bluuebunny/crossref_metadata_2025 huggingface dataset:
Enrichment of Tc1 cells and T cell resistance to suppression are associated with dysglycemia in the visceral fat in human obesity
Authors: Cardellini Sara , Socci Carlo , Bissolati Massimiliano , Pindozzi Fioralba , Giovenzana Anna , Saibene Alessandro , Bosi Emanuele , Battaglia Manuela , Petrelli Alessandra
Published: April 2020

Objective

Insulin resistance, defined as tissue inflammation leading to type 2 diabetes, is a feature of obesity. The immune system has been implicated in its pathogenesis, but the role of adaptive immunity in humans remains uncertain. Here, we aim to determine whether specific phenotypic and functional properties of visceral adipose tissue (VAT)-derived CD4 conventional T cells (Tconv) and CD8 T cells are associated with dysglycemia in human obesity.

Research design and methods

Peripheral blood and the stromal vascular fraction of obese patients without dysglycemia (n=23), with impaired fasting glucose or type 2 diabetes (n=17), and non-diabetic lean controls (n=11) were studied. Characterization of memory, activation profile, cytokine production, proliferative capacity, cytotoxic potential and transforming growth factor-β-mediated suppression of CD4 Tconv and CD8 T cells was performed. Correlation between anthropometric/metabolic parameters and VAT-derived T cell subsets was determined.

Results

In the VAT of the overall obese population, reduced frequency of interferon-γ-producing or tumor necrosis factor-α-producing CD4 (ie, T helper 1, Th1) and CD8 (ie, cytotoxic type 1, Tc1) T cells, as well as interleukin-17-producing CD8 T cells (ie, Tc17), was evident when compared with lean controls. However, enrichment of Tc1 cells, together with the impaired ability of CD4 and CD8 T cells to be suppressed, distinguished the visceral fat of obese patients with dysglycemia from the one of non-diabetic obese patients. Moreover, accumulation of Th1 and Tc1 cells in the VAT correlated with anthropometric and metabolic parameters.

Conclusions

Here, we define the VAT-specific characteristics of T cells in human obesity, showing that accumulation of Tc1 cells and T cell resistance to suppression can be harmful to the development of obesity-induced diabetes. These findings open new directions to investigate immunological targets in the obesity setting.
Diabetes mellitus as a risk factor for compression neuropathy: a longitudinal cohort study from southern Sweden
Authors: Rydberg Mattias , Zimmerman Malin , Gottsäter Anders , Nilsson Peter M , Melander Olle , Dahlin Lars B
Published: April 2020

Introduction

Compression neuropathies (CN) in the upper extremity, the most common being carpal tunnel syndrome (CTS) and ulnar nerve entrapment (UNE), are frequent among patients with diabetes mellitus (DM). Earlier studies have shown contradicting results regarding DM as a risk factor for CN. Thus, the aim of the present population-based, longitudinal study was to explore potential associations between DM, CTS, and UNE during long-term follow-up.

Research design and methods

A total of 30 466 participants aged 46–73 years, included in the population-based Malmö Diet and Cancer Study during 1991–1996, were followed up in Swedish national registries regarding incident CTS and UNE until 2016. Associations between prevalent DM at baseline and incident CTS or UNE were calculated using Cox proportional hazard models, adjusted for baseline confounders, such as sex, age at study entry, smoking, hypertension, use of antihypertensive treatment, alcohol consumption, and body mass index (BMI). HbA1c and fasting plasma glucose levels had been measured at baseline in a subgroup of 5508 participants and were related to incident CTS and UNE in age and sex-adjusted binary logistic regression models.

Results

A total of 1081 participants developed CTS and 223 participants developed UNE during a median follow-up of 21 years. Participants with incident CTS or UNE had higher prevalence of DM and higher BMI at baseline. Using multivariate Cox regression models, prevalent DM at baseline was independently associated with both incident CTS (HR 2.10; 95% CI 1.65 to 2.70, p<0.0001) and incident UNE (HR 2.20; 95% CI 1.30 to 3.74, p=0.003). Higher levels of HbA1c and plasma glucose were associated with an increased risk for CTS, but not for UNE.

Conclusion

This study establishes DM as a major risk factor in the development of both CTS and UNE. Furthermore, a higher BMI is associated with both CTS and UNE. Finally, hyperglycemia seems to affect the median and ulnar nerves differently.
The magnitude and determinants of violence against healthcare workers in Pakistan
Authors: Shaikh Shiraz , Baig Lubna Ansari , Hashmi Ibrahim , Khan Mirwais , Jamali Seemin , Khan Muhammad Naseem , Saleemi Munir Akhtar , Zulfiqar Komal , Ehsan Sumera , Yasir Iram , Haq Zia ul , Mazharullah Lubna , Zaib Samina
Published: April 2020

Objectives

To determine the magnitude and determinants of violence against healthcare workers (HCWs) and to identify the predominant types and causes of violence experienced by them.

Methodology

A cross-sectional survey based on structured questionnaire adopted from previous surveys and qualitative data was conducted in 4 large cities and 12 districts in 3 provinces of Pakistan. The survey covered 8579 from all cadres of HCWs, including doctors, nurses, technicians, support staff, ambulance workers, vaccinators, lady health visitors, midwives and lady health workers (LHWs). The predictors of overall violence experienced, physical violence experienced and verbal violence experienced were separately analysed for tertiary care hospitals, secondary care hospitals, primary care hospitals and field-level HCWs. Logistic regression was used to compute adjusted ORs with 95% CIs for the association of different factors with the violence experienced.

Results

More than one-third (38.4%) reported having experienced any form of violence in the last 6 months. Verbal violence was the most commonly experienced form (33.9%), followed by physical violence (6.6%). The main reasons for physical violence were death of patients (17.6%), serious condition of patients (16.6%) and delay in care (13.4%). Among the different types of field HCWs, emergency vehicle operators were significantly more likely to experience verbal violence compared with LHWs (adjusted OR=1.97; 95% CI 1.31 to 2.94; p=0.001). Among hospital HCWs, those working in private hospitals were significantly less likely to experience physical violence (adjusted OR=0.52; 95% CI 0.38 to 0.71; p=0.001) and verbal violence (adjusted OR=0.57; 95% CI 0.48 to 0.68; p=0.001).

Conclusion

Violence against HCWs exists in various forms among all cadres and at different levels of care. The gaps in capacity, resources and policies are evident. Specific strategies need to be adopted for different types of HCWs to protect them against violence.

*The study was conducted under the framework of ICRC’s Healthcare in Danger Initiative for protection of healthcare against Violence
Time for nutrition in medical education
Authors: Macaninch Elaine , Buckner Luke , Amin Preya , Broadley Iain , Crocombe Dominic , Herath Duleni , Jaffee Ally , Carter Harrison , Golubic Rajna , Rajput-Ray Minha , Martyn Kathy , Ray Sumantra
Published: April 2020

Aim

To synthesise a selection of UK medical students’ and doctors’ views surrounding nutrition in medical education and practice.

Methods

Information was gathered from surveys of medical students and doctors identified between 2015 and 2018 and an evaluation of nutrition teaching in a single UK medical school. Comparative analysis of the findings was undertaken to answer three questions: the perceived importance of nutrition in medical education and practice, adequacy of nutrition training, and confidence in current nutrition knowledge and skills.

Results

We pooled five heterogeneous sources of information, representing 853 participants. Most agreed on the importance of nutrition in health (>90%) and in a doctor’s role in nutritional care (>95%). However, there was less desire for more nutrition education in doctors (85%) and in medical students (68%). Most felt their nutrition training was inadequate, with >70% reporting less than 2 hours. There was a preference for face-to-face rather than online training. At one medical school, nutrition was included in only one module, but this increased to eight modules following an increased nutrition focus. When medical students were asked about confidence in their nutrition knowledge and on advising patients, there was an even split between agree and disagree (p=0.869 and p=0.167, respectively), yet few were confident in the UK dietary guidelines. Only 26% of doctors were confident in their nutrition knowledge and 74% gave nutritional advice less than once a month, citing lack of knowledge (75%), time (64%) and confidence (62%) as the main barriers. There was some recognition of the importance of a collaborative approach, yet 28% of doctors preferred to get specialist advice rather than address nutrition themselves.

Conclusion

There is a desire and a need for more nutrition within medical education, as well as a need for greater clarity of a doctor’s role in nutritional care and when to refer for specialist advice. Despite potential selection bias and limitations in the sampling frame, this synthesis provides a multifaceted snapshot via a large number of insights from different levels of training through medical students to doctors from which further research can be developed.
Recognition of anxiety disorders in children: a cross-sectional vignette-based survey among general practitioners
Authors: Aydin Semiha , Crone Mathilde R , Siebelink Bart M , Vermeiren Robert R J M , Numans Mattijs E , Westenberg P Michiel
Published: April 2020

Objective

To quantify general practitioners’ (GPs) sensitivity to anxiety disorders (ADs) when confronted with the range of symptoms common to children with ADs. Also, to explore GPs’ conscious preferences and implicit tendencies for referral of children with ADs to mental healthcare.

Design and setting

In a cross-sectional vignette-based survey, all attendees of a Dutch continuing medical education conference for primary care physicians were presented with subtitled audio fragments of five vignettes that we constructed to mimic symptom presentation of children with ADs in general practice. We asked attendees to select per vignette the most plausible diagnoses and most adequate referral option, and for their general referral preferences when they suspect each of the most common mental health problems.

Participants

A sample of 229 GPs, resulting in a total of 1128 vignette evaluations.

Main outcome measure

GPs’ selection rate of ADs in the five vignettes compared with a benchmark provided by mental health professionals (MHPs).

Results

Overall, recognition of ADs was less likely in GPs compared with MHPs (OR=0.26, 95% CI 0.15 to 0.46). GPs varied in their recognition of anxiety, with 44.1% not once selecting anxiety as the probable presenting problem. When asked explicitly, 63.9% of the GPs reported that they would refer a child to mental healthcare when they suspect probable ADs. By contrast, only 12.0% of the GPs who recognised anxiety in the vignettes actually selected that referral option.

Conclusion

A significant fraction of GPs did not notice the depicted symptoms as anxiety. Despite the widespread prevalence of ADs, GPs seem to overlook anxiety already in their early diagnostic opinion. Improving GPs’ familiarity with initial symptom presentation, ADs’ base-rate, relevance and impact yields potential for timely recognition.
Impact of smoking status on the efficacy of inhaled corticosteroids in chronic obstructive pulmonary disease: a systematic review
Authors: Sonnex Kimberley , Alleemudder Hanna , Knaggs Roger
Published: April 2020

Objectives

Inhaled corticosteroids (ICS) reduce exacerbation rates and the decline in lung function in people with chronic obstructive pulmonary disease (COPD). There is evidence that smoking causes ‘steroid resistance’ and thus reduces the effect of ICS. This systematic review aimed to investigate the effect of smoking on efficacy of ICS in COPD in terms of lung function and exacerbation rates.

Design

Systematic review.

Data sources

An electronic database search of PubMed, Ovid MEDLINE, Ovid Embase and Cochrane Library (January 2000 to January 2020).

Eligibility criteria

Fully published randomised controlled trials (RCTs), in the English language, evaluating the use of ICS in COPD adults that stratified the participants by smoking status. Trials that included participants with asthma, lung cancer and pneumonia were excluded. The primary outcome measures were changes in lung function and yearly exacerbation rates.

Data extraction and synthesis

Two independent reviewers extracted data and assessed risk of bias using the Cochrane Collaboration’s tool.

Results

Seven studies were identified. Four trials (17 892 participants) recorded change in forced expiratory volume in one second (FEV1) from baseline to up to 30 months after starting treatment. Heavier smokers (>36 pack years) using ICS had a greater decline in FEV1that ranged from −22 mL to −75 mL in comparison to lighter smokers. Smokers using ICS had mixed results in FEV1change: −8 mL to +77 mL in comparison to ex-smokers. Four trials (21 270 participants) recorded difference in COPD exacerbation rates at 52 weeks. The rate ratios favoured more exacerbations in ICS users who were current or heavier smokers than those who were ex-smokers or lighter smokers (0.81 to 0.99 vs 0.92 to 1.29).

Conclusions

In COPD, heavier or current smokers do not gain the same benefit from ICS use on lung function and exacerbation rates as lighter or ex-smokers do, however effects may not be clinically important.

PROSPERO registration number

CRD42019121833
Implementing receiver-driven handoffs to the emergency department to reduce miscommunication
Authors: Huth Kathleen , Stack Anne M , Hatoun Jonathan , Chi Grace , Blake Robert , Shields Robert , Melvin Patrice , West Daniel C , Spector Nancy D , Starmer Amy J
Published: April 2020

Background

Miscommunications during care transfers are a leading cause of medical errors. Recent consensus-based recommendations to standardise information transfer from outpatient clinics to the emergency department (ED) have not been formally evaluated. We sought to determine whether a receiver-driven structured handoff intervention is associated with 1) increased inclusion of standardised elements; 2) reduced miscommunications and 3) increased perceived quality, safety and efficiency.

Methods

We conducted a prospective intervention study in a paediatric ED and affiliated clinics in 2016–2018. We developed a bundled handoff intervention included a standard template, receiver training, awareness campaign and iterative feedback. We assessed a random sample of audio-recorded handoffs and associated medical records to measure rates of inclusion of standardised elements and rate of miscommunications. We surveyed key stakeholders pre-intervention and post-intervention to assess perceptions of quality, safety and efficiency of the handoff process.

Results

Across 162 handoffs, implementation of a receiver-driven intervention was associated with significantly increased inclusion of important elements, including illness severity (46% vs 77%), tasks completed (64% vs 83%), expectations (61% vs 76%), pending tests (0% vs 64%), contingency plans (0% vs 54%), detailed callback request (7% vs 81%) and synthesis (2% vs 73%). Miscommunications decreased from 48% to 26%, a relative reduction of 23% (95% CI −39% to −7%). Perceptions of quality (35% vs 59%), safety (43% vs 73%) and efficiency (17% vs 72%) improved significantly post-intervention.

Conclusions

Implementation of a receiver-driven intervention to standardise clinic-to-ED handoffs was associated with improved communication quality. These findings suggest that expanded implementation of similar programmes may significantly improve the care of patients transferred to the paediatric ED.
Influence of bedspacing on outcomes of hospitalised medicine service patients: a retrospective cohort study
Authors: Kohn Rachel , Harhay Michael O , Bayes Brian , Song Hummy , Halpern Scott D , Kerlin Meeta Prasad , Greysen S Ryan
Published: April 2020

Background

Specialty wards cohort hospitalised patients to improve outcomes and lower costs. When demand exceeds capacity, patients overflow and are “bedspaced” to alternate wards. Some studies have demonstrated that bedspacing among medicine service patients is associated with adverse patient-centred outcomes, however, results have been inconsistent and have primarily been performed within national health systems. The objective of this study was to assess the association of bedspacing with patient-centred outcomes among United States patients admitted to general medicine services.

Methods

We performed a retrospective cohort study of internal medicine, family medicine and geriatric service patients who were bedspaced vs cohorted for the entirety of their hospital stay within three large, urban United States hospitals (quaternary referral centre, tertiary referral centre and community hospital, with different patient demographics and case-mixes) in 2014 and 2015. We performed quantile regression to determine differences in length of stay (LOS) between bedspaced vs cohorted patients and logistic regression for in-hospital mortality and discharge to home.

Results

Among 18 802 patients in 33 wards, 6119 (33%) patients were bedspaced. Bedspaced patients had significantly longer LOS compared with cohorted patients at the 25th(0.1 days, 95% CI: 0.05 to 0.2, p=0.001), 50th(0.2 days, 95% CI: 0.1 to 0.3, p=0.003) and 75th(0.3 days, 95% CI: 0.2 to 0.5, p<0.001) percentiles; and no statistically significant differences in odds of mortality (OR=0.9, 95% CI: 0.6 to 1.3, p=0.5) or discharge to home (OR=0.9, 95% CI: 0.9 to 1.0, p=0.06) in adjusted analyses.

Conclusion

Bedspacing is associated with adverse patient-centred outcomes. Future work is needed to confirm these findings, understand mechanisms contributing to adverse outcomes and identify factors that mitigate these adverse effects in order to provide high-value, patient-centred care to hospitalised patients.
Intraindividual variation of the transversus abdominis plane block: an exploratory study in healthy volunteers
Authors: Juhl Christian Svendsen , Rothe Christian , Støving Kion , Aasvang Eske K , Rosenstock Charlotte V , Lange Kai Henrik Wiborg , Lundstrøm Lars Hyldborg
Published: April 2020

Introduction

The transversus abdominis plane block is widely used in postoperative pain management after abdominal surgery. However, large interindividual variation in the cutaneous distribution area of the block has been demonstrated. The purpose of the present study was to explore the reproducibility of the block by determining the intraindividual variation when repeating the block on two separate days.

Methods

Ultrasound-guided posterior transversus abdominis plane blocks were performed in 16 healthy volunteers and repeated after at least 2 days. Cutaneous sensory block areas and distributions, thresholds for mechanical stimulation, abdominal muscle thicknesses at rest and during maximal contraction, waist circumferences and block duration times were measured on both days. Outcome measurements from the 2 days were compared using a one-sample t-test and intraclass correlation coefficients were calculated for each parameter. Agreement was evaluated visually using Bland-Altman plots.

Results

None of the mean values of the outcome measurements differed significantly between the 2 days. Intraclass correlation coefficient was 0.75 (moderate-to-good reliability) for lateral abdominal muscle thickness during maximal contraction, but ranges from −0.07 to 0.67 were found for all other outcome measurements (poor-to-moderate reliability).

Conclusion

We found a moderate-to-good reproducibility for lateral abdominal muscle thickness during maximal voluntary contraction, but a moderate-to-poor reproducibility for all other block characteristics. However, the cutaneous distribution of the block was still located primarily inferior to a horizontal line through the umbilicus and lateral relative to a vertical line through the anterior superior iliac spine.
Illicit tobacco trade is ‘booming’: UK newspaper coverage of data funded by transnational tobacco companies
Authors: Evans-Reeves Karen , Hatchard Jenny , Rowell Andy , Gilmore Anna B
Published: April 2020

Background

Transnational tobacco companies (TTCs) have heavily publicised their argument that standardised tobacco packaging will increase the illicit tobacco trade. Leaked Philip Morris International (PMI) documents suggest that the company may have intended to use third parties to promulgate this argument in the UK.

Methods

We examined articles in UK newspapers (1 April 2013 to 31 March 2015) from LexisNexis for presence and nature of tobacco industry data. We also examined documents released by Freedom of Information requests made to Scottish Councils for evidence of how PMI operationalised its third-party strategy.

Findings

Two-thirds of newspaper articles (63%, 99/157) mentioned a PMI consultant; 36% of which did not disclose this industry funding. Most articles mentioned counterfeit tobacco, illicit whites or both (72%, 113/157), while few (4%, 7/157) specifically mentioned tobacco industry illicit tobacco and none explained that the latter can include tobacco-company involvement. Freedom of Information documents revealed that the PMI consultant sought to build relationships with Trading Standards officers, conducted undercover test purchases (UTPs) in illicit tobacco ‘hotspots’ and may have promoted unrepresentative findings in the media. While the data set featured PMI data predominantly, other TTCs also engaged in third-party techniques to promulgate messages on illicit tobacco.

Interpretation

PMI engaged a third party, seemingly with the aim of securing media coverage on illicit tobacco positing that standardised packaging would worsen the problem. The predominant focus of articles which featured industry-funded data and information was on counterfeit tobacco despite official data showing tobacco-industry illicit tobacco as the most prevalent. Other jurisdictions considering the policy should anticipate that third parties will promote the illicit-trade argument.
Compliance with San Francisco’s flavoured tobacco sales prohibition
Authors: Vyas Priyanka , Ling Pamela , Gordon Bob , Callewaert Jennifer , Dang Alvin , Smith Derek , Chan Brittany , Glantz Stanton
Published: April 2020

Background

In June 2018, San Francisco voters upheld the first comprehensive prohibition on sales of flavoured tobacco products (all products including menthol, everywhere in the city with no exceptions).

Methods

This paper used data collected by the San Francisco Department of Public Health as part of its implementation and enforcement of San Francisco’s city-wide ban on the sale of flavoured tobacco products. Every licensed tobacco retailer was visited and inspected. The San Francisco Department of Public Health and volunteers conducted an educational campaign from September 2018 to December 2018, including emailing all licensed tobacco retailers about the law, mailing a fact sheet poster, conducting four listening sessions and visiting permitted tobacco retailers to educate them about the law and solicit questions.

Results

Compliance inspections started in December 2018, which found that compliance was 17%. Compliance increased in January 2019 and averaged 80% between January 2019 and December 2019. After the phase-in period, all retailers were visited as part of routine inspections. This effort resulted in 80% compliance.

Conclusion

Including retailer education prior to enforcement can result in compliance with a comprehensive ban on the sale of menthol and other flavoured tobacco products.
Do people know that cigarette filters are mainly composed of synthetic material? A representative survey of the German population (the DEBRA study)
Authors: Kotz Daniel , Kastaun Sabrina
Published: April 2020

Introduction

Most cigarettes are smoked with filters made of synthetic plastic, which are not fully biodegradable. Littering used cigarette filters (butts) represents a substantial environmental hazard. It is unclear if people, in particular smokers, know that filters consist of synthetic plastic.

Methods

We used data collected in August/September 2019 from a representative household survey of the German population aged 14 years and over (wave 20 of the German Study on Tobacco Use; DEBRA). Respondents were asked: ‘The majority of smokers use cigarettes with a filter. What do you think these filters are composed of? (1) Mainly of natural material; (2) Mainly of synthetic material; (3) I don’t know what cigarette filters are composed of.’ Response option 2 indicated correct knowledge.

Results

A total of 2066 people were interviewed, including 625 current smokers. The weighted response rate to option 2 (‘mainly of synthetic material’) was 34.8% (95%CI 32.7 to 36.9) in the total sample and 42.7% (95%CI=38.7 to 46.8) in the subgroup of current smokers. In the latter subgroup, smokers with low compared with those with high educational level were less likely to know that filters are mainly composed of synthetic material (OR=0.62, 95%CI=0.39 to 0.99).

Conclusions

The majority of smokers in Germany does not know that cigarette filters are mainly composed of synthetic material. Our findings suggest a need for promoting awareness as well as knowledge of environmental health hazards of cigarette filters to the general population, and specifically to current smokers.

Trial registration number

DRKS00011322 and DRKS00017157.
Thermodynamic analysis of natural convection supercritical water flow past a stretching sheet using an equation of state approach
Authors: Basha Hussain , Reddy G. Janardhana , Venkata Narayanan N.S.
Published: April 2020

The present numerical study examines the free convection heat transfer characteristics of supercritical water flow past a stretching sheet. A suitable equation for the thermal expansion coefficient in a supercritical fluid region is derived based on the equation of state (EOS) approach in terms of compressibility factor, pressure, and temperature. In the present study, the Redlich–Kwong equation of state (RK-EOS) is used to calculate the thermal expansion coefficient in the supercritical region. The values of the thermal expansion coefficient calculated through RK-EOS lies close to the NIST data values when compared to the other equations of state like the Van der Waals equation of state and ideal gas EOS. Also, the behaviour of Nusselt number is studied to characterize the heat transfer characteristics of supercritical water. However, the equations governing the supercritical fluid flow past a stretching sheet are coupled and nonlinear in nature. Hence, the Runge–Kutta fourth-order integration scheme with shooting technique is used to solve these equations. Numerical computations are performed for supercritical water under the influence of various control parameters. Similarity solutions are obtained in terms of flow profiles in the supercritical fluid region. The present study reports that the normal velocity profile decreases and the temperature field increases for increasing values of reduced pressure and reduced temperature. Also, the axial velocity profile shows the dual behaviour for increasing values of unsteady parameter, reduced temperature, and reduced pressure in the supercritical boundary layer region. Furthermore, the component of the normal velocity profile decays for increasing values of the unsteady parameter in the supercritical fluid region. The calculated values of the thermal expansion coefficient using RK-EOS lies in the proximity of NIST data values when compared to Van der Waals and ideal gas equations of state. Also, the local skin-friction coefficient decreases for increasing values of reduced pressure and reduced temperature. Furthermore, the magnitude of local heat transfer rate increases with increasing values of unsteady parameter. The RK-EOS is the suitable EOS approach for predicting the free convection properties of water in a supercritical region.
The Rise of Xi Jinping and China’s New Era: Implications for the United States and Taiwan
Authors: THOMPSON DREW
Published: April 2020

Xi Jinping’s rise to power has heralded a new foreign policy that is more assertive and uncompromising toward China’s neighbors, the United States, and the rest of the world. This change presents challenges for the United States and Taiwan in particular which must be addressed with a sense of urgency due to Xi Jinping’s ambitious objectives and his firm grip on the levers of power which increase the likelihood that the Communist Party and government of China will seek to achieve them without delay.

This paper reviews changes to Chinese foreign policy in the Xi Jinping era and argues how the modernization of the People’s Liberation Army (PLA) over time has increased the threat to Taiwan, with concurrent risks for the United States. Taiwan and the US can address the challenge presented by China by strengthening their relationship to adapt to the new era under Xi Jinping’s leadership.

According to CIA (2018), China’s economy now stands at approximately US$12 trillion, second only to the United States (CIA [2018]. World fact book). Unlike in 1978, China’s economy today is dependent on access to globally sourced raw materials, and access to overseas consumer markets for its industrial and consumer goods. This dependency on overseas markets has increased China’s global presence and interests, driving the need to protect them. The Chinese Government’s now ample resources have been allocated to both hard and soft power means toward this purpose. The PLA has greatly benefitted from economic development and the expansion of the Chinese economy, transforming from a backward institution focused on private-sector moneymaking into the sharpest tool of China’s power and influence. Since Xi Jinping came to power in 2012, China’s foreign policy and strategy have undergone a dramatic shift away from Deng Xiaoping’s focus on increasing domestic productivity and avoiding potentially costly overseas entanglements. The confluence of accumulated national wealth, diplomatic, economic, and military power, and the will to use those levers of power, has dramatic implications for the United States and China’s neighbors. A more assertive China, confident in its wealth, power, and international status, is increasingly unafraid of overt competition with its neighbors and the United States, unwilling to back down or compromise in the face of disputes. This dynamic has resulted in a new paradigm in the Indo-Pacific region that is unlike previous challenges of the past 40 years.

The shift in China’s foreign policy and the PLA’s modernization threaten to challenge the credibility of US security assurances and alliances in the region, making the cultivation and strengthening of the US–Taiwan relationship, and the network of US bilateral alliances in the region an urgent imperative.
Dynamic Behavior and Fatigue Damage Evolution of Sandstone under Uniaxial Cyclic Loading
Authors: Sun Yidan , Yang Yu , Li Min
Published: April 2020

The mechanical response characteristics of sandstone specimens under different stress amplitudes and loading frequencies were tested by a TAW-2000 rock triaxial testing machine. The characteristics of the stress-strain curve and the evolution process of strain damage under cyclic loading are analyzed. Based on creep theory and the disturbance state concept, a theoretical model between the axial compressive strain, axial compressive stress, and cycle number is established. The results show that there exists an upper threshold value of stress in cyclic loading above which the specimen will be damaged. As peak stress increases, the energy loss and irreversible deformation caused by damage gradually increase. When loading to an unstable peak stress under cyclic loading, the fatigue damage of sandstone under cyclic loading undergoes three characteristic stages: the initial stage; the stable stage; and the accelerated failure stage. The parameters of the strain damage model based on the disturbance state concept of sandstone are identified by test data, and the rationality of the model is validated by comparing theoretical values with experimental measurements.
Impact of Age on Short- and Long-Term Outcomes after Pancreatoduodenectomy for Periampullary Neoplasms
Authors: Gruppo Mario , Tolin Francesca , Franzato Boris , Pilati Pierluigi , Spolverato Ylenia Camilla , Zingales Francesca , Angriman Imerio , Bardini Romeo
Published: April 2020

Background. Although mortality and morbidity of pancreatoduodenectomy (PD) have improved significantly over the past years, the impact of age for patients undergoing PD is still debated. This study is aimed at analyzing short- and long-term outcomes of PD in elderly patients. Methods. 124 consecutive patients who have undergone PD for pancreas neoplasms in our center between 2012 and 2017 were analyzed. Patients were divided into two groups: group I (<75 years) and group II (≥75 years). Demographic features and intraoperative and clinical-pathological data were collected. Primary endpoints were perioperative morbidity and mortality; complications were classified according to the Clavien-Dindo Score. Secondary endpoints included feasibility of adjuvant treatment and overall survival rates. Results. A total of 106 patients were included in this study. There were 73 (68.9%) patients in group I and 33 (31.1%) in group II. Perioperative deceases were 4 (3.6%), and postoperative pancreatic fistulas were 34 (32.1%). Significant difference between two groups was demonstrated for the ASA Score (p=0.004), Karnofsky Score (p=0.025), preoperative jaundice (p=0.004), and pulmonary complications (p=0.034). No significance was shown for diabetes, radicality of resection, stage of disease, operative time, length of stay, postoperative complications according to the Clavien-Dindo Score, postoperative mortality, pancreatic fistula, and reoperation rates. 69.9% of the patients in group I underwent adjuvant treatment vs. 39.4% of the older ones (p=0.012). Mean overall survival was 28.5 months in group I vs. 22 months in group II (p=0.909). Conclusion. PD can be performed safely in elderly patients. Advanced age should not be an absolute contraindication for PD, even if greater frailty should be considered. The outcome of elderly patients who have undergone PD is similar to that of younger patients, even though adjuvant treatment administration is significantly lower, demonstrating that surgery remains the main therapeutic option.
Identification of Pancreaticoduodenectomy Resection for Pancreatic Head Adenocarcinoma: A Preliminary Study of Radiomics
Authors: Hui Bei , Qiu Jia-Jun , Liu Jin-Heng , Ke Neng-Wen
Published: April 2020

Background. In a pathological examination of pancreaticoduodenectomy for pancreatic head adenocarcinoma, a resection margin without cancer cells in 1 mm is recognized as R0; a resection margin with cancer cells in 1 mm is recognized as R1. The preoperative identification of R0 and R1 is of great significance for surgical decision and prognosis. We conducted a preliminary radiomics study based on preoperative CT (computer tomography) images to evaluate a resection margin which was R0 or R1. Methods. We retrospectively analyzed 258 preoperative CT images of 86 patients (34 cases of R0 and 52 cases of R1) who were diagnosed as pancreatic head adenocarcinoma and underwent pancreaticoduodenectomy. The radiomics study consists of five stages: (i) delineate and segment regions of interest (ROIs); (ii) by solving discrete Laplacian equations with Dirichlet boundary conditions, fit the ROIs to rectangular regions; (iii) enhance the textures of the fitted ROIs combining wavelet transform and fractional differential; (iv) extract texture features from the enhanced ROIs combining wavelet transform and statistical analysis methods; and (v) reduce features using principal component analysis (PCA) and classify the resection margins using the support vector machine (SVM), and then investigate the associations between texture features and histopathological characteristics using the Mann–Whitney U-test. To reduce overfitting, the SVM classifier embedded a linear kernel and adopted the leave-one-out cross-validation. Results. It achieved an AUC (area under receiver operating characteristic curve) of 0.8614 and an accuracy of 84.88%. Setting p≤0.01 in the Mann–Whitney U-test, two features of the run-length matrix, which are derived from diagonal sub-bands in wavelet decomposition, showed statistically significant differences between R0 and R1. Conclusions. It indicates that the radiomics study is rewarding for the aided diagnosis of R0 and R1. Texture features can potentially enhance physicians’ diagnostic ability.
The Bethesda System for Reporting Thyroid Cytopathology: A Cytohistological Study
Authors: Anand Bakiarathana , Ramdas Anita , Ambroise Marie Moses , Kumar Nirmal P.
Published: April 2020

Introduction. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is a significant step to standardize the reporting of thyroid fine needle aspiration (FNA). It has high predictive value, reproducibility, and improved clinical significance. Aim. The study was aimed to evaluate the diagnostic utility and reproducibility of “TBSRTC” at our institute. Methods and Material. The study included 646 thyroid FNAs which were reviewed by three pathologists and classified according to TBSRTC. Cytohistological correlation was done for 100 cases with surgical follow-up and the sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, and risk of malignancy (ROM) were calculated. The interobserver variation among three pathologists was also assessed. Results. The distribution of cases in various TBSRTC categories is as follows: I—nondiagnostic 13.8%, II—benign 75.9%, III—atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS) 1.2%, IV—follicular neoplasm (FN)/suspicious for follicular neoplasm (SFN) 3.7%, V—suspicious for malignancy (SM) 2.6%, and VI—malignant 2.8%. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy are 72.4%, 94.3%, 84%, 89.2%, and 87.9%, respectively. The ROM of various TBSRTC categories were II—8.5%; III—66.7%; IV—63.6%; and V and VI—100%. Cohen’s Weighted Kappa score was 0.99 which indicates almost perfect agreement among the three pathologists. Conclusions. Our study substantiates greater reproducibility among pathologists using TBSRTC to arrive at a precise diagnosis with an added advantage of predicting the risk of malignancy which enables the clinician to plan for follow-up or surgery and also the extent of surgery.
Study on the Influence of Baseline Control System on the Fragility of Large‐Scale Wind Turbine considering Seismic‐Aerodynamic Combination
Authors: Yuan Chenyang , Li Jing , Chen Jianyun , Xu Qiang , Xie Yunfei
Published: April 2020

The purpose of this paper is to explore the effect of the baseline control system (BCS) on the fragility of large‐scale wind turbine when seismic and wind actions are considered simultaneously. The BCS is used to control the power output by regulating rotor speed and blade‐pitch angle in real time. In this study, the fragility analysis was performed and compared between two models using different peak ground acceleration, wind speeds, and specified critical levels. The fragility curves with different wind conditions are obtained using the multiple stripe analysis (MSA) method. The calculation results show that the probability of exceedance specified critical level increases as the wind speed increases in model 1 without considering BCS, while does not have an obvious change in the below‐rated wind speed range and has a significant decrease in the above‐rated wind speed range in model 2 with considering BCS. The comparison depicts that if the BCS is neglected, the fragility of large‐scale wind turbine will be underestimated in around the cut‐in wind speed range and overestimated in the over‐rated wind speed range. It is concluded that the BCS has a great effect on the fragility especially within the operating conditions when the rated wind speed is exceeded, and it should be considered when estimating the fragility of wind turbine subjected to the interaction of seismic and aerodynamic loads.
Serum Neuropeptide Y Levels Are Associated with TNF-α Levels and Disease Activity in Rheumatoid Arthritis
Authors: Ramirez-Villafaña Melissa , Saldaña-Cruz Ana M. , Aceves-Aceves Javier A. , Perez-Guerrero Edsaul E. , Fajardo-Robledo Nicté S. , Rubio-Arellano Edy D. , Nava-Valdivia Cesar A. , Carrillo-Escalante Maria O. , Totsuka-Sutto Sylvia E. , Cardona-Müller David , Contreras-Haro Betsabe , Salazar-Paramo Mario , Cardona-Muñoz Ernesto G. , Huerta M. , Gamez-Nava Jorge I. , Rodriguez-Jimenez Norma A. , Gonzalez-Lopez Laura
Published: April 2020

Background. Neuropeptide Y (NPY) is a sympathetic neurotransmitter with effects on the regulation of inflammatory cells. The role of NPY on autoimmune inflammatory diseases such as rheumatoid arthritis (RA) is not completely understood. Therefore, we evaluate if NPY levels are markers of disease activity in RA and if there is a correlation between NPY levels and tumor necrosis factor-alpha (TNF-α), leptin, and interleukin 6 (IL-6) levels. Methods. Cross-sectional design, including 108 women with RA. We assessed disease activity by DAS28-ESR (considering active disease a score of ≥2.6). Serum NPY levels and anti-CCP2 antibody, TNF-α, IL-6, and leptin levels were quantified (ELISA). Results. Sixty-eight RA had an active disease (RA-active), and 40 were in remission (RA-remission). RA-active patients had higher NPY levels vs. RA-remission (22.8±13.6 vs. 17.8±10.3; p=0.04). NPY levels correlated with increased TNF-α levels (r=0.32, p=0.001). Leptin or IL-6 did not correlate with NPY levels. In the logistic regression analysis, NPY increased the risk of disease activity (OR: 1.04, 95% CI 1.006-1.09, and p=0.03). Conclusion. Higher NPY levels are an independent marker of disease activity in RA. This study encourages the quantification of NPY levels as a surrogate marker for RA-active. Future studies evaluating the role of NPY levels interacting with other proinflammatory cytokines are required.
Disease Specific to Chronic Lymphedema and Class III Obesity
Authors: Figenshau Karen G. , Lindquist Matthew B.
Published: April 2020

Elephantiasis nostras verrucosa (ENV) is a unique, chronic condition found in patients with obesity and chronic secondary lymphedema. It develops due to chronic inflammation and recurrent infection, most commonly on gravity-dependent sites. Progressive tissue enlargement, deformity, and disability necessitate intervention. First, clinicians should explore the etiology of patients’ secondary lymphedema, as this is paramount in determining treatment for ENV. The fundamental goal is alleviating lymphatic obstruction. Our literature review of available cases of ENV elucidates Class III obesity as a factor common to all available cases of ENV. As such, weight loss is a key component of treatment. Medical management and weight loss are most effective when combined with physiologic interventions such as compression garments and decongestive physiotherapy. If surgical intervention is required, one of the mainstays of patient management is a reductive approach, aimed at removing excess adipose and fibrotic tissue to improve lymphatic patency and flow. Optimal postoperative outcomes are achieved when patients also undergo physiologic procedures to bypass obstructions and connect functioning lymphatic vessels.
PCR Detection of HHV8 DNA in the Saliva of Removable Denture Wearers Compared to Dentate Cases in Shiraz, South of Iran
Authors: Derafshi Reza , Ghapanchi Jannan , Rezazadeh Fahimeh , Kalantari Mohammad Hasan , Naeeni Amir Mosahebi , Farzin Mitra , Moattari Afagh
Published: April 2020

Background and aim. Removable dentures may act as reservoir for pathogens that can cause serious infections. Human herpesvirus 8 (HHV8) is an oncogenic virus that was found in the saliva more than genital secretions. Thus, this study was designed to evaluate HHV8 in the saliva of patients with removable dentures. Method and material. In this cross‐sectional study from March‐July 2019, saliva samples were collected from 50 denture wearers as a case group and 50 ages and gender matched dentate subjects as a control. Whole‐mouth saliva, parotid saliva, buccal, and palatal exfoliates were collected and processed for HHV8‐DNA amplification by nested PCR. A confirmatory real‐time PCR was also performed in order to prevent false result. Result. In the denture wearers, HHV8 DNA was detected in 11 cases. Two of the controls amplified HHV8 DNA. Fisher’s exact test demonstrates a significant difference between virus infection and using removable dentures (p = 0.015). Conclusion. Our findings suggested that HHV8 detection could be associated with use of denture.
FS118, a Bispecific Antibody Targeting LAG-3 and PD-L1, Enhances T-Cell Activation Resulting in Potent Antitumor Activity
Authors: Kraman Matthew , Faroudi Mustapha , Allen Natalie L. , Kmiecik Katarzyna , Gliddon Daniel , Seal Claire , Koers Alexander , Wydro Mateusz M. , Batey Sarah , Winnewisser Julia , Young Lesley , Tuna Mihriban , Doody Jacqueline , Morrow Michelle , Brewis Neil
Published: April 2020

Purpose:

Although programmed death-ligand 1 (PD-L1) antibody–based therapy has improved the outcome of patients with cancer, acquired resistance to these treatments limits their clinical efficacy. FS118 is a novel bispecific, tetravalent antibody (mAb2) against human lymphocyte activation gene-3 (LAG-3) and PD-L1 with the potential to reinvigorate exhausted immune cells and overcome resistance mechanisms to PD-L1 blockade. Here, using FS118 and a murine surrogate, we characterized the activity and report a novel mechanism of action of this bispecific antibody.

Experimental Design:

This study characterizes the binding activity and immune function of FS118 in cell lines and human peripheral blood mononuclear cells and further investigates its antitumor activity and mechanism of action using a surrogate murine bispecific antibody (mLAG-3/PD-L1 mAb2).

Results:

FS118 demonstrated simultaneous binding to LAG-3 and PD-L1 with high affinity and comparable or better activity than the combination of the single component parts of the mAb2 in blocking LAG-3- and PD-L1–mediated immune suppression and enhancing T-cell activity. In syngeneic tumor mouse models, mLAG-3/PD-L1 mAb2 significantly suppressed tumor growth. Mechanistic studies revealed decreased LAG-3 expression on T cells following treatment with the mouse surrogate mLAG-3/PD-L1 mAb2, whereas LAG-3 expression increased upon treatment with the combination of mAbs targeting LAG-3 and PD-L1. Moreover, following binding of mLAG-3/PD-L1 mAb2 to target-expressing cells, mouse LAG-3 is rapidly shed into the blood.

Conclusions:

This study demonstrates a novel benefit of the bispecific approach over a combination of mAbs and supports the further development of FS118 for the treatment of patients with cancer.