bluuebunny/crossref_metadata_2025 huggingface dataset:
Late presentation of left atrial appendage erosion and perforation by an Amplatzer™ Amulet™ closure device: a case report
Authors: Wilkins Ben , Carranza Christian L , Søndergaard Lars , De Backer Ole
Published: May 2020

Background

Percutaneous left atrial appendage (LAA) closure may reduce the risk of cardioembolic stroke in patients with non-valvular atrial fibrillation. Given the prophylactic nature of the procedure, identifying and managing complications are paramount.

Case summary

A 73-year-old man presented 14 months after percutaneous LAA closure with syncope and acute pericardial tamponade which required surgical exploration and haemostasis; the most temporally remote account of this complication albeit amongst very few case reports. Tissue erosion by the Amplatzer™ Amulet™ LAA closure device (Abbott, Plymouth, MN, USA) was noted at two separate anatomical locations, corresponding to the device disc and lobe, which has not been described previously.

Discussion

This case report highlights the anatomical relationship between the LAA and its surrounding structures, and the importance of recognizing the risk of late device erosion.
Infectious stentitis after treatment of coarctation of the aorta: a case report
Authors: van der Zwaan Heleen B , Sieswerda Gertjan Tj , Krings Gregor J , Voskuil Michiel
Published: May 2020

Background

Aortitis is a rare condition that can be caused by inflammatory or infectious aetiologies. The clinical presentation of aortitis includes a heterogeneous range of symptoms and clinical signs.

Case summary

We present a 53-year-old man whose medical history included presence of a ventricular septal defect, a bicuspid aortic valve, and coarctation of the aorta. The coarctation was treated with percutaneous stent implantation. One and a half years later, he presented to our hospital with complaints of fatigue, night sweats, and shivers. Physical examination revealed a fever, tachycardia, and hypertension. Imaging studies showed no signs of endocarditis. Positron emission tomography–computed tomography (PET–CT) showed an increase in 18F-fluorodeoxyglucose uptake at the distal end of the stent in the descending aorta. Blood cultures revealed a Streptococcus gordonii and antibiotic treatment was adjusted accordingly. The patients’ functional status improved quickly, the fever resolved, and the laboratory markers of inflammation returned to normal.

Discussion

Aortitis is extremely rare after stent implantation. Risk factors for aortitis include congenital vascular malformation and stent implantation. Computed tomography is currently the imaging study of choice for aortitis, while PET–CT seems ideal for identification of stent infection. Mortality associated with infectious aortitis ranges from 21% to 44%, with generally higher mortality if managed with antibiotics alone. The differential diagnosis of stent infection should be taken into account in patients presenting with fever and chills after previous stent procedures.
False-positive troponin elevation due to an immunoglobulin-G-cardiac troponin T complex: a case report
Authors: Akhtar Zaki , Dargan James , Gaze David , Firoozi Sami , Collinson Paul , Shanmugam Nesan
Published: May 2020

Background

Troponin is a crucial biomarker for the diagnosis of an acute coronary syndrome (ACS). It rises in response to myocardial injury from significant acute myocardial ischaemia caused by obstructive coronary artery disease [‘classical’ myocardial infarction (MI)]. However, raised levels have also been noted in conditions not recognized as classical ACS. This may include MI with non-obstructed coronary arteries such as takotsubo cardiomyopathy and other acute or chronic conditions such as pulmonary embolus or chronic kidney disease. This is commonly labelled as a ‘falsely elevated’ troponin although there is some myocardial strain to explain the rise, such as an increase in cardiac oxygen demand. True ‘falsely elevated’ troponin, characterized by a persistent elevation in the absence of cardiac injury does occur and thought to be secondary to an immunoglobulin-troponin complex (macrotroponin).

Case summary

A 53-year-old gentleman with a background of diabetes, hypertension, hypercholesterolaemia, and hepatitis B was admitted with chest pain and persistently elevated cardiac troponin T (cTnT) levels. Investigations revealed unobstructed coronary arteries and a structurally normal, well-functioning heart. Subsequent biochemical analysis found the persistently elevated cTnT secondary to macrotroponin T.

Discussion

Macrotroponin, an immunoglobulin-troponin bound complex should be considered as a differential diagnosis when the biochemistry is not reflective of the clinical picture. Early recognition requires effective collaboration with the biochemistry laboratory for accurate diagnosis.
The mysterious needle in the heart: a case report
Authors: Mahon Ciara , Gatehouse Peter , Baksi John , Mohiaddin Raad H
Published: May 2020

Background

A 53-year-old female with dyspnoea and atypical chest pain. Her electrocardiogram demonstrated a left bundle branch block, transthoracic echocardiogram demonstrated a mildly impaired left ventricle ejection fraction, and coronary angiogram revealed unobstructed coronary arteries. She was referred for cardiovascular magnetic resonance (CMR) for structural and functional assessment. Her imaging revealed an unexpected finding of an off-resonance artefact within the ventricle wall. This material was secondary to a ferromagnetic material.

Case summary

Chest X ray and computer tomography confirmed a needle-shaped structure in the ventricle wall. Understanding the basis of this off-resonance artefact aided in a new diagnosis, raised questions on the origin of the material, patient safety, and implementation of corrective strategies to optimize image acquisition.

Discussion

The continued development of CMR is revolutionizing our ability to establish diagnosis and guide patient treatment. The CMR sequences can be prone to artefact. This case highlights the importance of understanding the basis of CMR artefacts.
Cardiac tamponade due to ruptured coronary-pulmonary artery fistula aneurysm: a case report
Authors: Hijikata Sadahiro , Sakurai Kaoru , Maeba Satoru , Azegami Koji
Published: May 2020

Background

Coronary artery fistulas are rare and most commonly asymptomatic; however, they can become enlarged and rupture in some cases.

Case summary

We report a case of a 51-year-old woman who was brought to our hospital unconscious in an ambulance. Cardiac tamponade caused by the rupture of an aneurismal coronary-pulmonary artery fistula (CPAF) was detected by contrast-enhanced computed tomography and confirmed by invasive coronary angiography. Due to prompt diagnosis and subsequent surgical intervention, the patient’s condition was rapidly improved, and she was discharged from the hospital.

Discussion

Coronary-pulmonary artery fistula aneurysm rupture requires rapid diagnosis and treatment, and thus, in cases with cardiac tamponade and coronary aneurysm, CPAF aneurysm rupture should be considered.
Mechanical tricuspid balloon ‘valvuloplasty’ in a prohibitive risk patient with cardiogenic shock: a case report
Authors: Hanna Nader , Carmona Andres , Crespo Hector , Cubeddu Roberto J
Published: May 2020

Background

We present a complex case of a failing tricuspid mechanical valve prosthesis in a patient with refractory cardiogenic shock at prohibitive risk for surgery in whom balloon ‘valvuloplasty’ resulted in immediate haemodynamic improvement in valve function.

Case summary

A 67-year-old woman with remote history of endocarditis s/p tricuspid valve repair and mechanical aortic valve replacement was referred for second opinion and management of new severe symptomatic tricuspid valve stenosis resulting in progressive debilitating congestive heart failure (HF). The patient was approved by the heart team to undergo redo open heart for surgical repair of the tricuspid valve. Intraoperative technical challenges were met to repair the tricuspid valve. In turn, the native valve was resected and a 33 mm On-X mechanical valve prosthesis. The patient’s post-operative course was complicated by recurrent haemoptysis, prolonged mechanical respiratory support, acute kidney injury, and cardiogenic shock. Surgical re-exploration to address the dysfunctional mechanical tricuspid valve was felt to be prohibitive. Structural heart team was consulted. Cardiac catheterization was recommended to ascertain and confirm findings. The patient was transferred to the cardiac catheterization laboratory. Initial fluoroscopic examination of the heart confirmed the echocardiographic results of an immobile septal leaflet of the recently implanted mechanical tricuspid valve. An 8 × 40 mm Mustang OTW angioplasty balloon was then advanced across the mechanical valve and inflated gradually at nominal pressure. A single inflation resulted in successful restoration of valve leaflet function.

Discussion

To the best of our knowledge, this is the first balloon ‘valvuloplasty’ on a mechanical On-X valve in the tricuspid position.
Zero-iodinated contrast retrograde percutaneous coronary interventions of chronic total occlusions using gadolinium and imaging guidance: a case report of a patient with severe anaphylaxis to iodinated contrast
Authors: Gupta Ankur , Neupane Saroj , Basir Mir , Alaswad Khaldoon
Published: May 2020

Background

Gadolinium-based contrast agents have been used as an alternative to iodinated contrast agents for simple percutaneous coronary interventions (PCIs) in patients with obstructive coronary artery disease. Their use has been limited in complex PCI due to poor image quality with gadolinium contrast. Significant dilution of gadolinium is required in an effort to avoid malignant ventricular arrhythmias. Further, the recommended amount of gadolinium contrast that can be used is very limited.

Case summary

We describe a case of patient with severe anaphylaxis to iodinated contrast agents despite pre-exposure prophylaxis with steroids and histamine blockers who underwent intravascular imaging-guided PCI of chronic total occlusions (CTOs) of left anterior descending and dominant left circumflex arteries using gadolinium contrast.

Discussion

In patients with anaphylaxis to iodinated contrast agents (i) complex coronary interventions including CTO PCI can be successfully performed without use of iodinated contrast, and (ii) combination of intravascular ultrasound guidance and gadolinium-based contrast agents can be safely and effectively used to perform complex PCI.
A case report of an iatrogenic coronary cameral fistula treated by retrograde percutaneous coronary intervention
Authors: Ohayon Paul , Matta Anthony , Boudou Nicolas
Published: May 2020

Background

Acquired coronary cameral fistula is an extremely rare condition that involves an abnormal communication between a coronary artery and a cardiac chamber. It usually occurs after chest trauma or cardiovascular interventions, such as percutaneous coronary intervention (PCI) and is associated with various outcomes, ranging from a stable status to haemodynamic instability. Acquired coronary cameral fistula frequently arises from the right coronary artery and drains generally into the right ventricle.

Case summary

We report the unusual case of a 56-year-old male patient referred to an invasive cardiology centre for a suspected left anterior descending (LAD) coronary–left ventricular (LV) fistula resulting from a primary PCI for an anterior ST-elevation myocardial infarction. Here, the confirmed LAD–LV fistula was successfully treated by retrograde PCI with covered stent implantation. Clinical and angiographic outcomes were favourable at 1-month follow-up.

Discussion

Coronary cameral fistula can be a severe complication of primary PCI. Various treatment strategies can be considered based on haemodynamic status and anatomical features. In the case described herein, the use of a retrograde approach led to permanent fistula closure and complete revascularization.
Cardioembolic stroke in a young male with cor triatriatum sinister: a case report
Authors: Amara Richard S , Lalla Rakhee , Jeudy Jean , Hong Susie Nam
Published: May 2020

Background

Cor triatriatum sinister (CTS) is a rare congenital cardiac anomaly defined by a fibromuscular membrane which bisects the left atrium. Cor triatriatum sinister has been associated with cardioembolic stroke through mechanisms including stagnation of blood flow within the left atrium, an association with atrial fibrillation (AF), and/or an accompanying atrial septal defect (ASD) or patent foramen ovale. We describe a case highlighting the role that CTS may play in cardioembolic stroke, provide high-quality computed tomography angiography and two- and three-dimensional echocardiography of the CTS membrane, and outline management strategies for this uncommon clinical scenario.

Case summary

A 35-year-old man with no prior medical history presented with acute onset weakness and aphasia. He was found to have an embolic stroke with left M1 and A1 occlusions and received tissue plasminogen activator followed by mechanical thrombectomy with successful recanalization. A thorough stroke workup revealed CTS with an associated ASD as well as potential protein C deficiency. He was managed with indefinite anticoagulation with apixaban.

Discussion

This is the 13th reported case of CTS associated with stroke. In most previous cases evidence of blood stasis or frank thrombus was associated with the CTS membrane, and/or existing AF was noted. In this case, none of these were identified, particularly highlighting the surreptitious risk of CTS. In addition, the presence of potential protein C deficiency in this case compounded the risk for thromboembolism and factored into multidisciplinary management decisions.
A case report of a coronary myocardial bridge with impaired full-cycle ratio during dobutamine challenge
Authors: Usui Eisuke , Maehara Akiko , Ali Ziad A , Moses Jeffrey W
Published: May 2020

Background

A myocardial bridge (MB) is a coronary variant in which an epicardial coronary artery tunnels through the myocardial band. Although MBs have been reported to cause ischaemia, physiological assessment of an MB has not been fully established.

Case summary

We encountered a case with exertional chest pain who underwent coronary angiography showing an MB at the mid-left anterior descending artery with systolic compression. Optical coherence tomography showed an MB defined as a homogeneous intermediate intensity surrounding the epicardial artery. The full-cycle ratio, defined as the lowest ratio of distal coronary pressure (Pd) to aortic pressure (Pa) during the entire cardiac cycle, measured 0.89 at rest and 0.73 with intravenous dobutamine of 20 µg/kg/min with a distinctive waveform pattern (early diastolic Pd drop) during a dobutamine challenge. Metoprolol succinate dosage was increased. The patient has been free from chest pain for 7 months after the discharge.

Discussion

Optical coherence tomography may contribute to anatomical detections of MBs. Because a systolic compression of the MB and release of the vascular lumen during early diastole leads to an early steep pressure loss, early diastolic Pd drop should be one of the specific haemodynamic characteristics of MBs. On the other hand, in a severe atherosclerotic stenosis, Pd drop is typically observed in late diastole, which could be differentiated from that of MBs. Because full-cycle ratio reflects the whole cardiac cycle including early diastole, this might be more useful than other physiological indices for detection of MB-related ischaemia induced by a dobutamine challenge.
The Allocation of International Responsibility between International Organizations and Their Member States: A Case of Indirect Responsibility?
Authors: Ahlborn Christiane
Published: May 2020

While the responsibility of international organizations and their member states has been on the agenda of courts and scholars for decades, the adoption of the Articles on the Responsibility of International Organizations (ARIO) by the International Law Commission in 2011 has given new impetus to the debate. Nikolaos Voulgaris’ Allocating International Responsibility between Member States and International Organizations is one of the few general books on the topic that post-dates the adoption of the ARIO. Despite its broad title, however, the focus of the book is rather narrow: it concentrates on the responsibility of an international organization or a state in connection with the act of a/another state or international organization, which Voulgaris describes as ‘indirect responsibility’. Considering the book’s extensive discussion of the function and nature of international responsibility, this review essay first submits that the book’s actual aim is a rethinking of indirect responsibility. Second, it examines Voulgaris’ reconceptualization of the pertinent provisions on indirect responsibility in terms of what he calls the ‘complicity’ and ‘derivative responsibility’ models. This review essay concludes that the reader who expects detailed guidance on the allocation of responsibility between international organizations and their member states will be left wanting. Instead, the interaction between international organizations and their member states serves as an illustration for the book’s insightful analysis of the under-theorized provisions on international responsibility in connection with the act of another.
Effects of Metformin on Life Span, Cognitive Ability, and Inflammatory Response in a Short-Lived Fish
Authors: Wei Juntong , Qi He , Liu Keke , Zhao Changsheng , Bian Yan , Li Guorong
Published: May 2020

Metformin, an oral antidiabetic drug, prolongs the life span in nematode, silkworm, and other transgenic rodents, but its effects on longevity and aging-related cognitive ability using natural aging vertebrate models remain poorly understood. The genus of annual fish Nothobranchius show accelerated growth and expression of aging biomarkers. Here, using the short-lived fish Nothobranchius guentheri, we investigated effects of metformin on life span and aging-related cognitive ability and inflammation. Total of 145 fish, 72 fish were fed with metformin in the concentration of 2 mg/g food and 73 fish without metformin from 16 weeks of age until the end of their lives. The chronic feeding with metformin prolonged the life span of the fish and delayed aging with retarded accumulation of lipofuscin in liver, senescence-associated beta-galactosidase (SA-β-gal) activity in skin and serum levels of cholesterol and triglyceride significantly in the 10-month-old fish. Furthermore, metformin improved motor, learning, and memory skills by behavior tests accompanying with reduction of SA-β-gal activity and neurofibrillary degeneration and inhibition of inflammatory response including downregulated NF-κB and proinflammatory cytokines IL-8, TNF-α, and IL-1β expression and enhanced anti-inflammatory cytokine IL-10 level in brain. These findings demonstrate that metformin prolongs the life span and exerts neuroprotective and anti-inflammation function to improve cognitive ability in annual fish. It might be an effective strategy by using metformin to raise the possibility of promoting healthy aging of old population in aging process.
Imbalance Between Omega-6- and Omega-3-Derived Bioactive Lipids in Arthritis in Older Adults
Authors: Coras Roxana , Pedersen Brian , Narasimhan Rekha , Brandy Anahy , Mateo Lourdes , Prior-Español Agueda , Kavanaugh Arthur , Armando Aaron M , Jain Mohit , Quehenberger Oswald , Martínez-Morillo Melania , Guma Monica
Published: May 2020

Elderly-onset rheumatoid arthritis (EORA) and polymyalgia rheumatica (PMR) are common rheumatic diseases in older adults. Oxylipins are bioactive lipids derived from omega-6 (n-6) and omega-3 (n-3) polyunsaturated fatty acids (PUFAs) that serve as activators or suppressors of systemic inflammation. We hypothesized that arthritis symptoms in older adults were related to oxylipin-related perturbations. Arthritis in older adults (ARTIEL) is an observational prospective cohort with 64 patients older than 60 years of age with newly diagnosed arthritis. Patients’ blood samples at baseline and 3 months posttreatment were compared with 18 controls. A thorough clinical examination was conducted. Serum oxylipins were determined by mass spectrometry. Data processing and statistical analysis were performed in R. Forty-four patients were diagnosed with EORA and 20 with PMR. At diagnosis, EORA patients had a mean DAS28CRP (Disease Activity Score 28 using C-reactive protein) of 5.77 (SD 1.02). One hundred percent of PMR patients reported shoulder pain and 90% reported pelvic pain. Several n-6- and n-3-derived oxylipin species were significantly different between controls and arthritis patients. The ratio of n-3/n-6 PUFA was significantly downregulated in EORA but not in PMR patients as compared to controls. The top two candidates as biomarkers for differentiating PMR from EORA were 4-HDoHE, a hydroxydocosahexaenoic acid, and 8,15-dihydroxy-eicosatrienoic acid (8,15-diHETE). The levels of n-3-derived anti-inflammatory species increased in EORA after treatment. These results suggest that certain oxylipins may be key effectors in arthrtis in older adults and that the imbalance between n-6- and n-3-derived oxylipins might be related to pathobiology in this population.
More Than Just a Room: A Scoping Review of the Impact of Homesharing for Older Adults
Authors: Martinez Laura , Mirza Raza M , Austen Andrea , Hsieh Jessica , Klinger Christopher A , Kuah Michelle , Liu Anna , McDonald Lynn , Mohsin Rida , Pang Celeste , Rajewski Jennifer , Salomons Tonya , Sheikh Iqra
Published: May 2020

Background and Objectives

“Aging in place” is commonly defined as the ability to remain living safely and independently for as long as possible either in the home or community of one’s choosing. Yet, the literature indicates that older adults prefer to remain specifically in their own homes. Homesharing, an innovative exchange-based housing approach, is a means by which older adults can obtain additional income, companionship, and assistance by renting out a room to a home seeker, potentially increasing capacity to remain living independently in their homes. But what is known about their experiences of homesharing?

Research Design and Methods

A scoping review was conducted to map and consolidate the literature related to the experience of homeshare participation for adults aged 55 and older published from 1989 to 2018. Fifteen databases were searched, including 3 medical, 5 social science, and 7 gray literature databases. Following abstract and full-text review, 6 sources were retained for study inclusion. Thematic content analysis was used to identify major themes.

Results

Within included studies, 4 major themes were identified: (i) benefits of homeshare participation for older adults; (ii) challenges of participating in homeshare for older adults; (iii) intergenerational engagement as social exchange; and (iv) the key role of agency facilitation.

Discussion and Implications

Findings were used to derive practice, policy, and research implications. By focusing on older adults and the ways homesharing impacts their lives, we can better determine the viability of homeshare as a means for improving and prolonging experiences of living at home.
Property RD and Hypercontractivity for Orthogonal Free Quantum Groups
Authors: Brannan Michael , Vergnioux Roland , Youn Sang-Gyun
Published: May 2020

We prove that the twisted property RD introduced in [ 2] fails to hold for all non-Kac type, non-amenable orthogonal free quantum groups. In the Kac case we revisit property RD, proving an analogue of the $L_p-L_2$ non-commutative Khintchine inequality for free groups from [ 29]. As an application, we give new and improved hypercontractivity and ultracontractivity estimates for the generalized heat semigroups on free orthogonal quantum groups, both in the Kac and non-Kac cases.
Direct Analysis of Glyphosate, Glufosinate, and Their Metabolites in Palm Oil Using Liquid Chromatography with Tandem Mass Spectrometry
Authors: Shinde Raviraj , Halim Norizah , Banerjee and Kaushik
Published: May 2020

Background

Glyphosate and glufosinate are broad-spectrum herbicides which are frequently used in palm oil plantations for weed control. Metabolites of these herbicides are known to have environmental and food safety implications. As there is no validated method for multiresidue testing of these herbicides and their metabolites in palm oil products, a new method was needed for the purpose of regulatory analysis.

Objective

In this study, we endeavored to develop a rapid method for multiresidue analysis of glyphosate (+aminomethylphosphonic acid) and glufosinate (+3-methylphosphinicopropionic acid and N-acetyl-glufosinate) in refined and crude palm oil matrices using liquid chromatography (LC) tandem mass spectrometry (MS/MS).

Method

The optimized sample preparation workflow included extraction of refined or crude palm oil (10 g) with acidified water (0.1 M HCl), cleanup by phase separation with dichloromethane, and analysis by LC-MS/MS with multiple reaction monitoring.

Results

The use of a Torus-DEA LC column ensured simultaneous analysis of these compounds within a runtime of 10 min. The LOQ of these analytes was 0.01 mg/kg, except that of aminomethylphosphonic acid which was 0.02 mg/kg. The method sensitivity complied with the national maximum residue limits of Malaysia and the European Union. Also, the method selectivity, sensitivity, accuracy, and precision were aligned with the SANTE/12682/2019 guidelines of analytical quality control.

Conclusions

The potentiality of the optimized method lies in a high throughput direct analysis of glyphosate and glufosinate with their metabolites in a single chromatographic run. The method is fit for purpose for regulatory testing of these residues in a broad range of palm oil matrices.

Highlights

The study reports for the first time a validated method for simultaneous analysis of glyphosate, glufosinate, and their metabolites in a range of palm oil products. The method did not require a derivatization step and provided a high throughput analysis of these compounds with satisfactory selectivity, sensitivity, accuracy, and precision.
Adjuvant treatment of endometrial cancer today
Authors: Aoki Yoichi , Kanao Hiroyuki , Wang Xipeng , Yunokawa Mayu , Omatsu Kohei , Fusegi Atsushi , Takeshima Nobuhiro
Published: May 2020

Endometrial cancer frequently occurs in post-menopausal women, and the endometrium is a well-known site of cancer affecting women. Endometrial cancer is found with genital bleeding and often at an early stage. However, there are some risks of recurrence after hysterectomy. As a medical treatment after the diagnosis of endometrial cancer, appropriate adjuvant therapy is considered to lead to a decrease in the rate of recurrence and improvement of prognosis according to the determination of the cancer stage from the surgical and histopathological results. In this review, we describe post-operative adjuvant therapy administered for endometrial cancer and advanced disease, focusing on chemotherapy, radiation therapy and the combination of both. These treatments are divided according to the risk of recurrence as based primarily on the reported evidence.
Observation of exopolysaccharides (EPS) from Lactobacillus helveticus SBT2171 using the Tokuyasu method
Authors: Kamigaki Takamichi , Ogawa Akihiro
Published: May 2020

Some species of lactic acid bacteria used for the production of natural cheese produce exopolysaccharides (EPS). Electron microscopy is useful for analyzing the microstructure of EPS produced by lactic acid bacteria. However, pretreatments used to observe the microstructure of EPS by electron microscopy, such as dehydration and resin embedding, can result in EPS flowing out easily from the cell. Therefore, in this study, the Tokuyasu method was conducted on cryosection to reduce EPS outflow. Two types of observation method, namely, using lectin and ruthenium red, were conducted in an attempt to observe EPS produced by Lactobacillus helveticus SBT2171. Observation using the lectin method confirmed that colloidal gold particles conjugated with a lectin recognizing β-galactoside were present in the capsule. Structures that appeared to be β-galactoside-containing slime polysaccharides that were released from the cell wall were also observed. Observation using ruthenium red showed that capsular polysaccharides (CPS) in the capsule were present as a net-like structure. Colloidal gold conjugation with an anti-β-lactoglobulin antibody, in addition to ruthenium red staining, allowed the identification of slime polysaccharides released from the cell wall in the milk protein network derived from the culture medium. Based on these results, the Tokuyasu method was considered to be a useful pretreatment method to clarify and observe the presence of EPS. In particular, both CPS in the capsule and slime exopolysaccharides released from the cell wall were visualized.
Principlism’s Balancing Act: Why the Principles of Biomedical Ethics Need a Theory of the Good
Authors: Shea Matthew
Published: May 2020

Principlism, the bioethical theory championed by Tom Beauchamp and James Childress, is centered on the four moral principles of beneficence, non-maleficence, respect for autonomy, and justice. Two key processes related to these principles are specification—adding specific content to general principles—and balancing—determining the relative weight of conflicting principles. I argue that both of these processes necessarily involve an appeal to human goods and evils, and therefore require a theory of the good. A significant problem with principlism is that it lacks a theory of the good and consequently does not have an adequate solution to the problems of specification and balancing. My conclusion is that principlism must adopt some account of human well-being in order to be a satisfactory bioethical framework.
Performance, Satisfaction, or Loss Aversion? A Meso–Micro Assessment of Local Commitments to Sustainability Programs
Authors: Deslatte Aaron , Swann William L , Feiock Richard C
Published: May 2020

A normative assumption of government reform efforts such as New Public Management is that fostering a more innovative, proactive, and risk-taking organizational culture—developing what has been described as an “entrepreneurial orientation” (EO)—improves performance. But in arenas like urban sustainability, performance can be an ambiguous, multifaceted concept. Managers’ assessments of their own nimbleness, innovative thinking, and risk culture are also likely to influence how they interpret the risk-reward balance of opportunities to enhance organizational performance. This study examines how meso-level organizational decisions impact managers’ individual risk-assessments of sustainability initiatives. We do so through a combination of Bayesian structural equation modeling of US local government survey data collected over two time periods, and an artifactual survey experiment with empaneled local government employees. This multimethod design allows us to examine the role of organizational performance and EO—meso-level learning heuristics—in shaping the micro-foundations of managerial risk assessment. The organization-level observational results indicate that local governments engage in risk-seeking behavior in order to minimize their potential for losses of prior effort. Experimental results confirm local government administrators are loss-averse when asked to evaluate the merits of initiating a hypothetical sustainability program.
A rare case of signet ring cell carcinoma of the appendix
Authors: Caesar-Peterson Shannon , Tulla Katrina , Southall Colton , Lin Ying , Genelus-Dominique Elvita
Published: May 2020

Primary appendiceal carcinoma itself comprises less than 0.5% of all gastrointestinal malignant neoplasms. However, signet ring cell carcinoma of the appendix is an extremely rare subset of primary appendiceal carcinomas. This sub-type of appendiceal carcinoma represents only 4% of all appendiceal carcinomas. In this case report, we present a case of signet ring cell carcinoma found in a 65-year-old male patient which presented as acute appendicitis. He was diagnosed after a laparoscopic appendectomy by histopathological evaluation.
Tips for operation of inguinal hernia after implantation of artificial urinary sphincter following radical prostatectomy: report of two cases
Authors: Saito Ryusuke , Tanaka Naoki , Aizawa Takashi , Imoto Hirofumi , Yamamura Akihiro , Aoki Takeshi , Kawamorita Naoki , Musha Hiroaki , Ohnuma Shinobu , Motoi Fuyuhiko , Ito Akihiro , Kamei Takashi , Naitoh Takeshi , Unno Michiaki
Published: May 2020

Urinary incontinence is one of the common complications after radical prostatectomy along with inguinal hernia. Artificial urethral sphincter implantation is widely accepted as a treatment option. We report two surgical cases of inguinal hernia after artificial urethral sphincter implantation for urinary incontinence following radical prostatectomy. In Case 1, since the device went through the inguinal canal, adhesion around the pubis was extremely hard. In Case 2, the device was placed on the ventral side of the rectus abdominis muscle, so it was operable almost as normal. In each case, the surgical procedure was considered carefully after confirming the location of the device by preoperative computed tomography and ultrasonography. Hernia repair was successfully performed using the Lichtenstein method. There are few reports regarding surgical repair of inguinal hernia following artificial urinary sphincter implantation. Preoperative image and appropriate choice of approach could facilitate safe and secure surgery.
Incarcerated femoral hernia treated with elective totally extraperitoneal repair: a case report
Authors: Ninomiya Shigeo , Fujita Syunsuke , Ogawa Tadashi , Ueda Yoshitake , Shiraishi Norio , Inomata Masafumi , Shimoda Katsuhiro
Published: May 2020

Incarcerated groin hernia is a common surgical emergency. However, reports of incarcerated femoral hernia treated with elective totally extraperitoneal repair are extremely rare. A 62-year-old woman visited our hospital with lower abdominal pain and bulging from a right groin lesion. The patient was diagnosed as having right incarcerated femoral hernia containing greater omentum by computed tomography. As there were no clear findings of intestinal obstruction and peritonitis, elective surgery was performed. Intraoperatively, the hernia sac had herniated into the right femoral canal. We could release the hernia sac using laparoscopic forceps. After reduction of the hernia sac, polypropylene mesh was placed in the preperitoneal space and fixed to Cooper’s ligament. The patient’s postoperative course was uneventful, and she was discharged 3 days after surgery. We consider elective totally extraperitoneal repair for incarcerated femoral hernia to be an effective procedure for selected patients who have been diagnosed accurately.
Introduction
Authors: Baumann Antje , Pfitzner Tanja V
Published: May 2020

This introduction discusses arbitration as a method for resolving disputes. It first provides an overview of the advantages of arbitration as a dispute resolution mechanism and a brief historical background on the development of modern international arbitration before exploring the effects of arbitration agreements, taking into account the applicable law for the question of arbitrability (objective arbitrability and subjective arbitrability). It then considers two options between which parties can choose when deciding to settle their dispute by arbitration: institutional arbitration and ad hoc arbitration. It also analyses the parties’ right to choose—based on the principle of party autonomy—the place and language of arbitration, the substantive law applicable to the merits of the dispute, and number of arbitrators. Finally, it explains the applicable rules and general structure of arbitral proceedings as well as the enforceability of arbitral awards.
The International Centre for Dispute Resolution (ICDR) Rules
Authors: Gusy Martin F , Hosking James M , Schwarz Franz T
Published: May 2020

This chapter discusses the international arbitration rules of the International Centre for Dispute Resolution (‘ICDR’), the international arm of the American Arbitration Association (‘AAA’). It first provides a background on the AAA and the ICDR before analysing the ICDR’s International Dispute Resolution Procedures and the significant revisions to the ICDR Rules. It then offers a commentary on some key Articles of the ICDR Rules and explains how the ICDR Rules differ from those of other arbitral institutions. The comments particularly highlight the 2014 amendments and cover topics such as the scope of the ICDR Rules; joinder and consolidation; appointment of the arbitral tribunal; arbitral jurisdiction; arbitral awards, orders, decisions and rulings; and costs of arbitration. The chapter concludes with an overview of other important AAA/ICDR innovations, rules and practices, including those with regard to international expedited procedures, administrative conferences, appointment and qualifications of the arbitrator, and the arbitral award.
Islamic Project Finance
Authors: Dewar John , Hussain Munib
Published: May 2020

Islamic finance is concerned with the conduct of commercial and financial activities in accordance with Islamic law. Structuring the investment of such capital, therefore, requires a comprehensive understanding of Islamic finance principles, knowledge of international and domestic laws, and documenting such arrangements in a manner that satisfies the priorities of all the project participants, including those not necessarily constrained by Islamic finance principles. This chapter analyses how these priorities are accommodated and how Islamic finance techniques are applied in project financings. It begins with a discussion of the sources of Islamic finance. This is followed by a brief analysis of the principles and financing techniques that underpin Islamic finance. Then, it assesses how Islamic project finance techniques are utilized in practice, including how such arrangements are documented.
Ancillary Finance Documentation
Authors: Thompson Rob , Holmes Patrick
Published: May 2020

This chapter examines some of the myriad types of financial support given to a project by its sponsors and the way that support is provided. It also considers the types of assets over which security is taken to ensure that the senior lenders’ claims against the project are indeed senior to the claims of the sponsors; the contractual documentation between the senior lenders and the counterparties to the principal commercial contracts in relation to the project which (should things go wrong) allow the senior lenders to ‘step into’ the project company’s contractual shoes and thereby take control of the project in order to protect their commercial interests; and the way in which formal legal opinions are used in relation to a project financing as a means of confirming the extent to which the contractual arrangements for the project operate as the different parties and groups of parties intend.
The UK Financial Regulators
Authors: Russen Jonathan , Kingham Robin
Published: May 2020

This introductory chapter traces the evolution of the UK financial regulatory system and provides an overview of the UK financial regulators. Following the introduction of the Financial Services Act 1986, the Securities and Investments Board (SIB) was established as the primary UK financial regulatory authority. However, a series of scandals shook the sector in the 1990s and brought public confidence in the SIB into question. The era of self-regulation was over. The SIB was renamed the Financial Services Authority (FSA) in 1997 and, in December 2001, the FSA received a host of new powers through the commencement of the Financial Services and Markets Act 2000 (FSMA). Subsequently, the Financial Services Act 2012 significantly amended the FSMA, abolishing the FSA and creating in its place two new regulators: the Financial Conduct Authority (FCA) and the Prudential Regulation Authority (PRA). However, the FCA and the PRA are not the only UK financial regulators. Since 2001, the Financial Ombudsman Service (FOS) has acted as an adjudicator in disputes between financial services firms and UK consumers. Other regulators with discrete or overlapping areas of responsibility include the Competition and Markets Authority (CMA), the Payment Systems Regulator (PSR), and the Panel on Takeovers and Mergers.
Regulation Through Authorisation and Approval
Authors: Russen Jonathan , Kingham Robin
Published: May 2020

This chapter addresses the manner in which the Financial Conduct Authority (FCA) and the Prudential Regulation Authority (PRA) control those operating within the financial services market in fulfilment of the statutory objectives set out in the previous chapter, by ensuring that appropriate standards of conduct and behaviour are met. What might loosely be described as a system of ‘licensing’ by the FCA and PRA is implemented at two levels. There is first the need for any firm conducting a regulated activity to be authorised by the relevant regulator. In granting such permission, and in their regulation of a firm following authorisation, the regulators adopt a system of prudential supervision and conduct of business regulation. The second level of regulation comes through the requirement for approval of individual members of the senior management within the firm, carrying out so-called ‘controlled functions’, which involves consideration of the status of ‘senior managers’ under Part V of the Financial Services and Markets Act 2000 (FSMA).
Civil Liability of Firms for Regulatory Breaches
Authors: Russen Jonathan , Kingham Robin
Published: May 2020

This chapter focuses on the potential exposure of authorised firms to civil liability for breach of FCA rules at the suit of aggrieved investors and customers. Recent years have seen a great increase in such litigation, often in the context of so-called ‘mis-selling’ claims—in reality, a descriptive term applied to a variety of cases in which a customer or investor claims that a financial product sold to him was misrepresented, was unsuitable for his purposes, or has subsequently dropped in value outside some reasonable range of expectations. The detailed and technical nature of the rules imposed by the FCA in its Handbook provides fertile ground for litigation. However, breach of statutory duty is only one of a number of potential avenues of attack open to an aggrieved customer or investor; such claims are also often brought in respect of negligence, misrepresentation, and breach of contract. The chapter then looks at the FCA’s Business Standards sourcebooks and provides an explanation of one of the potential consequences of certain regulatory breaches: the unenforceability of agreements.
Introduction
Authors: Busch Danny , Ferrarini Guido , Franx Jan Paul
Published: May 2020

This introductory chapter discusses the new prospectus regime of the European Union (EU). In particular, it delves into the Action Plan on Building a Capital Markets Union (CMU). The CMU Action Plan should make it easier for providers and receivers of funds to come into contact with one another within Europe, especially across borders. This is regardless of whether raising capital occurs through the intermediation of banks, through the capital markets or through alternative channels such as crowdfunding. In addition, more non-bank funding will help to lessen dependence on the traditional banking industry and enhance the ability of the system to cope with economic shocks. The chapter considers what it means for the CMU Action Plan in light of recent events such as Brexit, before turning to a brief overview of the following chapters.
Transferable Securities and the Scope of the Prospectus Regulation
Authors: Ferrarini Guido , Giudici Paolo
Published: May 2020

This chapter analyses the concept of transferable security in the Prospectus Regulation and tests the flexibility and latitude of this concept with reference to the recent phenomenon of Initial Coin Offerings (ICOs). It firstly examines MiFID's (Markets in Financial Instruments Directive 2004) definitions of financial instrument and transferable security, and then focuses on the latter with special regard to the Prospectus Regulation. The chapter subsequently introduces the ICO phenomenon and the categories of tokens that are issued through blockchain in practice. It goes on to consider the treatment of ICOs under US securities regulation and then focuses on whether tokens issued in ICOs qualify as transferable securities under the EU Prospectus Regulation. The chapter gives a positive answer not only with respect to investment tokens, but also to hybrid tokens which present an investment functionality. It concludes that in given circumstances also utility tokens could qualify as securities.
The Contents of the Prospectus
Authors: de Serière Victor
Published: May 2020

This chapter addresses the non-financial information to be included in a prospectus, alongside an analysis of the fundamental concept of materiality. It examines some issues relating to non-financial information to be included in a prospectus under the new EU prospectus regime. A level playing field in terms of uniform investor protection within the EU accordingly has regrettably not been achieved. This chapter argues that the Prospectus Regulation could have achieved more by requiring Member States to impose certain uniform tort law requirements in their national prospectus liability regimes. Another topic addressed in this chapter relates to the possibility for offerors of securities to obtain liability protection by including exoneration clauses in prospectuses. The Prospectus Regulation does not regulate this topic, but the analysis in this chapter shows that the possibilities appear to be severely limited; practice in any event shows that exoneration is seldom (if ever) stipulated. The chapter concludes that all this appears to be relatively good news in terms of investor protection generally, but the lack of harmonisation stands in the way of a unified EU capital markets union.
Prospectus Formats and Shelf Registration
Authors: Fischer-Appelt Dorothee
Published: May 2020

This chapter discusses prospectus formats and shelf registration. It reveals that the new EU prospectus rules introduce more flexibility and efficiency in the use of different prospectus formats. Different options for formats overlap even more than in the past and their use will depend on the frequency of issuances and instruments issued. The overlap between the uniform registration document (URD) and simplified prospectus will leave issuers to choose what best suits their needs, depending on how often, through which instruments and from which investors issuers seek to raise capital in future and the timing of financial disclosures. The cost of keeping an URD up-to-date for more frequent issuers and issuers requiring both equity and debt must be balanced with the utility of having different equity and debt securities registered. The option of filing annual and half-yearly reports under the Transparency Directive in the form of a URD may reduce costs for certain issuers. According to this chapter, the ‘frequent issuer status’ may in practice not offer much improvement on the service already provided by certain competent authorities, also considering the advance notice requirement. The chapter concludes that there is room for improving the URD system in future.