bluuebunny/crossref_metadata_2025 huggingface dataset:
Dissolution of Different Reservoir Rocks by Organic Acids in Laboratory Simulations: Implications for the Effect of Alteration on Deep Reservoirs
Authors: Chen Jian , Xu Jie , Wang Susu , Sun Zhenyu , Li Zhong , Jia Wanglu , Peng Ping’an
Published: March 2021

Organic acids are important agents in the alteration of deep reservoirs. It is difficult, however, to assess the impact of organic acid alteration on deep reservoirs because different dissolution processes may occur during diagenesis. This study simulated the dissolution of three different types of reservoir rocks by acetic acid in a closed system and compared the mineral and elemental composition, surface morphology, pore structure, and water chemistry variations of the initial and altered samples. The study demonstrated that both micrite and sucrosic dolostone are strongly dissolved, losing about 20%–30% of their initial rock sample weights. Observation under SEM showed that the limestone dissolved homogenously, whereas the dolostone showed honeycomb-like dissolution. Both carbonate samples showed the development of large voids, including holes and cavities of micrometer scale, but nanopores of various sizes were blocked. In contrast, lithic arkose was heterogeneously altered, losing a weight proportion of about 13% by dissolution of calcite cement. These micrometer-scale microfissures were developed, but those nanometer-scale pores just varied in a narrow range of sizes. The volume increase in all three reservoir types is mainly attributed to the dissolution of carbonate minerals. In deep reservoirs, in situ generated organic acids can enlarge existing cavities in carbonates and develop microfissures in sandstones. The microfissure porosity in sandstone is limited but can increase through other geological processes such as overpressure. More importantly, these acids can maintain the acidity of pore waters, inhibit the precipitation of dissolved minerals, and help to preserve reservoir porosity. Although temperature plays an insignificant role in laboratory simulations, it influences both the generation and destruction processes of organic acids in deep reservoirs on geologic time scales and, thus, warrants further attention. The results provide a basis for recognizing the typical patterns of organic acid dissolution on different reservoir rocks and further suggest the potential role of organic acids in the formation and preservation of secondary porosity in deeply buried reservoirs.
Optimal Operation of a Single Unit with an Adjustable Blade in an Interbasin Water Transfer Pumping Station Based on Successive Approximation Discretization for Blade Angle
Authors: Gong Yi , Cheng Jilin , Che Li , Wang Liang , Chen Zaiyang , Chen Yongfeng
Published: March 2021

In the mathematical model of the optimal operation of a single pump unit with a fully adjustable blade in the Chinese South‐to‐North Water Diversion Project, the decision variable, namely, blade angle, was uniformly dispersed in its feasible region in a fixed step size in consideration of the requirements of the pumping head and matching motor power. 1D dynamic programming was applied to solve the original model. When the obtained blade for each time period was set as the middle reference value and the discrete region of the blade was reduced to two times of the step size in the previous time, the blade angle was correspondingly reduced and dispersed in this new discrete region, thus eliminating unnecessary optimization space. Then, 1D dynamic programming was applied again to optimize the blade angle of the single pump unit further. After a series of successive approximation discretization of the blade angle and corresponding solutions of the obtained mathematical model, the optimization process was considered completed when the given control precision met the requirement. A case study showed that under typical operating conditions, the total cost saving percentage of water pumping quantity reached 0.048%–0.463%, with an average saving rate of 0.192%. The actual total water pumping quantity of the single unit decreased by 2153 m3 on the average. The proposed discretization method exerted a better optimization effect and needed a smaller computational amount compared with traditional one‐time uniform discretization in the original feasible region of the blade angle.
Selection of In-Flight Duty-Free Product Suppliers Using a Combination Fuzzy AHP, Fuzzy ARAS, and MSGP Methods
Authors: Fu Yan-Kai , Wu Chung-Jen , Liao Chin-Nung
Published: March 2021

Over a billion people travel by air all over the world every year, and there are many in-flight retailing opportunities for the airline industry. This paper proposes a novel integration fuzzy analytical hierarchy process (FAHP), fuzzy additive ratio assessment (FARAS), and multisegment goal programming (MSGP) methods to select the best supplier for in-flight duty-free product in airline industry. The advantage of this proposed method is that it allows decision makers (DMs) to set multisegment aspiration vague levels considering both the qualitative and quantitative criteria for supplier selection simultaneously. To the best of our knowledge, a simultaneous consideration of qualitative and quantitative criteria for supplier selection of in-flight duty-free product has never been applied under the airline retail industry context. This research will fill into the gaps of supplier selection in in-fight duty-free product for airline industry. The integrated model is illustrated by an example in an airline company in Taiwan.
Fc-Optimized Anti-CCR8 Antibody Depletes Regulatory T Cells in Human Tumor Models
Authors: Campbell Joseph R. , McDonald Bryan R. , Mesko Paul B. , Siemers Nathan O. , Singh Priti B. , Selby Mark , Sproul Tim W. , Korman Alan J. , Vlach Logan M. , Houser Jeff , Sambanthamoorthy Sharmila , Lu Kai , Hatcher Sandra V. , Lohre Jack , Jain Renu , Lan Ruth Y.
Published: March 2021

FOXP3+ regulatory T cells (Treg) play a critical role in mediating tolerance to self-antigens and can repress antitumor immunity through multiple mechanisms. Therefore, targeted depletion of tumor-resident Tregs is warranted to promote effective antitumor immunity while preserving peripheral homeostasis. Here, we propose the chemokine receptor CCR8 as one such optimal tumor Treg target. CCR8 was expressed by Tregs in both murine and human tumors, and unlike CCR4, a Treg depletion target in the clinic, CCR8 was selectively expressed on suppressive tumor Tregs and minimally expressed on proinflammatory effector T cells (Teff). Preclinical mouse tumor modeling showed that depletion of CCR8+ Tregs through an FcyR-engaging anti-CCR8 antibody, but not blockade, enabled dose-dependent, effective, and long-lasting antitumor immunity that synergized with PD-1 blockade. This depletion was tumor Treg-restricted, sparing CCR8+ T cells in the spleen, thymus, and skin of mice. Importantly, Fc-optimized, nonfucosylated (nf) anti-human CCR8 antibodies specifically depleted Tregs and not Teffs in ex vivo tumor cultures from primary human specimens. These findings suggest that anti–CCR8-nf antibodies may deliver optimal tumor-targeted Treg depletion in the clinic, providing long-term antitumor memory responses while limiting peripheral toxicities.

Significance:

These findings show that selective depletion of regulatory T cells with an anti-CCR8 antibody can improve antitumor immune responses as a monotherapy or in combination with other immunotherapies.
Successful Treatment with Nivolumab in a Patient with Metastatic Salivary Duct Carcinoma
Authors: Sato Tsuyoshi , Maeta Takahiro , Abe Ryosuke , Yamada Hiroyuki , Ishida Kazuyuki , Yashima-Abo Akiko , Kiyohara Kazuki , Miyajima Shinri , Ito Shigeki
Published: March 2021

Salivary duct carcinoma (SDC) is a rare and highly aggressive malignancy. A 58-year-old man presented with a right-sided submandibular mass and metastatic lesions in the right supraclavicular and inferior internal jugular nodes. He underwent right submandibulectomy and right neck dissection followed by adjuvant chemoradiotherapy. However, relapse occurred in the hilar lymph node and lumbar spine. Although radiotherapy was performed, a second relapse appeared in the hilar lymph nodes and sacral bone. Immunohistochemical analysis revealed negativity for programmed death ligand-1 (PD-L1) in the primary tumor specimen. The patient then received the anti-programmed death-1 (PD-1) antibody nivolumab. His metastatic lesions were completely eliminated after 48 weeks of therapy. This case reveals that anti-PD-1 antibodies are effective even against PD-L1-negative SDC.
The Role of Ninjurin1 and Its Impact beyond the Nervous System
Authors: Liu Ke , Wang Yong , Li Hongge
Published: March 2021

Ninjurin1 (Ninj1) is a double-transmembrane cell surface protein that could promote nerve regeneration in the process of the peripheral nervous system injury and repairment. Nonetheless, the accurate function of Ninj1 in the central nervous system and outside the nervous system is not completely clear. According to the recent studies, we found that Ninj1 is also aberrantly expressed in various pathophysiological processes in vivo, including inflammation, tumorigenesis, and vascular, bone, and muscle homeostasis. These findings suggest that Ninj1 may play an influential role during these pathophysiological processes. Our review summarizes the diverse roles of Ninj1 in multiple pathophysiological processes inside and outside the nervous system. Ninj1 should be considered as an important and novel therapeutic target in certain diseases, such as inflammatory diseases and ischemic diseases. Our study provided a better understanding of Ninj1 in different pathophysiological processes and thereby provided the theoretical support for further research.
Clinical Outcomes with Multikinase Inhibitors after Progression on First-Line Atezolizumab plus Bevacizumab in Patients with Advanced Hepatocellular Carcinoma: A Multinational Multicenter Retrospective Study
Authors: Yoo Changhoon , Kim Jwa Hoon , Ryu Min-Hee , Park Sook Ryun , Lee Danbi , Kim Kang Mo , Shim Ju Hyun , Lim Young-Suk , Lee Han Chu , Lee Joycelyn , Tai David , Chan Stephen Lam , Ryoo Baek-Yeol
Published: March 2021

Introduction: Atezolizumab-bevacizumab is the new standard of care for first-line treatment of advanced hepatocellular carcinoma (HCC). However, the optimal sequence of therapy after disease progression on atezolizumab-bevacizumab is unclear. Methods: This multinational, multicenter, and retrospective study assessed clinical outcomes of patients with advanced HCC who received subsequent systemic therapy after progression on atezolizumab-bevacizumab between July 2016 and April 2019. Results: Among 71 patients treated with atezolizumab-bevacizumab, a total of 49 patients who received subsequent systemic therapy were included in this analysis; the median age was 60 years (range, 37–80) and 73.5% were male. All patients were classified as Child-Pugh A and Barcelona-Clinic Liver Cancer stage C. Multikinase inhibitors (MKIs), including sorafenib (n = 29), lenvatinib (n = 19), and cabozantinib (n = 1), were used as second-line therapy for all patients. The objective response rate and disease control rate were 6.1 and 63.3%, respectively, in all patients. With a median follow-up duration of 11.0 months, median progression-free survival (PFS) and overall survival (OS) were 3.4 months (95% confidence interval [CI] 1.8–4.9) and 14.7 months (95% CI 8.1–21.2) in all patients. Median PFS with lenvatinib was significantly longer than that with sorafenib (6.1 vs. 2.5 months; p = 0.004), although there was no significant difference in median OS (16.6 vs. 11.2 months; p = 0.347). Treatment-related adverse events (TRAEs) of any grade and grade 3 occurred in 42 (85.7) and 8 (16.3%) of patients. Common TRAEs included hand-foot syndrome (n = 26, 53.1%), fatigue (n = 14, 28.6%), hypertension (n = 14, 28.6%), and diarrhea (n = 12, 24.5%). Conclusion: Second-line treatment with MKIs, mostly sorafenib and lenvatinib, showed comparable efficacy and manageable toxicities in patients with advanced HCC after disease progression on atezolizumab-bevacizumab.
Liver and Pancreatic Injury in Response to ALK Inhibitors in a Patient with Primary Signet Ring Cell Carcinoma of the Lung: A Case Report
Authors: Yildiz Ibrahim
Published: March 2021

We report a patient with stage IV anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer (primary lung signet ring cell adenocarcinoma) who received serial crizotinib, chemotherapy, and lorlatinib over more than 4 years. The patient discontinued crizotinib after approximately 4 months due to crizotinib-associated hepatotoxicity. Twenty-five days later, when transaminases had normalized, crizotinib was resumed. However, the patient’s liver enzymes rapidly increased again, and crizotinib was discontinued. After 6 cycles of platinum-based chemotherapy, lorlatinib was initiated. Hepatotoxicity did not recur with lorlatinib, a next-generation ALK inhibitor, but grade 4 hypertriglyceridemia and acute pancreatitis were induced by lorlatinib after 4 months. To our knowledge, this is the first case report of acute pancreatitis with lorlatinib. Additionally, stereotactic body radiation therapy (SBRT) was performed for residual small primary lesions in the lung without stopping lorlatinib. Given the rarity of radiation pneumonitis, especially with the relatively small fields treated by SBRT, we suspect that lorlatinib enhanced the pulmonary toxicity. Physicians should be aware that ALK inhibitors, such as lorlatinib and crizotinib, have potentially lethal side effects.
Cellular miR-101-1 Reduces Efficiently the Replication of HSV-1 in HeLa Cells
Authors: Sadegh Ehdaei Bahar , Pirouzmand Ahmad , Shabani Mehdi , Mirzaei Arezoo , Moghim Sharareh
Published: March 2021

Introduction: Herpes simplex viruses (HSVs) are widely distributed in the human population. HSV type 1 (HSV-1) is responsible for a spectrum of diseases, ranging from gingivostomatitis to keratoconjunctivitis, and encephalitis. The HSVs establish latent infections in nerve cells, and recurrences are common. Their frequent reactivation in elderly and immunosuppressed patients causes serious health complications. Objectives: Due to the growing resistance to its main drug, acyclovir, alternative treatments with different mechanisms of action are required. MicroRNAs regulate host and viral gene expression posttranscriptionally. Previous studies reported that mir-101-2 expression has widely participated in the regulation of HSV-1 replication. In this study, we investigate the effect of hsa-miR-101-1 in the replication of HSV-1. Methods: We found that transfection of miR-101-1 into HeLa cells could reduce effectively HSV-1 replication using plaque assay and real-time PCR methods. Results: We showed that overexpression of miR-10-1 produced less viral progeny and manifested a weaker cytopathic effect, without affecting cell viability. Discussion/Conclusion: This result can give us new insights into the control of HSV-1 infections.
Preoperative Cerebrospinal Fluid Cortisol and the Risk of Postoperative Delirium: A Prospective Study of Older Hip Fracture Patients
Authors: Witlox Joost , Adamis Dimitrios , Koenderman Leo , Kalisvaart Kees , de Jonghe Jos F.M. , Houdijk Alexander P.J. , Maclullich Alasdair M.J. , Eikelenboom Piet , van Gool Willem A.
Published: March 2021

Background: Ageing, depression, and neurodegenerative disease are common risk factors for delirium in the elderly. These risk factors are associated with dysregulation of the hypothalamic-pituitary-adrenal axis, resulting in higher levels of cortisol under normal and stressed conditions and a slower return to baseline. Objectives: We investigated whether elevated preoperative cerebrospinal fluid (CSF) cortisol levels are associated with the onset of postoperative delirium. Methods: In a prospective cohort study CSF samples were collected after cannulation for the introduction of spinal anesthesia of 75 patients aged 75 years and older admitted for surgical repair of acute hip fracture. Delirium was assessed with the confusion assessment method (CAM) and the Delirium Rating Scale-Revised-98 (DRS-R98). Because the CAM and DRS-R98 were available for time of admission and 5 postoperative days, we used generalized estimating equations and linear mixed modeling to examine the association between preoperative CSF cortisol levels and the onset of postoperative delirium. Results: Mean age was 83.5 (SD 5.06) years, and prefracture cognitive decline was present in one-third of the patients (24 [33%]). Postoperative delirium developed in 27 (36%) patients. We found no association between preoperative CSF cortisol levels and onset or severity of postoperative delirium. Conclusions: These findings do not support the hypothesis that higher preoperative CSF cortisol levels are associated with the onset of postoperative delirium in elderly hip fracture patients.
Successful Montelukast Treatment in an Infant with Steroid-Resistant Eosinophilic Colitis
Authors: Wang Nai-Wei , Hsieh Hsuan , Yang Yao-Jong
Published: March 2021

Eosinophilic colitis (EC) belongs to a group of idiopathic diseases called eosinophilic gastrointestinal disorders, which are characterized by eosinophil-predominant inflammation in the gastrointestinal tract. Corticosteroids is the first-line pharmacotherapy for EC refractory to diet therapy. We report an infant with steroid-resistant EC, who successfully returned to a healthy growth trajectory under the combined therapy of montelukast and ketotifen. An 8-month-old boy presented with bloody diarrhea, anemia, and failure to thrive (FTT) that started 6 days after birth. The patient has no known allergies. A trial of elementary diet was unsuccessful. The results of several stool cultures were unremarkable. Similarly, lower gastrointestinal series failed to identify anything significant. At 3 months of age, an esophagogastroduodenoscopy with biopsies from the distal duodenum and proximal jejunum were unremarkable. The diarrhea and FTT persisted. A rectosigmoidoscopy with biopsies was performed; the results led to the diagnosis of EC at 5 months of age. Oral prednisolone 1 mg/kg/day was prescribed; however, 3 months into the treatment, persistent bloody diarrhea and FTT were still noted. Montelukast and ketotifen were added, after which diarrhea and weight gain started to improve. Prednisolone and montelukast/ketotifen were tapered off 6 months after. He remains symptom free and has normal growth and development in a 5-year follow-up.
Concomitant Vancomycin-Resistant Enterococcus faecium and Clostridium difficile Colitis
Authors: Mehershahi Shehriyar , Ghazanfar Haider , Ashraf Shoaib , Shaikh Danial H. , Ihimoyan Ariyo
Published: March 2021

Colitis is a chronic gastrointestinal system disease characterized by inflammation of the inner lining of the colon. Infectious colitis is one of the most common causes of colitis and is associated with significant mortality and morbidity. One of the rare causes of colitis includes vancomycin-resistant Enterococcus faecium (VRE). Lately, the prevalence of VRE has significantly increased in hospitals. We present a case of a 32-year-old American man who was initially admitted because of bilateral lower extremity weakness. The hospital course was complicated, with acute hypoxic respiratory failure secondary to pneumonia. The patient was intubated and was started on broad-spectrum antibiotics. Later on, the patient had severe diarrhea and was found to have clostridium difficile infection. Patient symptoms persisted despite completing the course of antibiotics. Colonoscopy was performed, and the patient was found to have a diffuse area of severely altered vascular, congested, erythematous, friable with contact bleeding, hemorrhagic, inflamed, nodular, and ulcerated mucosa in the sigmoid colon, in the descending colon, and the transverse colon. A biopsy was sent, and the patient was found to be growing VRE. Currently, there is no effective treatment available for VRE. Hospitals need to have an active surveillance program to identify these patients so that the infection does not spread to other patients.
Examining the Relationship between Social and School Environment and Children’s Caries Experience Using Primary and Secondary Data: A Cluster Analysis
Authors: Amato Juliana Neide , Eskenazi Ednalva Maria de Sousa , Ribeiro Simone Baccili , Guerrero Simone Lyz Pires Marcilio , Fonseca Fernando Luiz Affonso , Castelo Paula Midori
Published: March 2021

Dental caries is still prevalent worldwide, even with advances in preventive and curative measures. The aim was to examine clustering patterns of socioeconomic and environmental characteristics of schools and their associations with caries experience of schoolchildren. An epidemiological survey with cross-sectional design was conducted in 2014/2015 and included 5,213 students (aged 2–11 years) from 38 public schools of Carapicuíba (SP, Brazil). Primary data consisted of dental examinations performed at schools by 6 calibrated examiners to evaluate caries experience (dmf/DMFT index). Secondary data were extracted from the last official Demographic Census (2010) and School Census (2014 and 2015) to assess the socioeconomic and environmental characteristics of the territorial units and infrastructure of each school, respectively. Cluster analysis and ANOVA were applied to identify schools with similar social and environmental aspects and children’s caries experience. A logistic regression model was used to ascertain the effects of cluster variables on the likelihood that participants have caries experience, controlling for the stage of dentition and sex. Two valid and reliable clusters were identified: cluster 1 (“advantaged group”), characterized by 33 schools with the highest percentages of children without caries experience and located in regions with better socioenvironmental indicators, and cluster 2 (“least advantaged group”), characterized by 5 schools with higher percentages of children with caries experience, lower percentages of households with sanitary sewer and water supply, higher residents/household ratio and higher percentages of families living with up to 1 minimum wage. An increase in the odds of having caries experience for each percent of houses with well water and families which live with up to 1 minimum wage was observed. By using primary and secondary data, the study draws attention to the relationship between socioeconomic and environmental indicators and caries experience, identifying least advantaged regions and helping to design strategic health plans for this target population.
Impact of Circulating N-Acylethanolamine Levels with Clinical and Laboratory End Points in Hemodialysis Patients
Authors: Pai Alex Y. , Wenziger Cachet , Streja Elani , Argueta Donovan A. , DiPatrizio Nicholas V. , Rhee Connie M. , Vaziri Nosratola D. , Kalantar-Zadeh Kamyar , Piomelli Daniele , Moradi Hamid
Published: March 2021

Background: Patients with ESRD on maintenance hemodialysis (MHD) are particularly susceptible to dysregulation of energy metabolism, which may manifest as protein energy wasting and cachexia. In recent years, the endocannabinoid system has been shown to play an important role in energy metabolism with potential relevance in ESRD. N-acylethanolamines are a class of fatty acid amides which include the major endocannabinoid ligand, anandamide, and the endogenous peroxisome proliferator-activated receptor-α agonists, oleoylethanolamide (OEA) and palmitoylethanolamide (PEA). Methods: Serum concentrations of OEA and PEA were measured in MHD patients and their correlations with various clinical/laboratory indices were examined. Secondarily, we evaluated the association of circulating PEA and OEA levels with 12-month all-cause mortality. Results: Both serum OEA and PEA levels positively correlated with high-density lipoprotein-cholesterol levels and negatively correlated with body fat and body anthropometric measures. Serum OEA levels correlated positively with serum interleukin-6 (IL-6) (rho = 0.19; p = 0.004). Serum PEA and IL-6 showed a similar but nonsignificant trend (rho = 0.12; p = 0.07). Restricted cubic spline analyses showed that increasing serum OEA and PEA both trended toward higher mortality risk, and these associations were statistically significant for PEA (PEA ≥4.7 pmol/mL; reference: PEA <4.7 pmol/mL) after adjustments in a Cox model (hazard ratio 2.99; 95% confidence interval 1.04, 8.64). Conclusions: In MHD patients, OEA and PEA are significantly correlated with variables related to lipid metabolism and body mass. Additionally, higher serum levels of PEA are associated with mortality risk. Future studies are needed to examine the potential mechanisms responsible for these findings and their clinical implications.
FGF3 from the Hypothalamus Regulates the Guidance of Thalamocortical Axons
Authors: Liu Kuan , Lv Zhongsheng , Huang Hong , Yu Shuyang , Xiao Li , Li Xiang , Li Gang , Liu Fang
Published: March 2021

Thalamus is an important sensory relay station: afferent sensory information, except olfactory signals, is transmitted by thalamocortical axons (TCAs) to the cerebral cortex. The pathway choice of TCAs depends on diverse diffusible or substrate-bound guidance cues in the environment. Not only classical guidance cues (ephrins, slits, semaphorins, and netrins), morphogens, which exerts patterning effects during early embryonic development, can also help axons navigate to their targets at later development stages. Here, expression analyses reveal that morphogen Fibroblast growth factor (FGF)-3 is expressed in the chick ventral diencephalon, hypothalamus, during the pathfinding of TCAs. Then, using in vitro analyses in chick explants, we identify a concentration-dependent effect of FGF3 on thalamic axons: attractant 100 ng/mL FGF3 transforms to a repellent at high concentration 500 ng/mL. Moreover, inhibition of FGF3 guidance functions indicates that FGF3 signaling is necessary for the correct navigation of thalamic axons. Together, these studies demonstrate a direct effect for the member of FGF7 subfamily, FGF3, in the axonal pathfinding of TCAs.
Determining Variations in Access to Public Hospitals in Makkah, Kingdom of Saudi Arabia: A GIS-Based Approach
Authors: Baazeem Mazen , Tennant Marc , Kruger Estie
Published: March 2021

Background: Variation in gaining accessibility to public hospitals in Makkah, Saudi Arabia, has not been investigated before. Good access to public health facility will lead to improvements in the population’s health. Maps and geographical information system (GIS) technology can provide assistance to address public health coverage issues. Aims: This study aimed to use GISs to identify spatial accessibility to hospitals in Makkah, based on the radius and drive-time analysis technique. Method: Using Quantum GIS (QGIS), a geodatabase was created to include 8 public hospitals’ locations and data of population distribution across the city. Buffer zones at 2.5, 5, 7, and 10 km radius from the public hospitals were identified and examined. Results: The findings revealed that most of the health facilities across the suburbs of Makkah were located in urban areas, while rural and remote areas were neglected. Conclusion: Public health facilities were distributed relative to high population density. One-third of the city’s population does not have proper access to healthcare services.
MRI Features for Predicting Microvascular Invasion of Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis
Authors: Hong Seung Baek , Choi Sang Hyun , Kim So Yeon , Shim Ju Hyun , Lee Seung Soo , Byun Jae Ho , Park Seong Ho , Kim Kyung Won , Kim Suk , Lee Nam Kyung
Published: March 2021

Purpose: Microvascular invasion (MVI) is an important prognostic factor in patients with hepatocellular carcinoma (HCC). However, the reported results of magnetic resonance imaging (MRI) features for predicting MVI of HCC are variable and conflicting. Therefore, this meta-analysis aimed to identify the significant MRI features for MVI of HCC and to determine their diagnostic value. Methods: Original studies reporting the diagnostic performance of MRI for predicting MVI of HCC were identified in MEDLINE and EMBASE up until January 15, 2020. Study quality was assessed using QUADAS-2. A bivariate random-effects model was used to calculate the meta-analytic pooled diagnostic odds ratio (DOR) and 95% confidence interval (CI) for each MRI feature for diagnosing MVI in HCC. The meta-analytic pooled sensitivity and specificity were calculated for the significant MRI features. Results: Among 235 screened articles, we found 36 studies including 4,274 HCCs. Of the 15 available MRI features, 7 were significantly associated with MVI: larger tumor size (>5 cm) (DOR = 5.2, 95% CI [3.0–9.0]), rim arterial enhancement (4.2, 95% CI [1.7–10.6]), arterial peritumoral enhancement (4.4, 95% CI [2.8–6.9]), peritumoral hypointensity on hepatobiliary phase imaging (HBP) (8.2, 95% CI [4.4–15.2]), nonsmooth tumor margin (3.2, 95% CI [2.2–4.4]), multifocality (7.1, 95% CI [2.6–19.5]), and hypointensity on T1-weighted imaging (T1WI) (4.9, 95% CI [2.5–9.6]). Both peritumoral hypointensity on HBP and multifocality showed very high meta-analytic pooled specificities for diagnosing MVI (91.1% [85.4–94.8%] and 93.3% [74.5–98.5%], respectively). Conclusions: Seven MRI features including larger tumor size, rim arterial enhancement, arterial peritumoral enhancement, peritumoral hypointensity on HBP, nonsmooth margin, multifocality, and hypointensity on T1WI were significant predictors for MVI of HCC. These MRI features predictive of MVI can be useful in the management of HCC.
Stereotactic Body Radiotherapy of a Solitary Metachronous Sphenoid Metastasis from Renal Cell Cancer: A Case Report
Authors: Marchand Crety Charles , Vigneau Estelle , Invernizzi Camille
Published: March 2021

Nasosinus metastases from kidney cancer are an unusual clinical presentation although some cases are reported in the literature. Among these cases, sphenoidal metastases are even rarer. Here we report a case of lone sphenoid metastasis in patients with papillary renal cell cancer. Eight months after radical nephrectomy, the patient presented with progressively worsening diplopia. Magnetic resonance imaging showed a mass in the right sphenoid sinus. Histopathological examination of the biopsy sample confirmed diagnosis of sinonasal metastasis from papillary renal cell carcinoma. The patient was declined for surgical management and received stereotactic body radiation therapy. Reassessment MRI at 4 months showed a complete response of the treated sphenoid lesion.
Various Endoscopic Features in Monomorphic Epitheliotropic Intestinal T-Cell Lymphoma
Authors: Aoki Yasuhiro , Sujino Tomohisa , Takabayashi Kaoru , Mutakuchi Makoto , Emoto Katsura , Hosoe Naoki , Ogata Haruhiko , Kanai Takanori
Published: March 2021

A 77-year-old female who had an acute severe abdominal pain was taken to the emergency room in the previous hospital. CT scans showed jejunum and ileum wall thickening and fatty deposits around the small intestinal tract, and gastrointestinal perforation could not be ruled out. By using single anal and oral balloon endoscopy, we observed mild edema with petechial erythema, shallow erosions with edematous mucosa and ulcers with surrounded disrupted villous structures at the jejunum and ileum. Histological analysis revealed atypical lymphocytes infiltrating the small intestinal mucosa demonstrating intraepithelial lymphocytosis. Immunohistochemical staining revealed that CD3, CD7, and CD56 staining was positive, and CD4, CD5, and CD8 staining was negative in infiltrated lymphocytes. We made the diagnosis of monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) with the combination of HE staining and IHC. PET-CT showed abnormal uptake in irregular wall thickening of the small intestine, lymph nodes, ribs, spine and pelvic bone. She was treated with chemotherapy (etoposide, prednisolone, oncovin, cyclophosphamide, hydroxydaunorubicin) and is still alive 1 year after the diagnosis. We reported the various endoscopic findings in the same MEITL patient by using single balloon endoscopy. We also summarized endoscopic characteristics of MEITL patients.
Renal Functional Recovery Confounding the Assessment of Contrast Nephropathy: Propensity Score Analysis
Authors: Gorelik Yuri , Bloch-Isenberg Natalie , Heyman Samuel N. , Khamaisi Mogher
Published: March 2021

Background: Large data analyses confirm the relative safety of contrast-enhanced computed tomography (CT), except for those with advanced renal failure. However, the prevalence of post-contrast acute kidney injury may be masked by acute kidney functional recovery (AKR) in unstable inpatients, irrespective of contrast-enhanced imaging. Methods: In this work we aimed to assess AKI and AKR along with need for dialysis and mortality, among inpatients undergoing contrast-enhanced or non-enhanced CT. We performed a large-scale retrospective data analysis using propensity score matching (PSM) that compared patients undergoing contrast-enhanced and non-enhanced imaging. We also performed a subgroup analysis of subjects stratified by baseline renal function. Results: A total of 41,456 patients were analyzed. PSM resulted in well-balanced groups. AKR occurred substantially more often than AKI among hospitalized patients following CT imaging, especially among those with low baseline renal function. Yet, in this population, whereas the rate of AKI significantly increased, the rate of AKR significantly decreased following contrast-enhanced studies as compared to patients that underwent non-enhanced CT. A significantly higher proportion of patients with baseline advanced renal failure that underwent contrast-enhanced imaging required dialysis. Conclusions: The increased incidence of AKI and AKR as seen in patients with lower pre-imaging kidney function possibly suggests that both entities reflect impaired renal functional reserve. Unstable kidney function in inpatients, as demonstrated by rates of AKR and AKI, is an important confounder which requires attention in similar observational studies on the renal effects of contrast media and of various other renal injurious events.
Informed Consent in the Health Care System: An Overview from a Dental Perspective in Saudi Arabia
Authors: Nassar Afnan A. , Demyati Abrar K.
Published: March 2021

Background: Patient autonomy in the health care system is achieved by the vital principle of providing informed consent. Throughout history, informed consent gained recognition and improved to include more aids and steps to formalize and standardize the process of obtaining proper consent in medical and dental practice. Regardless of the type of informed consent obtained before the treatment, it should include an adequate understandable description of nature and diagnosis of the disease, treatment plan, proper alternatives, risks, and limitations. Summary: There is limited information in the ethics literature covering critical concepts related to different dental procedures in Saudi Arabia. In Saudi Arabia, informed consent in dentistry is not well-documented. As everything is evolving and changing in Saudi society, litigation has progressed and impacted dentistry. This overview will help in addressing aspects related to informed consent and closing the gaps in the dental health care system in Saudi Arabia, managing complex ethical issues associated with dental patients. In addition, providing recommendations and shedding some light on the importance of informed consent will improve the situation of the informed consent process in Saudi Arabia. Key Messages: Informed consent allows patients to be part of the decision-making process, and it provides legal protection for the practitioners from practice lawsuit cases. Dentists should take extra care in documenting the consent process and patient’s choice regarding their treatment to avoid unfavorable consequences. In Saudi Arabia, attention should be drawn toward the crucial role of informed consent, and more studies should be published in order to enrich the knowledge and to improve the health care system.
Cigarette Smoking, Incident Coronary Heart Disease, and Coronary Artery Calcification in Black Adults: The Jackson Heart Study
Authors: Oshunbade Adebamike A. , Kassahun‐Yimer Wondwosen , Valle Karen A. , Hamid Arsalan , Kipchumba Rodney K. , Kamimura Daisuke , Clark Donald , White Wendy B. , DeFilippis Andrew P. , Blaha Michael J. , Benjamin Emelia J. , O’Brien Emily C. , Mentz Robert J. , Rodriguez Carlos J. , Fox Ervin R. , Butler Javed , Keith Rachel J. , Bhatnagar Aruni , Marie Robertson Rose , Correa Adolfo , Hall Michael E.
Published: March 2021

Background

Although Black adults are more likely to die from coronary heart disease (CHD) compared with White adults, few studies have examined the relationship between cigarette smoking and CHD risk among Black adults. We evaluated the relationship between cigarette smoking, incident CHD, and coronary artery calcification in the JHS (Jackson Heart Study).

Methods and Results

We classified JHS participants without a history of CHD (n=4432) by self‐reported baseline smoking status into current, former (smoked at least 400 cigarettes/life) or never smokers at baseline (2000–2004). We further classified current smokers by smoking intensity (number of cigarettes smoked per day [1–19 or ≥20]) and followed for incident CHD (through 2016). Hazard ratios (HR) for incident CHD for each smoking group compared with never smokers were estimated with adjusted Cox proportional hazard regression models. At baseline, there were 548 (12.4%) current, 782 (17.6%) former, and 3102 (70%) never smokers. During follow‐up (median, 13.8 years), 254 participants developed CHD. After risk factor adjustment, CHD risk was significantly higher in current smokers compared with never smokers (HR, 2.11; 95% CI, 1.39–3.18); the difference between former smokers and never smokers (HR, 1.37; 95% CI, 1.0–1.90) did not achieve statistical significance. Among current smokers, we did not observe a dose‐response effect for CHD risk. Additionally, in multivariable logistic regression models with a subset of our analytic cohort, current smokers had greater odds of coronary artery calcification score >0 compared with never smokers (odds ratio, 2.63; 95% CI, 1.88–3.68).

Conclusions

In a large prospective cohort of Black adults, current smoking was associated with a >2‐fold increased risk of CHD over a median follow‐up of greater than a decade.
Cardio/Kidney Composite End Points: A Post Hoc Analysis of the EMPA‐REG OUTCOME Trial
Authors: Ferreira João Pedro , Kraus Bettina Johanna , Zwiener Isabella , Lauer Sabine , Zinman Bernard , Fitchett David H. , Koitka‐Weber Audrey , George Jyothis T. , Ofstad Anne Pernille , Wanner Christoph , Zannad Faiez
Published: March 2021

Background

Cardio/kidney composite end points are clinically relevant but rarely analyzed in cardiovascular trials. This post hoc analysis of the EMPA‐REG OUTCOME (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients) trial evaluated cardio/kidney composite end points by 2 statistical approaches.

Methods and Results

A total of 7020 patients with type 2 diabetes mellitus and established cardiovascular disease were treated with empagliflozin 10 or 25 mg (n=4687) or placebo (n=2333) on top of standard care. Cardio/kidney composite end points studied were: (1) cardiac or kidney death, kidney failure, hospitalization for heart failure, sustained decline in estimated glomerular filtration rate ≥40% from baseline, or sustained progression to macroalbuminuria; (2) cardiac or kidney death, kidney failure, hospitalization for heart failure, or sustained estimated glomerular filtration rate decline ≥40% from baseline; and (3) cardiac or kidney death, kidney failure, hospitalization for heart failure, or sustained doubling in serum creatinine from baseline. Cox regression using time‐to‐first‐event analysis and win ratio (WR) using hierarchical order of events were applied. Empagliflozin reduced the risk of all cardio/kidney composites. The results varied only slightly between Cox and WR (eg, composite 1: hazard ratio, 0.56 [95% CI, 0.49–0.64]; WR, 1.76 [95% CI, 1.53–2.02]. WR prioritizes events by clinical importance; in particular, all fatal events are evaluated, whereas Cox regression ignores deaths when preceded by nonfatal events. Of the 285 cardio/kidney deaths in the analysis, 44 to 56 (15%–20%), depending on the composite, occurred after a nonfatal event and were not evaluated in Cox regression but evaluated by the WR.

Conclusions

By considering the clinical relevance of different event types, the WR represents an appropriate method to complement the traditional time‐to‐first‐event analysis in cardio/kidney outcomes.

Registration

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01131676.
Immigration & the Origins of White Backlash
Authors: Hajnal Zoltan
Published: March 2021

The success of Donald Trump's anti-immigrant campaign surprised many. But I show that it was actually a continuation of a long-standing Republican strategy that has targeted immigrants and minorities for over five decades. It is not only a long-term strategy but also a widely successful one. Analysis of the vote over time shows clearly that White Americans with anti-immigrant views have been shifting steadily toward the Republican Party for decades. The end result is a nation divided by race and outcomes that often favor Whites over immigrants and minorities.
Immigration, Race & Political Polarization
Authors: Hout Michael , Maggio Christopher
Published: March 2021

Americans' views of immigration are substantially more positive than political discourse since 2010 might suggest. And they are becoming more positive. So too are Whites' views of Blacks, as racial resentment declined from 2010 to 2018. Views of immigration and race became more correlated over the last twenty years. And both are more correlated with political party preference now than at any time on record. While Republicans' views of immigration and their racial resentment have changed very little since 2010, Democrats' views of immigration have become far more positive and their racial resentment has declined substantially. The consequences of these trends were borne out dramatically in the 2016 presidential election. In combination, the two attitudes predict well who voted for Trump and who voted for Clinton. These trends and correlations make clear that xenophobic Americans are not ascendant, they are desperate. The dynamics of race, immigration, and polarization tilt in favor of both more immigration and a more progressive view of racial disparities.
The Unceasing Significance of Colorism: Skin Tone Stratification in the
United States
Authors: Monk Ellis P.
Published: March 2021

For many decades now, social scientists have documented immense ethnoracial inequalities in the United States. Much of this work is rooted in comparing the life chances, trajectories, and outcomes of African Americans to White Americans. From health to wealth and nearly every measure of well-being, success, and thriving one can find, White Americans remain ahead of Black Americans. What this focus on ethnoracial inequality between “groups” obscures, however, is long-standing skin tone inequality within groups. In this essay, I trace the trajectory of colorism and skin tone stratification in the United States over the past century. Next, I high-light the contemporary persistence of skin tone stratification, not only among African Americans, but among Latinx and Asian Americans as well. I conclude by arguing that future research on colorism will be essential to understand comprehensively the significance of race/ethnicity in a demographically shifting United States (such as immigration and “multiraciality”).
Approaching Crisis in a Subjunctive Mode
Authors: O’Brien Kevin J.
Published: March 2021

An undergraduate course in religion is an ideal place to discuss climate change, and a key task in these classrooms should be teaching students to thoughtfully and critically engage narratives used to make sense of and respond to the issue. Debates about anthropogenic climate change depend upon broad stories about the nature of reality and the place of humans within it; scholars of religion can teach skills of rigorous analysis, thoughtful tolerance, contextual understanding, and critical thinking that will help students grapple with these narratives. Students who are trained to think this way gain skills to respond to the competing facts and despair that can all-too-often make talking and teaching about climate change difficult.
Teaching Animals and Religion
Authors: Aftandilian Dave
Published: March 2021

Although animals have served as subjects and objects of religion since the Paleolithic, they are often omitted from standard religious studies courses. In this article, I discuss some best practices for introducing students to the study of animals and religion. After outlining some of the benefits of teaching about animals and religion, I explain the pros and cons of the two main approaches: by tradition or by topic. The majority of the article discusses some of the most important topics to include, as well as how best to approach several of them in terms of pedagogy and media. The final section explains the importance of bringing real animals into courses like this, and offers a variety of experiential education techniques for doing so, including contemplative practices.
„… durch das Blut des Einzelnen“
Authors: Hauck Marion Christina
Published: March 2021

In scholarly exegetical literature, there exists an important debate concerning whether Luke interprets the death of Jesus soteriologically in Luke-Acts. The passages Luke 22:19–20 and Acts 20:28 have been the centre of attention in this discussion. This essay presents a contribution to the debate by focusing on Acts 20:28: Maintaining the primary meaning of the term ἴδιος (“separate,” “distinct”) the author suggests a new translation of the prepositional phrase διὰ τοῦ αἵµατος τοῦ ἰδίου. The new reading conveys a more ecclesiological interpretation of the death of Jesus and has the advantage of being able to integrate Acts 20:28 into Luke’s wider conceptual framework.
Is It Time to Abolish the Substance of EU Citizenship Rights Test?
Authors: van den Brink Martijn
Published: March 2021

It is almost ten years since Ruiz Zambrano decided that Article 20 TFEU precludes national measures which deprive EU citizens of the genuine enjoyment of the substance of their citizenship rights. The CJEU has since then clarified when the substance of rights test applies. This article highlights several inconsistencies and unresolved puzzles in the case law. First, contrary to what was initially suggested, EU citizens can be deprived of the substance of their rights. Second, contrary to what initial judgments suggested, the substance of rights test is not independent of but grounded in the right to free movement. This suggests that the same level of protection can be provided to EU citizens without this test, simply by relying on EU free movement law. The paper concludes by suggesting that these deficiencies can only be resolved by reconsidering the substance of rights test altogether.
Expulsion and Article 20 TFEU: Some Practical and Conceptual Issues
Authors: Coutts Stephen
Published: March 2021

Rendón-Marín and CS permit the limitation of Article 20 TFEU rights on the basis of public security considerations. In elaborating a legal framework for this limitation, the Court of Justice draws on the body of law developed for that purpose under Article 21 TFEU rights and Chapter VI of Directive 2004/38/EC. However, the rights enjoyed by individuals on the basis of Article 20 TFEU are qualitatively different from those enjoyed under Article 21 TFEU, a difference that is not taken into account properly in the judgments of the Court. Conceptual and practical difficulties accordingly emerge. The judgments also reveal the increasing imbrication between Union law and national law in the regulation of citizenship and territory in the Union.