bluuebunny/crossref_metadata_2025 huggingface dataset:
Research on the Negative Externalities Evaluation for the Development of Weathered Crust Elution‐Deposited Rare Earth Ores
Authors: Ligang Xu , Meijuan Xu
Published: October 2020

To standardize the specification of negative externality management of mining resources development and promote the process of marketization and diversification of ecological compensation, the article reviews the perspective and method of quantitative evaluation of negative externalities based on summarizing the mineralization principle, characteristics, and three‐generation leaching process of weathered crust elution‐deposited rare earth ore. Then, the principle of external loss in the process of mining and separation of weathered crust elution‐deposited rare earth ore is analyzed and an external loss evaluation system is constructed. In this system, the market value method, shadow engineering method, and labor cost method are mainly used to measure and calculate the industrial “three‐waste” pollution control expenses, ecological environment repair cost, and negative external derivative management cost of weathered crust elution‐deposited rare earth ore development. Finally, based on the evaluation system, the data of the Longshe rare earth mining area in Jiading Town, Xinfeng County, was evaluated by the empirical study and it is obtained that the negative externality cost of the Longshe rare earth mining area in Xinfeng County is 102,900 RMB/t. National and local governments may refer to this model and data to strengthen the prevention and control of air, water, and soil pollution; scientifically control the ecological environment of weathered crust elution‐deposited rare earth waste mines; and safeguard the livelihood and well‐being of the residents of mining areas.
Hsp70/Bmi1-FoxO1-SOD Signaling Pathway Contributes to the Protective Effect of Sound Conditioning against Acute Acoustic Trauma in a Rat Model
Authors: Zhu Guoxia , Wu Yongxiang , Qiu Yang , Tian Keyong , Mi Wenjuan , Liu Xinqin , Chen Yuanyuan , Jia Jinwen , Luo Jiasheng , Lu Lianjun , Qiu Jianhua
Published: October 2020

Sound conditioning (SC) is defined as “toughening” to lower levels of sound over time, which reduces a subsequent noise-induced threshold shift. Although the protective effect of SC in mammals is generally understood, the exact mechanisms involved have not yet been elucidated. To confirm the protective effect of SC against noise exposure (NE) and the stress-related signaling pathway of its rescue, we observed target molecule changes caused by SC of low frequency prior to NE as well as histology analysis in vivo and verified the suggested mechanisms in SGNs in vitro. Further, we investigated the potential role of Hsp70 and Bmi1 in SC by targeting SOD1 and SOD2 which are regulated by the FoxO1 signaling pathway based on mitochondrial function and reactive oxygen species (ROS) levels. Finally, we sought to identify the possible molecular mechanisms associated with the beneficial effects of SC against noise-induced trauma. Data from the rat model were evaluated by western blot, immunofluorescence, and RT-PCR. The results revealed that SC upregulated Hsp70, Bmi1, FoxO1, SOD1, and SOD2 expression in spiral ganglion neurons (SGNs). Moreover, the auditory brainstem responses (ABRs) and electron microscopy revealed that SC could protect against acute acoustic trauma (AAT) based on a significant reduction of hearing impairment and visible reduction in outer hair cell loss as well as ultrastructural changes in OHCs and SGNs. Collectively, these results suggested that the contribution of Bmi1 toward decreased sensitivity to noise-induced trauma following SC was triggered by Hsp70 induction and associated with enhancement of the antioxidant system and decreased mitochondrial superoxide accumulation. This contribution of Bmi1 was achieved by direct targeting of SOD1 and SOD2, which was regulated by FoxO1. Therefore, the Hsp70/Bmi1-FoxO1-SOD signaling pathway might contribute to the protective effect of SC against AAT in a rat model.
Unilateral Upper Cervical Cord Infarction: A Report of Two Cases with Mild Neurological Symptoms Accompanying a Small Ischemic Lesion Detected by Brain MRI
Authors: Wada Manabu , Nagasawa Hikaru , Yamaguchi Yoshitaka
Published: October 2020

Spinal cord infarction (SCI) is rare, difficult to diagnose, and often fails to be detected by diffusion-weighted imaging (DWI) of spinal cord magnetic resonance imaging (MRI). Because the clinical features of SCI can vary widely, diagnosis during the acute phase of SCI is often challenging for clinicians. Although SCI shares similar etiologies with cerebral infarction, the characteristics of SCI without vessel dissection remain largely unknown. We present two older patients with mild neurological symptoms who each presented with a small, unilateral, upper cervical cord lesion, which was detected by thin-section, coronal DWI of brain MRI. Both unilateral small lesions were localized in the right lateral funiculus, and each patient showed good prognosis. The anatomical findings suggested that the pial collateral network surrounding the cervical cord contributed to lesion formation. Small and localized lesions have been associated with mild neurological symptoms and better short-term prognosis. The present report indicated that the use of thin-section coronal DWI when performing brain MRI may be helpful for the diagnosis of small, unilateral, upper cervical cord infarctions.
Burkholderia cepacia Sepsis in a Previously Healthy Full-Term Infant
Authors: Carmona Carlos A. , Marante Alberto , Levent Fatma , Marsicek Sarah
Published: October 2020

Burkholderia cepacia causes sepsis in neonates who are immunocompromised or exposed via nosocomial transmission. We report a case of B. cepacia sepsis in a previously healthy 5-week-old male originally treated for bacterial pneumonia per chest X-ray findings and 3 days of fevers. Regardless of appropriate antibiotics and an initial negative blood culture, he developed severe hypoglycemia, circulatory collapse with disseminated intravascular coagulopathy, and expired. A second blood culture taken following transfer to the intensive care unit resulted positive for B. cepacia postmortem. Review of the newborn screen and family history was otherwise normal. Subsequent postmortem autopsy showed multifocal bilateral pneumonia with necrotizing granulomatous and suppurative portions of lung tissue. Additionally, there was a prominent cavitary lesion 2.5 cm in the right lower lobe with branching and septate fungal hyphae. Stellate microabscesses with granulomas were present in the liver and spleen. These findings plus B. cepacia bacteremia are highly suggestive of an immunocompromised status. Review of the literature shows that its presence has been associated with chronic granulomatous disease. Therefore, in a persistently febrile infant not responding to antibiotics for common microbes causing community-acquired pneumonia, immunodeficiency workup should ensue in addition to respective testing for chronic granulomatous disease especially if B. cepacia culture-positive as it is strongly associated with neutrophil dysfunction.
Improved Personalized Recommendation Algorithm Based on Context-Aware in Mobile Computing Environment
Authors: Long Fei
Published: October 2020

With the development and popularization of e-commerce and Internet, more and more attention has been paid to personalized recommendation for users. The traditional user interest model only considers the user’s behavior on the project, ignoring the user’s context at that time. Pointing to the shortage that context-related factors are not considered in previous works, combining the characteristics of a mobile computing environment, this paper studies the algorithm and model of mobile service recommendation. A recommendation algorithm based on specified context filtering in mobile computing environment is proposed. The context of the classification is aggregated, by grouping the scenarios of the same category together. Through experiments, we found that the improved personalized recommendation algorithms are superior to the common collaborative filtering algorithm.
Serum Cystatin C, Klotho, and Neutrophil Gelatinase-Associated Lipocalin in the Risk Prediction of Acute Kidney Injury after Acute Myocardial Infarction
Authors: Pei Yuanyuan , Chen Wen , Mao Xue , Zhu Jihong
Published: October 2020

Background: Patients with acute myocardial infarction (AMI) are at high risk for acute kidney injury (AKI). Novel biomarkers that can predict AKI after AMI may facilitate immediate interventions. Recently, cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), and klotho have been established as novel AKI biomarkers. However, their effects have not been studied in patients presenting with AMI. In this study, we will measure the serum levels of these three biomarkers to find reliable biomarkers for early diagnosis of AKI in AMI patients. Methods: This prospective observational cohort study was conducted between May 2016 and November 2017. A total of 285 consecutive patients with AMI were enrolled. The study was approved by the institutional review board of Peking University People’s Hospital (No. 2016PHB 042-01). AKI was defined according to the KDIGO criteria in 2012. At admission, the clinical data of patients was collected and serum levels of several AKI biomarkers, including cystatin C, NGAL, and klotho, were measured by ELISA. The relationship between biomarker levels of AKI were analyzed and their discrimination performances were compared. Results: AKI incidence was 17.5% (50/285) during hospitalization. Compared to patients without AKI, the AKI group had higher mortality (20.0% vs. 0.4%, p < 0.001) and tended to be older, had higher incidence of chronic kidney disease, severe cardiac function, more cardiac complications, larger doses of diuretics, and less use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker and statins. Moreover, AKI patients experienced an increase in serum cystatin C (3,709.2 ± 2,281.5 vs. 1,918.5 ± 1,140.6 ng/mL, p < 0.001), NGAL (118.0 ± 70.3 vs. 91.8 ± 52.3 ng/mL, p = 0.003), and klotho (742.2 ± 497.4 vs. 470.3 ± 257.2 pg/mL, p <0.001). Furthermore, the areas under the receiver operating curves demonstrated that serum cystatin C levels at admission had modest discriminative powers for predicting AKI after AMI compared with serum creatinine (0.899, 95% CI, 0.855–0.944 vs. 0.734, 95% CI, 0.649–0.819, p <0.001). There was no difference between the discrimination performances of serum creatinine, NGAL, and klotho. Conclusion: Elevated cystatin C levels are associated with AKI in patients with AMI. This study provides reliable evidence that cystatin C levels may be superior to serum creatinine for predicting AKI after AMI at admission.
Scleroderma en Coup de Sabre, Parry-Romberg Hemifacial Atrophy and Associated Manifestations of the Eye, the Oral Cavity and the Teeth: A Danish Follow-Up Study of 35 Patients Diagnosed between 1975 and 2015
Authors: Ullman Susanne , Danielsen Patricia L. , Fledelius Hans C. , Daugaard-Jensen Jette , Serup Jørgen
Published: October 2020

Background: Scleroderma en coup de sabre (ECDS) and Parry-Romberg idiopathic hemifacial atrophy (IHA) may affect the eyes, oral cavity, teeth and possibly the brain. Objective: Systematic follow-up study of ECDS/IHA-associated manifestations including ophthalmic and dental status. Methods: Medical records of ECDS and IHA patients diagnosed in a 40-year period (1975–2015) were reviewed, and patients were re-examined. Results: Thirty-five patients were included. Twenty-two patients (63%) had ECDS and 4 patients (11%) IHA. In 9 cases (26%), ECDS and IHA were found in the same patient. The ipsilateral eye was affected in 9 patients (26%). Ipsilateral abnormalities of the teeth and the tongue were found in 13 (46%) out of 28 examined. Eleven (31%) had extrafacial scleroderma on the trunk or the extremities. Neurological findings were not verified as ECDS/IHA related. Conclusion: ECDS and IHA are related and often overlap with concomitant affections of the connective tissues of the face on the ipsilateral side. Ocular and dental abnormalities are common and follow the distribution of the primary affection, for example, a paramedian line in the front and segmental affection of the maxilla and the mandible. The affections point to predisposing dysmorphogenetic events in embryonal life affecting the face, with abnormality of crest cells at the stage when they migrate from behind over the scalp or laterally to the face to mix up with mesenchymal tissues of the frontonasal, maxillary and mandibular processes. The study emphasizes that routine evaluation of ECDS and IHA should include ophthalmological and dental specialist examinations.
Belated Diagnosis of a Primary Bone Lymphoma of the Elbow: A Rare Case and Review of the Literature
Authors: Boffano Michele , Ratto Nicola , Rezzoagli Martina , Conti Andrea , Pellegrino Pietro , Piana Raimondo
Published: October 2020

Primary non-Hodgkin bone lymphoma (PBL) is a rare disease that accounts for <2% of all lymphomas in adults. PBL can be monostotic or polyostotic, mainly causing destructive and lytic bone lesions frequently located in the femur, humerus, and pelvis. PBL is rarely considered a differential diagnosis of the osteolytic tumor. In addition, PBL is not uncommonly diagnosed with delay because patients do not experience symptoms nor show objective abnormalities in the early stage of disease. Here, we reported a 60-year-old woman with a PBL of the elbow.
Leukemic Phase of Histiocytic Sarcoma of the Digestive System: A Rare Manifestation of a Rare Disease
Authors: Hofstetter Liron , Aranovich David , Bernstine Hanna , Hayman Lucille , Shahal-Zimra Yael , Rabizadeh Esther , Cohen Amos , Lahav Meir , Raanani Pia , Wolach Ofir
Published: October 2020

Histiocytic sarcoma (HS) is a rare, malignant, and aggressive subtype of histiocytosis. We present an unusual case of aggressive HS presenting in the gastrointestinal tract and gallbladder that progressed after several lines of chemotherapy with a leukemic phase. We review the clinical, pathological, and molecular characteristics of HS in this case and review the literature on HS involving the digestive system as well as on overt leukemic phase of this disease. HS is often diagnosed at an advanced stage, and mortality is high. We discuss the therapeutic approach to patients with HS. We highlight the role of overexpression and somatic alterations in the RAF-MEK-ERK pathway in the pathogenesis of HS and discuss potential targeted approaches to treat these rare tumors.
Time Efficiency in Stereotactic Robot-Assisted Surgery: An Appraisal of the Surgical Procedure and Surgeon’s Learning Curve
Authors: Machetanz Kathrin , Grimm Florian , Schuhmann Martin , Tatagiba Marcos , Gharabaghi Alireza , Naros Georgios
Published: October 2020

Background: Frame-based stereotactic procedures are still the gold standard in neurosurgery. However, there is an increasing interest in robot-assisted technologies. Introducing these increasingly complex tools in the clinical setting raises the question about the time efficiency of the system and the essential learning curve of the surgeon. Methods: This retrospective study enrolled a consecutive series of patients undergoing a robot-assisted procedure after first system installation at one institution. All procedures were performed by the same neurosurgeon to capture the learning curve. The objective read-out were the surgical procedure time (SPT), the skin-to-skin time, and the intraoperative registration time (IRT) after laser surface registration (LSR), bone fiducial registration (BFR), and skin fiducial registration (SFR), as well as the quality of the registration (as measured by the fiducial registration error [FRE]). The time measures were compared to those for a patient group undergoing classic frame-based stereotaxy. Results: In the first 7 months, we performed 31 robot-assisted surgeries (26 biopsies, 3 stereotactic electroencephalography [SEEG] implantations, and 2 endoscopic procedures). The SPT was depending on the actual type of surgery (biopsies: 85.0 ± 36.1 min; SEEG: 154.9 ± 75.9 min; endoscopy: 105.5 ± 1.1 min; p = 0.036). For the robot-assisted biopsies, there was a significant reduction in SPT within the evaluation period, reaching the level of frame-based surgeries (58.1 ± 17.9 min; p < 0.001). The IRT was depending on the applied registration method (LSR: 16.7 ± 2.3 min; BFR: 3.5 ± 1.1 min; SFR: 3.5 ± 1.6 min; p < 0.001). In contrast to BFR and SFR, there was a significant reduction in LSR time during that period (p = 0.038). The FRE differed between the applied registration methods (LSR: 0.60 ± 0.17 mm; BFR: 0.42 ± 0.15 mm; SFR: 2.17 ± 0.78 mm; p < 0.001). There was a significant improvement in LSR quality during the evaluation period (p = 0.035). Conclusion: Introducing stereotactic, robot-assisted surgery in an established clinical setting initially necessitates a prolonged intraoperative preparation time. However, there is a steep learning curve during the first cases, reaching the time level of classic frame-based stereotaxy. Thus, a stereotactic robot can be integrated into daily routine within a decent period of time, thereby expanding the neurosurgeons’ armamentarium, especially for procedures with multiple trajectories.
Limited Treatment Options in Primary Hyperoxaluria with Renal Failure
Authors: Geiger Kyle , Mroch Henry
Published: October 2020

Primary hyperoxaluria (PH) is a rare autosomal recessive metabolic disorder where serum oxalate levels rise due to overproduction. The kidney tubule is a main target for oxalate deposition, resulting in damage to the organ. Kidney failure is rare in these patients. We present a 67-year-old female with hemodialysis-dependent end-stage renal disease likely due to PH type 2 or 3. With extremely high levels of serum oxalate (60.4 μmol/L), this patient had minimal treatment options for her rare disease. This report details a unique presentation of a rare disease where kidney biopsy was instrumental.
Treatment of Metabolic Syndrome in Children
Authors: Tagi Veronica Maria , Samvelyan Sona , Chiarelli Francesco
Published: October 2020

Although metabolic syndrome (MetS) in children and adolescents is a frequently discussed topic in the literature, uniform guidelines on its definition and treatment are still lacking. Insulin resistance, central obesity, dyslipidaemia, and hypertension are commonly considered the main components of MetS. The first recommended approach to all these pathological conditions in children and adolescents is lifestyle intervention (diet and physical exercise); however, in some selected cases, a pharmacological or surgical treatment might prove useful for the prevention of metabolic and cardiovascular complications. The aim of this review is to present the more recent evidence about the treatment of the major components of MetS in children and adolescents, focussing on the current recommendations concerning lifestyle changes, available drugs, and bariatric surgery.
Präzisionsmedizin bei NSCLC im Zeitalter der Immuntherapie: Neue Biomarker zur Selektion der am besten geeigneten Therapie oder des am besten geeigneten Patienten
Authors: Rossi Giovanni , Russo Alessandro , Tagliamento Marco , Tuzi Alessandro , Nigro Olga , Vollome Giacomo , Sini Claudio , Grassi Massimiliano , Dal Bello Maria Giovanna , Coco Simona , Longo Luca , Zullo Lodovica , Tanda Enrica Teresa , Dellepiane Chiara , Pronzato Paolo , Genova Carlo
Published: October 2020

Durch die Weiterentwicklung der Therapien konnten die Ergebnisse von Patienten mit nicht kleinzelligem Lungenkarzinom (NSCLC) in den letzten Jahren deutlich verbessert werden. Während molekulare zielgerichtete Therapien bei bestimmten Subgruppen von Patienten wirksam sind, hatten insbesondere Immuncheckpoint-Inhibitoren (ICIs) starken Einfluss auf die Outcomes von einem Großteil der Patienten mit nicht kleinzelligem Lungenkarzinom. Die Aktivität von Nivolumab wurde anfangs unabhängig von prädiktiven Biomarkern bewertet; in den nachfolgenden zulassungsrelevanten Studien mit anderen PD-1/PD-L1-Inhibitoren bei vorbehandelten Patienten mit fortgeschrittenem NSCLC (Atezolizumab in der OAK-Studie und Pembrolizumab in der KEYNOTE-010-Studie) wurde dagegen erstmals über eine Korrelation von klinischem Outcome und PD-L1-Expression berichtet. Die PD-L1-Expression allein reichte jedoch nicht aus, um Patienten auszuwählen, die möglicherweise von einer Immuntherapie profitieren. In zahlreichen Studien wurde versucht, präzisere, aus Tumorgewebe oder dem peripheren Blut stammende Marker zu finden. In der vorliegenden Übersichtsarbeit sollen sämtliche Charakteristika des Immunogramms, die als prädiktive Biomarker für das Ansprechen auf Immuncheckpoint-Inhibitoren herangezogen werden können, untersucht werden. Ferner beschreiben wir die wichtigste genetische Veränderung, die als Prädiktor für die Wirksamkeit der Immuntherapie dienen könnte.
Effectiveness of protected areas for jaguars: the case of the Taiamã Ecological Station in Brazil
Authors: Cardoso Henrique Matheus , Morato Ronaldo Gonçalves , Miyazaki Selma Samiko , Pereira Thadeu Deluque Costa , Araújo Gediendson Ribeiro de , Kantek Daniel Luis Zanella
Published: October 2020

The largest feline in the Americas and the third largest in the world, the jaguar is an apex predator in the food chain and a key species in the ecosystems where it occurs, developing important ecological functions in maintaining ecosystem balance. In Brazil, the Pantanal is considered an important refuge for the species, and protected areas such as the Taiamã Ecological Station (TES) are relevant for conservation of pristine ecosystem where the species persist. Thus, considering that this area is located in one of the regions with the highest concentration of this large cat in the Pantanal, the objective of this study was to evaluate the effectiveness of the protection given by the TES for the jaguar population. The station is a flooded island in the middle of the Paraguay river and surrounded by extensive wetlands. We monitored ten jaguars using GPS collar at the TES and its surroundings. The samples were separated into high-water season (January to June) and low-water season (July to December), and the estimated home ranges were grouped as: 1) residents only and 2) all monitored individuals. The stabilization of the home ranges of eight jaguars, considered residents, was determined through variograms. When all jaguars were analysed together there was 55% overlap between the clustered areas of the two analysed seasons. In the analysis excluding non-resident individuals there was 72% overlap between the clustered areas. The type of land cover inside these areas was very similar between these periods. The range of this protected area is not sufficient to effectively protect these jaguar populations, since the grouped home ranges of the resident animals studied are 3.5(wet)/2.5(dry) times larger than the area of the TES. However, the surroundings of the TES have low human impact and no deforestation and, in this way, the landscape context of the station may have a significant effect on the persistence of a large carnivore like the jaguar. However, it is necessary to create more protected areas in order to prevent possible future environmental changes in the areas surrounding TES.
Distribution and identification of the White-collared Kite Leptodon forbesi and the juvenile plumages of the Gray-headed Kite Leptodon cayanensis
Authors: Lima Rafael Dantas , Menq Willian , Pallinger Frederick
Published: October 2020

The genus Leptodon encompasses two Neotropical raptor species. The more widely-distributed Gray-headed Kite (Leptodon cayanensis) occurs in a vast area of Neotropical region, while the White-collared Kite (Leptodon forbesi) is endemic of the Atlantic Forest of northeastern Brazil, but there are some questions about the extent of its geographic distribution and about its sympatry with its congener. Here we present a review of the geographic distribution and the diagnoses of L. forbesi, correcting recent records based on misidentifications. We also clarify the main features of juvenile and subadult plumage of Leptodon raptors and describe new phases of juvenile plumage.
Risk Factors for Early Recurrence Following Ablation for Accessory Pathways
Authors: Dionne Audrey , Gauvreau Kimberlee , O’Leary Edward , Mah Douglas Y. , Abrams Dominic J. , Alexander Mark E. , DeWitt Elizabeth S. , Bezzerides Vassilios J. , Triedman John K. , Walsh Edward P.
Published: October 2020

Background:

Atrioventricular reentrant tachycardia is common in children. Catheter ablation is increasingly used as a first-line therapy with a high acute success rate, but recurrence during follow-up remains a concern. The aim of this study was to identify risk factors for recurrence after accessory pathway (AP) ablation.

Methods:

Retrospective cohort study including patients who underwent AP ablation between 2013 and 2018. Cox proportional hazards model was used to examine the association between patient and procedural characteristics and recurrence during follow-up.

Results:

From 558 AP ablation procedure, 542 (97%) were acutely successful. During a median follow-up of 0.4 (interquartile range, 0.1–1.4) years, there were 42 (8%) patients with documented recurrence. On univariate analysis, early recurrence was associated with younger age, congenital heart disease, multiple AP, AP location (right sided and posteroseptal versus left sided), cryoablation (versus radiofrequency), empirical ablation, the lack of full power radiofrequency lesions (<50 W), radiofrequency consolidation time <90 seconds and the use of fluoroscopy without a 3-dimensional electroanatomic mapping system. On multivariable analysis, only multiple AP (hazard ratio, 2.78 [95% CI, 1.063–4.74]) and radiofrequency consolidation time < 90 seconds (hazard ratio, 4.38 [95% CI, 1.92–9.51]) remained significantly associated with early recurrence; this association remained true when analyzed in subgroups by pathway location for right and left free wall AP.

Conclusions:

In our institutional experience, radiofrequency consolidation time <90 seconds after ablation of AP was associated with an increased risk of early recurrence.
Single-Cell Transcriptome Analysis Reveals Dynamic Cell Populations and Differential Gene Expression Patterns in Control and Aneurysmal Human Aortic Tissue
Authors: Li Yanming , Ren Pingping , Dawson Ashley , Vasquez Hernan G. , Ageedi Waleed , Zhang Chen , Luo Wei , Chen Rui , Li Yumei , Kim Sangbae , Lu Hong S. , Cassis Lisa A. , Coselli Joseph S. , Daugherty Alan , Shen Ying H. , LeMaire Scott A.
Published: October 2020

Background:

Ascending thoracic aortic aneurysm (ATAA) is caused by the progressive weakening and dilatation of the aortic wall and can lead to aortic dissection, rupture, and other life-threatening complications. To improve our understanding of ATAA pathogenesis, we aimed to comprehensively characterize the cellular composition of the ascending aortic wall and to identify molecular alterations in each cell population of human ATAA tissues.

Methods:

We performed single-cell RNA sequencing analysis of ascending aortic tissues from 11 study participants, including 8 patients with ATAA (4 women and 4 men) and 3 control subjects (2 women and 1 man). Cells extracted from aortic tissue were analyzed and categorized with single-cell RNA sequencing data to perform cluster identification. ATAA-related changes were then examined by comparing the proportions of each cell type and the gene expression profiles between ATAA and control tissues. We also examined which genes may be critical for ATAA by performing the integrative analysis of our single-cell RNA sequencing data with publicly available data from genome-wide association studies.

Results:

We identified 11 major cell types in human ascending aortic tissue; the high-resolution reclustering of these cells further divided them into 40 subtypes. Multiple subtypes were observed for smooth muscle cells, macrophages, and T lymphocytes, suggesting that these cells have multiple functional populations in the aortic wall. In general, ATAA tissues had fewer nonimmune cells and more immune cells, especially T lymphocytes, than control tissues did. Differential gene expression data suggested the presence of extensive mitochondrial dysfunction in ATAA tissues. In addition, integrative analysis of our single-cell RNA sequencing data with public genome-wide association study data and promoter capture Hi-C data suggested that the erythroblast transformation-specific related gene(
ERG
) exerts an important role in maintaining normal aortic wall function.

Conclusions:

Our study provides a comprehensive evaluation of the cellular composition of the ascending aortic wall and reveals how the gene expression landscape is altered in human ATAA tissue. The information from this study makes important contributions to our understanding of ATAA formation and progression.
Comprehensive Ex Vivo Comparison of 5 Clinically Used Conduit Configurations for Valve-Sparing Aortic Root Replacement Using a 3-Dimensional–Printed Heart Simulator
Authors: Paulsen Michael J. , Imbrie-Moore Annabel M. , Baiocchi Michael , Wang Hanjay , Hironaka Camille E. , Lucian Haley J. , Farry Justin M. , Thakore Akshara D. , Zhu Yuanjia , Ma Michael , MacArthur John W. , Woo Y. Joseph
Published: October 2020

Background:

Many graft configurations are clinically used for valve-sparing aortic root replacement, some specifically focused on recapitulating neosinus geometry. However, the specific impact of such neosinuses on valvular and root biomechanics and the potential influence on long-term durability are unknown.

Methods:

Using a custom 3-dimenstional–printed heart simulator with porcine aortic roots (n=5), the anticommissural plication, Stanford modification, straight graft (SG), Uni-Graft, and Valsalva graft configurations were tested in series using an incomplete counterbalanced measures design, with the native root as a control, to mitigate ordering effects. Hemodynamic and videometric data were analyzed using linear models with conduit as the fixed effect of interest and valve as a fixed nuisance effect with post hoc pairwise testing using Tukey’s correction.

Results:

Hemodynamics were clinically similar between grafts and control aortic roots. Regurgitant fraction varied between grafts, with SG and Uni-Graft groups having the lowest regurgitant fractions and anticommissural plication having the highest. Root distensibility was significantly lower in SG versus both control roots and all other grafts aside from the Stanford modification (
P
≤0.01 for each). All grafts except SG had significantly higher cusp opening velocities versus native roots (
P
<0.01 for each). Relative cusp opening forces were similar between SG, Uni-Graft, and control groups, whereas anticommissural plication, Stanford modification, and Valsalva grafts had significantly higher opening forces versus controls (
P
<0.01). Cusp closing velocities were similar between native roots and the SG group, and were significantly lower than observed in the other conduits (
P
≤0.01 for each). Only SG and Uni-Graft groups experienced relative cusp closing forces approaching that of the native root, whereas relative forces were >5-fold higher in the anticommissural plication, Stanford modification, and Valsalva graft groups.

Conclusions:

In this ex vivo modeling system, clinically used valve-sparing aortic root replacement conduit configurations have comparable hemodynamics but differ in biomechanical performance, with the straight graft most closely recapitulating native aortic root biomechanics.
National Variation in Congenital Heart Surgery Outcomes
Authors: Pasquali Sara K. , Thibault Dylan , O’Brien Sean M. , Jacobs Jeffrey P. , Gaynor J. William , Romano Jennifer C. , Gaies Michael , Hill Kevin D. , Jacobs Marshall L. , Shahian David M. , Backer Carl L. , Mayer John E.
Published: October 2020

Background:

Optimal strategies to improve national congenital heart surgery outcomes and reduce variability across hospitals remain unclear. Many policy and quality improvement efforts have focused primarily on higher-risk patients and mortality alone. Improving our understanding of both morbidity and mortality and current variation across the spectrum of complexity would better inform future efforts.

Methods:

Hospitals participating in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2014–2017) were included. Case mix–adjusted operative mortality, major complications, and postoperative length of stay were evaluated using Bayesian models. Hospital variation was quantified by the interdecile ratio (IDR, upper versus lower 10%) and 95% credible intervals (CrIs). Stratified analyses were performed by risk group (Society of Thoracic Surgeons–European Association for Cardiothoracic Surgery [STAT] category) and simulations evaluated the potential impact of reductions in variation.

Results:

A total of 102 hospitals (n=84 407) were included, representing ≈85% of US congenital heart programs. STAT category 1 to 3 (lower risk) operations comprised 74% of cases. All outcomes varied significantly across hospitals: adjusted mortality by 3-fold (upper versus lower decile 5.0% versus 1.6%, IDR 3.1 [95% CrI 2.5–3.7]), mean length of stay by 1.8-fold (19.2 versus 10.5 days, IDR 1.8 [95% CrI 1.8–1.9]), and major complications by >3-fold (23.5% versus 7.0%, IDR 3.4 [95% CrI 3.0–3.8]). The degree of variation was similar or greater for low- versus high-risk cases across outcomes, eg, ≈3-fold mortality variation across hospitals for STAT 1 to 3 (IDR 3.0 [95% CrI 2.1–4.2]) and STAT 4 or 5 (IDR 3.1 [95% CrI 2.4–3.9]) cases. High-volume hospitals had less variability across outcomes and risk categories. Simulations suggested potential reductions in deaths (n=282), major complications (n=1539), and length of stay (101 183 days) over the 4-year study period if all hospitals were to perform at the current median or better, with 37% to 60% of the improvement related to the STAT 1 to 3 (lower risk) group across outcomes.

Conclusions:

We demonstrate significant hospital variation in morbidity and mortality after congenital heart surgery. Contrary to traditional thinking, a substantial portion of potential improvements that could be realized on a national scale were related to variability among lower-risk cases. These findings suggest modifications to our current approaches to optimize care and outcomes in this population are needed.
Progress Toward Cardiac Xenotransplantation
Authors: Pierson Richard N , Fishman Jay A. , Lewis Gregory D. , D’Alessandro David A. , Connolly Margaret R. , Burdorf Lars , Madsen Joren C. , Azimzadeh Agnes M.
Published: October 2020

Consistent survival of life-supporting pig heart xenograft recipients beyond 90 days was recently reported using genetically modified pigs and a clinically applicable drug treatment regimen. If this remarkable achievement proves reproducible, published benchmarks for clinical translation of cardiac xenografts appear to be within reach. Key mechanistic insights are summarized here that informed recent pig design and therapeutic choices, which together appear likely to enable early clinical translation.
Angiogenic Factors and Long-Term Cardiovascular Risk in Women That Developed Preeclampsia During Pregnancy
Authors: Garrido-Gimenez Carmen , Mendoza Manel , Cruz-Lemini Monica , Galian-Gay Laura , Sanchez-Garcia Olga , Granato Chiara , Rodriguez-Sureda Victor , Rodriguez-Palomares Jose , Carreras-Moratonas Elena , Cabero-Roura Lluis , Llurba Elisa , Alijotas-Reig Jaume
Published: October 2020

Preeclampsia is caused by placental impairment with increased expression of sFlt-1 (soluble fms-like tyrosine kinase 1) and decreased PlGF (placental growth factor); it has been associated with cardiovascular morbidity and mortality later in life, but the underlying mechanism remains unknown. The aim of this study was to determine whether sFlt-1 and PlGF levels during preeclampsia are associated to long-term cardiovascular risk. We prospectively recruited 43 women with previous preeclampsia and 21 controls with uncomplicated pregnancies. Cardiovascular risk assessment ≈12 years later included maternal hemodynamic, cardiac function and structure, biomarker analysis, and carotid-intima thickness evaluation. Women with previous preeclampsia had higher prevalence of hypertensive disorders and dyslipidemia than controls. In addition, they had worse global longitudinal strain, thicker left ventricular septal and posterior walls, more myocardial mass and increased carotid intima-media thickness compared with controls. PlGF during pregnancy correlated positively with high-density lipoprotein (
r
=0.341;
P
=0.006), and negatively with global longitudinal strain (
r
=−0.581;
P
<0.001), carotid intima-media thickness (
r
=−0.251;
P
=0.045), and mean arterial blood pressure (
r
=−0.252;
P
=0.045), when adjusted by study group. sFlt correlated negatively with high-density lipoprotein (
r
=−0.372;
P
=0.002) and apolipoprotein A-1 (
r
=−0.257;
P
=0.040), and positively with carotid intima-media thickness (
r
=0.269;
P
=0.032) and left ventricular posterior wall thickness (
r
=0.368;
P
=0.003). The antiangiogenic state present in preeclampsia is related to greater prevalence of cardiovascular risk factors ≈12 years after delivery. The knowledge of altered angiogenic factors may help detect women with a higher risk for premature cardiovascular disease, who will require earlier follow-up after delivery.
Culture or Context?
Authors: Payette Alex , Chien Yi-Chun
Published: October 2020

Policy legacies are an important factor explaining how, regardless of the nontraditional discourse, previously implemented laws and policies have greatly influenced the state of eldercare arrangements in both China and Taiwan. On the one hand, Taiwan has been shifting eldercare responsibilities from the family to the public through a series of social policy reforms fueled by political demands from the civil society since its democratic transition, whereas the Chinese Party-State enacted a series of filial laws in addition to reform policies, which inflated the demand and supply for familial care while at the same time impacting the development of institutional eldercare. While the issue often framed as the prevalence of filial culture in Chinese societies, this article argues, through a path dependency-based perspective, that legal provisions, policies and the structure of the political competition are largely responsible for shaping current eldercare arrangements on both sides of the strait.
Privatizing the Temple Mount (Haram es-Sharif) and the Western Wall (Kotel)
Authors: Broyde Michael J. , Zeligman David
Published: October 2020

Proposals abound in Israel to address the question of pluralistic access to the Temple Mount and the Western Wall. Each of these proposals has been a source of great controversy. In this article, we propose a Swiftian solution of privatization. We propose that the government of Israel sell the Temple Mount, the Western Wall, and many other holy sites to specific faith groups that will then operate them as private property, with the ability to restrict various rights within them. This proposal is based on a model adopted and implemented in Salt Lake City, Utah, to address various questions regarding access to property purchased by the Church of Jesus Christ of Latter-day Saints.
A new species of Toxicocalamus (Squamata: Elapidae) from Papua New Guinea
Authors: KRAUS FRED
Published: October 2020

I describe a new species of the fossorial elapid snake genus Toxicocalamus from Mt. Simpson, Milne Bay Province, in southeastern New Guinea. The new species is similar to the poorly diagnosed T. loriae but differs from that species (and all other Toxicocalamus with the preocular distinct from the prefrontal) in having the preocular not in contact with the nasal and in having a pale-gray or yellow venter with gray bands across each ventral scale. The new species came from elevations of 1300–1490 m a.s.l. on the north slope of Mt. Simpson, and it seems likely to be confined to the mid-elevations of that mountain, judging from its morphological differences with specimens obtained from similar elevations on nearby Mt. Dayman. If true, this would make it the sixth species of herpetofauna apparently endemic to Mt. Simpson. This snake was common and found in both village gardens and adjacent primary rainforest, and I estimate its area of extent to be approximately 50,000 ha, so its IUCN conservation status would appear to be Least Concern.
Conversion of Abandoned Property to Green Space as a Strategy to Mitigate the Urban Heat Island Investigated with Numerical Simulations
Authors: Cady Timothy J. , Rahn David A. , Brunsell Nathaniel A. , Lyles Ward
Published: October 2020

Impervious surfaces and buildings in the urban environment alter the radiative balance and surface energy exchange and can lead to warmer temperatures known as the urban heat island (UHI), which can increase heat-related illness and mortality. Continued urbanization and anthropogenic warming will enhance city temperatures worldwide, raising the need for viable mitigation strategies. Increasing green space throughout a city is a viable option to lessen the impacts of the UHI but can be difficult to implement. The potential impact of converting existing vacant lots in Kansas City, Missouri, to green spaces is explored with numerical simulations for three heat-wave events. Using data on vacant property and identifying places with a high fraction of impervious surfaces, the most suitable areas for converting vacant lots to green spaces is determined. Land-use/land-cover datasets are modified to simulate varying degrees of feasible conversion of urban to green spaces in these areas, and the local cooling effect using each strategy is compared with the unmodified simulation. Under more aggressive greening strategies, a mean local cooling impact of 0.5°–1.0°C is present within the focus area itself during the nighttime hours. Some additional cooling via the “park cool island” is possible downwind of the converted green spaces under the more aggressive scenarios. Although moderate and conservative strategies of conversion could still lead to other benefits, those strategies have little impact on cooling. Only an aggressive approach yields significant cooling.
Financial Constraints and Global Value Chains Participation of Indian MSMEs
Authors: Reddy Ketan
Published: October 2020

This brief note highlights the importance of micro, small, and medium enterprises in India and the gains associated with the global value chain (GVC) participation for small and medium firms. The note also sheds light upon financial constraints as a major obstacle faced by these firms in their decision to participate in GVCs. The stagnancy in Indian manufacturing and the potential that GVC holds for the country, especially in line with the policy initiatives of Make in India, makes this a very pivotal area of research, and this research note aims to promote more research related to GVCs in India.
Paraprofessionals’ Perceptions of Behavior Problems in Elementary School Classrooms
Authors: Bronstein Briana , Breeden Nicole , Glover Todd A. , Reddy Linda A.
Published: October 2020

Paraprofessionals are increasingly being hired to support students with special needs in schools and are key implementers of behavior interventions for students. However, research is limited on how paraprofessionals perceive the management of student behavior. Using a mixed-methods design approach, the current investigation assesses paraprofessionals’ perceptions of common student behavior problems in elementary school classrooms. Results indicate coached paraprofessionals had a greater likelihood of reporting operationally defined behavior concerns than those in a control group. A qualitative constant comparative method of analysis of paraprofessionals’ behavior reports revealed themes of disruptive academic behaviors (off task, peer/verbal interactions, physical interference), aggressive behaviors (physical aggression toward people/objects, verbal aggression), noncompliance (physical/verbal refusal), and “other” behaviors (unclear/opposite or positive actions). Implications for practice and future research are discussed.
This is supposed to happen here: American gun culture and the rhetoric of child sacrifice
Authors: DeLay Tad
Published: October 2020

Recent years have seen the god Molech invoked within American gun control discourse as an accusation implying indifference to the loss of children in mass shootings. The historical record on child sacrifice mirrors the use of the accusation today; regardless of whether sacrifices to Molech or Cronos actually occurred, the accusation motivated ostracization. This article examines the record of child sacrifice and situates it within a reading of American gun culture and follows recent scholarship suggesting American gun culture is designed to delegate to persons, white men in particular, the ability to liquidate themselves, their families, and people of color. Finally, this article concludes by examining the gun as a fetish for enjoyment and by framing the gun psychoanalytically as a conversion symptom aiming to produce a “return of the repressed” in another’s body, namely, the corpse of a child which ensures more guns and more corpses will follow.
Discipline, motivation, and achievement in mathematics learning: An exploration in Shanghai
Authors: Ning Bo
Published: October 2020

Utilizing the Programme for International Student Assessment 2012 Shanghai dataset ([Formula: see text]), this study examined the relationship between school disciplinary climate aggregated from mathematics classrooms and student mathematics learning outcomes, including mathematics achievement and intrinsic and instrumental motivation to learn mathematics, from the perspective of the self-determination theory of academic motivation. The results of the analyses demonstrated challenges supporting students in Shanghai schools to simultaneously perform well in the three mathematics learning outcomes. Meanwhile, an orderly school disciplinary climate might hurt students’ instrumental motivation, although it is beneficial to students’ mathematics achievement.
The Effect of Perceived Social Support on Personal Resources Following Minor Adversity: An Experimental Investigation of Belonging Affirmation
Authors: Layous Kristin , Nelson-Coffey S. Katherine
Published: October 2020

People rely on their social relationships to help them cope with many stressors over the course of their lives. Across three experiments, we randomly assigned people to experience minor adversity or not and then to experience perceived social support (via belonging affirmation) or not. We found that those who underwent adversity without perceived social support had lower scores on personal resources (e.g., gratitude, connectedness) than the other conditions. In addition, we tested whether perceived social support helps people grow following adversity or simply buffers them from adversity-related declines in personal resources. Our findings comparing growth and buffering hypotheses were mixed; however, the evidence for buffering was slightly stronger than the evidence for growth. Thus, more research is needed to determine whether perceived social support buffers decrements in personal resources following adversity or actually promotes growth. Nevertheless, perceived social support is an important source of resilience when facing life’s inevitable challenges.