bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of serum uric acid with thyroid function in health check-up participants
Authors: Wang Xiao-Jun , Qian Xi-Wen , Zhang Xu , Han Li , Zheng Yu-Qi , Wu Tao , Qin Guo-You , Ye Zhi-Bin , Xiao Jing
Published: May 2020

Background

The relationship of uric acid (UA) with the thyroid function among healthy individuals remains unclear. We aimed to examine the relationship between UA contents and thyroid hormone levels in healthy Chinese individuals.

Methods

This was a cross-sectional study of 1186 Chinese adults (736 men and 450 women) who underwent a health check-up at the Huadong Hospital Affiliated to Fudan University (Shanghai, China) between January 1, 2010 and July 31, 2018. Clinical and thyroid hormone levels were compared in different UA groups (in male and menopause women groups, MG1: UA < 5 mg/dL; MG2: 5 mg/dL ≤ UA< 7 mg/dL; and MG3: UA ≥ 7 mg/dL; in female groups, FG1 to FG3 represent the UA levels of <4 mg/dL, 4 mg/dL ≤ UA< 6 mg/dL, and ≥6 mg/dL, respectively). In addition, natural cubic spline regression, together with Pearson correlation analysis, was performed in investigating the correlation of UA with thyroid hormones.

Results

After adjusting for confounding factors, low levels of UA (for males, UA < 5.30 mg/dL; for females, UA < 4.05 mg/dL) were negatively correlated with free triiodothyronine (FT3) both in men and women. UA levels between 4.83 and 6.06 mg/dL may act to protect FT3 in women, while UA levels between 6.39 and 7.09 mg/dL may protect FT3 in men. FT3 levels of low-range UA group reduced compared with mid-range UA and the high-range UA groups in both men and women.

Conclusions

Our results provide epidemiologic evidence to support the negative correlation between low UA contents and FT3 in the Chinese Han population, suggesting that the reduced UA contents may serve as the risk factor to predict poor thyroid function in Chinese individuals.
Transverse vs. parasagittal in-plane approaches in ultrasound-guided paravertebral block using a microconvex probe
Authors: Fujii Tasuku , Shibata Yasuyuki , Shinya Sonoe , Nishiwaki Kimitoshi
Published: May 2020

BACKGROUND

Several approaches have been proposed for ultrasound-guided thoracic paravertebral block, but the best approach remains unclear.

OBJECTIVE

We compared two ultrasound-guided in-plane approaches using a microconvex probe, transverse and parasagittal. We assessed whether either approach would facilitate successful catheter placement in the paravertebral space.

DESIGN

Randomised controlled trial.

SETTING

University hospital, July 2015 to March 2016.

PATIENTS

Sixty patients scheduled to undergo thoracotomy were randomly allocated into two groups.

INTERVENTIONS

A microconvex probe was placed transversely between adjacent ribs (transverse) or sagittally between adjacent transverse processes (parasagittal). When the Tuohy needle reached the paravertebral space, a catheter was inserted to a depth of 4 cm. Then, 0.5-ml radiocontrast was injected through the catheter under fluoroscopy.

MAIN OUTCOME MEASURES

The primary outcome was successful catheter placement in the paravertebral space; secondary outcomes were 0 to 100 mm visual analogue scale pain score and morphine consumption in the first 24 h.

RESULTS

All patients received the allocated paravertebral block. Correct catheter placement occurred in 23 (77%) and 24 patients (80%) using the transverse (n=30) and parasagittal approaches (n=30), respectively (P = 1.00). Five patients were excluded due to changes in surgical procedure. Postoperative pain, represented by median [IQR] visual analogue scale score, was 19.5 [12 to 25] at rest and 55 [44 to 77] on movement with the transverse approach (n=28) vs. 22 [12 to 33.5] at rest and 59 [41.5 to 75] on movement with the parasagittal approach (n=27) (P = 0.57 at rest, P = 0.76 on movement). Median morphine consumption was 11.5 [5 to 21] and 11 [5 to 18] mg in the transverse and parasagittal approaches, respectively (P = 0.99).

CONCLUSION

There were no clinically significant differences between approaches for continuous ultrasound-guided thoracic paravertebral block using a microconvex probe, and both approaches achieved a high rate of correct catheter placement.

TRIAL REGISTRATION

UMIN Clinical Trials Registry identifier: UMIN000015988.
Diagnosing endometriosis before laparoscopy: radiologic tools to evaluate the disease
Authors: Tavcar Jovana , Loring Megan , Movilla Peter R. , Clark Nisse V.
Published: May 2020

Purpose of review

The current gold standard for diagnosing endometriosis is laparoscopy with tissue biopsy. This review presents new evidence regarding advanced imaging for more optimal clinical assessment and preoperative evaluation for endometriosis.

Recent findings

A systematic approach to the imaging evaluation of endometriosis using transvaginal ultrasound and magnetic resonance imaging has been proposed by expert groups and societies. Evidence suggests that new imaging techniques improve the accuracy of clinical diagnosis and facilitate improved preoperative mapping of endometriotic lesions.

The clinical diagnosis of endometriosis, including new structured imaging protocols and techniques, is paramount in an initial evaluation. If surgery is indicated, clinical examination and imaging should provide sufficient information to anticipate the extent of surgery, properly counsel the patient, and when appropriate, refer to a minimally invasive gynecologic surgery specialist or assemble a multidisciplinary team.
Hypertension in obesity
Authors: Mendoza Michael F. , Kachur Sergey M. , Lavie Carl J.
Published: May 2020

Purpose of review

The obesity epidemic is progressively affecting majority of individuals worldwide leading to many adverse metabolic and cardiovascular outcomes. Increasingly concerning among them is obesity hypertension (HTN). In this review, we delve into the physiology and therapeutic options in obesity HTN as we discuss the implications of obesity HTN on society.

Recent findings

Obesity is the most common cause of primary HTN and is directly proportional to increases BMI. The significance of adiposity in obesity HTN centers on humoral mechanisms via stimulation of the renal-angiotensin system, leptin activity, sympathetic overdrive, and proinflammatory processes that potentiate vascular remodeling, which results in a higher incidence of the progression of many known serious cardiovascular diseases. Although lifestyle and medical therapies have been recommended for obesity and its sequelae, continued global progression of this disease has driven the development of newer therapies such as carotid baroreflex activation therapy, renal denervation, and selective leptin receptor antagonism.

The pathophysiology of obesity HTN has not yet been fully elucidated despite it being one of the oldest known diseases to mankind. Major efforts to understand obesity HTN endures, paving opportunities for newer and possibly superior therapeutic options
Trabecular microbypass stent implantation in pseudoexfoliative glaucoma: long-term results
Authors: Ferguson Tanner J. , Swan Russell J. , Bleeker Adam , Dockter Zachary , Karpuk Kayla L. , Schweitzer Justin , Ibach Mitch , Berdahl John P.
Published: May 2020

Purpose:

To evaluate the long-term safety and efficacy of an iStent trabecular microbypass stent in combination with cataract surgery in pseudoexfoliative glaucoma (PXG).

Setting:

Private practice, Sioux Falls, South Dakota, USA.

Design:

Retrospective, consecutive case series.

Methods:

Eyes with a preoperative diagnosis of PXG implanted with a single iStent trabecular microbypass stent with concomitant cataract surgery were included. Performance outcome measures included intraocular pressure (IOP) and number of glaucoma medications. Safety outcomes included intraoperative or postoperative complications and the need for secondary procedures.

Results:

The series included 117 eyes. IOP was reduced by 25% to 15.3 ± 3.7 mm Hg at 5 years postoperatively from 20.5 ± 6.6 mm Hg at baseline. The statistically significant (P < .01) 36% reduction in medication use through 36 months was not sustained, and medication use was unchanged from baseline (1.4 ± 1.0) at 5 years postoperatively (1.3 ± 1.1) (P > .05). At 5 years, 52% of eyes had an IOP of 15 mm Hg or lesser, increased from 22% at baseline. There were no severe postoperative complications; 5 eyes (4%) underwent an additional glaucoma procedure.

Conclusions:

Implantation of a trabecular microbypass stent with concomitant cataract surgery provided a sustained reduction in IOP up to 5 years postoperatively. The long-term safety profile of the device in this population was excellent with a low rate of postoperative IOP spikes and low percentage of eyes undergoing a secondary procedure.
Cranberry supplementation as a cause of major intraoperative bleeding during vascular surgery due to aspirin-like platelet inhibition
Authors: Moroi Morgan K. , Loloi Justin , Songdej Natthapol
Published: May 2020

We report severe excessive bleeding at initiation of vascular surgery in a 74-year-old woman with thoracoabdominal aortic aneurysm undergoing thoracic endovascular aortic repair. After extensive workup, bleeding cause was determined to be an aspirin-like effect from supplemental cranberry intake. After asking the patient to stop cranberry consumption, the aspirin-like effect ceased, and the patient underwent successful thoracic endovascular aortic repair. Cranberry consumption may create an aspirin-like effect that increases risk of bleeding. Providers should be aware of potential adverse effects of cranberries on platelet function and consider inquiring about supplement use in the perioperative period.
Standard and derived rotational thromboelastometry parameters for prediction of disseminated intravascular coagulation in septic patients
Authors: Scarlatescu Ecaterina , White Nathan J. , Tomescu Dana R.
Published: May 2020

Waiting for lab tests results for the calculation of disseminated intravascular coagulation (DIC) scores leads to unwanted delays in diagnosis. The use of rotational thromboelastometry (ROTEM) for this purpose would allow for a more rapid DIC diagnosis at the bedside. The aim of this study was to assess the ability of standard ROTEM parameters and calculated parameters from the ROTEM velocity curve to predict DIC. The retrospective observational study included 97 septic patients. Japanese Association for Acute Medicine score was used for DIC diagnosis and whole-blood ROTEM was performed at study inclusion. Univariate analysis revealed delayed coagulation initiation and propagation and reduced clot firmness and maximum elasticity in DIC patients compared with patients without DIC. To adjust for confounders, multivariable logistic regression models were created and fibrinogen levels, prothrombin time and ROTEM parameters such as maximum clot firmness, maximum clot elasticity (MCE) and total thrombus formation [area under the curve (AUC)] were identified as significant predictors of DIC. According to receiver operating characteristics analysis, MCE and total thrombus formation (AUC) were the most useful ROTEM parameters for DIC prediction. MCE less than 158 (73% sensitive, 80% specific) and AUC less than 6175 mm × 100 (73% sensitive, 76% specific) predicted DIC in septic patients. Both standard and derived ROTEM parameters are useful for rapid DIC prediction in septic patients, allowing the timely identification of patients with higher mortality risk which might benefit from additional therapies. Further studies are needed to assess the clinical relevance of these findings.
Predictors, incidence, and prognostic significance of PR interval prolongation in patients with ST-segment elevation myocardial infarction
Authors: Xue Yuzhou , Shen Jian , Liu Gang , Zhou Qi , Zhou Wei , Luo Suxin
Published: May 2020

Object

The relationship between PR interval prolongation during hospitalization and long-term prognosis in patients with acute ST-segment elevation myocardial infarction (STEMI) has not been elucidated. This study aimed to evaluate the prevalence, predictors, and outcomes of PR interval prolongation in a prospective cohort of patients with post-STEMI.

Methods

The values of ionized calcium were calculated as the mean level of two measurements during hospitalization. Variables from univariate analysis associated with PR interval prolongation were included in a multivariable logistic regression analysis using forward stepwise elimination to determine PR prolongation predictors.

Results

Among 915 patients with STEMI consecutively enrolled in this study, 87 (9.5%) patients developed first-degree atrioventricular block (PR interval prolongation >200 ms]. Lower calcium values during hospitalization, higher age, and male sex were strongly correlated with the development of PR interval prolongation. During the median follow-up period of 31 months (interquartile range: 22–39 months), 64 all-cause deaths (endpoint) were registered. After adjusting for confounding covariates via Cox regression analyses, PR interval prolongation was independently associated with poorer outcomes (hazard ratio 5.37; 95% confidence interval, 1.85–15.62; P = 0.002).

Conclusion

Prolongation of the PR interval is an independent predictor of long-term mortality in patients with STEMI during hospitalization.
Transjugular intrahepatic portosystemic shunt versus endoscopic therapy for prevention of variceal rebleeding in patients with hepatocellular carcinoma meeting the Milan criteria
Authors: Luo Junyang , Li Mingan , Wu Chun , Zhu Duo , Wang Haofan , Huang Mingsheng , Jiang Zaibo
Published: May 2020

Objective

Transjugular intrahepatic portosystemic shunt (TIPS) and endoscopic therapy (ET) have been recommended to prevent variceal rebleeding due to cirrhotic portal hypertension. However, which one is better for patients with hepatocellular carcinoma (HCC) remains controversial. Hence, we aimed to compare the clinical outcomes of these two treatments for these subpopulation.

Methods

This retrospective study was approved by the institutional review board. The data of 98 consecutive patients with HCC meeting the Milan criteria (mean age 54.1 years) who had received TIPS placement (34 patients) or ET (64 patients) between June 2010 and December 2017 were reviewed. The clinical outcomes were evaluated and were calculated by the Kaplan–Meier method and compared by using the log-rank test. A matched cohort composed of 34 patients from each group was selected after adjustment with propensity score matching to verify the robustness of the results.

Results

The median follow-up time was 33.1 months. The rebleeding rate was significantly lower in TIPS group (P = 0.016). A matched cohort composed of 34 patients from each group after adjustment with propensity score matching showed that TIPS reduced the risk of rebleeding (P = 0.030) without increasing long-term overt hepatic encephalopathy (P = 0.151), while there was no significant difference in overall liver transplant-free survival (P = 0.120). Thereafter, 25 patients in TIPS group (73.5%) and 42 patients in ET group (65.6%) received locoregional therapies for HCC (P = 0.431).

Conclusion

TIPS reduced the risk of rebleeding without improving survival. Locoregional therapies can be performed safely to manage HCC after sufficient prevention of variceal rebleeding.
Reducing prophylactic antibiotics use in laparoscopic cholecystectomy and liver resections
Authors: Liew Yi Xin , Chian David M. , Koh Ye-Xin , Chlebicki Maciej Piotr
Published: May 2020

Laparoscopic cholecystectomy and liver resections are commonly performed surgical procedures which require no or less (cefazolin only) antimicrobial prophylaxis respectively in light of recent evidence. To assess the validity of this data in the local context and increase compliance to such regimens, a multi-modal intervention including, changes to hospital antibiotic prophylaxis guidelines, departmental emphasis, information technology aids (involving the creation of order templates within our electronic medical system) and physical aids (in the form of cards given to junior staff) was implemented. Results comparing a 6-month preintervention period (January 2018 to June 2018) showed no significant increase in 30-day hospital readmission rates (P = 0.8, 0.7) despite a significant rise in compliance (P = 0.04, 0.03) in laparoscopic cholecystectomy (n = 371) and liver resections respectively (n = 193) compared to the 6-month intervention period (July 2018 to December 2018). Additionally, prescription behavior for liver resections was more varied than that of laparoscopic cholecystectomy likely due to the different anatomical considerations in the prior. In conclusion, removal of antibiotic prophylaxis in laparoscopic cholecystectomy and use of cefazolin only in liver resection is not associated with any significant increase in 30-day hospital readmission rates.
Treatment of neurogenic lower urinary tract symptoms: main contributions from 2018 and 2019
Authors: Abreu-Mendes Pedro , Cruz Francisco , Martins-Silva Carlos
Published: May 2020

Purpose of review

This review aims to update the studies involving the treatment of lower urinary tract symptoms (LUTS) in neurogenic patients, published in the last two years.

Recent findings

Treatment of neurogenic LUTS (NLUTS) patients with β3 adrenoreceptor agonists was investigated in real-life conditions. A randomized controlled trial compared the efficacy of antimuscarinics versus onabotulinum toxin A in neurogenic patients. The use of desmopressin to treat nocturia in multiple sclerosis patients is also reported. The long-term treatment with BontA efficacy, its discontinuation, and possible strategies to maintain patients on treatment were also evaluated. Sacral neuromodulation and tibial nerve stimulation are continuously being evaluated in neurogenic patients, especially in the last years.

The management of urinary tract infections and vesical lithiasis, two common complications in NLUTS patients, and the management of both these patients was assessed in clinical trials.

A trial evaluating the use of the anti-Nogo-A antibody after a spinal cord injury to facilitate neuronal rewiring and prevent or improve NLUTS was reported for the first time.
Outcomes of Local Radiation and Intensified Combined Intrathecal Methotrexate and High-dose Chemotherapy for Intracranial Germ Cell Tumors
Authors: Yamasaki Kai , Okada Keiko , Soejima Toshinori , Kosaka Yoshiyuki , Nagashima Tatsuya , Hara Junichi
Published: May 2020

Many attempts to reduce radiation fields for intracranial germ cell tumors (iGCTs) remain unsuccessful. To assess the possibility of reduction, we analyzed registry data of 57 patients who mostly underwent local irradiation for iGCTs between 1997 and 2006. The recommended treatment for pure germinomas (PGNs) included 3 courses of cisplatin and etoposide followed by 24 Gy local irradiation. Intensified chemotherapy using a combination of cyclophosphamide and intrathecal methotrexate was recommended for human chorionic gonadotropin-producing germinomas (hCG-GNs) and nongerminomatous germ cell tumors (NGGCTs); both received 50.4 Gy local irradiation. High-dose chemotherapy was only administered for residual NGGCTs after chemoradiotherapy. Craniospinal irradiation was recommended only in metastatic cases. During the median follow-up of 114.8 months, 8 of 9 relapses from 24 PGNs occurred outside irradiation fields, with a 5-year progression-free survival (5-year PFS) of 75%±8.8%. Conversely, no recurrences occurred from 11 hCG-GNs, with a 5-year PFS of 100%. Eleven of 22 patients with NGGCTs received high-dose chemotherapy; the 5-year PFS was 81.3%±8.4%; 2 of 3 relapses occurred in the spinal cord. Thus, local irradiation for PGNs was insufficient without treatment intensification. The introduction of intensified chemotherapy improved outcomes of both patients with hCG-GNs and NGGCTs. However, the contributions of either modality remained unclear.
The Methods of Reserving Integrity of Seriously Damaged Cavernous Carotid in the Management of Traumatic Carotid-Cavernous Fistula
Authors: Zhan Rucai , Jing Liu , Fu Maowu , Xin Tao , Wei Lin , Wang Jianjun , Guo Jian
Published: May 2020

Background:

The A type of carotid–cavernous fistulas (CCF-A) is characterized by direct communication between the internal carotid artery (ICA) with a very low incidence. But it severely endangers the health and even the life of patients, not only causes insufferable symptoms but also can induce fatal epistaxis, intracranial hemorrhages or even death. So, this disease needs therapy as early as possible. The ideal treatment for CCF-A is to exclude the fistula from circulation, preserving the carotid flow. Interventional therapy has become the chief method for CCF-A especially in recent years, but the prerequisite, that the microwire or and microcatheter in ICA can be navigated across the orificium fistulae and into distal ICA, is necessary. Otherwise it is difficult to reserve the communication of seriously injured ICA and the orificium fistulae could simultaneously be reliably closed. The authors used a series of new and novel CCF with good result.

Methods:

The authors experienced a patient of TCCF-A, whose ICA was seriously injured and customary method failed in the first treatment because the microwire and microcatheter could not cross the segment of orificium fistulae. Then, the authors applied military (outflanking techniques, aerial refueling, and retrograde navigation) to manage this case.

Results:

Finally, the CCF-A was completely cured and the parent artery was perfect preserved without any complication.

Conclusions:

For patients of TCCF-A with severe ICA injury, these strategies may be very important for some patients whose affected ICA cannot tolerant to be blocked.
Multiplane Facelift Following Facial Bone Contouring for Enhanced Mobilization and Rejuvenation
Authors: Yoo Han-Su , Byun Il Hwan , Ahn Deok Ki , Lee Joo Hong , Yoo Won Min
Published: May 2020

Introduction:

The aging process is inevitable in life, and the social demand for rejuvenation increases by year. The face acquires both soft tissue and skeletal changes through aging, and correcting only one side has limits in natural rejuvenation. Thus, the authors combined multiplane facelift with whole-facial bone contouring for maximal results.

Methods:

From March 2017 to February 2019, a total of 22 patients received multiplane facelift following facial bone contouring in our institute. The authors retrospectively reviewed information on demographics, surgical procedure, complications, and satisfaction. Under general anesthesia, the patient received reduction malarplasty, genioplasty, and mandible anglectomy via intraoral incisions, and multiplane facelift through retrotragal and postauricular incisions.

Results:

All patients were females with the mean age of 42.86 ± 9.55. The mean operation time was 296.39 ± 31.87 minutes and the mean follow-up period was 12.59 ± 6.77 months. Few complications included hematoma and unfavorable scars. More than 95% of the patients were very satisfactory with the result.

Conclusion:

In this study, the authors present our novel procedure of combining whole-facial bone contouring and multiplane facelift. This technique can reestablish the facial skeletal foundation and effectively lift soft tissues in various vectors with longevity and safety.
Platysmal Lineaments of the Neck With Emphasis on Endoscopic Endocrine Surgery
Authors: Zhang Daqi , Sun Hui , Tufano Ralph P. , Pontin Alessandro , Dionigi Gianlorenzo , Kim Hoon Yub
Published: May 2020

Background:

In endoscopic neck endocrine surgery, the subplatysmal plane is an anatomic key structure that must be identified and preserved, to progress with the dissection. We define the prevalence of platysma, in the intermediate plane of the anterior cervical region, and evaluate potential statistical correlations with clinical and pathologic variables.

Materials and Methods:

The study included patients who had thyroid surgery. Morphologies, asymmetry, and patterns of the platysma were described. The analysis of the different considered variables was quantitative and qualitative, using multiple data reports.

Results:

A total of 23 men and 90 women, aged 19 to 70 (median 41±19) years constituted the study cohort. Their neck circumference and height were 388.5±45 mm (334 to 479 mm) and 200±30 mm (160 to 270 mm), respectively. The hemi-platysmal muscle was bilaterally identified in 109 (96.4%). The mean platysmal thickness was 2.7±1.7 mm (range: 0.7 to 8.2 mm). The intermediate plane between the platysmal muscles was classified into 4 types, depending on the muscle features in the midline: Type A: the left and right platysmal fibers were interlaced with each other in the midline (7%); type B: the platysmal fibers were disconnected by <1 cm (27%); type C: between 1 and 3 cm (52%); and type D separated >3 cm (14%).

Conclusions:

We provide descriptive characteristics of the cervical platysma. A better understanding of the anatomic variability in cervical platysma may be useful in performing a more accurate dissection in endoscopic endocrine neck surgery.
Critical Appraisal of the Impact of Individual Surgeon Experience on the Outcomes of Minimally Invasive Distal Pancreatectomies: Collective Experience of Multiple Surgeons at a Single Institution
Authors: Goh Brian K.P. , Kabir Tousif , Koh Ye-Xin , Teo Jin-Yao , Lee Ser-Yee , Kam Juinn-Huar , Cheow Peng-Chung , Jeyaraj Prema R. , Chow Pierce K.H. , Ooi London L.P.J. , Chung Alexander Y.F. , Chan Chung-Yip
Published: May 2020

Background:

Presently, there are limited studies analyzing the learning experience of minimally invasive distal pancreatectomies (MIDPs) and these frequently focused on a single surgeon or institution learning curve. This study aims to critically analyze the impact of individual surgeon experience on the outcomes of MIDP based on the collective experiences of multiple surgeons at a single institution.

Methods:

A retrospective review of 90 consecutive MIDP from 2006 to 2018 was performed. These cases were performed by 13 surgeons over various time periods. The cohort was stratified into 4 groups according to individual surgeon experience. The case experience of these surgeons was as follows: <5 cases (n=8), 6 to 10 cases (n=2), 11 to 15 cases (n=2), and 30 cases (n=1).

Results:

The distribution of the 90 cases were as follows: experience <5 cases (n=44), 6 to 10 cases (n=20), 11 to 15 cases (n=11), and 15 cases (n=15). As individual surgeons gained increasing experience, this was significantly associated with increasingly difficult resections performed, increased frequency of the use of robotic assistance and decreasing open conversion rates (20.5% vs. 100% vs. 9.1% vs. 0%, P=0.038). There was no significant difference in other perioperative outcomes. These findings suggest that the outcomes of MIDP in terms of open conversion rate could be optimized after 15 cases. Subset analyses suggested that the learning curve for MIDP of low difficulty was only 5 cases.

Conclusion:

MIDP can be safely adopted today and the individual surgeon learning curve for MIDP of all difficulties in terms of open conversion rate can be overcome after 15 cases.
Endoscopic Transpapillary Gallbladder Drainage for Acute Cholecystitis After Biliary Self-Expandable Metal Stent Placement
Authors: Nakahara Kazunari , Morita Ryo , Michikawa Yosuke , Suetani Keigo , Morita Nozomi , Fujita Akashi , Sato Junya , Igarashi Yosuke , Ikeda Hiroki , Matsunaga Kotaro , Watanabe Tsunamasa , Kobayashi Shinjiro , Otsubo Takehito , Itoh Fumio
Published: May 2020

Background:

Endoscopic transpapillary gallbladder drainage (ETGBD) for acute cholecystitis (AC) after self-expandable metal stent (SEMS) placement is technically challenging and there are no reports about its outcome in a several cases. This study aims to assess the outcomes of ETGBD for AC after SEMS placement.

Methods:

Between April 2011 and April 2019, 314 patients underwent SEMS placement for biliary stricture. Among them, 12 of 21 patients who developed AC after SEMS placement underwent ETGBD. In general, ETGBD was performed after SEMS removal in cases in which a covered SEMS was previously placed or with the SEMS kept in place in cases in which an uncovered SEMS was previously placed. When the orifice of the cystic duct overlapped the uncovered SEMS, ETGBD was performed through the mesh of the SEMS.

Results:

Among the 12 patients who underwent ETGBD, the previously placed SEMS was in the distal (n=8) or perihilar (n=4) bile duct. The type of SEMS placed in the distal bile duct was covered in 7 (fully covered: 6, partially covered: 1) and uncovered in 1, whereas that in the perihilar bile duct was uncovered for all. The technical success rate of ETGBD was 83.3% (10/12), and that according to the previous SEMS placement site was 75.0% (6/8) for the distal bile duct and 100% (4/4) for the perihilar bile duct. In the technically successful, the clinical success rate for AC was 90.0% (9/10). The rate of adverse event was 16.7% (2/12) (stent kink: 1, tube self-removal: 1).

Conclusions:

ETGBD can have relatively good outcomes for AC after SEMS placement.
Defining the Term “Elderly” in the Field of Surgery: A Retrospective Study Regarding the Changes in the Immunoinflammatory Indices During the Immediate Perioperative Period of the Elective Uncomplicated Laparoscopic Cholecystectomy
Authors: Izumisawa Yusuke , Morioka Daisuke , Fuse Masahiro , Toyoda Junya , Ohyama Norio , Asano Fumio , Matsuyama Ryusei , Sato Yoshiki , Miura Masaru , Endo Itaru
Published: May 2020

Backgrounds:

The term “elderly” seems to have been used as “vulnerable to various stresses” but not well defined. To define the “elderly”, we investigated whether the increased age causes unfavorable changes in several immunoinflammatory indices that indicate the increased vulnerability in the surgical field.

Patients and Methods:

One-hundred forty-two patients undergoing an elective-uncomplicated laparoscopic cholecystectomy (within 60 min and without intraoperative-cholangiography, bile spillage, or open conversion) were retrospectively investigated. Before surgery, immediately after surgery, and on postoperative day (POD)1, whether the patient age correlated the following variables was examined: neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-C-reactive-protein ratio (LCR), C-reactive-protein-to-albumin ratio (CAR), and others.

Results:

The immunoinflammatory indices most unfavorably changed on POD1. The age correlated neither lymphocyte-to-monocyte ratio nor platelet-to-lymphocyte ratio on POD1, when NLR, LCR, and CAR showed the significant correlation with the age. Multiple regression analyses determined the following variables as the independent determinants of these 3 indices on POD1: age, intraoperative minimum body temperature ≥35.5°C (IntMinBT ≥35.5°C), maximum heart rate during POD0-1 (MaxHR) for NLR; age and IntMinBT ≥ 35.5°C for LCR; and age and MaxHR for CAR. The threshold of “elderly” was determined as 102-year-old for NLR, 94-year-old for LCR, and 97-year-old for CAR.

Conclusions:

The increased age causes the unfavorable changes in early postoperative immunoinflammatory indices after the uncomplicated laparoscopic cholecystectomy. Thus, the term “elderly” can be rephrased by the term “vulnerable to various surgical stresses.” The thresholds for “elderly” defined herein seem impractical. Namely, the increased vulnerability caused by the aging seems modified by the individual surgical procedures.
Identifying phase-varying periodic behaviour in conservative nonlinear systems
Authors: Hong Dongxiao , Nicolaidou Evangelia , Hill Thomas L. , Neild Simon A.
Published: May 2020

Nonlinear normal modes (NNMs) are a widely used tool for studying nonlinear mechanical systems. The most commonly observed NNMs are synchronous (i.e. single-mode, in-phase and anti-phase NNMs). Additionally, asynchronous NNMs in the form of out-of-unison motion, where the underlying linear modes have a phase difference of 90°, have also been observed. This paper extends these concepts to consider
general asynchronous NNMs
, where the modes exhibit a phase difference that is not necessarily equal to 90°. A single-mass, 2 d.f. model is firstly used to demonstrate that the out-of-unison NNMs evolve to general asynchronous NNMs with the breaking of the geometrically orthogonal structure of the system. Analytical analysis further reveals that, along with the breaking of the orthogonality, the out-of-unison NNM branches evolve into branches which exhibit amplitude-dependent phase relationships. These NNM branches are introduced here and termed
phase-varying backbone curves
. To explore this further, a model of a cable, with a support near one end, is used to demonstrate the existence of phase-varying backbone curves (and corresponding general asynchronous NNMs) in a common engineering structure.
Disruption of cross-feeding interactions by invading taxa can cause invasional meltdown in microbial communities
Authors: Herren Cristina M.
Published: May 2020

The strength of biotic interactions within an ecological community affects the susceptibility of the community to invasion by introduced taxa. In microbial communities, cross-feeding is a widespread type of biotic interaction that has the potential to affect community assembly and stability. Yet, there is little understanding of how the presence of cross-feeding within a community affects invasion risk. Here, I develop a metabolite-explicit model where native microbial taxa interact through both cross-feeding and competition for metabolites. I use this model to study how the strength of biotic interactions, especially cross-feeding, influence whether an introduced taxon can join the community. I found that stronger cross-feeding and competition led to much lower invasion risk, as both types of biotic interactions lead to greater metabolite scarcity for the invader. I also evaluated the impact of a successful invader on community composition and structure. The effect of invaders on the native community was greatest at intermediate levels of cross-feeding; at this ‘critical’ level of cross-feeding, successful invaders generally cause decreased diversity, decreased productivity, greater metabolite availability, and decreased quantities of metabolites exchanged among taxa. Furthermore, these changes resulting from a successful primary invader made communities further susceptible to future invaders. The increase in invasion risk was greatest when the network of metabolite exchange between taxa was minimally redundant. Thus, this model demonstrates a case of invasional meltdown that is mediated by initial invaders disrupting the metabolite exchange networks of the native community.
Frequency-dependent fitness and reproductive dynamics contribute to habitat segregation in sympatric jewelflowers
Authors: Christie Kyle , Strauss Sharon Y.
Published: May 2020

Coexistence results from a complex suite of past and contemporary processes including biogeographic history, adaptation, ecological interactions and reproductive dynamics. Here we explore drivers of local micro-parapatry in which two closely related and reproductively isolated
Streptanthus
species (jewelflower, Brassicaceae) inhabit continuous or adjacent habitat patches and occur within seed dispersal range, yet rarely overlap in fine-scale distribution. We find some evidence for abiotic niche partitioning and local adaptation, however differential survival across habitats cannot fully explain the scarcity of coexistence. Competition may also reduce the fitness of individuals migrating into occupied habitats, yet its effects are insufficient to drive competitive exclusion. Experimental migrants suffered reduced seed production and seed viability at sites occupied by heterospecifics, and we infer that heterospecific pollen transfer by shared pollinators contributes to wasted gametes when the two congeners come into contact. A minority disadvantage may reduce effective colonization of patches already occupied by heterospecifics, even when habitat patches are environmentally suitable. Differential adaptation and resource competition have often been evoked as primary drivers of habitat segregation in plants, yet negative reproductive interactions—including reproductive interference and decreased fecundity among low-frequency migrants—may also contribute to non-overlapping distributions of related species along local tension zones.
Unreported cases for Age Dependent COVID-19 Outbreak in Japan
Authors: Griette Quentin , Magal Pierre , Seydi Ousmane
Published: May 2020

We investigate the age structured data for the COVID-19 outbreak in Japan. We consider a mathematical model for the epidemic with unreported infectious patient with and without age structure. In particular, we build a new mathematical model and a new computational method to fit the data by using age classes dependent exponential growth at the early stage of the epidemic. This allows to take into account differences in the response of patients to the disease according to their age. This model also allows for a heterogeneous response of the population to the social distancing measures taken by the local government. We fit this model to the observed data and obtain a snapshot of the effective transmissions occurring inside the population at different times, which indicates where and among whom the disease propagates after the start of public mitigation measures.
Evolution of the COVID Pandemic: A Technique for Mathematical Analysis of Data
Authors: Tennakone K. , DeSilva L. Ajith , Wimalasena K. J. , Welchel Z. J.
Published: May 2020

The analysis of COVID-19 statistics in different regions of the world with the intention of understanding the trend of progression of the pandemic is a task of paramount importance. Publicly available data includes cumulative number of cases, new cases each day, and the mortality. Extracting information from this data necessitates mathematical modeling. In this note a simple technique is adopted to determine the trend towards stabilized elimination of the infection, as implicated by saturation of the cumulative number of cases. Results pertaining to several representative regions of the world are presented. In several regions, evidence there to the effect that the pandemic will come to an end. The estimated saturation values of the cumulative numbers are indicated.
Effect of cell size and tethering geometry on rotation rate, torque, and rotational bias ofE.colicells
Authors: Soman Vidhu , Malik Kanishk Singh , Nath Sunil , Elangovan Ravikrishnan
Published: May 2020

The bacterial flagellum has a rotary motor embedded in its membrane surrounded by stator-units. Torque is generated by electro-steric interactions between rotor and stator-units. Chemotactic signals entail the motor to switch its direction of rotation. However, other factors such as protonmotive force and torque are involved in switching. In this work, we used peritrichously flagellated E.coli that stochastically tethers on surfaces in random geometries and studied how the cell size and position of the rotational axis affect the output of the motor. We developed a Cell Tethering Analysis Program (CTAP) to measure the length of the cells, the axis of rotation, rotational frequency of tethered cells. A D/L ratio (diameter traced by the cell body to the length of the cell body) was used to quantify the location of the rotational axis wherein, a D/L ratio of 1 and 1.9 means the axis of rotation is at the center of the cell body and near the tip of the cell body respectively. We performed experiments in controlled conditions and quantified the effect of cell size and tethering geometry on the output of the flagellar motor. The estimated torque of the tethered cells was 951 pN.nm and 1390 pN.nm for a D/L ratio of ∼1.0 and ∼1.9 respectively. As the torque increased, the motors rotated exclusively in CCW direction. We conclude that quantifying the cell size and tethering geometry is significant to characterize the output of the flagellar motors in a tethered cell assay.
Alteration of menaquinone isoprenoid chain length and antibiotic sensitivity by single amino acid substitution in HepT
Authors: Panthee Suresh , Paudel Atmika , Hamamoto Hiroshi , Uhlemann Anne-Catrin , Sekimizu Kazuhisa
Published: May 2020

Objectives

Staphylococcus aureusSmith strain is a historical strain widely used for research purposes in animal infection models for testing the therapeutic activity of antimicrobial agents. We found that it displayed higher sensitivity towards lysocin E, a menaquinone (MK) targeting antibiotic, compared to otherS. aureusstrains. Therefore, we further explored the mechanism of this hypersensitivity.

Methods

MK production was analyzed by high-performance liquid chromatography and mass spectrometric analysis.S. aureusSmith genome sequence was completed using a hybrid assembly approach, and the MK biosynthetic genes were compared with otherS. aureusstrains. ThehepTgene was cloned and introduced intoS. aureusRN4220 strain using phage mediated recombination, and lysocin E sensitivity was analyzed by the measurement of minimum inhibitory concentration and colony-forming units.

Results

We found that Smith strain produced MKs with the length of the side chain ranging between 8 – 10, as opposed to otherS. aureusstrains that produce MKs 7 – 9. We revealed that Smith strain possessed the classical pathway for MK biosynthesis like the otherS. aureus. HepT, a polyprenyl diphosphate synthase involved in chain elongation of isoprenoid, in Smith strain was unique with a Q25P substitution. Introduction ofhepTfrom Smith to RN4220 led to the production of MK-10 and an increased sensitivity towards lysocin E.

Conclusions

We found that HepT was responsible for the definition of isoprenoid chain length of MKs and antibiotic sensitivity.
The decay and persistence of web references
Authors: Loan Fayaz Ahmad , Shah Ufaira Yaseen
Published: May 2020

Purpose

The purpose of this study is to identify the persistence and decay of uniform resource locator (URLs) associated with Web references. The decaying of Web references is analyzed in relation to their age, domain, technical errors and error codes.

Design/methodology/approach

The Web references of the Journal of Informetrics were selected for analysis and interpretation to fulfill the set objectives. The references of all the scholarly articles, excluding editorials and reviews published in the Journal of Informetrics for five years from 2007 to 2011 were recorded in a text file. Later, the URLs were extracted from the articles to verify their accessibility in terms of persistence and decay. The collected data were then transferred into an excel file and tabulated for further analysis and interpretation using simple statistical techniques.

Findings

The results showed that of the total 7,409 citations retrieved from 221 articles, 358 citations (4.8%) were Web citations. These Web citations were assessed to find their persistence and decay. The results reveal that 115 (32.12%) Web references were missing or dead. The most common error associated with the missing Web citations was Error 404 Page not found, contributing 60% of the total missing citations, followed by 400 Bad Request Error (35.65%). The domain analysis of missing Web citations depicts that most of the missing URLs were associated with the .gov domain (40%), followed by .edu (29.58%) and .com (26.04%).

Research limitations/implications

The Web references of a single journal, namely, Journal of Informetrics, were analyzed for five years, and hence, the generalization of findings needs to be cautioned.

Practical implications

The URL decay is becoming a major problem in the preservation and citation of the Web resources, and collaborative efforts are needed to reduce the decaying of URLs.

Originality/value

A good number of studies have been conducted to analyze the persistence and decay of Web references, as it is the hot topic of research across disciplines, and this study is a step further in the same direction.
Without borders: youth debaters reimagining the nature and purpose of public dialogue
Authors: Mirra Nicole , Liberation League Debate
Published: May 2020

Purpose

This paper aims to analyze how a group of middle-school debaters integrated their identities and epistemologies into the traditional literacy practice of debate to advocate for more expansive and inclusive forms of academic and civic discussion. The adult and youth co-researchers of the Debate Liberation League (DLL) detail their creation of a critical debate praxis through the use of spoken word and translanguaging and illustrate how they sought to redesign a foundational activity of English Language Arts on their own terms.

Design/methodology/approach

Drawing upon critical race and borderlands theories, the authors use critical ethnographic and participatory action research methods to explore how the DLL deconstructed the boundaries of what counts as public dialogue and offered an alternative model of what intergenerational and multi-voiced democratic discourse could look like in English Language Arts (ELA) classrooms and beyond.

Findings

The findings demonstrate how DLL students broke down normative binaries of affirmative/negative and objective/subjective in their debate performances and introduced testimonios as evidence for civic claims to make space for their voices and reimagine deliberation.

Originality/value

This study foregrounds dialogic data generation through a collaborative, intergenerational research approach. It highlights the constructed nature of literacy “rules,” demonstrates youth expertise in reimagining ELA, and offers a pathway toward a more compassionate public sphere.
Examining moderating role of personal identifying information in travel related decisions
Authors: Garg Prerna , Pandey Anoop
Published: May 2020

Purpose

The purpose of this study is to empirically verify the role of determinants of information quality in shaping attitudes and intention of respondents from major metro cities of India towards electronic word of mouth (e-WOM) using personal identifying information (PII) as a moderator.

Design/methodology/approach

For the purpose of measuring the role of information quality in predicting attitude towards e-WOM (moderated by PII), the study proposes and validates the research framework by collecting responses from 375 respondents with diverse demographics, belonging to select metro cities of India.

Findings

All the constructs of information quality have a significantly positive effect on attitude of travellers towards e-WOM. Attitude further impacts the behavioural intention to book via an online travel agency/agent (OTA). PII successfully moderated all the hypothesized relationships with attitude except review sidedness.

Research implications

The study offers a rationale to fill the gap between information quality and attitude as well as exploring new relationships using PII as a moderating variable. It further opens new avenues in researching the behavioural intention of travellers from metro cities of India with the disruptions created by Web 2.0.

Practical implications

OTAs in this competitive time must try to harmonize their systems to create content that is timely updated, unique, convincing and useful to build long-term relationships and generate continued revenues.

Originality/value

In the context of OTAs in India, this study has successfully identified the most relevant constructs of information quality and examined their effectiveness in creating a positive attitude towards e-WOM. The use of contemporary construct “PII” as a moderator will help marketers develop effective strategies for reducing anonymity in reviews and capturing the intention of experience-oriented travellers from the metro cities of India.