bluuebunny/crossref_metadata_2025 huggingface dataset:
The Attraction of the Mundane – How everyday life contributes to destination attractiveness in the Nordic region
Authors: Jørgensen Matias Thuen
Published: September 2020

The paper exhibits how environments, lifestyles and institutions that are considered as mundane parts of everyday life for locals, play an important role for Chinese tourists visiting the Nordic region – as motivators to visit and as tangible or intangible attractions during the visit. It contributes to ongoing discussions about the role of mundane everyday life in tourism studies, as it highlights that tourist do not only bring their everyday lives to destinations, they also travel to experience tangible and intangible elements that locals may regard as mundane. Based on these findings, the paper aims to position such mundane destination elements not only as a supplement to, but in line with traditional attractions, in terms of their contribution to destination attractiveness. The paper is based on the findings of a qualitative interview study on Chinese tourism to the Nordic region. The interviewees include fourteen Chinese tourists, sixteen representatives of Chinese tourism intermediaries and six tour guides.
Companies responses to scandal backlash caused by social media influencers
Authors: Kintu Belinda , Ben-Slimane Karim
Published: September 2020

The purpose of this article is to identify companies’ responses to scandal spillover stemming from their association with tainted social media influencers. Drawing on the literature on scandal, we show how the relationship between a social media influencer and a given brand is conducive to scandal spillover, triggered by the social media influencer’s deviance or wrongdoing. We conducted an explorative case study of the Operation Varsity Blues Scandal involving social media influencer Oliva Jade Gianulli, whose parents were both accused of bribing officials to have their daughters accepted into prestigious U.S. colleges. We collected secondary data from the internet on how 12 companies linked to Olivia Jade responded to the scandal backlash. Our article identifies four possible responses to scandal spillover resulting from association with a tainted social media influencer: proactive dissociation, reactive dissociation, mimetic dissociation, and the absence of response.
Global learning: Educational research in an emerging field
Authors: Scheunpflug Annette
Published: September 2020

Global learning may be understood as an educational response to the development towards a world society. The development of world society is accompanied by a wide range of adaptation challenges, such as the development of global social justice, the overcoming of paternalism or the facilitation of social solidarity and dealing with migration in an era of climate change. This paper reflects the learning of the understanding of world society by empirical studies. The paper shows some challenges for the research agenda, especially concerning the Organisation for Economic Co-operation and Development’s framework of global competences and suggests a framework for further research.
The competitive advantage of affiliation with business groups in the political environment: Evidence from the Arab Spring
Authors: Gedefaw Birhanu Addis , Wezel Filippo Carlo
Published: September 2020

Under weak market institutions, the positive association between group affiliation and firm performance has been empirically supported. However, the mechanisms behind this relationship remain unclear as business groups may create value for their affiliates via market and non-market strategies. We advance this discussion by leveraging an exogenous shock, namely the sudden government changes ignited by the Arab Spring, to examine: (a) whether business groups hold a competitive advantage in the political environment that enhances the performance of their affiliates and (b) which type of business groups provide that advantage to their affiliates. Our results suggest that the positive effect of group affiliation on performance is not only driven by groups’ capabilities to earn superior rents in the market environment as alluded in the literature, but also by their capabilities to earn greater influence rents compared to standalone firms in the political environment. This performance effect is stronger for affiliates of family than for non-family business groups, suggesting that political influence capabilities are heterogeneusly distributed across business group types.
Serum cystatin C: A potential predictor for hospital-acquired acute kidney injury in patients with acute exacerbation of COPD
Authors: Chen Dawei , Cao Changchun , Jiang Linglin , Tan Yan , Yuan Hongbo , Pan Binbin , Ma Mengqing , Zhang Hao , Wan Xin
Published: September 2020

Hospital-acquired acute kidney injury (HA-AKI) is associated with poor prognosis. In this study, we evaluated whether serum cystatin C on admission could predict AKI in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The retrospective study was conducted using data on adult inpatients with AECOPD from January 2014 to January 2017. A total of 1035 patients were included, among which 79 (7.6%) with HA-AKI were identified. Univariate and multivariate logistic regression analyses were used to investigate predictors of HA-AKI in patients with AECOPD. HA-AKI was associated with poor prognosis, and patients with HA-AKI had higher inpatient mortality (34.2% vs. 2.6%, p < 0.001). Furthermore, after adjusting for confounders, HA-AKI was an independent risk factor for inpatient mortality for patients with AECOPD (odds ratio (OR) 11.02; 95% confidence interval (CI) 4.77–25.45; p < 0.001). Four independent risk factors for HA-AKI (age, levels of urea and cystatin C, and platelet count on admission) were identified in patients with AECOPD. Cystatin C (OR 5.22; 95% CI 2.49–10.95; p < 0.001) was a significant independent predictor of AKI in patients with AECOPD. HA-AKI in patients with AECOPD could be identified with a sensitivity of 73.5% and a specificity of 75.9% (area under the curve (AUC) = 0.803, 95% CI 0.747–0.859) by cystatin C level (cutoff value = 1.3 mg/L) and with a sensitivity of 75.9% and a specificity of 82.0% (AUC = 0.853, 95% CI 0.810–0.896) using a model comprising all significant predictors. Serum cystatin C has the potential for use to predict the risk of HA-AKI in patients with AECOPD.
Potential Role of Targeting KDR and Proteasome Inhibitors in the Therapy of Esophageal Squamous Cell Carcinoma
Authors: Zhang Ling , Niu Xia , Bi Yanghui , Cui Heyang , Li Hongyi , Cheng Xiaolong
Published: September 2020

Esophageal squamous cell carcinoma (ESCC) is one of the most aggressive cancer types in China. In recent years, progress has been made in various types of cancer genomics including ESCC. However, the clinical significance of genomic variation of ESCC remains poorly defined. In the present study, genomic sequencing data from 469 ESCC cases were analyzed and potential therapeutic targets in the Druggable Genome Interaction Database (DGIdb) were screened. A series of potential therapeutic target genes and pathways were identified, of which treatment of ESCC with bortezomib (a specific inhibitor targeting proteasome) potently inhibited the proliferation of 5 ESCC cell lines and administration of bortezomib led to significant tumor xenograft regression in SCID mice. It was also identified that kinase insert domain receptor (KDR), which had drug recommendations from all 6 sources integrated by the DGldb and harbored significant amplification in ESCC, might be a downstream target of zinc finger protein 750 (ZNF750). ZNF750 acts as a transcription factor and has been demonstrated to harbor frequently inactivating mutations in ESCC by previous independent studies. In the present study, KDR was upregulated upon ZNF750 knockdown and the rescue of ZNF750 also led to marked restoration of KDR. KDR knockdown in stable ZNF750-knockdown KYSE150 and KYSE140 ESCC cells significantly attenuated the promotion of cell growth, colony formation, invasion and migration induced by ZNF750 knockdown. Further experiments found that apatinib treatment, a potent inhibitor of KDR, resulted in profound inhibition of cell proliferation and invasion. Collectively, the present study provided insight for genomic alterations as potential therapeutic targets in ESCC and supported the possibility of a therapeutic strategy targeting the proteasome in ESCC. The present results also suggested that targeting KDR may be an effective way to treat ESCC, not only in KDR variant cases, but also in individuals with ZNF750 mutations and deletions.
Fabric defect fetection via weighted low-rank decomposition and Laplacian regularization
Authors: Ji Xuan , Liang Jiuzhen , Di Lan , Xia Yunfei , Hou Zhenjie , Huan Zhan , Huan Yuxi
Published: September 2020

Low-rank decomposition models have potential for fabric defect detection, where a feature matrix is decomposed into a low-rank matrix that corresponding to repeated texture structure and a sparse matrix that represent defective regions. Two limitations, however, still exist. First, previous work might fail to detect some large homogeneous defective block. Second, when the background and defective regions are relatively coherent or the texture of fabric image is complex, it is difficult to use previous methods to separate them. To deal with these problems, a new weighted low-rank decomposition model with Laplace regularization (WLRL) is proposed in this paper: (1) a weighted low-rank decomposition model that can decompose the original image into background and defective regions, and (2) a Laplace regularization that can enlarge the distance between the background and the defective regions. The performance of the proposed method WLRL is evaluated on the box- and star-patterned fabric databases, and superior results are shown compared with state-of-the-art methods, that is, 98.70% ACC (accuracy) and 72.83% TPR (true positive rate) for box-patterned fabrics, 99.09% ACC (accuracy) and 83.63% TPR (true positive rate) for star-patterned fabrics.
Biosynthesis of ZnO Nanoparticles Using Bacillus Subtilis: Characterization and Nutritive Significance for Promoting Plant Growth in Zea mays L
Authors: Sabir Sumera , Zahoor Muhammad Asif , Waseem Muhammad , Siddique Muhammad Hussnain , Shafique Muhammad , Imran Muhammad , Hayat Sumreen , Malik Imran Riaz , Muzammil Saima
Published: September 2020

Nano-fertilizer(s), an emerging field of agriculture, is alternate option for enhancement of plant growth replacing the synthetic fertilizers. Zinc oxide nanoparticles (ZnO NPs) can be used as the zinc source for plants. The present investigation was carried out to assess the role of ZnO NPs in growth promotion of maize plants. Biosynthesized ZnO NPs (using Bacillus sp) were characterized using Scanning Electron Microscope (SEM), Transmission Electron Microscope (TEM), X-ray diffraction (XRD) and Zeta potential. Different concentrations of ZnO NPs (2, 4, 8, 16 mg/L) were explored in pot culture experiment. Size of ZnO NPs ranged between 16 and 20 nm. A significant increase in growth parameters like shoot length (61.7%), root length (56.9%) and significantly higher level of protein was observed in the treated plants. The overall pattern for growth biomarkers including the protein contents was maximum at 8 mg/L of ZnO NPs. It was observed that application of biosynthesized ZnO NPs has improved majority of growth biomarkers including plant growth parameters, protein contents and leaf area. Therefore, biosynthesized ZnO NPs could be considered as an alternate source of nutrient in Zn deficient soils for promoting the modern agriculture.
Therapeutic Response of Epimedium gandiflorum’s Different Doses to Restore the Antioxidant Potential and Reproductive Hormones in Male Albino Rats
Authors: Munir Naveed , Mahmood Zahed , Yameen Muhammad , Mustafa Ghulam
Published: September 2020

Current study was planned to explore the therapeutic response of different doses of hydroethanolic extract of Epimedium grandiflorum leaves in male albino rats. Phytochemical analysis, HPLC and FTIR spectroscopy results revealed the presence of wide range of phenolic compounds and functional groups, respectively. Further, extract not induced significant hemolysis (7.56 ± 1.297%) against PBS (3.65 ± 0.35%) as negative control; while have significant clot lysis (44 ± 5.2%) potential, exhibited DPPH (78.87 ± 5.427%) scavenging, H2O2 (31.82 ± 3.491%) scavenging, antioxidant and reducing power activities. In vivo experimentation in albino male rats’ revealed that administration of different doses (50, 100, 200 mg/Kg b.w.) of extract orally for 42 days after CCl4 intoxication significantly (P < 0.05) restore the selected parameters including liver enzymes, renal profiles, and stress markers and significantly (P < 0.05) increased reproductive hormones like testosterone, luteinizing hormone, follicle stimulating hormone and prolactin while significantly (P < 0.05) decreased progesterone and estradiol toward normal in dose dependent manner. Significant (P < 0.05) improvement in the structural architecture of testicular tissue particularly in high dose group (200 mg/Kg b.w.) was also observed. Results revealed E. grandiflorum has significant therapeutic response to address the healthcare problems particularly of impotency.
Storying Toward Pasin and Luksave: Permeable Relationships Between Papua New Guineans as Researchers and Participants
Authors: Backhaus Vincent , Neuendorf Nalisa , Brooksbank Lokes
Published: September 2020

In Oceania, Papua New Guinea (PNG) appears large in the consciousness of exploring social life through the notion of sociality. Scholarship within the Melanesian region employs sociality to interrogate forms of social life and the different ways research methods account for the understanding of interactions between individuals and communities. Yet for the three PNG authors this assumed coherency between epistemes and method highlighted specific conceptual challenges for us as researchers and participants. We identified with two conceptual notions: “pasin” and “luksave” as distinct Austronesian language ideas derived from Tok Pisin—a creolisation of English utilized as a lingua franca throughout the country. We explored the development of pasin and luksave and the ways the conceptual claims served a dual function of developing a methodological and epistemic pathway toward an ethical assurance of meaningful relationality. We extend on current understanding in two ways. Firstly employing the methodology of story as critique of research assumptions and secondly, extend on the process of story work to suggest storying as a novel but relatable research methodology. Storying such research experiences as both method and epistemic accountability, guided our responsibility toward the relationships we hold to people, community and knowledge. Pasin and luksave embed an emancipatory and de-colonial intent through the guise of oral stories. These intentions in our scholarship fostered a form of coherent expressions of research claim and method assumption and also raised questions for us regarding what decolonizing Papua New Guinea ought to consider. Our paper also highlights a reformulation of the different ways research considers Oceania in particular Melanesia and the Papua New Guinean research context.
Acknowledging Documentary Filmmaking as not Only an Output but a Research Process: A Case for Quality Research Practice
Authors: Fitzgerald Angela , Lowe Magnolia
Published: September 2020

Documentary films play an important role in how we see and position ourselves in the world. While traditionally viewed as a creative practice, documentary filmmaking has been transitioning into the academic world as a way to undertake and engage with research practices. Some question marks remain, however, over the nature of documentary filmmaking as a research method. This paper seeks to build a case for documentary as a research practice using Guba and Lincoln’s quality criteria, which is typically employed to ensure the trustworthiness of collected data, as a frame for sense making. This case for research innovation also draws upon the first author’s previous experiences with video ethnography and the second author’s expertise as a documentary film maker. Their collaboration resulted in a longitudinal research project that foregrounded documentary practices as key to data gathering and sense making. This research project sought to understand the early career experiences of Australian graduate teachers from their perspective. Using this research project as a context, this paper unpacks how seven quality criteria can be explored and addressed using documentary filmmaking as method. This work highlights the possibilities and challenges inherent in innovating in the qualitative methodology space when considering the use of documentary filmmaking practices. It also adds meaningful and practical insights to a growing groundswell of voices that recognize documentary filmmaking as a viable and valuable research method.
A novel detection fusion network for solid waste sorting
Authors: Yu Yan , Zou Siyu , Yin Kejie
Published: September 2020

Vision-based object detection technology plays a very important role in the field of computer vision. It is widely used in many machine vision applications. However, in the specific application scenarios, like a solid waste sorting system, it is very difficult to obtain good accuracy due to the color information of objects that is badly damaged. In this work, we propose a novel multimodal convolutional neural network method for RGB-D solid waste object detection. The depth information is introduced as the new modal to improve the object detection performance. Our method fuses two individual features in multiple scales, which forms an end-to-end network. We evaluate our method on the self-constructed solid waste data set. In comparison with single modal detection and other popular cross modal fusion neural networks, our method achieves remarkable results with high validity, reliability, and real-time detection speed.
Curcumin improves necrotising microscopic colitis and cell pyroptosis by activating SIRT1/NRF2 and inhibiting the TLR4 signalling pathway in newborn rats
Authors: Yin Yiyu , Wu Xiaole , Peng Bei , Zou Huaxin , Li Shixian , Wang Jian , Cao Junhua
Published: September 2020

This study aimed to explore comprehensively the biological function of curcumin, and its underlying mechanism, in protecting from necrotising microscopic colitis in newborn rats. A total of 20 normal healthy rats were selected, and a necrotising enterocolitis (NEC) model was established. After hypoxia and hypothermia stimulation, these rats were treated with different doses of curcumin (control group, NEC model group, NEC+20 mg/kg curcumin and NEC+50 mg/kg curcumin). Inflammation was identified using hematoxylin and eosin staining, and inflammatory factors were detected via ELISA. The mRNA and protein levels of SIRT1, NRF2, TLR4, NLRP3 and caspase-1 were determined by quantitative RT-PCR and Western blotting, respectively. Curcumin improved the inflammatory condition of NEC and inhibited the expression of inflammatory factors in NEC newborn rat intestinal tissue. Furthermore, the SIRT1/NRF2 pathway was inhibited in the intestinal tissue of NEC newborn rats, whereas curcumin treatment induced the activation of the SIRT1/NRF2 pathway and inhibited TLR4 expression in these animals. In addition, curcumin could also inhibit the expression of inflammatory factors and alleviate the LPS/ATP-induced focal death pathway in intestinal epithelial cells through the SIRT1 pathway. Curcumin can improve necrotising microscopic colitis and cell pyroptosis by attenuating NEC-induced inhibition of SIRT1/NRF2 and inhibiting the TLR4 signalling pathway in newborn rats.
Moving Beyond Simple Descriptive Statistics in the Analysis of Online Wildlife Trade: An Example From Clustering and Ordination
Authors: Lee Tamsin E. , Roberts David L.
Published: September 2020

Collecting data for reports on online wildlife trade is resource-intensive and time-consuming. Learning often focuses on the main item traded by each country only. However, online trade is increasing, providing potential to update the conversation from a national scale to a global scale. We demonstrate how hierarchical clustering can identify wildlife items that follow similar trading patterns. We also ordinate the clusters, and seek correlations between the clusters and global measures, such as Worldwide Governance Indicators. We primarily use a sample dataset from a published report of online traded wildlife, covering 16 countries and 31 taxa or product types. Clustering provided immediate insights, such as rhinos and pangolins were traded similarly to ivory and suspected ivory. Five out of eight clusters represented items predominately traded by one country. An ordination of these clusters, and representation of global measures on the ordination axis, show a strong correlation of the ‘Voice and accountability' score with the clusters. Consequently, from the ‘Voice and accountability' score of the United States, a country not included in our dataset, we inferred that it traded elephant items (not ivory) and owl items during 2014.
The Effect of Nasoseptal Flap Elevation on Post-Operative Olfaction and Sinonasal Quality of Life: A Prospective Double-Blinded Randomized Controlled Trial
Authors: Chou Courtney T. , Valappil Benita , Mattos Jose L. , Snyderman Carl H. , Gardner Paul A. , Fernandez-Miranda Juan C. , Wang Eric W.
Published: September 2020

Background

The use of nasoseptal flaps (NSF) for defect reconstruction in endoscopic endonasal approaches (EEA) to cranial base pathology has markedly reduced rates of cerebrospinal fluid leak. However, the effect of NSF use on post-operative olfaction remains unclear.

Objective

To evaluate the impact of NSF use during EEA on binarial and uninarial olfaction, and sinonasal quality of life (QOL).

Methods

This was a prospective double-blinded randomized controlled trial. Patients undergoing EEA for sellar pathology were recruited from the University of Pittsburgh Medical Center from December 2014 to May 2017. Subjects were randomized pre-operatively to a side of NSF harvest. Olfaction and QOL were assessed pre-operatively and 6 to 12 months post-operatively using the University of Pennsylvania Smell Identification Test, “Sniffin’ Sticks,” and Sinonasal Outcomes Test 22. The side of dominant uninarial olfaction was determined using “Sniffin’ Sticks.”

Results

Thirty-one patients were enrolled. Sixteen underwent EEA without NSF (control group) and 15 with NSF. A dominant side of olfaction was identified in 14 patients with NSF; 8 patients were randomized to NSF harvest on the dominant side and the remaining 6 on the non-dominant side. NSF elevation resulted in a 4% decrease in University of Pennsylvania Smell Identification Test scores, but was not statistically significant compared to controls. Similarly, NSF elevation on the side of dominant olfaction resulted in a 6% decrease, but was not statistically significant when compared to the non-dominant elevation group. Change in rhinologic QOL as determined by the Sinonasal Outcomes Test 22 was not significantly different between any of the groups.

Conclusions

The use of NSF during EEA for sellar pathology does not have a significant effect on olfaction or rhinologic QOL. The presence of a dominant side of olfaction is not a primary consideration when deciding the side of NSF harvest.
MRI predictors for brain invasion in meningiomas
Authors: Ong Thomas , Bharatha Aditya , Alsufayan Reema , Das Sunit , Lin Amy Wei
Published: September 2020

Background and purpose

In the 2016 revision of the World Health Organization classification of central nervous system tumours, brain invasion was added as an independent histological criterion for the diagnosis of a World Health Organization grade II atypical meningioma. The aim of this study was to assess whether magnetic resonance imaging characteristics can predict brain invasion for meningiomas.

Materials and methods

We conducted a retrospective review of all meningiomas resected at our institution between 2005 and 2016 which had preoperative magnetic resonance imaging and included brain tissue within the pathology specimen. One hundred meningiomas were included in the study, 60 of which had histopathological brain invasion, 40 of which did not. Magnetic resonance imaging characteristics of tumours were evaluated for potential predictors of brain invasion. Tumour location, size, perilesional oedema, contour, cerebrospinal fluid cleft, peritumoral cyst, dural venous sinus invasion, bone invasion, hyperostosis and the presence of enlarged pial arteries and veins were evaluated. Data were analysed using conventional chi-square, Fisher’s exact test and logistic regression.

Results

The volume of peritumoral oedema was significantly higher in the brain-invasive meningioma group compared to the non-brain-invasive group. The presence of a complete cleft was a rare finding that was only found in non-brain-invasive meningiomas. The presence of enlarged pial feeding arteries was a rare finding that was only found in brain-invasive meningiomas.

Conclusions

An increased volume of perilesional oedema is associated with the likelihood of brain invasion for meningiomas.
Predictors of preconception care behaviour among women of reproductive age using a behaviour-change model
Authors: Bayrami Roghieh , Didarloo Alireza , Asadinejad Afsaneh
Published: September 2020

Purpose:

Although preconception care (PCC) has been integrated into women’s care programmes in the country for more than a decade, it has not yet been welcomed by Iranian women, and the rate of PCC uptake is very low. Therefore, this study aims to determine predictors of uptake of PCC based on the Beliefs, Attitudes, Subjective Norms and Enabling Factors (BASNEF) model among women of reproductive age referred to health centres in Urmia, Northwest Iran, in 2019.

Methods:

This cross-sectional study was carried out on 230 women of childbearing age at Urmia health centres during 2019. Subjects were selected using a multistage sampling method. A valid reliable researcher-made questionnaire, including demographic information, items related to the BASNEF model constructs regarding PCC and items related to PCC behaviour, was used to collect data. Data were analysed using descriptive and inferential statistics (frequencies, means and standard deviations, independent t-test, chi-square test, logistic and linear regression).

Results:

The findings showed that the rate of receiving PCC was 19.6%. Overall, the BASNEF model predicted 42% of the intention to receive health care. Among the model constructs, enabling factors (β=0.32, p<0.001) and attitude (β=0.41, p<0.001) significantly explained women’s behavioural intention towards receiving PCC. In the logistic regression model, intention (β=0.15, p<0.001) and enabling factors (β=0.12, p=0.034) had a significant role in predicting PCC.

Conclusion:

The low uptake of PCC by women of childbearing age in Urmia suggests the need to design and implement interventions based on women’s attitudes, intentions and enabling factors in order to stimulate and maintain women’s health-promoting behaviours during childbearing age.
The state of the art of sound therapy for subjective tinnitus in adults
Authors: Wang Haiyan , Tang Dongmei , Wu Yongzhen , Zhou Li , Sun Shan
Published: September 2020

Background:

Sound therapy is a clinically common method of tinnitus management. Various forms of sound therapy have been developed, but there are controversies regarding the selection criteria and the efficacy of different forms of sound therapy in the clinic. Our goal was to review the types and forms of sound therapy and our understanding of how the different characteristics of tinnitus patients influence their curative effects so as to provide a reference for personalized choice of tinnitus sound therapy.

Method:

Using an established methodological framework, a search of six databases including PubMed identified 43 records that met our inclusion criteria. The search strategy used the following key words: tinnitus AND (acoustic OR sound OR music) AND (treatment OR therapy OR management OR intervention OR measure).

Results:

There are various forms of sound therapy, and most of them show positive therapeutic effects. The effect of customized sound therapy is generally better than that of non-customized sound therapy, and patients with more severe initial tinnitus respond better to sound therapy.

Conclusion:

Sound therapy can effectively suppress tinnitus, at least in some patients. However, there is a lack of randomized controlled trials to identify effective management strategies. Further studies are needed to identify the most effective form of sound therapy for individualized therapy, and large, multicenter, long-term follow-up studies are still needed in order to develop more effective and targeted sound-therapy protocols. In addition, it is necessary to analyze the characteristics of individual tinnitus patients and to unify the assessment criteria of tinnitus.
Autoimmune thyroid disease and type 1 diabetes mellitus: same pathogenesis; new perspective?
Authors: Li Liyan , Liu Shudong , Yu Junxia
Published: September 2020

Autoimmune thyroid disease (AITD) and type 1 diabetes mellitus (T1DM) are two common autoimmune diseases that can occur concomitantly. In general, patients with diabetes have a high risk of AITD. It has been proposed that a complex genetic basis together with multiple nongenetic factors make a variable contribution to the pathogenesis of T1DM and AITD. In this paper, we summarize current knowledge in the field regarding potential pathogenic factors of T1DM and AITD, including human leukocyte antigen, autoimmune regulator, lymphoid protein tyrosine phosphatase, forkhead box protein P3, cytotoxic T lymphocyte-associated antigen, infection, vitamin D deficiency, and chemokine (C-X-C motif) ligand. These findings offer an insight into future immunotherapy for autoimmune diseases.
Prostate adenocarcinoma and cutaneous metastases
Authors: John Jeff , Wantenaar Tanya , Lazarus John , Kesner Ken
Published: September 2020

Prostate cancer is the second most frequently diagnosed cancer in men and the fifth leading cause of mortality worldwide. Men of African descent with prostate adenocarcinoma tend to present late with advanced, aggressive and often metastatic disease. Cutaneous metastases are extremely rare, with the incidence reported to be as low as 0.36%. We report a case of prostate adenocarcinoma with cutaneous metastases. A 69-year-old African male known to the urology unit, with metastatic adenocarcinoma of the prostate, presented with a two-week history of pale-to-purple large nodular lesions on the skin of his left hemiscrotum and smaller nodules on the penile shaft. Punch biopsies of the scrotal nodules revealed metastatic prostate adenocarcinoma. Bilateral orchidectomy and excision of the cutaneous lesions were performed. Although cutaneous metastases are rare, more so in patients with adenocarcinoma of the prostate, any skin lesions in patients with a known primary malignancy should raise a suspicion of metastasis. All physicians should therefore have a low threshold for the biopsy of any unusual skin lesion in patients with known prostate cancer.

Level of evidence: 5.
The Theory of Emerging Adulthood 20 Years Later: A Look at Where It Has Taken Us, What We Know Now, and Where We Need to Go
Authors: Nelson Larry J.
Published: September 2020

For 20 years, the theory of emerging adulthood has shaped how we think about the third decade of life. In honor of that I would like to revisit the distinct features of emerging adulthood outlined in the theory but then discuss them in light of what we know now via a lens that looks not at what those distinct features are but what they afford, or offer, young people for good and for ill. By thinking about what emerging adulthood affords, we can better capture the heterogeneity of paths young people take through the 20s. Specifically, it is my hope to have us think about the potential positive and negative implications of emerging adulthood on the lives of young people throughout the 20s and into subsequent life stages. Finally, I will underscore the obligation we have to take what we now know to help emerging adults.
The evolution of an evidence based intervention designed to improve prescribing and reduce polypharmacy in older people with multimorbidity and significant polypharmacy in primary care (SPPiRE)
Authors: McCarthy Caroline , Moriarty Frank , Wallace Emma , Smith Susan M ,   Barbara Clyne for the SPPiRE Study Team
Published: September 2020

Introduction:

By the time an intervention is ready for evaluation in a definitive RCT the context of the evidence base may have evolved. To avoid research waste, it is imperative that intervention design and evaluation is an adaptive process incorporating emerging evidence and novel concepts. The aim of this study is to describe changes that were made to an evidence based intervention at the protocol stage of the definitive RCT to incorporate emerging evidence.

Methods:

The original evidence based intervention, a GP delivered web guided medication review, was modified in a five step process: Identification of core components of the original intervention. Literature review. Modification of the intervention. Pilot study. Final refinements. A framework, developed in public health research, was utilised to describe the modification process.

Results:

The population under investigation changed from older people with a potentially inappropriate prescription (PIP) to older people with significant polypharmacy, a proxy marker for complex multimorbidity. An assessment of treatment priorities and brown bag medication review, with a focus on deprescribing were incorporated into the original intervention. The number of repeat medicines was added as a primary outcome measure as were additional secondary patient reported outcome measures to assess treatment burden and attitudes towards deprescribing.

Conclusions:

A framework was used to systematically describe how and why the original intervention was modified, allowing the new intervention to build upon an effective and robustly developed intervention but also to be relevant in the context of the current evidence base.
Post-transplant cancer: An epidemiological evaluation
Authors: Francis Anna , Au Eric , Lim Wai H , Wong Germaine
Published: September 2020

Kidney transplantation is a lifechanging event for patients with end-stage kidney disease (ESKD) because it improves the quality of life and survival of these patients. However, it is not a cure and is not without complications. Transplant recipients have an excess risk of premature death (largely from cancer and cardiovascular disease (CVD)) by at least 10-times compared to the general population. Published work has identified cancer as one of the most important and feared outcomes in transplant recipients and is a key research priority recognised by both patients and health professionals. There is also convincing epidemiological evidence, suggesting the overall risk of developing cancer in the transplant population is approximately 2 to 3-fold higher compared to the age-matched general population. Unlike CVD, where the death rates have fallen considerably over the past decade in this population in response to better screening, preventative and intervention approaches, the excess risk of cancer-related deaths in transplant recipients remains at least 10-fold higher compared to cancer patients in the general population. The causes of the increased risk of death are unknown but may be a consequence of possible differences in tumour biology under the influence of immunosuppression. In this review, we will discuss the epidemiology of overall and site-specific cancer risk and death across different countries. We will also focus on the current evidence on the prevention and screening in our at-risk transplant candidates. Finally, management strategies of common cancers such as skin, post-transplant lymphoproliferative disease and solid organ cancers such as colorectal, breast and lung cancer will be evaluated.
Influence of Woodsmoke Exposure on Molecular Mechanisms Underlying Alzheimer’s Disease: Existing Literature and Gaps in Our Understanding
Authors: Schuller Adam , Montrose Luke
Published: September 2020

Woodsmoke poses a significant health risk as a growing component of ambient air pollution in the United States. While there is a long history of association between woodsmoke exposure and diseases of the respiratory, circulatory, and cardiovascular systems, recent evidence has linked woodsmoke exposure to cognitive dysfunction, including Alzheimer’s disease dementia. Alzheimer’s disease is a progressive neurodegenerative disorder with largely idiopathic origins and no known cure. Here, we explore the growing body of literature which relates woodsmoke-generated and ambient air pollution particulate matter exposure to Alzheimer’s disease (AD) onset or exacerbation, in the context of an inflammation-centric view of AD. Epigenetic modifications, specifically changes in DNA methylation patterns, are well documented following woodsmoke exposure and have been shown to influence disease-favoring inflammatory cascades, induce oxidative stress, and modulate the immune response in vitro, in vivo, and in humans following exposure to air pollution. Though the current status of the literature does not allow us to draw definitive conclusions linking these events, this review highlights the need for additional work to fill gaps in our understanding of the directionality, causality, and susceptibility throughout the life course.
Optimization design of low-density and high-strength ceramic proppants by orthogonal experiment
Authors: Li Xianjun , Hao Jianying
Published: September 2020

This study mainly focused on an orthogonal optimization design of low-density and high-strength ceramic proppants prepared by low-grade bauxite and feldspar that met the standard requirements. The orthogonal experimental design of L25 (53) was employed to study the significance sequence of three factors, including milling time of bauxite, milling time of feldspar, and sintering temperature. The results show that the particle size of feldspar is the most important factor for the performance of the proppants. The longer the milling time of feldspar is, the finer the particle size of feldspar is, and the easier it is to form liquid phase at a lower temperature. For the breakage ratio, the optimal experimental combination is bauxite milled for 4 h, feldspar milled for 8 h, and sintering temperature of 1280°C. The proppants prepared by the optimal combination have bulk density of 1.48 g cm−3, apparent density of 2.7 g cm−3, breakage ratio of 4.07% under 52 MPa closed pressure, and acid solubility of 2.15%.
Response to mepolizumab treatment is sustained across 4-weekly dosing periods
Authors: Pavord Ian D. , Bleecker Eugene R. , Buhl Roland , Chanez Pascal , Bel Elisabeth H. , Howarth Peter , Bratton Daniel J. , Albers Frank C. , Yancey Steven
Published: September 2020

Background

Mepolizumab (100 mg delivereds.c.every 4 weeks) is indicated for add-on maintenance treatment for patients with severe eosinophilic asthma. Mepolizumab has been shown to reduce exacerbations and the requirement for daily oral corticosteroids, and improve asthma control and symptoms. However, data on the durability of the response to mepolizumab during dosing periods are limited. The aim of this study was to investigate the efficacy profile in patients with severe eosinophilic asthma over the 4-weekly dosing period for various fixed mepolizumab doses.

Methods

This was apost hocanalysis of data from the phase IIb/III DREAM study. Patients ≥12 years of age with severe eosinophilic asthma were randomised (1:1:1:1) to receive intravenous mepolizumab 75 mg (equivalent to 100 mgs.c.),250 mg, 750 mg or placebo, plus standard of care, every 4 weeks for 52 weeks. The number of exacerbations and eDiary data (peak expiratory flow, rescue medication use and symptom scores) from two periods in each 4-weekly dosing interval (days 1–14 and 15–28) over the 52-week treatment period were analysed.

Findings

eDiary data and the proportion of patients experiencing ≥1 exacerbation were similar during the first and second 2 weeks of a dosing period across all mepolizumab doses.

Interpretation

These results demonstrate that the response to mepolizumab is sustained over the 4-weekly dosing period with no differences across a 10-fold dose range and supports the use of the current mepolizumab dosing regimen in patients with severe eosinophilic asthma.
Clinical course of asymptomatic small enhancing brain nodules in patients with nonsmall cell lung cancer: do we have to follow them up?
Authors: Lee Hyun Woo , Cho Jaeyoung , Kwak Nakwon , Hwang Inpyeong , Park Young Sik , Lee Chang-Hoon , Lee Sang-Min , Yoo Chul-Gyu , Kim Young Whan , Choi Sun Mi
Published: September 2020

Aims

Brain magnetic resonance imaging (MRI) is recommended during the initial work-up for nonsmall cell lung cancer (NSCLC). Although small enhancing brain nodules not radiologically confirmed as metastatic lesions have often been detected, their clinical course has not been well studied.

Methods

This nested case–control study included NSCLC patients who had small enhancing brain nodules detected by serial brain MRIs from January 2014 through December 2018 at a tertiary university hospital. Small enhancing brain nodules were defined as round enhancing nodules of ≤10 mm diameter without oedema in thin-section (1 mm) contrast MRIs. The incidence, natural course and risk factors of growing nodules were evaluated.

Results

A total of 171 small enhancing brain nodules in 123 patients were observed over an average of 22.1 months. The incidence of nodule growth was 49.1% with mean growth rate of 11 mm·year−1. We found that 25.0% of the growing nodules contributed to clinical upstaging compared to the initial stage. Cerebral events were more common in growing nodules; therefore, local therapy was performed more often. However, there was no difference in the cerebral event-related mortality. Nodule growth was more frequent in younger individuals, multiple nodules, advanced disease, poorly differentiated carcinoma, rim enhancement and larger initial size. In multivariable analysis, predictors of growth were N stage ≥1, existence of epidermal growth factor receptor mutation and larger initial size.

Conclusion

Considering the clinical course of small enhancing brain nodules, more intensive evaluation is required for early detection and pre-emptive intervention when accompanied by risk factors.
Somatotypes trajectories during adulthood and their association with COPD phenotypes
Authors: Divo Miguel J. , Marin Oto Marta , Casanova Macario Ciro , Cabrera Lopez Carlos , de-Torres Juan P. , Marin Trigo Jose Maria , Hersh Craig P. , Ezponda Casajús Ana , Maguire Cherie , Pinto-Plata Victor M. , Polverino Francesca , Ross James C. , DeMeo Dawn , Bastarrika Gorka , Silverman Edwin K. , Celli Bartolome R.
Published: September 2020

Rationale

Chronic obstructive pulmonary disease (COPD) comprises distinct phenotypes, all characterised by airflow limitation.

Objectives

We hypothesised that somatotype changes – as a surrogate of adiposity – from early adulthood follow different trajectories to reach distinct phenotypes.

Methods

Using the validated Stunkard's Pictogram, 356 COPD patients chose the somatotype that best reflects their current body build and those at ages 18, 30, 40 and 50 years. An unbiased group-based trajectory modelling was used to determine somatotype trajectories. We then compared the current COPD-related clinical and phenotypic characteristics of subjects belonging to each trajectory.

Measurements and main results

At 18 years of age, 88% of the participants described having a lean or medium somatotype (estimated body mass index (BMI) between 19 and 23 kg·m−2) while the other 12% a heavier somatotype (estimated BMI between 25 and 27 kg·m−2). From age 18 onwards, five distinct trajectories were observed. Four of them demonstrating a continuous increase in adiposity throughout adulthood with the exception of one, where the initial increase was followed by loss of adiposity after age 40. Patients with this trajectory were primarily females with low BMI andDLCO(diffusing capacity of the lung for carbon monoxide). A persistently lean trajectory was seen in 14% of the cohort. This group had significantly lower forced expiratory volume in 1 s (FEV1),DLCO, more emphysema and a worse BODE (BMI, airflow obstruction, dyspnoea and exercise capacity) score thus resembling the multiple organ loss of tissue (MOLT) phenotype.

Conclusions

COPD patients have distinct somatotype trajectories throughout adulthood. Those with the MOLT phenotype maintain a lean trajectory throughout life. Smoking subjects with this lean phenotype in early adulthood deserve particular attention as they seem to develop more severe COPD.
Pulmonary alveolar microlithiasis: no longer in the stone age
Authors: Bendstrup Elisabeth , Jönsson Åsa Lina M.
Published: September 2020

Pulmonary alveolar microlithiasis (PAM) is a rare parenchymal lung disease caused by variants in theSCL34A2gene and characterised by the accumulation of intra-alveolar microliths. PAM has been reported in fewer than 1100 cases throughout the world. It is an autosomal recessive hereditary disease and often associated with consanguinity. Progress with respect to the genetic background and pathophysiology has resulted in an increased understanding of the disease in recent years. Until now, 30 genetic differentSLC34A2variants have been reported, which all are considered significant for disease development. There is no sex difference and the majority of cases are diagnosed at the age of 30–40 years. Many patients are asymptomatic and the diagnosis is made at random. When symptomatic, dyspnoea, cough, chest pain and fatigue are common complaints. The diagnosis of PAM can confidently be based on typical radiographic findings and genetic testing proving rare biallelicSCL34A2gene variants. Bronchoalveolar lavage and histopathology may show microliths. There is no disease-specific treatment and management is supportive. Lung transplantation should be considered in advanced cases.
Identification of target zones for lung volume reduction surgery using three-dimensional computed tomography rendering
Authors: Caviezel Claudio , Froehlich Tamara , Schneiter Didier , Muehlematter Urs , Frauenfelder Thomas , Guglielmetti Laura-Chiara , Opitz Isabelle , Weder Walter
Published: September 2020

Background

The key issues for performing lung volume reduction surgery (LVRS) is the identification of the target zones. Recently introduced three-dimensional computed tomography rendering methods are used to identify the morphological distribution and its severity of lung emphysema by densitometry. We demonstrate a new software for emphysema imaging and show the pre- and post-operative results in patients undergoing LVRS planned based on this new technology.

Methods

A real-time three-dimensional image analysis software system was used pre- and 3 months post-operatively in five patients with heterogeneous emphysema and a single patient with homogeneous morphology scheduled for LVRS. Focus was on low attenuation areas with <950 HU, distribution on both lungs and the value of the three-dimensional images for planning surgery. Functional outcome was assessed by pulmonary function tests after 3 months.

Results

Five patients underwent bilateral LVRS and one patient had unilateral LVRS. All patients showed a median increase in forced expiratory volume in 1 s of 70% (range 30–120%), compared with baseline values. Hyperinflation (expressed as residual volume/total lung capacity ratio) was reduced by 30% (range 5–32%). In the patients with heterogeneous emphysema, the pre- and post-operative computed tomography scans and the densitometries showed a decrease in low attenuation areas by 23% (right side) and by 17% (left side), respectively.

Conclusion

We demonstrate three-dimensional computed tomography-rendered images for planning personalised remodelling of hyperinflated lungs using LVRS. This user-friendly software has the potential to assist surgeons and interventional pulmonologists to select patients and to visualise target areas in LVRS procedures.