bluuebunny/crossref_metadata_2025 huggingface dataset:
Flood diversions and bypasses: Benefits and challenges
Authors: Serra‐Llobet Anna , Kondolf George Mathias , Magdaleno Fernando , Keenan‐Jones Duncan
Published: October 2021

While levees are typically the focus of attention during floods, and higher levees are commonly demanded by the public for flood protection, levees alone cannot manage floods. Flood diversions take water from a flooding river to reduce stage in the main river, diverting excess flow to another location, often providing important ecological functions. Flood diversions are critically important complements to levees in managing floods on the Mississippi and Sacramento rivers, and elsewhere, with early examples going back 3000 years. Diversions range widely in design and function, so we propose a typology: flood bypasses, reconnected floodplains, compound channels, backwaters, distributaries, and inter‐basin transfers. Flood bypasses route floodwaters around critical reaches, rejoining the river downstream; they can be tunnels and hard‐engineered channels or wide areas of floodplain designated to convey flood flows, along a continuum of increasing residence time, greater potential for ecological benefit, but also greater land requirements. Managing the flow split (bifurcation) at the start of the flow diversion can be tricky. The flow split will depend on the angle and elevation difference between main channel and diversion, and can be affected by land subsidence, deposition of sediment, and accumulation of debris in either channel or control structures. One of the greatest challenges is keeping flow paths in the diversion free of development incompatible with inundation, but as these are often private lands and local governments are reluctant to withhold building permits, it has proved difficult to prevent such development, especially when the diversion is active only rarely.

This article is categorized under:

Engineering Water > Sustainable Engineering of Water

Water and Life > Conservation, Management, and Awareness

Science of Water > Water Extremes
Property Testing on Graphs and Games
Authors: Ito Hiro
Published: October 2021

Constant-time algorithms are powerful tools, since they run by reading only a constant-sized part of each input. Property testing is the most popular research framework for constant-time algorithms. In property testing, an algorithm determines whether a given instance satisfies some predetermined property or is far from satisfying the property with high probability by reading a constant-sized part of the input. A property is said to be testable if there is a constant-time testing algorithm for the property. This chapter covers property testing on graphs and games. The fields of graph algorithms and property testing are two of the main streams of research on discrete algorithms and computational complexity. In the section on graphs in this chapter, we present some important results, particularly on the characterization of testable graph properties. At the end of the section, we show results that we published in 2020 on a complete characterization (necessary and sufficient condition) of testable monotone or hereditary properties in the bounded-degree digraphs. In the section on games, we present results that we published in 2019 showing that the generalized chess, Shogi (Japanese chess), and Xiangqi (Chinese chess) are all testable. We believe that this is the first results for testable EXPTIME-complete problems.
Bosonic η-deformed AdS4 × $$ \mathbb{CP} $$3 background
Authors: Rado Laura , Rivelles Victor O. , Sánchez Renato
Published: October 2021

Abstract

We build the bosonic η-deformed AdS4 × $$ \mathbbm{CP} $$
CP
3 background generated by an r-matrix that satisfies the modified classical Yang-Baxter equation. In a special limit we find that it is the gravity dual of the noncommutative ABJM theory.
Unterschiede der Verletzungsmuster bei Motorradunfällen von Kindern und Jugendlichen
Authors: Oezel L. , Jaekel C. , Bieler D. , Stuewe D. , Neubert A. , Lefering R. , Grassmann J. P. , Windolf J. , Thelen S. ,   Sektion Notfall‑, Intensivmedizin und Schwerverletztenversorgung (Sektion NIS) der DGU
Published: October 2021

Hintergrund

Verkehrsunfälle und ihre Verletzungsfolgen stellen eine häufige traumatische Ursache für das Versterben und für das Auftreten von irreversiblen Schäden bei Kindern und Jugendlichen dar. Bei Motorradunfällen unterscheiden sich dabei Verletzungsmuster abhängig vom Patientenalter.

Ziel der Arbeit

Ziel dieser Studie ist es, die typischen Verletzungsmuster nach Motorradunfällen im Kindes- und Jugendalter vergleichend zu beschreiben, da diese einen ausschlaggebenden Einfluss auf die Prävention sowie die adäquate Behandlung der jeweiligen Patientengruppen bieten können.

Material und Methoden

In die Studie wurden innerhalb der Jahre 2002–2018 22.923 Patienten aus dem TraumaRegister der Deutschen Gesellschaft für Unfallchirurgie (DGU®) eingeschlossen. Die Auswertung erfolgte in 4 Altersgruppen: Gruppe 1 (4 bis 15 Jahre), Gruppe 2 (16 bis 17 Jahre), Gruppe 3 (18 bis 20 Jahre) sowie Gruppe 4 (21 bis 50 Jahre) als Kontrolle.

Ergebnisse

In Gruppe 2 stellten Extremitätenverletzungen das häufigste Verletzungsmuster dar und traten überwiegend im Bereich der unteren Extremität auf. Zudem ergab die Analyse, dass Gruppe 1 häufiger ein schweres Schädel-Hirn-Trauma erleidet, trotz initial schlechtem Zustand aber ein besseres Outcome aufweist. Thorakale, abdominelle sowie Wirbelsäulen- und Beckenverletzungen kommen bei den jüngeren Altersgruppen seltener vor. Insbesondere stellen Rippenfrakturen eine Rarität bei Kindern dar. In der Diagnostik werden Kinder im Vergleich zu Erwachsenen seltener einer Ganzkörper-CT-Diagnostik zugeführt.

Diskussion

Die Studie deckt altersabhängige Unterschiede in den Verletzungsmustern von Patienten auf, die als Beifahrer oder Fahrer eines Motorrades in einen Unfall involviert waren. Zudem konnten ebenso Unterschiede in der prä- und innerklinischen Versorgung herausgearbeitet werden.
Aktuelle Befunde zur Koinzidenz von zerebraler Amyloidangiopathie und Alzheimer-Erkrankung
Authors: Haußmann R. , Homeyer P. , Donix M. , Linn J.
Published: October 2021

Die zerebrale Amyloidangiopathie (CAA) tritt trotz verschiedener Pathomechanismen häufig koinzident zur Alzheimer-Demenz auf. Sie moduliert kognitive Defizite im Rahmen der Alzheimer-Erkrankung (AD) annehmbar durch additive Effekte, auch wenn die diesbezüglichen Zusammenhänge komplex sind. Die pathophysiologische Gemeinsamkeit beider Erkrankungen besteht in einem gestörten Amyloidmetabolismus, distinkt ist jedoch die pathologische Prozessierung von Amyloidvorläuferproteinen. Die CAA mit ihren verschiedenen Subtypen ist eine pathomechanistisch heterogene Gefäßerkrankung des Gehirns. Vaskuläre und parenchymatöse Amyloidablagerungen kommen gemeinsam, aber auch isoliert und unabhängig voneinander vor. Um den spezifischen Beitrag der CAA zu kognitiven Defiziten im Rahmen der AD zu untersuchen, bedarf es daher geeigneter diagnostischer Methoden, die der Komplexität der histopathologischen bzw. bildmorphologischen Charakteristika der CAA gerecht werden, sowie differenzierender testpsychometrischer Verfahren, anhand derer der Beitrag der CAA zu kognitiven Defiziten deskriptiv erfasst und damit ätiologisch besser zuordenbar wird.
„iFightDepression“ im stationären Setting
Authors: Schwarz Julian , Mauche Nicole , Oehler Caroline , Rummel-Kluge Christine , Hegerl Ulrich , Strauß Maria
Published: October 2021

Hintergrund

E‑Mental-Health (EMH) spielt im ambulanten Versorgungssetting depressiver Störungen zunehmend eine Rolle. Ziel dieser Studie war die Implementierung und Evaluierung der Anwendbarkeit und des Nutzens des onlinebasierten Selbstmanagementprogramms „iFightDepression“ (iFD) als Zusatzangebot im Rahmen einer leitliniengerechten Behandlung auf einer Spezialstation für affektive Störungen.

Methodik

Es wurden insgesamt 78 stationäre PatientInnen mit einer unipolaren Depression unterschiedlichen Schweregrades (ICD-10 F32.0‑3, F33.0-3) oder einer Dysthymie (F34) rekrutiert. Die Interventionsdauer mit dem iFD-Tool belief sich vom Zeitpunkt der stationären Aufnahme bis zur Entlassung und wurde vom Stationspersonal begleitet. Die Erhebung der Symptomschwere sowie von Parametern zur Behandlungserwartung und Therapievorerfahrung erfolgte online vor der Intervention (T0), die Interventionszufriedenheit wurde unmittelbar vor der stationären Entlassung (T1) mittels eines Paper-pencil-Fragebogens erfasst.

Ergebnisse

Von den 78 Teilnehmenden loggten sich 42 mindestens einmal in das iFD-Tool ein. Es zeigten sich moderat hohe Erwartungswerte sowie leicht überdurchschnittliche Zufriedenheitswerte bezüglich der Behandlung. 67 % der aktiven NutzerInnen gaben an, das iFD-Tool poststationär weiter nutzen zu wollen. Wesentliche Gründe gegen die Nutzung waren eine kurze Aufenthaltsdauer, eine schwere depressive Symptomatik und fehlende Medienkompetenz.

Diskussion

Eine Implementierung des iFD-Tools im stationären Setting ist prinzipiell machbar und führte zu positiven Rückmeldungen seitens der NutzerInnen. Auch konnten sich die meisten aktiv an der Studie Teilnehmenden eine weitere Nutzung des iFD-Tools nach der Entlassung gut vorstellen. Allerdings weisen die insgesamt geringen Nutzungs- (42/78, 54 %) und Komplettierungsraten auf Nutzungsbarrieren hin, deren Überwindung entsprechende Anpassungen der Intervention speziell für den stationären Einsatz erforderlich machen.
The malting parameters: steeping, germination, withering, and kilning temperature and aeration rate as possibilities for styrene mitigation in wheat beer
Authors: Kalb Valerian , Seewald Torsten , Hofmann Thomas , Granvogl Michael
Published: October 2021

Aiming at the mitigation of the toxicologically relevant styrene formed during wheat beer brewing, different malting parameters, such as steeping temperature, germination temperature, withering and kilning temperatures applied during kiln-drying, and aeration rate, were evaluated for their suitability to reduce the content of cinnamic acid, the precursor of styrene, in malts of barley and wheat, responsible for the input of the undesired precursor into the brewing process. According to the results of the present study, higher steeping temperatures, higher germination temperatures, lower aeration rates, and lower withering temperatures during malting are beneficial for the overall reduction of cinnamic acid in wort produced with barley and wheat malts. Thereby, the withering temperature showed the highest impact among the investigated parameters, able to reduce the soluble cinnamic acid content in wort by up to 72%, followed by the germination temperature in combination with the aeration rate and the steeping temperature with reduction capacities of 52 and 16%, respectively. Additionally, a kilning temperature of 200 °C led to the absence of enzyme activities in dark malts, which might also be the main reason for the low phenolic acid contents found in the corresponding wort, finally causing the low concentrations of styrene but also to a certain extent of desired vinyl aromatics in dark wheat beers.
A novel analytic approach for outcome prediction in diffuse large B-cell lymphoma by [18F]FDG PET/CT
Authors: Zhang Xiaohui , Chen Lin , Jiang Han , He Xuexin , Feng Liu , Ni Miaoqi , Ma Mindi , Wang Jing , Zhang Teng , Wu Shuang , Zhou Rui , Jin Chentao , Zhang Kai , Qian Wenbin , Chen Zexin , Zhuo Cheng , Zhang Hong , Tian Mei
Published: October 2021

Purpose

This study aimed to develop a novel analytic approach based on 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography ([18F]FDG PET/CT) radiomic signature (RS) and International Prognostic Index (IPI) to predict the progression-free survival (PFS) and overall survival (OS) of patients with diffuse large B-cell lymphoma (DLBCL).

Methods

We retrospectively enrolled 152 DLBCL patients and divided them into a training cohort (n = 100) and a validation cohort (n = 52). A total of 1245 radiomic features were extracted from the total metabolic tumor volume (TMTV) and the metabolic bulk volume (MBV) of pre-treatment PET/CT images. The least absolute shrinkage and selection operator (LASSO) algorithm was applied to develop the RS. Cox regression analysis was used to construct hybrid nomograms based on different RS and clinical variables. The performances of hybrid nomograms were evaluated using the time-dependent receiver operator characteristic (ROC) curve and the Hosmer–Lemeshow test. The clinical utilities of prediction nomograms were determined via decision curve analysis. The predictive efficiency of different RS, clinical variables, and hybrid nomograms was compared.

Results

The RS and IPI were identified as independent predictors of PFS and OS, and were selected to construct hybrid nomograms. Both TMTV- and MBV-based hybrid nomograms had significantly higher values of area under the curve (AUC) than IPI in training and validation cohorts (all P < 0.05), while no significant difference was found between TMTV- and MBV-based hybrid nomograms (P > 0.05). The Hosmer–Lemeshow test showed that both TMTV- and MBV-based hybrid nomograms calibrated well in the training and validation cohorts (all P > 0.05). Decision curve analysis indicated that hybrid nomograms had higher net benefits than IPI.

Conclusion

The hybrid nomograms combining RS with IPI could significantly improve survival prediction in DLBCL. Radiomic analysis on MBV may serve as a potential approach for prognosis assessment in DLBCL.

Trial registration

NCT04317313. Registered March 16, 2020. Public site: https://clinicaltrials.gov/ct2/show/NCT04317313
Proof of concept of a multimodal intravital molecular imaging system for tumour transpathology investigation
Authors: Liu Zhen , Cheng Tao , Düwel Stephan , Jian Ziying , Topping Geoffrey J. , Steiger Katja , Wang Qian , Braren Rickmer , Reder Sybille , Mittelhäuser Markus , Hundshammer Christian , Feuerecker Benedikt , Huang Sung-Cheng , Schwaiger Markus , Schilling Franz , Ziegler Sibylle I. , Shi Kuangyu
Published: October 2021

Background

Transpathology highlights the interpretation of the underlying physiology behind molecular imaging. However, it remains challenging due to the discrepancies between in vivo and in vitro measurements and difficulties of precise co-registration between trans-scaled images. This study aims to develop a multimodal intravital molecular imaging (MIMI) system as a tool for in vivo tumour transpathology investigation.

Methods

The proposed MIMI system integrates high-resolution positron imaging, magnetic resonance imaging (MRI) and microscopic imaging on a dorsal skin window chamber on an athymic nude rat. The window chamber frame was designed to be compatible with multimodal imaging and its fiducial markers were customized for precise physical alignment among modalities. The co-registration accuracy was evaluated based on phantoms with thin catheters. For proof of concept, tumour models of the human colorectal adenocarcinoma cell line HT-29 were imaged. The tissue within the window chamber was sectioned, fixed and haematoxylin–eosin (HE) stained for comparison with multimodal in vivo imaging.

Results

The final MIMI system had a maximum field of view (FOV) of 18 mm × 18 mm. Using the fiducial markers and the tubing phantom, the co-registration errors are 0.18 ± 0.27 mm between MRI and positron imaging, 0.19 ± 0.22 mm between positron imaging and microscopic imaging and 0.15 ± 0.27 mm between MRI and microscopic imaging. A pilot test demonstrated that the MIMI system provides an integrative visualization of the tumour anatomy, vasculatures and metabolism of the in vivo tumour microenvironment, which was consistent with ex vivo pathology.

Conclusions

The established multimodal intravital imaging system provided a co-registered in vivo platform for trans-scale and transparent investigation of the underlying pathology behind imaging, which has the potential to enhance the translation of molecular imaging.
Supervised Immediate Postoperative Mobilization After Elective Colorectal Surgery: A Feasibility Study
Authors: Thörn Rose‐Marie W. , Stepniewski Jan , Hjelmqvist Hans , Forsberg Anette , Ahlstrand Rebecca , Ljungqvist Olle
Published: October 2021

Background

Early mobilization is a significant part of the ERAS® Society guidelines, in which patients are recommended to spend 2 h out of bed on the day of surgery. However, it is not yet known how early patients can safely be mobilized after completion of colorectal surgery. The aim of this study was to evaluate the feasibility, and safety of providing almost immediate structured supervised mobilization starting 30 min post‐surgery at the postoperative anesthesia care unit (PACU), and to describe reactions to this approach.

Methods

This feasibility study includes 42 patients aged ≥18 years who received elective colorectal surgery at Örebro University Hospital. They underwent a structured mobilization performed by a specialized physiotherapist using a modified Surgical ICU Optimal Mobilization Score (SOMS). SOMS determines the level of mobilization at four levels from no activity to ambulating. Mobilization was considered successful at SOMS ≥ 2, corresponding to sitting on the edge of the bed as a proxy of sitting in a chair due to lack of space.

Results

In all, 71% (n = 30) of the patients reached their highest level of mobilization between the second and third hour of arrival in the PACU. Before discharge to the ward, 43% (n = 18) could stand at the edge of the bed and 38% (n = 16) could ambulate. Symptoms that delayed advancement of mobilization were pain, somnolence, hypotension, nausea, and patient refusal. No serious adverse events occurred.

Conclusions

Supervised mobilization is feasible and can safely be initiated in the immediate postoperative care after colorectal surgery.

Trial registration Clinical trials.gov identifier: NTC03357497.
Analysis of mammograms using artificial intelligence to predict response to neoadjuvant chemotherapy in breast cancer patients: proof of concept
Authors: Skarping I. , Larsson M. , Förnvik D.
Published: October 2021

Objectives

In this proof of concept study, a deep learning–based method for automatic analysis of digital mammograms (DM) as a tool to aid in assessment of neoadjuvant chemotherapy (NACT) treatment response in breast cancer (BC) was examined.

Methods

Baseline DM from 453 patients receiving NACT between 2005 and 2019 were included in the study cohort. A deep learning system, using the aforementioned baseline DM, was developed to predict pathological complete response (pCR) in the surgical specimen after completion of NACT. Two image patches, one extracted around the detected tumour and the other from the corresponding position in the reference image, were fed into a classification network. For training and validation, 1485 images obtained from 400 patients were used, and the model was ultimately applied to a test set consisting of 53 patients.

Results

A total of 95 patients (21%) achieved pCR. The median patient age was 52.5 years (interquartile range 43.7–62.1), and 255 (56%) were premenopausal. The artificial intelligence (AI) model predicted the pCR as represented by the area under the curve of 0.71 (95% confidence interval 0.53–0.90; p = 0.035). The sensitivity was 46% at a fixed specificity of 90%.

Conclusions

Our study describes an AI platform using baseline DM to predict BC patients’ responses to NACT. The initial AI performance indicated the potential to aid in clinical decision-making. In order to continue exploring the clinical utility of AI in predicting responses to NACT for BC, further research, including refining the methodology and a larger sample size, is warranted.

Key Points

• We aimed to answer the following question: Prior to initiation of neoadjuvant chemotherapy, can artificial intelligence (AI) applied to digital mammograms (DM) predict breast tumour response?

• DMs contain information that AI can make use of for predicting pathological complete (pCR) response after neoadjuvant chemotherapy for breast cancer.

• By developing an AI system designed to focus on relevant parts of the DM, fully automatic pCR prediction can be done well enough to potentially aid in clinical decision-making.
Inter-island local adaptation in the Galápagos Archipelago: genomics of the Galápagos blue-banded goby, Lythrypnus gilberti
Authors: Bernardi Giacomo
Published: October 2021

The Galápagos Archipelago is a place where terrestrial adaptive radiations of finches, mockingbirds, and tortoises have been studied extensively. In contrast, little is known about the potential for marine species to diverge among islands. The overall degradation of coral reefs in the Galápagos makes understanding the mechanisms and factors of speciation, the engine of biodiversity, important, and timely. While speciation in marine archipelagos has been described in the past, such as for cone snails in Cabo Verde Archipelago and limpets in Hawaii, adaptive radiations in the marine environment are still rare and poorly understood. In this study, we focused on the Galápagos blue-banded goby,Lythrypnus gilberti, a small endemic fish that is found in shallow subtidal rocky habitats. Using RAD sequencing, we analyzed 19,504 loci that were either neutral, or potentially under directional selection. As expected, considering the small geographic range, population structure based on neutral markers was weak. For loci under directional selection, however, marked differences between islands suggested potential for local adaptation. Our data suggest that for marine species, where dispersal barriers are less apparent, mechanisms of local adaptation may also be at play in the Galápagos Archipelago.
Septoplasty with and without additional sinonasal surgery: postoperative sequelae and the use of prophylactic antibiotics
Authors: Kotisalmi Ida , Hytönen Maija , Mäkitie Antti A. , Lilja Markus
Published: October 2021

Purpose

One of the most common complications after septoplasty is a postoperative infection. We investigated the number of postoperative infections and unplanned postoperative visits (UPV) in septoplasties with and without additional nasal surgery at our institution and evaluated the role of antibiotic prophylaxis.

Methods

We collected data of all consecutive 302 septoplasty or septocolumelloplasty patients operated during the year 2018 at the Department of Otorhinolaryngology-Head and Neck Surgery, HUS Helsinki University Hospital (Helsinki, Finland). Hospital charts were reviewed to record sociodemographic patient characteristics and clinical parameters regarding surgery and follow-up.

Results

Altogether 239 patients (79.1%) received pre- and/or postoperative prophylactic antibiotics and within this group 3.3% developed a postoperative infection. The infection rate in the non-prophylaxis group of 63 patients was 12.7% (p = 0.007). When all patients who received postoperative antibiotics were excluded, we found that the infection rate in the preoperative prophylaxis group was 3.8%, as opposed to an infection rate of 12.7% in the non-prophylaxis group (p = 0.013). When evaluating septoplasty with additional sinonasal surgery (n = 115) the rate of postoperative infection was 3.3% in the prophylaxis group and 16.7% in the non-prophylaxis group (p = 0.034). These results show a statistically significant stand-alone effect of preoperative prophylactic antibiotics in preventing postoperative infection in septoplasty, especially regarding additional sinonasal surgery.

Conclusion

The use of preoperative antibiotics as a prophylactic measure diminished statistically significantly the rate of infections and UPVs in septoplasty when all postoperative infections, superficial and mild ones included, were taken into account.
Factors associated with lifetime suicide attempts in bipolar disorder: results from an Italian nationwide study
Authors: Buoli Massimiliano , Cesana Bruno Mario , Bolognesi Simone , Fagiolini Andrea , Albert Umberto , Di Salvo Gabriele , Maina Giuseppe , de Bartolomeis Andrea , Pompili Maurizio , Palumbo Claudia , Bondi Emi , Steardo Luca , De Fazio Pasquale , Amore Mario , Altamura Mario , Bellomo Antonello , Bertolino Alessandro , Di Nicola Marco , Di Sciascio Guido , Fiorillo Andrea , Sacchetti Emilio , Sani Gabriele , Siracusano Alberto , Di Lorenzo Giorgio , Tortorella Alfonso , Altamura A. Carlo , Dell’Osso Bernardo ,   the ISBD Italian Chapter Epidemiologic Group
Published: October 2021

The purpose of the present study was to detect demographic and clinical factors associated with lifetime suicide attempts in Bipolar Disorder (BD). A total of 1673 bipolar patients from different psychiatric departments were compared according to the lifetime presence of suicide attempts on demographic/clinical variables. Owing to the large number of variables statistically related to the dependent variable (presence of suicide attempts) at the univariate analyses, preliminary multiple logistic regression analyses were realized. A final multivariable logistic regression was then performed, considering the presence of lifetime suicide attempts as the dependent variable and statistically significant demographic/clinical characteristics as independent variables. The final multivariable logistic regression analysis showed that an earlier age at first contact with psychiatric services (odds ratio [OR] = 0.97, p < 0.01), the presence of psychotic symptoms (OR = 1.56, p < 0.01) or hospitalizations (OR = 1.73, p < 0.01) in the last year, the attribution of symptoms to a psychiatric disorder (no versus yes: OR = 0.71, partly versus yes OR = 0.60, p < 0.01), and the administration of psychoeducation in the last year (OR = 1.49, p < 0.01) were all factors associated with lifetime suicide attempts in patients affected by BD. In addition, female patients resulted to have an increased association with life-long suicidal behavior compared to males (OR: 1.02, p < 0.01). Several clinical factors showed complex associations with lifetime suicide attempts in bipolar patients. These patients, therefore, require strict clinical monitoring for their predisposition to a less symptom stabilization. Future research will have to investigate the best management strategies to improve the prognosis of bipolar subjects presenting suicidal behavior.
The association of elevated blood pressure during ischaemic exercise with sport performance in Master athletes with and without morbidity
Authors: Zambolin Fabio , McPhee Jamie S. , Duro-Ocana Pablo , Ganse Bergita , Bagley Liam , Faisal Azmy
Published: October 2021

Background

An exaggerated exercise blood pressure (BP) is associated with a reduced exercise capacity. However, its connection to physical performance during competition is unknown.

Aim

To examine BP responses to ischaemic handgrip exercise in Master athletes (MA) with and without underlying morbidities and to assess their association with athletic performance during the World Master Track Cycling Championships 2019.

Methods

Forty-eight Master cyclists [age 59 ± 13yrs; weekly training volume 10.4 ± 4.1 h/week; handgrip maximum voluntary contraction (MVC) 46.3 ± 11.5 kg] divided into 2 matched groups (24 healthy MA and 24 MA with morbidity) and 10 healthy middle-aged non-athlete controls (age 48.3 ± 8.3 years; MVC 40.4 ± 14.8 kg) performed 5 min of forearm occlusion including 1 min handgrip isometric contraction (40%MVC) followed by 5 min recovery. Continuous beat-by-beat BP was recorded using finger plethysmography. Age-graded performance (AGP) was calculated to compare race performances among MA. Healthy Master cyclists were further grouped into middle-age (age 46.2 ± 6.4 years; N:12) and old-age (age 65.0 ± 7.7 years; N:12) for comparison with middle-aged non-athlete controls.

Results

Healthy and morbidity MA groups showed similar BP responses during forearm occlusion and AGP (90.1 ± 4.3% and 91.0 ± 5.3%, p > 0.05, respectively). Healthy and morbidity MA showed modest correlation between the BP rising slope for 40%MVC ischaemic exercise and AGP (r = 0.5, p < 0.05). MA showed accelerated SBP recovery after cessation of ischaemic handgrip exercise compared to healthy non-athlete controls.

Conclusion

Our findings associate long-term athletic training with improved BP recovery following ischaemic exercise regardless of age or reported morbidity. Exaggerated BP in Master cyclists during ischaemic exercise was associated with lower AGP during the World Master Cycling Championships.
Mapping input noise to escape noise in integrate-and-fire neurons: a level-crossing approach
Authors: Schwalger Tilo
Published: October 2021

Noise in spiking neurons is commonly modeled by a noisy input current or by generating output spikes stochastically with a voltage-dependent hazard rate (“escape noise”). While input noise lends itself to modeling biophysical noise processes, the phenomenological escape noise is mathematically more tractable. Using the level-crossing theory for differentiable Gaussian processes, we derive an approximate mapping between colored input noise and escape noise in leaky integrate-and-fire neurons. This mapping requires the first-passage-time (FPT) density of an overdamped Brownian particle driven by colored noise with respect to an arbitrarily moving boundary. Starting from the Wiener–Rice series for the FPT density, we apply the second-order decoupling approximation of Stratonovich to the case of moving boundaries and derive a simplified hazard-rate representation that is local in time and numerically efficient. This simplification requires the calculation of the non-stationary auto-correlation function of the level-crossing process: For exponentially correlated input noise (Ornstein–Uhlenbeck process), we obtain an exact formula for the zero-lag auto-correlation as a function of noise parameters, mean membrane potential and its speed, as well as an exponential approximation of the full auto-correlation function. The theory well predicts the FPT and interspike interval densities as well as the population activities obtained from simulations with colored input noise and time-dependent stimulus or boundary. The agreement with simulations is strongly enhanced across the sub- and suprathreshold firing regime compared to a first-order decoupling approximation that neglects correlations between level crossings. The second-order approximation also improves upon a previously proposed theory in the subthreshold regime. Depending on a simplicity-accuracy trade-off, all considered approximations represent useful mappings from colored input noise to escape noise, enabling progress in the theory of neuronal population dynamics.
Distribution of electric field in patients with obsessive compulsive disorder treated with deep brain stimulation of the bed nucleus of stria terminalis
Authors: Naesström Matilda , Johansson Johannes , Hariz Marwan , Bodlund Owe , Wårdell Karin , Blomstedt Patric
Published: October 2021

Background

Deep brain stimulation (DBS) is being investigated as a treatment for therapy-refractory obsessive compulsive disorder (OCD). Many different brain targets are being trialled. Several of these targets such as the ventral striatum (including the nucleus accumbens (NAc)), the ventral capsule, the inferior thalamic peduncle, and the bed nucleus of stria terminalis (BNST)) belong to the same network, are anatomically very close to one another, or even overlap. Data is still missing on how various stimulation parameters in a given target will affect surrounding anatomical areas and impact the clinical outcome of DBS.

Methods

In a pilot study of eleven participants with DBS of the BNST, we investigate through patient-specific simulation of electric field, which anatomical areas are affected by the electric field, and if this can be related to the clinical results. Our study combined individual patient’s stimulation parameters at 12- and 24-month follow-up with image data from the preoperative MRI and postoperative CT. These data were used to calculate the distribution of electric field and create individual anatomical models of the field of stimulation.

Results

The individual electric stimulation fields by stimulation in the BNST were similar at both the 12- and 24-month follow-up, involving mainly anterior limb of the internal capsule (ALIC), genu of the internal capsule (IC), BNST, fornix, anteromedial globus pallidus externa (GPe), and the anterior commissure. A statistical significant correlation (p < 0.05) between clinical effect measured by the Yale-Brown Obsessive Compulsive Scale and stimulation was found at the 12-month follow-up in the ventral ALIC and anteromedial GPe.

Conclusions

Many of the targets under investigation for OCD are in anatomical proximity. As seen in our study, off-target effects are overlapping. Therefore, DBS in the region of ALIC, NAc, and BNST may perhaps be considered to be stimulation of the same target.
In-hospital postoperative opioid use and its trends in neurosurgery between 2007 and 2018
Authors: Rautalin Ilari , Kallio Miia , Korja Miikka
Published: October 2021

Background

Postoperative opioid use plays an important role in the global opioid crisis, but little is known about in-hospital opioid use trends of large surgical units. We investigated whether postoperative in-hospital opioid consumption changed in a large academic neurosurgical unit between 2007 and 2018.

Methods

We extracted the data of consumed opioids in the neurosurgical intensive care unit and two bed wards between 2007 and 2018. Besides overall consumption, we analyzed the trends for weak (tramadol and codeine), strong, and the most commonly used opioids. The use of various opioids was standardized using the defined daily doses (DDDs) of each opioid agent. A linear regression analysis was performed to estimate annual treatment day-adjusted changes with 95% confidence intervals.

Results

Overall, 121 361 opioid DDDs were consumed during the 196 199 treatment days. Oxycodone was the most commonly used postoperative opioid (49% of all used opioids) in neurosurgery. In the bed wards, the use of oral oxycodone increased 375% (on average 13% (9–17%) per year), and the use of transdermal buprenorphine 930% (on average 26% (9–45%) per year) over the 12-year period. Despite the increased use of strong opioids in the bed wards (on average 3% (1–4%) per year), overall opioid use decreased 39% (on average 6% (4–7%) per year) between 2007 and 2018.

Conclusions

Due to the increase of strong opioid use in the surgical bed wards, we encourage other large teaching hospitals and surgical units to investigate whether their opioid use trends are similarly worrisome and whether the opioid consumption changes in the hospital setting are transferred to opioid use patterns or opioid-related harms after discharge.
Activation of whole body by high levels of polyamine intake in rats
Authors: Teratani Takumi , Kasahara Naoya , Ijichi Tetsuo , Fujimoto Yasuhiro , Sakuma Yasunaru , Sata Naohiro , Kitayama Joji
Published: October 2021

Polyamines are important to the survival and activation of organs and tissues via a homeostatic cell-metabolic process, and the polyamine content in cytoplasm decreases with aging. Decreases in cellular polyamine have been known to augment mutagenesis and cell death. Thus, supplementary polyamine in food is important to the prevention of aging. Here we show the anti-aging effects of oral intake of polyamine using luciferase-transgenic rats. Healthy rats, 10–12 weeks old, were given foods containing 0.01% and 0.1% (w/w) of polyamine, as compared a control food without polyamine, for 4 weeks. Using a bioimaging system, the photon intensities seen in the whole bodies and livers of rats consuming 0.1% of polyamine in food were stronger than those in rats consuming 0.01% and 0% of polyamine. However, there were no differences between groups in other characteristics, such as liver damage and body weight. In conclusion, we found that polyamine intake can activate cells throughout the whole body, providing an anti-aging effect.
Feature definition and comprehensive analysis on the robust identification of intraretinal cystoid regions using optical coherence tomography images
Authors: de Moura Joaquim , Vidal Plácido L. , Novo Jorge , Rouco José , Penedo Manuel G. , Ortega Marcos
Published: October 2021

Currently, optical coherence tomography is one of the most used medical imaging modalities, offering cross-sectional representations of the studied tissues. This image modality is specially relevant for the analysis of the retina, since it is the internal part of the human body that allows an almost direct examination without invasive techniques. One of the most representative cases of use of this medical imaging modality is for the identification and characterization of intraretinal fluid accumulations, critical for the diagnosis of one of the main causes of blindness in developed countries: the Diabetic Macular Edema. The study of these fluid accumulations is particularly interesting, both from the point of view of pattern recognition and from the different branches of health sciences. As these fluid accumulations are intermingled with retinal tissues, they present numerous variants according to their severity, and change their appearance depending on the configuration of the device; they are a perfect subject for an in-depth research, as they are considered to be a problem without a strict solution. In this work, we propose a comprehensive and detailed analysis of the patterns that characterize them. We employed a pool of 11 different texture and intensity feature families (giving a total of 510 markers) which we have analyzed using three different feature selection strategies and seven complementary classification algorithms. By doing so, we have been able to narrow down and explain the factors affecting this kind of accumulations and tissue lesions by means of machine learning techniques with a pipeline specially designed for this purpose.
Functional capacity vs side effects: treatment attributes to consider when individualising treatment for patients with rheumatoid arthritis
Authors: Bywall Karin Schölin , Esbensen Bente Appel , Lason Marta , Heidenvall Marie , Erlandsson Inger , Johansson Jennifer Viberg
Published: October 2021

Introduction

Individualisation of rheumatoid arthritis (RA) treatment needs to take account of individual patients’ preferences to increase patient-centeredness in treatment decisions. The aim of this study was to identify patient-relevant treatment attributes to consider when individualising treatment for patients with RA.

Method

Patients with RA in Sweden were invited to rank the most important treatment attributes in an online survey (April to May 2020). Semi-structured interviews were conducted (October to November 2020) to further identify and frame potential attributes for shared decision-making. The interviews were audio-recorded, transcribed and analysed using thematic framework analysis. Patient research partners and rheumatologists supported the selection and framing of the treatment attributes across the assessment.

Results

The highest ranked attributes (N = 184) were improved functional capacity, reduced inflammation, reduced pain and fatigue and the risk of getting a severe side effect. The framework analysis revealed two overarching themes for further exploration: treatment goals and side effects. ‘Treatment goals’ emerged from functional capacity, revealing two dimensions: physical functional capacity and psychosocial functional capacity. ‘Side effects’ revealed that mild and severe side effects were the most important to discuss in shared decision-making.

Conclusions

Functional capacity (physical and psychosocial) and potential side effects (mild and severe) are important treatment attributes to consider when individualising RA treatment. Future research should assess how patients with RA weigh benefits and risks against each other, in order to increase patient-centeredness early on the treatment trajectory.

Key Points• It is essential for the individualisation of treatment to identify what attributes patients with RA are willing to trade off in order to increase patient-centeredness in precision care.• Individualisation of rheumatoid arthritis treatment needs to account for patients’ preferences on functional capacity and side effects.• Future research is needed to assess how patients with rheumatoid arthritis weigh functional capacity against side effects, in order to increase patient-centeredness in treatment decisions.
Die Testung von Äpfeln auf ihre Allergenität
Authors: Becker Soraya , Becker Sylvia , Chebib Soraya , Schwab Wilfried , Dierend Werner , Zuberbier Torsten , Bergmann Karl-Christian
Published: October 2021

Äpfel besitzen mehrere Allergene, die beim Essen innerhalb von 5–10 min zu Symptomen im Mundbereich führen – und deshalb von Apfelallergikern nicht gegessen werden können. In Deutschland haben rund 7,5 Mio. Menschen spezifische Antikörper gegen das Hauptallergen (Mal d 1) in Äpfeln entwickelt und sind damit sensibilisiert. Mindestens 3,5 Mio. von ihnen entwickeln die teilweise erheblichen allergischen Symptome als Ausdruck eines Oralen Allergie-Syndroms. Es gibt bisher keine medikamentöse Therapie gegen diese Allergie.

Apfelallergiker können daher nur auf Äpfel ganz verzichten, oder vorher erhitzte Äpfel essen oder Sorten suchen, die wenig Allergene enthalten und deshalb als allergikerfreundliche Apfelsorten bezeichnet werden können.

Alleinige Bestimmungen von Allergenen im Labor können nicht voraussagen, ob ein Apfel ohne allergische Symptome von Apfelallergikern gegessen werden kann; dazu bedarf es klinischer Prüfungen.

Wir beschreiben eine standardisierte klinische, orale Provokationstestung, die zur Charakterisierung eines allergenarmen, allergikerfreundlichen Apfels bzw. Apfelsorte benutzt werden kann.. Die Ergebnisse solcher mindestens dreijährigen Tests können zur Verleihung des ECARF-Siegels für allergikerfreundliche Produkte genutzt werden
Making Every Contact Count and Healthy Conversation Skills as very brief or brief behaviour change interventions: a scoping review
Authors: Parchment Amelia , Lawrence Wendy , Perry Rachel , Rahman Em , Townsend Nick , Wainwright Elaine , Wainwright David
Published: October 2021

Aim

To identify and map the available evidence regarding the implementation of Making Every Contact Count and/or Healthy Conversation Skills for both staff delivering and service users receiving the brief or very brief intervention/s.

Methods

A scoping review approach was used to rapidly map and provide an overview of the relevant literature, identify gaps in knowledge, and inform further, related research. Articles investigating experiences, perceptions and impact of Making Every Contact Count and/or Healthy Conversation Skills were included. Quantitative, qualitative, and mixed methods studies were eligible for inclusion, as were reviews and reports.

Results

Twenty-two articles were included in total. Healthy Conversation Skills training was found to be acceptable, and had a positive impact on staff confidence and competence in supporting behaviour change, across studies. Some positive effects of intervention exposure on the sedentary behaviour and dietary quality of service users were evidenced. Changes in confidence following Making Every Contact Count training were varied, as was perceived acceptability of the intervention for staff. Two studies highlighted positive impacts of the intervention on service user health; however, statistical significance was not reported. The perceived barriers and facilitators of implementation for both interventions mapped mostly to ‘Environmental Context and Resources’ on the Theoretical Domains Framework.

Conclusion

Healthy Conversation Skills is an acceptable and effective behaviour change intervention that could provide a consistent approach to Making Every Contact Count training and evaluation. Further research is warranted to evaluate this approach for more staff and service user groups.
Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners
Authors: Littman Lisa
Published: October 2021

The study’s purpose was to describe a population of individuals who experienced gender dysphoria, chose to undergo medical and/or surgical transition and then detransitioned by discontinuing medications, having surgery to reverse the effects of transition, or both. Recruitment information with a link to an anonymous survey was shared on social media, professional listservs, and via snowball sampling. Sixty-nine percent of the 100 participants were natal female and 31.0% were natal male. Reasons for detransitioning were varied and included: experiencing discrimination (23.0%); becoming more comfortable identifying as their natal sex (60.0%); having concerns about potential medical complications from transitioning (49.0%); and coming to the view that their gender dysphoria was caused by something specific such as trauma, abuse, or a mental health condition (38.0%). Homophobia or difficulty accepting themselves as lesbian, gay, or bisexual was expressed by 23.0% as a reason for transition and subsequent detransition. The majority (55.0%) felt that they did not receive an adequate evaluation from a doctor or mental health professional before starting transition and only 24.0% of respondents informed their clinicians that they had detransitioned. There are many different reasons and experiences leading to detransition. More research is needed to understand this population, determine the prevalence of detransition as an outcome of transition, meet the medical and psychological needs of this population, and better inform the process of evaluation and counseling prior to transition.
Reexamining the Formation of Environmentally Persistent Free Radicals from Aromatic Molecules on Metal Oxides
Authors: Morazzoni Franca
Published: October 2021

The subject is a debate on the formation mechanism of the environmentally persistent free radicals (EPFR), by interaction of aromatics with transition metal oxides. Literature reports contrasting opinions concerning the stabilization of the phenoxyradicals mainly as concerns the suggested reduction of interacting transition metal centers. The present paper, in accordance with the mechanisms assessed by a number of spectroscopic and computational results, excludes the necessity that the catalytic mechanism involves the reduction of the metal centers by interaction with the aromatics.

Graphic Abstract
The lymphatic system and sentinel lymph nodes: conduit for cancer metastasis
Authors: Leong Stanley P. , Pissas Alexander , Scarato Muriel , Gallon Francoise , Pissas Marie Helene , Amore Miguel , Wu Max , Faries Mark B. , Lund Amanda W.
Published: October 2021

The lymphatic system is a complicated system consisting of the lymphatic vessels and lymph nodes draining the extracellular fluid containing cellular debris, excess water and toxins to the circulatory system. The lymph nodes serve as a filter, thus, when the lymph fluid returns to the heart, it is completely sterile. In addition, the lymphatic system includes the mucosa-associated lymphoid tissue, such as tonsils, adenoids, Peyers patches in the small bowel and even the appendix. Taking advantage of the drainage system of the lymphatics, cancer cells enter the lymphatic vessels and then the lymph nodes. In general, the lymph nodes may serve as a gateway in the majority of cases in early cancer. Occasionally, the cancer cells may enter the blood vessels. This review article emphasizes the structural integrity of the lymphatic system through which cancer cells may spread. Using melanoma and breast cancer sentinel lymph node model systems, the spread of early cancer through the lymphatic system is progressive in a majority of cases. The lymphatic systems of the internal organs are much more complicated and difficult to study. Knowledge from melanoma and breast cancer spread to the sentinel lymph node may establish the basic principles of cancer metastasis. The goal of this review article is to emphasize the complexity of the lymphatic system. To date, the molecular mechanisms of cancer spread from the cancer microenvironment to the sentinel lymph node and distant sites are still poorly understood and their elucidation should take major priority in cancer metastasis research.