bluuebunny/crossref_metadata_2025 huggingface dataset:
Associations between severe co‐morbidity and muscle measures in advanced non‐small cell lung cancer patients
Authors: Grønberg Bjørn H. , Valan Christine Damgaard , Halvorsen Tarje , Sjøblom Bjørg , Jordhøy Marit S.
Published: August 2019

Background

Studies show that low skeletal muscle index (SMI) and low skeletal muscle density (SMD) are negative prognostic factors and associated with more toxicity from systemic therapy in cancer patients. However, muscle depletion can be caused by a range of diseases, and many cancer patients have significant co‐morbidity. The aim of this study was to investigate whether there were associations between co‐morbidity and muscle measures in patients with advanced non‐small cell lung cancer.

Methods

Patients in a Phase III trial comparing two chemotherapy regimens in advanced non‐small cell lung cancer were analysed (n = 436). Co‐morbidity was assessed using the Cumulative Illness Rating Scale for Geriatrics (CIRS‐G), which rates co‐morbidity from 0 to 4 on 14 different organ scales. Severe co‐morbidity was defined as having any grades 3 and 4 CIRS‐G score. Muscle measures were assessed from baseline computed tomography slides at the L3 level using the SliceOMatic software.

Results

Complete data were available for 263 patients (60%). Median age was 66, 57.0% were men, 78.7% had performance status 0–1, 25.9% Stage IIIB, 11.4% appetite loss, 92.4% were current/former smokers, 22.8% were underweight, 43.7% had normal weight, 26.6% were overweight, and 6.8% obese. The median total CIRS‐G score was 7 (range: 0–16), and 48.2% had severe co‐morbidity. Mean SMI was 44.7 cm2/m2 (range: 27–71), and the mean SMD was 37.3 Hounsfield units (HU) (range: 16–60). When comparing patients with and without severe co‐morbidity, there were no significant differences in median SMI (44.5 vs. 44.1 cm2/m2; 0.70), but patients with severe co‐morbidity had a significantly lower median SMD (36 HU vs. 39 HU; 0.001), mainly due to a significant difference in SMD between those with severe heart disease and those without (32.5 vs. 37.9 HU; 0.002). Linear regression analyses confirmed the association between severe co‐morbidity and SMD both in the simple analysis (0.001) and the multiple analysis (0.037) adjusting for baseline characteristics. Stage of disease, gender, and body mass index (BMI) were significantly associated with SMI in both the simple and multiple analyses. Age and BMI were significantly associated with SMD in the simple analysis; and age, gender, and BMI were significantly associated in the multiple analysis.

Conclusions

There were no significant differences in SMI between patients with and patients without severe co‐morbidity, but patients with severe co‐morbidity had lower SMD than other patients, mainly due to severe heart disease. Co‐morbidity might be a confounder in studies of the clinical role of SMD in cancer patients.
Family communication following a diagnosis of myotonic dystrophy: To tell or not to tell?
Authors: Taylor Shelby , Rodrigues Miriam , Poke Gemma , Wake Samantha , McEwen Alison
Published: August 2019

Family communication about genetic information enables informed medical and reproductive decision–making. The literature suggests that a significant proportion of genetically at‐risk family members remain uninformed about genetic risk information as a result of non‐disclosure. This study explored the experiences of New Zealand families communicating about a diagnosis of type 1 myotonic dystrophy (DM1). Eligible individuals were identified and recruited from the New Zealand (NZ) MD Prev study, a nationwide study which aimed to determine the prevalence, impact, and costs of genetic muscle disorders across the lifespan. Twelve qualitative semi‐structured interviews were conducted with 17 participants. The findings demonstrate diversity among and within families, with several distinct family narratives described. Most participants reported a motivation to tell relatives about their diagnosis to promote autonomy. Women were pivotal throughout communication processes and this was often tied to the concept of maternal responsibility and a desire to promote relatives’ reproductive autonomy. The diagnosis of DM1 and the subsequent family communication decisions altered relationships for many, with both positive and negative impacts described. The findings demonstrate that individuals require time to explore the impact of a diagnosis of DM1 on self, family and intimate partner relationships to anticipate unique communication challenges. Genetic counselors can use these findings to inform their approach to counseling families with DM1. Longitudinal genetic counseling may be beneficial as a way to provide individuals with life stage specific support as they communicate with their relatives about a diagnosis of DM1.
Sequence of same‐day upper and lower gastrointestinal endoscopy does not affect total procedure' time or medication use: A randomized trial
Authors: Hammami Muhammad B , Reddy Kavya M , Pandit Pratik , Chahla Elie J , Koro Nabeel , Schuelke Matthew J , Hachem Christine
Published: August 2019

Background and Aim

Same‐day double upper and lower gastrointestinal endoscopy is frequently performed due to overlapping indications. However, it is unclear whether an upper–lower (U‐L) or lower–upper (L‐U) sequence is optimal. We analyzed the effect of sequence on total procedure time and sedation use.

Methods

A total of 100 patients scheduled for same‐day double endoscopy were randomized to the U‐L or L‐U sequence arm. Primary outcomes, mean total procedure time, and sedative dosages were compared using a t‐test. We also explored associations of the primary outcomes with patient‐related and procedure‐related factors.

Results

Comparing U‐L and L‐U sequences, mean total procedure time was 41.9 (16.2) versus 43.0 (14.5) min (P = 0.73), diphenhydramine dose 5.5 (15.4) versus 4.5 (14.0) mg (P = 0.74), fentanyl dose 71.5 (119.3) versus 77.6 (164.02) μg (P = 0.83), midazolam dose 1.6 (2.5) versus 1.4 (2.7) mg (P = 0.69), and propofol dose 437.4 (351.4) versus 444.5 (256.0) mg (P = 0.91), respectively. Total procedure and upper endoscopy times were significantly longer with trainee presence (P = 0.0002) and shorter with conscious sedation (P = 0.003). Upper endoscopy time was longer with higher body mass index (P = 0.001), and lower endoscopy time was longer in patients with cirrhosis or chronic kidney disease (P = 0.002 and 0.009, respectively). Time between procedures was significantly longer in the L‐U sequence (7.4 [2.9] vs 5.3 [1.1] min, [P < 0.001]). The study had 80% power to detect an 8 min difference in total procedure time.

Conclusions

The sequence of same‐day double gastrointestinal endoscopy does not affect total procedure time or medication use. Longer total procedure and upper endoscopy times were associated with trainee presence and use of conscious sedation.
Potential influential factors on incidence and prevalence of inflammatory bowel disease in mainland China
Authors: Qiao Yuqi , Ran Zhihua
Published: August 2019

The incidence of inflammatory bowel disease (IBD) has increased annually in newly industrialized countries. In mainland China, there is also a trend of increasing incidence and prevalence of IBD. Epidemiological studies have shown that the incidence of IBD in mainland China is higher in the south and lower in the north. However, the existing research results are affected by the factor of floating population. Some socioeconomic factors also seem to play a role in the rising trend of IBD incidence and prevalence. These underlying factors provide opportunities and challenges for our IBD epidemiological studies over the next decade.
Histogram analysis of diffusion kurtosis imaging based on whole‐volume images of breast lesions
Authors: Li Ting , Hong Yuan , Kong Dexing , Li Kangan
Published: August 2019

Background

Breast diffusion kurtosis imaging (DKI) is a novel MRI technique to assess breast cancer but the effectivity still remains to be improved.

Purpose

To investigate the performance of whole‐volume histogram parameters derived from a DKI model for differentiating benign and malignant breast lesions.

Study Type

Retrospective.

Population

In all, 120 patients with breast lesions (62 malignant, 58 benign).

Sequence

DKI sequence with seven b‐values (0, 500, 1000, 1500, 2000, 2500, and 3000 s/mm2) and DWI sequence with two b‐values (0 and 1000 s/mm2) on 3.0T MRI.

Assessment

Histogram parameters of the DKI model (K and D) and the DWI model (ADC), including the minimum, maximum, mean, percentile values (25th, 50th, 75th, and 95th), standard deviation, kurtosis and skewness, were calculated by two radiologists for the whole lesion volume.

Statistical Tests

Student's t‐test was used to compare malignant and benign lesions. The diagnostic performances were evaluated by receiver operating characteristic (ROC) analysis.

Results

Kmax, Dmin, and ADCmin had the highest area under the curve (AUC) (0.875, 0.830, and 0.847, respectively), sensitivity (85.5%, 74.2%, and 77.4%, respectively), and accuracy (85.0%, 79.2%, and 81.7%, respectively) in their individual histogram parameter groups, and Kmax was found to outperform Dmin and ADCmin. ADC histogram parameters (from ADCmin to ADCsd) were significantly lower than D histogram parameters in all groups.

Data Conclusion

Kmax, Dmin, and ADCmin were found to be better metrics than the corresponding average values for differentiating benign from malignant tumors. Histogram parameters derived from the DKI model provided more information and had better diagnostic performance than ADC parameters derived from the DWI model.

Level of Evidence: 3

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2020;51:627–634.
Does traditional asian vegetables (ulam) consumption correlate with brain activity using fMRI? A study among aging adults from low‐income households
Authors: You Yee Xing , Shahar Suzana , Mohamad Mazlyfarina , Yahya Hanis Mastura , Haron Hasnah , Abdul Hamid Hamzaini
Published: August 2019

Background

Working memory and cognitive flexibility are supported by the dorsolateral prefrontal cortex (DLPFC). Aging adults from low‐income households are individuals with a high risk of cognitive decline who incorporate ulam in their daily diet.

Purpose

To examine relationship between ulam consumption and the working memory and cognitive flexibility among aging adults from low‐income households who are more susceptible to cognitive decline.

Study Type

Cross‐sectional.

Population/Subjects

Thirty‐two aging adults (45–75 years old).

Field Strength/Sequence

Task‐based fMRI, 3.0T, T1‐weighted anatomical images, T2*‐weighted imaging data.

Assessment

The dietary and ulam consumption were assessed using the respective validated Dietary History and semiquantitative Food Frequency questionnaires. Working memory and cognitive flexibility were evaluated by using neuropsychological batteries (ie, mini‐mental state examination [MMSE], Digit Span, and Rey auditory verbal learning test [RAVLT]) and task‐based fMRI (N‐back and Stroop Color Word Test [SCWT]). Brodmann's areas 9 and 46 were the regions of interest (ROIs) of DLPFC activation.

Statistical Tests

Multiple linear regression used to understand the relationship between ulam consumption and the working memory and cognitive flexibility, while analysis of covariance (ANCOVA) was used to compare the difference of working memory and cognitive flexibility among four percentiles of ulam consumption, after age, gender, and education years adjustments. Significance was decided by two‐sided, P < 0.0042 and P < 0.05.

Results

The multiple linear regression revealed that ulam consumption was positively associated with the Digit Span (R2 = 0.51, β = 0.702, P < 0.001), right DLPFC activation (1‐back) (R2 = 0.34, β = 0.591, P = 0.001), left DLPFC activation (SCWT‐1) (R2 = 0.33, β = 0.553, P = 0.002), and left DLPFC activation (SCWT‐2) (R2 = 0.34, β = 0.497, P = 0.004). The ulam consumption at the 75th and 100th percentile from the ANCOVA analysis had shown a better working memory and cognitive flexibility as compared with those of the 25th and 50th percentiles (P < 0.05).

Data Conclusion

This study found that high ulam consumption was related to a high intensity of brain activation in DLPFC; however, the elucidation of the neuroprotective properties of ulam have yet to be established from clinical trial studies.

Level of Evidence: 2

Technical Efficacy: Stage 4

J. Magn. Reson. Imaging 2020;51:1142–1153.
Citric acid extraction—An underestimated method in forest nutrition?
Authors: Fäth Julian , Mellert Karl , Blum Uwe , Göttlein Axel
Published: August 2019

Since recent studies reveal citric acid to be favorable for estimating plant‐available P in soils, we investigated if it can also be used for assessing other nutrients. According to our results, it provides stronger correlations with the tree nutrition for Mg (beech, spruce), Ca+K (beech) and Fe (spruce) than the standard methods for determining exchangeable cations. Thus, when estimating plant‐available P by citric acid‐extraction, these cations should be additionally measured in ICP analysis.
Comparative metabolites profiling of harvested papaya (Carica papaya L.) peel in response to chilling stress
Authors: Wu Qixian , Li Zhiwei , Chen Xi , Yun Ze , Li Taotao , Jiang Yueming
Published: August 2019

BACKGROUND

Papaya, as one of the most important tropical fruits in the world, is easily subjected to chilling injury (CI). Research on the effect of chilling temperature storage on the metabolic changes of papaya peel is limited.

RESULTS

Chilling temperature (4 °C) inhibited fruit ripening and induced CI on papaya fruit. Additionally, low temperature altered the concentrations of 45 primary metabolites and 52 aroma volatile compounds in the papaya peel. Papaya fruit stored at different temperatures could be separated using partial least squares‐discriminant analysis (PLS‐DA) with primary metabolites and volatile compounds as variables. In total, 18 primary metabolites and 22 volatiles with variable importance in projection (VIP) score higher than one might be considered as potential markers in papaya peel in response to chilling stress. Metabolites related to aroma, such as organic acid, amino acids, hexanal, carbonic acid, pentadecyl propyl ester and methyl geranate, caryophyllene accounted for major part of the metabolism changes of papaya peel and contributed a lot in response to cold stress.

CONCLUSION

This study added new insights regarding effect of chilling stress on metabolites in papaya peel. Some important metabolites might be indicator for chilling stress and detection of these metabolites will guide us to regulate the storage temperature to avoid chilling and to prolong storage of papaya fruit. © 2019 Society of Chemical Industry
Effects of acoustic power and pH on pectin‐enriched extracts obtained from citrus by‐products. Modelling of the extraction process
Authors: Umaña Mónica M , Dalmau María E , Eim Valeria S , Femenia Antoni , Rosselló Carmen
Published: August 2019

BACKGROUND

The ultrasound‐assisted extraction of pectic polysaccharides from orange by‐products was investigated. Kinetics of mechanical agitation (0.2 × g) and acoustic (US1: 542 W L−1 and US2: 794 W L−1) extractions, were obtained and modelled at different pH values (1.5 and 2.0). All extractions were carried out at 25 °C, using citric acid as the extraction solvent.

RESULTS

Higher pectic polysaccharides extraction yields were obtained with ultrasonic assistance, in comparison with the results obtained using mechanical agitation. Moreover, yield increases were significantly higher using the more acidic pH. Thus, at pH 1.5, pectin yield increased from ∼19%, obtained with agitation, to ∼47%, applying ultrasound; whereas, at pH 2.0, this increase was from ∼10%, with agitation, to ∼18%, applying ultrasound. A considerable decrease of the galacturonic acid proportion was observed on the extracts when ultrasound were applied for 60 min under pH 2.0. High methoxyl pectins were extracted at pH 1.5 whereas at pH 2.0, pectins exhibited a low methylation degree. Curves of acoustic and mechanical agitation extractions were properly represented by a second‐order rate model (average mean relative error ≤ 7.4%). The extraction rate constant, initial extraction rate and maximum yield were determined for all experimental conditions.

CONCLUSION

Overall, the results clearly indicated that the effect of ultrasound was highly dependent on the pH. Therefore, adequate acidic conditions must be applied in order to improve the efficiency of ultrasound on the pectin extraction process. © 2019 Society of Chemical Industry
Interaction of race and pathology for neuroendocrine tumors: Epidemiology, natural history, or racial disparity?
Authors: DePalo Danielle K. , Lee Rachel M. , Lopez‐Aguiar Alexandra G. , Gamboa Adriana C. , Rocha Flavio , Poultsides George , Dillhoff Mary , Fields Ryan C. , Idrees Kamran , Nathan Hari , Abbott Daniel , Maithel Shishir K. , Russell Maria C. ,   other members of the United States Neuroendocrine Tumor Study Group
Published: August 2019

Background and Objectives

Although minority race has been associated with worse cancer outcomes, the interaction of race with pathologic variables and outcomes of patients with gastroenteropancreatic neuroendocrine tumors (GEP‐NETs) is not known.

Methods

Patients from the US Neuroendocrine Study Group (2000‐2016) undergoing curative‐intent resection of GEP‐NETs were included. Given few patients of other races, only Black and White patients were analyzed.

Results

A total of 1143 patients were included. Median age was 58 years, 49% were male, 14% Black, and 86% White. Black patients were more likely to be uninsured (7% vs 2%, P = .011), and to have symptomatic bleeding (13% vs 7%, P = .009), emergency surgery (7% vs 3%, P = .006), and positive lymph nodes (LN) (47% vs 36%, P = .021). However, Black patients had improved 5‐year recurrence‐free survival (RFS) (90% vs 80%, P = .008). Quality of care was comparable between races, seen by similar LN yield, R0 resections, postoperative complications, and need for reoperation/readmission (all P > .05). While both races were more likely to have pancreas‐NETs, Black patients had more small bowel‐NETs (22% vs 13%, P < .001). LN positivity was prognostic for pancreas‐NETs (5‐year RFS 67% vs 83%, P = .001) but not for small‐bowel NETs.

Conclusions

Black patients with GEP‐NETs had more adverse characteristics and higher LN positivity. Despite this, Black patients have improved RFS. This may be attributed to the epidemiologic differences in the primary site of GEP‐NETs and variable prognostic value of LN‐positive disease.
Increases in Midwestern cougars despite harvest in a source population
Authors: Larue Michelle A. , Nielsen Clayton K. , Pease Brent S.
Published: August 2019

Although cougars (Puma concolor) appear to be recolonizing the midwestern United States, there is concern that hunting in source populations (primarily the Black Hills, SD and WY, USA) may prevent cougars from dispersing eastward. We use carcass data of cougars (n =147 carcasses at known locations, of which 111 were of known sex) in the Midwest collected during 1990–2015 to quantify whether cougar hunting in the Black Hills affected cougar distribution and presence in the Midwest. We separated carcass data into 2 time periods: before hunting in the Black Hills (i.e., pre‐hunt; 1990–2004) and after hunting (i.e., post‐hunt; 2005–2015). We hypothesized that if hunting prevented dispersal into the Midwest, cougar distribution would be random and their presence less, relative to the pre‐hunt period. We also were interested in sex ratios of carcasses over time, given the importance of that demographic metric to the potential establishment of viable populations. During the pre‐hunt period, 25 carcasses were dispersed randomly in the Midwest. During the post‐hunt period, we found nearly 4 times the number of carcasses in the Midwest (n = 86), carcasses were significantly clustered, and a greater percentage of carcasses were female (pre‐hunt n = 6 [24%]; post‐hunt n = 27 [31%]). Relative to the pre‐hunt period, we observed a 460‐km northward shift in the directional distribution of carcass locations during the post‐hunt period. These findings do not support the idea that hunting in the Black Hills has prevented cougar presence from increasing in the Midwest. Alternatively, we suggest the potential for immigration from cougar populations farther to the west as an explanation for the increase in cougar presence (particularly females) confirmed after the initiation of cougar hunting in the Black Hills. © 2019 The Wildlife Society.
Survival and growth of northern bobwhite offspring post‐translocation
Authors: Lunsford Kyle D. , Howell Paige E. , Roberts Thomas B. , Terhune Theron M. , Martin James A.
Published: August 2019

Continual population declines in northern bobwhites (Colinus virginianus) have prompted the use of population restoration techniques in conjunction with habitat management to restore their populations. We tested the site familiarity hypothesis to determine if translocation to new environments affected offspring survival and growth rates of bobwhites. We used bobwhites from north Florida and translocated them to a study site in Brunswick County, North Carolina, USA, and monitored birds during April−October 2016 and April−October 2017. We used the corral capture method and modified‐suture technique to capture and radio‐tag chicks to evaluate offspring growth and survival rates of resident and translocated bobwhites. Offspring survival varied by year and age. We did not find any difference in offspring survival rates of resident and translocated individuals, lending no support to the site familiarity hypothesis with regards to survival. Offspring of resident bobwhites did not grow at a faster rate than offspring of translocated bobwhites, indicating a lack of support for the site familiarity hypothesis in terms of physiological development. Survival, however, is a more important metric for determining post‐translocation population dynamics, and our results indicated that translocated bobwhites can reproduce and raise offspring similar to resident counterparts, but both had low survival. © 2019 The Wildlife Society.
Formation of Zirconium(IV)–Heparin Complex Multilayers on Solid Surfaces for Long‐Lasting Antiplatelet Application
Authors: Jeong Yeonwoo , Kang Sung Min
Published: August 2019

A facile approach to enhancing the blood compatibility of solid surfaces based on ZrIV–heparin complexation is reported. Solid surfaces are pretreated with tannic acid (TA)/ZrIV complexes. Heparin is then deposited on the surface through a spin‐coating process and fixed by a ZrIV‐mediated crosslinking reaction. Using this approach, TA/ZrIV/heparin complex multilayers that are highly resistant to human platelet adhesion are formed on various substrates including metal, metal oxides, ceramics, and synthetic polymers. This approach presents a sustainable way for the immobilization of heparin onto surfaces because it does not require any derivatization of heparin molecule as well as time‐consuming processes.
Development of 3D Biofabricated Cell Laden Hydrogel Vessels and a Low‐Cost Desktop Printed Perfusion Chamber for In Vitro Vessel Maturation
Authors: Distler Thomas , Ruther Florian , Boccaccini Aldo R. , Detsch Rainer
Published: August 2019

The vascular system represents the key supply chain for nutrients and oxygen inside the human body. Engineered solutions to produce sophisticated alternatives for autologous or artificial vascular implants to sustainably replace diseased vascular tissue still remain a key challenge in tissue engineering. In this paper, cell‐laden 3D bioplotted hydrogel vessel‐like constructs made from alginate di‐aldehyde (ADA) and gelatin (GEL) are presented. The aim is to increase the mechanical stability of fibroblast‐laden ADA‐GEL vessels, tailoring them for maturation under dynamic cell culture conditions. BaCl2is investigated as a crosslinker for the oxidized alginate‐gelatin system. Normal human dermal fibroblast (NHDF)‐laden vessel constructs are optimized successfully in terms of higher stiffness by increasing ADA concentration and using BaCl2, with no toxic effects observed on NHDF. Contrarily, BaCl2crosslinking of ADA‐GEL accelerates cell attachment, viability, and growth from 7d to 24h compared to CaCl2. Moreover, alignment of cells in the longitudinal direction of the hydrogel vessels when extruding the cell‐laden hydrogel crosslinked with Ba2+is observed. It is possible to tune the stiffness of ADA‐GEL by utilizing Ba2+as crosslinker. In addition, a customized, low‐cost 3D printed polycarbonate (PC) perfusion chamber for perfusion of vessel‐like constructs is introduced.
Mechanical Strengths of Hydrogels of Poly(N,N‐Dimethylacrylamide)/Alginate with IPN and of Poly(N,N‐Dimethylacrylamide)/Chitosan with Semi‐IPN Microstructures
Authors: Bai Changzhuang , Huang Qiuhua , Zhang Xiao , Xiong Xiaopeng
Published: August 2019

Tough hydrogels receive continuous attention because of their promising applications in many fields. Herein, tough hydrogels of poly (N,N‐dimethylacrylamide) (PDMAA)/alginate (SA) are prepared, with interpenetrating network (IPN) and of PDMAA/chitosan (CS) with semi‐IPN microstructure, respectively. The toughening of the hydrogel by incorporating natural polymers is studied by compressing tests and dynamic mechanical analyses. Moreover, cyclic load–unload compressing of the two types of hydrogels are performed at low strains and under relatively high strains, in order to compare their strength and anti‐fatigue properties. The results indicate that the mechanical strength can be markedly improved upon addition of the natural polymers, and the IPN hydrogel of PDMAA/SA reveals much higher mechanical performances but is less stable. However, the semi‐IPN hydrogel of PDMAA/CS displays excellent anti‐fatigue stability, but with relatively low strength. Swelling tests, scanning electron microscopy, and Fourier transform infrared spectroscopy are carried out to study the microstructures of the hydrogels, which are carefully analyzed to understand the difference in mechanical performances of those hydrogels. The results suggest that the presence of sacrificial unit and higher chain density in the IPN are helpful for toughening hydrogels, while the semi‐IPN network is beneficial to improve the energy dissipation efficiency.
Oxidative phosphorylation inhibition induces anticancerous changes in therapy‐resistant–acute myeloid leukemia patient cells
Authors: Vitkevičienė Aida , Janulis Vytautas , Žučenka Andrius , Borutinskaitė Veronika , Kaupinis Algirdas , Valius Mindaugas , Griškevičius Laimonas , Navakauskienė Rūta
Published: August 2019

Treatment of acute myeloid leukemia (AML) is still a challenge because of common relapses or resistance to treatment. Therefore, the development of new therapeutic approaches is necessary. Various studies have shown that certain cancers, including some chemoresistant AML subsets, have upregulated oxidative phosphorylation. In this study, we aimed to assess treatment‐resistant AML patients’ cell modulation using oxidative phosphorylation inhibitors metformin and atovaquone alone and in various combinations with cytosine analog cytarabine and apoptosis inducer venetoclax. Metabolic activity analysis using Agilent Seahorse XF Extracellular Flux Analyzer revealed that peripheral blood mononuclear cells’ metabolic state was different among treatment‐resistant AML patients. We demonstrated that metformin decreased therapy‐resistant–AML cell oxidative phosphorylation ex vivo, cotreatment with cytarabine and venetoclax slightly increased the effect. However, treatment with atovaquone did not have a marked effect in our experiment. Cell treatment had a slight effect on cell proliferation inhibition; combination of metformin, cytarabine, and venetoclax had the strongest effect. Moreover, a slightly higher effect on cell proliferation and cell cycle regulation was demonstrated in the cells with higher initial oxidative phosphorylation rate as demonstrated by gene expression analysis using reverse transcription quantitative polymerase chain reaction (RT‐qPCR). Proteomic analysis by liquid chromatography–mass spectrometry demonstrated that chemoresistant AML cell treatment with metformin modulated metabolic pathways, while metformin combination with cytarabine and venetoclax boosted the effect. We suggest that oxidative phosphorylation inhibition is effective but not sufficient for chemoresistant AML treatment. Indeed, it causes anticancerous changes that might have an important additive role in combinatory treatment.
A 57‐Year‐Old Woman With Progressive Left Hand Clumsiness and Falls
Authors: Paramanandam Vijayashankar , Olszewska Diana Angelika , Shakya Bhattacharjee , Chalissery Albi Jose , O'Connell Martin , Farrell Michael , Lynch Tim
Published: August 2019

Clinical History

A 57‐year old woman presented with left hand pain, periodic leg movement during sleep, gradual onset of stiffness, clumsiness, and falls. Neurological examination showed: generalized rigidity and bradykinesia. There was left hand dystonic posturing and ideomotor apraxia, as well as mirror movements of upper limbs and stimulus‐sensitive myoclonus. The patient had a high‐pitched voice and hypophonia (Video S1).

Discussion

Experts discuss localization and the syndromic diagnosis and predict the underlying pathology. The pathological diagnosis is then provided and clinical learning points are considered.
The relationship between the firm's social media strategy and the consumers' engagement behavior in aviation
Authors: Sigurdsson Valdimar , Larsen Nils Magne , Sigfusdottir Arna Dogg , Fagerstrøm Asle , Alemu Mohammed Hussen , Folwarczny Michal , Foxall Gordon
Published: August 2019

Social media platforms constitute a new frontline for brands to build relationships with their customers. Nevertheless, the literature on social media engagement behavior is unidimensional, as it focuses on customer engagement while neglecting the customer's influence on managerial decisions. The current paper goes a step further by applying the theory of the marketing firm (TMF). We investigated consumer‐firm bilateral contingencies through three studies. The first study captures up to 60% of the variance in consumer responses given on Icelandair's Facebook page. The second study shows how customers engage with Icelandair's social media platforms. The third study illustrates the firm's social media strategy from a managerial perspective.
A complex analysis approach to Atangana–Baleanu fractional calculus
Authors: Fernandez Arran
Published: August 2019

The standard definition for the Atangana–Baleanu fractional derivative involves an integral transform with a Mittag‐Leffler function in the kernel. We show that this integral can be rewritten as a complex contour integral which can be used to provide an analytic continuation of the definition to complex orders of differentiation. We discuss the implications and consequences of this extension, including a more natural formula for the Atangana–Baleanu fractional integral and for iterated Atangana–Baleanu fractional differintegrals.
Effect of ICRU report 90 recommendations on Monte Carlo calculatedkQfor ionization chambers listed in the Addendum to AAPM’s TG‐51 protocol
Authors: Kawachi Toru , Saitoh Hidetoshi , Katayose Tetsurou , Tohyama Naoki , Miyasaka Ryohei , Cho Sang Yong , Iwase Tsutomu , Hara Ryusuke
Published: August 2019

Purpose

The ICRU has published new recommendations for ionizing radiation dosimetry. In this work, the effect of recommendations on the water‐to‐air and graphite‐to‐air restricted mass electronic stopping power ratios (sw, airandsg, air) and the individual perturbation correction factorsPiwas calculated. The effect on the beam quality conversion factorskQfor reference dosimetry of high‐energy photon beams was estimated for all ionization chambers listed in the Addendum to AAPM’s TG‐51 protocol.

Methods

Thesw, air,sg, air, individualPi,andkQwere calculated using EGSnrc Monte Carlo code system and key data of both ICRU report 37 and ICRU report 90. First, thePiandkQwere calculated using precise models of eight ionization chambers: NE2571 (Nuclear Enterprise), 30013, 31010, 31021 (PTW), Exradin A12, A12S, A1SL (Standard imaging), and FC‐65P (IBA). In this simulation, the radiation sources were one60Co beam and ten photon beams with nominal energy between 4 MV and 25 MV. Then, the change inkQfor ionization chambers listed in the Addendum to AAPM’s TG‐51 protocol was calculated by changing the specification of the simple‐model of ionization chamber. The simple‐models were made with only cylindrical component modules. In this simulation, the radiation sources of60Co beam and 24 MV photon beam were used.

Results

The significant changes (p < 0.05) were observed forsw, air,sg, air, the wall correction factorPwall, and the waterproofing sleeve correction factorPsleeve. The decrease insw, airvaried from −0.57% for a60Co beam to −0.36% for the highest beam quality. The decrease insg, airvaried from −0.72% to −1.12% in the same range. The changes inPwallandPsleevewere up to 0.41% and 0.14% and those maximum changes were observed for the60Co beam. All changes in the central electrode correction factorPcel, the stem correction factorPstem, and the replacement correction factorPreplwere from −0.02% to 0.12%. Those changes were statistically insignificant (p = 0.07 or more) and were independent of photon energy. The change inkQwas mainly characterized by the change insw, air,Pwall, andPsleeve. The relationship between the change inkQand the beam quality index was linear approximately. The changes inkQof the simple‐models were agreed with those of the precise‐models within 0.08%.

Conclusion

The effects of ICRU‐90 recommendations onkQfor the ionization chambers listed in the Addendum to AAPM's TG‐51 protocol were from −0.15% to 0.30%. To remove the known systematic effect on the clinical reference dosimetry, thekQbased on ICRU‐37 should be updated to thekQbased on ICRU‐90.
Predicting gamma passing rates for portal dosimetry‐based IMRT QA using machine learning
Authors: Lam Dao , Zhang Xizhe , Li Harold , Deshan Yang , Schott Brayden , Zhao Tianyu , Zhang Weixiong , Mutic Sasa , Sun Baozhou
Published: August 2019

Purpose

Intensity‐modulated radiation therapy (IMRT) quality assurance (QA) measurements are routinely performed prior to treatment delivery to verify dose calculation and delivery accuracy. In this work, we applied a machine learning‐based approach to predict portal dosimetry based IMRT QA gamma passing rates.

Methods

182 IMRT plans for various treatment sites were planned and delivered with portal dosimetry on two TrueBeam and two Trilogy LINACs. A total of 1497 beams were collected and analyzed using gamma criteria of 2%/2 mm with a 5% threshold. The datasets for building the machine learning models consisted of 1269 beams. Ten‐fold cross‐validation was utilized to tune the model and prevent “overfitting.” A separate test set with the remaining 228 beams was used to evaluate model performance. Each beam was characterized by a set of 31 features including both plan complexity metrics and machine characteristics. Three tree‐based machine learning algorithms (AdaBoost, Random Forest, and XGBoost) were used to train the models and predict gamma passing rates.

Results

Both AdaBoost and Random Forest had 98% of predictions within 3% of the measured 2%/2 mm gamma passing rates with a maximum error less than 4% and a mean absolute error < 1%. XGBoost showed a slightly worse prediction accuracy with 95% of the predictions within 3% of the measured gamma passing rates and a maximum error of 4.5%. The three models identified the same nine features in the top 10 most important ones that are related to plan complexity and maximum aperture displacement from the central axis or the maximum jaw size in a beam.

Conclusion

We have demonstrated that portal dosimetry IMRT QA gamma passing rates can be accurately predicted using tree‐based ensemble learning models. The machine learning based approach allows physicists to better identify the failures of IMRT QA measurements and to develop proactive QA approaches.
Application of the DC resistivity method in urban geological problems of karstic areas
Authors: Plank Zsuzsanna , Polgár Dorottya
Published: August 2019

Terminating industrial activities may have harmful side effects on the infrastructure of a civil society. One effective method of solving environmental and geotechnical problems in urban areas is a direct‐current resistivity survey. In karstic areas, large‐scale geological structures directly affect the near‐surface, small‐scale events. Reliable data on the geological background of harmful events are acquired through suitable combinations of large‐scale and of small‐scale high‐resolution surveys. In this study, the geological background of three urban subsurface‐related problems was investigated in a karstic area: collapse of a sinkhole, suffusion of a basement area, and contamination of an urban creek. In each case, the scientific work aimed at setting up of a suitable model that describes the harmful event and its geological background. For this purpose, a combination of large‐scale and high‐resolution resistivity data was acquired and augmented by borehole information and laboratory analyses. The error analyses of the resulting models suggest that the methodology of dual‐scale geoelectric investigation of urban hazards in karstic areas can provide applicable models for mitigation measures.
Estimating sex using isolated appendicular skeletal elements from Chachapoyas, Peru
Authors: Anzellini Armando , Toyne J. Marla
Published: August 2019

The estimation of sex from human skeletal remains is one of the primary steps in the creation of a bioarchaeological demography. Conventionally, sex has been estimated from the crania or os coxae, but commingled contexts pose challenges when associating these key elements with the rest of the remains becomes impossible or if the sample is mostly represented by postcranial appendicular elements. Following successful applications of logistic regression to appendicular metrics in forensic anthropology for the estimation of sex using appropriate reference samples, this study aims to create a similar method to be applied in archaeological contexts in the Andes. This is achieved through the collection of osteometric data from complete burials of previously estimated sex recovered at the archaeological site of Kuelap, in Chachapoyas, Peru. Using these data, we created logistic regression formulae, using both frequentists and Bayesian approaches, that utilize standard metrics of the humerus, femur, and tibia to estimate the sex of individuals in this sample, testing their apparent accuracy and, through their application to a commingled context, their applicability in situations when only appendicular remains may be present or complete. Both frequentist and Bayesian‐derived formulae provided a correct classification of between 82% and 93% for the previously estimated sample, on par with correct classification rates of cranial nonmetrics. No significant difference was observed between the Bayesian approach and the frequentist approach. The application of this method for sex estimation to a commingled context also provided a demography consistent with that created using only os coxae and cranial remains. These results underscore the validity and reliability of this methodology and provide further support for its application in other bioarchaeological contexts across the Andean region.
Facile and green preparation of thermal and ph sensitive hydrogel microspheres based on spray drying and the diels–alder reaction
Authors: Wei Hongliang , Yang Xiaoqing , Chu Huijuan , Li Jingjing
Published: August 2019

Thermal and pH dual‐sensitive hydrogel microspheres were fabricated using spray drying. During the spray drying, chemical crosslinks were formed in situ via the Diels–Alder reaction without the involvement of any catalysts or organic solvents. The structures and morphologies of the products were characterized by Fourier Transform infrared spectroscopy (FTIR), nuclear magnetic resonance (NMR), Raman spectroscopy, scanning electron microscopy (SEM), X‐ray diffraction (XRD), and thermogravimetric analysis (TGA). A general weighing method was applied to study the swelling behavior of the microspheres at different temperatures and pHs. Using urea as a model molecule, the ability of the microspheres to control the release of urea was explored by spectrophotometry and calculated from the calibration curve obtained from the reaction of urea and diaminobenzaldehyde. The as‐prepared microspheres show a reversible and reproducible volume change with varying pH or temperature, and their swelling ratios increase with increasing temperature or pH. Furthermore, the urea release rates can be tuned by changing the pH or the temperature. Since spray drying can easily produce microspheres on a large scale, the strategy demonstrated here has the potential for applications in the green preparation of hydrogel microspheres. POLYM. ENG. SCI., 59:1999–2007, 2019. © 2019 Society of Plastics Engineers
Women's initial experiences of their appearance after mastectomy and/or breast reconstruction: A qualitative study
Authors: Herring Beth , Paraskeva Nicole , Tollow Philippa , Harcourt Diana
Published: August 2019

Objective

Surgical procedures intended to treat breast cancer or reduce risk of developing the disease typically result in changes to appearance and scarring of the breast area, and any donor sites. The longer‐term impact of these changes on body image and quality of life are well documented, but research in this field has failed to explore women's initial experiences of their appearance after surgery. This study used a qualitative approach to gain insight and better understand the experiences of women at this time point in their treatment pathway.

Methods

Women (n=128) who had undergone mastectomy and/or breast reconstruction following a diagnosis of breast cancer or to reduce their risk of developing the disease completed an online survey. Open‐ended questions asked participants about their experiences when seeing the postsurgical appearance of their breast/breast area (and donor site, if relevant) for the first time, and the support available to them.

Results

Thematic analysis generated four key themes: “preparedness and support,” “first thoughts and emotions,” “loss and grief,” and “the reaction of others.”

Conclusions

There was considerable variability in women's experiences. Some felt prepared and emotionally supported at this time, whilst others felt this element of care was missing. The findings suggest that there is a need to ensure all women are informed and have the necessary support when looking at the results of their surgery for the first time. Areas for improvement were proposed, including preoperative discussions, increased preparation and support. This could potentially contribute to better patient outcomes overall.
Focal organizing pneumonia simulating lung malignancy: treated with prednisolone
Authors: Kilaru Hemanth , Jalna Mohd Vaseem , Kilaru Satish Chandra , Nandury Eshwar Chandra , Khan Mohammed Zia Ur Rehman
Published: August 2019

Focal cryptogenic organizing pneumonia (FOP) is a localized form of cryptogenic organizing pneumonia (COP). It is an uncommon clinicopathological entity associated with non‐specific symptoms and radiographic findings simulating lung malignancy. Incidence of idiopathic FOP is not known and only reported as case series. Its treatment usually involved surgical resection. Here, we report a case of a 62‐year‐old female presenting with a history of dyspnoea, persistent paroxysms of dry cough, and low‐grade fever of three weeks duration with a solitary consolidation on imaging. Computed tomography‐guided biopsy showed an organizing pneumonia pattern. A therapeutic trial with prednisolone resulted in resolution without the need for surgical resection, without recurrence after follow‐up for 12 months.
Neural adaptive global stability control for robot manipulators with time‐varying output constraints
Authors: Fan Yongqing , Kang Tongtong , Wang Wenqing , Yang Chenguang
Published: August 2019

In this paper, a novel adaptive control scheme is proposed based on radial basis function neural network (RBFNN). The considered system is deduced by the structure of RBFNN with nonzero time‐varying parameter that installed in the fore‐end and terminal of RBFNN. With this structure and the Taylor expansion of any smooth continuous nonlinear function, a universal approximation of RBFNN is addressed according to the analysis of the character of continuous homogenous function and the Euler's theorem. The approximation accuracies can be adjusted online by the nonzero time‐varying parameter in the device with the degree of continuous homogenous function, which expand the semiglobally stability to global stability over conventional neural controller design approaches. Based on the theory analysis of barrier Lyapunov function, the violation of time‐varying constraints can be subjugated without wrecked. Finally, simulation results are carried out to verify the effectiveness by the design methods.
Predicting Functional Responses of Progenitor Cell Exosome Potential with Computational Modeling
Authors: Trac David , Hoffman Jessica R. , Bheri Sruti , Maxwell Joshua T. , Platt Manu O. , Davis Michael E.
Published: August 2019

Congenital heart disease can lead to severe right ventricular heart failure (RVHF). We have shown that aggregated c-kit+ progenitor cells (CPCs) can improve RVHF repair, likely due to exosome-mediated effects. Here, we demonstrate that miRNA content from monolayer (2D) and aggregated (3D) CPC exosomes can be related to in vitro angiogenesis and antifibrosis responses using partial least squares regression (PLSR). PLSR reduced the dimensionality of the data set to the top 40 miRNAs with the highest weighted coefficients for the in vitro biological responses. Target pathway analysis of these top 40 miRNAs demonstrated significant fit to cardiac angiogenesis and fibrosis pathways. Although the model was trained on in vitro data, we demonstrate that the model can predict angiogenesis and fibrosis responses to exosome treatment in vivo with a strong correlation with published in vivo responses. These studies demonstrate that PLSR modeling of exosome miRNA content has the potential to inform preclinical trials and predict new promising CPC therapies. Stem Cells Translational Medicine  2019;8:1212–1221
Quantifying degrees of necessity and of sufficiency in cause‐effect relationships with dichotomous and survival outcomes
Authors: Gleiss Andreas , Schemper Michael
Published: August 2019

We suggest measures to quantify the degrees of necessity and of sufficiency of prognostic factors for dichotomous and for survival outcomes. A cause, represented by certain values of prognostic factors, is considered necessary for an event if, without the cause, the event cannot develop. It is considered sufficient for an event if the event is unavoidable in the presence of the cause. Necessity and sufficiency can be seen as the two faces of causation, and this symmetry and equal relevance are reflected by the suggested measures. The measures provide an approximate, in some cases an exact, multiplicative decomposition of explained variation as defined by Schemper and Henderson for censored survival and for dichotomous outcomes.

The measures, ranging from zero to one, are simple, intuitive functions of unconditional and conditional probabilities of an event such as disease or death. These probabilities often will be derived from logistic or Cox regression models; the measures, however, do not require any particular model.

The measures of the degree of necessity implicitly generalize the established attributable fraction or risk for dichotomous prognostic factors and dichotomous outcomes to continuous prognostic factors and to survival outcomes. In a setting with multiple prognostic factors, they provide marginal and partial results akin to marginal and partial odds and hazard ratios from multiple logistic and Cox regression.

Properties of the measures are explored by an extensive simulation study. Their application is demonstrated by three typical real data examples.