bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigation of the effect of drying air temperature on drying time by numerical method for textile bobbins
Authors: Akyol U , Karakoca A , Shaliyev R , Akal D , Uzuneanu K
Published: September 2019

Drying of the yarn bobbins in the textile sector is a very important stage among the textile finishing processes. Because this process takes a lot of time and causes a large amount of energy consumption. In this study, drying times for different drying air inlet temperatures at a constant drying air pressure were determined with the help of mathematical model for textile bobbin drying process. Finite difference method was used in mathematical model solution and the effect of different space and time steps were taken into consideration during the solution.
Sorption characteristics of subtropical fruit – Lucuma powder
Authors: Durakova A , Bogoeva A , Krasteva R , Gogova T , Krasteva A , Georgieva N
Published: September 2019

The current scientific research is focused on the Lucuma powder. We were determined the moisture equilibrium data (adsorption and desorption) at three different temperatures: 10°C, 25°C and 40°C and relative humidity from 0.11 to 0.90, using the static gravimetric method of saturated salt solution. The results showed that the sorption capacity decreased when the temperature increases in the conditions of constant water activity. We were used four different mathematical models – modified Chung–Pfost, modified Oswin, modified Halsey and modified Henderson for description of isotherms of Lucuma powder. According to obtained experimental data, we were recommended the modified Halsey model for description satisfactorily the sorption isotherms of powder.
Fabrication of Fe3Al cladding layers by cold metal transfer arc deposited technique
Authors: Chen Chen , Zhao Jingyu , Zhou Jian , Xue Feng
Published: September 2019

Fe3Al cladding layers were fabricated on the steel plate using cold metal transfer arc deposited technique. The effect of current intensity on the morphologies, microstructures, and mechanical properties of the cladding layers was investigated. Under low-current conditions, the Fe3Al cladding layer exhibited excellent formability, favourable wettability, and low dilution rate without defects such as gas holes and cracks. The cladding layer was composed of Fe3Al phase and FeAl phase. The microstructure of the cladding layer was divided into a fine grain zone, a columnar grain zone, and an equiaxed grain zone. A transition layer appeared at Fe3Al/steel interface, and the bonding strength between the cladding layer and steel plate was high. With increasing current, cracks were generated at Fe3Al/steel interface and the bonding strength was reduced.
Numerical simulation of Kerr nonlinear systems; analyzing non-classical dynamics
Authors: Agasti Souvik
Published: September 2019

We simulate coherent driven free dissipative Kerr nonlinear system numerically using Euler’s method by solving Heisenberg equation of motion and time evolving block decimation (TEBD) algorithm, and demonstrate how the numerical results are analogous to classical bistability. The comparison with analytics show that the TEBD numerics follow the quantum mechanical exact solution obtained by mapping the equation of motion of the density matrix of the system to a Fokker-Plank equation . Comparing between two different numerical techniques, we see that the semi-classical Euler’s method gives the dynamics of the system field of one among two coherent branches, whereas TEBD numerics generate the superposition of both of them. Therefore, the time dynamics determined by TEBD numerical method undergoes through a non-classical state which is also shown by determining second order correlation function.
Distinguished cycles on varieties with motive of abelian type and the Section Property
Authors: Fu Lie , Vial Charles
Published: September 2019

A remarkable result of Peter O’Sullivan asserts that the algebra epimorphism from the rational Chow ring of an abelian variety to its rational Chow ring modulo numerical equivalence admits a (canonical) section. Motivated by Beauville’s splitting principle, we formulate a conjectural Section Property which predicts that for smooth projective holomorphic symplectic varieties there exists such a section of algebra whose image contains all the Chern classes of the variety. In this paper, we investigate this property for (not necessarily symplectic) varieties with a Chow motive of abelian type. We introduce the notion of a symmetrically distinguished abelian motive and use it to provide a sufficient condition for a smooth projective variety to admit such a section. We then give a series of examples of varieties for which our theory works. For instance, we prove the existence of such a section for arbitrary products of varieties with Chow groups of finite rank, abelian varieties, hyperelliptic curves, Fermat cubic hypersurfaces, Hilbert schemes of points on an abelian surface or a Kummer surface or a K3 surface with Picard number at least 19, and generalized Kummer varieties. The latter cases provide evidence for the conjectural Section Property and exemplify the mantra that the motives of holomorphic symplectic varieties should behave as the motives of abelian varieties, as algebra objects.
Role of Blood Pressure in Mediating Carotid Artery Dilation in Response to Sympathetic Stimulation in Healthy, Middle-Aged Individuals
Authors: Peace Arron , Pinna Virginia , Timmen Friso , Speretta Guillherme , Jones Helen , Lotto Robyn , Jones Ian , Thijssen Dick
Published: September 2019

Objectives

Carotid artery diameter responses to sympathetic stimulation, i.e., carotid artery reactivity (CAR), represent a novel test of vascular health and relates to cardiovascular disease (CVD)/risk. This study aims to understand the relationship between the increase in blood pressure and carotid artery diameter response during the CAR-test in healthy, middle-aged men.

Methods

Sample consisted of 40 normotensive men (aged 31–59 years) with no history of CVD of currently taking medication. Noninvasive ultrasound was used to measure carotid artery diameter during the cold pressor test (CPT), with CAR% being calculated as the relative change from baseline (%). Mean arterial pressure (MAP) was measured with beat-to-beat blood pressure recording.

Results

CAR% was 4.4 ± 5.4%, peaking at 92 ± 43 seconds. MAP increased from 88 ± 9 mmHg to 110 ± 15 mmHg, peaked at 112 ± 38 seconds, which was significantly later than the diameter peak (P = 0.04). The correlation between resting MAP and CAR% was weak (r = 0.209 P = 0.197). Tertiles based on resting MAP or MAP-increase revealed no significant differences between groups in subject characteristics including age, body mass index, or CAR% (all P > 0.05). Subgroup analysis of individuals with carotid constriction (n = 6) vs. dilation (n = 34), revealed no significant difference in resting MAP or increase in MAP (P = 0.209 and 0.272, respectively).

Conclusion

Our data suggest that the characteristic increase in MAP during the CPT does not mediate carotid artery vasomotion.
Ecometric modelling of tooth shape and precipitation gradients among lemurs on Madagascar
Authors: Fulwood Ethan L
Published: September 2019

Ecometric modelling relates spatial environmental variables to phenotypic characters to better understand morphological adaptation and help reconstruct past environments. Here, the community means of the dental topography metrics Dirichlet normal energy (DNE) and orientation patch count (OPC) are tested against annual precipitation and precipitation seasonality among lemurs across Madagascar. Dry, seasonal environments are expected to be associated with high DNE and OPC, as lemurs living in these environments are more likely to rely on tougher foods. Ecometric models are also used to calculate ecometric loads for lemur taxa hypothesized to be experiencing evolutionary disequilibria and to reconstruct annual precipitation and precipitation seasonality at the ~500 years BP subfossil cave site of Ankilitelo. DNE was highest in highly seasonal but wet environments. Seasonal exploitation of fallback foods and the availability of new leaves during wet periods may be most important in driving community DNE. OPC was weakly predicted by annual precipitation and seasonality but its distribution appeared to be driven by a stepwise increase in its community values in rainforest environments. The lemur fauna from Ankilitelo appears to resemble communities from moister environments than occur in the spiny desert zone in which the site is situated today.
Right ventricular strain rate during exercise accurately identifies male athletes with right ventricular arrhythmias
Authors: Claeys Mathias , Claessen Guido , Claus Piet , De Bosscher Ruben , Dausin Christoph , Voigt Jens-Uwe , Willems Rik , Heidbuchel Hein , La Gerche Andre
Published: September 2019

Aims

Athletes with right ventricular (RV) arrhythmias, even in the absence of desmosomal mutations, may have subtle RV abnormalities which can be unmasked by deformation imaging. As exercise places a disproportionate stress on the right ventricle, evaluation of cardiac function and deformation during exercise might improve diagnostic performance.

Methods and results

We performed bicycle stress echocardiography in 17 apparently healthy endurance athletes (EAs), 12 non-athletic controls (NAs), and 17 athletes with RV arrhythmias without desmosomal mutations (EI-ARVCs) and compared biventricular function at rest and during low (25% of upright peak power) and moderate intensity (60%). At rest, we observed no differences in left ventricular (LV) or RV function between groups. During exercise, however, the increase in RV fractional area change (RVFAC), RV free wall strain (RVFWSL), and strain rate (RVFWSRL) were significantly attenuated in EI-ARVCs as compared to EAs and NAs. At moderate exercise intensity, EI-ARVCs had a lower RVFAC, RVFWSL, and RVFWSRL (all P < 0.01) compared to the control groups. Exercise-related increases in LV ejection fraction, strain, and strain rate were also attenuated in EI-ARVCs (P < 0.05 for interaction). Exercise but not resting parameters identified EI-ARVCs and RVFWSRL with a cut-off value of >−2.35 at moderate exercise intensity had the greatest accuracy to detect EI-ARVCs (area under the curve 0.95).

Conclusion

Exercise deformation imaging holds promise as a non-invasive diagnostic tool to identify intrinsic RV dysfunction concealed at rest. Strain rate appears to be the most accurate parameter and should be incorporated in future, prospective studies to identify subclinical disease in an early stage.
Fluorouracil-induced Takotsubo cardiomyopathy causing cardiogenic shock: a case report of clinical and acute cardiac magnetic resonance imaging features
Authors: Joy George , Eissa Hany , Al Karoudi Riyad , White Steven K
Published: September 2019

Background

Takotsubo cardiomyopathy (TTS) is an extremely rare complication of fluorouracil containing chemotherapy regimes such as FOLFOX used for colorectal cancer, occurring in only five previous case reports. Due to its potentially fatal outcomes, yet infrequent presence in the literature, it is worthwhile reviewing the clinical features and outcomes of this phenomenon.

Case summary

A 54-year-old lady was admitted with cardiogenic shock. A cardiac magnetic resonance imaging (CMR) showed mid-ventricle to apical hypokinesis and confirmed TTS. She was managed with inotropes and non-invasive ventilation after which she recovered fully both clinically and in her CMR features 6 weeks following discharge.

Discussion

This is the first case showing the acute CMR features of this complication and highlights the need for awareness of this rarely occurring cardiotoxicity. It also shows the potentially fatal phenomenon can be fully reversible when diagnosed and managed promptly even in patients with metastatic cancer and critical illness.
Lamb performance in hardwood silvopastures, I: animal gains and forage measures in summer
Authors: Pent Gabriel J , Greiner Scott P , Munsell John F , Tracy Benjamin F , Fike John H
Published: September 2019

The integration of trees into pasture systems can have variable effects on forage and animal growth. Some reports of these systems have indicated that animal gains are similar or better even when tree presence lowers forage yield. Forage production and animal performance were compared in black walnut (Juglans nigra L.)-based and honeylocust (Gleditisia triacanthose L.)-based silvopasture systems and open pastures in a randomized complete block design with three blocks over three summers. Cool season-based, mixed grass pastures were rotationally stocked with four to seven lambs depending on available forage. A rising plate meter was used to estimate pre- and post-graze forage mass. Forage samples of the mixed sward were collected and analyzed for nitrogen (N) and neutral detergent fiber (NDF) concentrations. Species percent cover was estimated using a modified Daubenmire approach at the same 12 points within each experimental unit every 4 wk during the study. Pre-graze herbage mass was similar (P = 0.0717) in honeylocust silvopastures (5020 ± 30 kg·ha−1) and open pastures (4930 ± 30 kg·ha−1) and lowest (P < 0.0001) in the black walnut silvopastures (3560 ± 30 kg·ha−1). Forages in the black walnut and honeylocust silvopastures had similar (P = 0.4867) N concentrations (23.3 ± 0.4 and 23.9 ± 0.4 g·kg−1, respectively), which was greater (P ≤ 0.0003) than that of the forages in the open pastures (21.0 ± 0.4 g·kg−1). Forages in the honeylocust silvopasture had lower (P ≤ 0.0042) NDF concentrations (507 ± 3 g·kg−1) than forages in the black walnut silvopasture and open pastures (mean = 525 ± 3 g·kg−1). Forage species present in the black walnut silvopastures differed from those present in the open and honeylocust systems, which had similar composition. Despite differences in stocking rates, total lamb weight gains per system did not differ (P ≥ 0.7592) among black walnut, honeylocust, and open pasture systems (10 ± 2, 12 ± 2, and 10 ± 2 kg·d−1, respectively). Silvopasture practices can improve land productivity when incorporated into cool season forage pastures.
Get to know female athlete triad
Authors: Perkins Amanda
Published: September 2019

Nurses can play a significant role in the prevention, identification, and treatment of this disorder affecting physically active girls and women.
The Role of the NICU in Father Involvement, Beliefs, and Confidence
Authors: Hearn Gesine , Clarkson Gina , Day Matthew
Published: September 2019

Background:

Fathers are important to infant outcomes. Infants of involved fathers have improved weight gain, sleep, and psychosocial behaviors. Father involvement with neonatal intensive care unit (NICU) infants reduces the length of stay.

Purpose:

The purpose of this study was to explore and describe involvement, confidence, and beliefs of fathers of infants who were hospitalized in the NICU and discharged home in order to begin to investigate NICU father involvement from a longitudinal perspective.

Methods:

This exploratory qualitative study was conducted 4 to 5 years after the initial NICU stay using telephone interviews. Fathers who participated in this study were selected from participants of a previous NICU study. Qualitative analysis was conducted using standard procedures for grounded theory.

Results:

Nineteen fathers participated in the study. The major themes were “It was scary,” “Just be there,” “It was rough,” “It's not about yourself,” “A special bond,” and “Almost a treat.” The fathers reported that the NICU providers, nurses, and staff helped them to overcome uncertainty and lack of knowledge, which helped them improve their confidence and involvement during the NICU stay.

Implications for Practice:

Fathers see nurses as a source of support. Nurses can encourage fathers to visit regularly and participate in infant care activities. NICU presence aids fathers in developing confidence and knowledge in parenting during their child's infancy, which can set the stage for ongoing involvement.

Implications for Research:

Future work should continue to focus on longitudinal studies of fathering and the role of the NICU in encouraging involvement and parenting readiness.
The Anatomy of the Clavicle and Its In Vivo Relationship to the Vascular Structures: A 2D and 3D Reconstructive Study Using CT Scans
Authors: Steinmetz Garrett , Conant Scott , Bowlin Barrett , Hamilton John , Allen Judd , Stoner Julie , White Christopher
Published: September 2019

Objectives:

To describe in detail both the proximity and location of the subclavian vessels relative to both the right and left clavicle. This will give surgeons a more precise knowledge of safe and dangerous areas for screw placement during operative stabilization of clavicle fractures.

Methods:

A radiology storage database was reviewed to obtain a total sample of 103 clavicles with no evidence of periclavicular pathology. Each clavicle was divided along its length into 13 specific points of measurement. At each point, the distance and angular position between the clavicle and each subclavian vessel were measured.

Results:

The mean distance of the subclavian artery was greater than 10 mm at all positions. At the most medial point of the clavicle, the right subclavian artery was on average 1 cm closer to the clavicle than on the left. From medial to lateral, in the sagittal plane, the position of the subclavian artery transitions obliquely across the clavicle from a 2 to 6 o'clock position. The mean distance to the subclavian vein is less than 10 mm along the medial half of the clavicle on both sides of the body. In these areas, the position of the subclavian vein to the clavicle transitions from the 3 to 5 o'clock positions from medial to the mid-point of the clavicle.

Conclusions:

The subclavian vein is the vascular structure at highest risk during clavicle fracture fixation. The major area of danger in our study is the medial clavicle with distance being less than 1 centimeter over the entire medial half of the clavicle on both right and left. In this danger area, the subclavian vein courses from 3 to 5 o'clock positions. The subclavian artery is more distant and relatively safer but is closer at the right medial clavicle than the left.
Cutaneous Histiocytic Sarcoma With Cellular Cannibalism
Authors: Nanri Aya , Katayama Eri , Imamura Taichi , Muto Ikko , Saruta Hiroshi , Akiba Jun , Ohshima Koichi , Nakama Takekuni , Ohata Chika
Published: September 2019

Cutaneous histiocytic sarcoma (HS) is a rare malignant tumor. An 82-year-old woman presented with a 4 × 2-cm irregular-shaped red nodule on the left posterior scalp. A biopsy specimen revealed sheets of pleomorphic atypical cells in the dermis and subcutis. A diagnosis of HS was made based on the results of a panel of immunohistochemical stains that revealed positivity of leukocyte common antigen, CD4, CD163, and HLA-DR. At the time of resection, the tumor grew rapidly to 12 × 6.5 × 5 cm in size in 2 months. The resected tumor comprised round, oval, plasmacytoid, and spindled cells. Signet-ring cell type tumor cells were also observed. The histiocytic nature of HS was confirmed owing to the presence of cellular cannibalism, emperipolesis, Langhans giant cell–like cells, Touton giant cell–like cells, foreign-body giant cell–like cells, and hemosiderin laden cells. In some foci, a storiform pattern and fascicular pattern were occasionally observed. Local recurrence occurred shortly after resection. Subsequent radiation therapy showed insufficient effectiveness. It is challenging to make a diagnosis of HS without performing immunohistochemical studies; however, a variety of histiocytic features confirmed in hematoxylin and eosin–stained sections may suggest HS.
Differences in regional grey matter volume of the brain are related to mean blood pressure and muscle sympathetic nerve activity in normotensive humans
Authors: Kobuch Sophie , Fatouleh Rania H. , Macefield Julius M. , Henderson Luke A. , Macefield Vaughan G.
Published: September 2019

Objectives:

The brainstem plays a critically important role in the beat-to-beat control of blood pressure, as well as setting mean blood pressure (MBP). We recently showed that regional cerebral blood flow to specific brainstem nuclei is inversely related to resting MBP in healthy normotensive individuals. Here we tested the hypothesis that grey matter volume in these same nuclei, and areas above the brainstem to which they are connected, is also associated with resting MBP and muscle sympathetic nerve activity (MSNA).

Methods:

Structural MRI of the brain and recordings of MSNA and BP were collected in 54 healthy participants. Subjects were divided into a lower MBP group (mean ± SEM 78.8 ± 1.5 mmHg,n=27) and higher MBP group (96.6 ± 1.2 mmHg,n = 27), as well as into a lower MSNA (9.5 ± 0.8 bursts/min,n = 27) and higher MSNA (25.4 ± 1.2 bursts/min,n = 27) group.

Results:

Regional grey matter volume was higher in the region of the rostral ventrolateral medulla, nucleus tractus solitarius, and medullary raphe in the group with higher MBP and correlated significantly with mean MBP across all participants. Grey matter volume was significantly higher in the dorsomedial hypothalamus and anterior and posterior cingulate cortices in the group with lower MSNA and was inversely related to MSNA across all participants.

Conclusion:

We conclude that small differences in MBP and MSNA are associated with significant differences in grey matter volume in cortical and subcortical regions known to be involved in blood pressure regulation, suggesting that these structural differences contribute to resting MBP and MSNA and can predict the establishment of hypertension.
Concurrent heterozygous Von-Hippel–Lindau and transmembrane-protein-127 gene mutation causing an erythropoietin-secreting pheochromocytoma in a normotensive patient with severe erythrocytosis
Authors: Negro Aurelio , Graiani Gallia , Nicoli Davide , Farnetti Enrico , Casali Bruno , Verzicco Ignazio , Tedeschi Stefano , Ghirarduzzi Angelo , Cannone Valentina , Marco Loredana D.E. , Filice Angela , Gemelli Giuseppe , Giunta Alessandro , Cabassi Aderville
Published: September 2019

Background:

Mutations of genes related to Krebs cycle enzymes, kinases or to pseudohypoxic signaling pathways, including Von-Hippel–Lindau (VHL) and transmembrane-protein-127 predispose to pheochromocytoma and paraganglioma development. Homozygous loss of function mutation of VHL (VHL 598C>T) gene can associate with polycythemia because of an altered hypoxia sensing.

Patient:

A 19-year-old normotensive man presented with headache, fatigue associated with severe erythrocytosis (hematocrit 76%), high hemoglobin (25.3 g/dl) in normoxic condition. Bone marrow biopsy showed marked hyperplasia of erythroid series. The Janus kinase 2 (V617F) mutation was absent. Abdominal computed tomography scan showed a 8-mm left adrenal pheochromocytoma with tracer uptake on 68GaDOTA-octreotate PET. Twenty-four-hour urinary metanephrine excretion was slightly increased, while normetanephrine, 3-methoxytyramine were normal. Adrenal veins sampling showed high left-side erythropoietin secretion.

Results:

Next-generation sequencing genetic analysis evidenced two concurrent heterozygous mutation of VHL598C>T and of transmembrane-protein-127 c.268G>A. Left side adrenalectomy improved symptoms, erythrocytosis, hemoglobin, and erythropoietin circulating levels. Adrenal histologic sections showed a pheochromocytoma with extensive immunostaining for erythropoietin, but also coexpression of chromogranin A, a marker of chromaffin tissue.

Conclusion:

Congenital polycythemia was clinically diagnosed, mimicking Chuvash polycythemia. Chuvash polycythemia is an autosomal recessive disorder that usually harbors a homozygous mutation of VHL598C>T but not predispose to pheochromocytoma development; in contrast our patient showed for the first time that the concurrent heterozygous VHL and TMEM mutations, resulted in a clinical phenotype of a normotensive patient with polycythemia due to erythropoietin-secreting pheochromocytoma that improved after adrenalectomy.
N-acetylcysteine and atorvastatin alleviates lung injury due to ischemia-reperfusion injury in rats
Authors: Guo Da-Wei , Wang Chien-Ying , Shih Hsin-Chin
Published: September 2019

Background:

Acute lung injury is a major cause of death following severe injury and ischemia-reperfusion (IR). We investigated the protective effect of pretreatment with N-acetylcysteine (NAC) and atorvastatin (ATOR) in a mesenteric IR rat model.

Methods:

Male rats were randomly divided into five experimental groups: sham; mesenteric IR; and ATOR, NAC, ATOR + NAC (A + N) pretreatment followed by IR. Blood gas and cytokine levels, biochemistry, and cell count were analyzed. Lung injury was evaluated through histopathology and by using the wet-to-dry lung weight (W/D) ratio.

Results:

Following IR, significant changes were noted in biochemistry, cytokine, and lung injury. Compared with those in the IR group, neutrophil-to-lymphocyte ratio, lactate and alanine aminotransferase (ALT) levels were lower in all pretreatment groups, and creatinine and alkaline phosphatase (ALKP) levels were lower only in the A + N group. Blood pH and base excess (BE) were higher, and partial pressure of carbon dioxide in venous blood (PvCO2) lowered significantly in the ATOR and A + N groups than those in the IR group, and bicarbonate (HCO3-) levels increased only in the A + N group. Lung injury scores and W/D indicated significant attenuation in the A + N group. Compared with those in the IR group, tissue tumor necrosis factor-α levels were significantly lower in all the pretreatment groups and interleukin-1β levels were lower in the A + N group.

Conclusion:

NAC and ATOR decreased inflammation and lung injury following mesenteric IR in rats. NAC and ATOR may alleviate lung injury more efficiently in combination than individually.
Clusterin expression in nontumor tissue in patients with resectable hepatocellular carcinoma related with postresectional survival
Authors: Kuo Po-Chung , Chau Ivy Yenwen , Li Anna Fen-Yau , Chau Yat-Pang , Hsia Cheng-Yuan , Chau Gar-Yang
Published: September 2019

Background:

Surgical resection offers an effective treatment for patients with hepatocellular carcinoma (HCC); however, it has high tumor recurrence rate. Clusterin is a highly conserved glycoprotein that enhances cell aggregation in vitro. It is upregulated in several types of cancers such as breast, ovarian, colon, prostate and kidney cancers, and HCC. Clusterin overexpression is correlated with tumor metastasis. We evaluated the significance of clusterin expression levels in serum and resected tissues of patients with HCC.

Methods:

Serum, resected tumor tissue, and nontumor tissue were collected from 140 patients with HCC undergoing hepatic resection. Serum clusterin levels were determined by enzyme-linked immunosorbent assay. Clusterin expression in resected tissue was evaluated by immunohistochemistry. Median follow-up time was 57.8 months.

Results:

Mean serum clusterin levels were found to be 130.0 ± 58.7 µg/mL (range, 10.1-366.6 µg/mL). Serum clusterin levels were independent of tumor stage and deterioration of liver function in patients. No significant difference was observed in the survival of patients with high (>130.0 ± 58.7 µg/mL) or low (≤130.0 ± 58.7 µg/mL) serum clusterin level. Clusterin was expressed in HCC tissues of 76 patients (54.3%) and nontumor liver tissues of 53 patients (37.9%). No significant difference was observed in the survival of patients with positive or negative clusterin expression in HCC tissues. In nontumor tissues, patients with positive clusterin expression were observed to have low postoperative disease-free survival rate (p = 0.001) compared to patients with negative clusterin expression. Multivariate analysis showed that tumor with macrovascular/microvascular invasion and clusterin expression in nontumor tissues are independent prognostic factors following hepatic resection.

Conclusion:

In HCC, clusterin expression in nontumor tissue shows worse prognosis after hepatic resection. Clusterin can be a prognostic marker for patients with postresection HCC.
Serum γ-globulin and albumin concentrations predict secondary loss of response to anti-TNFα in inflammatory bowel disease patients
Authors: Schoenefuss Fabian , Hoffmann Peter
Published: September 2019

Background:

Loss of response to anti-TNFα treatment occurs frequently in IBD- patients. We evaluatedthe predictive value of serum albumin and γ-globulin concentrations for treatment failure.

Methods:

Prospectively, all patients treated for the first time with either infliximab or adalimumab for IBD between 2007 and 2018 were included. All patients were tested for serum albumin and γ-globulin concentrations and were followed up until June 2018.

Results:

128 patients (95 Crohn’s disease, 67 females, age 40.1 ± 13.7 years) were included in the study. 81patients (63.3%) received infliximab and 47 (36.7%) adalimumab first line. Eight patients (6.3%) were primary non-responders, 50 patients (39.0%) showed a sustained clinical remission and 70 patients (54.7%) developed a secondary loss of response. Meantime to develop secondary loss of response was 24.5 ± 20.5 months. Albumin serum concentrations in the clinical response group were significantly higher than in the secondary loss of response group (39.8 ± 5.7 g/L vs. 35.0 ± 5.4 g/L). γ-globulin serum concentrations in the sustained response group were significantly lower than in the secondary loss of response group (11.8 ± 2.8 g/L vs. 14.7 ± 4.5 g/L). Hypoalbuminemia and hypergammaglobulinemia were associated with the loss of response. Immunosuppressant co-medication in patients with high γ-globulin serum concentrations reduced the risk of secondary loss of response.

Conclusion:

Low albumin and increased γ-globulin serum concentrations are strongly associated with a higher risk for loss of response to an anti-TNFα treatment. Increased serum γ-globulin concentrations may have a higher risk to produce anti-drug antibodies or a different phenotype of disease less responsive to anti-TNFα treatment.
Isolated ileal blind loop inflammation after intestinal resection with ileocolonic anastomosis in Crohn’s disease: an often neglected endoscopic finding with an unfavorable outcome
Authors: Beelen Evelien M.J. , de Vries Annemarie C. , Bodelier Alexander G. , Moolenaar Jolyn , Schouten W. Rudolph , van der Woude C. Janneke
Published: September 2019

Objective

Postoperative endoscopic recurrence in patients with Crohn’s disease (CD) is commonly classified using the Rutgeerts score. Ulcerations in the ileal blind loop are not taken into account in the Rutgeerts score, and the clinical relevance of these lesions is unknown. This study aimed to assess the outcome of isolated ileal blind loop inflammation (IBLI) in postoperative CD patients.

Methods

Adult CD patients who underwent intestinal surgery with ileocolonic anastomosis between 1997 and 2017 were included and postoperative endoscopy reports were retrospectively reviewed. IBLI was defined as isolated inflammation of the ileal blind loop with or without ulcera confined to the anastomosis. Outcome was assessed using endoscopic recurrence (Rutgeerts >i2) and surgical recurrence (re-resection).

Results

A total of 341 CD patients were included. In 125 out of 341 (37%) patients, the ileal blind loop was described in the endoscopy reports. IBLI was reported in 43 of 341 (13%) patients. Start or step-up drug therapy was initiated in 10 of 32 (31%) IBLI patients with abdominal symptoms within a median of 0.9 months [interquartile range (IQR) 0.7–1.4] after ileocolonoscopy. Endoscopic recurrence occurred in 4 out of 38 (11%) IBLI patients without re-resection, within a median of 12.4 months (IQR 6.8–13.3). Intestinal re-resection was performed in 5 out of 43 (16%) IBLI patients within a median of 3.7 months (IQR 3.5–10.8).

Conclusion

IBLI is associated with symptoms and an unfavorable outcome, with a high risk of endoscopic recurrence in the neoterminal ileum and intestinal re-resection during short-term follow-up. Therefore, the blind ileal loop needs to be assessed during endoscopy in postoperative CD patients.
Parental Attitudes Towards Prenatal Genetic Testing For Sickle Cell Disease
Authors: Stevens Evelyn M. , Patterson Chavis A. , Tchume-Johnson Trudy , Antiel Ryan M. , Flake Alan , Smith-Whitley Kim , Barakat Lamia P.
Published: September 2019

Uptake of prenatal genetic testing (PGT) is low among those with sickle cell disease (SCD). This study evaluated the association of knowledge and attitudes towards prenatal genetic counseling (PGC), awareness of posttesting intervention options and omission bias with attitudes towards PGT. In addition, we explored changes among knowledge, attitudes, and awareness of options following exposure to an educational, clinical vignette among parents of children with SCD. Parents (n=44) completed a questionnaire and an educational, clinical vignette presenting a detailed account of a pregnant woman with sickle cell trait seeking PGT and PGC was read to each participant.tTests, Spearman correlations, multivariable regressions, and moderation/mediation analyses were used. More positive attitudes towards PGC (P=0.01), lesser tendency of omission bias (P<0.01) and private insurance (P=0.04) were significant correlates of more positive attitudes towards PGT. Omission bias mediated the relationship of attitudes towards PGC and attitudes towards PGT (95% confidence interval: 0.13, 3.03). Awareness of options (P=0.02), knowledge of PGC (P=0.01) and knowledge of PGT (P=0.01) significantly improved after exposure to the clinical vignette. Patients and families with SCD can benefit from education about the importance of prenatal diagnosis to improve attitudes, address omission bias and promote more informed decisions of PGT.
The effects of electromyography-triggered neuromuscular electrical stimulation plus tilt sensor functional electrical stimulation training on gait performance in patients with subacute stroke: a randomized controlled pilot trial
Authors: Mitsutake Tsubasa , Sakamoto Maiko , Horikawa Etsuo
Published: September 2019

The effects of electromyography-triggered neuromuscular electrical stimulation and tilt sensor functional electrical stimulation on ankle dorsiflexion during walking are unclear. This study investigated whether combined electrical stimulation training affects gait performance in patients with stroke. Thirty-six patients were randomly assigned to a control (n = 13), electromyography-triggered neuromuscular electrical stimulation training (single electrical stimulation group, n = 12), or a combined electromyography-triggered neuromuscular electrical stimulation and tilt sensor functional electrical stimulation training (combined electrical stimulation group, n = 11) group. Both experimental groups undertook 60-minute interventions for two weeks. All patients’ gait performances were evaluated according to walking speed and trunk acceleration during 10-meter walking tests undertaken pre-intervention and at two weeks post-intervention. A wireless triaxial accelerometer measured trunk acceleration, and the root mean square values of the vertical, mediolateral, and anterioposterior planes were calculated from randomly selected 10-step sequences. Compared with baseline, the 10-meter walking tests improved significantly after two weeks in the single and combined electrical stimulation groups. In the combined electrical stimulation group, the 10-meter walking tests scores and root mean square of the mediolateral plane improved significantly compared with those in the control group. Electromyography-triggered neuromuscular electrical stimulation and tilt sensor functional electrical stimulation training may improve body perturbation stability and walking quality.
Association of Duration of Hypotension With Survival After Pediatric Cardiac Arrest
Authors: Laverriere Elizabeth K. , Polansky Marcia , French Benjamin , Nadkarni Vinay M. , Berg Robert A. , Topjian Alexis A.
Published: September 2019

Objectives:

To evaluate the association of a single episode of hypotension and burden of hypotension with survival to hospital discharge following resuscitation from pediatric cardiac arrest.

Design:

Retrospective cohort study.

Setting:

Single-center PICU.

Patients:

Patients between 1 day and 18 years old who had a cardiac arrest, received chest compressions for more than 2 minutes, had return of spontaneous circulation for more than 20 minutes, and survived to receive postresuscitation care in the ICU.

Interventions:

None.

Measurement and Main Results:

One-hundred sixteen patients were evaluable. Hypotension, defined as systolic blood pressure less than the fifth percentile for age and sex, occurred in 37 patients (32%) within the first 6 hours and 64 (55%) within 72 hours of postresuscitation ICU care. There was no significant difference in survival to discharge for patients who had a single episode of hypotension within 6 hours (51% vs 69%; p = 0.06) or within 72 hours (56% vs 73%; p = 0.06). Burden of hypotension was defined as the percentage of hypotension measurements that were below the fifth percentile. After controlling for patient and cardiac arrest event characteristics, a higher burden of hypotension within the first 72 hours of ICU postresuscitation care was associated with decreased discharge survival (adjusted odds ratio = 0.67 per 10% increase in hypotension burden; 95% CI, 0.48–0.86; p = 0.006).

Conclusions:

After successful resuscitation from pediatric cardiac arrest, systolic hypotension was common (55%). A higher burden of postresuscitation hypotension within the first 72 hours of ICU postresuscitation care was associated with significantly decreased discharge survival, after accounting for potential confounders including number of doses of epinephrine, arrest location, and arrest etiology due to airway obstruction or trauma.
Necrotizing Enterocolitis and Associated Mortality in Neonates With Congenital Heart Disease: A Multi-Institutional Study
Authors: Spinner Joseph A. , Morris Shaine A. , Nandi Deipanjan , Costarino Andrew T. , Marino Bradley S. , Rossano Joseph W. , Shamszad Pirouz
Published: September 2019

Objective:

There are scarce data about the prevalence and mortality of necrotizing enterocolitis in neonates with congenital heart disease. The purpose of this study is to provide a multi-institutional description and comparison of the overall prevalence and mortality of necrotizing enterocolitis in neonates with congenital heart disease.

Design:

Retrospective multi-institutional study.

Setting:

The Pediatric Health Information System database.

Patients:

Neonates with congenital heart disease between 2004 and 2014.

Interventions:

None.

Measurements and Main Results:

The primary study measure is the prevalence of necrotizing enterocolitis. Secondary measures include in-hospital mortality, hospital charges, ICU length of stay, hospital length of stay, and 30-day readmission. The prevalence of necrotizing enterocolitis was 3.7% (1,448/38,770) and varied significantly among different congenital heart disease diagnoses. The lowest prevalence of necrotizing enterocolitis was in transposition of the great arteries (n = 104, 2.1%). Compared with transposition of the great arteries, necrotizing enterocolitis occurred more frequently in neonates with hypoplastic left heart syndrome (odds ratio, 2.7; 95% CI, 2.1–3.3), truncus arteriosus (odds ratio, 2.6; 95% CI, 1.9–3.5), common ventricle (odds ratio, 2.1; 95% CI, 1.5–2.8), and aortic arch obstruction (odds ratio, 1.4; 95% CI, 1.1–1.7). Prematurity is a significant risk factor for necrotizing enterocolitis and for mortality in neonates with necrotizing enterocolitis, conferring varying risk by cardiac diagnosis. Unadjusted mortality associated with necrotizing enterocolitis was 24.4% (vs 11.8% in neonates without necrotizing enterocolitis; p < 0.001), and necrotizing enterocolitis increased the adjusted mortality in neonates with transposition of the great arteries (odds ratio, 2.5; 95% CI, 1.5–4.4), aortic arch obstruction (odds ratio, 1.8; 95% CI, 1.3–2.6), and tetralogy of Fallot (odds ratio, 1.6; 95% CI, 1.1–2.4). Necrotizing enterocolitis was associated with increased hospital charges (p < 0.0001), ICU length of stay (p = 0.001), and length of stay (p = 0.001).

Conclusions:

The prevalence of necrotizing enterocolitis among neonates with congenital heart disease is 3.7% and is associated with increased in-hospital mortality, length of stay, and hospital charges. The prevalence and associated mortality of necrotizing enterocolitis in congenital heart disease vary among different heart defects.
Differential Influence of Donor Age Depending on the Indication for Liver Transplantation—A Collaborative Transplant Study Report
Authors: Houben Philipp , Döhler Bernd , Weiß Karl H. , Mieth Markus , Mehrabi Arianeb , Süsal Caner
Published: September 2019

Background.

Despite steadily increasing donor age, there are no general guidelines for the use of organs from elderly donors in liver transplantation. This study focuses on identifying the recipients who are less affected from an old-donor organ graft and conversely in whom a rather unfavorable outcome is expected because of high donor age.

Methods.

Forty-eight thousand two hundred sixty-one adult liver transplantations, performed between 2000 and 2017 and reported to the Collaborative Transplant Study, were analyzed.

Results.

The proportion of ≥65-year-old donors has risen to >33% in recent years. The donor age has an approximately linear influence on graft survival. On average, each year’s rise in the donor age was associated with a 0.9% increase in the risk of graft loss (hazard ratio [HR], 1.009; P < 0.001). The impact of donor age was strong in patients with hepatitis C–related cirrhosis (HR, 1.013; P < 0.001), substantial in patients with alcoholic cirrhosis (HR, 1.007; P < 0.001) and rather weak in patients with hepatocellular carcinoma (HR, 1.003; P = 0.038). The increase in the risk of graft loss per year rise in donor age was 1.4% for 18 to 49 year olds, 1.0% for middle-aged, and only 0.4% for ≥60-year-old recipients (all P < 0.001).

Conclusions.

Consequently, older recipients and especially patients with hepatocellular carcinoma seem to be less affected by an increased donor age, whereas the donor age is an important factor in all other patient groups.
Outcomes of Conversion From Calcineurin Inhibitor to Belatacept-based Immunosuppression in HLA-sensitized Kidney Transplant Recipients
Authors: Sethi Supreet , Najjar Reiad , Peng Alice , Choi Jua , Lim Kathlyn , Vo Ashley , Jordan Stanley C. , Huang Edmund
Published: September 2019

Background.

The efficacy and safety of belatacept when converted from calcineurin inhibitors (CNI) in HLA-sensitized (HS) kidney transplant recipients has not been established.

Methods.

The study included 108 kidney transplant recipients converted from CNI to belatacept between July 1, 2012, and September 30, 2017. Rejection-free, patient, and graft survival over 5 years follow-up were compared between HS and non-HLA-sensitized (non-HS) recipients using the Kaplan-Meier product-limit method. The estimated glomerular filtration rate slope postconversion was compared using linear mixed effects models.

Results.

There were 29 HS and 79 non-HS recipients included. Rejections after conversion were mostly cell-mediated. There was no difference in rejection-free survival (log-rank P = 0.30; at 5 y, HS: 82%; non-HS: 84.6%); however, rejection-free survival was lower among HS recipients converted within the first-year posttransplant compared to non-HS recipients (log-rank P = 0.03; at 5 y, HS: 55.6%; non-HS: 75.0%). There was no difference in patient survival (log-rank P = 0.75; at 5 y, HS: 85.7%, non-HS: 83.7%) or graft survival (log-rank P = 0.17; at 5 y, HS: 78.5%, non-HS: 89.8%) in the 2 groups. On average, estimated glomerular filtration rate slope improved postconversion in non-HS (0.28 mL/min/1.73 m2/y [0.03 to 0.53]) but declined in HS recipients (-0.44 mL/min/1.73 m2/y [-0.85 to -0.03]).

Conclusions.

There was no difference in rejection-free, patient, or graft survival after conversion to belatacept over 5 years among HS and non-HS recipients. However, rejection-free survival was lower in HS recipients converted to belatacept within the first-year posttransplant. Conversion from CNI to belatacept should be done cautiously in high immunologic risk patients.
Doesin uteroHIV-exposure and the early nutritional environment influence infant development and immune outcomes? Findings from a pilot study in Pretoria, South Africa
Authors: White Marina , Feucht Ute D , Duffley Eleanor , Molokoane Felicia , Durandt Chrisna , Cassol Edana , Rossouw Theresa , Connor Kristin L
Published: September 2019

Background

As mother-to-child-transmission of HIV decreases, and the population of infants who are born HIV-exposed, but uninfected (HEU) continues to rise, there is growing need to understand the development and health outcomes of infants who are HEU to ensure that they have the healthiest start to life.

Methods

In a prospective cohort pilot study at Kalafong Hospital, Pretoria, South Africa, we aimed to determine if we could recruit new mothers living with HIV on antiretrovirals (ART; n=20) and not on ART (n=20), and new mothers without HIV (n=20) through our clinics to study the effects of HEU on growth, immune- and neuro-development in infants in early life, and test the hypothesis that infants who were HEU would have poorer health outcomes compared to infants who were HIV-unexposed, uninfected (HUU). We also undertook exploratory analyses to investigate relationships between the early nutritional environment, food insecurity, and infant development. Infant growth, neurodevelopment (Guide for Monitoring Child Development [GMCD]) and levels of monocyte subsets (CD14, CD16, and CCR2 expression [flow cytometry]) were measured in infants at birth and 12 weeks (range 8-16 weeks).

Results

We recruited 33 women living with HIV on ART, and 22 women living without HIV within four days of delivery from June-December 2016. 21 women living with HIV and 10 without HIV returned for a follow-up appointment at 12 weeks postpartum. The high mobility of this population presented major challenges to participant retention. Preliminary analyses revealed lower head circumference and elevated CCR2+ (% and median fluorescence intensity) on monocytes at birth among infants who were HEU compared to HUU. Maternal reports of food insecurity were associated with lower maternal nutrient intakes at 12 weeks postpartum and increased risk of stunting at birth for infants who were HEU, but not infants who were HUU.

Conclusions

Our small feasibility pilot study suggests that HEU may adversely affect infant development, and further, infants who are HEU may be even more vulnerable to the programming effects suboptimal nutritionin uteroand postnatally. This pilot and preliminary analyses have been used to inform our research questions and protocol in our ongoing, full-scale study.