bluuebunny/crossref_metadata_2025 huggingface dataset:
A Case for Avoiding Hydraulic Shock Suppressors (Snubbers) in the Vibratory Environments
Authors: Gawande Kshitij P. , Wiseman Phillip , Mayes Alex
Published: November 2018

Whenever undesirable dynamic events occur within power plant, refinery, or process piping systems, specialty supports and restraints have the task of protecting the mechanical equipment and connecting piping from damaging loads and displacements. The array of components that may be affected include, but are not limited to, piping systems, pumps, valve assemblies, pressure vessels, steam generators, boilers, and heat exchangers. In particular, the dynamic events can be classified into two distinct types that originate from either internal events or external events. The internal dynamic load generating events include plant system start-up and shut-down, pressure surges or impacts from rapid valve closures such as steam and water hammer, boiler detonations, pipe rupture, and operating vibratory displacements that may be either low frequency or high frequency vibrations. The external dynamic load generating events include wind loads, earthquake, airplane impact to supporting structures and buildings, and explosions. Most of the aforementioned dynamic load generating events can be defined quite simply as impact loads, i.e., forces and moments that are applied over very short periods of time, for example, less than one second. While earthquake loads may be applied over a total time period of an hour or so, the peak loads and resulting displacements occur on a more sinusoidal basis of peak-to-peak amplitudes. One of the most common specialty restraint components utilized in the piping industry to absorb and transfer the dynamic load resulting from impact events is the hydraulic shock suppressor, otherwise known as the snubber. The snubber is a formidable solution to protecting plant piping systems and equipment from impact loading while not restricting the thermal displacements during routine operations. In the dynamic events that may be characterized by an impact type loading, snubbers provide an instantaneous, practically rigid, axial connection between the piping or other component to be secured and the surrounding structure whether it be concrete or steel (for example). In this way, the kinetic energy can be transmitted and harmlessly dissipated. In the vibratory environment, however, neither the impact load scenario nor the rapid translations are imposed upon snubbers, thereby presenting the competing intended application of the snubber to protect against impact loads versus, in many cases, the improper selection of the snubber to dampen vibratory (other than seismic) loads. The details of the hydraulic shock suppressor design are reviewed and discussed to exemplify why a case can and should be made against the use of snubbers in piping systems within an operating vibratory environment.
Voltage control of unidirectional anisotropy in ferromagnet-multiferroic system
Authors: Manipatruni Sasikanth , Nikonov Dmitri E. , Lin Chia-Ching , Prasad Bhagwati , Huang Yen-Lin , Damodaran Anoop R. , Chen Zuhuang , Ramesh Ramamoorthy , Young Ian A.
Published: November 2018

Magnetoelectricity enables a new class of nonvolatile, ultralow-energy computing with quantum materials for AI & Moore’s law.
Multifunctional wafer-scale graphene membranes for fast ultrafiltration and high permeation gas separation
Authors: Choi Kyoungjun , Droudian Amirhossein , Wyss Roman M. , Schlichting Karl-Philipp , Park Hyung Gyu
Published: November 2018

Wafer-scale porous graphene demonstrates high-performance ultrafiltration and scaffolds self-supported thin polymer membrane.
Physiological Studies of
Chlorobiaceae
Suggest that Bacillithiol Derivatives Are the Most Widespread Thiols in Bacteria
Authors: Hiras Jennifer , Sharma Sunil V. , Raman Vidhyavathi , Tinson Ryan A. J. , Arbach Miriam , Rodrigues Dominic F. , Norambuena Javiera , Hamilton Chris J. , Hanson Thomas E.
Published: November 2018

Low-molecular-weight thiols are key metabolites that participate in many basic cellular processes: central metabolism, detoxification, and oxidative stress resistance. Here we describe a new thiol, N-methyl-bacillithiol, found in an anaerobic phototrophic bacterium and identify a gene that is responsible for its synthesis from bacillithiol, the main thiol metabolite in many Gram-positive bacteria. We show that the presence or absence of this gene in a sequenced genome accurately predicts thiol content in distantly related bacteria. On the basis of these results, we analyzed genome data and predict that bacillithiol and its derivatives are the most widely distributed thiol metabolites in biology.
Mycobacterium tuberculosis Type VII Secretion System Effectors Differentially Impact the ESCRT Endomembrane Damage Response
Authors: Mittal Ekansh , Skowyra Michael L. , Uwase Grace , Tinaztepe Emir , Mehra Alka , Köster Stefan , Hanson Phyllis I. , Philips Jennifer A.
Published: November 2018

Mycobacterium tuberculosis
causes tuberculosis, which kills more people than any other infection.
M. tuberculosis
grows in macrophages, cells that specialize in engulfing and degrading microorganisms. Like many intracellular pathogens, in order to cause disease,
M. tuberculosis
damages the membrane-bound compartment (phagosome) in which it is enclosed after macrophage uptake. Recent work showed that when chemicals damage this type of intracellular compartment, cells rapidly detect and repair the damage, using machinery called the endosomal sorting complex required for transport (ESCRT). Therefore, we hypothesized that ESCRT might also respond to pathogen-induced damage. At the same time, our previous work showed that the EsxG-EsxH heterodimer of
M. tuberculosis
can inhibit ESCRT, raising the possibility that
M. tuberculosis
impairs this host response. Here, we show that ESCRT is recruited to damaged
M. tuberculosis
phagosomes and that EsxG-EsxH undermines ESCRT-mediated endomembrane repair. Thus, our studies demonstrate a battle between host and pathogen over endomembrane integrity.
Bacillus subtilis
Biofilms: a Matter of Individual Choice
Authors: Ryan-Payseur Bridgett K. , Freitag Nancy E.
Published: November 2018

Bacillus subtilis
has the capacity to choose between two mutually exclusive lifestyles: biofilm formation and flagellum-mediated swimming motility. Interestingly, this choice is made at the individual cell level, with bacterial cells in a population expressing genes required for biofilm formation or genes required for swimming motility but not both.
Management of severe bronchiolitis: impact of NICE guidelines
Authors: Griffiths Benedict , Riphagen Shelley , Lillie Jon
Published: November 2018

Objective

To understand the impact of the National Institute for Health and Care Excellence (NICE) bronchiolitis guidelines on the management of children referred to paediatric intensive care unit (PICU) with bronchiolitis.

Design and setting

Data were collected on all children referred to a regional PICU transport service with the clinical diagnosis of bronchiolitis during the winter prior to the NICE consultation period (2011–2012) and during the winter after publication (2015–2016). Management initiated by the referring hospital was assessed.

Results

There were 165 infants referred with bronchiolitis in epoch 1 and 187 in epoch 2. Nebuliser use increased from 28% in epoch 1 to 53% in epoch 2. Increased use of high-flow nasal cannula oxygen and reduction in continuous positive airway pressure use were observed. The use of antibiotics did not change between epochs.

Conclusion

The use of nebulised therapies has increased in the management of severe bronchiolitis despite national guidance to the contrary.
Musculoskeletal anomalies in children with Down syndrome: an observational study
Authors: Foley Charlene , Killeen Orla G
Published: November 2018

Background

Musculoskeletal complications of Down syndrome (DS) are common but infrequently reported. The combination of ligamentous laxity and low muscle tone contributes to increased risk of a number of musculoskeletal disorders and a delay in acquisition of motor milestones. The primary aim of this study was to describe musculoskeletal anomalies reported in a national cohort of children with DS.

Methods

This was an observational study. Children with DS, aged 0–21 years, were invited to attend a musculoskeletal assessment clinic conducted by a paediatric physician. Relevant musculoskeletal history and clinical findings were documented.

Results

Over an 18-month period, 503 children with DS were examined (56% male). The median age was 8.1 years (0.6–19.2). Pes planus was almost universal, occurring in 91% of the cohort. A range of other musculoskeletal anomalies were observed, with inflammatory arthritis (7%) and scoliosis (4.8%) occurring most frequently after pes planus. Delay in ambulation was common; the median age to walk was 28 months (12–84).

Conclusion

Children with DS are at increased risk of a number of potentially debilitating musculoskeletal problems. These conditions can present in variable manners or be completely asymptomatic. Pes planus is common; therefore, early consideration of orthotics and lifelong appropriate supportive footwear should be considered. Delayed ambulation is frequently noted. A significant proportion of children with DS have arthritis; however, despite a high prevalence, it is often missed, leading to delayed diagnosis. An annual musculoskeletal assessment for all children with DS could potentially enable early detection of problems, allowing for timely multidisciplinary team intervention and better clinical outcomes.
Simplified management protocol for term neonates after prolonged rupture of membranes in a setting with high rates of neonatal sepsis and mortality: a quality improvement study
Authors: Olita’a Diana , Barnabas Roland , Vali Boma Gamini , Pameh Wendy , Vince John , Duke Trevor
Published: November 2018

In low-income and middle-income countries, courses of antibiotics are routinely given to term newborns whose mothers had prolonged rupture of membranes (PROM). Rational antibiotic use is vital given rising rates of antimicrobial resistance and potential adverse effects of antibiotic exposure in newborns. However missing cases of sepsis can be life-threatening.This is a quality improvement evaluation of a protocol for minimal or no antibiotics in term babies born after PROM in Papua New Guinea. Asymptomatic, term babies born to women with PROM >12 hours prior to birth were given a stat dose of antibiotics, or no antibiotics if the mother had received intrapartum antibiotics, reviewed and discharged at 48–72 hours with follow-up. Clinical signs of sepsis within the first week and the neonatal period were assessed. Of 170 newborns whose mothers had PROM, 133 were assessed at 7 days: signs of sepsis occurred in 10 babies (7.5%; 95% CI 4.4% to 13.2%) in the first week. Five had isolated fever, four had skin pustules and one had fever with periumbilical erythema. An additional four (3%) had any sign of sepsis between 8 and 28 days. There was one case of bacteraemia and no deaths. 37 were lost to follow-up, but hospital records did not identify any subsequent admissions for infection. A rate of sepsis was documented that was comparable with other studies in low-income countries. This protocol may reduce antimicrobial resistance and consequences of antibiotic exposure in newborns, provided safeguards are in place to monitor for signs of sepsis.
Economic cost of congenital CMV in the UK
Authors: Retzler Jenny , Hex Nick , Bartlett Chris , Webb Anne , Wood Sharon , Star Caroline , Griffiths Paul , Jones Christine E
Published: November 2018

Objective

Congenital cytomegalovirus (cCMV) is the most common infectious cause of congenital disability. It can disrupt neurodevelopment, causing lifelong impairments including sensorineural hearing loss and developmental delay. This study aimed, for the first time, to estimate the annual economic burden of managing cCMV and its sequelae in the UK.

Design

The study collated available secondary data to develop a static cost model.

Setting

The model aimed to estimate costs of cCMV in the UK for the year 2016.

Patients

Individuals of all ages with cCMV.

Main outcome measures

Direct (incurred by the public sector) and indirect (incurred personally or by society) costs associated with management of cCMV and its sequelae.

Results

The model estimated that the total cost of cCMV to the UK in 2016 was £732 million (lower and upper estimates were between £495 and £942 million). Approximately 40% of the costs were directly incurred by the public sector, with the remaining 60% being indirect costs, including lost productivity. Long-term impairments caused by the virus had a higher financial burden than the acute management of cCMV.

Conclusions

The cost of cCMV is substantial, predominantly stemming from long-term impairments. Costs should be compared against investment in educational strategies and vaccine development programmes that aim to prevent virus transmission, as well as the value of introducing universal screening for cCMV to both increase detection of children who would benefit from treatment, and to build a more robust evidence base for future research.
Exploring the developmental tasks of emerging adults after paediatric heart transplantation: a cross-sectional case control study
Authors: Sepke Maria , Ferentzi Hannah , Disselhoff Vera Stephanie Umutoni , Albert Wolfgang
Published: November 2018

Objective

Paediatric heart transplantation (PHTX) comprises 12% of all cardiac transplants and many of the children now survive into adulthood. Only a few studies have investigated the long-term psychosocial well-being of young adult patients after PHTX; no studies have investigated developmental tasks of emerging adulthood in different domains (family, social environment, education and profession, partnership, social environment).

Setting

Specialised heart centre in Germany.

Participants

Thirty-eight young adults aged 22.11 years (SD=4.7) who underwent PHTX and a control group of 46 participants with no known chronic diseases, aged 22.91 years (SD=1.8), participated in the study.

Outcome measures

All participants completed the following questionnaires: sociodemographic, the F-SozU, to measure perceived social support, the Gießener Beschwerde-Bogen to measure subjective complaints experienced by patients, the KIDSCREEN-27 to measure well-being and the SF-36 to measure health-related quality of life (QoL).

Results

‘Family’: the quality of the relationship with the parents was found to be equal in both groups, while PHTX patients stayed in closer spatial proximity to their parents. ‘Social environment’: PHTX patients reported lower social support by peers than the control group. ‘Education and profession’: PHTX patients most often worked full-time (23%), had no job and/or received a pension (21%). In comparison, most of the healthy controls did an apprenticeship (40%) and/or worked part time (32%). ‘Partnership’: fewer of the PHTX patients had a partner than the control group while relationship duration did not differ. In exploratory regression analyses, social support by peers predicted physical QoL, whereas physical complaints and the physical role predicted mental QoL in PHTX patients.

Conclusions

Our exploratory findings highlight important similarities and differences in specific developmental tasks between PHTX patients and healthy controls. Future studies should focus on developmental tasks of PHTX patients in this age group more systematically, investigating their role in physical and mental well-being in a confirmatory manner.
Differences in infant and child mortality before and after the Great East Japan Earthquake and Tsunami: a large population-based ecological study
Authors: Tashiro Ai , Sakisaka Kayako , Okamoto Etsuji , Yoshida Honami
Published: November 2018

Objectives

To examine associations between access to medical care, geological data, and infant and child mortality in the area of North-Eastern Japan that was impacted by the Great East Japan Earthquake and Tsunami (GEJET) in 2011.

Design

A population-based ecological study using publicly available data.

Setting

Twenty secondary medical areas (SMAs) in the disaster-affected zones in the north-eastern prefectures of Japan (Iwate, Fukushima and Miyagi). Participants: Children younger than 10 years who died in the 20 SMAs between 2008 and 2014 (n=1 748). Primary and secondary outcome measures: Multiple regression analysis for infant and child mortality rate. The mean values were applied for infant and child mortality rates and other factors before GEJET (2008–2010) and after GEJET (2012–2014).

Results

Between 2008 and 2014, the most common cause of death among children younger than 10 years was accidents. The mortality rate per 100 000 persons was 39.1±41.2 before 2011, 226.7±43.4 in 2011 and 31.4±39.1 after 2011. Regression analysis revealed that the mortality rate was positively associated with low age in each period, while the coastal zone was negatively associated with fewer disaster base hospitals in 2011. By contrast, the number of obstetrics and gynaecology centres (β=−189.9, p=0.02) and public health nurses (β=−1.7, p=0.01) was negatively associated with mortality rate per person in 2011.

Conclusions

In 2011, the mortality rate among children younger than 10 years was 6.4 times higher than that before and after 2011. Residence in a coastal zone was significantly associated with higher child mortality rates.
How does a new patient education programme for renal recipients become situated and adapted when implemented in the daily teaching practice in a university hospital? An ethnographic observation study
Authors: Lillehagen Ida , Andersen Marit Helen , Urstad Kristin Hjorthaug , Wahl Astrid , Engebretsen Eivind
Published: November 2018

Objective

To understand how a new patient education programme for renal recipients becomes situated and adapted when implemented in daily hospital teaching practice. The analysis focuses in particular on how principles of individual tailoring and patient involvement are adapted.

Design

Ethnographic observation study. 19 teaching sessions were observed, resulting in 35 pages of data written observation notes.

Setting

A Norwegian University hospital. The study included the transplantation (TX) post, the medical post and the outpatient clinic.

Participants

10 newly transplanted patients receiving the education programme, and 13 nurses trained in the new programme participated in the study.

Results

We observed that the nurses attempted to implement the programme’s core principles of individual tailoring and patient involvement as intended, but that patients found it difficult to formulate their knowledge needs and interest. Patients and nurses developed an approach to individual tailoring and patient involvement, which used knowledge about the patients’ life and experiences as basis for translating generalised knowledge into knowledge that is individualised and meaningful for the patient. The individual tailoring was however also limited, as the nurses balanced between responsibilities for the programme’s principles of individual adaption and patient involvement at the one hand, and responsibilities of safety and economy from a health systems perspective on the other hand.

Conclusion

Individual tailoring is observed to be a comprehensive practice which includes verbal, practical and emotional involvement with the patient’s life world. This extends the notion and practice of individual tailoring as selecting among predefined, generalised knowledge based on an initial mapping of the patients’ knowledge. While the adaptions to individual tailoring could have been seen as inaccurate implementation, in-depth analyses discloses that the extended approach to individual tailoring is in fact what retains the programme’s core principles in the implementation context.
Serum alkaline phosphatase and the risk of coronary heart disease, stroke and all-cause mortality: Tehran Lipid and Glucose Study
Authors: Kabootari Maryam , Raee Mohammad Reza , Akbarpour Samaneh , Asgari Samaneh , Azizi Fereidoun , Hadaegh Farzad
Published: November 2018

Objectives

To investigate the association of alkaline phosphatase (ALP) levels with the risk of the composite end point of cardiovascular disease (CVD), and all-cause mortality as well as each of them separately.

Design

Prospective cohort study.

Setting

Within the framework of the Tehran Lipid and Glucose Study (TLGS) cohort, participants were followed from baseline examination (1999–2001) until March 2014.

Participants

A total of 2578 participants, aged ≥30 years free of prevalent CVD at baseline examination.

Primary outcome

The main outcome measures were composite end point of coronary heart disease (CHD), stroke, all-cause mortality and each per se.

Results

During a median follow-up of 11.3 years, 369, 68, 420, 170 and 495 participants experienced CHD, stroke, CVD, all-cause mortality and the composite outcome, respectively. In the multivariable Cox regression models, the adjusted HRs (95% CI) for mentioned events per one SD increase in ALP level after full adjustment were 1.11 (1.01 to 1.22), 1.20 (0.97 to 1.49, p=0.058), 1.10 (1.01 to 1.21), 1.16 (1.01 to 1.33) and 1.11 (1.02 to 1.21), respectively. Furthermore, participants with ALP levels in the highest tertile had significant adjusted HRs (95% CI) for stroke (1.88 (1.00 to 3.61)), CVD (1.30 (1.01 to 1.68)) and composite outcome (1.27 (1.00 to 1.61)). The cut-off value of ALP ≥199 IU/L for predicting composite outcome was derived using Youden’s index, based on which this cut-off point was associated with significant risk of 80%, 26%, 43% and 26% for incident stroke, CVD, all-cause mortality and composite outcome. Additionally, no improvement was seen in the predictive ability of traditional risk factors models after adding ALP values, considering the levels of Akaike information criterion, C-index and Net Reclassification Index.

Conclusion

Independent associations between ALP levels and the risks of CVD and mortality events were shown, despite the fact that adding the data of ALP to known risk factors did not improve the prediction of these events.
Impact of telemedicine on neonatal resuscitation in the emergency department: a simulation-based randomised trial
Authors: Couturier Katherine , Whitfill Travis , Bhatnagar Ambika , Panchal Rajavee A , Parker John , Wong Ambrose H , Bruno Christie J , Auerbach Marc A , Gross Isabel T
Published: November 2018

Background

The delivery and initial resuscitation of a newborn infant are required but rarely practised skills in emergency medicine. Deliveries in the emergency department are high-risk events and deviations from best practices are associated with poor outcomes.

Introduction

Telemedicine can provide emergency medicine providers real-time access to a Neonatal Resuscitation Program (NRP)-trained paediatric specialist. We hypothesised that adherence to NRP guidelines would be higher for participants with access to a remotely located NRP-trained paediatric specialist via telemedicine compared with participants without access.

Materials and methods

Prospective single-centre randomised trial. Emergency Medicine residents were randomised into a telemedicine or standard care group. The participants resuscitated a simulated, apnoeic and bradycardic neonate. In the telemedicine group a remote paediatric specialist participated in the resuscitation. Simulations were video recorded and assessed for adherence to guidelines using four critical actions. The secondary outcome of task load was measured through participants’ completion of the NASA Task Load Index (NASA-TLX) and reviewers completed a detailed NRP checklist.

Results

Twelve participants were included. The use of telemedicine was associated with significantly improved adherence to three of the four critical actions reflecting NRP guidelines as well as a significant improvement in the overall score (p<0.001). On the NASA-TLX, no significant difference was seen in overall subjective workload assessment, but of the subscore components, frustration was statistically significantly greater in the control group (p<0.001).

Conclusions

In this study, telemedicine improved adherence to NRP guidelines. Future work is needed to replicate these findings in the clinical environment.
Alcoholic and non-alcoholic fatty liver disease and associations with coronary artery calcification: evidence from the Kangbuk Samsung Health Study
Authors: Chang Yoosoo , Ryu Seungho , Sung Ki-Chul , Cho Yong Kyun , Sung Eunju , Kim Han-Na , Jung Hyun-Suk , Yun Kyung Eun , Ahn Jiin , Shin Hocheol , Wild Sarah Helen , Byrne Christopher D
Published: November 2018

Objective

Recent evidence suggests that alcoholic fatty liver disease (AFLD) and non-alcoholic fatty liver disease (NAFLD) may differentially affect risk of cardiovascular mortality. To investigate whether early liver disease due to AFLD or NAFLD have similar or dissimilar effects on risk of early coronary artery atherosclerosis, we have investigated the associations between AFLD and NAFLD and coronary artery calcium (CAC).

Design

A cross-sectional study was performed in 105 328 Korean adults who attended a health check-up programme. CAC score was assessed using CT, daily alcohol intake was recorded as grams/day and liver fat by ultrasound. Logistic regression model was used to calculate ORs with 95% CIs for prevalent CAC.

Results

Both NAFLD and AFLD were positively associated with CAC score. After adjusting for potential confounders, multivariable-adjusted OR (95% CIs) for CAC >0 comparing NAFLD and AFLD to the reference (absence of both excessive alcohol use and fatty liver disease) were 1.10 (95% CI 1.05 to 1.16) and 1.20 (95% CI 1.11 to 1.30), respectively. In post hoc analysis, OR (95% CI) for detectable CAC comparing AFLD to NAFLD was 1.09 (95% CI 1.01 to 1.17). Associations of NAFLD and AFLD with CAC scores were similar in both non-obese and obese individuals without significant interaction by obesity (p for interaction=0.088). After adjusting for homeostasis model assessment of insulin resistance and high-sensitivity C reactive protein, the associations between fatty liver disease and CAC scores remained statistically significant.

Conclusion

In this large sample of young and middle-aged individuals, early liver disease due to NAFLD and AFLD were both significantly associated with the presence of coronary artery calcification.
Influence of chronic diseases on societal participation in paid work, volunteering and informal caregiving in Europe: a 12-year follow-up study
Authors: Scharn Micky , Oude Hengel Karen , Boot Cécile R L , Burdorf Alex , Schuring Merel , van der Beek Allard J , Robroek Suzan J W
Published: November 2018

Background

This study aims to provide insight into (1) the associations between having a chronic disease and participation in paid work, volunteer activities or informal care, (2) the associations between the onset of a chronic disease and these forms of societal participation, and (3) whether these associations differ across educational level and gender.

Methods

The study population consisted of n=21 875 respondents of the Survey of Health, Ageing and Retirement in Europe aged between 50 years and the country-specific retirement age. The influence of having and the onset of a chronic disease on societal participation was analysed using a hybrid Poisson regression model, combining fixed and random effects, and presented by relative risks (RRs).

Results

Individuals with a chronic disease were less likely to participate in paid work (RR: 0.69; 95% CI 0.67 to 0.71) and volunteer activities (RR: 0.92; 95% CI 0.88 to 0.97), but more likely to give informal care (RR: 1.05; 95% CI 1.01 to 1.08). Onset of a chronic disease was associated with a higher likelihood to quit paid work (RR: 0.91; 95% CI 0.86 to 0.97) and to give informal care (RR: 1.08; 95% CI 1.01 to 1.16). Lower educated individuals with a chronic disease or with the onset of a chronic disease were less likely to have paid work than higher educated individuals.

Conclusion

Individuals with a chronic disease were less likely to participate in paid work and volunteer activities, and more likely to provide informal care. Educational inequalities were present for paid work. More insight into which factors hinder societal participation among individuals with a chronic disease is needed.
Reasons for failed endovascular recanalization attempts in stroke patients
Authors: Leischner Hannes , Flottmann Fabian , Hanning Uta , Broocks Gabriel , Faizy Tobias Djamsched , Deb-Chatterji Milani , Bernhardt Martina , Brekenfeld Caspar , Buhk Jan-Hendrik , Gellissen Susanne , Thomalla Götz , Gerloff Christian , Fiehler Jens
Published: November 2018

Purpose

Mechanical thrombectomy (MT) is a highly effective therapy in patients with acute ischemic stroke due to large vessel occlusion (LVO). However, complete recanalization of the occluded vessel cannot be achieved in all patients, leading to poor clinical outcome. We analyzed the reasons for failed recanalization to help direct future improvements in therapy.

Methods

648 consecutive stroke patients with LVO and an MT attempt were retrospectively analyzed for none or minimal recanalization, assessed according to the Thrombolysis in Cerebral Infarction (TICI) score (0/1). Procedural parameters were evaluated in a standardized approach. Among other variables, number of retrieval attempts, devices, duration of the intervention, and rescue methods were analyzed.

Results

TICI 0/1 was observed in 72/648 patients (11%). In these patients, the thrombus could not be reached in 21% (n=15/72), was reached but not passed in 21% (n=15/72), and was reached and passed in 58% (n=42/72). Only a minor degree of initial recanalization was achieved in 19% (n=8/42) of patients with a reached occlusion during the course of the intervention. Furthermore, a higher number of passes with a single retriever device led to significant prolongation of the intervention. Therefore, major reasons for failed endovascular recanalization were difficult anatomical access and hard or resistant occlusions that might reflect hard thrombi or pre-existing atherosclerotic stenosis. Procedural complications such as dissection or perforation played a minor role.

Conclusion

In stroke patients with failed MT attempts, approximately 60% of occlusions can be passed. In such cases, rescue therapy might be considered to improve recanalization and clinical outcome. Further development of access devices might help in the remaining cases where the microcatheter could not be manipulated to or through the occlusion.
Can early neurological improvement after mechanical thrombectomy be used as a surrogate for final stroke outcome?
Authors: Soize Sebastien , Fabre Guillaume , Gawlitza Matthias , Serre Isabelle , Bakchine Serge , Manceau Pierre-François , Pierot Laurent
Published: November 2018

Background and purpose

We aimed to identify the best definition of early neurological improvement (ENI) at 2 and 24 hours after mechanical thrombectomy (MT) and determine its ability to predict a good functional outcome at 3 months.

Methods

This retrospective analysis was based on a prospectively collected registry of patients treated by MT for ischemic stroke from May 2010 to March 2017. We included patients treated with stent-retrievers with National Institute of Health Stroke Scale (NIHSS) score before treatment and at 2 and/or 24 hours after treatment and modified Rankin Score (mRS) at 3 months. Receiver operating characteristic curve analysis was performed to estimate optimal thresholds for ENI at 2 and 24 hours. The relationship between optimal ENI definitions and good outcome at 3 months (mRS 0–2) was assessed by logistic regression.

Results

The analysis included 246 patients. At 2 hours, the optimal threshold to predict a good outcome at 3 months was improvementin the NIHSS score of >1 point (AUC 0.83,95% CI 0.77 to 0.87), with sensitivity and specificity 78.3% (62.2–85.7%) and 84.6% (77.2–90.3%), respectively, and OR 12.67 (95% CI 4.69 to 31.10, p<0.0001). At 24 hours, the optimal threshold was an improvementin the NIHSS score of >4 points (AUC 0.93, 95% CI 0.89 to 0.96), with sensitivity and specificity 93.8% (87.7–97.5%) and 83.2% (75.7–89.2%), respectively, and OR 391.32 (95% CI 44.43 to 3448.35, p<0.0001).

Conclusions

ENI 24 hours after thrombectomy appears to be a straightforward surrogate of long-term endpoints and may have value in future research.
Comparison of analogue and electronic stethoscopes for pulmonary auscultation by internal medicine residents
Authors: Gottlieb Eric R , Aliotta Jason M , Tammaro Dominick
Published: November 2018

Background

Electronic stethoscopes are becoming more common in clinical practice. They may improve the accuracy and efficiency of pulmonary auscultation, but the data to support their benefit are limited.

Objective

To determine how auscultation with an electronic stethoscope may affect clinical decision making.

Methods

An online module consisting of six fictional ambulatory cases was developed. Each case included a brief history and lung sounds recorded with an analogue and electronic stethoscope. Internal medicine resident participants were randomly selected to hear either the analogue or electronic lung sounds. Numbers of correct answers, time spent on each case and numbers of times the recordings were played were compared between the groups who heard each mode of auscultation, with a p value of less than 0.05 indicating statistical significance.

Results

61 internal medicine residents completed at least one case, and 41 residents completed all six cases. There were no significant differences in overall scores between participants who heard analogue and electronic lung sounds (3.14±0.10 out of 6 correct for analogue, 3.20±0.10 out of 6 for electronic, p=0.74). There were no significant differences in performance for any of the six cases (p=0.78), time spent on the cases (p=0.67) or numbers of times the recordings were played (p=0.85).

Conclusion

When lung sounds were amplified with an electronic stethoscope, we did not detect an effect on performance, time spent on the cases or numbers of times participants listened to the recordings.
Shikonin exerts antitumor activity by causing mitochondrial dysfunction in hepatocellular carcinoma through PKM2–AMPK–PGC1α signaling pathway
Authors: Liu Bing , Jin Jiangbo , Zhang Ziyu , Zuo Li , Jiang Meixiu , Xie Caifeng
Published: November 2018

Shikonin, a naphthoquinone derivative isolated from the root of Lithospermum erythrorhizon, exhibits broad-spectrum antitumor activity via different molecular mechanisms. In this study, we investigated the effect of shikonin on mitochondrial dysfunction in hepatocellular carcinoma (HCC). Our results showed that shikonin inhibited the proliferation, migration, and invasiveness of HCCLM3 cells, and promoted cell apoptosis in a dose-dependent manner. More importantly, shikonin affected mitochondrial function by disrupting mitochondrial membrane potential and oxidative stress (OS) status. Furthermore, shikonin decreased the oxygen consumption rate of HCCLM3 cells, as well as the levels of ATP and metabolites involved in the tricarboxylic acid cycle (TCA cycle). We also investigated the molecular mechanisms underlying the regulation of mitochondrial function by shikonin as an inhibitor of PKM2. Shikonin decreased the expression of PKM2 in the mitochondria and affected other metabolic pathways (AMPK and PGC1α pathways), which aggravated the oxidative stress and nutrient deficiency. Our results indicate a novel role of shikonin in triggering mitochondria dysfunction via the PKM2–AMPK–PGC1α signaling pathway and provide a promising therapeutic approach for the treatment of HCC.
Adaptive drought tolerance during germination of Salsola drummondii seeds from saline and nonsaline habitats of the arid Arabian deserts
Authors: Elnaggar Attiat , El-Keblawy Ali , Mosa Kareem A. , Navarro Teresa
Published: November 2018

The effects of temperature, light, salinity, and drought on germination of halophytes have been extensively studied. However, few studies have focused on the germination of plants that grow well in both saline and nonsaline habitats (i.e., habitat-indifferent halophytes). Here, we assess the impacts of population origin, temperature, and light on drought tolerance, as simulated with polyethylene glycol (PEG), during germination of Salsola drummondii Ulbr., a habitat-indifferent halophyte from the arid Arabian deserts. Seeds were collected from both saline and nonsaline habitats and germinated at six concentrations of PEG at three temperatures and two light regimes. An increase in the concentration of PEG resulted in a significant reduction in seed germination, especially at higher temperatures. Seeds from the nonsaline habitat attained significantly greater germination efficiency at concentrations of PEG up to –1.2 MPa, but there was no difference in germination of seeds between the two habitats at concentrations of –1.5 MPa. Seeds from the saline habitat germinated significantly faster at higher concentrations of PEG. Germination was significantly higher in darkness than in light at –1.5 MPa at the lower temperatures, but the opposite was true for the higher temperatures. Seeds from saline habitats had higher levels of dormancy and faster rates of germination at higher concentrations of PEG because of their adaptation to low osmotic potentials.
Parallel Metric Tree Embedding Based on an Algebraic View on Moore-Bellman-Ford
Authors: Friedrichs Stephan , Lenzen Christoph
Published: November 2018

A
metric tree embedding
of expected
stretch α ≥ 1
maps a weighted
n
-node graph
G
= (
V
,
E
, ω) to a weighted tree
T
= (
V

T

,
E

T

, ω

T

) with
V
⊑
V

T

such that, for all
v
,
w
∈
V
, dist(
v
,
w
,
G
) ≤ dist(
v
,
w
,
T
), and E[dist(
v
,
w
,
T
)] ≤ α dist(
v
,
w
,
G
). Such embeddings are highly useful for designing fast approximation algorithms as many hard problems are easy to solve on tree instances. However, to date, the best parallel polylog
n
)-depth algorithm that achieves an asymptotically optimal expected stretch of α ∈ O(log
n
) requires Ω (
n
2
) work and a metric as input.

In this article, we show how to achieve the same guarantees using polylog
n
depth and Õ(
m
1+ε
) work, where
m
= |
E
| and ε > 0 is an arbitrarily small constant. Moreover, one may further reduce the work to Õ(
m
+
n
1+ε
) at the expense of increasing the expected stretch to O(ε
−1
log
n
).

Our main tool in deriving these parallel algorithms is an algebraic characterization of a generalization of the classic Moore-Bellman-Ford algorithm. We consider this framework, which subsumes a variety of previous “Moore-Bellman-Ford-like” algorithms, to be of independent interest and discuss it in depth. In our tree embedding algorithm, we leverage it to provide efficient query access to an approximate metric that allows sampling the tree using polylog
n
depth and Õ(
m
) work.

We illustrate the generality and versatility of our techniques by various examples and a number of additional results. Specifically, we (1) improve the state of the art for determining metric tree embeddings in the Congest model, (2) determine a (1 + εˆ)-approximate metric regarding the distances in a graph
G
in polylogarithmic depth and Õ(
n
(
m
+
n
1 + ε
)) work, and (3) improve upon the state of the art regarding the
k
-median and the buy-at-bulk network design problems.
The Effect and Mechanism of KLF7 in the TLR4/NF-κB/IL-6 Inflammatory Signal Pathway of Adipocytes
Authors: Zhang Meixiu , Wang Cuizhe , Wu Jinxiu , Ha Xiaodan , Deng Yuchun , Zhang Xueting , Wang Jingzhou , Chen Keru , Feng Jiale , Zhu Jiaojiao , Xie Jianxin , Zhang Jun
Published: November 2018

Objective. To investigate the role and possible molecular mechanism of Krüppel-like factor 7 (KLF7) in the TLR4/NF-κB/IL-6 inflammatory signaling pathway activated by free fatty acids (FFA). Methods. The mRNA and protein expression levels of KLF7 and the factors of TLR4/NF-κB/IL-6 inflammatory signal pathways were detected by qRT-PCR and Western blotting after cell culture with different concentrations of palmitic acid (PA). The expression of KLF7 or TLR4 in adipocytes was upregulated or downregulated; after that, the mRNA and protein expression levels of these key factors were detected. KLF7 expression was downregulated while PA stimulated adipocytes, and then the mRNA and protein expressions of KLF7/p65 and downstream inflammatory cytokine IL-6 were detected. The luciferase reporter assay was used to determine whether KLF7 had a transcriptional activation effect on IL-6. Results. (1) High concentration of PA can promote the expression of TLR4, KLF7, and IL-6 in adipocytes. (2) TLR4 positively regulates KLF7 expression in adipocytes. (3) KLF7 positively regulates IL-6 expression in adipocytes. (4) PA promotes IL-6 expression via KLF7 in adipocytes. (5) KLF7 has a transcriptional activation on IL-6. Conclusion. PA promotes the expression of the inflammatory cytokine IL-6 by activating the TLR4/KLF7/NF-κB inflammatory signaling pathway. In addition, KLF7 may directly bind to the IL-6 promoter region and thus activate IL-6.
Bilirubin‐Induced Oxidative Stress Leads to DNA Damage in the Cerebellum of Hyperbilirubinemic Neonatal Mice and Activates DNA Double‐Strand Break Repair Pathways in Human Cells
Authors: Rawat Vipin , Bortolussi Giulia , Gazzin Silvia , Tiribelli Claudio , Muro Andrés F.
Published: November 2018

Unconjugated bilirubin is considered a potent antioxidant when present at moderate levels. However, at high concentrations, it produces severe neurological damage and death associated with kernicterus due to oxidative stress and other mechanisms. While it is widely recognized that oxidative stress by different toxic insults results in severe damage to cellular macromolecules, especially to DNA, no data are available either on DNA damage in the brain triggered by hyperbilirubinemia during the neonatal period or on the activation of DNA repair mechanisms. Here, using a mouse model of neonatal hyperbilirubinemia, we demonstrated that DNA damage occurs in vivo in the cerebellum, the brain region most affected by bilirubin toxicity. We studied the mechanisms associated with potential toxic action of bilirubin on DNA in in vitro models, which showed significant increases in DNA damage when neuronal and nonneuronal cells were treated with 140 nM of free bilirubin (Bf), as determined by γH2AX Western blot and immunofluorescence analyses. Cotreatment of cells with N‐acetyl‐cysteine, a potent oxidative‐stress inhibitor, prevented DNA damage by bilirubin, supporting the concept that DNA damage was caused by bilirubin‐induced oxidative stress. Bilirubin treatment also activated the main DNA repair pathways through homologous recombination (HR) and nonhomologous end joining (NHEJ), which may be adaptive responses to repair bilirubin‐induced DNA damage. Since DNA damage may be another important factor contributing to neuronal death and bilirubin encephalopathy, these results contribute to the understanding of the mechanisms associated with bilirubin toxicity and may be of relevance in neonates affected with severe hyperbilirubinemia.
A Spectrum Efficient Secure Transmission Scheme Based on Directional Polarization Modulation for Wireless Communication Systems
Authors: Pei Zhongmin , Luo Zhangkai , Zou Bo
Published: November 2018

In this paper, a spectrum efficient secure transmission scheme based on directional polarization modulation (DPM) is proposed. Specifically, the polarized signals are divided into two parts, i.e., I and Q, and a dual-polarized antenna array is designed to form beams to transmit these signals. Naturally, the constellation structure is associated with the beam gain, which can be controlled to make the constellation structure distort in undesired directions. Thus the security is enhanced for the symbol error rate performance deteriorates in undesired directions. Additionally, a kind of directional modulation technique is utilized to transform one component of the polarized signal into QPSK signal and thus improves the modulation order without extra transmitting power consummation. Finally, theoretical analysis and simulation results demonstrate that the proposed scheme can improve the transmission efficiency and provide a security transmission method for wireless communication systems.
Long-Term Anatomic and Functional Outcomes after Macular Hole Surgery
Authors: Kaźmierczak Karolina , Stafiej Joanna , Stachura Joanna , Żuchowski Paweł , Malukiewicz Grażyna
Published: November 2018

Aim. To evaluate the structural and functional outcomes in patients who underwent macular hole (MH) surgery in the long-term follow-up. Materials and Methods. Forty-four eyes of 40 patients (28 females and 12 males) were examined. The examination included visual acuity, optical coherence tomography, and colour vision testing. The same evaluation was performed in 30 fellow eyes. Results. MH closure was obtained in 42 eyes (95.45%). There was no reopening of the initially closed MHs. In long-term postoperative examination, we observed IS/OS junction defects in 28 (63.6%) eyes and ELM defects in 19 (43.2%) eyes. We found that the IS/OS junction defects correlated with the diameter of the MH (p=0.016), whereas ELM defects correlated with both the diameter of the MH (p=0.001) and duration time of the MH (p=0.008). The presence of ELM defects in OCT was the cause of inferior BCVA in long-term observation time (p=0.004). The mean BCVA before the MH surgery was 0.15. It improved significantly both in early (p<0.001) and long-term postoperative observation (p<0.005). Generally, the functional outcomes were better in eyes with short-time duration of the MH, when a smaller diameter (<400 μm) of the hole was measured and a V-shaped closure of the MH and the restoration of the ELM line on OCT were present. Pseudoprotanomaly was noted in 13 (35.1%) eyes. In the fellow eye group, mean BCVA was 0.95 (range, 0.6–1.0). In 3 eyes, we detected vitreomacular traction, and in 4 eyes, initial cataract. These conditions, as well as probably early stage of diabetes mellitus, influenced functional outcomes of studied eyes. Conclusions. The anatomic and functional outcomes after macular surgery are satisfactory and improve with time. After a successful closing of the MH, the restoration of the retina progresses at a slower pace than improvement in visual acuity.
Further Results on Sampled-Data Synchronization for Complex Dynamical Networks with Time-Varying Coupling Delay
Authors: Lee Hea-Min , Kwon Wookyong , Lee Sangmoon , Kang Dongyeop
Published: November 2018

This paper deals with the sampled-data synchronization problem for complex dynamical networks (CDNs) with time-varying coupling delay. To get improved results, two-sided free-weighting stabilization method is utilized with a novel looped functional taking the information of the present sampled states and next sampled states, which can more precisely account for the sawtooth shape of the sampling delay. Also, the quadratic generalized free-weighting matrix inequality (QGFWMI), which provides additional degree of freedom (DoF), is utilized to calculate the upper limit of the integral term. Based on the novel looped functional and QGFWMI, improved conditions of stability are derived from forms of linear matrix inequalities (LMIs). The numerical examples show the validity and effectiveness.