bluuebunny/crossref_metadata_2025 huggingface dataset:
Tomographic reconstruction of atmospheric gravity wave parameters from airglow observations
Authors: Song Rui , Kaufmann Martin , Ungermann Jörn , Ern Manfred , Liu Guang , Riese Martin
Published: April 2017

Abstract. Gravity waves (GWs) play an important role in atmospheric dynamics. Especially in the mesosphere and lower thermosphere (MLT) dissipating GWs provide a major contribution to the driving of the global wind system. Therefore global observations of GWs in the MLT region are of particular interest. The small scales of GWs, however, pose a major problem for the observation of GWs from space. We propose a new observation strategy for GWs in the mesopause region by combining limb and sub-limb satellite-borne remote sensing measurements for improving the spatial resolution of temperatures that are retrieved from atmospheric soundings. In our study, we simulate satellite observations of the rotational structure of the O2 A-band nightglow. A key element of the new method is the ability of the instrument or the satellite to operate in so called target mode, i.e. to stare at a particular point in the atmosphere and collect radiances at different viewing angles. These multi-angle measurements of a selected region allow for tomographic reconstruction of a 2-dimensional atmospheric state, in particular of gravity wave structures. As no real data is available, the feasibility of this tomographic retrieval is carried out with simulation data in this work. It shows that one major advantage of this observation strategy is that much smaller scale GWs can be observed. We derive a GW sensitivity function, and it is shown that target mode observations are able to capture GWs with horizontal wavelengths as short as ~ 50 km for a large range of vertical wavelengths. This is far better than the horizontal wavelength limit of 100–200 km obtained for conventional limb sounding.
Low pCO2 under sea-ice melt in the Canada Basin of the western
Arctic Ocean
Authors: Kosugi Naohiro , Sasano Daisuke , Ishii Masao , Nishino Shigeto , Uchida Hiroshi , Yoshikawa-Inoue Hisayuki
Published: April 2017

Abstract. In September 2013, we observed an expanse of surface water with low CO2 partial pressure (pCO2sea) (
Calibrating a wetland methane emission model with hierarchical modeling and adaptive MCMC
Authors: Susiluoto Jouni , Raivonen Maarit , Backman Leif , Laine Marko , Mäkelä Jarmo , Peltola Olli , Vesala Timo , Aalto Tuula
Published: April 2017

Abstract. Methane (CH4) emission estimation for natural wetlands is complex and the estimates contain large uncertainties. The models used for the task are typically heavily parametrized and the parameter values are not well known. In this study we perform a Bayesian model calibration for a new wetland CH4 model to improve quality of the predictions and to understand the limitations of such models. The detailed process model that we analyze contains descriptions for CH4 production from anaerobic respiration, CH4 oxidation, and gas transportation by diffusion, ebullition, and the aerenchyma cells of vascular plants. The processes are controlled by several tunable parameters. We use a hierarchical statistical model to describe the parameters and obtain the posterior distributions of the parameters and uncertainties in the processes with adaptive MCMC techniques. For the estimation, the analysis utilizes measurement data from the Siikaneva flux measurement site in Southern Finland. The model parameters are calibrated using six different modeled peat column depths, and the hierarchical modeling allows us to assess the effect of the parameters on an annual basis. The results of the calibration and their cross validation suggest that the early spring net primary production and soil temperatures could be used to predict the annual methane emissions. The modeled peat column depth has an effect on how much the plant transport pathway dominates the gas transport, and the optimization moved most of the gas transport from the diffusive pathway to plant transport. This is in line with other research, highlighting the usefulness of algorithmic calibration of biogeochemical models. Modeling only 70 cm of the peat column gives the best flux estimates at the flux measurement site, while the estimates are worse for a column deeper than one meter or shallower than 50 cm. The posterior parameter distributions depend on the modeled peat depth. At the process level, the flux measurement data is able to constrain CH4 production and gas transport processes, but for CH4 oxidation, which is an important constituent of the total CH4 emission, the determining parameter is not identifiable.
UTILIZAÇÃO DA CINZA DA CASCA DO COCO VERDE COMO SUBSTITUIÇÃO PARCIAL DO CIMENTO PORTLAND EM ARGAMASSAS
Authors: Carneiro Guimarães Cleidson , Raiza Carvalho Matos Samile
Published: April 2017

RESUMO: O presente trabalho tem como objetivo principal avaliar a influência da cinza da casca de coco verde (CCCV) nas propriedades das argamassas no estado fresco e endurecido, a partir da substituição parcial do cimento Portland (CP) por cinza. Esta proposta surge da problemática ligada à destinação da casca do coco como resíduo urbano e agroindustrial e dos impactos ambientais provocados pela produção do cimento Portland. Para realização dessa pesquisa foram produzidas uma argamassa de referência e outras três argamassas com diferentes teores de substituição do CP por CCCV. Inicialmente, foi feita a caracterização dos materiais utilizados no trabalho e a análise de índice de pozolanicidade da cinza. Em seguida, foram feitas análises referenciais das propriedades das argamassas produzidas no estado fresco e no estado endurecido. A partir das análises pode-se perceber que a presença da cinza na argamassa influencia na trabalhabilidade, resistência mecânica e na durabilidade da argamassa e que a CCCV não possui potencial pozolânico. A adição de até 10% de CCCV substituindo o cimento Portland é viável.

ABSTRACT: This study aims to evaluate the influence of ash green coconut shell (AGCS) on the properties of mortars in fresh and hardened, from the partial replacement of Portland cement (PC) by gray. This proposal arises from problems linked to the allocation of coconut shell as urban and agro-industrial waste and environmental impacts caused by the production of Portland cement. For this survey were produced a reference mortar and three mortars with different CP replacement levels by AGCS. Initially, it was the characterization of the materials used at work and ash pozzolanicity index analysis. Next, analyzes were made reference the properties of mortars produced in fresh and hardened state. From the analysis it can be seen that the ash presence in the mortar influences the workability, strength and durability of the mortar and the CCCV not have pozzolanic potential. The addition of up to 10% AGCS replacing the Portland cement is feasible.
PERCEPÇÃO DE CIDADÃOS DE UMA CIDADE DE MÉDIO PORTE EM RELAÇÃO AO USO DA BICICLETA COMO MODO DE TRANSPORTE
Authors: Ricieri Mariana Grade , Barbosa Fontenele Heliana , Prado Da Silva Junior Carlos Alberto
Published: April 2017

RESUMO: As cidades de porte médio no Brasil têm ocupado posição de destaque nos últimos anos. Porém, estas cidades têm seguido o mesmo caminho das cidades brasileiras mais populosas e negligenciado aspectos que garantam à manutenção das condições que favorecem investimentos públicos e principalmente privados. Em relação aos sistemas de transporte e logística, cada vez mais as cidades de porte médio têm se tornado dependente do uso do automóvel e evitado políticas de incentivo à mobilidade urbana sustentável. Desta forma, entender a percepção dos usuários dos sistemas de transporte urbano é fundamental para traçar medidas de incentivo para modos alternativos de viagens urbanas. O objetivo deste estudo é apresentar uma análise da percepção dos usuários quanto aos modos de deslocamento urbano, principalmente a bicicleta e medidas específicas de incentivo ao uso deste modo não motorizado. A pesquisa foi realizada por meio de entrevistas com um questionário impresso. As respostas possibilitaram obter a opinião sobre o uso da bicicleta como modo de transporte, caracterizar o perfil socioeconômico dos entrevistados e simular um cenário em relação ao uso da bicicleta. Para o caso específico deste estudo ficou evidente que os entrevistados são favoráveis ao uso da bicicleta e uma parcela está disposta a usar o ciclismo desde que sejam implantadas medidas de incentivo.

ABSTRACT: The medium-sized cities in Brazil have occupied a prominent position in the last years. However, these cities have followed the same path of the most populous Brazilian cities and have neglected aspects that guarantee the maintenance of the conditions that favor public and private investments. Regarding transport and logistics systems, more and more medium-sized cities have become dependent on the use of the car and have avoided policies to encourage sustainable urban mobility. In this way, understanding the users' perception of urban transport systems is fundamental to outline incentive measures for alternative modes of urban travel. The objective of this study is to present an analysis of the perception of the users regarding urban displacement modes, especially the bicycle and specific measures to encourage the use of this non-motorized mode. The research was conducted through interviews with a printed questionnaire. The answers made it possible to obtain the opinion about the use of the bicycle as a mode of transportation, characterize the socioeconomic profile of the interviewees and simulate a scenario regarding the use of the bicycle. For the specific case of this study it was evident that the interviewees are favorable to the use of the bicycle and a portion is willing to use the bicycle provided that incentive measures are implemented.
LAMA RESIDUAL DE USINAS DE CONCRETO: CARACTERÍSTICAS E APLICAÇÕES NA CONFECÇÃO DE BLOCOS
Authors: Martins De Paula Heber , Batista Bonfim Walter , Baldin Victor , Rodrigues Pereira Ruvier
Published: April 2017

RESUMO: A produção de concreto em usinas dosadoras está em crescimento e, com isso, há também o aumento de resíduos inerentes do processo produtivo. O objetivo deste artigo, é verificar o panorama das pesquisas relacionadas com a lama residual de concreto, com ênfase na sua reciclagem em unidades de alvenaria. Para tanto, foi realizado o mapeamento sistêmico com a finalidade de encontrar as principais publicações e estudos referentes a vertente desejada, através da base de dados Periódicos CAPES, sendo as buscas pertencentes a dois tópicos principais: utilização de resíduos em alvenarias de concreto e estudos relacionados com a lama residual de concreto. Em linhas gerais, pode-se observar que há uma grande variedade de resíduos aplicados em alvenarias, sendo o mais estudado a utilização de cinzas volantes e resíduos de construção e demolição. Em contrapartida, ainda são poucos os estudos que utilizam a lama residual em produtos de concreto, sobretudo para produção de alvenarias. Nesse contexto, entende-se que não há um consenso quanto à melhor utilização da lama residual de concreto, ressaltando a necessidade de pesquisas que corroborem ou contradigam os resultados obtidos. Por fim, esse trabalho aponta um resíduo ainda pouco estudado, mas com possíveis aplicações em novas pesquisas. Suas características como, por exemplo, presença de SiO2 e CaO apontam um potencial para uso como aglomerante, o que pode gerar uma redução no consumo de cimento.

ABSTRACT: The production of concrete in dosing plants is growing and, with this, there is also an increase of inherent residues of the production process. The objective of this paper is to verify the panorama of the research related to residual sludge of concrete with emphasis on its recycling in masonry units. In order to do so, the systemic mapping was performed with the purpose of finding main publications and studies referring to the desired slope, through the CAPES Periodic database, and the searches belong to two main topics: the use of residues in concrete masonry and studies related to concrete sludge waste. In general, it can be observed that there is a great variety of residues applied in masonry, being the most studied the use of fly ash and construction and demolition residues. On the other hand, there are still few studies that use residual sludge in concrete products, mainly for the production of masonry. In this context, it is understood that there is no consensus regarding the best use of concrete sludge waste, emphasizing the need for research to corroborate or contradict the results obtained. Finally, this work points to a residue that has not yet been studied, but with possible applications in new research. Its characteristics such as the presence of SiO2 and CaO indicate a potential for use as a binder, which can lead to a reduction in the consumption of cement.
COTAS ÉTNICO-RACIAIS COMO POLÍTICA DE REPARO
Authors: Tassia Ferreira de Freitas Samylla , Mara Santos Lemos de Oliveira Sandra , Cruvinel Beatriz , Corrêa Odineia , Neves Eva Luzia das
Published: April 2017

O presente artigo trata da análise dos resultados de uma pesquisa qualitativa/quantitativa desenvolvida junto aos arquivos da Coordenação de Registros Escolares. Dados quanto à cor/etnia de alunos que ingressaram antes e depois da lei 12.711/2012 começar a ser aplicada na instituição foram coletados a fim de observar o aumento ou diminuição de alunos negros e pardos no curso de agronomia do Instituto Federal Goiano, Campus Rio Verde. Esse levantamento foi realizado com finalidade estatística, como também suscitar a discussão sobre a exclusão racial e a indiferença de parte do universo acadêmico a esse respeito. Para tanto, utilizamos os teóricos Carvalho, Nascimento, Durham, Faria, Gonçalves, Hino, Santos e Kaczmarek no debate sobre cotas; Munanga, Neves, Silva e Barbosa com os conceitos de raça, etnia, cor e participação política; Boris e Prado Júnior para a formação do povo brasileiro. A população negra tem crescido significativamente, entretanto, continuam sendo minoria nos cursos de graduação. Cotas são instrumentos de justiça social para o ingresso no ensino superior e visam diminuir a insondável dívida da sociedade para com os negros. A criação de leis e decretos passou a garantir o ingresso do negro, assim como do pardo e do indígena nas instituições públicas de ensino superior, obedecendo outros critérios, como a procedência de escola pública e renda familiar per capita de no máximo 1,5 salários mínimos, sendo reservada a esse público 50% das vagas nas instituições federais de ensino. A política de reparo tem mostrado eficácia ao possibilitar o maior acesso de negros à graduação, oportunizando a ascensão social e reduzindo a elitização e o branqueamento visto historicamente no ensino superior. Embora medidas sociais tenham sido tomadas, ainda há muito que avançar e que democratizar quanto ao acesso e permanência, tornando a educação possível a todos, sem distinção. Palavras-chave: Acesso à universidade. Desigualdade social. Escravidão.
Postoperative Esotropia: Initial Overcorrection or Consecutive Esotropia?
Authors: Jeon Hyeshin , Choi Heeyoung
Published: April 2017

Purpose

To investigate the length of time required for diagnosing consecutive esotropia rather than initial overcorrection and examine risk factors for persistent postoperative esotropia after intermittent exotropia surgery.

Methods

This is a retrospective case series in a tertiary medical center. Fifty consecutive patients with postoperative esotropia ≥6 prism diopters at 1 week following exotropia surgery, managed with nonsurgical management and followed up for more than 6 months from 2014 to 2015, were included. Patients were allocated to 1 of 2 groups depending on whether the postoperative esotropia was resolved at 1 month after surgery. Patients with ongoing nonsurgical management were reevaluated monthly. Timing that significant resolution occurred was assessed. Clinical characteristics and motor and sensory successes were evaluated at 6 months after surgery.

Results

Thirty-two patients were allocated to group 1 and 18 to group 2. Significant resolution occurred between 1 week and 1 month after surgery. Patients were older and preoperative deviation at distance was larger in group 2 than in group 1 (p = 0.006 and 0.015). A significantly larger proportion of patients in group 2 showed combined vertical deviation (p = 0.019). Motor and sensory success rates were comparable.

Conclusions

When initial postoperative esotropia persists for more than 1 month, it should be regarded as consecutive esotropia. Older age, a larger preoperative deviation, and concurrent vertical deviation are risk factors for persistent postoperative esodeviations. Therefore, more postoperative attention should be given to these patients.
Relationship between Corneal Biomechanical Properties and Optic Nerve Head Changes after Deep Sclerectomy
Authors: Díez-Álvarez Laura , Muñoz-Negrete Francisco J. , Casas-Llera Pilar , Oblanca Noelia , de Juan Victoria , Rebolleda Gema
Published: April 2017

Purpose

To evaluate corneal biomechanical properties and optic nerve head (ONH) changes following deep sclerectomy (DS) and the relation to each other.

Methods

Forty-nine eyes with primary open-angle glaucoma that underwent DS were studied. Corneal biomechanical properties were assessed using the Ocular Response Analyzer and the ONH was evaluated by Spectralis optical coherence tomography with enhanced depth imaging technology before surgery and 3 months postoperatively. Changes in corneal hysteresis (CH), corneal resistance factor (CRF), optic nerve cupping, prelaminar tissue thickness, and lamina cribrosa depth and thickness were registered. A correlation matrix and multiple linear regression models were used to determine predictors of ONH changes.

Results

At 3 months after surgery, mean corneal compensated intraocular pressure (IOPcc) significantly decreased by 27.9% (p<00.001) and mean Goldmann-correlated IOP (IOPg) decreased by 30.52% (p<00.001). Mean CH increased and CRF decreased by 18.4% and 10.1%, respectively (p<00.001). There was a significant reversal of ONH cupping mainly due to a prelaminar tissue thickening (p<00.001). Significant associations were found between ONH cupping reversal and prelaminar tissue thickening with preoperative IOPcc (p = 0.046), IOPg (p = 0.02), and CRF (p = 0.002) and with changes in IOP, CH, and CRF (p<00.001, p = 0.004, p = 0.018, respectively) after surgery.

Conclusions

Corneal hysteresis increased and CRF decreased significantly 3 months after DS. Corneal resistance factor was the single largest preoperative factor influencing cupping reversal changes. Despite the influence of preoperative variables, postoperative IOP reduction was the only independent factor influencing changes observed in the ONH after surgery.
Prewound Assisted Technique for Hydrophobic Foldable Intraocular Lens Implantation
Authors: Shiba Takuya , Tsuneoka Hiroshi
Published: April 2017

Purpose

To describe a technique for intraocular lens (IOL) implantation that lessens the degree of surgical invasiveness by implanting a tightly rolled IOL through a small incision without touching the eye with the cartridge tip.

Methods

An IOL was inserted through an incision by first allowing the leading haptic to protrude slightly from the cartridge tip. It was then injected through the incision without allowing any part of the cartridge to touch the eye during IOL implantation. In one eye, the entire circumference of the beveled portion of the cartridge tip was inserted into the anterior chamber to implant the IOL, whereas in the other eye, the IOL was inserted through the incision by first allowing the leading haptic to protrude slightly from the cartridge tip. It was then injected through the incision without allowing any part of the cartridge to touch the eye during IOL implantation. We analyzed the incision width before and after IOL implantation and the degree of surgically induced astigmatism on the day after surgery and at 1 and 3 months after surgery.

Results

Using our technique, both the amount by which the wound was enlarged and the hydration rate were significantly lower compared with conventional IOL implantation. Our method enables IOL implantation to be carried out through a small incision at a width that was only previously possible with forcible insertion.

Conclusions

Our IOL implantation technique can be performed using both hands with no need to immobilize the eyeball.
Ahmed Valves vs Trabeculectomy Combined with Pans Plana Vitrectomy for Neovascular Glaucoma with Vitreous Hemorrhage
Authors: Wang Menghua H. , Li Qiuming M. , Dong Hongtao T. , Dong Shuqian Q. , Li Yang , Zheng Chunyan Y.
Published: April 2017

Purpose

Vitreous hemorrhage is common in advanced neovascular glaucoma (NVG), which has poor visual prognosis. This study aimed to compare the efficacy of 23-G pars planar vitrectomy (PPV) combined with either Ahmed glaucoma valve (AGV) implantation or trabeculectomy after intravitreal ranibizumab (IVR) treatment for NVG with vitreous hemorrhage.

Methods

This retrospective, nonrandomized study included 33 eyes of 33 patients with NVG with vitreous hemorrhage. After IVR treatment for 3-7 days, 18 eyes underwent PPV + AGV (AGV group) and 15 underwent PPV + trabeculectomy (trabeculectomy group). The success criterion was a postoperative intraocular pressure (IOP) of 6-21 mm Hg, with or without antiglaucoma medication.

Results

Postoperative IOP decreased significantly in both groups, but the mean IOP after 12 months was significantly lower in the AGV group (16.92 ± 2.75 mm Hg) than the trabeculectomy group (21.50 ± 5.79 mm Hg; p = 0.018). The AGV group required fewer glaucoma medications than the trabeculectomy group. The cumulative probabilities of surgical success rates for the AGV and trabeculectomy groups at 12 months were 71.3% and 46.7%, respectively. No significant differences in postoperative complications were observed between the groups.

Conclusions

For NVG with vitreous hemorrhage, PPV with AGV implantation may reduce IOP more effectively than PPV with trabeculectomy.
Long-Term Visual Outcomes in Children with Primary Congenital Glaucoma
Authors: Yassin Sanaa A.
Published: April 2017

Purpose

To determine the long-term visual outcomes and risk factors for visual loss in children with primary congenital glaucoma (PCG) who underwent angle surgery over a 21-year period.

Methods

This was a retrospective study of patients who underwent trabeculotomy, trabeculectomy, or combined trabeculotomy-trabeculectomy for PCG. Visual acuity (VA), surgeries, and underlying cause of visual impairment were recorded and compared. Main outcome measures were final best-corrected good VA (20/20 to 20/50), moderate VA (<20/50 to 20/200), or poor VA (<20/200); age at surgery, sex, laterality, type of initial glaucoma surgery, and number of surgeries were recorded.

Results

Fifty-three eyes were eligible to be included in the study. The mean logMAR VA was 0.61 ± 0.57. A good VA was attained in 51%, moderate VA in 30%, and poor VA in 19%. The main cause of visual impairment with VA <20/50 was deprivation amblyopia (64%). There was no association between VA level and status of success (controlled with or without medications) (p = 0.202). The mean spherical equivalent of refraction was -4.47 ± 5.66; myopia was the predominant refractive error (74%) and astigmatism >2 D (40%). A statistically significant high myopic shift was more frequent in the visually impaired group. None of the studied factors was statistically associated with moderate to poor visual outcome (all p>0.05).

Conclusions

A favorable VA outcome was achieved. Topical antiglaucoma medication has an adjuvant role in maintaining the success rate of surgery without risking the visual outcome. Corneal opacification and anisometropia were the cause of amblyopia.
Towards a Bioengineered Kidney: Recellularization Strategies for Decellularized Native Kidney Scaffolds
Authors: Fedecostante Michele , Onciu Oana G. , Westphal Koen G.C. , Masereeuw Rosalinde
Published: April 2017

Patients with end-stage renal disease often undergo dialysis as a partial substitute for kidney function while waiting for their only treatment option: a kidney transplant. Several research directions emerged for alternatives in support of the ever-growing numbers of patients. Recent years brought big steps forward in the field, with researchers questioning and improving the current dialysis devices as well as moving towards the design of a bioengineered kidney. Whole-organ engineering is also being explored as a possibility, making use of animal or human kidney scaffolds for engineering a transplantable organ. While this is not a new strategy, having been applied so far for thin tissues, it is a novel approach for complex organs such as the kidneys. Kidneys can be decellularized and the remaining scaffold consisting of an extracellular matrix can be repopulated with (autologous) cells, aiming at growing ex vivo a fully transplantable organ. In a broader view, such organs might also be used for a better understanding of fundamental biological concepts and disease mechanisms, drug screening and toxicological investigations, opening new pathways in the treatment of kidney disease.

Decellularization of whole organs has been widely explored and described; therefore, this manuscript only briefly reviews some important considerations with an emphasis on scaffold decontamination, but focuses further on recellularization strategies. Critical aspects, including cell types and sources that can be used for recellularization, seeding strategies and possible applications beyond renal replacement are discussed.
Effect of Body Mass Index on the Outcome of Surgical Patients Receiving Extracorporeal Devices (VV ECMO, pECLA) for Respiratory Failure
Authors: Swol Justyna , Buchwald Dirk , Strauch Justus T. , Schildhauer Thomas A. , Ull Christopher
Published: April 2017

Introduction

To determine whether obese surgical patients are at a significant disadvantage in terms of outcomes after extracorporeal device (ECD) support, such as veno-venous extracorporeal membrane oxygenation (VV ECMO) or pumpless extracorporeal lung assist (pECLA), for respiratory failure, the relationship between body mass index (BMI) and hospital outcomes was analyzed.

Methods

This retrospective study included data on patients who were supported with an ECD between January 1, 2008 and December 31, 2014. The analysis included 89 patients (74 male).

Results

The median BMI was 30 kg/m2 (19–88.5). The median duration of the ECD support was 9.0 days, with a maximum of 37.1 days. The median LOS (length of stay) in the intensive care unit (ICU) was 21 days (range 0.06–197.6). The median hospital LOS was 34.9 days (range 0.1–213.8). VV ECMO was performed 72 times, and pECLA was performed 18 times. The number of patients successfully weaned off the ECD was 54 (60.6%). Survival at the discharge from the hospital was 48.3%.

Conclusions

54 (60.6%) patients were successfully weaned off the ECD; 43 (48.3%) patients survived and were discharged from the hospital. The analysis of correlations between BMI and outcomes of surgical patients treated with ECD showed no association between BMI and mortality. Complications (especially oxygenator clotting) were not more frequent in obese and extremely obese patients. We hypothesized that patients with higher or morbid BMIs would have increased mortality after ECD support. A BMI of 30.66 kg/m2 corresponded to the desired sensitivity and specificity to predict mortality. This finding applied only to the study group. Treatment with ECD in obese patients presents unique challenges, including percutaneous cannulation and increased staff requirements. However, based on these data, obesity should not be an exclusion criterion for ECD therapy.
Stopping Conventional Showering Decreases Pseudomonas Infections in left Ventricular Assist Device Patients
Authors: Aburjania Nana , Sherazi Saadia , Tchantchaleishvili Vakhtang , Alexis Jeffrey D. , Hay Christine M.
Published: April 2017

Background

Left ventricular assist device (LVAD) exit-site infections represent a major challenge in the era of modern LVADs. Infections caused by Pseudomonas are particularly difficult to treat due to limited antibiotic susceptibility. We hypothesized that keeping the LVAD exit site dry while bathing could result in reduced incidence of Pseudomonas infections.

Methods

Starting in April 2013, all patients who underwent placement of HeartMate II (HM II) LVAD were instructed not to take conventional showers and to keep the exit site dry while bathing. We retrospectively reviewed patients who underwent HeartMate II LVAD implantation at our institution. Overall and Pseudomonas exit-site infections were compared between two groups: Group 1 was implanted with an LVAD prior to intervention (4/1/2013) and Group 2 after the intervention. Both groups were subjected to cumulative hazard analysis and compared using log-rank test.

Results

From November 2006 to September 2015, 283 patients underwent HM II LVAD placement at a single institution (Group 1, 163 patients; Group 2, 120 patients). Median age was 59 years (interquartile range [IQR] 50–65), and 57 (20%) were female. Overall, driveline infection was noted in 86 (30%) patients. Pseudomonas was the causative or coexisting organism in 16 (6%) patients. Median days to infection were 347 (IQR, 162–568). Driveline infection was identified in 69 (42%) patients in Group 1 and 17 (14 %) in Group 2. Pseudomonas was an infectious organism in 15 (9%) patients of Group 1 and one (1%) patient of Group 2. The incidence of Pseudomonas exit-site infections (p = 0.077) decreased substantially after the intervention.

Conclusions

Stopping conventional showering may reduce the rate of Pseudomonas LVAD exit-site infections. Additional, multi-institutional data are needed to further evaluate these findings.
Characterization of a Rare Nonpathogenic Sequence Variant (c.1905C>T) of the Dihydropyrimidine Dehydrogenase Gene (DPYD)
Authors: Palmirotta Raffaele , Lovero Domenica , Silvestris Erica , Carella Claudia , Felici Claudia , Quaresmini Davide , Cafforio Paola , Silvestris Franco
Published: April 2017

Background

In the era of precision medicine, the suitability of fluoropyrimidine therapies in clinical oncology can be checked by pharmacogenetic investigations of single patients, thus optimizing resources and indicating the appropriate drugs to personalize their chemotherapy. For example, the presence of dihydropyrimidine dehydrogenase gene ( DPYD) polymorphisms in cancer patients may lead to adverse effects when adopting fluoropyrimidine-based therapies.

Methods

We detected in a cancer patient a rare germline synonymous heterozygous variant of DPYD (c.1905C>T) in proximity to the exon 14 splice donor site. Because in silico analyses hypothesized potential deleterious effects of the splice site, we performed both quantitative and qualitative mRNA analyses to investigate the possible pathogenic nature of the variant.

Results

We did not detect any alterations in mRNA expression or in the cDNA sequence of DPYD gene transcript.

Conclusions

Our observations suggest that the c.1905C>T variant of DPYD does not have a pathogenic effect. Therefore, assessment of the clinical significance of rare sequence variants could emphasize the predictive value of DPYD gene alterations in identifying patients at potential risk for fluoropyrimidine-related toxicity.
Circulating Neuregulin-1 and Galectin-3 can be Prognostic Markers in Breast Cancer
Authors: De luliis Francesca , Salerno Gerardo , Taglieri Ludovica , Lanza Rosina , Cardelli Patrizia , Scarpa Susanna
Published: April 2017

Background

It is important to identify novel plasmatic biomarkers that can contribute to assessing the prognosis and outcome of breast cancer patients. Neuregulin-1 (NRG1) and galectin-3 (Gal-3) are proteins that are involved in breast cancer development and patient survival; therefore, we studied whether the serum concentration of these 2 proteins can be correlated to breast cancer progression.

Methods

Plasmatic NRG1 and Gal-3 were evaluated in 25 healthy controls and 50 breast cancer patients at baseline and at 3 and 6 months after treatment with anthracyclines and taxanes, with or without trastuzumab.

Results

NRG1 and Gal-3 were significantly more elevated in cancer patients than in healthy controls; furthermore, NRG1 and Gal-3 were significantly increased after chemotherapy and were predictive of mortality at 1 year.

Conclusions

Circulating NRG1 and Gal-3 can be additional biomarkers indicative of prognosis and outcomes for breast cancer patients.
Facile Synthesis of Reduced Graphene Oxide/Fe3O4 Nanocomposite Film
Authors: Ma Cunqing , Yang Kaiyu , Wang Lili , Wang Xin
Published: April 2017

Background

This study aims at proposing a facile method to prepare rGO/Fe3O4 composite film with adjusted magnetic properties and electronic conductivity.

Methods

Colloidal solution of graphene oxide (GO)/Fe3O4 nanoparticles (F-NPs) with a size in the range of 20-80 nm were prepared by a solution-blending method and heated step-by-step from room temperature to 60°C, 120°C and 160°C for 12 hours, respectively, to obtain a reduced graphene oxide (rGO)/F-NP composite film. The structure, morphology, components, magnetic properties and electrical conductivity of the composite films were characterized by X-ray diffraction, scanning electron microscopy, Fourier transform infrared spectroscopy, X-ray photoelectron spectroscopy, Raman spectroscopy, superconducting quantum interference devices and 4-probe instrument.

Results

The results indicated that the F-NPs were uniformly distributed on the graphene film, and the composite exhibited good ferromagnetic properties and conductivity, which could be adjusted easily via different loadings of F-NPs. A high content of F-NPs (200 mg) led to a strong saturation magnetization of 63.6 emu·g−1, with a coercivity of about 104.9 oersted (Oe). Whereas a high conductivity of 6.5 S·m−1was obtained at low amounts of F-NPs (40 mg). Notably, rGO/Fe3O4 composite film fabricated by this simple method is widely used in various fields including magnetoelectronics, electrochemical energy conversion and storage, and magnetic nanodevices and others.

Conclusions

A graphene-based film deposited by Fe3O4 nanoparticles with controllable loadings has been fabricated by a step-by-step heating treatment of GO/Fe3O4 colloidal solution.
Diagnostic Hysteroscopy and Adenomyosis: The Case of a Uterine Cornual Cavern. A Video Article
Authors: Mazzon Ivan , Favilli Alessandro , Grasso Mario , Gerli Sandro
Published: April 2017

Introduction

The aim of this study is to show a rare case of adenomyosis presented as a “cavern” which completely involves a uterine cornu.

Case description

A 39-year-old nulliparous patient, with five previous laparoscopic myomectomies during which multiple myomas and adenomyomas have been removed, presented at the Arbor Vitae Centre for Endoscopic Gynaecology in Rome because of an abnormal uterine bleeding. A 6 cm myoma with multiple endometrial glands inside, located on the left uterine cornu, was enucleated during the last procedure. The ultrasound scan showed a 1 cm endometrial polyp and suspected adenomyosis reaching the serosa on the left uterine cornu. Free-anaesthesia diagnostic hysteroscopy was performed with carbon dioxide as distension medium and using a 30-degree fore-oblique rigid telescope with a diameter of 2.9 mm, covered with a single-flow examination sheath. An electronic hysteroflator was set at a flow rate of 30 mL/min and a maximum intrauterine pressure of 75 mm Hg. Multiple adenomyosis caverns that deepen into the myometrium were found on the left uterine cornu.

Conclusions

Previous multiple myomectomy may seriously alter the internal uterine anatomy, especially in presence of adenomyosis. In case of presence of numerous recesses in the uterine cavity, a suspicion of adenomyosis should be considered.
A Decade of Pelvic Pain and Infertility: A Case Report of an Unexpected Intraoperative Discovery
Authors: Stephens Angela , Gavrilova-Jordan Larisa P. , Ray Chadburn
Published: April 2017

Introduction

Retained surgical objects can impact quality of life as it relates to chronic pelvic pain and reproductive health.

Case report

A 39-year-old G1P0010 with chronic pelvic pain and infertility attributed to pelvic adhesions and bilateral hydrosalpinx caused by an 18-cm surgical drain left 10 years prior.

Conclusions

Our case highlights the significance of thoughtful perioperative care as well as special considerations when approaching patients with pelvic pain and infertility with histories of abdominopelvic surgery.
Sciatic Nerve Involvement as an Unusual Presentation of Deep Endometriosis
Authors: Carrasco Ana López , Gutiérrez Alicia Hernández , Gutiérrez Paula Alegría Hidalgo , González Roberto Rodríguez , Bolívar Patricia Isabel Salas , Elio Ramón Usandizaga , Gutiérrez Ignacio Zapardiel , De Santiago García Javier
Published: April 2017

Introduction

Endometriosis affecting the sciatic nerve is extremely uncommon. Its main symptom is catamenial sciatica but it can result in neuropathy. The diagnosis is usually delayed for years. Our objective is to communicate our experience in the diagnosis, management and treatment of this pathology by presenting two patients.

Methods

Retrospective revision of medical charts of all sciatic endometriosis cases treated in the Endometriosis Unit of the University Hospital, La Paz, Spain.

Results

Two nulliparous patients 35 and 39 years old, with unilateral sciatica related to sciatic nerve endometriosis are presented. The lag time between the onset of symptoms and diagnosis was 8 and 5 years. Both patients had problems with locomotion and muscle atrophy, so laparoscopic neurolysis was performed with success in pain control but not total recovery of deambulation defect.

Conclusions

Directed anamnesis and magnetic resonance imaging (MRI) are good tools for diagnosis of endometriosis affecting sciatic nerve. In absence of neuropathy, hormonal pharmacotherapy can be used to control symptoms, but when it is present, surgical nerve decompression must not be delayed, and laparoscopic approach is feasible for trained surgeons. In our cases, neurolysis improved pain but complete recovery of motor function has not been reached. Physicians responsible for primary care need to be aware of the catamenial sciatica due to the nerve damage caused by endometriosis, even when it is very uncommon, because the consequences of the delay in assessment and treatment by a specialized multidisciplinary team in dedicated units may be irreversible.
Controversies on the Use of Steroids in Systemic Sclerosis
Authors: Herrick Ariane L.
Published: April 2017

The use of corticosteroids in patients with systemic sclerosis (SSc) always requires caution (especially because corticosteroids are a risk factor for scleroderma renal crisis [SRC]), and is often controversial. This review focuses on the main area of controversy, that is whether corticosteroids should be prescribed in patients with early diffuse cutaneous SSc (dcSSc). The arguments for and against corticosteroids in this clinical situation are presented, along with two case histories to illustrate the clinical dilemma. In favour of corticosteroids, is that these might suppress the musculoskeletal manifestations and itch that are so disabling in early disease, the argument against is that patients with early dcSSc are those at highest risk of SRC. That current opinion is divided amongst clinicians is evidenced by a roughly even split between patients previously prescribed and those not prescribed corticosteroids in the recent European Scleroderma Observational Study of early dcSSc (43% of 326 patients were on corticosteroids at their baseline visit or had previously been prescribed these). Other clinical situations in which corticosteroids may be considered in patients with SSc (mainly overlap syndromes and pulmonary involvement) are briefly discussed. Finally, some additional concerns relating to corticosteroid use specifically in patients with SSc are highlighted.
Complex Pathophysiology of Pulmonary Hypertension Associated with Systemic Sclerosis: Potential Unfavorable Effects of Vasodilators
Authors: Shirai Yuichiro , Kuwana Masataka
Published: April 2017

Therapeutic advance by pulmonary vasodilators has provided huge impacts on prognosis in patients with pulmonary arterial hypertension (PAH), but outcomes of systemic sclerosis (SSc)-associated PAH still remain unsatisfactory. One of the major reasons is a series of potential unfavorable effects triggered by pulmonary vasodilators, which result from the complex pathophysiology of SSc-PAH. We herein present and discuss five representative conditions potentially induced by pulmonary vasodilators, including (i) emergence of latent pulmonary veno-occlusive disease, (ii) emergence of latent left-heart disease, (iii) worsening of pulmonary gas change in the presence of interstitial lung disease, (iv) ischemic limb gangrene by stealing of blood flow, and (v) uncontrolled hemorrhage from gastrointestinal telangiectasia. The former three conditions are common causes for worsening of dyspnea or oxygenation during treatment with pulmonary vasodilators, whereas the latter two are rare, but have significant negative impacts on patients’ quality of life and survival. These unfavorable conditions are pitfalls in clinical practice, and interfere with optimizing therapies in patients with SSc-PAH. Therefore, pre-assessment of pathophysiology of pulmonary hypertension and cautious monitoring during the treatment are necessary to achieve better outcomes in patients with SSc-PAH.
Successful Balloon Assisted Percutaneous Thrombin Injection of Right Subclavian Artery Pseudoaneurysm
Authors: Brown Andrew D. , Hirpara Dhruvin H. , Jaberi Arash , Oreopoulos George D. , Simons Martin E.
Published: April 2017

Purpose

To report the use of a balloon catheter to facilitate percutaneous ultrasound-guided thrombin injection of a subclavian artery pseudoaneurysm.

Case report

A 36-year-old man presented with hoarseness after the insertion of a right temporary internal jugular line. Arteriography showed a short neck right subclavian artery pseudoaneurysm. A 6 mm × 40 mm balloon catheter was positioned across the neck of the pseudoaneurysm to permit percutaneous ultrasound-guided thrombin injection. Immediate post-treatment angiogram demonstrated no filling of the pseudoaneurysm. Seven-month clinical and imaging follow-up confirmed resolution of the pseudoaneurysm and hoarseness.

Conclusions

This clinical vignette highlights the potential of balloon catheter-assisted percutaneous ultrasound-guided thrombin injection as an alternative to open or endovascular repair of pseudoaneurysms of the subclavian arteries.
Teaching medical students ultrasound-guided vascular access - which learning method is best?
Authors: Lian Alwin , Rippey James C.R. , Carr Peter J.
Published: April 2017

Introduction

Ultrasound is recommended to guide insertion of peripheral intravenous vascular cannulae (PIVC) where difficulty is experienced. Ultrasound machines are now common-place and junior doctors are often expected to be able to use them. The educational standards for this skill are highly varied, ranging from no education, to self-guided internet-based education, to formal, face-to-face traditional education. In an attempt to decide which educational technique our institution should introduce, a small pilot trial comparing educational techniques was designed.

Methods

Thirty medical students were enrolled and allocated to one of three groups. PIVC placing ability was then observed, tested and graded on vascular access phantoms.

Results

The formal, face-to-face traditional education was rated best by the students, and had the highest success rate in PIVC placement, the improvement statistically significant compared to no education (p = 0.01) and trending towards significance when compared to self-directed internet-based education (p<0.06).

Conclusions

The group receiving traditional face-to-face teaching on ultrasound-guided vascular access, performed significantly better than those not receiving education. As the number of ultrasound machines in clinical areas increases, it is important that education programs to support their safe and appropriate use are developed.
Adjuvant and Neoadjuvant Chemotherapy for Soft Tissue Sarcomas: A Personal Point of View
Authors: Benjamin Robert S.
Published: April 2017

Dr. Gianni Bonadonna is internationally recognized as one of the foremost medical oncologists of the 20th century. He is best known for his pioneering work in the development of adjuvant chemotherapy for breast cancer, but he was also the father of sarcoma chemotherapy. The first investigator to study the new chemotherapeutic agent adriamycin in the late 1960s, he noted activity against sarcomas. This article, focusing on adjuvant chemotherapy, adriamycin, and sarcomas, memorializes his achievements and their progeny.
Transurethral Contact Ureterolithotripsy in Gas (СО2) Medium
Authors: Korolev Dmitry O. , Glybochko Peter V. , Rapoport Leonid M. , Tsarichenko Dmitry G.
Published: April 2017

Background

Transurethral intracorporeal lithotripsy is the modality of choice for the endoscopic disintegration of large, long-standing, radiolucent or high-density stones. Despite several advantages and proven benefits of contact ureterolithotripsy/ureterolithoextraction (CULT), the application of irrigation carries significant risks of untoward perioperative events including retrograde stone migration and postoperative pyelonephritis.

Methods

We describe a new technique – endoscopic intracorporeal lithotripsy in the gas (СО2) medium. It is a prospective randomized, single blinded pilot study that included total of (n = 60) patients with urolithiasis who were allocated to either experimental or control group. Out of the total pool of patients, 30 underwent treatment with the new approach (experimental group) and other 30 (control group) had contact ureterolithotripsy in a standard of care 0.9% NaCL medium. We included patients >18 years old, with known symptomatic renal calculi disease who were eligible and scheduled for CULT and free from significant coexisting pathologies of urinary tract.

Results

No retrograde migration of the stone fragments into the kidney was reported in the experimental group [complications rate 0%, confidence interval (CI): 0-11.6%]. In the control group, complications were observed in eight cases (complications rate 26.7%, CI: 14.7-42.3%); retrograde migration was in five patients (16.6%), and acute pyelonephritis/exacerbation of chronic pyelonephritis was seen in three (10%) patients. There was not any acute pyelonephritis in the experimental group. Reliability of frequency differences – p = 0.0023 (χ2).

Conclusions

The novel method of contact ureterolithotripsy is a safe and promising alternative to the conventional contact ureterolithotripsy in a fluid medium in a carefully selected patient population.
Safety and Efficacy Outcomes of ZSI 475 Penile Prosthesis
Authors: Blewniewski Mariusz , Ostrowski Ireneusz , Pottek Tobias , Neugart Frank , Ciechan Janusz , Llorens Christophe , Rozanski Waldemar
Published: April 2017

Objective

The aim of this study was to demonstrate safety and efficacy of ZSI 475 hydraulic penile prosthesis three components. Preparation, procedure and functional results are similar to AMS 700 and Coloplast Titan. This study was conducted from September 2012 to December 2016.

Patients and Method

From September 2012 to December 2016, 29 ZSI 475 hydraulic penile prostheses three components were implanted by six surgeons in 28 patients in five European centres. Mean age of patients was 60 years old (44-75). Standard peno-scrotal incision procedure was performed for the 28 patients. Erectile function was assessed by IIEF-5 self-administered questionnaire.

Results

Median follow-up was 35.11 months (8-47). Postoperative complications were limited to scrotal pump torsion that required a revision, an armed tubing breakage and a scrotal haematoma. At the end of follow-up, 100% of patients had a functional prosthesis and 92.86% were satisfied.

Conclusions

Implantation, risks of complications, functional outcome and patient satisfaction with penile implant ZSI 475 are similar to standard hydraulic penile implants three components as AMS 700 and Coloplast Titan.