bluuebunny/crossref_metadata_2025 huggingface dataset:
Survival Benefits Based on the Number of Lymph Nodes Removed during Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: Systematic Review and Meta-Analysis
Authors: Choo Min Soo , Yoo Sangjun , Yuk Hyeong Dong , Jeong Chang Wook , Cho Min Chul , Kwak Cheol , Jeong Hyeon , Kim Hyeon Hoe , Ku Ja Hyeon
Published: June 2020

The role of lymph node dissection (LND) is still controversial for upper tract urothelial carcinoma (UTUC), and there are no guidelines regarding its use. This study was conducted to find a higher level of evidence for the survival benefits based on the number of LNs removed during radical nephroureterectomy (RNUx) through a systematic review and meta-analysis. We included studies comparing patients who underwent LND during RNUx for UTUC. We searched the major electronic databases (Pubmed, Embase®, and Scopus®) and conducted manual searches of the electronically available abstracts of the major international urology cancer meetings [American Society of Clinical Oncology (ASCO), American Urological Association (AUA), and Eropean Association of Urology (EAU)] prior to April 2019 using grouped terms of nephroureterectomy (nephroureterectom*) and lymph node excision (lymphadenectomy; lymph + node*; lymph* + metasta*) with variations in the terms. Study selection, data collection, and risk of bias assessment were performed by two independent authors (A and B). Six retrospective case-control studies included a total of 33,944 patients who underwent RNUx for UTUC, 5071 of whom underwent LND and were finally included in the meta-analysis. The pooled hazard ratio (HR) in these studies revealed that an increased number of LNs removed during RNUx was associated with improved cancer-specific survival (CSS) in patients with UTUC (HR = 0.95, 95% CI: 0.91–0.99; p = 0.07). In addition, increased numbers of LNs removed were associated with improved overall survival (OS) in pN0 patients. However, in pN+ patients, the number of LNs removed showed no survival benefit on CSS, overall survival (OS), or progression-free survival (PFS). Higher numbers of LNs removed during RNUx were associated with improved survival outcomes in patients with UTUC. This study confirmed that LND also has oncological benefits in UTUC patients. Although still a controversial topic, meticulous LND must be considered, and efforts should be made to eliminate as many LNs as possible when administering RNUx for UTUC, especially in patients without clear evidence of LN metastasis.
Multimodal Imaging in the Management of Choroidal Neovascularization Secondary to Central Serous Chorioretinopathy
Authors: Hagag Ahmed M. , Chandra Shruti , Khalid Hagar , Lamin Ali , Keane Pearse A. , Lotery Andrew J. , Sivaprasad Sobha
Published: June 2020

The diagnosis and treatment of choroidal neovascularization (CNV) in eyes with chronic central serous chorioretinopathy (CSCR) can be challenging. The purpose of this study was to classify eyes with suspected CNV using multimodal imaging. The effect of intravitreal anti-vascular endothelial growth factor (VEGF) was assessed and compared to controls. This retrospective study included chronic CSCR patients with suspected secondary CNV who received intravitreal bevacizumab. Eyes were divided into “definite CNV” and “no CNV” based on optical coherence tomography angiography (OCTA). Eyes that did not undergo OCTA imaging were considered as “presumed CNV”. One-year outcome in visual acuity (VA) and central foveal thickness (CFT) were investigated and compared to non-treated control patients to assess the response to anti-VEGF. Logistic regression analysis was used to explore predictive biomarkers of CNV detection and improvement after anti-VEGF. Ninety-two eyes with chronic CSCR from 88 participants were included in this study. Sixty-one eyes received bevacizumab and 31 eyes were non-treated control subjects. The presence of subretinal hyperreflective material (SHRM) and shallow irregular retinal pigment epithelium (RPE) elevation (SIRE) with sub-RPE hyperreflectivity on OCT was associated with a significantly increased risk of detecting CNV on OCTA. Intravitreal anti-VEGF caused significant functional and anatomical improvement in patients with neovascular CSCR as compared to non-treated eyes. In contrast, VA and CFT changes were not significantly different between treated and non-treated CSCR with no evidence of CNV on OCTA. No clinical or anatomical biomarkers were found to be associated with response to treatment. In conclusion, OCTA should be used to confirm the presence CNV in suspected chronic CSCR patients. Intravitreal anti-VEGF treatment resulted in a significantly better one-year outcome in patients with definitive OCTA evidence of CNV.
Bioinformatics Approach for Identifying Novel Biomarkers and Their Signaling Pathways Involved in Interstitial Cystitis/Bladder Pain Syndrome with Hunner Lesion
Authors: Saha Subbroto Kumar , Jeon Tak-Il , Jang Soo Bin , Kim Se Jong , Lim Kyung Min , Choi Yu Jin , Kim Hyeong Gon , Kim Aram , Cho Ssang-Goo
Published: June 2020

The complexity of interstitial cystitis/bladder pain syndrome (IC/BPS) has led to considerable uncertainty in terms of diagnosis and prevalence of the condition. Here, we try to identify the IC/BPS-associated genes through an integrated analysis of Gene Expression Omnibus (GEO) datasets and confirm experimentally to predict the pathologic diagnosis of IC/BPS. Data mining analysis of GEO datasets (GSE621, GSE11783, GSE28242, and GSE57560) revealed a total of 53 (51 upregulated and two downregulated) common differentially expressed genes (DEGs) in IC/BPS. A protein–protein interaction (PPI) network was then constructed with the 53 common DEGs using Cytoscape v3.7.2, and subsequently, six hub genes (CD5, CD38, ITGAL, IL7R, KLRB1, and IL7R) were identified using cytoHubba v0.1 that were upregulated in IC/BPS. Enrichment analysis of common DEGs revealed that hematopoietic cell lineage, immune system, and T-cell receptor (TCR) signaling in naïve CD4+ T cell signaling pathways were prominently involved with the common 51 upregulated DEGs. The two common downregulated DEGs may enrich linoleic acid metabolism and synthesis of epoxy (EET) and dihydroxyeicosatrienoic acid (DHET) signaling pathways in IC/BPS. Moreover, our RT-PCR data confirmed that the expression of the five hub genes (CD38, ITGAL, IL7R, KLRB1, and IL7R) was significantly augmented in IC/BPS patients’ samples when compared with their normal counterparts. In this study, we systematically predict the significant biomarkers and possible signaling pathways involved in IC/BPS, confirming the differential expression of the hub genes in tissue samples from patients with IC/BPS. Thus, the hub genes might be used as potential diagnostic biomarkers of IC/BPS.
Benzodiazepines Reduce Relapse and Recurrence Rates in Patients with Psychotic Depression
Authors: Shiwaku Hiroki , Fujita Masako , Takahashi Hidehiko
Published: June 2020

The long-term use of benzodiazepines is not recommended for the treatment of major depressive disorder (MDD) due to the risk of adverse effects, including dependence, falls, dementia, mortality and the lack of evidence of effectiveness for symptoms other than anxiety. However, there are many patients with MDD for whom antidepressants are co-administrated with benzodiazepines. This study aimed to identify whether the use of benzodiazepines is associated with a lower risk of relapse or recurrence of MDD in some patients, and the characteristics of these patients. Kaplan–Meier survival analysis was used to quantify the relapse and recurrence of MDD in 108 patients with MDD who achieved remission during hospitalization. Among them, 26 patients had been diagnosed with severe MDD with psychotic features. There was no significant difference in the rate of relapse/recurrence between patients with and without benzodiazepines when all patients were analyzed together. However, among the 26 patients with psychotic depression, 21.2% in the benzodiazepine group and 75.0% in the non-benzodiazepine group experienced relapse (log rank p = 0.0040). Kaplan–Meier survival analysis revealed that this effect was dose-dependent. The adjunctive use of benzodiazepines may reduce relapse/recurrence rates in patients with severe MDD with psychotic features.
Independent Predictive Ability of Procalcitonin of Acute Kidney Injury among Critically Ill Patients
Authors: Huang Ya-Ting , Lai Min-Yu , Kan Wei-Chih , Shiao Chih-Chung
Published: June 2020

It is unclear whether serum procalcitonin (PCT) levels rise in patients with acute kidney injury (AKI), and it is also unclear whether the elevation of PCT levels in this setting is independent of the existence of infection and impaired renal clearance. We conducted a retrospective study in a regional teaching hospital in Taiwan to evaluate the AKI-predictive ability of serum PCT among critically ill patients. We enrolled 330 patients (mean age, 70.5 ± 16.4 years; 57.0% men) who were admitted to the intensive care unit (ICU) from 1 July 2016, to 31 December 2016, and who had serum PCT measurement performed within 24 h after ICU admission. We used the generalized additive model and generalized linear model to evaluate the association of serum PCT levels and renal function variables. In addition, we used the multivariate logistic regression method to demonstrate serum PCT level as an independent predictor of AKI in both the non-infected patients (odds ratio (OR) = 1.38, 95% confidence interval (CI) = 1.12–1.71, p = 0.003) and the infected patients (OR = 1.23, 95% CI = 1.03–1.46, p = 0.020). In conclusion, serum PCT level at ICU admission is an independent predictor of developing AKI irrespective of infection among critically ill patients.
Genetic Variation in CCL18 Gene Influences CCL18 Expression and Correlates with Survival in Idiopathic Pulmonary Fibrosis: Part A
Authors: Wiertz Ivo A. , Moll Sofia A. , Seeliger Benjamin , Barlo Nicole P. , van der Vis Joanne J. , Korthagen Nicoline M. , Rijkers Ger T. , Ruven Henk J.T. , Grutters Jan C. , Prasse Antje , van Moorsel Coline H.M.
Published: June 2020

Idiopathic pulmonary fibrosis (IPF) is a progressive fibrotic disease, characterized by fibroblast proliferation and extracellular matrix deposition. CC-chemokine ligand 18 (CCL18) upregulates the production of collagen by lung fibroblasts and is associated with mortality. This study was designed to evaluate the influence of single nucleotide polymorphisms (SNPs) in the CCL18 gene on CCL18 expression and survival in IPF. Serum CCL18 levels and four SNPs in the CCL18 gene were analyzed in 77 Dutch IPF patients and 349 healthy controls (HCs). CCL18 mRNA expression was analyzed in peripheral blood mononuclear cells (PBMCs) from 18 healthy subjects. Survival analysis was conducted, dependent on CCL18-levels and -genotypes and validated in two German IPF cohorts (Part B). IPF patients demonstrated significantly higher serum CCL18 levels than the healthy controls (p < 0.001). Both in IPF patients and HCs, serum CCL18 levels were influenced by rs2015086 C > T genotype, with the highest CCL18-levels with the presence of the C-allele. Constitutive CCL18 mRNA-expression in PBMCs was significantly increased with the C-allele and correlated with serum CCL18-levels. In IPF, high serum levels correlated with decreased survival (p = 0.02). Survival was worse with the CT-genotype compared to the TT genotype (p = 0.01). Concluding, genetic variability in the CCL18-gene accounts for differences in CCL18 mRNA-expression and serum-levels and influences survival in IPF.
Recognizing Risks and Optimizing Perioperative Care to Reduce Respiratory Complications in the Pediatric Patient
Authors: Egbuta Chinyere , Mason Keira P.
Published: June 2020

There have been significant advancements in the safe delivery of anesthesia as well as improvements in surgical technique; however, the perioperative period can still be high risk for the pediatric patient. Perioperative respiratory complications (PRCs) are some of the most common critical events that can occur in pediatric surgical patients and they can lead to increased length of hospitalization, worsened patient outcomes, and higher hospital and postoperative costs. It is important to determine the various factors that put pediatric patients at increased risk of PRCs. This will allow for more detailed and accurate informed consent, optimized perioperative management strategy, improved allocation of clinical resources, and, hopefully, better patient experience. There are only a few risk prediction models/scoring tools developed for and validated in the pediatric patient population, but they have been useful in helping identify the key factors associated with a high likelihood of developing PRCs. Some of these factors are patient factors, while others are procedure-related factors. Some of these factors may be modified such that the patient’s clinical status is optimized preoperatively to decrease the risk of PRCs occurring perioperatively. Fore knowledge of the factors that are not able to be modified can help guide allocation of perioperative clinical resources such that the negative impact of these non-modifiable factors is buffered. Additional training in pediatric anesthesia or focused expertise in pediatric airway management, vascular access and management of massive hemorrhage should be considered for the perioperative management of the less than 3 age group. Intraoperative ventilation strategy plays a key role in determining respiratory outcomes for both adult and pediatric surgical patients. Key components of lung protective mechanical ventilation strategy such as low tidal volume and moderate PEEP used in the management of acute respiratory distress syndrome (ARDS) in pediatric intensive care units have been adopted in pediatric operating rooms. Adequate post-operative analgesia that balances pain control with appropriate mental status and respiratory drive is important in reducing PRCs.
Defining the Most Effective Patient Blood Management Combined with Tranexamic Acid Regime in Primary Uncemented Total Hip Replacement Surgery
Authors: Pérez-Chrzanowska Hanna , Padilla-Eguiluz Norma G. , Gómez-Barrena Enrique
Published: June 2020

The application of patient blood management (PBM) combined with tranexamic acid administration (TXA) results in decreased total blood loss volume (TVB) and transfusions in total hip replacements (THRs). Dosages, timing, and routes of administration of TXA are still under debate as all these aspects, as well as interpatient variations, may affect the efficacy of the protocol. This study aims to examine the effectiveness of timing and route of administration of TXA in combination with PBM by reducing the TBV following THR surgery. Consecutive primary uncemented THRs operated by a single surgical and anaesthetic team had the data prospectively collected and then retrospectively studied. Five treatment groups were formed, reflecting the progressive evolution of our protocol. Group 1 included patients managed with PBM alone (preoperative erythrocyte mass optimisation to at least 14 g/dL haemoglobin (Hb), hypotensive spinal anaesthesia and restrictive red blood cell transfusion criteria). Group 2 included patients with PBM and topical 3 g TXA diluted in normal saline to a total volume of 50 mL. Group 3 were patients with PBM and an IV dose of 20 mg/kg TXA at induction, followed by 20 mg/kg TXA as a continuous infusion for the duration of the operation. Group 4 consisted of patients managed as per Group 3 plus another 20 mg/kg TXA at three-hour post-procedure. Group 5 (combined): PBM and IV TXA as per Group 4 and topical TXA as per Group 2. A generalised linear model with the treatment group as an independent variable was modelled, using TBV as the dependent variable. The transfusion rate for all groups was 0%. TBV at 24 h, oscillated from 613.5 ± 337.63 mL in Group 1 to 376.29 ± 135.0 mL in Group 5. TBV at 48 h oscillated from 738.3 ± 367.3 mL (PBM group) to 434 ± 155.2 mL (PBM + combined group). The multivariate regression model confirmed a significant decrease of TBV in all groups with TXA compared with the PBM-only group. Overweight and preoperative Hb were confirmed to significantly influence TBV. The optimal regime to achieve the least TBV and a transfusion rate of 0% requires PBM and one loading 20 mg/kg dose of TXA, followed by continuous infusion of 20 mg/kg for the duration of the operation in uncemented THRs. Additional doses of TXA did not add a clear benefit.
Dominantly Inherited Hereditary Nonpolyposis Colorectal Cancer Not Caused by MMR Genes
Authors: Terradas Mariona , Capellá Gabriel , Valle Laura
Published: June 2020

In the past two decades, multiple studies have been undertaken to elucidate the genetic cause of the predisposition to mismatch repair (MMR)-proficient nonpolyposis colorectal cancer (CRC). Here, we present the proposed candidate genes according to their involvement in specific pathways considered relevant in hereditary CRC and/or colorectal carcinogenesis. To date, only pathogenic variants in RPS20 may be convincedly linked to hereditary CRC. Nevertheless, accumulated evidence supports the involvement in the CRC predisposition of other genes, including MRE11, BARD1, POT1, BUB1B, POLE2, BRF1, IL12RB1, PTPN12, or the epigenetic alteration of PTPRJ. The contribution of the identified candidate genes to familial/early onset MMR-proficient nonpolyposis CRC, if any, is extremely small, suggesting that other factors, such as the accumulation of low risk CRC alleles, shared environmental exposures, and/or gene–environmental interactions, may explain the missing heritability in CRC.
A Novel Clinical and Stress Cardiac Magnetic Resonance (C-CMR-10) Score to Predict Long-Term All-Cause Mortality in Patients with Known or Suspected Chronic Coronary Syndrome
Authors: Marcos-Garces Victor , Gavara Jose , Monmeneu Jose V , Lopez-Lereu Maria P , Perez Nerea , Rios-Navarro Cesar , De Dios Elena , Moratal David , Miñana Gema , Nuñez Julio , Chorro Francisco J , Bodi Vicente
Published: June 2020

Vasodilator stress cardiac magnetic resonance (stressCMR) has shown robust diagnostic and prognostic value in patients with known or suspected chronic coronary syndrome (CCS). However, it is unknown whether integration of stressCMR with clinical variables in a simple clinical-imaging score can straightforwardly predict all-cause mortality in this population. We included 6187 patients in a large registry that underwent stressCMR for known or suspected CCS. Several clinical and stressCMR variables were collected, such as left ventricular ejection fraction (LVEF) and ischemic burden (number of segments with stress-induced perfusion defects (PD)). During a median follow-up of 5.56 years, we registered 682 (11%) all-cause deaths. The only independent predictors of all-cause mortality in multivariable analysis were age, male sex, diabetes mellitus (DM), LVEF and ischemic burden. Based on the weight of the chi-square increase at each step of the multivariable analysis, we created a simple clinical-stressCMR (C-CMR-10) score that included these variables (age ≥ 65 years = 3 points, LVEF ≤ 50% = 3 points, DM = 2 points, male sex = 1 point, and ischemic burden > 5 segments = 1 point). This 0 to 10 points C-CMR-10 score showed good performance to predict all-cause annualized mortality rate ranging from 0.29%/year (score = 0) to >4.6%/year (score ≥ 7). The goodness of the model and of the C-CMR-10 score was separately confirmed in 2 internal cohorts (n > 3000 each). We conclude that a novel and simple clinical-stressCMR score, which includes clinical and stressCMR variables, can provide robust prediction of the risk of long-term all-cause mortality in a population of patients with known or suspected CCS.
Influence of Chronic Periodontitis on the Long-Term Mortality and Cardiovascular Events in Kidney Transplant Recipients
Authors: Wynimko Marta , Walicka Magdalena , Sanchak Yaroslav , Gozdowski Dariusz , Błach Anna , Więcek Andrzej , Śliwczyński Andrzej , Franek Edward , Kolonko Aureliusz
Published: June 2020

Chronic periodontitis (CP) is associated with cardiovascular disease and mortality in different populations. The aim of this study was to examine an association of CP with hard endpoints in patients after kidney transplantation during a 15-year follow-up period. Study group consist of 117 patients (77M/40F, median age 44 years) divided into two subgroups: those with initially advanced CP (CPITN 3–4) and those with no or moderate CP (CPITN 0–2). All cardiovascular events, graft losses, and re-transplantations were recorded. All deaths were noted and verified, including those occurred after the return to dialysis therapy, the causes of death were identified. Cox regression with Firth’s penalized maximum likelihood models were used for data analysis. During the observation period, 49 deaths occurred. Advanced CP (n = 35) was not associated with overall mortality but was associated with increased risk of death with functioning graft (DWFG) [HR 3.54 (1.20–10.45); p < 0.05]. Risk of graft loss was not associated with CP status. In conclusion, an advanced CP was independently associated with increased risk of DWFG, but not all-cause or cardiovascular mortality after renal transplantation.
Prognostic Impact of Active Mechanical Circulatory Support in Cardiogenic Shock Complicating Acute Myocardial Infarction, Results from the Culprit-Shock Trial
Authors: Feistritzer Hans-Josef , Desch Steffen , Freund Anne , Poess Janine , Zeymer Uwe , Ouarrak Taoufik , Schneider Steffen , de Waha-Thiele Suzanne , Fuernau Georg , Eitel Ingo , Noc Marko , Stepinska Janina , Huber Kurt , Thiele Holger
Published: June 2020

Objectives: To analyze the use and prognostic impact of active mechanical circulatory support (MCS) devices in a large prospective contemporary cohort of patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI). Background: Although increasingly used in clinical practice, data on the efficacy and safety of active MCS devices in patients with CS complicating AMI are limited. Methods: This is a predefined subanalysis of the CULPRIT-SHOCK randomized trial and prospective registry. Patients with CS, AMI and multivessel coronary artery disease were categorized in two groups: (1) use of at least one active MCS device vs. (2) no active MCS or use of intra-aortic balloon pump (IABP) only. The primary endpoint was a composite of all-cause death or renal replacement therapy at 30 days. Results: Two hundred of 1055 (19%) patients received at least one active MCS device (n = 112 Impella®; n = 95 extracorporeal membrane oxygenation (ECMO); n = 6 other devices). The primary endpoint occurred significantly more often in patients treated with active MCS devices compared with those without active MCS devices (142 of 197, 72% vs. 374 of 827, 45%; p < 0.001). All-cause mortality and bleeding rates were significantly higher in the active MCS group (all p < 0.001). After multivariable adjustment, the use of active MCS was significantly associated with the primary endpoint (odds ratio (OR) 4.0, 95% confidence interval (CI) 2.7–5.9; p < 0.001). Conclusions: In the CULPRIT-SHOCK trial, active MCS devices were used in approximately one fifth of patients. Patients treated with active MCS devices showed worse outcome at 30 days and 1 year.
Novel Estimation of Penumbra Zone Based on Infarct Growth Using Machine Learning Techniques in Acute Ischemic Stroke
Authors: Kim Yoon-Chul , Kim Hyung Jun , Chung Jong-Won , Kim In Gyeong , Seong Min Jung , Kim Keon Ha , Jeon Pyoung , Nam Hyo Suk , Seo Woo-Keun , Kim Gyeong-Moon , Bang Oh Young
Published: June 2020

While the penumbra zone is traditionally assessed based on perfusion–diffusion mismatch, it can be assessed based on machine learning (ML) prediction of infarct growth. The purpose of this work was to develop and validate an ML method for the prediction of infarct growth distribution and volume, in cases of successful (SR) and unsuccessful recanalization (UR). Pre-treatment perfusion-weighted, diffusion-weighted imaging (DWI) data, and final infarct lesions annotated from day-7 DWI from patients with middle cerebral artery occlusion were utilized to develop and validate two ML models for prediction of tissue fate. SR and UR models were developed from data in patients with modified treatment in cerebral infarction (mTICI) scores of 2b–3 and 0–2a, respectively. When compared to manual infarct annotation, ML-based infarct volume predictions resulted in an intraclass correlation coefficient (ICC) of 0.73 (95% CI = 0.31–0.91, p < 0.01) for UR, and an ICC of 0.87 (95% CI = 0.73–0.94, p < 0.001) for SR. Favorable outcomes for mismatch presence and absence in SR were 50% and 36%, respectively, while they were 61%, 56%, and 25%, respectively, for the low, intermediate, and high infarct growth groups. The presented method can offer novel and alternative insights into selecting patients for recanalization therapy and predicting functional outcome.
Clinical Validation of a Deep Learning Algorithm for Detection of Pneumonia on Chest Radiographs in Emergency Department Patients with Acute Febrile Respiratory Illness
Authors: Kim Jae Hyun , Kim Jin Young , Kim Gun Ha , Kang Donghoon , Kim In Jung , Seo Jeongkuk , Andrews Jason R. , Park Chang Min
Published: June 2020

Early identification of pneumonia is essential in patients with acute febrile respiratory illness (FRI). We evaluated the performance and added value of a commercial deep learning (DL) algorithm in detecting pneumonia on chest radiographs (CRs) of patients visiting the emergency department (ED) with acute FRI. This single-centre, retrospective study included 377 consecutive patients who visited the ED and the resulting 387 CRs in August 2018–January 2019. The performance of a DL algorithm in detection of pneumonia on CRs was evaluated based on area under the receiver operating characteristics (AUROC) curves, sensitivity, specificity, negative predictive values (NPVs), and positive predictive values (PPVs). Three ED physicians independently reviewed CRs with observer performance test to detect pneumonia, which was re-evaluated with the algorithm eight weeks later. AUROC, sensitivity, and specificity measurements were compared between “DL algorithm” vs. “physicians-only” and between “physicians-only” vs. “physicians aided with the algorithm”. Among 377 patients, 83 (22.0%) had pneumonia. AUROC, sensitivity, specificity, PPV, and NPV of the algorithm for detection of pneumonia on CRs were 0.861, 58.3%, 94.4%, 74.2%, and 89.1%, respectively. For the detection of ‘visible pneumonia on CR’ (60 CRs from 59 patients), AUROC, sensitivity, specificity, PPV, and NPV were 0.940, 81.7%, 94.4%, 74.2%, and 96.3%, respectively. In the observer performance test, the algorithm performed better than the physicians for pneumonia (AUROC, 0.861 vs. 0.788, p = 0.017; specificity, 94.4% vs. 88.7%, p < 0.0001) and visible pneumonia (AUROC, 0.940 vs. 0.871, p = 0.007; sensitivity, 81.7% vs. 73.9%, p = 0.034; specificity, 94.4% vs. 88.7%, p < 0.0001). Detection of pneumonia (sensitivity, 82.2% vs. 53.2%, p = 0.008; specificity, 98.1% vs. 88.7%; p < 0.0001) and ‘visible pneumonia’ (sensitivity, 82.2% vs. 73.9%, p = 0.014; specificity, 98.1% vs. 88.7%, p < 0.0001) significantly improved when the algorithm was used by the physicians. Mean reading time for the physicians decreased from 165 to 101 min with the assistance of the algorithm. Thus, the DL algorithm showed a better diagnosis of pneumonia, particularly visible pneumonia on CR, and improved diagnosis by ED physicians in patients with acute FRI.
Retrospective Study of Dupilumab Treatment for Moderate to Severe Atopic Dermatitis in Korea: Efficacy and Safety of Dupilumab in Real-World Practice
Authors: Jang Dong Hyek , Heo Seok Jae , Jung Hye Jung , Park Mi Yeon , Seo Seong Jun , Ahn Jiyoung
Published: June 2020

Among biological agents for the treatment of atopic dermatitis (AD), dupilumab is a front-runner. Although many studies have been conducted on the real-world use of dupilumab, the sample size is often small and data is primarily on Western people. Therefore, we investigated the efficacy and safety of dupilumab in patients with moderate-to-severe AD in Korea. All patients with moderate-to-severe AD treated with dupilumab from September 2018 to June 2019 in this institution were included and analyzed by medical records. They were evaluated using the Eczema Area and Severity Index (EASI), Numerical Rating Scale (NRS), Patient Oriented Eczema Measure (POEM), and Dermatology Quality of Life Index (DLQI), respectively on admission, after two weeks (only EASI and NRS) and after 16 weeks. Laboratory tests were measured before and 16 weeks after treatment. A total of 101 patients were included. All efficacy tools showed a significant decrease after 16 weeks; EASI 77.4%, NRS 70.0%, POEM 60.7%, and DLQI 65.0%. EASI was characterized by a marked improvement of 51.5% in just two weeks. The treatment response was not significantly different according to the interval of treatment. Elevated Lactate Dehydrogenase (LDH) at 16 weeks was associated with poor treatment response. Moreover, a high eosinophil count was related to a lower change in EASI and POEM. In the correlation analysis, EASI was not correlated to DLQI before treatment. For changes after 16 weeks, POEM showed the highest correlation with DLQI. (R = 0.66, p < 0.001) In the additional analysis for factors affecting treatment response, the female gender was associated with good treatment response. (odds ratio = 5.4, p = 0.04) Adverse events from treatment included facial erythema (9.9%) and conjunctivitis (5.0%). Overall, it was confirmed that the efficacy of dupilumab in the real-world is similar to that of the existing clinical trials. We suggest that POEM is a useful tool for identifying the quality of life. The female gender was associated with a good treatment response. Both an elevated LDH and a high eosinophil count could be a therapeutic biomarker. Further research will be needed for a long-term period.
Numerical Modelling and Dynamic Response Analysis of Curved Floating Bridges with a Small Rise-Span Ratio
Authors: Wan Ling , Jiang Dongqi , Dai Jian
Published: June 2020

As a potential option for transportation applications in coastal areas, curved floating bridges with a same small specified rise to span ratio of 0.134, supported by multiple pontoons, are investigated in this paper. Two conceptual curved bridges are proposed following a circular arc shape with different span lengths (500 and 1000 m). Both bridges are end-connected to the shoreline without any underwater mooring system, while the end-connections can be either all six degrees of freedom (D.O.F) fixed or two rotational D.O.F released. Eigen value analysis is carried out to identify the modal parameters of the floating bridge system. Static and dynamic analysis under extreme environmental conditions are performed to study the pontoon motions as well as structural responses of the bridge deck. Deflections and internal forces (axial forces, shear forces, and bending moment) are thoroughly studied with the variation of the span length and end support conditions in terms of the same specified small rise-span ratio. The ratio of axial force to horizontal bending moment are presented. From the study, it is found that the current parameters for the bridge are relatively reasonable regarding responses. However, the small rise-span does not provide enough arch effects. A higher rise-span ratio or stiffer bridge cross-sectional property is preferred, especially for the long bridge. In addition, the flexible end connections are preferred considering the structural responses at the end regions.
Coastal Scenic Evaluation of Continental Ecuador and Galapagos Islands: Human Impacts and Management Issues
Authors: Mestanza-Ramón Carlos , Anfuso Giorgio , Chica-Ruiz J. Adolfo , Mooser Alexis , Botero Camilo M. , Pranzini Enzo
Published: June 2020

The scenery, safety, facilities, water quality and litter quantities in coastal areas are relevant and determining elements in the choice of a tourist destination. This paper focused on the evaluation of coastal scenic value in 55 and 12 sites respectively located in continental Ecuador and the Galapagos Islands. The information obtained gives public administrators and coastal managers the relevant data to avoid further environmental degradation and suggests measures to improve the present scenic value of tourist destinations. The methodology used was based on the analysis of 26 physical/human factors and applied fuzzy logic analysis and weighting matrices that allowed the sites to be classified into five classes, from Class I (natural areas with superior scenic characteristics) to Class V (poor scenic areas with relevant impact of human interventions). The most attractive beaches were in the Galapagos Islands due to the magnificent physical and environmental characteristics, while the Esmeraldas province presented sites of lower scenic beauty due to the low natural scenic value and the increase of human impacts. In total, 22% (15 out of 67) of the beaches investigated belonged to Class I, 12% (8) to Class II and 15% (10) to Class III. The last two classes included 51% of the beaches (i.e., 34 out of 67), of which 31% (21) was in Class IV and 20% (13) in Class V. Such results provide local managers and planners a solid inventory on coastal scenic characteristics and baseline information for any envisaged subsequent management plan.
Arsenolipids in Cultured Picocystis Strain ML and Their Occurrence in Biota and Sediment from Mono Lake, California
Authors: Glabonjat Ronald A. , Blum Jodi S. , Miller Laurence G. , Webb Samuel M. , Stolz John F. , Francesconi Kevin A. , Oremland Ronald S.
Published: June 2020

Primary production in Mono Lake, a hypersaline soda lake rich in dissolved inorganic arsenic, is dominated by Picocystis strain ML. We set out to determine if this photoautotrophic picoplankter could metabolize inorganic arsenic and in doing so form unusual arsenolipids (e.g., arsenic bound to 2-O-methyl ribosides) as reported in other saline ecosystems and by halophilic algae. We cultivated Picocystis strain ML on a seawater-based medium with either low (37 µM) or high (1000 µM) phosphate in the presence of arsenite (400 µM), arsenate (800 µM), or without arsenic additions (ca 0.025 µM). Cultivars formed a variety of organoarsenic compounds, including a phytyl 2-O-methyl arsenosugar, depending upon the cultivation conditions and arsenic exposure. When the cells were grown at low P, the organoarsenicals they produced when exposed to both arsenite and arsenate were primarily arsenolipids (~88%) with only a modest content of water-soluble organoarsenic compounds (e.g., arsenosugars). When grown at high P, sequestration shifted to primarily water-soluble, simple methylated arsenicals such as dimethylarsinate; arsenolipids still constituted ~32% of organoarsenic incorporated into cells exposed to arsenate but < 1% when exposed to arsenite. Curiously, Picocystis strain ML grown at low P and exposed to arsenate sequestered huge amounts of arsenic into the cells accounting for 13.3% of the dry biomass; cells grown at low P and arsenite exposure sequestered much lower amounts, equivalent to 0.35% of dry biomass. Extraction of a resistant phase with trifluoroacetate recovered most of the sequestered arsenic in the form of arsenate. Uptake of arsenate into low P-cultivated cells was confirmed by X-ray fluorescence, while XANES/EXAFS spectra indicated the sequestered arsenic was retained as an inorganic iron precipitate, similar to scorodite, rather than as an As-containing macromolecule. Samples from Mono Lake demonstrated the presence of a wide variety of organoarsenic compounds, including arsenosugar phospholipids, most prevalent in zooplankton (Artemia) and phytoplankton samples, with much lower amounts detected in the bottom sediments. These observations suggest a trophic transfer of organoarsenicals from the phytoplankton (Picocystis) to the zooplankton (Artemia) community, with efficient bacterial mineralization of any lysis-released organoarsenicals back to inorganic oxyanions before they sink to the sediments.
Friction and Temperature Behavior of Lubricated Thermoplastic Polymer Contacts
Authors: Reitschuster Stefan , Maier Enzo , Lohner Thomas , Stahl Karsten
Published: June 2020

This work focuses on the friction and temperature behavior of thermo-elastohydrodynamically lubricated (TEHL) contacts under rolling-sliding conditions. For this purpose, a twin-disk test rig is used with a hybrid setup of plain and fiber-reinforced polyamide (PA) 66 and polyetheretherketone (PEEK) disks paired with case-hardened steel disks and three different lubricants. Experimental investigations include various lubrication regimes by varying sum velocity and oil temperature as well as load and slip ratio. The measured friction in thermoplastic TEHL contacts is particularly very low in the area of high fluid load portion, which refers to the large deformation of the compliant polymer surface. Newtonian flow behavior mainly determines fluid friction. The low thermal effusivity of polymers insulates the contact and can further reduce the effective lubricant viscosity, and thus the fluid friction. For low sum velocities, solid friction influences the tribological behavior depending on the solid load portion. Although the interfacial contact friction is comparably small, material damping strongly contributes to power losses and increases bulk temperature, which in turn affects the TEHL contact. Thus, loading frequency and the resulting bulk temperature are identified as one of the main drivers of power losses and tribological behavior of lubricated thermoplastic polymer contacts.
Superelastic Behavior of Ti-Nb Alloys Obtained by the Laser Engineered Net Shaping (LENS) Technique
Authors: Kalita Damian , Rogal Łukasz , Bobrowski Piotr , Durejko Tomasz , Czujko Tomasz , Antolak-Dudka Anna , Cesari Eduard , Dutkiewicz Jan
Published: June 2020

The effect of Nb content on microstructure, mechanical properties and superelasticity was investigated for a series of Ti-xNb alloys, fabricated by the laser engineered net shaping method, using elemental Ti and Nb powders. The microstructure of as-deposited materials consisted of columnar β-phase grains, elongated in the built direction. However, due to the presence of undissolved Nb particles during the deposition process, an additional heat treatment was necessary. The observed changes in mechanical properties were explained in relation to the phase constituents and deformation mechanisms. Due to the elevated oxygen content in the investigated materials (2 at.%), the specific deformation mechanisms were observed at lower Nb content in comparison to the conventionally fabricated materials. This made it possible to conclude that oxygen increases the stability of the β phase in β–Ti alloys. For the first time, superelasticity was observed in Ti–Nb-based alloys fabricated by the additive manufacturing method. The highest recoverable strain of 3% was observed in Ti–19Nb alloy as a result of high elasticity and reverse martensitic transformation stress-induced during the loading.
Experimental Behavior of Cracked Reinforced Concrete Columns Strengthened with Reinforced Concrete Jacketing
Authors: Mohamed Sayed Ahmed , Mohamed Rashwan Mohamed , Emad Helmy Mohamed
Published: June 2020

Reinforced concrete (RC) columns often need to be strengthened or rehabilitated to allow them to carry the loads applied to them. In previous studies, RC columns have been strengthened by jacketing, without considering the occurrence of cracking. In this study, the behavior of RC columns strengthened externally by jacketing after cracking is analyzed. The accuracy of the existing models was verified by analyzing the performance of fifteen RC columns with different cross-sections to determine the effect of new variables, such as the column size, amount of steel reinforcement, and whether the column was cracked or not, on the effectiveness of strengthening. The analysis demonstrated that this strengthening technique could effectively improve both the ductility and strength of RC column cross-sections. The results indicate that the model suggested by the ACI-318 code can predict the ultimate load capacity of RC columns without strengthening, or strengthened by RC jacketing before or after cracking, with higher accuracy and material efficiency. The RC columns without strengthening met the safety limit of the ACI-318 model. However, for strengthened columns, a reduction coefficient must be used to enable the columns to meet the safety limit, with values of 94% and 76% for columns strengthened before and after cracking, respectively. Furthermore, strengthening after cracking affects the ultimate load capacity of the column, with 15.7%, 14.1%, and 13.5% lower loads for square, rectangular, and circular columns than those strengthened before cracking, respectively.
Synthesis and Characterization of LiFePO4–PANI Hybrid Material as Cathode for Lithium-Ion Batteries
Authors: Ajpi Cesario , Leiva Naviana , Vargas Max , Lundblad Anders , Lindbergh Göran , Cabrera Saul
Published: June 2020

This work focuses on the synthesis of LiFePO4–PANI hybrid materials and studies their electrochemical properties (capacity, cyclability and rate capability) for use in lithium ion batteries. PANI synthesis and optimization was carried out by chemical oxidation (self-assembly process), using ammonium persulfate (APS) and H3PO4, obtaining a material with a high degree of crystallinity. For the synthesis of the LiFePO4–PANI hybrid, a thermal treatment of LiFePO4 particles was carried out in a furnace with polyaniline (PANI) and lithium acetate (AcOLi)-coated particles, using Ar/H2 atmosphere. The pristine and synthetized powders were characterized by XRD, SEM, IR and TGA. The electrochemical characterizations were carried out by using CV, EIS and galvanostatic methods, obtaining a capacity of 95 mAhg−1 for PANI, 120 mAhg−1 for LiFePO4 and 145 mAhg−1 for LiFePO4–PANI, at a charge/discharge rate of 0.1 C. At a charge/discharge rate of 2 C, the capacities were 70 mAhg−1 for LiFePO4 and 100 mAhg−1 for LiFePO4–PANI, showing that the PANI also had a favorable effect on the rate capability.
Effect of Tempering Temperature after Thermo-Mechanical Control Process on Microstructure Characteristics and Hydrogen-Induced Ductility Loss in High-Vanadium X80 Pipeline Steel
Authors: Li Longfei , Song Bo , Yang Biwen , Wang Lei , Cheng Wensen
Published: June 2020

In this study, an optimum tempering temperature after a thermo-mechanical control process (TMCP) was proposed to improve the hydrogen-induced ductility loss of high-vanadium X80 pipeline steel. The results showed that with increasing tempering temperature from 450 to 650 °C, the size and quantity of granular bainite decreased but the spacing of deformed lath ferrite and the fraction of massive ferrite increased. The number of fine vanadium carbides increased as well. However, as the tempering temperature increased to 700 °C, the microstructure of T700 steel completely converted to massive ferrite and the grain size became larger. Additionally, the amount of nanoscale precipitates decreased again, and the mean size of precipitates evidently increased in T700 steel. The steel tempering at 650 °C, containing the most vanadium precipitates with a size less than 20 nm, had the lowest hydrogen diffusion coefficient and the best resistance to hydrogen-induced ductility loss.
An Enhanced Method to Evaluate Tensile Yield Stress by Small Punch Tests Using Deflection Curves
Authors: Gülçimen Çakan Betül , Hähner Peter , Soyarslan Celal , Bargmann Swantje
Published: June 2020

While force–displacement curves are often preferred in Small Punch (SP) tests due to the ease of the experimental set-up, they encompass significant uncertainties arising from frame compliance. In this work, a methodology is presented to predict yield stresses from the force vs. deflection curves. The present method relies on determining different force levels from the initial part of the force–deflection curve to reflect both the slope and the curvature instead of using a single force level only. The predicted yield stresses for different types of materials, that is, low- and high-strength alloys, are found to be in good agreement with the actual proof stresses with a maximum error of 16%.
The Square-Zero Basis of Matrix Lie Algebras
Authors: Durán Díaz Raúl , Gayoso Martínez Víctor , Hernández Encinas Luis , Muñoz Masqué Jaime
Published: June 2020

A method is presented that allows one to compute the maximum number of functionally-independent invariant functions under the action of a linear algebraic group as long as its Lie algebra admits a basis of square-zero matrices even on a field of positive characteristic. The class of such Lie algebras is studied in the framework of the classical Lie algebras of arbitrary characteristic. Some examples and applications are also given.
On the Effects of Circulation around a Circle on the Stability of a Thomson Vortex N-gon
Authors: Kurakin Leonid , Ostrovskaya Irina
Published: June 2020

The stability problem of the stationary rotation of N identical point vortices is considered. The vortices are located on a circle of radius R 0 at the vertices of a regular N-gon outside a circle of radius R. The circulation Γ around the circle is arbitrary. The problem has three parameters N, q, Γ , where q = R 2 / R 0 2 . This old problem of vortex dynamics is posed by Havelock (1931) and is a generalization of the Kelvin problem (1878) on the stability of a regular vortex polygon (Thomson N-gon) on the plane. In the case of Γ = 0 , the problem has already been solved: in the linear setting by Havelock, and in the nonlinear setting in the series of our papers. The contribution of this work to the solution of the problem consists in the analysis of the case of non-zero circulation Γ ≠ 0 . The linearization matrix and the quadratic part of the Hamiltonian are studied for all possible parameter values. Conditions for orbital stability and instability in the nonlinear setting are found. The parameter areas are specified where linear stability occurs and nonlinear analysis is required. The nonlinear stability theory of equilibria of Hamiltonian systems in resonant cases is applied. Two resonances that lead to instability in the nonlinear setting are found and investigated, although stability occurs in the linear approximation. All the results obtained are consistent with those known for Γ = 0 . This research is a necessary step in solving similar problems for the case of a moving circular cylinder, a model of vortices inside an annulus, and others.
Implicit-Explicit Methods for a Convection-Diffusion-Reaction Model of the Propagation of Forest Fires
Authors: Bürger Raimund , Gavilán Elvis , Inzunza Daniel , Mulet Pep , Villada Luis Miguel
Published: June 2020

Numerical techniques for approximate solution of a system of reaction-diffusion-convection partial differential equations modeling the evolution of temperature and fuel density in a wildfire are proposed. These schemes combine linearly implicit-explicit Runge–Kutta (IMEX-RK) methods and Strang-type splitting technique to adequately handle the non-linear parabolic term and the stiffness in the reactive part. Weighted essentially non-oscillatory (WENO) reconstructions are applied to the discretization of the nonlinear convection term. Examples are focused on the applicative problem of determining the width of a firebreak to prevent the propagation of forest fires. Results illustrate that the model and numerical scheme provide an effective tool for defining that width and the parameters for control strategies of wildland fires.