bluuebunny/crossref_metadata_2025 huggingface dataset:
Innovation, institutions and development: a critical review and grounded heterodox economic analysis of late-industrialising contexts
Authors: Perry Keston K
Published: September 2019

This paper critically reviews dominant approaches to the economics of innovation in contemporary developing societies, namely new institutional economics (NIE) and National Innovation Systems (NIS). Both traditions explain capitalist development in late-industrialising countries using underlying assumptions and logics of advanced industrialised societies with respect to transaction costs, path dependence, the nature and structure of institutions and economic history. At their core, both approaches proffer ideal-type institutions as an essentialist route to technological and productivity improvement akin to a staged theory of development. The NIS framework became dominant in scholarly and policy circles but has neglected the implication that the concept was developed at the Organisation of Economic Cooperation and Development during the emergence of first-stage neoliberalism. NIE has become an essential analytical toolkit of mainstream economists and international organisations promoting competitiveness in developing countries. Analyses of the economic performance of developing countries have thus diverged from structural perspectives on development, attributing instead lacklustre technological deepening to certain national features, institutional gaps or linkage failures. The paper exposes narrow assumptions and illustrates that the ‘transition costs’ that arise from new socio-institutional configurations during the development process induces firms and other actors to compete for rents. Conversely, power asymmetries, historical factors and constraining forces in the global capitalist system generate unevenness in productive forces and technological progress. The paper proposes a political economy of technological change that considers the structural, technical and socio-political interdependencies and tensions that underpin transformative policies to improve technological, coordination and collective capabilities in the economic system.
Tofacitinib Reprograms Human Monocytes of IBD Patients and Healthy Controls Toward a More Regulatory Phenotype
Authors: Cordes Friederike , Lenker Eva , Spille Lea J , Weinhage Toni , Bettenworth Dominik , Kessel Christoph , Schmidt Hartmut H , Foell Dirk , Varga Georg
Published: September 2019

Background

The inhibition of Janus kinases (JAKs) and subsequent signal transducers and activators of transcription (STATs) by tofacitinib represents a new therapeutic strategy in inflammatory bowel diseases (IBD) as clinical trials have led to approval of tofacitinib for ulcerative colitis (UC) and hint at a possible efficacy for Crohn`s disease (CD). However, the impact of tofacitinib on cellular response of monocytes, which are key players in inflammatory responses, has not been investigated so far. We aimed to analyze JAK/STAT-inhibition by tofacitinib in monocytes of IBD patients and healthy controls.

Methods

Primary monocytes of IBD patients with active disease and healthy controls (n = 18) were analyzed for cytokine expression and phenotype after granulocyte macrophage colony-stimulating factor (GM-CSF)/interferon (IFN)γ-stimulation and tofacitinib pretreatment (1–1000 nM) and capacity to induce Foxp3+-regulatory T cells (Tregs) in cocultures. In total, 20 UC patients and 21 CD patients were included. Additionally, dose-dependent inhibition of JAK/STAT-phosphorylation was analyzed in controls.

Results

Pro-inflammatory costimulation with GM-CSF/IFNγ resulted in significant tumor necrosis factor (TNFα) and interleukin (IL)-6 increase, whereas IL-10 expression decreased in monocytes. Tofacitinib modulated the responses of activated monocytes toward a regulatory phenotype through reduced TNFα and IL-6 secretion and enhanced Treg induction in cocultures. However, in monocytes from active IBD patients, higher tofacitinib dosages were needed for blockade of pro-inflammatory cytokines. Tofacitinib induced stronger regulatory phenotypes in monocytes of UC patients, including more effective inhibition of pro-inflammatory pathways and better restoration of anti-inflammatory mechanisms as compared with CD-derived monocytes.

Conclusion

Tofacitinib dose-dependently reprograms monocytes toward a more regulatory cell type. This beneficial effect possibly results from selective JAK/STAT-blockade by adequate tofacitinib dosage with inhibition of pro-inflammatory responses and permission of a balance-shift toward regulatory pathways.
The Unique Disease Course of Children with Very Early onset-Inflammatory Bowel Disease
Authors: Kelsen Judith R , Conrad Maire A , Dawany Noor , Patel Trusha , Shraim Rawan , Merz Audrey , Maurer Kelly , Sullivan Kathleen E , Devoto Marcella
Published: September 2019

Background

Insight into the pathogenesis of very early onset-inflammatory bowel disease (VEO-IBD) has expanded through the identification of causative monogenic defects detected in a subset of patients. However, the clinical course of this population remains uncertain. The study objective is to determine whether VEO-IBD is associated with more severe disease, defined as increased surgical intervention and growth failure, than older pediatric IBD. Secondary outcomes included therapeutic response and hospitalizations.

Methods

Subjects with IBD diagnosed younger than 6 years old (VEO-IBD) were compared with children diagnosed 6 to 10 (intermediate-onset) and older than 10 years of age (older-onset IBD). Metadata obtained from the medical record included age of onset, disease phenotype and location, surgeries, medical therapy, and comorbid conditions. Length of follow-up was at least 1 year from diagnosis.

Results

There were 229, 221, and 521 subjects with VEO, intermediate-onset, and older-onset IBD, respectively. Very early onset-inflammatory bowel disease subjects underwent more diverting ileostomies (P < 0.001) and colectomies (P < 0.001) than the older children. There was less improvement in weight- and height-for-age Z scores during the follow-up period in subjects with VEO-IBD. Additionally, subjects with VEO-IBD had higher rates of medication failure at 1 year and were more frequently readmitted to the hospital. Targeted therapy was successfully used almost exclusively in VEO-IBD.

Conclusion

Patients with VEO-IBD can have a more severe disease course with increased surgical interventions and poor growth as compared with older-onset IBD patients. Further, VEO-IBD patients are more likely to be refractory to conventional therapies. Strategies using targeted therapy in these children can improve outcome and, in some cases, be curative.
Female breast cancer risk in Bryansk Oblast, Russia, following prolonged low dose rate exposure to radiation from the Chernobyl power station accident
Authors: Rivkind Nikolai , Stepanenko Valeriy , Belukha Irina , Guenthoer Jamie , Kopecky Kenneth J , Kulikov Sergei , Kurnosova Irina , Onstad Lynn , Porter Peggy , Shklovskiy-Kordi Nikita , Troshin Vladislav , Voillequé Paul , Davis Scott
Published: September 2019

Background

Ionizing radiation is a known cause of female breast cancer, but there have been few studies of the risk after prolonged radiation exposure at low dose rates.

Methods

This population-based case-control study estimated breast cancer risk after ∼25 years’ exposure to radiation from the Chernobyl accident. Cases (n = 468) were women ≤55 years old when first diagnosed with invasive breast cancer during October 2008 through  February 2013, who lived in Bryansk Oblast, Russia at the time of the accident and their diagnoses. Controls, individually matched to cases on birth year, administrative district of residence and urban vs non-urban settlement during the accident, were women without breast cancer who lived in Bryansk Oblast at the time of the accident and on their cases’ diagnosis dates (n = 468). Subjects were interviewed regarding residence, dietary and food source histories to support individualized estimation of their radiation doses to the breast, which ranged from 0.04 − 41 centigray (cGy) (mean 1.3 cGy).

Results

In multivariable analyses, the odds ratio for breast cancer risk was 3.0 [95% confidence interval (CI): 1.3, 7.0] and 2.7 (95% CI: 1.0, 7.3) in the seventh and eighth dose octiles, respectively, relative to the lowest octile. Analyses of dose effect modification suggested that radiation-related risk may have been higher in women who were younger at the time of the accident and/or at the time of diagnosis.

Conclusions

This study suggests that prolonged exposure to ionizing radiation at low dose rates can increase risk of breast cancer.
Social Welfare Programs and Trust: Evidence from Six Latin American Cities
Authors: Chong Alberto , Ríos-Salas Vanessa , Ñopo Hugo
Published: September 2019

Using individual-level data that are representative at the city level for six Latin American capital cities (Bogota, Buenos Aires, Caracas, Lima, Montevideo, and San José), we find that participation in government social welfare programs is negatively associated to trust, a result that is robust to the inclusion of individual risk measures and a broad array of controls. Our findings support the notion that low take-up rates may be linked to stigma and not to high transaction costs as commonly suggested (JEL D01, O12, O10).
Temporal Variation of the Presence of Rhodnius prolixus (Hemiptera: Reduviidae) Into Rural Dwellings in the Department of Casanare, Eastern Colombia
Authors: Rincón-Galvis Helen Jineth , Urbano Plutarco , Hernández Carolina , Ramírez Juan David
Published: September 2019

Rhodnius prolixus (Stål, 1859) is the major vector of Trypanosoma cruzi in Colombia and Venezuela. The species is strongly associated with high-altitude ecotopes, such as sylvatic palms (Attalea butyracea), where spatially and temporally stable infestations are established. We investigated temporal variation in regards to the presence of R. prolixus in rural dwellings in the department of Casanare (eastern Colombia) over a period of 12 mo. Thirty houses were sampled from January to December 2017 by installing Maria sensors, collecting triatomines through community entomological surveillance, and conducting a monthly search in each house. The collection of specimens from the houses varied significantly by month with the higher number of collections occurring in the low-rainfall season and the lower number of collections occurring in the months of increased precipitation. The proportions of males, females, and nymphs also varied significantly throughout the time period: nymphs (fifth instar only) were reported only during May, July, and September and significantly greater numbers of females than males were reported in the inspected dwellings in all months. Density, crowding, and colonization indices varied according to the season. A bloodmeal analysis revealed 17 different hosts. A total of 42 randomly selected R. prolixus specimens were subjected to molecular analyses for detection of T. cruzi DNA with 22 found positive (infection prevalence of 52%). In conclusion, we observed a high presence of R. prolixus (infected with T. cruzi) in dwellings close to native palm plantations. These findings indicate a high risk of vector transmission of T. cruzi for people in the study areas and challenges for the current vector control schemes in the region.
Is nitric oxide a critical key factor in ABA-induced stomatal closure?
Authors: Van Meeteren Uulke , Kaiser Elias , Malcolm Matamoros Priscila , Verdonk Julian C , Aliniaeifard Sasan
Published: September 2019

The role of nitric oxide (NO) in abscisic acid (ABA)-induced stomatal closure is a matter of debate. We conducted experiments in Vicia faba leaves using NO gas and sodium nitroprusside (SNP), a NO-donor compound, and compared their effects to those of ABA. In epidermal strips, stomatal closure was induced by ABA but not by NO, casting doubt on the role of NO in ABA-mediated stomatal closure. Leaf discs and intact leaves showed a dual dose response to NO: stomatal aperture widened at low dosage and narrowed at high dosage. Overcoming stomatal resistance by means of high CO2 concentration ([CO2]) restored photosynthesis in ABA-treated leaf discs but not in those exposed to NO. NO inhibited photosynthesis immediately, causing an instantaneous increase in intercellular [CO2] (Ci), followed by stomatal closure. However, lowering Ci by using low ambient [CO2] showed that it was not the main factor in NO-induced stomatal closure. In intact leaves, the rate of stomatal closure in response to NO was about one order of magnitude less than after ABA application. Because of the different kinetics of photosynthesis and stomatal closure that were observed, we conclude that NO is not likely to be the key factor in ABA-induced rapid stomatal closure, but that it fine-tunes stomatal aperture via different pathways.
Communicating With Leadership: Behavioral Health and HIPAA in the Field
Authors: Shank Christopher G , Alampay Miguel M
Published: September 2019

It can be challenging for a general medical officer to determine a patient’s fitness for duty in the field. Communicating with commanding officers can be difficult given a general medical officer’s loyalties as both a physician and medical officer. We present a case of a junior officer that highlights these issues.
Invariant Manifolds and the Capture of Comet Shoemaker-Levy 9★
Authors: Swenson Travis E , Lo Martin W , Woollands Robyn M
Published: September 2019

The impact of Comet Shoemaker-Levy 9 (SL9) with Jupiter in 1994 was the ultimate confirmation of Eugene Shoemaker’s theory that impacts are a common, fundamental process in the Solar System. On Earth, asteroid impacts have produced several near extinction level events. We tend to visualise these collisions as billiard balls hitting one another. But how, exactly, do they occur? The actual dynamics is much more complex and subtle because it is highly non-linear and involves chaos in the three-body problem. In this paper we investigate the effects of Lyapunov orbits, halo orbits, and their associated invariant manifolds, on the orbital motion of SL9. We demonstrate that periodic orbits act as gateways to Jupiter, and their invariant manifolds controlled the dynamics of SL9 during the initial capture phase.
A kinematic confirmation of the hidden Vela supercluster
Authors: Courtois Hélène M , Kraan-Korteweg Renée C , Dupuy Alexandra , Graziani Romain , Libeskind Noam I
Published: September 2019

The Universe region obscured by the Milky Way is very large and only future blind large H i redshift, and targeted peculiar surveys on the outer borders will determine how much mass is hidden there. Meanwhile, we apply for the first time two independent techniques to the galaxy peculiar velocity catalogue CosmicFlows−3 in order to explore for the kinematic signature of a specific large-scale structure hidden behind this zone: the Vela supercluster at cz ∼18 000 km s−1. Using the gravitational velocity and density contrast fields, we find excellent agreement when comparing our results to the Vela object as traced in redshift space. The article provides the first kinematic evidence of a major mass concentration (knot of the Cosmic Web) located in the direction behind Vela constellation, pin pointing that the Zone of Avoidance should be surveyed in detail in the future.
Poly(ADP-ribose)-dependent chromatin unfolding facilitates the association of DNA-binding proteins with DNA at sites of damage
Authors: Smith Rebecca , Lebeaupin Théo , Juhász Szilvia , Chapuis Catherine , D’Augustin Ostiane , Dutertre Stéphanie , Burkovics Peter , Biertümpfel Christian , Timinszky Gyula , Huet Sébastien
Published: September 2019

The addition of poly(ADP-ribose) (PAR) chains along the chromatin fiber due to PARP1 activity regulates the recruitment of multiple factors to sites of DNA damage. In this manuscript, we investigated how, besides direct binding to PAR, early chromatin unfolding events controlled by PAR signaling contribute to recruitment to DNA lesions. We observed that different DNA-binding, but not histone-binding, domains accumulate at damaged chromatin in a PAR-dependent manner, and that this recruitment correlates with their affinity for DNA. Our findings indicate that this recruitment is promoted by early PAR-dependent chromatin remodeling rather than direct interaction with PAR. Moreover, recruitment is not the consequence of reduced molecular crowding at unfolded damaged chromatin but instead originates from facilitated binding to more exposed DNA. These findings are further substantiated by the observation that PAR-dependent chromatin remodeling at DNA lesions underlies increased DNAse hypersensitivity. Finally, the relevance of this new mode of PAR-dependent recruitment to DNA lesions is demonstrated by the observation that reducing the affinity for DNA of both CHD4 and HP1α, two proteins shown to be involved in the DNA-damage response, strongly impairs their recruitment to DNA lesions.
Lumbar Epidural Contrast Spread Patterns for the Interlaminar Approach: Three-Dimensional Analysis Using Antero-Posterior, Lateral, and Contralateral Oblique Views
Authors: Gill Jatinder , Simopoulos Thomas , Orhurhu Vwaire , Nagda Jyotsna , Aner Moris
Published: September 2019

Objective

To describe and analyze lumbar epidural contrast spread patterns in antero-posterior (AP), lateral, and contralateral oblique (CLO) views.

Methods

Lumbar epidural contrast spread patterns after interlaminar injection were prospectively collected in AP, lateral, and several CLO views and analyzed for multiple variables; three-dimensional mapping was also performed.

Results

Epidural contrast patterns were prospectively analyzed in 28 subjects. The median volume of contrast injected was 2 mL; the AP view was more sensitive than the lateral view to detect foraminal uptake (13/28, 46%, 95% confidence interval [CI] = 27–66%, vs 7/28, 25%, 95% CI = 11–45% subjects). CLO view demonstrated the most consistent location for epidural contrast spread, with contrast contacting the ventral laminar margin in 28/28 (100%, 95% CI = 87–100%) patients. The most common location of contrast spread in the lateral view was at the facet joint lucency, with only 8/28 (29%, 95% CI = 13%–49%) subjects showing contrast contacting the spinolaminar junction. Lateral view was more sensitive than the CLO view in ventral epidural contrast spread detection. The extent and distribution of the spread did not bear any relationship to the volume injected or to the needle location in AP view.

Conclusions

CLO view provides the most consistent landmark for lumbar epidural contrast spread, and lateral view is most suited to confirming ventral epidural spread. The AP view may be the most optimal for determining target access when considering access to the dorsal root ganglia; in an individual patient, the volume injected and needle location in AP view do not reliably predict target access. The volume to be injected and the need to re-access or obtain multisite access must be prospectively determined, based upon observation of the spread.
15. Eosinophilic pneumonitis secondary to baricitinib
Authors: Yein Khin , Ahmed Azeem
Published: September 2019

Introduction

We present a case of drug-induced pneumonitis in a patient taking baricitinib.

Case description

A 63-year-old patient with longstanding sero-positive erosive RA (anti-CCP >340) on long term methotrexate started taking baricitinib for his poorly-controlled arthritis 5 weeks prior to the hospital admission with two-week history of increasingly short of breath, productive cough with yellow sputum and right sided pleuritic chest pain.

On examination, he was febrile with temperature 38.2, tachypnoeic, respiratory rate 22/min and O2 saturation 92% on room air, with stable blood pressure 130/75 and normal sinus rhythm. He had some crepitations and reduced air entry in both lung bases on auscultation. He had no rash. CRP was > 190, total white cell 4.5, neutrophils 2.9, and eosinophils 0.56 (0.02-0.5). He had a transient rise in liver enzyme ALT (52) and bilirubin (22), both normalised on discharge. Kidney functions remained normal.

Influenza A, B and respiratory virus PCR, urinary legionella and pneumococcal antigen, blood, urine and sputum cultures were negative.

CXR showed no obvious consolidations or acute changes. CT angiogram to exclude pulmonary embolism showed scattered ground glass opacification throughout both lungs affecting multiple zones with no architectural distortion and no confluent consolidation.

Despite treatment with IV antibiotics for suspected community acquired pneumonia, he continued to spike temperatures and was dependent on oxygen. When we reviewed him, our impression was that his symptoms, clinical findings and CT changes were consistent with drug-induced pneumonitis, most likely due to baricitinib.

Methotrexate and baricitinib were suspended. He responded well to 40 mg of prednisolone; his fever subsided and he became less dyspnoeic and CRP and eosinophil counts improved. He went home after 7 days of admission. A repeat CT chest 8 weeks later showed a complete resolution of the pneumonitis. He was still on a low but reducing dose of prednisolone and methotrexate was restarted and tolerated well.

Discussion

We believe this is one of the first few reported cases of drug-induced pneumonitis to baricitinib. The patient had been treated in the community with antibiotics for 2 weeks as well as during admission with very poor response.

Baricitinib was the only new medication he took 4-5 weeks before the symptoms developed. Previously, he had been stable on his usual medications including methotrexate for over 10 years.

The temporal relationship between the start of the new medication and the onset of the symptoms, clinical and laboratory findings and radiological changes suggested that this was baricitinib-induced pneumonitis.

Key learning points

It is important to have a high index of suspicion for hypersensitivity pneumonitis in patients presenting with acute lung injury shortly after starting a new treatment as early diagnosis and treatment can lead to the complete resolution of the condition.

Conflict of interest

The authors declare no conflicts of interest.
The Cultural Origin of CEOs’ Attitudes toward Uncertainty: Evidence from Corporate Acquisitions
Authors: Pan Yihui , Siegel Stephan , Yue Wang Tracy
Published: September 2019

We examine the role of cultural heritage in shaping U.S. CEOs’ attitudes toward uncertainty, in the context of their corporate acquisition decisions. We find that CEOs with a more uncertainty-avoiding cultural heritage are less likely to engage in acquisitions. Conditional on making an acquisition, uncertainty-averse CEOs prefer targets in familiar industries and targets that can be more easily integrated. The emphasis on cultural identity by CEOs’ parents and the ethnic composition of CEOs’ early life environment significantly influence the cultural transmission process. Cultural differences about uncertainty attitudes persist over multiple generations, but become less pronounced over time. (JEL G34, G4, G40, G41)
Mutual Funding
Authors: Gil-Bazo Javier , Hoffmann Peter , Mayordomo Sergio
Published: September 2019

Using data on Spanish mutual funds, we show that bank-affiliated funds provide funding support to their parent company via purchases of bonds in the primary market. Support from affiliated funds is more sizeable in crisis times and for riskier banks. These trades generate negative abnormal returns and thus benefit banks at the expense of fund investors. To minimize negative effects on their asset management business, banks concentrate the burden of funding support in funds without performance fees and those catering to retail investors. We provide evidence consistent with funding support helping to limit credit rationing over the 2008–2012 period.
Predicting stress resilience and vulnerability: brain-derived neurotrophic factor and rapid eye movement sleep as potential biomarkers of individual stress responses
Authors: Sweeten Brook L W , Sutton Amy M , Wellman Laurie L , Sanford Larry D
Published: September 2019

Study Objectives

To examine the rapid eye movement sleep (REM) response to mild stress as a predictor of the REM response to intense stress and brain-derived neurotrophic factor (BDNF) as a potential biomarker of stress resilience and vulnerability.

Methods

Outbred Wistar rats were surgically implanted with electrodes for recording electroencephalography (EEG) and electromyogram (EMG) and intraperitoneal Data loggers to record body temperature. Blood was also obtained to measure circulating BDNF. After recovery, rats were exposed to mild stress (novel chamber, NC) and later intense stress (shock training, ST), followed by sleep recording. Subsequently, rats were separated into resilient (Res; n=27) or vulnerable (Vul; n = 15) based on whether or not there was a 50% or greater decrease in REM after ST compared to baseline. We then compared sleep, freezing, and the stress response (stress-induced hyperthermia, SIH) across groups to determine the effects of mild and intense stress to determine if BDNF was predictive of the REM response.

Results

REM totals in the first 4 hours of sleep after exposure to NC predicted REM responses following ST with resilient animals having higher REM and vulnerable animals having lower REM. Resilient rats had significantly higher baseline peripheral BDNF compared to vulnerable rats.

Conclusions

These results show that outbred rats display significant differences in post-stress sleep and peripheral BDNF identifying these factors as potential markers of resilience and vulnerability prior to traumatic stress.
A new ichthyosaur from the Late Jurassic of north-west Patagonia (Argentina) and its significance for the evolution of the narial complex of the ophthalmosaurids
Authors: Campos Lisandro , Fernández Marta S , Herrera Yanina
Published: September 2019

Ophthalmosaurids were highly derived and the youngest clade of ichthyosaurs. Their evolutionary history comprises ~76 Myr (from the early Middle Jurassic to the final extinction of the group at the Cenomanian–Turonian boundary). Fossil records indicate that soon after they emerged they achieved a widespread geographical distribution. Analyses of disparity based on craniodental morphologies, and the co-occurrence of different bone histology and microstructure among the members of the group, indicate that ophthalmosaurids are not only taxonomically but also ecologically diverse. A region of the skull that is particularly complex among ophthalmosaurid taxa is the external nares and surrounding areas, but there have been few attempts to explore this topic. We describe a new ophthalmosaurid from the Late Jurassic of Patagonia (Argentina) in the genus Arthropterygius and analyse its phylogenetic relationships. A detailed exploration of the skull, using computed tomography, reveals the division of the external nares by means of a stout bony pillar. This condition was previously known only in some Cretaceous forms and, within a phylogenetic framework, its distribution among ophthalmosaurids indicates that this morphology was the result of convergent evolution. Based on available data on extant (and some extinct) forms, we explore putative soft structures involved in the narial region. We propose that the division of the external nares (complete or partly osseous) was related functionally to the separation of the air passage from the outlet of nasal salt glands in such a way that the salt glands could be evacuated underwater, while the air passage could be closed by a valvular system.
Radial nerve palsies associated with paediatric supracondylar humeral fractures: a caution in the interpretation of neurophysiological studies
Authors: Dolan Roisin T. , Giele Henk P.
Published: September 2019

Traumatic and iatrogenic neurological complications associated with paediatric supracondylar humeral fractures are well recognised. The severity of the nerve injury associated with supracondylar humeral fractures can be difficult to assess clinically and relies upon clinical progression or absence of recovery and neurophysiology. It is accepted that complete nerve palsy with neurophysiological complete block and absence of clinical recovery after three months requires surgical exploration and reconstruction. However, we argue that even a partial nerve palsy that is failing to recover as expected by 3 months should be explored even when the neurophysiology suggests the nerve is in continuity. We report two cases of closed Gartland type III paediatric extension-type supracondylar humeral fractures treated with closed reduction and percutaneous pinning and open reduction and internal fixation, respectively. Both children developed persistent postoperative radial nerve motor palsy. Neurophysiological studies sought prior to exploration indicated a degree of sensory nerve function in both cases, indicating a nerve in continuity. Subsequent surgical exploration revealed interfragmentary radial nerve compression at the fracture site at two levels in one case and at one level in the second case. The site of compression was excised and the nerve grafted. Excellent near-normal radial nerve recovery was achieved except for the persistent loss of extensor carpi radialis function in the first child. We publish these findings to highlight the possibility of misinterpreting the incomplete nerve lesion and the neurophysiology of a nerve in continuity, as a nerve that would spontaneously recover. At exploration, in these two cases, it was clear by the level of interfragmentary compression that the nerve would not have recovered without surgical intervention. We recommend exploration and repair of the radial nerve, when function to the nerve is compromised, even in the face of neurophysiological evidence of an intact nerve.
Transcriptomic analysis reveals that heat shock protein 90α is a potential diagnostic and prognostic biomarker for cancer
Authors: Chen Wei , Li Guanghua , Peng Jianjun , Dai Weigang , Su Qiao , He Yulong
Published: September 2019

The molecular chaperone heat shock protein 90 (Hsp90) is highly expressed in tumor tissue according to many studies. However, there is no large-scale study investigating the expression of Hsp90 in pan-cancer so far, and the molecular mechanisms leading to aberrant Hsp90 expression are also largely unknown. To address these questions, we performed an in silico analysis of Hsp90 expression using mRNA sequencing data from The Cancer Genome Atlas study. The results were further validated using independent datasets. We found that the expression of HSP90AA1, a subtype of Hsp90, was much higher in hepatocellular carcinoma than in adjacent normal liver tissue. A large cancer panel with eight more cancer types revealed a similar trend except for prostate cancer, which had low HSP90AA1 expression in tumor tissue. Heat shock factor 1 followed a similar trend as HSP90AA1, with higher expression in cancer. HSP90AA1 expression was closely related to its copy numbers. Deletion of the HSP90AA1 locus in a subset of hepatocellular carcinoma led to low HSP90AA1 expression. In addition, higher HSP90AA1 expression was associated with poorer prognosis in hepatocellular carcinoma patients. In a multivariable analysis including tumor, node and metastasis stage, HSP90AA1 expression remained a negative prognostic factor, suggesting that the effect of HSP90AA1 was independent of tumor stage. In conclusion, we demonstrated that high HSP90AA1 expression was ubiquitous in cancer and that HSP90AA1 was a potential diagnostic and prognostic biomarker for hepatocellular carcinoma.
Mohs Micrographic Surgery as the Standard of Care for Nail Unit Squamous Cell Carcinoma
Authors: Gou Darlene , Nijhawan Rajiv I. , Srivastava Divya
Published: September 2019

BACKGROUND

There is no established standard of care for treatment of nail unit squamous cell carcinoma (SCC).

OBJECTIVE

The aim of the study is to further characterize the clinical characteristics and diagnostic considerations of nail unit SCC and to examine the outcomes of patients with nail unit SCC treated with Mohs micrographic surgery (MMS).

MATERIALS AND METHODS

A retrospective review was conducted of patients treated for nail unit SCC with MMS from January 1, 2006, to December 30, 2016. Demographic data were collected along with lesion characteristics, treatment characteristics, and follow-up results.

RESULTS

Forty-two cases of nail unit SCC were treated with MMS. Recurrences were observed in 3 patients (7.1%). Recurrent cases were treated with MMS. There were no cases of distant metastases, subsequent recurrence, or death. Two of 3 recurrences occurred in patients with histologic features of verruca vulgaris.

CONCLUSION

Mohs micrographic surgery provides an excellent cure rate for the treatment of nail unit SCC. This technique offers the greatest ability to achieve histological clearance while maximizing tissue sparing, thereby reducing unnecessary amputations and patient morbidity.
Prognostic value of negative lymph node count in patients with jejunoileal neuroendocrine tumors
Authors: Jiang Sujing , Han Xufeng , Dong Daye , Zhao Rongjie , Ren Lulu , Liu Zhen , Yang Xinmei , Liu Hao , Dong Ying , Han Weidong
Published: September 2019

A negative lymph node (NLN) count has been shown to have a significant impact on the prognosis of many types of cancer. However, its prognostic value for jejunoileal neuroendocrine tumors (NETs) remains unclear. In this study, we investigated the prognostic value of NLN count in patients with resected jejunoileal NETs diagnosed between 1988 and 2014. The data were retrieved from the Surveillance, Epidemiology and End Results database. The X-tile program was used to determine the cutoff value of the NLN count. Univariate and multivariate Cox proportional hazards models were used to assess the prognostic value of NLN count on survival. Harrell concordance index was used to compare the prognostic validity of NLN count with 2 current prognostic systems. The optimal cutoff point of the NLN count was 8. Kaplan-Meier analysis revealed a progressively worse overall survival (OS) with an NLN count ≤8 compared with an NLN count > 8 (
P
< 0.001). Univariate analysis showed that the NLN count, age, tumor site, tumor size and T classification were significant prognostic factors for the OS of jejunoileal NETs, while the number of positive lymph nodes had no significant impact on OS (
P
= 0.513). Multivariate analysis indicated that the NLN count was an independent prognostic factor for OS of jejunoileal NETs. A higher NLN count was associated with better OS (hazards ratio: 0.641; 95% confidence interval: 0.519-0.793;
P
< 0.001). Compared with 2 other prognostic systems, the NLN counts in this study had similar prognostic value in patients with jejunoileal NETs. Our findings suggest that the NLN count is an important independent prognostic factor for patients with jejunoileal NETs, and that it is a good adjunct for disease staging.
The relationship between HbA1c control levels and antituberculosis treatment effects: a meta-analysis
Authors: Song Chao , Xie Wang , Gong Li , Ren Min , Pan Pinhua , Luo Bailing
Published: September 2019

Background:

Multiple studies of tuberculosis (TB) treatment have indicated that patients with diabetes mellitus (DM) may experience poor outcomes. We performed a meta-analysis to summarize evidence for the relationship between HbA1c control levels and anti-TB treatment effects in patients afflicted with both TB and DM.

Methods:

Both English and Chinese databases were searched. Chinese databases included CNKI, WanFang, SinoMed, and VIP. PubMed, Ovid MEDLINE, Embase, Cochrane Library, and Web of Science were searched for English articles. We included studies that were restricted to the relationship between HbA1c levels and anti-TB treatment effects (sputum conversion rate [SCR] and TB focus absorption) in diabetic patients receiving treatment for TB. We used RevMan 5.3 software to analyze the data.

Results:

We included 12 studies, of which five reported SCR at 2 months, seven reported the conversion at 3 months, and seven reported TB focus absorption. According to the five studies which reported 2 months-SCR, patients with diabetes and TB had an odds ratio (OR) of 2.14 (95% CI: 0.84-5.43) for the 2 months-SCR between controlled (HbA1c <7.0) and uncontrolled diabetes (HbA1c ≥7.0). However, additional seven studies reporting 3 months-SCR showed that controlled diabetics had higher SCR than uncontrolled (OR 3.39, 95% CI: 2.12-5.43). Moreover, seven of the 12 studies demonstrated that there were differences in TB focus absorption between controlled and uncontrolled diabetes (OR 2.69, 95% CI: 1.91-3.79).

Conclusion:

HbA1c control levels influence the SCR at 3 months and the TB focus absorption at the end of the anti-TB intensive treatment phase. This study highlights a need for increased attention to HbA1c or glucose control in patients afflicted with both TB and DM.
Screening key genes and microRNAs in sepsis by RNA-sequencing
Authors: Qin Yanjun , Guo Xuan , Yu Yueqing , Dong Shimin , Yan Yan , Bian Xiaohua , Zhao Caiyan
Published: September 2019

Background:

Sepsis is a life-threatening organ dysfunction, initiated by a dysregulated host response to infection. This study aimed to determine key genes and microRNAs (miRNAs) correlated with sepsis.

Methods:

Three patients with sepsis and three healthy individuals treated as controls were recruited in the current study. To identify differentially expressed mRNAs (DEmRNAs) and differentially expressed miRNAs (DEmiRNAs) between patients with sepsis and controls, RNA-sequencing and bioinformatics analysis were conducted. DEmiRNA-target DEmRNAs analysis and functional annotation of DEmiRNA-target DEmRNAs were performed. Dataset GSE46955, used to validate the expression of selected DEmRNAs, was downloaded from the Gene Expression Omnibus database.

Results:

Compared with septic patients, a total of 1199 DEmRNAs and 23 DEmiRNAs were identified. Based on DEmiRNA-target DEmRNAs analysis, hsa-miR-106b-5p (degree = 155), hsa-miR-128-3p (degree = 128), and hsa-miR-144-3p (degree = 79) were the top 3 DEmiRNAs that covered most DEmRNAs. The T cell receptor signaling pathway, pathways in cancer, FoxO signaling pathway, and influenza A were the significantly enriched Kyoto Encyclopedia of Genes and Genomes pathways of DEmiRNA-target DEmRNAs in sepsis.

Conclusion:

We identified key genes and miRNAs related to sepsis. Our findings will provide new insights into understanding sepsis pathogenesis.
Ambulatory blood pressure monitoring parameters in obese children and adolescents with masked hypertension
Authors: Yegül-Gülnar Gökçe , Kasap-Demir Belde , Alparslan Caner , Çatli Gönül , Mutlubaş Fatma , Yavaşcan Önder , Özkan Bülent , Dündar Bumin Nuri , Aksu Nejat
Published: September 2019

Objective

We aimed to compare the demographic, laboratory, and ambulatory blood pressure monitoring (ABPM) parameters of patients with masked hypertension (MHT), define factors predicting MHT, and determine the ABPM parameters affecting left ventricular mass index (LVMI) in obese youth.

Methods

Data of obese patients were evaluated retrospectively. Patients with ambulatory hypertension (AHT), white-coat hypertension (WCHT), MHT, or normotension (NT) were determined. Demographic and laboratory findings, office and ABPM measurements, blood pressure variability (BPV), and heart rate variability (HRV) were compared between the groups. The factors predicting MHT and the association between LVMI and ABPM, BPV/HRV parameters were analyzed.

Results

None of the 118 patients (M/F: 52/66) had WCHT. Three groups were formed: AHT (n: 60, 51%), MHT (n: 46, 39%), and NT (n: 12, 10%). Striae were significantly more frequent in AHT and MHT groups (P: 0.003). Cut-off levels for office BP measurements predicting MHT were 0.85 and 0.76 for systolic and diastolic BP (SBP and DBP) indexes, respectively. Most of the ABPM parameters of MHT group were as high as those of AHT group. On regression analysis, only daytime MAP had a positive (β: 0.340; P < 0.01) and diastolic dip (β: −0.204; P < 0.01) had a significantly negative association with LVMI.

Conclusion

Stria and cut-off levels for office SBP/DBP indexes, which were defined for the first time in this study, may determine the patients at risk of MHT. Although BPV or HRV had no relation to LVMI, daytime MAP and diastolic dip represented independent associations with LVMI.
18F-choline positron emission tomography/computed tomography for the detection of prostate cancer relapse: assessment of maximum standardized uptake value correlation with prostate-specific antigen levels
Authors: Siminiak Natalia , Wojciechowska Karolina , Miechowicz Izabela , Cholewiński Witold , Ruchała Marek , Czepczyński Rafał
Published: September 2019

Objective

Patients with prostate cancer are monitored by prostate-specific antigen (PSA) evaluation and PET [PET/computed tomography (CT)]. The aim of our study was to evaluate correlations between PSA levels and standardized uptake values (SUV) in patients with recurrent prostate cancer.

Methods

We analyzed 282 prostate cancer patients undergoing PET-CT due to suspicion of recurrence. Levels of PSA and PSA change per month were analyzed, together with maximum standardized uptake value (SUVmax).

Results

PET/CT results were positive in 175 patients (62.1%) and negative in 107 patients (37.9%). In the positive group, PSA levels were significantly higher. The ROC curve analysis indicated PSA level of 1.70 ng/ml and PSA level change in time of 0.12 ng/ml are the optimal cut-off values. Patients were divided into subgroups: with metastases (M), local relapse (L), and local relapse and metastases (M + L). The latest PSA levels, were similar in subgroups L and M: 5.00 (2.98–10.30) ng/ml and 3.90 (1.27–14.08) ng/ml, but lower than in subgroup M + L: 12.43 (6.08–49.36) ng/ml. PSA level change in time was similar in the subgroups L and M: 0.63 (0.09–1.00) ng/ml/month and 0.33 (0.02–1.73) ng/ml/month, but lower in subgroup M + L: 2.21 (0.22–10.34) ng/ml/month, P < 0.05. SUVmax was significantly (P < 0.05) lower in subgroup L than in M and L + M: 3.00 (2.30–4.00), 4.60 (2.70–7.40), and 4.90 (3.80–8.00), respectively. PSA level significantly correlated with SUVmax in patients from subgroups L (R = 0.424; P < 0.05) and M (R = 0.314; P < 0.01). Positive correlation between PSA change and SUVmax was observed in subgroup M + L (R = 0.561; P < 0.01) and M (R = 0.270; P < 0.05).

Conclusion

The study confirmed that patients with high PSA level and fast PSA increase are likely to be diagnosed with both, local relapse and metastases. Moreover, SUVmax values in metastatic lesions are usually higher.
Outcomes of Infants Supported With Extracorporeal Membrane Oxygenation Using Centrifugal Versus Roller Pumps: An Analysis From the Extracorporeal Life Support Organization Registry
Authors: O’Halloran Conor P. , Thiagarajan Ravi R. , Yarlagadda Vamsi V. , Barbaro Ryan P. , Nasr Viviane G. , Rycus Peter , Anders Marc , Alexander Peta M. A.
Published: September 2019

Objectives:

To determine whether mortality differs between roller and centrifugal pumps used during extracorporeal membrane oxygenation in infants weighing less than 10 kg.

Design:

Retrospective propensity-matched cohort study.

Setting:

All extracorporeal membrane oxygenation centers reporting to the Extracorporeal Life Support Organization.

Patients:

All patients less than 10 kg supported on extracorporeal membrane oxygenation during 2011–2016 within Extracorporeal Life Support Organization Registry.

Interventions:

Centrifugal and roller pump recipients were propensity matched (1:1) based on predicted probability of receiving a centrifugal pump using demographic variables, indication for extracorporeal membrane oxygenation, central versus peripheral cannulation, and pre-extracorporeal membrane oxygenation patient management.

Measurements and Main Results:

A total of 12,890 patients less than 10 kg were supported with extracorporeal membrane oxygenation within the Extracorporeal Life Support Organization registry during 2011–2016. Patients were propensity matched into a cohort of 8,366. Venoarterial and venovenous extracorporeal membrane oxygenation runs were propensity matched separately. The propensity-matched cohorts were similar except earlier year of extracorporeal membrane oxygenation (standardized mean difference, 0.49) in the roller pump group. Within the propensity-matched cohort, survival to discharge was lower in the centrifugal pump group (57% vs 59%; odds ratio, 0.91; 95% CI, 0.83–0.99; p = 0.04). Hemolytic, infectious, limb injury, mechanical, metabolic, neurologic, pulmonary, and renal complications were more frequent in the centrifugal pump group. Hemorrhagic complications were similar between groups. Hemolysis mediated the relationship between centrifugal pumps and mortality (indirect effect, 0.023; p < 0.001).

Conclusions:

In this propensity score–matched cohort study of 8,366 extracorporeal membrane oxygenation recipients weighing less than 10 kg, those supported with centrifugal pumps had increased mortality and extracorporeal membrane oxygenation complications. Hemolysis was evaluated as a potential mediator of the relationship between centrifugal pump use and mortality and met criteria for full mediation.
Managing Patient Expectations
Authors: Latte-Naor Shelly
Published: September 2019

Expectations and beliefs about complementary and integrative medicine are the main predictors of its use in cancer patients. These expectations are rarely informed by consultation with a health care provider but are, rather, a result of family endorsement and information from nonmedical sources. As a rising number of cancer patients pursue integrative medicine, it is of increasing importance that health care providers understand their patients' expectations and motivations. These can range from symptom management to unrealistic hopes for cure. Complementary and integrative medicine can be used to complement criterion-standard cancer care, but is sometimes dangerously touted as an alternative for it. Awareness of these nuances enables providers to initiate effective communication about complementary and integrative medicine and to intervene when unrealistic expectations stand in the way of lifesaving care. Refining patient-centered communication around integrative medicine is essential to avoid unsupervised, potentially harmful use, delays, or interruptions in cancer care and, ultimately, to maximize the benefits of integrative therapies during cancer treatment.
Imaging Diagnosis of Von Hippel-Lindau Syndrome
Authors: Xu Nan , Duan Wenshuai , Zhang Ruopeng , Yang Bin
Published: September 2019

Introduction:

Von Hippel-Lindau (VHL) syndrome is a group of rare autosomal dominant hereditary diseases that involve multiple organs. Due to its high recurrence rate and complex and diverse clinical manifestations, VHL is prone to being either misdiagnosed or missed entirely. Therefore, patients with VHL syndrome have a poor prognosis.

Clinical features:

This study reports the details of 2 patients, a 55-year-old male and a 37-year-old female, who were diagnosed as having VHL syndrome with a positive family history. The male patient presented with upper abdominal discomfort 2 years prior to the current study, and was diagnosed in another hospital as having a space-occupying lesion at the head of the pancreas. After undergoing hemangioblastoma resection of the right cerebellar hemisphere 1 month ago, he was admitted to the hospital for recent aggravation of upper abdominal discomfort to receive further diagnosis and treatment. The female patient previously underwent right ovarian cystectomy and T5-T6 intramedullary hemangioblastoma resection. She was diagnosed at another hospital as having pancreatic cancer, and was admitted to the hospital for recent aggravation of upper abdominal discomfort to receive further diagnosis and treatment.

Conclusion:

The diagnosis and treatment of VHL syndrome is currently relatively difficult. It poses a substantial threat to patients and their families. The early and timely diagnosis and treatment of VHL syndrome can improve patients’ prognosis and rates of survival.