Large-Scale Circulation Anomalies Associated with Extreme Heat in South Korea and Southern–Central Japan
Authors: Xu Ke , Lu Riyu , Kim Baek-Jo , Park Jong-Kil , Mao Jiangyu , Byon Jae-Young , Chen Ruidan , Kim Eun-Byul
Published: March 2019

The large-scale circulation anomalies associated with extreme heat (EH) in South Korea and southern–central Japan are examined using data during the time period 1979–2016. Statistical analysis indicates that EH days in these two regions are concentrated in July and August and tend to occur simultaneously. These EH days are therefore combined to explore the physical mechanisms leading to their occurrence. The composite results indicate that the anomalous atmospheric warming during EH days is dominantly caused by a significant subsidence anomaly, which is associated with a deep anomalous anticyclone over East Asia. Further investigation of the evolution of circulation anomalies suggests that the anomalous anticyclone over East Asia related to EH is primarily initiated by wave trains originating from upstream regions, which propagate eastward along the Asian westerly jet in the upper troposphere. These wave trains can be categorized into two types that are characterized by the precursor anticyclonic and cyclonic anomalies, respectively, over central Asia. The distinction between these two types of wave train can be explained by the wavenumbers of the Rossby waves, which are modulated by both the intensity and the shape of the Asian westerly jet as the background basic flow.
On Internal Waves Propagating across a Geostrophic Front
Authors: Li Qiang , Mao Xianzhong , Huthnance John , Cai Shuqun , Kelly Samuel
Published: March 2019

Reflection and transmission of normally incident internal waves propagating across a geostrophic front, like the Kuroshio or Gulf Stream, are investigated using a modified linear internal wave equation. A transformation from depth to buoyancy coordinates converts the equation to a canonical partial differential equation, sharing properties with conventional internal wave theory in the absence of a front. The equation type is determined by a parameter Δ, which is a function of horizontal and vertical gradients of buoyancy, the intrinsic frequency of the wave, and the effective inertial frequency, which incorporates the horizontal shear of background geostrophic flow. In the Northern Hemisphere, positive vorticity of the front may produce Δ ≤ 0, that is, a “forbidden zone,” in which wave solutions are not permitted. Thus, Δ = 0 is a virtual boundary that causes wave reflection and refraction, although waves may tunnel through forbidden zones that are weak or narrow. The slope of the surface and bottom boundaries in buoyancy coordinates (or the slope of the virtual boundary if a forbidden zone is present) determine wave reflection and transmission. The reflection coefficient for normally incident internal waves depends on rotation, isopycnal slope, topographic slope, and incident mode number. The scattering rate to high vertical modes allows a bulk estimate of the mixing rate, although the impact of internal wave-driven mixing on the geostrophic front is neglected.
The Great Plains Low-Level Jet during PECAN: Observed and Simulated Characteristics
Authors: Smith Elizabeth N. , Gebauer Joshua G. , Klein Petra M. , Fedorovich Evgeni , Gibbs Jeremy A.
Published: March 2019

During the 2015 Plains Elevated Convection at Night (PECAN) field campaign, several nocturnal low-level jets (NLLJs) were observed with integrated boundary layer profiling systems at multiple sites. This paper gives an overview of selected PECAN NLLJ cases and presents a comparison of high-resolution observations with numerical simulations using the Weather Research and Forecasting (WRF) Model. Analyses suggest that simulated NLLJs typically form earlier than the observed NLLJs. They are stronger than the observed counterparts early in the event, but weaker than the observed NLLJs later in the night. However, sudden variations in the boundary layer winds, height of the NLLJ maximum and core region, and potential temperature fields are well captured by the WRF Model. Simulated three-dimensional fields are used for a more focused analysis of PECAN NLLJ cases. While previous studies often related changes in the thermal structure of the nocturnal boundary layer and sudden mixing events to local features, we hypothesize that NLLJ spatial evolution plays an important role in such events. The NLLJ is shown to have heterogeneous depth, wind speed, and wind direction. This study offers detailed documentation of the heterogeneous NLLJ moving down the slope of the Great Plains overnight. As the NLLJ evolves, westerly advection becomes significant. Buoyancy-related mechanisms are proposed to explain NLLJ heterogeneity and down-slope motion. Spatial and temporal heterogeneity of the NLLJ is suggested as a source of the often observed and simulated updrafts during PECAN cases and as a possible mechanism for nocturnal convection initiation. The spatial and temporal characteristics of the NLLJ are interconnected and should not be treated independently.