bluuebunny/crossref_metadata_2025 huggingface dataset:
Lipophilic 9,10‐Dehydrofukinone Action on Pathogenic and Non‐Pathogenic Bacterial Biofilms. Why Is This Main Volatile Metabolite in Senecio?
Authors: Verni María C. , Garay José A. , Mendoza Lucía , Bardón Alicia , Borkosky Susana , Arena Mario E. , Cartagena Elena
Published: April 2020

The effect of a natural sesquiterpene ketone, 9,10‐dehydrofukinone (DHF), on pathogenic Staphylococcus aureus and Pseudomonas aeruginosa strains isolated from chronic infectious processes, was the focus of the present study. Lipophilic DHF produced important antibacterial synergistic effects in association with ciprofloxacin (CPX) against two biofilm‐forming strains of S. aureus HT1 (FIC=0.21) and P. aeruginosa HT5 (FIC=0.05). Hence, this mixture constitutes an excellent strategy to combat these biofilm‐producing bacteria that overexpress drug efflux pumps as a resistance mechanism. Additionally, a substantial rise in beneficial Lactobacillus biofilm biomass was determined as a very significant finding of this association. Particularly, a non‐pathogenic biofilm increment of 119 % was quantified when the mixture was added to a probiotic L. acidophilus ATCC SD‐5212 culture. A surface activity enhanced in 71 % with respect to untreated L. acidophilus culture was also generated by the DHF and CPX association, and therefore, a glycoprotein synthesis induction mediated by the mixture is discussed. The results obtained could help in the development of new selective antibiotics. From an ecological standpoint, the present study strongly suggests that DHF is a polyfunctional organic molecule produced with a high yield in Senecio punae that exerts a positive impact on a non‐pathogenic plant bacterium L. plantarum CE105.
Evolving practices to improve student performance and efficiency in competency‐based postsecondary technical training
Authors: Cummings Kevin , Stephens Terri , Horne Owen
Published: April 2020

The Davis Technical College pioneered competency‐based vocational/technical education. The institution's early model allowed students freedom to create their own schedule and to move at their own pace, but proved ineffective at encouraging students to be efficient in completing their training. A sharp increase in enrollment in the early 2000s drove the college to revise the model which resulted in increased efficiency and, thus, higher throughput.
Incidence, risk, and treatment of binary restenosis after vertebral artery stenting
Authors: Qiu Zhihua , Liu Jun , Huang Ruiyun , Liu Dezhi , Dai Zheng , Luo Ming , Jiang Yongjun
Published: April 2020

Background

In‐stent restenosis (ISR) is the major concern of vertebral artery stenting (VAS). We aimed to investigate the feasibility and outcome of redo angioplasty for ISR of vertebral artery.

Method

The patients were retrospectively reviewed for the significant ISR (>50%). Redo angioplasty including balloon angioplasty and stenting was performed for symptomatic ISR (>50%) or asymptomatic ISR (≥70%). The clinical follow‐up was performed on the 1, 3, 6, and 12 months and then yearly in the clinic or by telephone. The angiographic follow‐up was performed at 6–12 months after redo angioplasty.

Result

A total of 72 patients had significant ISR and 48 redo angioplasty (92.3%, 48/52) were successfully achieved with 13 located in the V4 and 35 in the ostium of vertebral artery. Twenty‐six lesions were implanted by the second stent and the others received balloon angioplasty. No stroke or transient ischemic attack (TIA) occurred in the perioperative time. One patient died 2 months after redo angioplasty due to nonstroke cause. Redo angioplasty nonsignificantly decreased the stroke or TIA compared with medical treatment. Sixteen patients developed the binary restenosis, which was lower in the patients receiving stent implantation than balloon angioplasty.

Conclusion

Redo angioplasty was a feasible method for the ISR of VAS and redo stenting might be the first choice.
Impact of manual thrombectomy on microvascular obstruction in STEMI patients
Authors: Meier David , Fournier Stephane , Masci Pier G. , Eeckhout Eric , Antiochos Panagiotis , Tzimas Georgios , Stoyanov Nikolay , Muenkaew Muenpetch , Monney Pierre , Schwitter Juerg , Muller Olivier , Harbaoui Brahim
Published: April 2020

Objective

To assess the effect of manual thrombectomy (MT) on microvascular obstruction (MVO) using cardiac magnetic resonance (CMR) in ST‐segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).

Methods and results

Three hundred and eighty‐three patients admitted for STEMI and undergoing CMR fulfilled the inclusion criteria and were categorized into two groups (did or did not undergo MT). The two primary endpoints were the occurrence and extent of MVO, analyzed as a categorical variable and as a semicontinuous variable. Among the 383 patients, 49.1% exhibited MVO. Both the incidence of MVO and the median number of segments presenting with MVO were significantly higher in the MT group than in the no‐MT group, (59.5 vs. 38.9%, p < .001) and (1.5 [0;4] vs. 0 [0;2], p < .001). Analysis stratified on coronary thrombus grade showed similar results, only in patients with a high thrombus burden (60.7 vs. 43.5%, p = .004, and 2 [0;4] vs. 0 [0;3], p = .001. When adjusting for baseline differences, MT remained a determinant of MVO occurrence and extent (odds ratio, OR 1.802 [95% confidence interval, CI 1.080–3.009], p = .024) and β = .137, p = .024) in patients with a high thrombus grade.

Conclusion

In STEMI patients, MT was associated with the occurrence and extent of MVO, on CMR, especially in patients with a high thrombus burden.
Core carbo‐mer of an Extended Tetrathiafulvalene: Redox‐Controlled Reversible Conversion to a carbo‐Benzenic Dication
Authors: Listunov Dymytrii , Hammerich Ole , Caballero‐Quintana Irving , Poater Albert , Barthes Cécile , Duhayon Carine , Larsen Mie Højer , Maldonado José‐Luis , Ramos‐Ortiz Gabriel , Nielsen Mogens Brøndsted , Maraval Valérie , Chauvin Remi
Published: April 2020

carbo‐Benzene is an aromatic molecule devised by inserting C2 units within each C−C bond of the benzene molecule. By integrating the corresponding carbo‐quinoid core as bridging unit in a π‐extended tetrathiafulvalene (exTTF), it is shown that a carbo‐benzene ring can be reversibly formed by electrochemical reduction or oxidation. The so‐called carbo‐exTTF molecule was thus experimentally prepared and studied by UV–visible absorption spectroscopy and cyclic voltammetry, as well as by X‐ray crystallography and by scanning tunneling microscopy (STM) on a surface of highly oriented pyrolytic graphite (HOPG). The molecule and its oxidized and reduced forms were subjected to a computational study at the density functional theory (DFT) level, supporting carbo‐aromaticity as a driving force for the formation of the dication, radical cation, and radical anion. By allowing co‐planarity of the dithiolylidene rings and carbo‐quinoidal core, carbo‐exTTFs present a promising new class of redox‐active systems.
Characteristic Boundary Layers for MixedHyperbolic‐ParabolicSystems in One Space Dimension and Applications to theNavier‐StokesandMHDEquations
Authors: Bianchini Stefano , Spinolo Laura V.
Published: April 2020

We provide a detailed analysis of the boundary layers for mixed hyperbolic‐parabolic systems in one space dimension and small amplitude regimes. As an application of our results, we describe the solution of the so‐called boundary Riemann problem recovered as the zero viscosity limit of the physical viscous approximation. In particular, we tackle the so‐calleddoubly characteristiccase, which is considerably more demanding from the technical viewpoint and occurs when the boundary is characteristic for both the mixed hyperbolic‐parabolic system and for the hyperbolic system obtained by neglecting the second‐order terms. Our analysis applies in particular to the compressible Navier‐Stokes and MHD equations in Eulerian coordinates, with both positive and null electrical resistivity. In these cases, the doubly characteristic case occurs when the velocity is close to 0. The analysis extends to nonconservative systems. © 2020 Wiley Periodicals, Inc.
Impact of IgA isoforms on their ability to activate dendritic cells and to prime T cells
Authors: Gayet Rémi , Michaud Eva , Nicoli Francesco , Chanut Blandine , Paul Mireille , Rochereau Nicolas , Guillon Christophe , He Zhiguo , Papagno Laura , Bioley Gilles , Corthesy Blaise , Paul Stéphane
Published: April 2020

Human IgA could be from different isotypes (IgA1/IgA2) and/or isoforms (monomeric, dimeric, or secretory). Monomeric IgA mainly IgA1 are considered as an anti‐inflammatory isotype whereas dimeric/secretory IgA have clearly dual pro‐ and anti‐inflammatory effects. Here, we show that IgA isotypes and isoforms display different binding abilities to FcαRI, Dectin‐1, DC‐SIGN, and CD71 on monocyte‐derived dendritic cells (moDC). We describe that IgA regulate the expression of their own receptors and trigger modulation of moDC maturation. We also demonstrate that dimeric IgA2 and IgA1 induce different inflammatory responses leading to cytotoxic CD8+ T cells activation. moDC stimulation by dimeric IgA2 was followed by a strong pro‐inflammatory effect. Our study highlights differences regarding IgA isotypes and isoforms in the context of DC conditioning. Further investigations are needed on the activation of adaptive immunity by IgA in the context of microbiota/IgA complexes during antibody‐mediated immune selection.
Chemical Stability of α‐Tocopherol in Colloidal Lipid Particles with Various Morphologies
Authors: Schröder Anja , Sprakel Joris , Schroën Karin , Berton‐Carabin Claire C.
Published: April 2020

Colloidal lipid particles (CLPs) are promising encapsulation systems for lipophilic bioactives, such as oil‐soluble antioxidants that are applied in food and pharmaceutical formulations. Currently, there is no clear consensus regarding the relation between particle structure and the chemical stability of such bioactives. Using α‐tocopherol as a model antioxidant, it is shown that emulsifier type (Tween 20 or 40, or sodium caseinate) and lipid composition (tripalmitin, tricaprylin, or combinations thereof) modulated particle morphology and antioxidant stability. The emulsifier affects particle shape, with the polysorbates facilitating tripalmitin crystallization into highly ordered lath‐like particles, and sodium caseinate resulting in less ordered spherical particles. The fastest degradation of α‐tocopherol is observed in tripalmitin‐based CLPs, which may be attributed to its expulsion to the particle surface induced by lipid crystallization. This effect is stronger in CLPs stabilized by Tween 40, which may act as a template for crystallization. This work not only shows how the architecture of CLPs can be controlled through the type of lipid and emulsifier used, but also gives evidence that lipid crystallization does not necessarily protect entrapped lipophilic bioactives, which is an important clue for encapsulation system design.

Practical Applications: Interest in enriching food and pharmaceutical products with lipophilic bioactives such as antioxidants through encapsulation in lipid particles is growing rapidly. This research suggests that for efficient encapsulation, the particle architecture plays an important role; to tailor this, the contribution of both the lipid carrier and the emulsifier needs to be considered.
Morphology does not covary with predicted behavioral correlations of the domestication syndrome in dogs
Authors: Hansen Wheat Christina , van der Bijl Wouter , Wheat Christopher W.
Published: April 2020

Domesticated animals display suites of altered morphological, behavioral, and physiological traits compared to their wild ancestors, a phenomenon known as the domestication syndrome (DS). Because these alterations are observed to co-occur across a wide range of present day domesticates, the traits within the DS are assumed to covary within species and a single developmental mechanism has been hypothesized to cause the observed co-occurrence. However, due to the lack of formal testing it is currently not well-resolved if the traits within DS actually covary. Here, we test the hypothesis that the presence of the classic morphological domestication traits white pigmentation, floppy ears, and curly tails predict the strength of behavioral correlations in support of the DS in 78 dog breeds. Contrary to the expectations of covariation among DS traits, we found that morphological traits did not covary among themselves, nor did they predict the strength of behavioral correlations among dog breeds. Further, the number of morphological traits in a breed did not predict the strength of behavioral correlations. Our results thus contrast with the hypothesis that the DS arises due to a shared underlying mechanism, but more importantly, questions if the morphological traits embedded in the DS are actual domestication traits or postdomestication improvement traits. For dogs, it seems highly likely that strong selection for breed specific morphological traits only happened recently and in relation to breed formation. Present day dogs therefore have limited bearing of the initial selection pressures applied during domestication and we should reevaluate our expectations of the DS accordingly.
Comparative Effectiveness of Entecavir Versus Tenofovir for Preventing Hepatocellular Carcinoma in Patients with Chronic Hepatitis B: A Systematic Review and Meta‐Analysis
Authors: Dave Shravan , Park Sooyoung , Murad M. Hassan , Barnard Abbey , Prokop Larry , Adams Leon A. , Singh Siddharth , Loomba Rohit
Published: April 2020

Background and Aims

Chronic hepatitis B (CHB) can lead to hepatocellular carcinoma (HCC). While both tenofovir disoproxil (TDF) and entecavir (ETV) have been shown to reduce the risk of HCC, their comparative effectiveness is unclear. We estimated the comparative effectiveness of these two agents in reducing the risk of HCC in patients with CHB, through a systematic review and meta‐analysis.

Approach and Results

We searched multiple electronic databases from January 1, 1998, to October 31, 2019, for randomized controlled trials and observational comparative effectiveness studies in adults with CHB treated with ETV compared to TDF, reporting the incidence of HCC (minimum follow‐up 12 months). Primary outcome was incidence of HCC, calculated as incidence rate ratio (IRR) with 95% confidence interval (CI, unadjusted analysis) and hazard ratio (HR) with 95% CI (adjusted analysis, where reported). Of 1,971 records identified, 14 studies (263,947 person‐years) were included for quantitative analysis. On unadjusted meta‐analysis of 14 studies, the risk of HCC was not statistically different between ETV and TDF (IRR, 1.28; 95% CI, 0.99‐1.66). When using available adjusted data (multivariate or propensity‐matched data), the risk of HCC among patients treated with ETV was 27% higher when compared to TDF (seven studies; 95% CI, 1.01‐1.60, P = 0.04). Additional analysis of adjusted data when separately reported among patients with cirrhosis demonstrated an adjusted HR of 0.90 (95% CI, 0.66‐1.23), suggesting no difference between ETV‐treated and TDF‐treated groups. The overall confidence in estimates was very low (observational studies, high heterogeneity).

Conclusions

TDF may be associated with lower risk of HCC when compared to ETV.
Osteoporosis evaluation through full developed speckle imaging
Authors: Amaral Marcello Magri , del‐Valle Matheus , Raele Marcus Paulo , De Pretto Lucas Ramos , Ana Patricia Aparecida
Published: April 2020

Osteoporosis is a disease characterized by bone mineral density reduction, weakening the bone structure. Its diagnosis is performed using ionizing radiation, increasing health risk. Optical techniques are safer, due to non‐ionizing radiation use, but limited to the analyses of bone tissue. This limitation may be circumvented in the oral cavity. In this work we explored the use of laser speckle imaging (LSI) to differentiate the sound and osteoporotic maxilla and mandible bones in an in vitro model. Osteoporosis lesions were simulated with acid attack. The samples were evaluated by optical profilometry and LSI, using a custom software. Two image parameters were evaluated, speckle contrast ration and patches ratio. With the speckle contrast ratio, it was possible to differentiate sound from osteoporotic tissue. From speckle patches ratio it was observed a negative correlation with the roughness parameter. LSI is a promissory technique for assessment of osteoporosis lesions on alveolar bone.
Sialolithiasis: Application parameters for an optimal laser therapy
Authors: Faklaris Ioannis , Bouropoulos Nikolaos , Vainos Nikolaos A.
Published: April 2020

In‐vitro experimental parametric studies of laser ablation using natural sialoliths and artificial stones have been performed toward an efficient laser treatment of sialolithiasis. Surface microstructure and water adsorption become critical for coupling high power pulsed Ho:YAG laser radiation (λ = 2080 nm, τ ∼250 μsec), inducing ablative interactions and stone fragmentation. Results reveal a generic trend, with single pulse laser energy density threshold for sialolith ablative erosion at ∼200 J cm−2 (corresponding to intensity ∼800 kW cm−2) and fragmentation rates reaching ∼1 mm/pulse at ∼2400 J cm−2. This process shows no saturation, suggesting that very high energy density irradiation at low pulse repetition rate is an efficient approach. Such operation facilitates rapid cooling and minimal thermal loading of the oral and maxillofacial area, thus causing negligible adverse effects. The method is expected to contribute to the establishment of an easy and optimal therapeutic protocol for sialolithiasis pathology.
Construction of lncRNA‐associated ceRNA networks to identify prognostic lncRNA biomarkers for glioblastoma
Authors: Liu Zhendong , Wang Xiaoxiong , Yang Guang , Zhong Chen , Zhang Ruotian , Ye Junyi , Zhong Yingqiang , Hu Junlong , Ozal Beylerli , Zhao Shiguang
Published: April 2020

Long noncoding RNAs (lncRNAs) serve as competitive endogenous RNAs (ceRNAs) that play significant regulatory roles in the pathogenesis of tumors. However, the role of lncRNAs, especially the lncRNA‐related ceRNA regulatory network, in glioblastoma (GBM) has not been fully elucidated. The goal of the current study was to construct lncRNA‐microRNA‐mRNA‐related ceRNA networks for further investigation of their mechanism of action in GBM. We downloaded data from The Cancer Genome Atlas (TCGA) and the Gene Expression Omnibus (GEO) databases and identified differential lncRNAs, microRNAs (miRNAs), and messenger RNAs (mRNAs) associated with GBM. A ceRNA network was constructed and analyzed to examine the relationship between lncRNAs and patients’ overall survival. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGGs) were used to analyze the related mRNAs to indirectly explain the mechanism of action of lncRNAs. The potential effective drugs for the treatment of GBM were identified using the connectivity map (CMap). After integrated analysis, we obtained a total of 210 differentially expressed lncRNAs, 90 differentially expressed miRNAs, and 2508 differentially expressed mRNAs (DEmRNAs) from the TCGA and GEO databases. Using these differential genes, we constructed a lncRNA‐associated ceRNA network. Six lncRNAs in the ceRNA network were associated with the overall survival of patients with GBM. Through KEGG analysis, it was found that the DEmRNAs involved in the network are related to cancer‐associated pathways, for instance, mitogen‐activated protein kinase and Ras signaling pathways. CMap analysis revealed four small‐molecule compounds that could be used as drugs for the treatment of GBM. In this study, a multi‐database joint analysis was used to construct a lncRNA‐related ceRNA network to help identify the regulatory functions of lncRNAs in the pathogenesis of GBM.
Dehydration enhances cellular and humoral immunity in a mesic snake community
Authors: Brusch George A. , Mills Anthony M. , Walman Rachel M. , Masuda Garrett , Byeon Andy , DeNardo Dale F. , Stahlschmidt Zachary R.
Published: April 2020

The immunocompetence of a community of free‐living animals can be affected by seasonality, sex, and parasite burden. However, each of these factors is often examined independently. Recent studies have also found that dehydration can enhance aspects of immunocompetence in drought‐adapted species. To explore how all of these factors interact, and their effect on the immune system in mesic‐adapted species, we collected blood samples from a community of free‐ranging snakes in coastal South Carolina, United States, across 2 years. We specifically examined (a) how sex and seasonality influence humoral and cellular immunocompetence and parasite burden, (b) the dynamics among hydration state, parasite burden, and immunocompetence, and (c) whether mesic‐adapted species also show enhanced innate immunity with dehydration. Consistent with previous work on drought‐adapted species, we found that dehydration enhances multiple aspects of humoral immunity in mesic species, and we are the first to report that dehydration also enhances aspects of cellular immunocompetence. Contrary to previous results in other squamates, sex and season did not impact immunocompetence or parasite prevalence. Our results also reveal complex interactions among parasite prevalence, immunocompetence, and hydration state demonstrating that hydration state and parasitism are two ubiquitous factors that should continue to be considered in future studies examining ecoimmunological variation.
Hyperthyroidism and hepatic dysfunction: Report of 17 cases
Authors: Wafa Benothman , Faten Hadjkacem , Mouna Elleuch , Fatma Mnif , Mohamed Abid
Published: April 2020

Aims

Hyperthyroidism has been known to be associated with abnormalities of serum liver chemistry. The objective of our study is to describe clinical, biochemical and therapeutic features of hepatic dysfunction in hyperthyroidism.

Methods and Results

This retrospective study was conducted on patients hospitalized in our endocrinology department over 20 years. We included patients with untreated and noniatrogenic hyperthyroidism among whom biochemical findings noted hepatic dysfunction and excluded those with concomitant liver disease. Our population is composed of 10 men and 7 women. The average age was 41.4 years. The mean serum level of free thyroxine was 83.8 pmol/L. The serum thyrotropin level was below the detection limit in 10/17 cases. Graves' disease was the most frequently found etiology of hyperthyroidism. Fourteen patients had hyperthyroidism's complications. Eleven patients manifested congestive heart failure. Hepatic dysfunction was moderate and severe in eight and two cases, respectively. Fifteen patients had cholestasis, associated with jaundice in five cases. Hepatocellular injury and synthetic liver dysfunction were noted in seven and five cases, respectively. Thyroid peroxidase antibodies were positively correlated with the serum level of bilirubin (ρ = 0.695; P = 0.038). A negative correlation was noted between alanine aminotransferase and left ventricular ejection fraction (ρ = −0.812; P = 0.05). Radioactive iodine was indicated in 15/17 cases. Follow‐up liver tests were performed in 11 cases. They all had normalized hepatic function once euthyroidism restored.

Conclusion

Liver injury in hyperthyroidism is relatively common, ranging from mild to severe. Therefore, patients presenting unexplained hepatic abnormalities require close examination and an evaluation of the thyroid function should be sought.
Clinicopathological features and menin expression of pancreatic neuroendocrine neoplasm associated with multiple endocrine neoplasia type 1
Authors: Sonoda Akari , Yamashita Yo‐ichi , Kondo Tatsuya , Hayashi Hiromitsu , Imai Katsunori , Higashi Takaaki , Yamamura Kensuke , Yamao Takanobu , Hashimoto Daisuke , Baba Hideo
Published: April 2020

Background/Purpose

We examined therapeutic strategies for pancreatic neuroendocrine neoplasm (pNEN) associated with MEN1 (M‐pNEN) by investigating clinicopathological features and menin expression.

Methods

Seventy‐seven patients who underwent resection of pNEN at our department from January 2001 to December 2017 were retrospectively analyzed. Immunohistochemical analysis of menin was performed using resected specimens.

Results

Seven patients (9%) met the diagnostic criteria for MEN1. M‐pNEN had more tumors (P < .01), a higher recurrence rate (P = .028), and higher residual pancreatic recurrence (P < .01) than sporadic pNEN (S‐pNEN). There were no significant differences in tumor size, lymph node metastasis, or World Health Organization grade between the two groups. Reduced menin staining in the tumor nuclei was found in 86% of M‐pNEN; whereas only 34% of S‐pNEN showed decreased nuclear staining. The remainder (66%) showed strong nuclear staining similar to normal islet cells (P = .0071). Furthermore, four patients (57%) with MEN1 had many microadenomas with reduced nuclear menin staining. Overall survival of M‐pNEN patients was significantly better than S‐pNEN patients (P = .049).

Conclusion

M‐pNEN patients tend to develop spatially and temporally multifocal pNENs. However, M‐pNEN patient prognosis is good with repeated surgeries at recurrence. Therefore, minimal resection with strict follow‐up is recommended rather than extensive pancreatic resections for consideration of recurrence in M‐pNEN.
Study on the differences in water vapour characteristics and predictive signals of low‐frequency precipitation in the pre‐flood season of South China between flood and drought years
Authors: Li Liping , Ma Chenyu , Yang Chunyan
Published: April 2020

Using 753 station's precipitation daily data in China and NCEP/NCAR daily reanalysis data from 1980 to 2017, the lead–lag correlations between 10 and 20 days low‐frequency (LF) precipitation and LF water vapour transport are comparatively analysed in the pre‐flood season of South China during typical flood and drought years, and verified using Hybrid Single Particle Lagrangian Integrated Trajectory (HYSPLIT) backward trajectory model. The same features during both the flood and drought years include that, (a) the primary LF water vapour sources are the south side of Lake Baikal, the northern Sea of Japan and the Yellow Sea, the South China Sea and the western Pacific Ocean. (b)The key LF water vapour circulation systems are the Lake Baikal anticyclone (LBAC), the Northeast China cyclone (NECC), the Philippine Sea anticyclone (PSAC) and the South China cyclone (SCC). The different features between the flood and drought years include that, (a) the southern Sea of Japan is another water vapour source and the Australia anticyclone (AAC) is another key LF water vapour circulation system in the flood years. (b) There are two southwest warm water vapour flows and one southeast cross‐equatorial water vapour flow in the flood years, while there is only one southwest warm water vapour flow in the drought years. In addition, most of notable predictive signals start appearing at approximately −4 days in both the flood and drought years. However, there is a difference in the time of occurrence of similar predictive signals, and some predictive signals only appear in the flood years.
Evaluation of the ability of regional climate models and a statistical model to represent the spatial characteristics of extreme precipitation
Authors: Yang Lichao , Franzke Christian L. E. , Fu Zuntao
Published: April 2020

Extreme precipitation is one of the most severe weather hazards which have a significant influence on society, agriculture and ecosystems. The spatial extension and intensity of extreme precipitation events are two important features which need to be quantified for improved flood risk and water resource management. Here, we evaluate how well regional climate models (RCMs) reproduce precipitation extremes with respect to spatial dependency and intensity. We show by using seasonal extreme intensities in Brandenburg‐Berlin, Germany, that some RCMs underestimate the spatial dependence of extremes in summer and overestimate it in winter, compared with an observational‐based data set. Most RCMs significantly underestimate the magnitudes of extremes in summer and overestimate the magnitudes in autumn and winter. A statistical model, based on a max‐stable process, accounting for both the spatial and temporal variability is developed. We show that this model performs better in representing the spatial dependency and intensity characteristics of extreme precipitation compared to the RCMs.
Assessment of the impact of soil moisture on spring surface air temperature over the low‐latitude highlands of China
Authors: Zhao Jingchuan , Pan Wei , Wu Jian , Yang Yali
Published: April 2020

The low‐latitude highlands (LLH) of China are situated in the subtropical southwest China. The spring climatic characteristics of the LLH were previously regarded as being governed by remote sea surface temperature forcing and large‐scale atmospheric circulations. Recent studies qualitatively demonstrated that the LLH is a relatively strong soil moisture (SM)‐surface air temperature (SAT) coupling region in China during spring. In this study, the quantitative spring SM‐SAT coupling (mean of March and April before wet season) is further statistically analysed using two different SM data sources (one reanalysis data set and one land surface assimilation product). The results show that significant negative SM‐SAT feedbacks mainly occur in the western and middle part of the LLH. Over these areas, 10–50% of the total SAT variance could be explained by the SM‐induced negative feedbacks with a feedback parameter of −0.2°C·(standardized SM)−1 to −0.8°C·(standardized SM)−1. Further analyses show that SM negatively impacts Bowen ratio in the western and middle part of the LLH where Bowen ratio positively affects SAT, therefore significant negative SM‐SAT feedbacks occur therein. The potential impact of India–Burma Trough (IBT) on the SM‐SAT coupling is also investigated in this study, the results of which suggest that SM‐SAT coupling and the effects of SM on land surface energy balance may be immune to the influence of the IBT. Furthermore, SM and IBT may comparably affect SAT in the western and middle part of the LLH. This highlights that SM might have prominent effects on the subseasonal predictability of spring SAT over these areas.
Biosafety of Sonography: Survey of Current Knowledge and Practice Patterns in Obstetrics Providers
Authors: Wasickanin Morgan , Lentscher Jessica , Foglia Lisa , Colburn Zachary , Estrada Sarah
Published: April 2020

Objectives

Sonography is routinely performed in obstetrics. For safety purposes, intensity‐output displays are included in all ultrasound machines. There are few studies performed on provider understanding of ultrasound safety. We sought to assess obstetrics providers' level of knowledge on ultrasound biosafety before and after educational intervention.

Methods

This is a cross‐sectional study using survey research to examine the knowledge of obstetrics providers performing sonography. The study included faculty, fellows, and residents in obstetrics and gynecology and family medicine, and certified nurse midwives. After completion of the initial survey, subjects were randomly assigned to 1 of 3 educational interventions. The interventions included reading an article, watching an educational video, or viewing a PowerPoint presentation. After completing the intervention, subjects answered a post‐intervention survey.

Results

A total of 138 responses were received from the initial survey. Fifty‐eight individuals completed the intervention and post‐intervention survey. Across all levels of training and practice, before intervention, 70% of providers indicated that they did not recognize output display standard functions. Of the 58 individuals who completed the intervention and both surveys, all knowledge‐based questions resulted in statistically significant improvements in scores.

Conclusions

Sonography is increasingly used in the obstetric setting, and it is essential that providers and trainees understand the risks of the procedures they perform. Our data suggests a need for improved education on ultrasound safety. Improvement in scores on the post‐intervention knowledge assessment suggests that the educational interventions used may be beneficial in enhancing provider understanding of obstetric ultrasound safety.
Zero‐Degree Endoscopic Visualization of the Frontal Sinus Predicts Improved Topical Irrigation Delivery
Authors: Spielman Daniel B. , Kim Matthew , Overdevest Jonathan , Gudis David A.
Published: April 2020

Objective

Management of chronic frontal rhinosinusitis is challenging with high rates of treatment failure, exacerbated by limitations of topical irrigation delivery. We hypothesize that intraoperative zero‐degree visualization of the frontal sinus predicts improved postoperative irrigation penetration. Extending a Draf IIa frontal sinusotomy with a limited resection of the middle turbinate axilla‐agger nasi complex can allow zero‐degree endoscopic visualization of the frontal sinus. This study investigates the change in frontal sinus irrigation delivery after standard Draf IIa frontal sinusotomy versus further resection to achieve zero‐degree visualization.

Study Design

This is a prospective cohort study conducted in a surgical skills laboratory.

Methods

The extent of irrigant penetration into the frontal sinuses was evaluated in 10 cadaveric frontal sinuses following Draf IIa sinusotomy using a standardized trephine visualization model. Irrigant penetration was assessed by three blinded reviewers using the following scale: 0 = irrigation restricted to nasal cavity; 1 = irrigation reaches frontal recess; 2 = irrigation reaches frontal sinus proper; 3 = irrigation fills entire frontal sinus. These results were compared to irrigation after achieving zero‐degree endoscopic visualization by performing limited resection of the middle turbinate axilla‐agger nasi complex.

Results

Irrigant penetration following standard Draf IIa frontal sinusotomy improved after the axilla‐agger nasi complex was resected to achieve zero‐degree endoscopic visualization (median score 2 [interquartile range: 1–2] vs. 3 [interquartile range: 2–3], P < .01).

Conclusion

This study demonstrates improved penetration of frontal sinus irrigation following limited resection of the middle turbinate axilla‐agger nasi complex to achieve zero‐degree endoscopic visualization of the frontal sinus as compared to standard Draf IIa frontal sinusotomy.

Level of Evidence

N/A Laryngoscope, 131:250–254, 2021
Tracheotomy Timing and Outcomes in the Critically Ill: Complexity and Opportunities for Progress
Authors: Altman Kenneth W. , Ha Tu‐Anh N. , Dorai Vaithianathan K. , Mankidy Babith J. , Zhu Huirong
Published: April 2020

Objectives/Hypothesis

To characterize the effects of tracheotomy timing at our institution on intensive care unit (ICU) length of stay (LOS) and overall hospital LOS.

Study Design

Retrospective cohort study.

Methods

A retrospective study was performed at a tertiary care medical center for patients undergoing tracheotomy over 2.5 years from January 1, 2016 through June 30, 2018. Demographics, survival, duration of endotracheal intubation, timing of tracheotomy, and ICU and overall hospital LOS were assessed. Tracheotomy was considered early (ET) if it was performed by day 7 of mechanical ventilation and late (LT) thereafter. Readmission, mortality, and costs were also tabulated for each aggregate group. Nonparametric statistics were used to compare results.

Results

Of the 536 patients included in the analysis, 160 received tracheotomy early and 376 late. Differences between age and sex were not statistically significant. Duration of total ICU stay was shortened by 65% (12.84 ± 17.69 days vs. 38.49 ± 26.61 days; P < .0001), and length of overall hospital course was reduced by 54% (22.71 ± 26.65 days vs. 50.37 ± 34.20 days; P < .0001) in the early tracheotomy group. Observed/expected (O/E) values standardized results to case mix index and revealed LOS of 1.5 for ET and 2.5 for LT, and mortality of 0.76 for ET and 1.25 for LT, and comparable readmissions of both groups.

Conclusions

Early tracheotomy in ICU patients is associated with earlier ICU discharge, decreased length of overall hospital stay, and lower mortality when controlling for case mix index. Opportunities exist to optimize patient outcomes and O/E performance.

Level of Evidence

4 Laryngoscope, 131:282–287, 2021
Spatiotemporal characteristics of land degradation in the Fuxian Lake Basin, China: Past and future
Authors: Yang Chao , Li Qingquan , Chen Junyi , Wang Junjie , Shi Tiezhu , Hu Zhongwen , Ding Kai , Wang Guihua , Wu Guofeng
Published: April 2020

Fuxian Lake is one of the most important freshwater supply lakes of China; however, its water quality is affected by land degradation in its basin. This study aimed to monitor and simulate the spatiotemporal characteristics of land degradation in Fuxian Lake Basin. A comprehensive land degradation index (LDI), which integrates the indices for land use/land cover (LULC), vegetation coverage (VC), water loss and soil erosion (WLSE), wind erosion (WE) and soil moisture content (SMC), was proposed to describe the spatiotemporal characteristics of land degradation in 1990–2015; a CA‐Markov model was used to simulate and forecast the land degradation in 2020 and 2025; and the mechanisms behind land degradation were analyzed. The results showed that: (a) the degree of land degradation from 1990 to 2015 generally decreased, the most severe years of land degradation were 1990, 2000, and 2005, and the total area of degraded land remained steady at around 250 km2 from 2005 to 2015; (b) the land degradation in different years was primarily moderate, with few severe or extreme degradation; (c) the simulation showed land degradation would remain relatively stable in 2020 and 2025, and the degraded area would fluctuate slightly compared with that in 2015; and (d) the land degradation in this region was driven by both human factors and natural drivers. Therefore, some land degradation control measures should be set in advance for protecting this important supply area for freshwater.
Technical Note: Comprehensive performance tests of the first clinical real‐time motion tracking and compensation system using MLC and jaws
Authors: Chen Guang‐Pei , Tai An , Keiper Timothy D. , Lim Sara , Li X. Allen
Published: April 2020

Purpose

To evaluate the performance of the first clinical real‐time motion tracking and compensation system using multileaf collimator (MLC) and jaws during helical tomotherapy delivery.

Methods

Appropriate mechanical and dosimetry tests were performed on the first clinical real‐time motion tracking system (Synchrony on Radixact, Accuray Inc) recently installed in our institution. kV radiography dose was measured by CTDIw using a pencil chamber. Changes of beam characteristics with jaw offset and MLC leaf shift were evaluated. Various dosimeters and phantoms including A1SL ion chamber (Standard Imaging), Gafchromic EBT3 films (Ashland), TomoPhantom (Med Cal), ArcCheck (Sun Nuclear), Delta4 (ScandiDos), with fiducial or high contrast inserts, placed on two dynamical motion platforms (CIRS dynamic motion‐CIRS, Hexamotion‐ScandiDos), were used to assess the dosimetric accuracy of the available Synchrony modalities: fiducial tracking with nonrespiratory motion (FNR), fiducial tracking with respiratory modeling (FR), and fiducial free (e.g., lung tumor tracking) with respiratory modeling (FFR). Motion detection accuracy of a tracking target, defined as the difference between the predicted and instructed target positions, was evaluated with the root mean square (RMS). The dose accuracy of motion compensation was evaluated by verifying the dose output constancy and by comparing measured and planned (predicted) three‐dimensional (3D) dose distributions based on gamma analysis.

Results

The measured CTDIw for a single radiograph with a 120 kVp and 1.6 mAs protocol was 0.084 mGy, implying a low imaging dose of 8.4 mGy for a typical Synchrony motion tracking fraction with 100 radiographs. The dosimetric effect of the jaw swing or MLC leaf shift was minimal on depth dose (<0.5%) and was <2% on both beam profile width and output for typical motions. The motion detection accuracies, that is, RMS, were 0.84, 1.13, and 0.48 mm for FNR, FR, and FFR, respectively, well within the 1.5 mm recommended tolerance. Dose constancy with Synchrony was found to be within 2%. The gamma passing rates of 3D dose measurements for a variety of Synchrony plans were well within the acceptable level.

Conclusions

The motion tracking and compensation using kV radiography, MLC shifting, and jaw swing during helical tomotherapy delivery was tested to be mechanically and dosimetrically accurate for clinical use.
Practical guidance for managing electromyography requests and testing during the COVID‐19 pandemic
Authors: Kassardjian Charles D. , Desai Urvi , Narayanaswami Pushpa ,   the AANEM Quality and Patient Safety Committee of the AANEM
Published: April 2020

The COVID‐19 pandemic has necessitated cancelation of elective or nonurgent contact with the healthcare system, including nonurgent nerve conduction studies and electromyography (electrodiagnostic [EDX] studies). The definitions of elective and nonurgent are physician judgments, and often are not straightforward. Clinical care must be provided to help our patients in a timely manner, while keeping them, healthcare personnel, and the community safe. Benefit/risk stratification is an important part of this process. We have stratified EDX studies into three categories: Urgent, Non‐urgent, and Possibly Urgent, in an effort to help clinicians triage these referrals. For each category, we provide a rationale and some examples. However, each referral must be reviewed on a case‐by‐case basis, and the clinical situation will evolve over time, necessitating flexibility in managing EDX triaging. Engaging the referring clinician and, at times, the patient, may be useful in the triage process.
Congenital neutropenia with variable clinical presentation in novel mutation of the SRP54 gene
Authors: Goldberg Lior , Simon Amos J. , Rechavi Gideon , Lev Atar , Barel Ortal , Kunik Vered , Toren Amos , Schiby Ginette , Tamary Hannah , Steinberg‐Shemer Orna , Somech Raz
Published: April 2020

Background

The SRP54 (signal recognition protein 54) is a conserved component of the ribonucleoprotein complex that mediates cotranslational targeting and translocation of proteins to the endoplasmic reticulum. In 2017, mutations in the gene have been described as a cause of congenital neutropenia with or without pancreatic insufficiency, and since then, only limited cases were added to the literature.

Methods

Two patients with neutropenia underwent hematological, immunological, and genetic work‐up, including lymphocyte phenotyping, immunoglobulins, and complement levels, antineutrophil and antinuclear antibodies, bone marrow FISH panel for myelodysplastic syndrome, whole‐exome sequencing, and in silico proteomic analysis.

Results

Clinical findings in the two families revealed a wide spectrum of immunological and clinical manifestations, ranging from mild asymptomatic neutropenia during febrile illnesses to severe neutropenia and life‐threatening infection requiring leg amputation. Immunological and hematological work‐up showed isolated neutropenia with normal lymphocyte subpopulations, immunoglobulin and complement levels, and negative autoimmune tests. Bone marrow aspirations showed variability ranging from normal myelopoiesis to myeloid maturation arrest at the promyelocytic stage, with normal FISH panel for myelodysplastic syndrome. Genetic analysis identified a novel, de novo, in‐frame deletion in the SRP54 gene, c.342‐344delAAC, p.T115del. In silico proteomic analysis suggested impaired SRP54 protein function due to reduced GTP activity and stability.

Conclusions

We describe congenital neutropenia with variable clinical presentation in novel mutation of the SRP54 gene.
Physical activity for children undergoing acute cancer treatment: A qualitative study of parental perspectives
Authors: Grimshaw Sarah L. , Taylor Nicholas F. , Mechinaud Francoise , Conyers Rachel , Shields Nora
Published: April 2020

Background

Little is known about how to facilitate participation in physical activity among children receiving acute cancer treatment.

Objective

To understand the parental perspectives on physical activity for children during acute cancer treatment and explore strategies to overcome physical inactivity.

Methods

A qualitative study was completed. Data were collected via semistructured interviews with parents of children (aged 4‐18 years) who were in their first nine months of cancer treatment. Data were analyzed thematically.

Results

Twenty parents were interviewed. A childhood cancer diagnosis and subsequent treatment were described as setting in motion a spiral of physical inactivity. Parents identified movement restrictions as a result of commencing treatment and the hospital environment as factors initiating this decline. Parents described the subsequent impact of movement restrictions on their child over time including loss of independence, isolation, and low motivation. These three consequences further contributed to an inability and unwillingness to be physically active. Parents responded in a variety of ways to their child's inactivity, and many were motivated to overcome the barriers to physical activity yet exhibited a reduced capacity to do so. Suggested intervention strategies highlighted the need for comprehensive support from the organization providing treatment.

Conclusions

Reasons for reduced physical activity in children receiving acute treatment for cancer are complex and multifactorial. Inactivity cannot be addressed by children and parents alone but requires support from the oncology team through changes to the environment, services, and policies to promote physical activity. These findings may be used to inform targeted, effective, and feasible physical activity interventions.
Burnout in pediatric hematology oncology fellows: Results of a cross‐sectional survey
Authors: Moerdler Scott , Li Yunhui , Weng Shicheng , Kesselheim Jennifer
Published: April 2020

Burnout is a significant problem in the medical community, including among pediatric hematology/oncology (PHO) faculty. However, the prevalence of burnout, its associated risk factors, and outcomes within PHO fellows are unknown. We present the results of a cross‐sectional study of PHO fellows from 21 training programs. A total of 45/115 fellows (39.1%) met criteria for high level of burnout. Fellows who met criteria for high burnout also demonstrated poor outcomes including decreased empowerment, increased doctor‐centered care, decreased self‐assessed humanism, and decreased satisfaction with training. Further longitudinal investigation is needed to better understand burnout and the causative factors affecting PHO fellows.
Fetal kidney charts of a novel measurement of the renal parenchymal thickness to evaluate fetal kidney growth and potential function
Authors: Brennan Sonja , Kandasamy Yogavijayan , Rudd Donna , Schneider Michal , Watson David
Published: April 2020

Objective

The objective of this study was to develop new standard growth charts for fetal renal parenchymal thickness, length, and volume to define normal ranges for use in clinical practice and to assess the reliability of these measurements.

Methods

This was a prospective, longitudinal study of 72 low‐risk singleton pregnancies undergoing serial ultrasound examinations at least every four weeks. Multiple renal measurements were performed on both kidneys at each scan. The renal parenchymal thickness was measured in the mid‐sagittal plane. Standard charts were developed and the intra and interobserver reliability for the renal measurements was analysed.

Results

Standard charts were developed for fetal renal parenchymal thickness, length, and volume.

Conclusion

We present novel charts, which demonstrate the growth of the fetal renal parenchyma during pregnancy. They will be useful in clinical practice to identify any alterations from these normal ranges, which may be an important criterion for assisting prenatal diagnosis of renal pathologies and future studies in the prediction of kidney function.