bluuebunny/crossref_metadata_2025 huggingface dataset:
Health outcomes after stopping long-term mepolizumab in severe eosinophilic asthma: COMET
Authors: Liu Mark C. , Bel Elisabeth H. , Kornmann Oliver , Moore Wendy C. , Kaneko Norihiro , Smith Steven G. , Martin Neil , Price Robert G. , Yancey Steven W. , Humbert Marc
Published: October 2021

Asthma worsening and symptom control are clinically important health outcomes in patients with severe eosinophilic asthma. This analysis of COMET evaluated whether stoppingversuscontinuing long-term mepolizumab therapy impacted these outcomes.

Patients with severe eosinophilic asthma with ≥3 years continuous mepolizumab treatment (viaCOLUMBA (NCT01691859) or COSMEX (NCT02135692) open-label studies) were eligible to enter COMET (NCT02555371), a randomised, double-blind, placebo-controlled study. Patients were randomised 1:1 to continue mepolizumab 100 mg subcutaneous every 4 weeks or to stop mepolizumab, plus standard of care asthma treatment. Patients could switch to open-label mepolizumab following an exacerbation. Health outcome endpoints included time to first asthma worsening (composite endpoint: rescue use, symptoms, awakening at night and morning peak expiratory flow (PEF)), patient and clinician assessed global rating of asthma severity and overall perception of response to therapy, and unscheduled healthcare resource utilisation.

Patients who stopped mepolizumab showed increased risk of and shorter time to first asthma worsening compared with those who continued mepolizumab (hazard ratio (HR) 1.71; 95% CI 1.17–2.52; p=0.006), including reduced asthma control (increased risk of first worsening in rescue use (HR 1.36; 95% CI 1.00–1.84; p=0.047) and morning PEF (HR 1.77; 95% CI 1.21–2.59; p=0.003). There was a higher probability of any unscheduled healthcare resource use (HR 1.81; 95% CI 1.31–2.49; p<0.001), and patients and clinicians reported greater asthma severity and less favourable perceived response to therapy for patients who stoppedversuscontinued mepolizumab.

These data suggest that patients with severe eosinophilic asthma continuing long-term mepolizumab treatment sustain clinically important improvements in health outcomes.
Global shifts in species richness have shaped carpet shark evolution
Authors: Boyd Bret M. , Seitz Jason C.
Published: October 2021

Background

The evolutionary processes that shape patterns of species richness in marine ecosystems are complex and may differ between organismal groups. There has been considerable interest in understanding the evolutionary processes that led to marine species richness being concentrated in specific geographical locations. In this study we focus on the evolutionary history of a group of small-to-medium sized sharks known as carpet sharks. While a few carpet shark species are widespread, the majority of carpet shark species richness is contained within a biodiversity hotspot at the boundary of the Indian and Pacific oceans. We address the significance of this biodiversity hotspot in carpet shark evolution and speciation by leveraging a rich fossil record and molecular phylogenetics to examine the prehistoric distribution of carpet sharks.

Results

We find that carpet sharks species richness was greatest in shallow seas connected to the Atlantic Ocean during the Late Cretaceous, but that there was a subsequent loss of biodiversity in Atlantic waters. Fossil evidence from sites in close geographic proximity to the current center of carpet shark diversity are generally restricted to younger geologic strata.

Conclusions

From this data we conclude that (1) center of carpet shark biodiversity has shifted during the last 100 million years, (2) carpet sharks have repeatedly dispersed to nascent habitat (including to their current center of diversity), and (3) the current center of carpet shark biodiversity conserves lineages that have been extirpated from this prehistoric range and is a source of new carpet shark species. Our findings provide insights into the roles of marine biodiversity hotspots for higher-tropic level predators and the methods applied here can be used for additional studies of shark evolution.
Sensitivity and specificity of self-reported psychiatric diagnoses amongst patients treated for opioid use disorder
Authors: Leung Kelly , Xu Emily , Rosic Tea , Worster Andrew , Thabane Lehana , Samaan Zainab
Published: October 2021

Background

Patients with opioid use disorder (OUD) frequently present with comorbid psychiatric illnesses which have significant implications for their treatment outcomes. Notably, these are often identified by self-report. Our study examined the sensitivity and specificity of self-reported psychiatric diagnoses against a structured diagnostic interview in a cohort of patients receiving outpatient pharmacological treatment for OUD.

Methods

Using cross-sectional data from adults receiving outpatient opioid agonist treatment for OUD in clinics across Ontario, Canada, we compared participants’ self-reported psychiatric diagnoses with those identified by the Mini Neuropsychiatric Interview (MINI) Version 6.0 administered at the time of study entry. Sensitivity and specificity were calculated for self-report of psychiatric diagnoses.

Results

Amongst a sample of 683 participants, 24% (n = 162) reported having a comorbid psychiatric disorder. Only 104 of these 162 individuals (64%) reporting a comorbidity met criteria for a psychiatric disorder as per the MINI; meanwhile, 304 (75%) participants who self-reported no psychiatric comorbidity were in fact identified to meet MINI criteria for a psychiatric disorder. The sensitivity and specificity for any self-reported psychiatric diagnoses were 25.5% (95% CI 21.3, 30.0) and 78.9% (95% CI 73.6, 83.6), respectively.

Conclusions

Our findings raise questions about the utility of self-reported psychiatric comorbidity in patients with OUD, particularly in the context of low sensitivity of self-reported diagnoses. Several factors may contribute to this including remittance and relapse of some psychiatric illnesses, underdiagnosis, and the challenge of differentiating psychiatric and substance-induced disorders. These findings highlight that other methods should be considered in order to identify comorbid psychiatric disorders in patients with OUD.
Prediction of gold stage in patients hospitalized with COPD exacerbations using blood neutrophils and demographic parameters as risk factors
Authors: Chen Jing , Yang Zhao , Yuan Qun , Guo Li-quan , Xiong Da-xi
Published: October 2021

Background

Patients hospitalized with chronic obstructive pulmonary disease (COPD) exacerbations are unable to complete the pulmonary function test reliably due to their poor health conditions. Creating an easy-to-use instrument to identify the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage will offer valuable information that assists clinicians to choose appropriate clinical care to decrease the mortality in these patients. The objective of this study was to develop a prediction model to identify the GOLD stage in the hospitalized exacerbation of chronic obstructive pulmonary disease (ECOPD) patients.

Methods

This prospective study involved 155 patients hospitalized for ECOPD. All participants completed lung function tests and the collection of blood neutrophils and demographic parameters. Receiver operating characteristic (ROC) curve was plotted based on the data of 155 patients, and was used to analyze the disease severity predictive capability of blood neutrophils and demographic parameters. A support vector regression (SVR) based GOLD stage prediction model was built using the training data set (75%), whose accuracy was then verified by the testing data set (25%).

Results

The percentage of blood neutrophils (denoted as NEU%) combined with the demographic parameters was associated with a higher risk to severe episode of ECOPD. The area under the ROC curve was 0.84. The SVR model managed to predict the GOLD stage with an accuracy of 90.24%. The root-mean-square error (RMSE) of the forced expiratory volume in one second as the percentage of the predicted value (denoted as FEV1%pred) was 8.84%.

Conclusions

The NEU% and demographic parameters are associated with the pulmonary function of the hospitalized ECOPD patients. The established prediction model could assist clinicians in diagnosing GOLD stage and planning appropriate clinical care.
Functionalized nanoparticles with monocyte membranes and rapamycin achieve synergistic chemoimmunotherapy for reperfusion-induced injury in ischemic stroke
Authors: Wang Yanyun , Wang Yi , Li Shuyu , Cui Yuliang , Liang Xiping , Shan Juanjuan , Gu Wei , Qiu Juhui , Li Yiliang , Wang Guixue
Published: October 2021

Background

Ischemic stroke is an acute and severe neurological disease, and reperfusion is an effective way to reverse brain damage after stroke. However, reperfusion causes secondary tissue damage induced by inflammatory responses, called ischemia/reperfusion (I/R) injury. Current therapeutic strategies that control inflammation to treat I/R are less than satisfactory.

Results

We report a kind of shield and sword nano-soldier functionalized nanoparticles (monocyte membranes-coated rapamycin nanoparticles, McM/RNPs) that can reduce inflammation and relieve I/R injury by blocking monocyte infiltration and inhibiting microglia proliferation. The fabricated McM/RNPs can actively target and bind to inflammatory endothelial cells, which inhibit the adhesion of monocytes to the endothelium, thus acting as a shield. Subsequently, McM/RNPs can penetrate the endothelium to reach the injury site, similar to a sword, and release the RAP drug to inhibit the proliferation of inflammatory cells. In a rat I/R injury model, McM/RNPs exhibited improved active homing to I/R injury areas and greatly ameliorated neuroscores and infarct volume. Importantly, in vivo animal studies revealed good safety for McM/RNPs treatment.

Conclusion

The results demonstrated that the developed McM/RNPs may serve as an effective and safe nanovehicles for I/R injury therapy.

Graphic abstract
COVID19 infection in a patient undergoing treatment for Paroxysmal Nocturnal Hemoglobinuria (PNH) with Ravulizumab
Authors: Shikdar Sufana , Borogovac Azra , Mohamad Elabdallah , Khawandanah Mohamad
Published: October 2021

Background

In the recent COVID19 pandemic, patients with hematological disorders were considered at high risk for severe disease. Limited data is available regarding the course of COVID19 infection in this subgroup.

Case Presentation

We describe a case of a 32-year-old man with paroxysmal nocturnal hemoglobinuria (PNH) undergoing treatment with ravulizumab (Ultomiris) who presented with COVID19 infection. He experienced only mild symptoms and had a rapid recovery from COVID19 infection.

Conclusion

This case may demonstrate the beneficial effects of ravulizumab on complement mediated inflammatory damage linked with COVID19 infection especially in PNH patients.
Non-circular signal DOA estimation based on coprime array MIMO radar
Authors: Zhang Fei , Ji Chuantang , Zhang Zijing , Yin Dayu , Wang Yi
Published: October 2021

Aiming at the problems of low degree of freedom, small array aperture, and phase ambiguity in traditional coprime array direction-of-arrival estimation methods, a non-circular signal DOA estimation method based on expanded coprime array MIMO radar is proposed. Firstly, this method combines the coprime array and the MIMO radar to form transmitter and receiver array. Secondly, the array is expanded using the non-circular signal characteristics to reconstruct the received signal matrix. Then the dimensionality reduction is performed. The two-dimensional spectral peak search is converted into an optimization problem, and the optimization of the two-dimensional MUSIC algorithm is reconstructed using constraints, and a cost function is constructed to solve the problem. In addition, use the power series of the noise eigenvalues to correct the noise subspace to further improve the accuracy of the algorithm. Finally, the problem of no phase ambiguity in the method in this article is derived. Simulation experiments show that the method in this article can effectively avoid phase ambiguity, greatly improve the degree of freedom, and expand the array aperture. Compared with the traditional MUSIC algorithm and the mutual prime array MUSIC algorithm, it has better resolution and DOA estimation accuracy.
Diagnostic value of chest computed tomography imaging for COVID-19 based on reverse transcription-polymerase chain reaction: a meta-analysis
Authors: Liu Jing , Yang Xue , Zhu Yunxian , Zhu Yi , Liu Jingzhe , Zeng Xiantao , Li Hongjun
Published: October 2021

Background

The computed tomography (CT) diagnostic value of COVID-19 is controversial. We summarized the value of chest CT in the diagnosis of COVID-19 through a meta-analysis based on the reference standard.

Methods

All Chinese and English studies related to the diagnostic value of CT for COVID-19 across multiple publication platforms, was searched for and collected. Studies quality evaluation and plotting the risk of bias were estimated. A heterogeneity test and meta-analysis, including plotting sensitivity (Sen), specificity (Spe) forest plots, pooled positive likelihood ratio (+LR), negative likelihood ratio (-LR), dignostic odds ratio (DOR) values and 95% confidence interval (CI), were estimated. If there was a threshold effect, summary receiver operating characteristic curves (SROC) was further plotted. Pooled area under the receiver operating characteristic curve (AUROC) and 95% CI were also calculated.

Results

Twenty diagnostic studies that represented a total of 9004 patients were included from 20 pieces of literatures after assessing all the aggregated studies. The reason for heterogeneity was caused by the threshold effect, so the AUROC = 0.91 (95% CI: 0.89–0.94) for chest CT of COVID-19. Pooled sensitivity, specificity, +LR, -LR from 20 studies were 0.91 (95% CI: 0.88–0.94), 0.71 (95% CI: 0.59–0.80), 3.1(95% CI: 2.2–4.4), 0.12 (95% CI: 0.09–0.17), separately. The I2 was 85.6% (P = 0.001) by Q-test.

Conclusions

The results of this study showed that CT diagnosis of COVID-19 was close to the reference standard. The diagnostic value of chest CT may be further enhanced if there is a unified COVID-19 diagnostic standard. However, please pay attention to rational use of CT.

Graphic Abstract
The α-dystrobrevins play a key role in maintaining the structure and function of the extracellular matrix–significance for protein elimination failure arteriopathies
Authors: Sharp Matthew MacGregor , Cassidy Jordan , Thornton Thomas , Lyles James , Keable Abby , Gatherer Maureen , Yasui Masato , Abe Yoichiro , Shibata Shinsuke , Weller Roy O. , Górecki Dariusz C. , Carare Roxana O.
Published: October 2021

The extracellular matrix (ECM) of the cerebral vasculature provides a pathway for the flow of interstitial fluid (ISF) and solutes out of the brain by intramural periarterial drainage (IPAD). Failure of IPAD leads to protein elimination failure arteriopathies such as cerebral amyloid angiopathy (CAA). The ECM consists of a complex network of glycoproteins and proteoglycans that form distinct basement membranes (BM) around different vascular cell types. Astrocyte endfeet that are localised against the walls of blood vessels are tethered to these BMs by dystrophin associated protein complex (DPC). Alpha-dystrobrevin (α-DB) is a key dystrophin associated protein within perivascular astrocyte endfeet; its deficiency leads to a reduction in other dystrophin associated proteins, loss of AQP4 and altered ECM. In human dementia cohorts there is a positive correlation between dystrobrevin gene expression and CAA. In the present study, we test the hypotheses that (a) the positive correlation between dystrobrevin gene expression and CAA is associated with elevated expression of α-DB at glial-vascular endfeet and (b) a deficiency in α-DB results in changes to the ECM and failure of IPAD. We used human post-mortem brain tissue with different severities of CAA and transgenic α-DB deficient mice. In human post-mortem tissue we observed a significant increase in vascular α-DB with CAA (CAA vrs. Old p < 0.005, CAA vrs. Young p < 0.005). In the mouse model of α-DB deficiency, there was early modifications to vascular ECM (collagen IV and BM thickening) that translated into reduced IPAD efficiency. Our findings highlight the important role of α-DB in maintaining structure and function of ECM, particularly as a pathway for the flow of ISF and solutes out of the brain by IPAD.
Are only floods with large discharges threatening? Flood characteristics evolution in the Yangtze River Basin
Authors: Liu Suning , Zheng Yi , Feng Lian , Chen Ji , Lakshmi Venkataraman , Shi Haiyun
Published: October 2021

This study focuses on the evolution of flood risk in the Yangtze River Basin under climate change, which is a critical issue for socioeconomic development in future. In this study, we (1) compared the 1998 and 2020 floods and found that the destructiveness of a given discharge is now greater than before; (2) revealed three issues related to the above finding; and (3) prospected the future development of up-to-date technologies to better address the issue that floods with high water levels will frequently threaten us. The outcomes of this study would be of great significance to future flood control operation of large river basins.
Placement of sutures for inside-out meniscal repair: both sutures through meniscal tissue reduces displacement on cyclical loading
Authors: Yamakawa Satoshi , Mae Tatsuo , Ogasawara Issei , Hirose Takehito , Konda Shoji , Nakata Ken
Published: October 2021

Purpose

The inside-out meniscal repair is widely performed to preserve the function of meniscus. In this technique, the outer suture is passed through the capsule as well as the outer meniscus, while the inner suture is inserted into the meniscus. The aim of this study was to biomechanically compare the suture stability between meniscus-meniscus and meniscus-capsule suture methods for the longitudinal meniscal tear with inside-out technique.

Methods

Twenty-seven porcine knees were dissected to maintain the femur-medial capsule/meniscus-tibia complex, and the inner meniscus was cut off along the meniscus circumferential fiber with 3 mm width of the peripheral meniscus preserved. After one needle with a 2-0 polyester suture was inserted into the inner portion of the meniscus, the other needle was inserted through 1) the peripheral meniscus (Group A), 2) capsule just above the meniscus (Group B), and 3) capsule at 10 mm apart from the meniscus-capsule junction (Group C) in the inside-out manner. Then, the suture was manually tied on the capsule. The suture gap at the repair site during 300 times of cyclic loading and the ultimate failure load in the load-to-failure test were measured. The statistical significance of the data between two groups in each combination was considered by Bonferroni correction, following a one-way analysis of variance.

Results

In the cyclic loading test, the suture gap was 0.68 ± 0.26 mm in Group A, 1.08 ± 0.36 mm in Group B, and 1.94 ± 0.57 mm in Group C with a significant difference. In the load-to-failure test, the ultimate failure load was 59.1 ± 13.6 N in Group A, 60.0 ± 7.9 N in Group B, and 57.4 ± 4.7 N in Group C, and there was no significant difference.

Conclusion

The stitching region in the inside-out technique for longitudinal meniscal tear affected the stability of the tear site, and stitching the mid-substance region of the meniscus provides good stability in response to cyclic tensile loading. In addition, the stitching region did not affect the ultimate failure load.

Clinical relevance

In the inside-out meniscal repair, the outer suture should be inserted into the remaining peripheral meniscus or the capsule near the meniscus.
Hidden ileostomy as a rescue procedure in major colorectal surgeries: a novel technique to prevent re-laparotomy in anastomotic leak cases
Authors: Ezzy Mohsen , Elshafei Moustafa , Hamdi Khalid , Kraus Thomas , Heinz Peter , Svoboda Michael , Fleischer Katrin , Grimm Kersten , Berkhoff Stefan
Published: October 2021

Background

Anastomotic leak is a major cause of morbidity and mortality of patients worldwide, and it has remained stable over the last years. Routine construction of protective ileostomy is associated with stoma and negatively affects patients’ quality of life. Developing another technique to minimize those drawbacks with at least the same clinical success can help patients with anastomotic leak. We present the novel technique “Hidden Ileostomy” as an alternative to protective ileostomy that can achieve that balance.

Materials and methods

Eight patients presented to our department underwent the novel technique “Hidden Ileostomy” as a rescue procedure for different reasons. The associated risk factors and clinical scenarios, together with the follow-up data, are presented.

Results

For the eight cases in this study, one patient was ASA grade 1, 3 patients were classified as ASA grade 2, and 4 were grade 3. The mean ± SD operative time and blood loss were 196.3 ± 16.4 min and 325 ± 204.6 ml, respectively. The hidden ileostomy was removed after an average of 8 days. Only Case 6 reported an anastomotic leak on a postoperative day 10.

Conclusion

A hidden ileostomy is an alternative and feasible technique in selected cases in colorectal surgery. This technique could be adopted in our practice instead of routine instruction of ileostomy, especially in the equivocal anastomosis.
The Code Silver Exercise: a low-cost simulation alternative to prepare hospitals for an active shooter event
Authors: Kim Julie J. , Howes Daniel , Forristal Chantal , Willmore Andrew
Published: October 2021

Mass-shooting incidents have been increasing in recent years and Code Silver—the hospital response to a person with a weapon such as an active shooter in many Provinces or States in North America—is quickly shifting from a theoretical safety measure to a realistic scenario for which hospitals must prepare their staff. A Code Silver Exercise (CSE) involving an independent mental practice exercise with written responses to scenarios and questions, followed by a facilitated debrief with all participants, was conceptualized and trialled for feasibility and efficacy. The CSE was piloted as a quality improvement and emergency preparedness initiative in three different settings including in situ within a hospital Emergency Department or Intensive Care Unit, offsite in a large conference room workshop, and online via virtual platform. These sessions took place in 4 different cities in Canada and included 3 academic teaching hospitals. Participants of the in situ and virtual CSE completed pre- and post-simulation surveys which showed improved understanding of Code Silver protocols following participation.

The CSE is a reproducible simulation alternative, designed to operationalize a Code Silver policy at a large healthcare institution in a sustainable way. This training model can be administered in multiple settings in-person (in situ or offsite), and virtually, making it versatile and easily accessible for participants. This exercise enables participants to mentally rehearse practical responses to an active shooter in their unique work environments and to discuss ethical and medical-legal implications of their responses during a facilitated debrief with fellow healthcare providers. Implementation of a CSE for training in hospitals may help staff to create a mental schema prior to an active shooter event, and thus indirectly improve the chances of survivability in the event of a real active shooter situation.
Bicyclist-evoked arousal and greater attention to bicyclists independently promote safer driving
Authors: Kim Andy Jeesu , Alambeigi Hananeh , Goddard Tara , McDonald Anthony D. , Anderson Brian A.
Published: October 2021

While attention has consistently been shown to be biased toward threatening objects in experimental settings, our understanding of how attention is modulated when the observer is in an anxious or aroused state and how this ultimately affects behavior is limited. In real-world environments, automobile drivers can sometimes carry negative perceptions toward bicyclists that share the road. It is unclear whether bicyclist encounters on a roadway lead to physiological changes and attentional biases that ultimately influence driving behavior. Here, we examined whether participants in a high-fidelity driving simulator exhibited an arousal response in the presence of a bicyclist and how this modulated eye movements and driving behavior. We hypothesized that bicyclists would evoke a robust arousal and orienting response, the strength of which would be associated with safer driving behavior. The results revealed that encountering a bicyclist evoked negative arousal by both self-report and physiological measures. Physiological and eye-tracking measures were themselves unrelated, however, being independently associated with safer driving behavior. Our findings offer a real-world demonstration of how arousal and attentional prioritization can lead to adaptive behavior.
“Wild fish are a blessing”: changes in fishing practices and folk fish cuisine around Laguna Lake, Northern Philippines
Authors: Mendoza Jimlea Nadezhda , Mattalia Giulia , Prūse Baiba , Kochalski Sophia , Ciriaco Aimee , Pieroni Andrea , Sõukand Renata
Published: October 2021

Several coastal communities rely heavily on wild-caught fish for personal consumption and their livelihoods, thus being sensitive to the rapid global change affecting fish availability. However, in the last century, aquaculture has been increasingly adopted. To understand the uses and changes of wild-caught fish, we conducted 30 semi-structured interviews with fishers of Laguna Lake, Philippines. Fishermen, with up to 60 years’ experience, reported catching 31 fish species as a staple food. The taxa with the greatest variety of food uses were the farmedOreochromis aureus,and the wildChanna striataandCyprinus carpio. Fish was boiled, fried, grilled and dried, and over 20 different local dishes were reported. Fishers reported that local communities previously relied more on wild fish, while today a greater proportion of consumed fish comes from aquaculture fish species such asOreochromis aureusandHypophthalmichthys nobilis. Wild fish remains a crucial aspect of local gastronomic diversity, underpinning the biodiversity of the Laguna Lake, while also representing an important element for food sovereignty. The study stresses the need to sustain local ecological knowledge to ensure the ecological, social and economic sustainability of the communities.
Distributed Kalman filter for UWB/INS integrated pedestrian localization under colored measurement noise
Authors: Xu Yuan , Cao Jing , Shmaliy Yuriy S. , Zhuang Yuan
Published: October 2021

Colored Measurement Noise (CMN) has a great impact on the accuracy of human localization in indoor environments with Inertial Navigation System (INS) integrated with Ultra Wide Band (UWB). To mitigate its influence, a distributed Kalman Filter (dKF) is developed for Gauss–Markov CMN with switching Colouredness Factor Matrix (CFM). In the proposed scheme, a data fusion filter employs the difference between the INS- and UWB-based distance measurements. The main filter produces a final optimal estimate of the human position by fusing the estimates from local filters. The effect of CMN is overcome by using measurement differencing of noisy observations. The tests show that the proposed dKF developed for CMN with CFM can reduce the localization error compared to the original dKF, and thus effectively improve the localization accuracy.
Clinico-epidemiological profile and treatment outcomes in patients with squamous cell carcinoma of the esophagus following docetaxel-based neoadjuvant chemotherapy: experience from a cancer care center in Northeast India
Authors: Roy Partha Sarathi , Kumar Gaurav , Mallik Sreya , Sarangi Satya Sadhan , Saikia Bhargab Jyoti , Hazarika Munlima , Talukdar Abhijit
Published: October 2021

Background

Squamous cell carcinoma of the esophagus ranks as the most common cause of cancer incidence and mortality in males and the second most common in females. Surgery alone is associated with poor long-term survival. Neoadjuvant chemoradiation and perioperative chemotherapy without radiation have been tried to improve survival rates.

Methods

We retrospectively evaluated the neoadjuvant chemotherapy in forty-eight patients with non-metastatic, non-cervical squamous cell carcinoma of the esophagus with a docetaxel-based three-drug regimen to improve complete pathological response rates.

Results

The median age of presentation was 52 years, with male preponderance. All the patients received three cycles of docetaxel-cisplatin-fluorouracil-based chemotherapy. A complete pathological response to neoadjuvant chemotherapy was seen in 8 patients (17%). Rates of grade 3 hematological toxicities were seen in 12% of patients, with no observed grade 4 toxicity. The most common non-hematological toxicity was grade 3 alopecia (seen in 40%) and grade 2 nausea/vomiting in 8% of patients. At a median follow-up of 26.5 months, 2-year survival for the patients receiving chemotherapy and surgery is 66%.

Conclusions

Preoperative chemotherapy with a taxane-based triple-drug regimen is a reasonable approach in squamous cell carcinoma of the esophagus, associated with improvement in complete pathological response rates, increases complete resection rates, with manageable toxicity.
Role of multi-parametric MRI in the differentiation between mucinous breast carcinoma and fibroadenoma
Authors: Bayoumi Dalia , Sakrana Amal , Abdelhalim Ebrahim , Alnaghy Eman
Published: October 2021

Background

The purpose of this study was to evaluate diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and functional MRI (diffusion and MR spectroscopy) using the latest MRI breast imaging reporting and data system (MRI-BIRADS) descriptors and non-BIRADS items for differentiation of mucinous breast carcinomas from fibroadenomas.

Methods

We included 19 cases of mucinous breast carcinoma and 37 cases of fibroadenoma. DCE-MRI, Diffusion-weighted MR imaging (DWI) and multi-voxel MR spectroscopy (MRS) were done, MRI-BIRADS (5th edition) analysis of the lesions was performed, and histopathological examination of all cases was done.

Results

According to univariate analysis, mucinous carcinoma was frequently detected in older age-group (COR = 1.4, 95% CI = 1.1–1.7 and p value < 0.001) and had more frequent irregular borders and non-circumscribed margins than fibroadenoma (COR = 11.6, 95% CI = 2–66.4 and p value  = 0.002). All mucinous carcinoma had high T2 signal. Fibroadenomas had more frequent homogenous enhancement than mucinous carcinoma; none of the fibroadenomas had rim enhancement nor enhancing internal septations; mucinous carcinoma had more frequent rim enhancement and (n = 6, p value  < 0.001) and enhancing internal septations (n = 7, p value  < 0.001). Fibroadenoma had frequent dark non-enhancing internal septations than mucinous carcinoma (p value  < 0.001). On multivariate analysis, mucinous carcinoma had significant combination of being common in older age, larger in size, with irregular shape, and non-circumscribed margins. On ADC map and MRS, mucinous carcinoma had higher ADC values and higher CHO.SNR than fibroadenoma. The mean ADC value of mucinous carcinoma was 1.3 ± 0.1 × 10−3mm2/s, which was significantly higher than that of fibroadenoma (1.1 ± 0.1 × 10−3mm2/s), with p = 0.002. Also, the mean CHO.SNR was significantly higher in mucinous carcinoma (3.1 ± 0.8) than fibroadenoma (0.8 ± 0.5) with p value  < 0.001. According to our results, the presence of type 3 (washout curve), dark internal septations, non-circumscribed margins and irregular shape of the lesion showed the highest sensitivity and accuracy for differentiation of mucinous carcinomas and fibroadenomas (100, 78.6%), (89.4, 82%), (86.5, 80.3%) and (81, 71.4%), respectively.

Conclusion

The combined use of DCE-MRI, DW-MRI and MRS with breast MRI-BIRADS descriptors and non-BIRADS items increases the diagnostic accuracy for differentiation of mucinous carcinomas from fibroadenomas.
Anesthetic Effects on the Progression of Parkinson Disease in the Rat DJ-1 Model
Authors: Xu Daniel A. , DeYoung Timothy P. , Kondoleon Nicholas P. , Eckenhoff Roderic G. , Eckenhoff Maryellen F.
Published: October 2021

BACKGROUND:

Parkinson disease is a chronic and progressive movement disorder characterized by the loss of dopaminergic neurons in the substantia nigra pars compacta (SNpc). The causes of Parkinson disease are not clear but may involve genetic susceptibilities and environmental factors. As in other neurodegenerative disorders, individuals predisposed to Parkinson disease may have an accelerated onset of symptoms following perioperative stress such as anesthesia, surgery, pain, and inflammation. We hypothesized that anesthesia alone accelerates the onset of Parkinson disease–like pathology and symptoms.

METHODS:

A presymptomatic Parkinson rat model (the protein, DJ-1, encoded by the Park7 gene [DJ-1], PARK7 knockout) was exposed to a surgical plane of isoflurane or 20% oxygen balanced with nitrogen for 2 hours on 3 occasions between 6 and 7 months of age. Acute and long-term motor and neuropathological effects were examined from 7 to 12 months of age in male DJ-1 rats, using the ladder rung, rotarod, and novel object recognition assays, as well as the immunohistochemical localization of tyrosine hydroxylase in dopaminergic neurons in the substantia nigra and ionized calcium-binding adaptor protein-1 (Iba-1) microglial activation in the substantia nigra and hippocampus.

RESULTS:

In the acute group, after the third anesthetic exposure at 7 months of age, the isoflurane group had a significant reduction in the density of dopaminergic neurons in the SNpc compared to controls. However, this reduction was not associated with increased microglial activation in the hippocampus or substantia nigra. With the ladder rung motor skills test, there was no effect of anesthetic exposure on the total number of foot faults or the ladder rung pattern in the acute group. The rotarod test also detected no differences before and after the third exposure in controls. For the long-term group, immunohistochemical analyses detected no differences in the density of dopaminergic neurons or microglial cells compared to unexposed DJ-1 rats from 8 to 12 months of age. The ladder rung test in the long-term group showed no differences in the total number of foot faults with time and exposure or between ladder rung patterns. The rotarod test detected no significant effect of exposure with time or between groups at any time point. The novel object recognition task in the long-term group revealed no differences in short- or long-term memory or in the number of rearings as a function of exposure.

CONCLUSIONS:

Multiple isoflurane exposures in this rat model of Parkinson disease transiently enhanced dopaminergic neurodegeneration in the SNpc that resolved over time and had no effects on progression in this Parkinson disease–like phenotype.
Raspberry Pi-Based Data Archival System for Electroencephalogram Signals From the SedLine Root Device
Authors: Suresha Pradyumna B. , Robichaux Chad J. , Cassim Tuan Z. , García Paul S. , Clifford Gari D.
Published: October 2021

BACKGROUND:

The retrospective analysis of electroencephalogram (EEG) signals acquired from patients under general anesthesia is crucial in understanding the patient’s unconscious brain’s state. However, the creation of such database is often tedious and cumbersome and involves human labor. Hence, we developed a Raspberry Pi-based system for archiving EEG signals recorded from patients under anesthesia in operating rooms (ORs) with minimal human involvement.

METHODS:

Using this system, we archived patient EEG signals from over 500 unique surgeries at the Emory University Orthopaedics and Spine Hospital, Atlanta, for about 18 months. For this, we developed a software package that runs on a Raspberry Pi and archives patient EEG signals from a SedLine Root EEG Monitor (Masimo) to a secure Health Insurance Portability and Accountability Act (HIPAA) compliant cloud storage. The OR number corresponding to each surgery was archived along with the EEG signal to facilitate retrospective EEG analysis. We retrospectively processed the archived EEG signals and performed signal quality checks. We also proposed a formula to compute the proportion of true EEG signal and calculated the corresponding statistics. Further, we curated and interleaved patient medical record information with the corresponding EEG signals.

RESULTS:

We retrospectively processed the EEG signals to demonstrate a statistically significant negative correlation between the relative alpha power (8–12 Hz) of the EEG signal captured under anesthesia and the patient’s age.

CONCLUSIONS:

Our system is a standalone EEG archiver developed using low cost and readily available hardware. We demonstrated that one could create a large-scale EEG database with minimal human involvement. Moreover, we showed that the captured EEG signal is of good quality for retrospective analysis and combined the EEG signal with the patient medical records. This project’s software has been released under an open-source license to enable others to use and contribute.
A Simple Risk Scoring System for Predicting the Occurrence of Aspiration Pneumonia After Gastric Endoscopic Submucosal Dissection
Authors: Park Kyemyung , Kim Na Young , Kim Ki Jun , Oh Chaerim , Chae Dongwoo , Kim So Yeon
Published: October 2021

BACKGROUND:

Aspiration pneumonia after endoscopic submucosal dissection (ESD) is rare, but can be fatal. We aimed to investigate risk factors and develop a simple risk scoring system for aspiration pneumonia.

METHODS:

We retrospectively reviewed medical records of 7833 patients who underwent gastric ESD for gastric neoplasm under anesthesiologist-directed sedation. Candidate risk factors were screened and assessed for significance using a least absolute shrinkage and selection operator (LASSO)-based method. Top significant factors were incorporated into a multivariable logistic regression model, whose prediction performance was compared with those of other machine learning models. The final risk scoring system was created based on the estimated odds ratios of the logistic regression model.

RESULTS:

The incidence of aspiration pneumonia was 1.5%. The logistic regression model showed comparable performance to the best predictive model, extreme gradient boost (area under receiver operating characteristic curve [AUROC], 0.731 vs 0.740). The estimated odds ratios were subsequently used for the development of the clinical scoring system. The final scoring system exhibited an AUROC of 0.730 in the test dataset with risk factors: age (≥70 years, 4 points), male sex (8 points), body mass index (≥27 kg/m2, 4 points), procedure time (≥80 minutes, 5 points), lesion in the lower third of the stomach (5 points), tumor size (≥10 mm, 3 points), recovery time (≥35 minutes, 4 points), and desaturation during ESD (9 points). For patients with total scores ranging between 0 and 33 points, aspiration pneumonia probabilities spanned between 0.1% and 17.9%. External validation using an additional cohort of 827 patients yielded AUROCs of 0.698 for the logistic regression model and 0.680 for the scoring system.

CONCLUSIONS:

Our simple risk scoring system has 8 predictors incorporating patient-, procedure-, and sedation-related factors. This system may help clinicians to stratify patients at risk of aspiration pneumonia after ESD.
Hyperventilation and Respiratory Alkalosis After Olanzapine for Insomnia: A Case Report
Authors: Hang Dustin , Iqbal Zafar , Dolinski Sylvia Y.
Published: October 2021

Olanzapine is increasingly used as a sleep aid in hospitalized patients. Although thought to have less extrapyramidal effects, known side effects include oversedation, arrythmias, and hypotension. We present the unusual case of hyperventilation with respiratory alkalosis after the administration of olanzapine for insomnia in an elderly postoperative patient. This led to a second admission to the intensive care unit with invasive interventions including mechanical ventilation and vasopressor support. Caution must be exercised in prescribing antipsychotics for off-label use, especially in a population whose baseline characteristics can affect the pharmacokinetics of second-generation antipsychotics.
Commercial catches and discards composition in the central Tyrrhenian Sea: a multispecies quantitative and qualitative analysis from shallow and deep bottom trawling
Authors: TIRALONGO FRANCESCO , MANCINI EMANUELE , VENTURA DANIELE , DE MALERBE STEPHANIE , PALADINI DE MENDOZA FRANCESCO , SARDONE MASSIMILIANO , ARCIPRETE ROBERTO , MASSI DANIELA , MARCELLI MARCO , FIORENTINO FABIO , MINERVINI ROBERTO
Published: October 2021

In the Mediterranean Sea, the catch of bottom trawl fisheries is composed of a complex mix of fish and invertebrates with a considerable amount of discards. Seasonal composition of catches and discards of bottom trawls operating at different depths in the central Tyrrhenian Sea were investigated from October 2014 to October 2015. The mean total catch per unit effort (CPUE) ranged between 30.93±8.43 and 27.52±9.88 kg/h in shallow and deep fishing grounds, respectively. The discarded fraction of the catch was 39.9 % in shallow and 43.3% in deep fishing grounds. The mean CPUE of commercial target species were similar in shallow and deep trawling (10.81+5.82 vs 8.92±3.16 kg/h). The commercial bycatch was lower in shallow (6.66±1.25 kg/h) than in deep grounds (8.24±2.91 kg/h), whilst the discards were lower in deep (10.43±5.14 kg/h) than shallow grounds (13.43±5.29 kg/h). Overall, 246 species were caught during fishing operations, out of which 209 were included in discards. The number of species recorded in shallow grounds (199 caught species with 166 discarded) was higher than that recorded in deep grounds (116 caught species with 102 discarded). Fish were the most represented taxa in the shallow discards, followed by echinoderms; crustaceans, and were the main discarded taxa in deep water. Depth was the main factor affecting both commercial catches and discards composition, whereas the season affected the CPUE of main target species only. The results confirmed that discards were higher in shallow than in deep trawling, suggesting that the latter is more efficient than the former in catching fishery resources for human consumption. Understanding the factors that affect discarding is the starting point for adopting management measures to mitigate negative impacts of trawl fisheries on marine resources and benthic communities.
Temporal and spatial genetic variation of Engraulis encrasicolus in the Adriatic Sea
Authors: MALAVOLTI SARA , RUGGERI PAOLO , FIORAVANTI TATIANA , TIČINA VJEKOSLAV , COSTANTINI ILARIA , DE FELICE ANDREA , SPLENDIANI ANDREA , GAŠPAREVIĆ DENIS , CAPUTO BARUCCHI VINCENZO , LEONORI IOLE
Published: October 2021

Small pelagic fish play a key role in the marine ecosystem, controlling predator abundance and regulating primary production rates by foraging on plankton. Alterations induced at different ecological levels by fishing activities and/or environmental changes are affecting the reproductive success of several small pelagics, including European anchovy (Engraulis encrasicolus), which is a major target of Adriatic mid-water trawl and purse-seine fisheries. In this study, we evaluated short-term genetic changes of the species in the Adriatic Sea by applying molecular markers in samples of three generations of European anchovy. Thirteen polymorphic microsatellite markers and a mitochondrial gene were used in cohorts of adults and larvae, collected at three sites in the north-east, central, and southern Adriatic Sea in 2015. Furthermore, temporal, and spatial genetic variation was assessed by comparing the above dataset with a sample of adult anchovy collected in 2012 at three sites close to those sampled in 2015. Expected heterozygosity was higher in adults than in larvae, suggesting a loss of genetic diversity and uneven reproduction. In addition, a comparison of the two datasets demonstrated a change in the anchovy population structure from 2012 to 2015. In the reproductive event of 2015, this change led the two main genetic stocks described in the Adriatic Sea to merge into one. We suggest that the population structure of European anchovy in the north-eastern Adriatic may be influenced by changes in environmental parameters and by periodic alterations in the temporal pattern of population connectivity.
Ecology and seasonality of Pseudo-nitzschia species (Bacillariophyceae) in the northwestern Adriatic Sea over a 30-years period (1988–2020)
Authors: GIULIETTI SONIA , ROMAGNOLI TIZIANA , CAMPANELLI ALESSANDRA , TOTTI CECILIA , ACCORONI STEFANO
Published: October 2021

The ecology and seasonality of Pseudo-nitzschia species and their contribution to phytoplankton community were analysed for the first time at the coastal station of the LTER-Senigallia-Susak transect (north-western Adriatic Sea) from 1988 to 2020. Species composition was addressed using DNA sequence data obtained from 106 monoclonal strains isolated from January 2018 to January 2020. The mean annual cycle of total phytoplankton in the study period (Feb 1988–Jan 2020) showed maximum abundances in winter followed by other peaks in spring and autumn. Diatoms were the main contributors in terms of abundance during the winter and the spring blooms. The autumn peak was due to phytoflagellates and diatoms. In summer phytoflagellates dominated the community, followed by diatoms and dinoflagellates, which in this season reached their annual maximum. Pseudo-nitzschia spp. represented on average 0.4–17.6% of diatom community, but during their blooms they could reach up to up to 90% of the total diatom abundances with 106 cells l-1. By LM, six different taxa were recognized: Pseudo-nitzschia cf. delicatissima and P. cf. pseudodelicatissima were the most abundant, followed by P. cf. fraudulenta, P. pungens, P. multistriata and P. cf. galaxiae. P. cf. fraudulenta and P. pungens were indicator taxa of winter. P. cf. delicatissima and P. cf. pseudodelicatissima were spring and summer taxa, respectively. P. galaxiae showed maximum abundances in autumn. DNA sequences revealed the presence of two species belonging to the ’P. seriata group’ (i.e. P. fraudulenta and P. pungens) and four species belonging to the ‘P. delicatissima group’ (P. calliantha and P. mannii within the P. pseudodelicatissima species complex, and P. delicatissima and P. cf. arenysensis within the P. delicatissima species complex). The presence of several cryptic and pseudo-cryptic species highlights the need to combine LM observations with DNA sequence data when the ecology of Pseudo-nitzschia is investigated.