bluuebunny/crossref_metadata_2025 huggingface dataset:
Cervical Electrical Neuromodulation Effectively Enhances Hand Motor Output in Healthy Subjects by Engaging a Use-Dependent Intervention
Authors: Kumru Hatice , Flores África , Rodríguez-Cañón María , Edgerton Victor R. , García Loreto , Benito-Penalva Jesús , Navarro Xavier , Gerasimenko Yury , García-Alías Guillermo , Vidal Joan
Published: January 2021

Electrical enabling motor control (eEmc) through transcutaneous spinal cord stimulation is a non-invasive method that can modify the functional state of the sensory-motor system. We hypothesize that eEmc delivery, together with hand training, improves hand function in healthy subjects more than either intervention alone by inducing plastic changes at spinal and cortical levels. Ten voluntary participants were included in the following three interventions: (i) hand grip training, (ii) eEmc, and (iii) eEmc with hand training. Functional evaluation included the box and blocks test (BBT) and hand grip maximum voluntary contraction (MVC), spinal and cortical motor evoked potential (sMEP and cMEP), and resting motor thresholds (RMT), short interval intracortical inhibition (SICI), and F wave in the abductor pollicis brevis muscle. eEmc combined with hand training retained MVC and increased F wave amplitude and persistency, reduced cortical RMT and facilitated cMEP amplitude. In contrast, eEmc alone only increased F wave amplitude, whereas hand training alone reduced MVC and increased cortical RMT and SICI. In conclusion, eEmc combined with hand grip training enhanced hand motor output and induced plastic changes at spinal and cortical level in healthy subjects when compared to either intervention alone. These data suggest that electrical neuromodulation changes spinal and, perhaps, supraspinal networks to a more malleable state, while a concomitant use-dependent mechanism drives these networks to a higher functional state.
Clostridioides difficile Infection in Chronic Kidney Disease—An Overview for Clinicians
Authors: Dudzicz Sylwia , Wiecek Andrzej , Adamczak Marcin
Published: January 2021

Increased incidence of Clostridioides difficile infection (CDI), occurrence of severe and complicated CDI, and more frequent occurrence of drug-resistant, recurrent or non-hospital CDI has become a worldwide clinical problem. CDI is more common in patients with chronic kidney disease (CKD) than in the general population. CDI seems to be associated with frequent hospitalization, frequently used antibiotic therapy, dysbiosis, and abnormalities of the immune system observed in CKD patients. Dysbiosis is a common disorder found in CKD patients. It may be related to insufficient fiber content in the diet, reduced amount of consumed fluids and often reduced physical activity, constipation, impaired gastrointestinal motility, multidrug pharmacotherapy, and uremic milieu in CKD stage 5. In patients with CKD the clinical manifestations of CDI are similar to the general population; however, more frequent recurrence of CDI and higher prevalence of severe CDI are reported. Moreover, the increase in CDI related mortality is observed more in CKD patients than in the general population. The aim of this review paper is to summarize the current knowledge concerning the epidemiology, pathogenesis, clinical picture, and prevention and treatment in CKD patients.
The Multifaceted Interplay between Atrial Fibrillation and Myocardial Infarction: A Review
Authors: Belkouche Alban , Yao Hermann , Putot Alain , Chagué Frédéric , Rochette Luc , Danchin Nicolas , Fauchier Laurent , Zeller Marianne , Cottin Yves
Published: January 2021

This review was conducted to emphasize the complex interplay between atrial fibrillation (AF) and myocardial infraction (MI). In type 1 (T1) MI, AF is frequent and associated with excess mortality. Moreover, AF after hospital discharge for T1MI is not rare, suggesting the need to improve AF screening and to develop therapeutic strategies for AF recurrence. Additionally, AF is a common trigger for type 2 MI (T2MI), and recent data have shown that tachyarrhythmia or bradyarrhythmia could be a causal factor in, respectively, 13–47% or 2–7% of T2MI. In addition, AF is involved in T2MI pathogenesis as a result of severe anemia related to anticoagulants. AF is also an underestimated and frequent cause of coronary artery embolism (CE), as a situation at risk of myocardial infarction with non-obstructive coronary arteries. AF-causing CE is difficult to diagnose and requires specific management. Moreover, patients with both AF and chronic coronary syndromes represent a therapeutic challenge because the treatment of AF include anticoagulation, depending on the embolic risk, and ischemic heart disease management paradoxically includes antiplatelet therapy.
Phrenic Nerve Stimulation Improves Physical Performance and Hypoxemia in Heart Failure Patients with Central Sleep Apnea
Authors: Potratz Max , Sohns Christian , Dumitrescu Daniel , Sommer Philipp , Fox Henrik
Published: January 2021

Background: Central sleep apnea (CSA) is a common comorbidity in patients with heart failure (HF) and has been linked to increased morbidity and mortality risk. In addition, CSA is associated with impaired quality of life, reduced physical performance capacity, and hypoxemia. Phrenic nerve stimulation (PNS) is a novel approach to the treatment of CSA and has been shown to be safe and effective in this indication. However, there are currently no data on the effects of PNS on physical performance and hypoxia in CSA HF patients, both of which have been shown to be linked to mortality in HF. Methods: This prospective study enrolled patients with HF and CSA diagnosed using polysomnography. All were implanted with a PNS system (remedē® system, Respicardia Inc., Minnetonka, MN, USA) for the treatment of CSA. Examinations included polysomnography (to determine hypoxemic burden), echocardiography and a standardized 6-min walk test prior to device implantation (baseline) and after 6 months of follow-up. Results: A total of 24 patients were enrolled (mean age 67.1 ± 11.2 years, 88% male). The 6-min walk distance was 369.5 ± 163.5 m at baseline and significantly improved during follow-up (to 410 ± 169.7 m; p = 0.035). Hypoxemic burden, determined based on time with oxygen saturation < 90% improved from 81 ± 55.8 min at baseline to 27.9 ± 42.8 min during PNS therapy (p < 0.01). Conclusion: In addition to safely and effectively treating CSA, PNS is also associated with improved physical performance capacity and reduced hypoxemic burden in patients with HF.
Treatment of Heart Failure with Mid-Range Ejection Fraction: What Is the Evidence
Authors: Koufou Eleni-Evangelia , Arfaras-Melainis Angelos , Rawal Sahil , Kalogeropoulos Andreas P.
Published: January 2021

In this review, we briefly outline our current knowledge on the epidemiology, outcomes, and pathophysiology of heart failure (HF) with mid-range ejection fraction (HFmrEF), and discuss in more depth the evidence on current treatment options for this group of patients. In most studies, the clinical background of patients with HFmrEF is intermediate between that of patients with HF and reduced ejection fraction (HFrEF) and patients with HF and preserved ejection fraction (HFpEF) in terms of demographics and comorbid conditions. However, the current evidence, stemming from observational studies and post hoc analyses of randomized controlled trials, suggests that patients with HFmrEF benefit from medications that target the neurohormonal axes, a pathophysiological behavior that resembles that of HFrEF. Use of β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, and sacubitril/valsartan is reasonable in patients with HFmrEF, whereas evidence is currently scarce for other therapies. In clinical practice, patients with HFmrEF are treated more like HFrEF patients, potentially because of history of systolic dysfunction that has partially recovered. Assessment of left ventricular systolic function with contemporary noninvasive modalities, e.g., echocardiographic strain imaging, is promising for the selection of patients with HFmrEF who will benefit from neurohormonal antagonists and other HFrEF-targeted therapies.
Unilateral versus Bilateral Endoscopic Nasobiliary Drainage and Subsequent Metal Stent Placement for Unresectable Malignant Hilar Obstruction: A Multicenter Randomized Controlled Trial
Authors: Hakuta Ryunosuke , Kogure Hirofumi , Nakai Yousuke , Kawakami Hiroshi , Maguchi Hiroyuki , Mukai Tsuyoshi , Iwashita Takuji , Saito Tomotaka , Togawa Osamu , Matsubara Saburo , Hayashi Tsuyoshi , Maetani Iruru , Ito Yukiko , Hasebe Osamu , Itoi Takao , Hanada Keiji , Isayama Hiroyuki
Published: January 2021

(1) Background: Endoscopic management of hilar biliary obstruction is still challenging. Compared with unilateral drainage, bilateral drainage could preserve larger functional liver volume and potentially improve clinical outcomes. To evaluate the effectiveness of bilateral drainage, we conducted this multicenter randomized controlled study. (2) Methods: Patients with unresectable malignant hilar biliary obstruction were assigned to unilateral or bilateral group. At first, patients underwent endoscopic nasobiliary drainage (ENBD), and subsequently underwent self-expandable metallic stent (SEMS) deployment. Primary outcomes were the functional success rate of ENBD and time to recurrent biliary obstruction (TRBO) after SEMS deployment. (3) Results: During the study period, 38 and 39 patients were enrolled in the unilateral and bilateral groups. The functional success rate was similar in the uni- and bi-ENBD group (57% vs. 56%; p = 0.99), but the rate of additional drainage was higher in uni-ENBD group. Although TRBO and overall survival time after SEMS deployment were not different between the groups (p = 0.11 and 0.78, respectively), the incidence of early adverse events tended to be higher in the bi-SEMS group (5.3% vs. 28%; p = 0.11). (4) Conclusions: Our study failed to demonstrate the superiority of bilateral over unilateral biliary drainage in terms of functional success rate and TRBO.
Short-Term Morphological Changes in Asymptomatic Perimandibular Muscles after Dry Needling Assessed with Rehabilitative Ultrasound Imaging: A Proof-of-Concept Study
Authors: Botticchio Alice , Mourad Firas , Fernández-Carnero Samuel , Arias-Buría José Luis , Santodomingo Bueno Alejandro , Mesa Jiménez Juan , Gobbo Massimiliano
Published: January 2021

Facial anatomical structures are not easily accessible to manual palpation. The aim of our study is to objectively assess temporomandibular joint and perimandibular muscles dimensions by means of sonographic measurements before and after dry needling (DN) in asymptomatic subjects. Seventeen subjects participated in this before-after study with a within-subject control. After random allocation, one side of the face was used for the intervention and the contralateral as control. DN was performed on the temporal, masseter, and sternocleidomastoid muscles. Each subject was examined bilaterally before, immediately after, and one month after the intervention through Rehabilitative Ultrasound Imaging (RUSI) of the temporomandibular articular disc and the three target muscles. Maximum mouth opening was measured at baseline and at one month. After a single DN session, articular disc thickness significantly decreased; muscles’ thicknesses (except for temporal thickness) significantly decreased immediately and at follow-up on the treated side; no significant changes resulted for the control side. The maximum mouth opening increased from 4.77 mm to 4.86 mm. RUSI may be useful to assess the dimensions and thickness of the temporomandibular disc and muscles before and after an intervention. DN influences muscle morphology, and it has a positive influence on mouth opening in the short term.
Inhibitor in Congenital Factor VII Deficiency; a Rare but Serious Therapeutic Challenge—A Systematic Literature Review
Authors: Ramezanpour Nahid , Zaker Farhad , Biswas Arijit , Dorgalaleh Akbar
Published: January 2021

Background: Congenital factor (F) VII deficiency is a rare coagulation factor deficiency with an estimated incidence of 1 per 500,000 individuals. Patients with severe FVII deficiency present a broad range of clinical presentations. Alloimmunization against exogenous FVII, as the main challenge of replacement therapy, is an extremely rare phenomenon that is accompanied by a high rate of life-threatening bleeding, that renders replacement therapy less effective. Due to the importance of the issue, we performed a systematic literature review in order to assess incidence, molecular basis, clinical presentations, and therapeutic challenge and management of inhibitor in congenital FVII deficiency. Strategy of search: This systematic review was performed in accordance with PRISMA guidelines. We performed an English-language literature review in the PubMed, EMBASE, Scopus, and Google Scholar databases, using the following keywords: “factor VII inhibitor”, “factor VII inhibitors”, “FVII inhibitors”, “congenital FVII deficiency”, “recombinant factor VII”, “anti rFVIIa”, “replacement therapy”, and “alloantibody”. Results: Out of 380 patients in the 13 studies, 27 had inhibitor against FVII; 18 were male, 7 were female, while the sex of 2 was not stated. The majority (92%) developed a high-titer inhibitor (Bethesda Unit > 5). All patients had severe FVII deficiency (FVII:C < 10%), and the majority received recombinant FVII prior to inhibitor development (N: 24, 89%). Among ten patients with a detected mutation, three subjects had a common non-sense (30%), and two had a deletion (20%). Conclusions: Inhibitor development is a relatively rare phenomenon seen only in severe FVII deficiency, where it is associated with severe and life-threatening presentations, treatment challenge, and economic burden on the patients and their families.
Cardiac Output Evaluation on Septic Shock Patients: Comparison between Calibrated and Uncalibrated Devices during Vasopressor Therapy
Authors: Persona Paolo , Valeri Ilaria , Saraceni Elisabetta , De Cassai Alessandro , Calabrese Fabrizia , Navalesi Paolo
Published: January 2021

There are no reliable, non-invasive methods to accurately measure cardiac output (CO) in septic patients. MostCare (Vytech Health™, Vygon, Padova, Italy), is a beat-to-beat, self calibrated method for CO measurement based on continuous analysis of reflected arterial pressure waveforms. We enrolled 40 patients that were suffering from septic shock and requiring norepinephrine infusion to target blood pressure in order to to evaluate the level of agreement between a calibrated transpulmonary thermodilution device (PiCCO System, Pulsion Medical Systems, Feldkirchen, Germany) and the MostCare system in detecting and tracking changes in CO measurements related to norepinephrine reduction in septic shock patients,. PiCCO was connected to a 5 Fr femoral artery catheter and to a central venous catheter. System calibration was performed with 15 mL of cold saline injection over about 3 s. The MostCare device was connected to the artery catheter to analyze the arterial waveform. Before reducing norepinephrine infusion, the PiCCO system was calibrated, the MostCare waveform was optimized, and the values of the complete hemodynamic profile were recorded (T1). Norepinephrine infusion was then reduced by 0.03 mcg/Kg/min. After 30 min, a new calibration of PiCCO system and a new record on both monitors were performed (T2). Static measurements agreements were assessed using the Bland-Altman test, while trending ability was investigated using polar plot analysis. If volume expansion occurred, then related data were separately analyzed. At T1 mean the CO was 5.38 (SD 0.60) L/min, the mean difference was 0.176 L/min, the limits of agreement (LoA) was +1.39 and −1.04 L/min, and the percentage error (PE) was 22.6%; at T2 the mean CO was 5.44 (SD 0.73) L/min, the mean difference was 0.053 L/min, the LoA was +1.51 and −1.40, and the PE was 27%. After considering the volume expansion between T1 and T2, the mean CO at T1 was 5.39 L/min (SD 0.47), the LoA was +1.09 and −0.78 L/min, and the percentage error (PE) was 17%; at T2 the mean CO was 5.35 L/min (SD 0.81), the LoA was +1.73 and −1.52 L/min, and the PE was 30%. The polar plot diagram seems to confirm the trending ability of MostCare system versus the reference method. In septic patients, when the arterial waveform is accurate, MostCare and PiCCO transpulmonary thermodilution exhibit good agreement even after the reduction of norepinephrine and changes in vascular tone or volume expansion. MostCare could be a rapid to set, reliable, and useful tool to monitor hemodynamic variations in septic patients in emergency contexts where thermodilution methods or other advanced systems are not easily available.
Interobserver Agreement and Plane-Dependent Intraobserver Variability of Shear Wave Sonoelastography in the Differential Diagnosis of Ectopic Thymus Tissue
Authors: Adamczewski Zbigniew , Stasiak Magdalena , Stasiak Bartłomiej , Adamczewska Magdalena , Lewiński Andrzej
Published: January 2021

Shear wave elastography (SWE) has been demonstrated to be a useful tool in the differential diagnosis of ectopic thymus tissues (ETs), providing quantitative values of the shear wave stiffness (SWS) of both ETs and adjacent thyroid tissue. However, no data are available on the potential influence of the imaging plane (transverse vs. longitudinal) on the obtained SWS and shear wave ratio (SWR) values in SWE of these tissues. Moreover, no reports on the interobserver repeatability of SWE were published in regard to ETs. The aim of this study has been to evaluate the potential influence of the examination plane—transverse vs. longitudinal—on the SWS and SWR results, as well as to determine whether SWE of ETs is subjected to interobserver variability. SWE was demonstrated to have high inter- and intraobserver agreement in the evaluation of ETs and adjacent thyroid tissue. Significant differences between SWS values, but not SWR values, obtained in the transverse and longitudinal planes were observed. This phenomenon is probably a result of anisotropy-related artifacts and does not reduce the reliability of the method. SWE operators should be aware of the presence of plane-dependent artifacts to properly interpret the obtained results.
Prospective International Multicenter Pelvic Floor Study: Short-Term Follow-Up and Clinical Findings for Combined Pectopexy and Native Tissue Repair
Authors: Noé Günter K. , Schiermeier Sven , Papathemelis Thomas , Fuellers Ulrich , Khudyakov Alexander , Altmann Harald-Hans , Borowski Stefan , Morawski Pawel P. , Gantert Markus , De Vree Bart , Tkacz Zbigniew , Ugarteburu Rodrigo Gil , Anapolski Michael
Published: January 2021

Efforts to use traditional native tissue strategies and reduce the use of meshes have been made in several countries. Combining native tissue repair with sufficient mesh applied apical repair might provide a means of effective treatment. The study group did perform and publish a randomized trial focusing on the combination of traditional native tissue repair with pectopexy or sacrocolpopexy and observed no severe or hitherto unknown risks for patients (Noé G.K. J Endourol 2015;29(2):210–215). The short-term follow-up of this international multicenter study carried out now is presented in this article. Material and Methods: Eleven clinics and 13 surgeons in four European counties participated in the trial. In order to ensure a standardized approach and obtain comparable data, all surgeons were obliged to follow a standardized approach for pectopexy, focusing on the area of fixation and the use of a prefabricated mesh (PVDF PRP 3 × 15 Dynamesh). The mesh was solely used for apical repair. All other clinically relevant defects were treated with native tissue repair. Colposuspension or TVT were used for the treatment of incontinence. Data were collected independently for 14 months on a secured server; 501 surgeries were registered and evaluated. Two hundred and sixty-four patients out of 479 (55.1%) returned for the physical examination and interview after 12–18 months. Main Outcome and Results: The mean duration of follow-up was 15 months. The overall success of apical repair was rated positively by 96.9%, and the satisfaction score was rated positively by 95.5%. A positive general recommendation was expressed by 95.1% of patients. Pelvic pressure was reduced in 95.2%, pain in 98.0%, and urgency in 86.0% of patients. No major complications, mesh exposure, or mesh complication occurred during the follow-up period. Conclusion: In clinical routine, pectopexy and concomitant surgery, mainly using native tissue approaches, resulted in high satisfaction rates and favorable clinical findings. The procedure may also be recommended for use by general urogynecological practitioners with experience in laparoscopy.
Structural and Functional Characteristics of Mitral Paravalvular Leakage Identified by Multimodal Imaging and Their Implication on Clinical Presentation
Authors: Choi Jah Yeon , Suh Young Joo , Seo Jiwon , Choi Kang-Un , Hong Geu-Ru , Lee Sak , Lee Seung-Hyun , Ha Jong-Won , Kim Young Jin , Shim Chi Young
Published: January 2021

Objective: Clinical presentation of patients with mitral paravalvular leakage (PVL) varies from asymptomatic to heart failure related with hemolytic anemia or pulmonary hypertension. We aimed to investigate the structural and functional characteristics of mitral PVL by multimodal imaging and their association with the severity of hemolysis and hemodynamic significance. Methods: A total of 74 patients with mitral PVL who underwent both cardiac computed tomography (CT) and echocardiography from March 2010 to December 2017 was investigated. Location and size of PVL, degree of left atrial (LA) calcification as measured by CT, and hemodynamic variables as measured by echocardiography were comprehensively analyzed. To investigate the degree of hemolysis and pulmonary hypertension, level of lactate dehydrogenase (LDH) and Doppler estimated systolic pulmonary artery pressure (SPAP) were used respectively. Results: Level of LDH was not related to PVL perimeter and was variable, especially in patients with a small PVL. However, it was positively correlated with mean mitral regurgitation velocity. Additionally, SPAP was significantly correlated with PVL perimeter and LA calcium score. In multivariable analysis, mean mitral regurgitation velocity was significantly correlated with levels of LDH (β = 0.345; p = 0.016), and PVL perimeter and LA calcium score were independently associated with SPAP (β = 0.249; p = 0.036 and β = 0.467; p < 0.001, respectively). Conclusions: Characteristics of mitral PVL and adjacent structures are associated with the severity of hemolysis and pulmonary hypertension. Evaluating the structural and functional characteristics of mitral PVL by complementary multimodal imaging would be important for understanding the clinical presentation and deciding optimal treatments for individual patients.
The Human Cutaneous Sensory Corpuscles: An Update
Authors: Cobo Ramón , García-Piqueras Jorge , Cobo Juan , Vega José A.
Published: January 2021

Sensory corpuscles of human skin are terminals of primary mechanoreceptive neurons associated with non-neuronal cells that function as low-threshold mechanoreceptors. Structurally, they consist of an extreme tip of a mechanosensory axon and nonmyelinating peripheral glial cells variably arranged according to the morphotype of the sensory corpuscle, all covered for connective cells of endoneurial and/or perineurial origin. Although the pathologies of sensitive corpuscles are scarce and almost never severe, adequate knowledge of the structure and immunohistochemical profile of these formations is essential for dermatologists and pathologists. In fact, since sensory corpuscles and nerves share a basic structure and protein composition, a cutaneous biopsy may be a complementary method for the analysis of nerve involvement in peripheral neuropathies, systemic diseases, and several pathologies of the central nervous system. Thus, a biopsy of cutaneous sensory corpuscles can provide information for the diagnosis, evolution, and effectiveness of treatments of some pathologies in which they are involved. Here, we updated and summarized the current knowledge about the immunohistochemistry of human sensory corpuscles with the aim to provide information to dermatologists and skin pathologists.
Implementation of Robotic Assistance in Pancreatic Surgery: Experiences from the First 101 Consecutive Cases
Authors: Timmermann Lea , Biebl Matthias , Schmelzle Moritz , Bahra Marcus , Malinka Thomas , Pratschke Johann
Published: January 2021

Robotic assisted minimally invasive surgery has been implemented to overcome typical limitations of conventional laparoscopy such as lack of angulation, especially during creation of biliary and pancreatic anastomoses. With this retrospective analysis, we provide our experience with the first 101 consecutive robotic pancreatic resection performed at our center. Distal pancreatectomies (RDP, N = 44), total pancreatectomies (RTP, N = 3) and pancreaticoduodenectomies (RPD, N = 54) were included. Malignancy was found in 45.5% (RDP), 66.7% (RTP) and 61% (RPD). Procedure times decreased from the first to the second half of the cohort for RDP (218 min vs. 128 min, p = 0.02) and RPD (378 min vs. 271 min, p < 0.001). Overall complication rate was 63%, 33% and 66% for RPD, RPT and RDP, respectively. Reintervention and reoperation rates were 41% and 17% (RPD), 33% and 0% (RTP) and 50% and 11.4% (RPD), respectively. The thirty-day mortality rate was 5.6% for RPD and nil for RTP and RDP. Overall complication rate remained stable throughout the study period. In this series, implementation of robotic pancreas surgery was safe and feasible. Final evaluation of the anastomoses through the median retrieval incision compensated for the lack of haptic feedback during reconstruction and allowed for secure minimally invasive resection and reconstruction.
Retro-Auricular Approach to the Fractures of the Mandibular Condyle: A Systematic Review
Authors: Sikora Maciej , Chęciński Maciej , Chlubek Dariusz
Published: January 2021

This systematic review was conducted to evaluate the retro-auricular trans-meatal approach (RA) to mandibular head fractures. Fractures of the mandibular head (8%) are a specific type of mandibular condyle fractures (34%). Despite numerous complications of conservative treatment, e.g., limited mobility and even ankylosis of the temporomandibular joint, as well as shortening of the mandibular ramus resulting in malocclusion, surgical intervention in this type of fracture is still problematic. The main problems with the dominant pre-auricular approach are the high risk of paralysis of the facial nerve and persistence of a visible scar. An attractive alternative is RA, which, despite its long history, has been described in English very few times, i.e., in only two clinical trials described in three articles in the last 21 years. According to these studies, RA gives a minimum of 90% of ideal positions of bone fragments and an always fully preserved function of the facial nerve in the course of long-term observation. RA allows the application of long screws for fixation, which provide good stabilization. In addition, new types of headless screws leave a smooth, non-irritating bone surface, and the immediate future may be dominated by their resorbable varieties. RA can, therefore, be treated as a very favorable access to fractures of the mandibular head, especially due to the protection of the facial nerve and the possibility of providing a stable and predictable fixation.
Filaggrin Loss-of-Function Mutations Are Risk Factors for Severe Food Allergy in Children with Atopic Dermatitis
Authors: Astolfi Annalisa , Cipriani Francesca , Messelodi Daria , De Luca Matilde , Indio Valentina , Di Chiara Costanza , Giannetti Arianna , Ricci Lorenza , Neri Iria , Patrizi Annalisa , Ricci Giampaolo , Pession Andrea
Published: January 2021

Atopic dermatitis is frequently associated with the onset of other allergic conditions, such as asthma, rhino-conjunctivitis and food allergy. The etiology of atopic dermatitis is marginally understood in spite of the number of predisposing factors, above all, mutations in the Filaggrin gene (FLG). In this study, the association between loss-of-function variants in the FLG gene and other allergic manifestations, in particular food allergy, was evaluated in an Italian pediatric population affected by atopic dermatitis. The 10 more frequently mutated loci in the FLG gene were genotyped in 238 children affected by atopic dermatitis and tested for association with clinical features of allergic disorders by a multivariate logistic regression model. R501X and 2282del4 were the only two mutations identified; 12.2% of children carry one of these variants, corresponding to an allelic frequency of 6.5%. According to multivariate statistical analysis, loss-of-function variants in the FLG gene represent a risk factor for the onset of severe manifestations of food allergy (OR = 8.9; CI: 3.1–28.3). Peanut and hazelnut were identified as high-risk foods in patients with FLG mutations. This study demonstrates that atopic children carrying FLG mutations represent a high-risk population due to their predisposition to develop severe food allergy reactions, such as anaphylaxis.
The Neurosurgeon’s Armamentarium for Gliomas: An Update on Intraoperative Technologies to Improve Extent of Resection
Authors: Schupper Alexander J. , Yong Raymund L. , Hadjipanayis Constantinos G.
Published: January 2021

Maximal safe resection is the standard of care in the neurosurgical treatment of high-grade gliomas. To aid surgeons in the operating room, adjuvant techniques and technologies centered around improving intraoperative visualization of tumor tissue have been developed. In this review, we will discuss the most advanced technologies, specifically fluorescence-guided surgery, intraoperative imaging, neuromonitoring modalities, and microscopic imaging techniques. The goal of these technologies is to improve detection of tumor tissue beyond what conventional microsurgery has permitted. We describe the various advances, the current state of the literature that have tested the utility of the different adjuvants in clinical practice, and future directions for improving intraoperative technologies.
MRI Texture Analysis for the Prediction of Stereotactic Radiosurgery Outcomes in Brain Metastases from Lung Cancer
Authors: Park Jung Hyun , Choi Byung Se , Han Jung Ho , Kim Chae-Yong , Cho Jungheum , Bae Yun Jung , Sunwoo Leonard , Kim Jae Hyoung
Published: January 2021

This study aims to evaluate the utility of texture analysis in predicting the outcome of stereotactic radiosurgery (SRS) for brain metastases from lung cancer. From 83 patients with lung cancer who underwent SRS for brain metastasis, a total of 118 metastatic lesions were included. Two neuroradiologists independently performed magnetic resonance imaging (MRI)-based texture analysis using the Imaging Biomarker Explorer software. Inter-reader reliability as well as univariable and multivariable analyses were performed for texture features and clinical parameters to determine independent predictors for local progression-free survival (PFS) and overall survival (OS). Furthermore, Harrell’s concordance index (C-index) was used to assess the performance of the independent texture features. The primary tumor histology of small cell lung cancer (SCLC) was the only clinical parameter significantly associated with local PFS in multivariable analysis. Run-length non-uniformity (RLN) and short-run emphasis were the independent texture features associated with local PFS. In the non-SCLC (NSCLC) subgroup analysis, RLN and local range mean were associated with local PFS. The C-index of independent texture features was 0.79 for the all-patients group and 0.73 for the NSCLC subgroup. In conclusion, texture analysis on pre-treatment MRI of lung cancer patients with brain metastases may have a role in predicting SRS response.
A Meta-Analysis on the Rate of Hepatocellular Carcinoma Recurrence after Liver Transplant and Associations to Etiology, Alpha-Fetoprotein, Income and Ethnicity
Authors: Tan Darren J. H. , Wong Chloe , Ng Cheng Han , Poh Chen Wei , Jain Sneha Rajiv , Huang Daniel Q. , Muthiah Mark D.
Published: January 2021

Hepatocellular carcinoma (HCC) recurrence after liver transplant is associated with a poor prognosis and significantly increases morbidity and mortality among liver transplant patients. Therefore, this meta-analysis aims to evaluate the overall prevalence of HCC recurrence following liver transplant. Medline and Embase databases were searched, and a meta-analysis of proportions was conducted. Observational studies reporting the prevalence of recurrent hepatocellular carcinoma (HCC) after liver transplant were included, with the analysis being stratified by adherence to Milan criteria, ethnicity, socio-economic status, alpha fetoprotein (AFP) levels, living donor vs. deceased donor, and the underlying aetiology of the liver disease. A meta-regression on the date of the study completion was also performed. Of a total 40,495 patients, 3888 developed an HCC recurrence. The overall prevalence of recurrent HCC was 13% (CI: 0.12–0.15). Patients beyond the Milan criteria (MC) were more likely to recur than patients within MC. Asian populations had the greatest prevalence of HCC recurrence (19%; CI: 0.15–0.24) when compared to Western (12%; CI: 0.11–0.13) and Latin American populations (11%; CI: 0.09–0.14). The prevalence of recurrent HCC was the highest in patients infected with hepatitis B virus (HBV) (18%; CI: 0.11–0.27) compared to other aetiologies. A higher AFP also resulted in an increased recurrence. This highlights interesting differences based on ethnicity, income, and aetiology, and further studies are needed to determine the reasons for the disparity.
Mortality and Transfusion Requirements in COVID-19 Hospitalized Italian Patients According to Severity of the Disease
Authors: Grandone Elvira , Pesavento Raffaele , Tiscia Giovanni , De Laurenzo Antonio , Ceccato Davide , Sartori Maria Teresa , Mirabella Lucia , Cinnella Gilda , Mastroianno Mario , Dalfino Lidia , Colaizzo Donatella , Vettor Roberto , Ostuni Angelo , Margaglione Maurizio
Published: January 2021

There is paucity of data on the transfusion need and its impact on the overall mortality in patients with COVID-19. We explored mortality in hospitalized patients with COVID-19 who required transfusions. Information on clinical variables and in-hospital mortality were obtained from medical records of 422 patients admitted to medical wards or the Intensive Care Unit (ICU). In-hospital mortality occurred in 147 (34.8%) patients, 94 (63.9%) of whom were admitted to the ICU. The median fatalities age was 77 years (IQR 14). Overall, 100 patients (60 males) received transfusion during hospitalization. The overall mortality was significantly and independently associated with age, ICU admission, Chronic Kidney Disease (CKD), and the number of transfused Red Blood Cell (RBC) units. Specifically, CKD was associated with mortality in patients admitted to medical wards, whereas the number of transfused RBC units predicted mortality in those admitted to the ICU. Transfusion strongly interacted with the admission to ICU (OR: 9.9; 95% CI: 2.5–40.0). In patients with COVID-19, age is one of the strongest risk factors in predicting mortality independently of the disease’s severity. CKD confers a higher risk of mortality in patients admitted to medical wards. In those admitted to the ICU, the more RBC units are transfused, the more mortality increases.
Editorial for the Special Issue: Multifunctional Composites in the Journal of Composites Science
Authors: Nguyen-Tri Phuong
Published: January 2021

With the progress in nanotechnology and production methods, composite materials are becoming lighter, cheaper, more durable, and more versatile [...]
Influence of SiC Addition on Mechanical Behavior of Thermal Barriers with the Aid of Acoustic Emission
Authors: Busquets David Jeronimo , Bloem Carlos , Borrell Amparo , Salvador Maria Dolores
Published: January 2021

The improvement of high temperature materials with lower heat transfer coefficients lead to the development of thermal barrier coatings (TBCs). One of the most widely used materials for thermal barrier coatings is Y2O3 stabilized ZrO2 (Y-TZP) because of its excellent shock resistance, low thermal conductivity, and relatively high coefficient of thermal expansion. The aim of this work is to study the TBCs mechanical behavior with the addition of SiC into the suspension of Y-TZP/Al2O3 by acoustic emission (AE). Additionally, a microstructural analysis and a finite elements model were carried out in order to compare results. The coatings were made by suspension plasma spray (SPS) on metal plates of 70 × 12 × 2 mm3. An intermetallic was deposited as a bond coating, followed by a coating of Y-TZP/Al2O3 with and without 15 wt.% SiC, with thicknesses between 87 and 161 μm. The AE becomes a fundamental tool in the study of the mechanical behavior of thermal barriers. The use of wavelet transforms streamlines the study and analysis of recorded sound spectra. The crack generation arises at very low stress levels.
Modeling Strategies of Finite Element Simulation of Reinforced Concrete Beams Strengthened with FRP: A Review
Authors: Naser M. Z. , Hawileh Rami Antoun , Abdalla Jamal
Published: January 2021

Fiber-reinforced polymer (FRP) composites do not only possess superior mechanical properties, but can also be easy to tailor, install, and maintain. As such, FRPs offer novel and attractive solutions to facilitate strengthening and/or retrofitting of aging, weakened, and upgraded structures. Despite the availability of general code provisions, the design and analysis of FRP-strengthened concrete structures is both tedious and complex—especially in scenarios associated with unique loading conditions. As such, designers often leverage advanced finite element (FE) simulation as a mean to understand and predict the performance of FRP-strengthened structures. In order to narrow this knowledge gap, this paper details suitable strategy for developing and carrying out advanced FE simulations on FRP-strengthened concrete structures. The paper also covers techniques related to simulating adhesives (bonding agents), material constitutive properties and plasticity (cracking/crushing of concrete, yielding of steel reinforcement, and delamination of FRP laminates), as well as different material types of FRP (CFRP, GFRP, and their hybrid combinations), and FRP strengthening systems (sheets, plates, NSM, and rods) under various loading conditions including ambient, earthquake, and fire. The principles, thumb rules, and findings of this work can be of interest to researchers, practitioners, and students.
EXAM: A Framework of Learning Extreme and Moderate Embeddings for Person Re-ID
Authors: Qi Guanqiu , Hu Gang , Wang Xiaofei , Mazur Neal , Zhu Zhiqin , Haner Matthew
Published: January 2021

Person re-identification (Re-ID) is challenging due to host of factors: the variety of human positions, difficulties in aligning bounding boxes, and complex backgrounds, among other factors. This paper proposes a new framework called EXAM (EXtreme And Moderate feature embeddings) for Re-ID tasks. This is done using discriminative feature learning, requiring attention-based guidance during training. Here “Extreme” refers to salient human features and “Moderate” refers to common human features. In this framework, these types of embeddings are calculated by global max-pooling and average-pooling operations respectively; and then, jointly supervised by multiple triplet and cross-entropy loss functions. The processes of deducing attention from learned embeddings and discriminative feature learning are incorporated, and benefit from each other in this end-to-end framework. From the comparative experiments and ablation studies, it is shown that the proposed EXAM is effective, and its learned feature representation reaches state-of-the-art performance.
Comparison between Model Test and Three CFD Studies for a Benchmark Container Ship
Authors: Chiroșcă Ana-Maria , Rusu Liliana
Published: January 2021

An alternative to experiments is the use of numerical model tests, where the performances of ships can be evaluated entirely by computer simulations. In this paper, the free surface viscous flow around a bare hull model is simulated with three Computational Fluid Dynamics (CFD) software packages (FINE Marine, ANSYS CFD and SHIPFLOW) and compared to the results obtained during the experimental tests. The bare hull model studied is the Duisburg Test Case (DTC), developed at the Institute of Ship Technology, Ocean Engineering and Transport Systems (ISMT) for benchmarking and validation of the numerical methods. Hull geometry and model test results of resistance, conducted in the experimental facility at SVA Postdam, Nietzschmann, in 2010, are publicly available. A comparative analysis of the numerical approach and experimental results is performed, related to the numerical simulation of the free surface viscous flow around a typical container ship. Further, a comparative analysis between the results provided by NUMECA, ANSYS and SHIPFLOW is performed. Regarding the solution obtained, a satisfactory agreement between the towing test results and the computation results can be noticed. The minimum mean error was obtained through the SHIPFLOW case, 2.011%, which proved the best solution for the case studied.
Oil Spill Detection Using LBP Feature and K-Means Clustering in Shipborne Radar Image
Authors: Xu Jin , Pan Xinxiang , Jia Baozhu , Wu Xuerui , Liu Peng , Li Bo
Published: January 2021

Oil spill accidents have seriously harmed the marine environment. Effective oil spill monitoring can provide strong scientific and technological support for emergency response of law enforcement departments. Shipborne radar can be used to monitor oil spills immediately after the accident. In this paper, the original shipborne radar image collected by the teaching-practice ship Yukun of Dalian Maritime University during the oil spill accident of Dalian on 16 July 2010 was taken as the research data, and an oil spill detection method was proposed by using LBP texture feature and K-means algorithm. First, Laplacian operator, Otsu algorithm, and mean filter were used to suppress the co-frequency interference noises and high brightness pixels. Then the gray intensity correction matrix was used to reduce image nonuniformity. Next, using LBP texture feature and K-means clustering algorithm, the effective oil spill regions were extracted. Finally, the adaptive threshold was applied to identify the oil films. This method can automatically detect oil spills in shipborne radar image. It can provide a guarantee for real-time monitoring of oil spill accidents.
The Tsunami Caused by the 30 October 2020 Samos (Aegean Sea) Mw7.0 Earthquake: Hydrodynamic Features, Source Properties and Impact Assessment from Post-Event Field Survey and Video Records
Authors: Triantafyllou Ioanna , Gogou Marilia , Mavroulis Spyridon , Lekkas Efthymios , Papadopoulos Gerassimos A. , Thravalos Manolis
Published: January 2021

The tsunami generated by the offshore Samos Island earthquake (Mw = 7.0, 30 October 2020) is the largest in the Aegean Sea since 1956 CE. Our study was based on field surveys, video records, eyewitness accounts and far-field mareograms. Sea recession was the leading motion in most sites implying wave generation from seismic dislocation. At an epicentral distance of ~12 km (site K4, north Samos), sea recession, followed by extreme wave height (h~3.35 m), occurred 2′ and 4′ after the earthquake, respectively. In K4, the main wave moved obliquely to the coast. These features may reflect coupling of the broadside tsunami with landslide generated tsunami at offshore K4. The generation of an on-shelf edge-wave might be an alternative. A few kilometers from K4, a wave height of ~1 m was measured in several sites, except Vathy bay (east, h = 2 m) and Karlovasi port (west, h = 1.80 m) where the wave amplified. In Vathy bay, two inundations arrived with a time difference of ~19′, the second being the strongest. In Karlovasi, one inundation occurred. In both towns and in western Turkey, material damage was caused in sites with h > 1 m. In other islands, h ≤ 1 m was reported. The h > 0.5 m values follow power-law decay away from the source. We calculated a tsunami magnitude of Mt~7.0, a tsunami source area of 1960 km2 and a displacement amplitude of ~1 m in the tsunami source. A co-seismic 15–25 cm coastal uplift of Samos decreased the tsunami run-up. The early warning message perhaps contributed to decrease the tsunami impact.
Screening and Virulence of the Entomopathogenic Fungi Associated with Chilo suppressalis Walker
Authors: Shahriari Morteza , Zibaee Arash , Khodaparast Seyyed Akbar , Fazeli-Dinan Mahmoud
Published: January 2021

The current study aimed to explore the entomopathogenic fungi associated with the larvae of Chilo suppressalis Walker, a serious pest of rice, in northern Iran. The collected specimens were cultured and identified through morphological and molecular methods. The 38 specimens were identified by microscopic examination and genetic sequencing of the ITS region as follows: twenty-one isolates of Beauveria bassiana, five isolates of Akanthomyces lecanii, four isolates of Akanthomyces muscarious, three isolates of Metarhizium anisopliae, two isolates of Hirsutella subulata, two isolates of Trichoderma sp. and one isolate of Aspergillus sp. All the identified isolates were treated on the larvae through bioassay, evaluating the amount of hydrophobin and the activities of proteases, chitinases and lipase to find their virulence. Moreover, the percentage of thermotolerant and cold activity of the isolates were tested to determine their environmental persistence. The overall results revealed the isolates of B. bassiana, including BBRR1, BBAL1 and BBLN1 as the most virulent and environmental adaptive isolates among the fungi associated with C. suppressalis.
Morphological Characterization of the In Vitro Mycorrhizae Formed between Four Terfezia Species (Pezizaceae) with Cistus salviifolius and Cistus ladanifer—Towards Desert Truffles Production in Acid Soils
Authors: Louro Rogério , Natário Bruno , Santos-Silva Celeste
Published: January 2021

Terfezia species are obligate symbiotic partners of several xerophytic host plants, mainly belonging to the Cistaceae. Yet, their mycorrhizal associations with members of the genus Cistus remain poorly characterized and their potential application in desert truffle cultivation remains unexplored. This work provides the first anatomic descriptions of the mycorrhizae formed in vitro by four Terfezia species (i.e., T. arenaria; T. extremadurensis; T. fanfani, T. pini) with C. ladanifer and C. salviifolius, two of the most widespread and common Cistus species in acidic soils. All the tested associations resulted in the formation of ectomycorrhizae with well-developed Hartig net, but with a varying degree of mantle development. Our results also demonstrate that all the experimented Terfezia-Cistus combinations expressed high mycorrhization rates. Moreover, the present work shows that C. salviifolius and C. ladanifer are suitable plant hosts for Terfezia species, including some that are, to date, known to be only associated with annual herbs or tree species. This new evidence might aid in broadening the number of situations whereby Terfezia spp. can be cultivated in acid soils.