bluuebunny/crossref_metadata_2025 huggingface dataset:
High-performance inverted planar perovskite solar cells using a pristine fullerene mixture as an electron-transport layer
Authors: Xu Chongyang , Liu Zhihai , Lee Eun-Cheol
Published: May 2019

A mixture of C60/C70can improve the solubility and maintain the original electron-transport property at the same time.
Predicting Speech Recognition Using the Speech Intelligibility Index and Other Variables for Cochlear Implant Users
Authors: Lee Sungmin , Mendel Lisa Lucks , Bidelman Gavin M.
Published: May 2019

Purpose

Although the speech intelligibility index (SII) has been widely applied in the field of audiology and other related areas, application of this metric to cochlear implants (CIs) has yet to be investigated. In this study, SIIs for CI users were calculated to investigate whether the SII could be an effective tool for predicting speech perception performance in a population with CI.

Method

Fifteen pre- and postlingually deafened adults with CI participated. Speech recognition scores were measured using the AzBio sentence lists. CI users also completed questionnaires and performed psychoacoustic (spectral and temporal resolution) and cognitive function (digit span) tests. Obtained SIIs were compared with predicted SIIs using a transfer function curve. Correlation and regression analyses were conducted on perceptual and demographic predictor variables to investigate the association between these factors and speech perception performance.

Result

Because of the considerably poor hearing and large individual variability in performance, the SII did not predict speech performance for this CI group using the traditional calculation. However, new SII models were developed incorporating predictive factors, which improved the accuracy of SII predictions in listeners with CI.

Conclusion

Conventional SII models are not appropriate for predicting speech perception scores for CI users. Demographic variables (aided audibility and duration of deafness) and perceptual–cognitive skills (gap detection and auditory digit span outcomes) are needed to improve the use of the SII for listeners with CI. Future studies are needed to improve our CI-corrected SII model by considering additional predictive factors.

Supplemental Material

https://doi.org/10.23641/asha.8057003
Language Growth Predicts Stuttering Persistence Over and Above Family History and Treatment Experience: Response to Marcotte
Authors: Leech Kathryn A. , Bernstein Ratner Nan , Brown Barbara , Weber Christine M.
Published: May 2019

Purpose

This response addresses comments made by
Marcotte (2019)
regarding our recent publication, “Preliminary Evidence That Growth in Productive Language Differentiates Childhood Stuttering Persistence and Recovery” (
Leech, Bernstein Ratner, Brown, & Weber, 2017
). Marcotte calls into question our finding that language growth is a valid predictor of recovery from stuttering because we did not account for treatment and family history.

Conclusions

In response to her comments, we provide additional empirical analyses couched in a larger discussion of the difficulty of calibrating treatment and family history of stuttering. In short, we show that once treatment history and family history of stuttering are accounted for, the effect of language growth remains a significant predictor of stuttering persistence.
High-spectral resolution M-band observations of CO Rot-Vib absorption lines towards the Galactic center
Authors: Moultaka J. , Eckart A. , Tikare K. , Bajat A.
Published: May 2019

Context. In the near- to mid-infrared wavelength domain, bright continuum sources in the central parsec of the Galactic center (GC) are subject to foreground absorption. These sources therefore represent ideal probes of the intervening material that is responsible for the absorption along the line of sight.

Aims. Our aim is to shed light on the location and physics of the absorbing clouds. We try to find out which of the gaseous absorbing materials is intimately associated with the GC and which one is associated with clouds at a much larger distance.

Methods. We used the capabilities of CRIRES spectrograph located at ESO Very Large Telescope in Chile to obtain absorption spectra of individual lines at a high spectral resolution of R = 50 000, that is, 5 km s−1. We observed the 12CO R(0), P(1), P(2), P(3), P(4), P(5), P(6), P(7) and P(9) transition lines, applied standard data reduction, and compared the results with literature data.

Results. We present the results of CRIRES observations of 13 infrared sources located in the central parsec of the Galaxy. The data provide direct evidence for a complex structure of the interstellar medium along the line of sight and in the close environment of the central sources. In particular we find four cold foreground clouds at radial velocities vLSR of the order of −145, −85, −60, and −40 ± 15 km s−1 that show absorption in the lower transition lines from R(0) to P(2) and in all the observed spectra. We also find in all sources an absorption in velocity range of 50–60 km s−1, possibly associated with the so-called 50 km s−1 cloud and suggesting an extension of this cloud in front of the GC. Finally, we detect individual absorption lines that are probably associated with material much closer to the center and with the sources themselves, suggesting the presence of cold gas in the local region.
Endoscopic submucosal dissection for early squamous cell carcinoma in the anal canal and Lugol chromoendoscopy for assessment of the lateral margin
Authors: Uozumi Takeshi , Sumiyoshi Tetsuya , Kondo Hitoshi , Minagawa Takeyoshi , Fujii Ryoji , Yosida Masahiro , Tokuchi Kaho , Mizukami Takuya , Morita Koutarou , Ihara Hideyuki , Okagawa Yutaka , Takayama Toshizo , Ooiwa Shutaro , Hirayama Michiaki , Oyamada Yumiko
Published: May 2019

A 66-year-old man underwent follow-up colonoscopy after colon polypectomy. The retroflexed view of the anal canal with white-light imaging revealed a whitish, slightly elevated lesion on the dentate line and an ill-defined flat lesion. A biopsy of the whitish elevation revealed squamous cell carcinoma (SCC), and endoscopic submucosal dissection (ESD) was planned. The lateral margin of the SCC was identified by spraying with Lugol’s iodine, and the tumor was resected en bloc with no complications. The pathological findings were SCC in situ with parakeratosis in the whitish elevation and high-grade intraepithelial neoplasia in the ill-defined flat lesion, which exhibited a wide iodine-unstained area by chromoendoscopy. Early SCC in the anal canal is a rare gastrointestinal cancer, and Lugol chromoendoscopy helped visualize the tumor margin for ESD.
Gehirn und Geist am Computer trainieren?
Authors: Spitzer Manfred
Published: May 2019

Immer wieder findet man die Behauptung, dass Video-und Computerspiele dazu geeignet seien, das Gehirn bzw. geistige Leistungen zu trainieren. Hierzu wird eigens programmierte Software verkauft oder es werden käufliche Spiele, die nicht zum Training programmiert sind, auf entsprechende Auswirkungen untersucht. Die Ergebnisse zeigen, dass zwar die jeweils bearbeitete Aufgabe besser/schneller bearbeitet wird, diese Fähigkeit jedoch nicht auf andere Fähigkeiten generalisiert. Die vermeintlichen positiven Auswirkungen von (zu Unterhaltungszwecken produzierten) Computerspielen halten einer genaueren Betrachtung nicht stand und entpuppen sich u. a. als Fehlinterpretationen der (zu erwartenden) höheren Ablenkbarkeit. Die Möglichkeiten der modernen Gehirnforschung wurden verwendet, um die Auswirkungen bei der vermeintlicher „Trainingsverfahren“ (Trainings-software und Unterhaltungssoftware) auf die Struktur und die Funktion des Gehirns zu untersuchen. Wieder werden Befunde fehlinterpretiert und aus einer klar erkennbaren Beeinträchtigung der normalen Gehirnentwicklung als Anzeichen einer vermeintlichen Verbesserung gewertet. Schließlich werden Aktivierungsmuster je nach Bedarf interpretiert, vermehrte Aktivierung als klares Zeichen von Verbesserung und verminderte Aktivierung als klares Zeichen von Aufwandsverminderung (also ebenfalls Verbesserung). Auf die bekannten Risiken und Nebenwirkungen wird in der Literatur zur vermeintlichen Verbesserung geistiger Leistungen durch Computerspiele praktisch nie hingewiesen, was man – wie die „positiven“ Ergebnisse auch – als Zeichen des Einflusses massiver Lobbyarbeit einer milliardenschweren Spieleindustrie werten kann, die privatwirtschaftlich Gewinn produziert. Wissenschaftlich nachgewiesene positive Auswirkungen von Computerspielen existieren nicht, ihre negativen Folgen, deren Kosten die Allgemeinheit trägt, sind nachgewiesen.
Rezidivierende Kopf-Hals-Tumore: Bewertung der Salvage-Operation
Authors: Harréus Uli
Published: May 2019

Eine Salvage-Operation des rezidivierenden Plattenepithelkarzinoms im Kopf/Halsbereich im fortgeschrittenen Stadium (HNSCC) hat eine schlechte Prognose. Da es nur kleine und heterogene Studien mit einer großen Vielfalt an Outcome-Messungen gibt, wollte eine niederländische Arbeitsgruppe die Literatur hinsichtlich Krankheitskontrolle, Überleben sowie Komplikationen nach einer Radio- oder Chemotherapie des HNSCC durchleuchten.
Aktualisierte S2k-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) „Komplikationen der Leberzirrhose“
Authors: Gerbes Alexander L. , Labenz Joachim , Appenrodt Beate , Dollinger Matthias , Gundling Felix , Gülberg Veit , Holstege Axel , Lynen-Jansen Petra , Steib Christian J. , Trebicka Jonel , Wiest Reiner , Zipprich Alexander ,   Collaborators:,   Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV),   Deutsche Gesellschaft für Innere Medizin e. V. (DGIM),   Deutsche Gesellschaft für Infektiologie e. V. (DGI),   Deutsche Gesellschaft für Pathologie e. V./Bundesverband deutscher Pathologen e. V. (DGP/BDP),   Deutsche Röntgengesellschaft e. V. (DRG),   Deutsche Gesellschaft für Interventionelle Radiologie und minimal-invasive Therapie (DeGIR),   Deutsche Gesellschaft für Nephrologie (DGFN),   Deutsche Gesellschaft für Ultraschall in der Medizin (DEGUM),   Deutsche Gesellschaft für Neurologie e. V. (DGN),   Deutsche Gesellschaft für Ernährungsmedizin e. V. (DGEM),   Lebertransplantierte Deutschland e. V.
Published: May 2019

Die Leitlinie Komplikationen der Leberzirrhose der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) ersetzt die Leitlinie aus dem Jahr 2011. Sie basiert auf den Empfehlungen der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) für eine evidenzbasierte Konsensus-Leitlinie der Entwicklungsstufe S2k und wurde interdisziplinär unter Beteiligung aller relevanten Fachgesellschaften und der Patientenvertretung erstellt. Neben den in der Vorgängerversion behandelten Kapiteln Aszites, spontan bakterielle Peritonitis, hepatorenales Syndrom, hepatischer Hydrothorax und hepatopulmonales Syndrom wurden die Kapitel Diagnostik und Therapie der Hepatischen Enzephalopathie neu aufgenommen.
Behandlung der Folgezustände nach Poliomyelitis acuta anterior
Authors: Ruetz Axel
Published: May 2019

Seit mehreren Jahrzehnten ist bekannt, dass die immer noch in Deutschland lebenden Betroffen der Poliomyelitis acuta anterior durch den erlittenen Alpha-Motoneuron-Schaden sowohl an motorischen Störungen in Form von Paresen und Plegien und Gebrauchsstörungen von Rumpf und Extremitäten sowie Atemmuskulatur leiden, es aber auch unter der Diagnose Post-Polio-Syndrom (ICD G14) eine neuromuskuläre Zweiterkrankung nach inzwischen klaren Definitionen gibt, die interdisziplinär mit Kompetenz in neuromuskulärer Evaluation und Therapie und mit neuem Verständnis des degenerativen Overuse-Modells für Motoneurone behandelt werden muss. Die notwendigen Assessment-Tools werden dargestellt, mit denen das Restleistungsvermögen bestimmt wird, die therapeutischen Konzepte beschrieben, die sowohl die Gebiete Physiotherapie, Beatmungsmedizin, Schmerztherapie, Unfallversorgung als auch die Orthopädietechnik betreffen. Die Krankheitsbilder müssen stadiengerecht behandelt werden, die Fehleinschätzung der Restleistungsfähigkeit führt häufig zu unnötigen Invalidisierungen, da die Fallhäufigkeit selten ist und nicht zu Diagnostik- und Therapiesicherheit führt.
Rehabilitation bei Amyotropher Lateralsklerose
Authors: Groß Martin , Summ Oliver
Published: May 2019

In der stationären neurologischen Rehabilitation in Deutschland werden vorwiegend akute neurologische Erkrankungen, aber nur selten schwere, fortschreitende neuromuskuläre Erkrankungen wie die Amyotrophe Lateralsklerose behandelt. Mittlerweile liegt jedoch in Bezug auf die Amyotrophe Lateralsklerose eine umfangreiche Evidenz für den positiven Nutzen in der Rehabilitation angewandter Methoden und den Einsatz von in der Rehabilitation tätigen Fachbereichen vor: Physiotherapie, Übungsbehandlung, Atmungstherapie, Logopädie, Ernährungstherapie, Ergotherapie, der Einsatz von Hilfsmitteln, assistive Technologien, Elektrorollstühlen und Unterstützter Kommunikation sowie multidisziplinäre Zusammenarbeit und Palliative Care können das Leben der Patienten verlängern, Teilhabe und Lebensqualität verbessern und ein würdevolles Sterben ermöglichen. Essenziell sind die Integration der Angehörigen und beatmungsmedizinischer Expertise in die Behandlung. Ambulante und stationäre neurologische sollten daher fester Bestandteil der Behandlung der Amyotrophen Lateralsklerose sein.
Kopfschmerz News der DMKG
Authors: Dresler Thomas , Kraya Torsten , Ruscheweyh Ruth , Evers Stefan , Palla Antonella
Published: May 2019

Studien legen nahe, dass bei Jugendlichen mit Migräne nur etwa 75 % der Medikamenteneinnahmen wie verordnet erfolgen. Es wäre somit wünschenswert, kostengünstige Interventionen anzubieten, um die Adhärenz und dadurch den Therapieerfolg zu verbessern. Auch die Einbeziehung von Angehörigen stellt hierbei eine Möglichkeit dar, unterstützend einzugreifen.
Juristische Stellungnahme zur Indikation einer Nasenseptumoperation bei behinderter Nasenatmung
Authors: Wienke Albrecht
Published: May 2019

Der Medizinische Dienst (MDK) in Bayern stuft in jüngster Zeit die auf einer reinen Nasen-Septumdeviation fußende Nasenatmungsbehinderung als Befindlichkeitsstörung ein und verweigert operative Korrekturen des Septums im Rahmen der Gesetzlichen Krankenversicherung (GKV). Ob dies mit den maßgeblichen rechtlichen Bestimmungen vereinbar ist, soll nachstehend in Ergänzung der medizinisch-wissenschaftlichen Stellungnahme der AHRIN und der APKO untersucht werden.
Evaluation der 3. Verordnung zur Änderung der BtMVV („Substitutions-Novelle“)
Authors: Rühling Elke
Published: May 2019

Der Beschluss der Gesundheitsministerkonferenz vom Juni 2018, eine Evaluation der Neuregelung zur substitutionsgestützten Behandlung opioidabhängiger Menschen durchzuführen, wird umgesetzt.
The Relationship Between Visceral Adiposity Index and Epicardial Adipose Tissue in Patients with Type 2 Diabetes Mellitus
Authors: Baloglu Ismail , Turkmen Kultigin , Selcuk Nedim Yılmaz , Tonbul Halil Zeki , Ozcicek Adalet , Hamur Hikmet , Iyısoy Sinan , Akbas Emin Murat
Published: May 2019

Introduction and aim Cardiovascular diseases remain the most common cause of morbidity and mortality in patients with diabetes. Epicardial adipose tissue (EAT), visceral fat depot of the heart, was found to be associated with coronary artery disease in cardiac and non-cardiac patients. Increased visceral adiposity is associated with proinflammatory activity, impaired insulin sensitivity, increased risk of atherosclerosis and high mortality. In the present study we aimed to investigate the relationship between EAT and visceral adiposity index (VAI) in patients with diabetes.

Methods This was a cross-sectional study involving 128 patients with type 2 diabetes mellitus (73 females, 55 males; mean age, 54.09+±+9.17 years) and 32 control subjects (23 females, 9 males; mean age, 50.09+±+7.81 years). EAT was measured by using a trans-thoracic echocardiograph. Parameters such as waist circumference (WC), body mass index (BMI), triglyceride and high density lipoprotein (HDL) cholesterol were used to calculate VAI.

Result EAT and VAI measurements were significantly higher in patients with diabetes when compared to control subjects. In the bivariate correlation analysis, VAI was positively correlated with uric acid level (r=0.214, p=0.015), white blood cell count (r= 0.262, p=0.003), platelet count (r=0.223, p=0.011) and total cholesterol levels (r= 0.363, p<0.001). Also, VAI was found to be the independent predictor of EAT.

Conclusion Simple calculation of VAI was found to be associated with increased EAT in patients with type 2 diabetes.
Clinical Strategies to Prevent Acute Respiratory Distress Syndrome
Authors: Odeyemi Yewande , Herasevich Svetlana , Gong Michelle , Gajic Ognjen
Published: May 2019

Acute respiratory distress syndrome (ARDS) remains an important clinical entity in the intensive care unit with a significant impact on morbidity and mortality. Effective therapeutic interventions are limited; thus current research focus has shifted from treatment to the prevention of this pulmonary syndrome. In recent decades, a decrease in the incidence of ARDS has been observed and this reduction is largely due to preventive strategies including safe lung ventilation practices, avoidance of iatrogenic exposures, and improvement in care of predisposing conditions such as sepsis and pneumonia. Early identification of at-risk patients, prompt treatment of predisposing conditions, and adoption of evidence-based best practice including restrictive transfusion strategies, conservative fluid management, avoidance of large tidal volume ventilation, and aspiration precaution practices are key preventive strategies with demonstrated benefits. There are currently no effective pharmacological preventive strategies for ARDS.
Acute Respiratory Distress Syndrome: Respiratory Monitoring and Pulmonary Physiology
Authors: Coudroy Remi , Chen Lu , Pham Tài , Piraino Thomas , Telias Irene , Brochard Laurent
Published: May 2019

The high prevalence of acute respiratory distress syndrome (ARDS), its morbidity and mortality continue to fare a huge burden in the intensive care unit. More than 40 years ago, experimental studies have highlighted that, albeit essential, mechanical ventilation could be harmful to lungs and more recently to the diaphragm. Despite life-saving advances in mechanical ventilation (such as low tidal-volume ventilation, neuromuscular blockers agents, or prone positioning), a recent international observational study reported that most ARDS patients were not appropriately monitored. The monitoring capabilities of ventilators, in particular the simple interaction of the patient and the mechanical ventilation, are very powerful but are underutilized. This lack of monitoring may contribute to the persisting poor outcome of patients with ARDS. Providing a more careful ventilation is a priority to improve patients' outcomes. To achieve this goal, it is of paramount importance to better understand the complex relationship between the patient and the ventilator: the impact of ventilator settings on lungs during passive controlled ventilation, but also of patient's breathing efforts on lungs during assisted ventilation. In this review we present available tools to monitor respiratory mechanics at the bedside aiming at optimizing and personalizing mechanical ventilation. Hopefully, this careful management can decrease mortality of patients with ARDS in the future.
New results from exact solution of the dispersion relation for nonextensive electron-ion plasma in the framework of collisionless kinetic theory
Authors: Esfandyari-Kalejahi A. , Afsari-Ghazi M.
Published: May 2019

The electrostatic (ES) oscillations, spatio-temporal Landau damping and growth in an electron-ion (EI) plasma is investigated by taking into account the effect of ion (electron) dynamics on the electron (ion) oscillations in the context of nonextensive particle distributions. The dispersion relation is exactly solved without employing approximations on the phase velocity, in contrast to the procedure developed by Landau where some approximations are applied on the phase velocity. This enables us to obtain some results which are not shown previously duo to approximate numerical and analytical studies. It is remarked that four kinds of ES modes; a high frequency mode (well-known Langmuir wave), two low and high intermediate frequency (LIF and HIF) modes and a very low frequency mode (well-known IA wave) may propagate in desired plasma system. In particular, these ES modes represent very different behavior when moving to left and right directions, from the point of view of spatio-temporal damping and growth. In addition, it is shown that exact solution of the dispersion relation gives rise to some interesting phenomena; such as the existence of non-acoustic electron and ion modes, the frequency and wavelength cutoffs and the existence of backward waves.
Floral development and anatomy of
Authors: Ronse De Craene Louis P. , Wei Lai
Published: May 2019

We investigated the floral anatomy and development of Macarthuria australis Hügel ex Endl., an unusual genus endemic to Australia, in the context of floral evolution of core Caryophyllales. Flower initiation is spiral, with sepals developing quincuncially. The first two petals continue the sequence of sepal initiation, but the remaining petals arise from common stamen–petal primordia. The androecium develops sequentially as three inner antesepalous and five outer antepetalous stamens. The globular ovary is trimerous with a short symplicate zone and two arillate ovules per locule. The rapid emergence of the androecium leads to a partial absorption of the petal primordia within the androecial tissue. The two first-formed petals have more room for development and precede the androecium, supporting the fact that petals are not staminodial in origin. This heterochronic shift correlates with an inversed developmental sequence of the antesepalous stamens. The constraint caused by the spatial occupation of sepals and carpels leads to the loss of two stamens, and the re-arrangement of stamens and petals along the flanks of the carpels. The floral development of Macarthuria anticipates a syndrome of stamen and petal development in other core Caryophyllales and culminating in the Caryophyllaceae.
Phonological (in)visibility
Authors: Chappell Whitney
Published: May 2019

Reduced vowels between obstruents and rhotics are durationally variable and phonologically invisible in Spanish, e.g.pərado‘field’ as /pɾ/. The present study compares L1-Spanish speakers, English monolinguals, and L2-Spanish learners’ perceptual boundaries for reduced vowels in Spanish. A native speaker produced 70 Spanish nonce words with word-initial obstruent + vowel + flap sequences, and the duration of each vowel was manipulated from 100% to 75%, 50%, and 25% of its original duration. To determine whether these groups perceive variably reduced vowels as phonologically visible, 78 listeners counted the number of syllables perceived in 280 target audio files. Linear regression models fitted to 21,436 responses indicate that English monolinguals apply an L1 perceptual strategy, but L2-Spanish learners have shifted their perceptual boundaries. The study concludes that the perception of highly variable acoustic information becomes more native-like with greater L2 proficiency, while age of acquisition is less predictive of native-like perception.
Globe Temperature and Its Measurement: Requirements and Limitations
Authors: Oliveira A Virgílio M , Raimundo António M , Gaspar Adélio R , Quintela Divo A
Published: May 2019

This study addresses the measurement of the globe temperature. For this purpose, two globe thermometers with different diameters (50 and 150 mm) and a variety of thermal environmental conditions were considered. The assessments of the response times and of the influences of the globe diameter and the air velocity on the measured globe temperatures are discussed. The results of the response times clearly put in evidence that the values usually stated in the literature can be questioned and that longer measurement periods must be considered. In fact, response times >30 min were obtained in 68% of the tests performed. Moreover, differences >20ºC were obtained between the 150 and 50 mm sensors, highlighting the influence of the globe diameter. The analysis of the effect of the air velocity on the globe temperature shows mean relative differences >30% between tests in still air and with the higher air velocity considered (1.81 m s–1). On the basis of measurements carried out with the 50 mm globe, correction equations to the standard globe temperature for both natural and forced convection are proposed.
Intramyocardial dissecting haematoma mimicking left ventricular clot, a rare complication of myocardial infarction: a case report
Authors: Lee Tjen Jhung , Roslan Aslannif , Teh Khai Chih , Ghazi Azmee
Published: May 2019

Background

Intramyocardial dissecting haematoma is a rare complication of myocardial infarction (MI) associated with high mortality rates. Studies and research of this occurrence are limited largely to isolated case reports or case series.

Case summary

We report a case of late presenting MI, where on initial echocardiogram had what was thought to be an intraventricular clot. However, upon further evaluation, the patient actually had an intramyocardial haematoma, with the supporting echocardiographic features to distinguish it from typical left ventricular (LV) clot. While this prevented the patient from receiving otherwise unnecessary anticoagulation, this diagnosis also put him at a much higher risk of mortality. Despite exhaustive medical and supportive management, death as consequence of pump failure occurred after 2 weeks.

Discussion

This report highlights the features seen on echocardiography which support the diagnosis of an intramyocardial haematoma rather than an LV clot, notably the various acoustic densities, a well visualized myocardial dissecting tear leading into a neocavity filled with blood, and an independent endocardial layer seen above the haematoma. Based on this report, we wish to highlight the importance of differentiating intramyocardial haematomas from intraventricular clots in patients with recent MI.
An atypical cause of myocardial infarction: case report of an obstructing papillary fibroelastoma of the aortic valve
Authors: Logan Niamh , Islam Mohammad Sirajul , Chughtai Jehan Zeb , Murphy Niamh F
Published: May 2019

Background

Papillary fibroelastomas are rare primary cardiac tumours with a prevalence of 0.01% at autopsy. They are histologically benign tumours but have been demonstrated through case series to confer an increased risk of thrombo-embolism resulting in: transient ischaemic attack, stroke, myocardial infarction, and pulmonary and systemic embolization.

Case summary

A 54-year-old woman presented with central chest pain radiating to her left arm. At presentation there was a significant troponin rise; initial high-sensitivity troponin-I (hsTn-I) 660 pg/mL increased to 3340 pg/mL at 6 h. Coronary angiogram did not reveal any obstructing coronary artery disease. Echocardiography revealed a rounded, mobile mass on the left coronary cusp of the aortic valve suspicious for papillary fibroelastoma. The patient underwent shave excision of the lesion. Intra-operatively it was noted that the mass intermittently sat within the ostium of the left main resulting in its occlusion. Histology confirmed a papillary fibroelastoma.

Discussion

Primary cardiac tumours are rare but can cause life-threatening complications such as stroke, myocardial infarction, and cardiac arrest. In the literature, the mechanism of these complications is mainly attributed to thrombo-embolism. This case demonstrates the utility of echocardiogram in investigating and diagnosing a rare cause of myocardial infarction and highlights an unusual mechanism, that is tumour causing obstruction of the coronary ostium.
Three-dimensional printed cardiac fistulae: a case series
Authors: Aroney Nicholas , Markham Ryan , Putrino Anthony , Crowhurst James , Wall Douglas , Scalia Gregory , Walters Darren
Published: May 2019

Background

Three-dimensional (3D) printing of cardiac fistulae allows for immediate understanding of their complex courses and anatomical relations. Models can be used to improve patient understanding, enhance the consenting process, facilitate communication between multidisciplinary staff at heart team meetings, and help plan surgical or percutaneous interventions.

Case summary

We report four cases where 3D printed models were used as an adjunct with traditional measures in treating patients with complex cardiac fistulae.

Discussion

In our cases, overall patient understanding was improved, staff at heart team meetings were more aware of anatomical anomalies and perioperatively planning saw adjustments made that may have ultimately benefited patient outcome. Our cases highlight the additional benefit that 3D printed models can play when treating patients with complex cardiac fistulae.
A case report of extramedullary haematopoiesis within left ventricle myocardium and apical thrombus in acute heart failure: diagnosis, treatment, and long-term outcome
Authors: Pasupula Deepak Kumar , Siddappa Malleshappa Sudeep Kumar , Bhatt Anusha Ganapati , Kormos Robert L
Published: May 2019

Background 

Extramedullary haematopoiesis (EMH) within myocardium is a rare phenomenon, and its occurrence in left ventricle myocardium or apical thrombus of a young female has never been reported.

Case summary 

A 23-year-old active female with progressive worsening of dyspnoea. A transthoracic echocardiogram demonstrated a left ventricular ejection fraction of 10–15% and apical thrombus. Bilateral upper extremity Doppler showed deep venous thrombus in the left arm and superficial vein thrombus in both arms. She had reduced activity of antithrombin III, deficiency of protein C and S. Computed tomography of the head showed right thalamic infarct. Having failed optimal medical therapy, rapidly worsening of symptoms (New York Heart Association Class IV and clinical Class C) and cardiogenic shock, she underwent HeartWare® left ventricular assist device (LVAD) placement as a bridge to heart transplant. Intraoperative apical thrombus was carefully extracted while maintaining adequate anticoagulation with heparin infusion. Pathology report of the excised apical myocardium and thrombus demonstrated haematopoietic cells. Twenty-six months since LVAD implantation, she remains active and Status 7 on transplant list (due to body mass index) without any further episodes of thromboembolic events.

Discussion

We report an unprecedented case of an active young female with EMH within left ventricular myocardium and apical thrombus. Although redirected differentiation and embolic haematopoietic cells seem to explain this phenomenon, the exact pathophysiology remains unknown. Despite having pre-existing apical thrombus and acute deep vein thrombus, the key towards success was meticulous extraction of apical thrombus while preserving inherent trabecular architecture and adequate anticoagulation.
Incidence of device-related infection in 97 750 patients: clinical data from the complete Danish device-cohort (1982–2018)
Authors: Olsen Thomas , Jørgensen Ole Dan , Nielsen Jens Cosedis , Thøgersen Anna Margrethe , Philbert Berit Thornvig , Johansen Jens Brock
Published: May 2019

Aims

Device-related infection (DRI) is a severe complication to cardiac implantable electronic devices (CIED) therapy. Device-related infection incidence and its risk factors differ between previous studies. We aimed to define the long-term incidence and incidence rates of DRI for different types of CIEDs in the complete Danish device-cohort and identify patient-, operation- and device-related risk factors for DRI.

Methods and results

From the Danish Pacemaker (PM) and implantable cardioverter-defibrillator (ICD) Register, we included consecutive Danish patients undergoing CIED implantation or reoperation from January 1982 to April 2018, resulting in 97 750 patients, 128 045 operations and follow-up of in total 566 275 device years (DY). We identified 1827 DRI causing device removals. Device-related infection incidence during device lifetime was 1.19% (1.12–1.26) for PM, 1.91% (1.71–2.13) for ICD, 2.18% (1.78–2.64) for cardiac resynchronization therapy (CRT)-pacemakers (CRT-P), and 3.35% (2.92–3.83) for CRT-defibrillators (CRT-D). Incidence rates in de novo implantations were 2.04/1000 DY for PM, 3.84 for ICD, 4.38 for CRT-P, and 6.76 for CRT-D. Using multiple-record and multiple-event per subject proportional hazard analysis, we identified implantation of complex devices (ICD and CRT), reoperations, prior DRI, male sex, and younger age as significantly associated with higher DRI risk.

Conclusion

Overall risk of infection was low in PM implantations but considerably higher in CRT systems and after reinterventions. These data support the importance of evaluating all patients considered for CIED therapy thoroughly, in order to identify potential modifiable risk factors and reduce the risk of early reoperations.
Efficacy of catheter ablation for atrial fibrillation in patients with congenital heart disease
Authors: Guarguagli Silvia , Kempny Aleksander , Cazzoli Ilaria , Barracano Rosaria , Gatzoulis Michael A , Dimopoulos Konstantinos , Ernst Sabine
Published: May 2019

Aims

Advances in surgical techniques allow an increasing number of children with congenital heart disease (CHD) to reach adulthood. As patients grow older, atrial fibrillation (AF) is evolving into a major clinical concern and can be difficult to manage medically. Primary AF catheter ablation may, therefore, have a role in this setting but few reports have evaluated its efficacy in CHD patients.

Methods and results

We retrospectively reviewed 58 consecutive patients [median age 51, interquartile range (IQR) 44–63 years, 57% male] with AF (45% paroxysmal) who underwent 122 ablation procedures in our tertiary centre in the last decade. The majority had CHD of moderate or severe complexity (57%, Bethesda Class 2 or 3) with a dilated left atrium (LA) (81%) and/or right atrium (86%). At 1-year from the first ablation, 32.8% of patients remained in sinus rhythm. Multiple procedures were required in 35 (60%) patients. Freedom from AF at 1-year after the 2nd and 3rd ablation was 40.9% and 36.5%, respectively. Multivariable predictors of AF recurrence were underlying anatomic complexity [hazard ratio (HR) in Bethesda 3 1.98, P = 0.006], type of AF (HR for persistent 1.87, P = 0.004), and indexed LA dimensions (HR for cm2/m2 1.06, P = 0.03).

Conclusion

While ablation may be a valid option for the treatment of AF in CHD patients, multiple procedures are likely to be required. Early referral and careful patient selection are essential to optimize the results of AF ablation, achieving a low rate of recurrence. Further studies are needed to validate our prognostic model and guide clinical practice.
Frenzied Flappers: The Hysterical Female in Early Twentieth-Century Social Dance
Authors: Margetts Hope
Published: May 2019

It is widely acknowledged that the freer, more sexualized movements of social dancing in the early twentieth century (1900–1929) accompanied the beginnings of female emancipation both socially and politically. However, less explored are the similarities between the provocative, inelegant choreography of such social dances and the symptoms of female hysteria, a medical phenomenon that saw the body as a canvas for mental distress as provoked by social tensions. This essay will address the possible alignment of hysteria and popular social dance in relation to the evolving Modern Woman. It will examine the motivations of modern, ‘hysterical’ dances, and discuss their progressive status in terms of gender by considering perceived psychosomatic interactions within the female dancing body.
High Flavonoid Cocoa Supplement Ameliorates Plasma Oxidative Stress and Inflammation Levels While Improving Mobility and Quality of Life in Older Subjects: A Double-Blind Randomized Clinical Trial
Authors: Munguia Levy , Rubio-Gayosso Ivan , Ramirez-Sanchez Israel , Ortiz Alicia , Hidalgo Isabel , Gonzalez Cristian , Meaney Eduardo , Villarreal Francisco , Najera Nayelli , Ceballos Guillermo
Published: May 2019

Background

The age-related decline in mass, strength, and performance of skeletal muscle is associated with loss of independence, falls risk, disability, institutionalization, and death.

Methods

To determine whether a cocoa supplement enriched in flavonoids can improve plasma markers of oxidative stress and inflammation, physical performance and frailty in middle-aged and older subjects, we conducted a two-phase, randomized, double-blind, clinical trial. The initial study included 60 subjects (55- to 70-year-old) allocated into placebo (P), highly alkalinized (no-flavonoid; NF), or flavonoid-rich natural cocoa (F) beverage groups. The follow-up study included 74 older subjects (65- to 90-year-old) randomly distributed into NF or F groups. Subjects were instructed to consume the beverages once/day for up to 12-weeks. A comprehensive (aging relevant) set of end points were assessed, which included mean change in blood plasma metabolic and oxidative stress indicators, in physical performance tests and quality of life (QoL).

Results

In the initial study, the F group showed improved glycemia, triglyceridemia, High-density lipoprotein cholesterol, Low-density lipoprotein cholesterol, triglyceridemia/HDL index, and oxidative markers. Performance on the Up and Go test, skeletal muscle index, and quality of life also improved. In the follow-up study, F treatment was associated with significant improvements in metabolic, oxidative stress, and inflammatory endpoints and positive effects on physical performance, frailty indicators, and quality of life (F vs. NF group).

Conclusions

Regular flavonoids consumption positively affects blood oxidative stress and inflammation end points, cardiometabolic risk markers, physical performance, and quality of life. The sum of such effects may help to mitigate the extent of frailty development in the elderly people.

Trial Registration

NCT03585868
Vitamin K Status and Mobility Limitation and Disability in Older Adults: The Health, Aging, and Body Composition Study
Authors: Shea M Kyla , Kritchevsky Stephen B , Loeser Richard F , Booth Sarah L
Published: May 2019

Background

Vitamin K has been implicated in chronic diseases associated with increased risk for mobility disability, such as osteoarthritis and cardiovascular disease. However, the association between vitamin K status and mobility disability is unknown. Therefore, we examined the association between vitamin K status and incident mobility disability in the Health, Aging, and Body Composition Study.

Methods

Plasma phylloquinone (vitamin K1) was categorized as <0.5, 0.5–<1.0 and ≥1.0 nmol/L (n = 1,323, 48% male). Plasma ucMGP, which increases when vitamin K status is low, was measured in 716 participants and categorized into tertiles. Mobility limitation and disability, defined as two consecutive semiannual reports of having any or a lot of difficulty walking a one-fourth mile or climbing 10 steps without resting, were assessed over a median 6–10 years of follow-up. Multivariate Cox proportional hazard models were used to evaluate the association between vitamin K status and incident mobility limitation and disability.

Results

Participants with plasma phylloquinone less than 0.5 nmol/L were more likely to develop mobility limitation and disability compared to those with at least 1.0 nmol/L (adjusted HR (95% CI) mobility limitation: 1.27 (1.05–1.53); disability: 1.34 (1.01–1.76)). After further adjustment for knee pain, the associations were partially attenuated (HR (95% CI) mobility limitation: 1.20 (0.99–1.45); disability: 1.26 (0.96–1.67)). Plasma ucMGP was not associated with incident mobility limitation, but was nonlinearly associated with incident mobility disability (HR (95% CI), compared to tertile 1: tertile 2 = 1.64 (1.19–2.27), tertile 3 = 1.17 (0.83–1.66), fully adjusted).

Conclusion

Our results suggest vitamin K may be involved in the disablement process in older age. Future studies are needed to confirm our findings and clarify the underlying mechanism.
Prevalence and Correlates of Falls Among Centenarians: Results from the Five-Country Oldest Old Project (5-COOP)
Authors: Chen Tuo-Yu , Chan Angelique , Andersen-Ranberg Karen , Herr Marie , Fors Stefan , Jeune Bernard , Herrmann François R , Robine Jean-Marie , Gondo Yasuyuki , Saito Yasuhiko
Published: May 2019

Background

Many studies have been conducted to investigate risk factors of falls in older people, but little is known about falls among centenarians. We analyzed the cross-sectional data from the Five-Country Oldest Old Project (5-COOP) to investigate the prevalence and correlates of falls among centenarians.

Methods

Data collection was carried out in 2011–2014 in Japan, France, Switzerland, Sweden, and Denmark. The sample consisted of 1,165 centenarians who were at least 100 years old in 2011. The outcome variable was falls in the past 6 months. Demographics, chronic conditions, pain, visual impairment, global cognitive function, dizziness and syncope, number of medications, functional limitation (ie, dressing, bathing, toileting, transferring, incontinence, and feeding), mobility difficulty, poor strength, and assistive device usage were included in the analysis.

Results

The prevalence of falls within the last 6 months was 33.7%, ranging from 21.6% (Japan) to 40.9% (France). Being male, experiencing dizziness, syncope, incontinence, and using assistive devices indoors were associated with an increased risk of falls among centenarians. Significant cross-country differences in the relationships between some risk factors (ie, gender, difficulty with bathing, toileting, transferring, and feeding, and using assistive devices for walking indoors and outdoors) and falls were observed. Subsample analysis using data from each country also showed that factors related to falls were different.

Conclusions

The prevalence of falls among centenarians is high and fall-related factors may be different than those for their younger counterparts. Given that centenarians is an emerging population, more studies investigating risk factors are needed to better understand falls among centenarians.
Semantic Relatedness Corrects the Age-Related Binding Deficit in Working Memory and Episodic Memory
Authors: Loaiza Vanessa M , Srokova Sabina
Published: May 2019

Objectives

It is well known that age differentially impacts aspects of long-term episodic memory (EM): Whereas a binding deficit indicates that older adults are less capable than younger adults to encode or retrieve associations between information (e.g., the pairing between two memoranda, such as lock – race), item memory is relatively intact (e.g., recognizing lock without its original pairing).

Method

We tested whether this deficit could be corrected by facilitating establishment of the bindings in working memory (WM) through adapting the semantic relatedness of studied pairs according to participants’ ongoing performance (Experiments 1 and 2). We also examined whether this was evident for the long-term retention of pairs that were not tested in WM (Experiment 2).

Results

The results revealed matched binding and item memory in WM and EM between age groups. Most importantly, older adults required increased semantic strength between word pairs to achieve similar performance to that of younger adults, regardless of whether pairs were immediately tested during the WM task.

Discussion

These findings indicate that relying on their superior semantic memory can correct the commonly exhibited profound deficit in binding memory in older age.
Discordant Patterns of Introgression Suggest Historical Gene Flow into Thai Weedy Rice from Domesticated and Wild Relatives
Authors: Wedger Marshall J , Pusadee Tonapha , Wongtamee Anupong , Olsen Kenneth M
Published: May 2019

Weedy relatives of crop species infest agricultural fields worldwide, reducing harvests and threatening global food security. These weeds can potentially evolve and adapt through gene flow from both domesticated crop varieties and reproductively compatible wild relatives. We studied populations of weedy rice in Thailand to investigate the role of introgression from cultivated and wild rice in their evolution. We examined 2 complementary sources of genetic data: allelic variation at 3 rice domestication genes (Bh4, controlling hull color; Rc, controlling pericarp color and seed dormancy; and sh4, controlling seed shattering), and 12 previously published SSR markers. Sampling spanned 3 major rice growing regions in Thailand (Lower North, North East, and Central Plain) and included 124 cultivated rice accessions, 166 weedy rice accessions, and 98 wild rice accessions. Weedy rice strains were overall closely related to the cultivated varieties with which they co-occur. Domestication gene data revealed potential adaptive introgression of sh4 shattering alleles from wild rice. Introgression of potentially maladaptive rc crop alleles (conferring reduced dormancy) was also detected, with the frequency of the crop allele highest in northern populations. Although SSR markers also indicated introgression into weed populations from wild and cultivated rice, there was little overlap with domestication genes in the accessions showing admixed ancestry. This suggests that much of the introgression we detected at domestication genes most likely reflects past introgression rather than recent gene flow. This finding has implications for understanding long-term gene flow dynamics between rice and its weedy and wild relatives, including potential risks of transgene escape.
Dynamic Adaptive Mixture Models with an Application to Volatility and Risk
Authors: Catania Leopoldo
Published: May 2019

In this paper we propose a new class of dynamic mixture models (DAMMs) being able to sequentially adapt the mixture components as well as the mixture composition using information coming from the data. The information driven nature of the proposed class of models allows to exactly compute the full likelihood and to avoid computer intensive simulation schemes. Specific models for financial data are developed starting from the general specification. These models nest many specifications already available in the literature. The properties of the new class of models are discussed through the paper and a large-scale application in quantitative risk management using U.S. equity data is reported.
Individualized Correction of the Interference of Hemolysis on Glycated Albumin Determined by the Ketamine Oxidase Method
Authors: Chen Li , Zhang Bingfeng , Yang Lu , Lou Jianfang , Jiang Ye , Zhang Shichang
Published: May 2019

Objective

To investigate the effect of hemolysis on glycated albumin (GA) levels, as determined by the ketamine oxidase method.

Methods

GA levels and the hemolysis index were determined in nonhemolyzed serum and hemolyzed serum from corresponding patients. We developed an equation to correct the interference of hemolysis on GA, using multiple regression analysis.

Results

The degree of hemolysis was negatively correlated with GA levels (R2 = 0.9500). A correction equation for GA (corrected GA = 2.703 × OD of hemolysis + 1.044 × measured GA −0.906) can revert GA concentrations of hemolyzed specimens to values that were not significantly different from the GA concentration of corresponding nonhemolyzed specimens. The bias of GA concentrations before and after correction was statistically significantly different (P <.01).

Conclusions

Our results indicate that the level of GA measured through the ketamine oxidase method is negatively affected by hemolysis. The individualized correction of GA results provides increased accuracy in hemolyzed specimens.
Influenza Before the 1890 and 1918 Pandemics in the US Army and at the US Military Academy
Authors: Shanks G Dennis , Eslinger Melissa
Published: May 2019

Influenza rates for the US Army and West Point cadets showed that seasonal influenza was not necessarily an annual event, and there was little influenzal illness in the decade before 1918 except for 1911 and 1916. Annual records from 1862–1918 also indicated a similar paucity of influenzal illness before 1890.