bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of Activin pathway modulation on the expression of both pluripotency and differentiation markers during early zebrafish development compared with other vertebrates
Authors: Hasanpour Shaghayegh , Eagderi Soheil , Poorbagher Hadi , Angrand Pierre‐Olivier , Hasanpour Mohammad , Lashkarbolok Maryam
Published: October 2021

Activin‐like factors control many developmental processes, including pluripotency maintenance and differentiation. Although Activin‐like factors' action in mesendoderm induction has been demonstrated in zebrafish, their involvement in preserving the stemness remains unknown. To investigate the role of maternal Activin‐like factors, their effects were promoted or blocked using synthetic human Activin A or SB‐431542 treatments respectively until the maternal to zygotic transition. To study the role of zygotic Activin‐like factors, SB‐431542 treatment was also applied after the maternal to zygotic transition. The effect of the pharmacological modulations of the Activin/Smad pathway was then studied on the mRNA expressions of the ndr1, ndr2, tbxta (no tail/ntl) as the differentiation index, mych, nanog, and oct4 (pou5f3) as the pluripotency markers of the zebrafish embryonic cells as well as sox17 as a definitive endoderm marker. Expression of the target genes was measured at the 16‐cell, 256‐cell, 1K‐cell, oblong, dome, and shield stages using the real‐time quantitative polymerase chain reaction (RT‐qPCR). Activation of the maternal Activin signaling pathway led to an increase in zygotic expression of the tbxta, particularly marked at the oblong stage. In other words, promotion of the maternal Activin/Smad pathway induced differentiation by advancing the major peaks of ndr1 and nanog, thereby eliciting tbxta expression. Whereas suppression of the maternal or zygotic Activin/Smad pathway sustained the pluripotency by preventing the major peaks of ndr1 and nanog as well as tbxta encoding.
Quantitative Assessment of Lung Ultrasound Grayscale Images Based on Shannon Entropy for the Detection of Pulmonary Aeration
Authors: Fang Jui , Ting Yen‐Nien , Chen Yi‐Wen
Published: October 2021

Objective

Lung ultrasound (LUS) is a radiation‐free, affordable, and bedside monitoring method that can detect changes in pulmonary aeration before hypoxic damage. However, visual scoring methods of LUS only enable subjective diagnosis. Therefore, quantitative analysis of LUS is necessary for obtaining objective information on pulmonary aeration. Because raw data are not always available in conventional ultrasound systems, Shannon entropy (ShanEn) of information theory without the requirement of raw data is valuable. In this study, we explored the feasibility of ShanEn estimated through grayscale histogram (GSH) analysis of LUS images for the quantification of pulmonary aeration.

Methods

Different degrees of pulmonary aeration caused by edema was induced in 32 male New Zealand rabbits intravenously injected with 0.1 mL/kg saline (the control group) and 0.025, 0.05, and 0.1 mL/kg oleic acid (mild, moderate, and severe groups, respectively). In vivo grayscale LUS images were acquired using a commercial point‐of‐care ultrasound system for estimation of GSH and corresponding ShanEn. Both lungs of each rabbit were dissected, weighed, and dried to determine the wet weight‐to‐dry weight ratio (W/D) through gravimetry.

Results

The determination coefficients of linear correlations between ShanEn and W/D increased from 0.0487 to 0.7477 with gain and dynamic range (DR). In contrast to visual scoring methods of pulmonary aeration that use median gain and low DR, ShanEn for quantifying pulmonary aeration requires high gain and DR.

Conclusion

The current findings indicate that ShanEn estimated through GSH analysis of LUS images acquired using conventional ultrasonic imaging systems has great potential to provide objective information on pulmonary aeration.
Temperature‐Stress Bimodal Sensing Conductive Hydrogel‐Liquid Metal by Facile Synthesis for Smart Wearable Sensor
Authors: Wang Chen , Li Jie , Fang Zhaozhou , Hu Zhirui , Wei Xiaotong , Cao Yang , Han Jing , Li Yingchun
Published: October 2021

Conductive hydrogels have attracted great attention due to their promising applications in wearable sensors. However, developing conductive hydrogels with excellent sensor properties and multiple stimuli responsiveness for smart wearable devices is still a challenge. This paper presents a facile synthetic method of a crosslinked chitosan quaternary ammonium salt and liquid metal (CHACC‐LM) composite hydrogel with temperature–stress bimodal sensing for smart wearable sensor. LM as liquid fillers toughen the hydrogel matrix (stress: 1.11 MPa) and enhance the hydrogel extensibility (strain: 233%). The CHACC‐LM hydrogel exhibits conductivity , excellent antibacterial properties (> 99%), an electrical self‐healing property, and strain sensitivity (GF = 1.6). In addition, the CHACC‐LM hydrogel can be used as wearable flexible sensors with the ability of monitoring human activities directly and the distinguished ability of discerning subtle motions (handwriting). It also shows sensitivity in the external environment such as low temperature, thermal response, and water solution. Importantly, the composite hydrogel simultaneous response to different stress and temperature stimuli. Furthermore, the CHACC‐LM hydrogel can be used for gesture recognition and to control the manipulator in human–computer interaction. All these properties provide a great scope for researchers to achieve practical advances in smart wearable sensors.
A Novel Schiff Base‐Modified Dialdehyde Cellulose‐Based Fluorescent Probe for Al3+ and Its Application in Environmental Analysis
Authors: Meng Zhiyuan , Yin Jie , Li Mingxin , Liang Yueyin , Wang Xiaoyuan , Wu Yangmei , Kou Jiali , Wang Zhonglong , Yang Yiqin
Published: October 2021

Cellulose is the most abundant natural polymer with good biodegradability and biocompatibility. In this paper, a novel fluorescent probe DAC‐SD‐NA for aluminum (Al3+) detection is successfully synthesized based on dialdehyde cellulose (DAC). DAC‐SD‐NA exhibited a remarkable “turn‐on” fluorescence response to Al3+ in a wide pH range, and the fluorescence color of DAC‐SD‐NA solution turned from colorless to bright blue at the presence of Al3+. The detection limit for Al3+ is computed to be 6.06×10−7 m. The reaction mechanism of DAC‐SD‐NA towards Al3+ is confirmed by Job's plot, X‐ray photoelectron spectroscopy, and density functional theory (DFT) calculations. In view of DAC‐SD‐NA exhibited good sensitivity and selectivity, it is applied to detect Al3+ in real water. What's more, DAC‐SD‐NA‐loaded fluorescent hydrogel can serve as a convenient tool for the detection of Al3+.
An improvised extrapolated collocation algorithm for solving Kuramoto–Sivashinsky equation
Authors: Shallu  , Kukreja Vijay Kumar
Published: October 2021

In the present work, the numerical solution of the Kuramoto–Sivashinsky (KS) equation is obtained using an improvised quintic B‐spline extrapolated collocation technique. This equation helps in the study of wave production in dissipative medium, investigates the hydrodynamic uncertainty in laminar flames, describes the turbulence of diverse physical processes, and so on. In this work, splines are used due to their higher smoothness property and the sparse nature of the matrices corresponding to the B‐splines. The improvised B‐splines are formed by forcing the quintic B‐spline interpolant to satisfy the interpolatory and some special end conditions. These basis functions are used in the collocation method for space integration and a weighted finite difference scheme is used for temporal domain integration. The stability of the technique is analyzed using the von Neumann scheme, and it is found to be unconditionally stable. The proposed method is found to be sixth‐order convergent in space and second‐order convergent in the time direction. The theoretical order of convergence is matching perfectly with the numerical one. The efficiency of this scheme is demonstrated by applying it to a number of examples. The L2,  L∞, and global relative errors are calculated and compared with the previous work, especially with those where quintic B‐splines are used as basis functions. Also, the behavior of some KS equations is discussed for which the exact solution is not available. The aim of the paper is to show that such an improvised technique can be implemented to solve partial differential equations like the KS equation.
Analytical solution for distributed torsional low strain integrity test for pipe pile
Authors: Zhang Yunpeng , Jiang Guosheng , Wu Wenbing , El Naggar M. Hesham , Liu Hao , Wen Minjie , Wang Kuihua
Published: October 2021

Low strain integrity tests (LSITs) are the most popular non‐destructive methods for pile testing. However, traditional LSITs have encountered unprecedented challenges as the need for long pile and existing pile testing keeps multiplying. Compared to traditional longitudinal excitations, the torsional wave is less influenced by the velocity attenuation effect and can be subjected at the pile shaft for existing piles. Distributed torsional LSIT is proposed in this article with the presentation of the corresponding analytical solutions that exhibiting the velocity responses along the pile shaft. The solution is verified with previous simplified theoretical and rigorous finite element method (FEM) answers. At the end, the application of this method is exhibited through the identification of necking and concrete segregation defects on pipe piles, which shows the advantage of this method on long pile testing.
Can we model cultural ecosystem services, and are we measuring the right things?
Authors: Jones Laurence , Boeri Marco , Christie Mike , Durance Isabelle , Evans Karl L. , Fletcher David , Harrison Laura , Jorgensen Anna , Masante Dario , McGinlay James , Paterson David M. , Schmucki Reto , Short Chris , Small Natalie , Southon Georgina , Stojanovic Timothy , Waters Ruth
Published: October 2021

Cultural ecosystem services (CES), a key aspect of nature's contributions to people, remain a challenge to incorporate into decision making. One contributing factor is the difficulty of defining and describing these, due partly to: ongoing poor understanding of what drives people to interact with nature, a lack of appropriate data to quantify these interactions, and basic difficulties in measuring and modelling the complex array of social, psychological and behavioural attributes which help explain people's actions.

In this study we present a framework which develops the concepts of cultural capital, social capital and human capital as specific forms of human‐centred capital, in the context of their contribution to understanding CES. Each form of capital encompasses separate attributes of beneficiaries.

Testing the framework with data from a separate trans‐disciplinary study illustrated that the framework was readily applicable to specific situations. A measure of cultural capital, EcoCentrism, explained more variation than a suite of seven demographic variables.

Applying the framework also showed that despite using a wide range of explanatory variables, a large proportion of observed variation remained unaccounted for. This suggests that more work is needed to understand and to develop metrics which can measure additional factors which underlie peoples’ motivations to engage with nature. The framework is applicable to other types of ecosystem service, and may also be useful for exploring relational values.

A free Plain Language Summary can be found within the Supporting Information of this article.
Preparation of 3D porous cellulose‐chitosan hybrid gel macrospheres by alkaline urea system for enzyme immobilization
Authors: Sun Zhouquan , Su Hui , Zhong Yi , Xu Hong , Wang Bijia , Zhang Linping , Sui Xiaofeng , Feng Xueling , Mao Zhiping
Published: October 2021

In order to find a low‐cost, green and sustainable immobilized enzyme carrier, cellulose material has been widely used in the field of immobilized enzyme, but the low specific surface area and apparent porosity limit its further application. In this article, cellulose and chitosan are dissolved in alkaline urea system through freeze–thaw cycle, then regenerate in weakly alkaline by sol–gel method and solvent exchange. A novel 3D porous cellulose‐chitosan hybrid gel macrospheres (CCMs) with high specific surface area (235.4–325.3 m2/g) are obtained after lyophilization. The cellulose‐chitosan macrospheres are characterized by Fourier transform infrared (FTIR) spectroscopy, thermogravimetric analysis (TGA), and X‐ray diffractive analysis (XRD) and the size, surface, and internal morphology of CCMs are observed by scanning electron microscopy (SEM). Furthermore, it is found that α‐amylase (AMY) could be successfully immobilized on the hybrid gel microspheres by glutaraldehyde regent. Compared with free α‐amylases, immobilized enzymes exhibit higher thermal stability, more broadly pH adaptive, and improved storage stability. After 10 cycles, the immobilized enzymes retain 77.5% of their initial activity.
Brachytherapy in children, adolescents, and young adults: An underutilized modality in the United States?
Authors: Zakem Sara J. , Cost Carrye R. , Cost Nicholas G. , Robin Tyler P. , Milgrom Sarah A.
Published: October 2021

Background

Brachytherapy (BT) delivers highly conformal radiation and spares surrounding tissues, which may limit late effects in pediatric, adolescent, and young adult (AYA) patients. We aimed to characterize trends in BT use for this population in the United States, focusing on patients with rhabdomyosarcoma (RMS).

Methods

The National Cancer Database was queried to identify patients ≤ 21 who were treated for solid tumor malignancies in the United States from 2004 to 2016. We obtained disease, treatment, and outcome data for patients treated with BT, in particular for RMS.

Results

99 506 pediatric and AYA patients met study inclusion. Of these, 22 586 (23%) received radiation therapy (external beam radiation therapy [EBRT] and/or BT) and 240 (0.2%) received BT. Among patients treated with BT, 139 (58%) underwent surgery and 58 (24%) received EBRT. A total of 3836 patients were treated for RMS during this period. Of these, 2531 (66%) received any radiation and 37 (1%) received BT (EBRT + BT in 3, BT in 34). Of patients treated with BT for RMS, 28 (76%) underwent surgery + BT. Survival data were available for 31 patients treated with BT for RMS. With a median follow‐up of 63 months, overall survival was 100% for patients with RMS of a favorable site treated with BT.

Conclusions

BT is rarely used to treat pediatric and AYA patients in the United States. Patients treated with BT for RMS experienced favorable survival, suggesting that this approach may not compromise oncologic outcomes and warrants further study as a therapeutic option in pediatric and AYA patients, specifically in RMS.
Exploring primary breast cancer survivors' self‐management of sustained cancer‐related cognitive impairment in the workplace
Authors: Chapman Bethany , Derakshan Nazanin , Grunfeld Elizabeth A.
Published: October 2021

Objective

Work plays a central role in return to a more ‘normal’ life among women diagnosed with primary breast cancer. However, ongoing cancer‐related cognitive impairment (CRCI) and cancer‐related sequelae continue to detrimentally impact workability. Only a few studies have explored the long‐term consequences of CRCI and self‐management coping strategies applied in the workplace. This study explored women's experiences of sustained post‐treatment CRCI and its impact on workability beyond the initial return‐to‐work (RTW), as well as experiences of self‐management coping strategies.

Method

Forty employed women with a diagnosis of primary breast cancer who were between 6 and 60 months post‐active treatment completed a semi‐structured telephone interview. A ‘framework’ analysis approach was used.

Results

Two superordinate themes were identified: ‘Sustained consequences of CRCI’ and ‘Self‐management coping strategies to support work‐related performance’. We found that the impact of CRCI extends beyond the initial RTW. The adopted self‐management coping strategies could provoke mixed emotions, including emotional distress. Reduced workability was experienced up to 5‐years post‐active‐treatment.

Conclusion

Sustained CRCI induces negative emotions, fatigue and diminishes confidence reducing workability long into survivorship beyond RTW. The self‐management coping strategies implemented to manage these sequelae generate mixed feelings, with some describing the strategies as problematic and of little benefit.
Origin of Perpendicular Magnetic Anisotropy Enhancement in Co/Ni Bilayer Due to Plasma Oxidation
Authors: Anastaziak Błażej , Głowiński Hubert , Urbaniak Maciej , Frąckowiak Łukasz , Stobiecki Feliks , Kuświk Piotr
Published: October 2021

In spintronics and magnonics, materials that offer tunable perpendicular magnetic anisotropy (PMA) along with low Gilbert damping and high spin polarization are particularly important. Therefore, a lot of studies are performed on Co/Ni films, that aim at satisfying all these requirements. Moreover, the Dzyaloshinskii−Moriya interaction is induced in them by surrounding the magnetic layers with heavy metal or oxide layers. For this reason, the study of the oxidation of Co/Ni is of particular interest. Therefore, the magnetic properties of Co/Ni bilayers after plasma oxidation (PO) are investigated. It is shown that the magnetic anisotropy of these bilayers can be tuned, not only by the thicknesses of Co and Ni layers, but also by oxidation time varied in the range between 15 and 220 s. After PO, the effective thickness of ferromagnetic Ni is reduced, but it does not oxidize more than ≈2 nm, even for longer oxidation. However, the contribution to PMA increases for the entire range of oxidation times. This indicates that the thickness reduction of the Ni layer is not the only source of PMA enhancement. This additional contribution is attributed to the exchange bias coupling between the ferromagnetic (Co/Ni) and the antiferromagnetic NiO layers.
Ellagitannins, promising pharmacological agents for the treatment of cancer stem cells
Authors: Senobari Zohre , Karimi Gholamreza , Jamialahmadi Khadijeh
Published: October 2021

Human tumors comprise subpopulations of cells called cancer stem cells (CSCs) that possess stemness properties. CSCs can initiate tumors and cause recurrence, metastasis and are also responsible for chemo‐ and radio‐resistance. CSCs may use signaling pathways similar to normal stem cells, including Notch, JAK/STAT, Wnt and Hedgehog pathways. Ellagitannins (ETs) are a broad group of substances with chemopreventive and anticancer activities. The antitumor activity of ETs and their derivatives are mainly related to their antiinflammatory capacity. They are therefore able to modulate secretory growth factors and pro‐inflammatory mediators such as IL‐6, TGF‐β, TNF‐α, IL‐1β and IFN‐γ. Evidence suggests that ETs display their anticancer effect by targeting CSCs and disrupting stem cell signaling. However, there are still few studies in this field. Therefore, high‐quality studies are needed to firmly establish the clinical efficacy of the ETs on CSCs. This paper reviews the structures, sources and pharmacokinetics of ETs. It also focuses on the function of ETs and their effects on CSCs‐related cytokines and the relationship between ETs and signaling pathways in CSCs.
Interface Pattern Engineering in Core‐Shell Upconverting Nanocrystals: Shedding Light on Critical Parameters and Consequences for the Photoluminescence Properties
Authors: Hudry Damien , De Backer Annick , Popescu Radian , Busko Dmitry , Howard Ian A. , Bals Sara , Zhang Yang , Pedrazo‐Tardajos Adrian , Van Aert Sandra , Gerthsen Dagmar , Altantzis Thomas , Richards Bryce S.
Published: October 2021

Advances in controlling energy migration pathways in core‐shell lanthanide (Ln)‐based hetero‐nanocrystals (HNCs) have relied heavily on assumptions about how optically active centers are distributed within individual HNCs. In this article, it is demonstrated that different types of interface patterns can be formed depending on shell growth conditions. Such interface patterns are not only identified but also characterized with spatial resolution ranging from the nanometer‐ to the atomic‐scale. In the most favorable cases, atomic‐scale resolved maps of individual particles are obtained. It is also demonstrated that, for the same type of core‐shell architecture, the interface pattern can be engineered with thicknesses of just 1 nm up to several tens of nanometers. Total alloying between the core and shell domains is also possible when using ultra‐small particles as seeds. Finally, with different types of interface patterns (same architecture and chemical composition of the core and shell domains) it is possible to modify the output color (yellow, red, and green‐yellow) or change (improvement or degradation) the absolute upconversion quantum yield. The results presented in this article introduce an important paradigm shift and pave the way toward the emergence of a new generation of core‐shell Ln‐based HNCs with better control over their atomic‐scale organization.
Prediction of the Martensite Start Temperature in High‐Carbon Steels
Authors: Ingber Jerome , Kunert Maik
Published: October 2021

A new model for estimating the martensite start temperature (Ms) as a function of chemical composition is presented. It is developed and optimized for high‐carbon steels with aMsrange between 0 and 50 °C. It is based on the mean value of the best 8 of 21 considered models from the literature. A comprehensive evaluation is made by comparing the calculatedMswith experimentalMsdata. Within the targetedMsrange, the average absolute deviation of the calculatedMsis as low as 13 °C. The investigations further show that the new model also makes accurate predictions outside the targetedMsrange. The average absolute deviation in theMsrange from 0 to 400 °C is found to be 21 °C, the lowest of all compared models. Furthermore, 75% of all calculations are within a deviation of 25 °C and 93% are within 50 °C. In general, the new model outperforms the models from which it is built.
The Silicone Self: Examining Sexual Selfhood and Stigma within the Love and Sex Doll Community
Authors: Hanson Kenneth R.
Published: October 2021

While previous research has theorized the potential benefits and consequences of intimate relationships with robots and dolls, little empirical research has been conducted on today's love and sex doll owners. By drawing on digital ethnographic data and interviews with 41 love and sex doll community members, I explore how love and sex doll owners account for their transgressive sex practice. I argue these accounts reveal the underlying sexual selfhood project of doll owners, what I term the silicone self. I analyze silicone selves to show how doll community members manage stigma by emphasizing sexual individualism and drawing on pro‐sex, feminist, and anti‐feminist discourses. I further highlight tensions within the community that stem from conflicting views about gender and sexuality.
Estimating extreme level ice and ridge thickness for offshore wind turbine design: Case study Kriegers Flak
Authors: Tikanmäki Maria , Heinonen Jaakko
Published: October 2021

When designing offshore wind turbines in ice‐covered seas, site‐specific ice conditions present crucial input for the structural design. In this study, methods of estimating the maximum level ice thickness occurring once in 50 years and parameters of a design ice ridge in an area where no direct ice thickness measurements exists are presented. The site of Kriegers Flak at the Southern Baltic Sea is taken as a case study. Rather than just applying basic equations found from the standards, the method gives more detailed estimates by utilizing available ice chart information, ice reports and atlases together with measured air temperature data to estimate the starting and ending date of ice growth. The maximum level ice thickness occurring once in 50 years at the site of Kriegers Flak wind farm was estimated to be between 0.26 and 0.44 m depending on the assumptions. The effect of the studied history length, the utilized weather station and the use of snow thicknesses to the 50‐year ice thickness estimates are compared and discussed. Interaction with ice ridges was found to be a relevant but infrequent, load scenario for the site of Kriegers Flak. For this reason, a representative ridge for determining ice ridge loads is presented. The most important parameter in a ridge, the thickness of the consolidated layer, was found based on scenario analyses to be in a range between 0.43 and 0.67 m can be used to calculate ice loads against the wind turbine substructures.
Learning to isolate muons
Authors: Collado Julian , Bauer Kevin , Witkowski Edmund , Faucett Taylor , Whiteson Daniel , Baldi Pierre
Published: October 2021

Abstract

Distinguishing between prompt muons produced in heavy boson decay and muons produced in association with heavy-flavor jet production is an important task in analysis of collider physics data. We explore whether there is information available in calorimeter deposits that is not captured by the standard approach of isolation cones. We find that convolutional networks and particle-flow networks accessing the calorimeter cells surpass the performance of isolation cones, suggesting that the radial energy distribution and the angular structure of the calorimeter deposits surrounding the muon contain unused discrimination power. We assemble a small set of high-level observables which summarize the calorimeter information and close the performance gap with networks which analyze the calorimeter cells directly. These observables are theoretically well-defined and can be studied with collider data.
Schwerverletztenversorgung durch Notärzte aus unterschiedlichen Fachgebieten
Authors: Gäßler Michael , Ruppert Matthias , Lefering Rolf , Bouillon Bertil , Wafaisade Arasch ,   TraumaRegister DGU
Published: October 2021

Hintergrund und Ziel

Die S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung stellt den definierten Rahmen für eine leitliniengerechte Erstversorgung des schwer verletzten Patienten dar. Mutmaßlich werden diagnostische und therapeutische Entscheidungsfindungen in der Präklinik durch die klinische Expertise aus dem Fachgebiet des Notarztes mitbeeinflusst.

Material und Methoden

Retrospektive, multizentrische Studie aus Daten der ADAC (Allgemeiner Deutscher Automobil-Club e. V.) Luftrettung und des TraumaRegister der Deutschen Gesellschaft für Unfallchirurgie®. Im Untersuchungszeitraum von 2011 bis 2015 konnten 11.019 schwer verletzte Patienten eingeschlossen und der Versorgung durch Notärzte aus den Fachgebieten Anästhesie (ANÄ), innere Medizin (INN) und Chirurgie (CHIR) zugeordnet werden.

Ergebnisse

Durch ANÄ wurden 81,9 %, durch INN 7,6 % und durch CHIR 10,5 % versorgt. Präklinisch wurden 40,5 % der Patienten intubiert (ANÄ 43,0 %, INN 31,2 %, CHIR 28,3 %; p < 0,001), 5,5 % haben eine Thoraxdrainage (ANÄ 5,9 %, INN 4,2 %, CHIR 2,8 %; p = 0,004) und 10,8 % eine Katecholamintherapie erhalten (ANÄ 11,3 %, INN 8,3 %, CHIR 8,3 %; p = 0,022). Bewusstlose Patienten wurden in 96,0 % intubiert (ANÄ 96,1 %, INN 97,7 %, CHIR 93,9 %; p = 0,205). Die Mortalität wurde nicht durch die fachliche Herkunft des Notarztes beeinflusst.

Diskussion

In diesem Kollektiv aus dem Bereich der Luftrettung zeigten sich in den Gruppen Unterschiede bei der Indikationsstellung zu invasiven Maßnahmen, die möglicherweise durch die jeweilige klinische Expertise bedingt sind. Am Beispiel der Intubation konnte gezeigt werden, dass Leitlinienempfehlungen in hohem Maße – unabhängig von der Fachgebietszugehörigkeit des Notarztes – umgesetzt werden.
Predictors of Left Ventricular Outflow Tract Obstruction After Conventional Repair for Patients with Interrupted Aortic Arch or Coarctation of the Aorta, Combined with Ventricular Septal Defect: A Single-Center Experience
Authors: Szaflik Katarzyna , Goreczny Sebastian , Ostrowska Katarzyna , Kazmierczak Piotr , Moll Maciej , Moll Jadwiga A.
Published: October 2021

Left ventricular outflow tract obstruction (LVOTO) affects survival and reoperation rates after surgical treatment of patients with interruption of the aortic arch (IAA) or coarctation of the aorta (CoA) with ventricular septal defect (VSD). The aim of the study was to determine predictors of LVOTO and to evaluate the relationship between aortic valve (AoV) morphology and the re-intervention rate. Retrospective review of patients, who underwent a conventional repair for IAA/CoA with VSD at a tertiary referral center between 1996 and 2017. The preoperative demographic data as well as pre- and post-operative echocardiographic parameters and re-interventions were reviewed. In the median follow-up of 8.3 years (range of 6.15–10.27) 5 patients (11.9%) from a total of 47 patients included in the study presented with a significant LVOTO. Four of them required reoperation after median period of 2.3 years (range of 0.3–7.9) after the initial surgery. Multivariable logistic regression identified AoV z-score (OR 0.44, p = 0.017) as predictor of LVOTO. The mean AoV z-score before the primary repair was significantly smaller in those with LVOTO as compared to those with unobstructed flow from the LV (− 3.58 ± 1.96 vs. − 1.44 ± 1.55; p = 0.0016). At 1-year follow-up, both groups showed an increase in the AoV z-score (p = 0.98). The re-intervention rate after primary repair (both surgical procedures and percutaneous interventions), either for LVOTO or reCoA, was higher in patients with AoV z-score ≤  − 3 (p = 0.007 vs. p = 0.46) and those, whose aortic annulus was less or equal than patient’s weight (kg) + 1.5 mm as compared to those with larger aortic annulus (p = 0.03 vs. p = 0.16). In patients after surgical treatment of IAA/CoA with VSD, the AoV z-score at diagnosis is a significant risk factor for reoperation for LVOTO. With age, AoV growth and z-score improvement is expected. Small AoV at diagnosis is correlated with increased rate of re-intervention for LVOTO and reCoA.
Innate immune genes of the chicken MHC and related regions
Authors: Kaufman Jim
Published: October 2021

Compared to the major histocompatibility complex (MHC) of typical mammals, the chicken BF/BL region is small and simple, with most of the genes playing central roles in the adaptive immune response. However, some genes of the chicken MHC are almost certainly involved in innate immunity, such as the complement component C4 and the lectin-like receptor/ligand gene pair BNK and Blec. The poorly expressed classical class I molecule BF1 is known to be recognised by natural killer (NK) cells and, analogous to mammalian immune responses, the classical class I molecules BF1 and BF2, the CD1 homologs and the butyrophilin homologs called BG may be recognised by adaptive immune lymphocytes with semi-invariant receptors in a so-called adaptate manner. Moreover, the TRIM and BG regions next to the chicken MHC, along with the genetically unlinked Y and olfactory/scavenger receptor regions on the same chromosome, have multigene families almost certainly involved in innate and adaptate responses. On this chicken microchromosome, the simplicity of the adaptive immune gene systems contrasts with the complexity of the gene systems potentially involved in innate immunity.
Reproducibility of Novel Soft-Tissue Landmarks on Three-Dimensional Human Facial Scan Images in Caucasian and Asian
Authors: Li Zhouxiao , Giunta Riccardo Enzo , Frank Konstantin , Schenck Thilo Ludwig , Koban Konstantin Christoph
Published: October 2021

Background

Three-dimensional surface imaging is established in many disciplines for objective facial acquisition regarding anthropometry. Former studies addressed the validation of landmark-based measurements for single race. In order to distinguish racial difference, the reproducibility of the landmark measurements must first be validated.

Objectives

Our purpose is to validate the reproducibility of 46 facial soft-tissue landmarks on x, y, z axes to prove their reliability as 3D reference points.

Methods

The study included 80 European Caucasian and 80 Chinese volunteers. Standardized 3D surface imaging was performed using Vectra 3D system. Two raters identified and defined 46 landmarks (138 coordinates), then repeatedly 3D-imaged volunteers' facial region in separate sessions. Coordinates' reproducibility of landmarks is divided into three categories (< 0.5 mm, < 1 mm, and >1 mm) for intra- and inter-rater reproducibility assessments.

Results

Coordinates' reproducibility of 160 samples was distributed as follows: Intra-rater: < 0.5 mm (45%), < 1 mm (42%), >1 mm (13%); inter-rater: < 0.5 mm (31.2%), < 1 mm (42%), > 1 mm (26.8%). The reproducibility of landmarks in nasal tip region differs slightly between Caucasians and Asians. Compared to females, males typically have higher landmark reproducibility in lip and chin region. However, there were no differences in the reproducibility ranking of landmarks by gender.

Conclusion

The majority of the 46 landmarks in the 3D plane are reproducible to 1 mm, which is clinically acceptable. All selected landmarks showed strong consistency across race and gender, suggesting their potential use as reference points in prospective clinical practice.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Indigenous Influence and Engagement in Mining Permitting in British Columbia, Canada: Lessons for Sweden and Norway?
Authors: Allard Christina , Curran Deborah
Published: October 2021

Mine developments in Indigenous territories risk disrupting Indigenous cultures and their economies, including spiraling already high levels of conflict. This is the situation in Canada, Sweden, and Norway, as elsewhere, and is fostered by current state legal framework that reflect historical trajectories, although circumstances are gradually changing. Promising institutional changes have taken place in British Columbia (BC), Canada, with respect to new legislative reforms. Notably, new legislation from 2019 intends to implement the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) in the province, by promoting consent-based and collaborative decision-making mechanisms. New environmental assessment legislation is another example; this legislation includes early engagement, collaborative decision-making, and Indigenous-led assessments. The article’s aim is, first, to analyze how Indigenous communities can influence and engage in the mining permitting system of BC, and, secondly, to highlight the positive features of the BC system using a comparative lens to identify opportunities for Sweden and Norway regarding mining permitting and Indigenous rights. Applying a legal-scientific and comparative analysis, the article analyzes traditional legal sources. The article concludes that the strong points that the BC regime could offer the two Nordic countries are: the concept of reconciliation, incorporation of UNDRIP, the spectrum of consultation and engagement approaches, and the structure of environmental assessments. All three jurisdictions, however, struggle with balancing mine developments and securing Indigenous authority and influence over land uses in their traditional territories.
Burnout Among Surgeons in the UK During the COVID‐19 Pandemic: A Cohort Study
Authors: Houdmont Jonathan , Daliya Prita , Theophilidou Elena , Adiamah Alfred , Hassard Juliet , Lobo Dileep N. ,   the East Midlands Surgical Academic Network (EMSAN) Burnout Study Group, Ahmed Jamil , Babu Victor , Baker Daryll , Bartlett David , Beckingham Ian , Bhatti Imran , Brooks Adam , Brown Steven , Burke Josh , Byrne Hannah , Chetter Ian , Cook Hannah , Coulston James , Cruddas Lucinda , Dias Richard , Dor Frank , Dube Mukul , Grant Katherine , Hammond John , Hargest Rachel , Joachim Theophilus , Joseph Annie , Kara Naveed , Karavias Dimitrios , Kotecha Sita , Kushairi Anisa , Lal Roshan , Lam Kit , Lasrado Irwin , Lee Rachel , Mann Gurminder , Mannu George , Maxwell‐Armstrong Charles , McCaslin James , McDermot Frank , Miller Andrew , Miller Sarah , Morgan Jenna , Nandhra Sandip , Narayanasamy Sangara , O'Brien Patrick , Parry Laura , Peters Kizzie , Pitsika Marina , Psaltis Emmanouil , Sargen Kevin , Sarmah Panchali , Shyamsundar Murali , Reddy Chinnappa , Rollins Katie , Roslan Farah , Shalhoub Joseph , Stanislas Matt , Tan Benjamin , Tewari Nilanjana , Thomas Pradeep , Thomas Tony , Tiernan Jim , Toogood Giles , Trimble Karl , Vauhan Peter , Wheldon Luke , White Steven , White Tim , Wijetunga Imeshi , Wilson Michael , Winterborn Rebecca , Wyld Lynda , Young Lora
Published: October 2021

Background

Surgeon burnout has implications for patient safety and workforce sustainability. The aim of this study was to establish the prevalence of burnout among surgeons in the UK during the COVID‐19 pandemic.

Methods

This cross‐sectional online survey was set in the UK National Health Service and involved 601 surgeons across the UK of all specialities and grades. Participants completed the Maslach Burnout Inventory and a bespoke questionnaire. Outcome measures included emotional exhaustion, depersonalisation and low personal accomplishment, as measured by the Maslach Burnout Inventory‐Human Services Survey (MBI‐HSS).

Results

A total of 142 surgeons reported having contracted COVID‐19. Burnout prevalence was particularly high in the emotional exhaustion (57%) and depersonalisation (50%) domains, while lower on the low personal accomplishment domain (15%). Burnout prevalence was unrelated to COVID‐19 status; however, the greater the perceived impact of COVID‐19 on work, the higher the prevalence of emotional exhaustion and depersonalisation. Degree of worry about contracting COVID‐19 oneself and degree of worry about family and friends contacting COVID‐19 was positively associated with prevalence on all three burnout domains. Across all three domains, burnout prevalence was exceptionally high in the Core Trainee 1–2 and Specialty Trainee 1–2 grades.

Conclusions

These findings highlight potential undesirable implications for patient safety arising from surgeon burnout. Moreover, there is a need for ongoing monitoring in addition to an enhanced focus on mental health self‐care in surgeon training and the provision of accessible and confidential support for practising surgeons.
Evaluation of the absolute oral bioavailability of the anaplastic lymphoma kinase/c-ROS oncogene 1 kinase inhibitor lorlatinib in healthy participants
Authors: Hibma Jennifer E. , O’Gorman Melissa , Nepal Sunil , Pawlak Sylvester , Ginman Katherine , Pithavala Yazdi K.
Published: October 2021

Purpose

Lorlatinib is a third-generation tyrosine kinase inhibitor currently approved for the treatment of anaplastic lymphoma kinase (ALK)-positive metastatic non-small cell lung cancer. This open-label, phase 1, randomized two-sequence, two-treatment, two-period, crossover study investigated the absolute oral bioavailability of lorlatinib in healthy participants.

Methods

Eligible participants were randomized to receive two treatments in one of two sequences: lorlatinib 100 mg single oral dose followed by lorlatinib 50 mg intravenous (IV) dose, or lorlatinib IV dose followed by lorlatinib oral dose, each with at least a 10-day washout between successive lorlatinib doses. Blood samples for pharmacokinetics were collected for up to 144 hours (h) after dosing. Validated liquid chromatographic-tandem mass spectrometry was used to determine plasma concentrations of lorlatinib and its benzoic acid metabolite PF-06895751.

Results

In total, 11 participants were enrolled (mean age 37.6 years, all male). The adjusted geometric mean (90% confidence interval) for the absolute oral bioavailability was 80.78% (75.73–86.16%). Using non-compartmental analysis, the estimated arithmetic mean elimination plasma half-life of lorlatinib was 25.5 and 27.0 h after the oral and IV doses, respectively. No deaths, serious adverse events (AEs), or severe AEs were reported, and most treatment-emergent AEs were mild in severity, with two events of transaminase increase of moderate severity. All treatment-emergent AEs were resolved by the end of the study.

Conclusion

Both oral and IV lorlatinib were well-tolerated in healthy participants and oral lorlatinib is highly bioavailable after oral administration.
Spatial distribution of cerebral microbleeds reveals heterogeneous pathogenesis in CADASIL
Authors: Chen Ya-Fang , Chen Chih-Hao , Wu Wen-Chau , Lee Bo-Ching , Tsai Hsin-Hsi , Tang Sung-Chun
Published: October 2021

Objectives

Radiological diagnosis of subtypes of cerebral small vessel diseases remains challenging. This study aimed to explore the spatial distribution of cerebral microbleeds (CMBs) in cerebral autosomal dominant arteriopathy with subcortical infarct and leukoencephalopathy (CADASIL) in contrast to cerebral amyloid angiopathy (CAA) in the lobar regions.

Methods

Thirty-two patients with CADASIL and 33 patients with probable CAA were prospectively and consecutively included. On 3-Tesla susceptibility-weighted magnetic resonance images, CMBs were analyzed for incidence and volume within atlas-based regions of interest, followed by voxel-wise analysis using risk mapping. The distribution of CMBs was correlated with the status of hypertension. Correlation and group differences with ap-value less than 0.05 were considered to be significant.

Results

As compared with the CAA group, the CADASIL group presents a larger CMB volume in hippocampus/amygdala and white matter (nonparametric analysis of covariance,p = 0.014 and 0.037, respectively), a smaller CMB volume in parietal lobe (p = 0.038), and a higher incidence in hippocampus/amygdala, white matter, and insula (logistic regression,p = 0.019, 0.024, and 0.30, respectively). As part of the exclusion criteria of probable CAA, thalamus, basal ganglia, and pons exhibit greater CMB volume/incidence in the CADASIL group. In CADASIL patients, hot spots of CMBs are identified in the putamen and posteromedial thalamus; hypertension is associated with larger CMB volumes in insula, basal ganglia, and pons.

Conclusions

The spatial distribution of CMBs is differentiable between CADASIL and CAA in lobar regions. In CADASIL patients, hypertension has a region-dependent mediating effect on the CMB volume.

Key Points

•The topological distribution of lobar CMBs is differentiable between CADASIL and CAA.

•In CADASIL patients, hypertension mediates CMB volume and the mediation is region dependent.

•CMB risk mapping allows for voxel-wise exploration of CMB distribution and reveals hot spots in the putamen and posteromedial thalamus in CADASIL.
A novel augmented reality-based surgical guidance system for total knee arthroplasty
Authors: Fucentese Sandro F. , Koch Peter P.
Published: October 2021

Introduction

Many of the functional complications that arise after total knee arthroplasty (TKA) are caused by a non-optimal balance of the knee after surgery. Over the past 20 years, technology has been used in the Operating Room (OR) to help improve precision and balance. The results of Computer-Assisted Surgery (CAS) and robotic systems show improved accuracy regarding implant positioning but a relatively small improvement in patient-reported outcomes and implant survival compared to conventional TKA. Recently, Augmented Reality (AR) has been proposed as a technology that could improve accuracy in orthopaedic surgery, providing a more efficient and cost-effective solution.

Materials and methods

This article describes a novel AR-based surgical guidance system that measures intra-operatively the effect of prosthesis alignment and positioning on soft tissue balance. The system is integrated in a pair of smart glasses and two small sensors and displays surgical targets directly in the field of view of the surgeon.

Results

The system has been used in a limited number of cases. While the preliminary experience has been positive, clinical research is ongoing to confirm to confirm the performance of the system and the impact on clinical outcomes.

Conclusion

Augmented Reality can be a valuable tool to improve accuracy in TKA. The use of smart glasses and integrated sensors improves the efficiency of the procedure, particularly when coupled with single-use instrumentation. A novel protocol for soft tissue assessment allows for a 3-dimensional evaluation of the ligaments and a better measurement of the effect of tibial rotation.
Nonradiation-to-endoscopist ERCP is non-inferior to standard ERCP
Authors: Zeng Wei , Hu Jie , Pan Yanglin , Zhang Mingqing , Xu Li
Published: October 2021

Background

Radiation exposure is inherently involved in endoscopic retrograde cholangiopancreatography (ERCP), which could cause radiation-induced injury to endoscopists with long-term exposure. Nonradiation ERCP has been applied to pregnant patients. Conceivably, the same techniques could be used to benefit endoscopists. This study was designed to evaluate the effectiveness and safety of nonradiation-to-endoscopist (NRE) ERCP, compared with standard ERCP.

Methods

A retrospective, single-center study was conducted from August 2010 to December 2015. Patients aged 18–90 years and with choledocholithiasis (< 15 mm) or distal biliary stricture were eligible. Pre-ERCP evaluation with magnetic resonance cholangiopancreatography was mandatory. To overcome selection bias, we performed 1:2 match using propensity score matching (PSM) between NRE and standard groups. The primary endpoint was overall ERCP success rate. Secondary endpoints were cannulation success rate, stone clearance rate, complication rate, and duration of hospitalization.

Results

A total of 329 patients met inclusion criteria. After PSM, 73 patients were included in the NRE group and 146 in the standard group. The ERCP overall success rate for NRE and standard groups was equivalent (94.5% vs. 93.2%, P = 0.70). There was no difference in cannulation success rates between the two groups (95.6% vs. 97.8%, P = 0.39). A total of 88.3% of patients in the NRE group and 93.9% of patients in the standard group had stones cleared at initial ERCP (P = 0.57). No difference in overall stone clearance rate between the two groups (95.0% vs. 93.9%, P = 0.77) was found after second ERCP. The complication rate (1.4% vs. 1.4%, P = 1.00) and hospital duration (8.3 ± 5.1 vs. 10.2 ± 8.8 days, P = 0.07) were not different between the two groups.

Conclusion

Although technically demanding, NRE-ERCP is both safe and feasible in selected patients compared with standard ERCP.