bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Automatic Segmentation Algorithms for the Subthalamic Nucleus
Authors: Polanski Witold H. , Zolal Amir , Sitoci-Ficici Kerim Hakan , Hiepe Patrick , Schackert Gabriele , Sobottka Stephan B.
Published: May 2020

Introduction: Various automatic segmentation algorithms for the subthalamic nucleus (STN) have been published recently. However, most of the available software tools are not approved for clinical use. Objective: The aim of this study is to evaluate a clinically available automatic segmentation tool of the navigation planning software Brainlab Elements (BL-E) by comparing the output to manual segmentation and a nonclinically approved research method using the DISTAL atlas (DA) and the Horn electrophysiological atlas (HEA). Methods: Preoperative MRI data of 30 patients with idiopathic Parkinson’s disease were used, resulting in 60 STN segmentations. The segmentations were created manually by two clinical experts. Automatic segmentations of the STN were obtained from BL-E and Advanced Normalization Tools using DA and HEA. Differences between manual and automatic segmentations were quantified by Dice and Jaccard coefficient, target overlap, and false negative/positive value (FNV/FPV) measurements. Statistical differences between similarity measures were assessed using the Wilcoxon signed-rank test with continuity correction, and comparison with interrater results was performed using the Mann-Whitney U test. Results: For manual segmentation, the mean size of the segmented STN was 133 ± 24 mm3. The mean size of the STN was 121 ± 18 mm3 for BL-E, 162 ± 21 mm3 for DA, and 130 ± 17 mm3 for HEA. The Dice coefficient for the interrater comparison was 0.63 and 0.54 ± 0.12, 0.59 ± 0.13, and 0.52 ± 0.14 for BL-E, DA, and HEA, respectively. Significant differences between similarity measures were found for Dice and Jaccard coefficient, target overlap and FNV between BL-E and DA; and FPV between BL-E and HEA. However, none of the differences were significant compared to interrater variability. The analysis of the center of gravity of the segmentations revealed that the BL-E STN ROI was located more medially, superior and posterior compared to other segmentations. Regarding the target overlap for beta power within the STN ROI included with the HEA, the BL-E segmentation showed a significantly higher value compared to manual segmentation. Conclusion: Automatic image segmentation by means of the clinically approved software BL-E provides STN segmentations with similar accuracy like research tools, and differences are in the range of observed interrater variability. Further studies are required to investigate the clinical validity, for example, by comparing segmentation results of BL-E with electrophysiological data.
Using Kinetic eGFR for Drug Dosing in AKI: Concordance between Kinetic eGFR, Cockroft-Gault Estimated Creatinine Clearance, and MDRD eGFR for Drug Dosing Categories in a Pilot Study Cohort
Authors: Bairy Manohar
Published: May 2020

Introduction: Drug dosing in patients with acute kidney injury (AKI) is based on the Cockroft-Gault (CG) equation-derived estimated Creatinine clearance (CGeCrCl) for historical reasons due to the lack of a validated method for estimating glomerular filtration rate (GFR) when Cr is rapidly changing. The kinetic equation (kinetic estimated GFR [KeGFR]) estimates GFR for the nonsteady-state Cr level. It is being validated in patient cohorts and could potentially be used for drug dosing when the Cr level is in the nonsteady state. Objective: The aim of the study was to measure the concordance and the degree of agreement between KeGFR-, CGeCrCl, and MDRD eGFR-based drug dosing categories in patients with nonsteady Cr levels. Methods: In the pilot study published previously, 80 adult patients with a significant change in Cr level after admission to the acute medical ward were classified as per the Acute Kidney Injury Network (AKIN) criteria and compared to a KeGFR-based criterion. The CG equation and the MDRD equation were applied retrospectively to the same dataset, and the concordance of the eGFR categories between the 3 methods was studied. The 3 eGFR categories (<30, 30–49, and >50 mL/min) were chosen to reflect the frequently used drug dosing categories in patients with renal impairment. Results: The concordance between CGeCRCL and KeGFR for drug dosing categories was only 62%, with 27 (90%) of the 30 discordant subjects falling into a higher eGFR category when KeGFR was used. The agreement between KeGFR and CGeCrCl was also unsatisfactory. There was better concordance (75%), but the agreement was also not satisfactory between MDRD eGFR and KeGFR for the drug dosing categories. Conclusions: In AKI, compared to CGeCrCL, using KeGFR may affect drug dosing significantly by changing the eGFR category. Further studies of KeGFR for drug dosing will need therapeutic drug monitoring and pharmacokinetic studies for validation.
Efficacy of Budesonide Nasal Spray on Neutrophilic Chronic Rhinosinusitis with Nasal Polyps: A Combined Clinical and Experimental Study
Authors: Lin Lin , Lan Jing , Dai Fei , Wei Jinjin , Chen Zheng , Sun Guangbin
Published: May 2020

Background: Neutrophilic chronic rhinosinusitis with nasal polyps (CRSwNP) occur predominantly in Asian subjects. Appropriate treatments for this endotype have not been elucidated. This study aimed to evaluate the efficacy of budesonide nasal spray on neutrophilic CRSwNP. Materials and Methods: Fifteen neutrophilic CRSwNP patients were included, and then they received budesonide nasal spray treatment for 3 months. Biopsies of nasal polyps (NPs) were obtained from these subjects. Their clinical indexes were scored using Visual Analog Scale (VAS), Sino-Nasal Outcome Test (SNOT)-22, and Endoscopic Appearances (EAs). Histological analyses were used to assess numbers of neutrophils, goblet cells, and submucosal gland cells in NPs. Percentages of CD8+ T cells and CD4+CD25+Foxp3+ regulatory T cells (Tregs) were evaluated using flow cytometry. Mucin 5AC (MUC5AC), MUC5B, myeloperoxidase (MPO), interferon (IFN)-γ, and interleukin (IL)-1β and their mRNAs were also examined. After that, we cultured NP tissues in vitro and evaluated the abovementioned inflammatory parameters before and after the administration of budesonide. Results: Budesonide nasal spray did not improve clinical evaluations including VAS, SNOT-22, and EA scores. Numbers of neutrophils and goblet cells, the score of submucosal gland cells, percentages of CD8+ T cells and Tregs, MUC5AC, MUC5B, MPO, IFN-γ, and IL-1β and their mRNAs were not decreased in NPs after the budesonide treatment. Furthermore, the administration of budesonide into NP cultures also did not reduce their levels in comparison with those before the treatment. Conclusion: These findings demonstrate that budesonide treatment may not alleviate the inflammatory condition in neutrophilic CRSwNP.
Introducing the Bird Chromosome Database: An Overview of Cytogenetic Studies in Birds
Authors: Degrandi Tiago M. , Barcellos Suziane A. , Costa Alice L. , Garnero Analía D.V. , Hass Iris , Gunski Ricardo J.
Published: May 2020

Bird chromosomes, which have been investigated scientifically for more than a century, present a number of unique features. In general, bird karyotypes have a high diploid number (2n) of typically around 80 chromosomes that are divided into macro- and microchromosomes. In recent decades, FISH studies using whole chromosome painting probes have shown that the macrochromosomes evolved through both inter- and intrachromosomal rearrangements. However, chromosome painting data are available for only a few bird species, which hinders a more systematic approach to the understanding of the evolutionary history of the enigmatic bird karyotype. Thus, we decided to create an innovative database through compilation of the cytogenetic data available for birds, including chromosome numbers and the results of chromosome painting with chicken (Gallus gallus) probes. The data were obtained through an extensive literature review, which focused on cytogenetic studies published up to 2019. In the first version of the “Bird Chromosome Database (BCD)” (https://sites.unipampa.edu.br/birdchromosomedatabase) we have compiled data on the chromosome numbers of 1,067 bird species and chromosome painting data on 96 species. We found considerable variation in the diploid numbers, which ranged from 40 to 142, although most (around 50%) of the species studied up to now have between 78 and 82 chromosomes. Despite its importance for cytogenetic research, chromosome painting has been applied to less than 1% of all bird species. The BCD will enable researchers to identify the main knowledge gaps in bird cytogenetics, including the most under-sampled groups, and make inferences on chromosomal homologies in phylogenetic studies.
ACE2 (Angiotensin-Converting Enzyme 2), COVID-19, and ACE Inhibitor and Ang II (Angiotensin II) Receptor Blocker Use During the Pandemic
Authors: South Andrew M. , Brady Tammy M. , Flynn Joseph T.
Published: May 2020

Potential but unconfirmed risk factors for coronavirus disease 2019 (COVID-19) in adults and children may include hypertension, cardiovascular disease, and chronic kidney disease, as well as the medications commonly prescribed for these conditions, ACE (angiotensin-converting enzyme) inhibitors, and Ang II (angiotensin II) receptor blockers. Coronavirus binding to ACE2 (angiotensin-converting enzyme 2), a crucial component of the renin-angiotensin-aldosterone system, underlies much of this concern. Children are uniquely impacted by the coronavirus, but the reasons are unclear. This review will highlight the relationship of COVID-19 with hypertension, use of ACE inhibitors and Ang II receptor blockers, and lifetime risk of cardiovascular disease from the pediatric perspective. We briefly summarize the renin-angiotensin-aldosterone system and comprehensively review the literature pertaining to the ACE 2/Ang-(1–7) pathway in children and the clinical evidence for how ACE inhibitors and Ang II receptor blockers affect this important pathway. Given the importance of the ACE 2/Ang-(1–7) pathway and the potential differences between adults and children, it is crucial that children are included in coronavirus-related research, as this may shed light on potential mechanisms for why children are at decreased risk of severe COVID-19.
The Unity of Composite Substance: The Scholastic Background to the Vinculum Substantiale in Leibniz’s Correspondence with Des Bosses
Authors: Anfray Jean-Pascal
Published: May 2020

This paper explores the scholastic context of the discussion about the unity of the composite or corporeal substance and the nature of the vinculum substantiale or substantial bond in Leibniz’s correspondence with Des Bosses. Three prominent scholastic views are examined: Duns Scotus’s antireductionist account of the composite substance as an entity irreducible to its essential parts (i.e., matter and substantial form); Ockham’s parts-whole identity thesis, which entails a reductionist view of the composite substance; and Suárez’s explanation of the unity of composite substance through the presence of a substantial mode of union. It is then shown that Leibniz initially combines a reductionist account of the composite substance, with the vinculum playing the role of bond among the component monads. In his last letters, he moves away from this to an antireductionist account of the composite substance, with which he now identifies the vinculum.
Fighting Excessive Pharmaceutical Prices: Evaluating the Options
Authors: den Exter André
Published: May 2020

New treatment options for various cancer therapies appear to be extremely expensive and prices may increase further. The affordability and availability of life-saving medicines is therefore a key issue in the national health policies of all countries. International and European law grant several price-reducing options, including compulsory licensing. Still, countries are reluctant to apply for compulsory licensing and/or other regulatory options to curtail pharmaceutical prices. Why is that? Evaluating the options will support health policy decision-making on safeguarding access to affordable innovative medicines.
The War on Terror as a Business: Lessons from Kenya and the Somalia Interventions
Authors: Campbell Horace G.
Published: May 2020

The documented evidence of the Kenyan military collaborating with the so-called forces of terror in Somalia to maintain their accumulation of approximately $400 million every year hardly made the international headlines as the leaders of Kenya have been rehabilitated into the ranks of those allied to US imperialism in waging a war on terror. There is an examination of the links between the US intelligence forces and the Kenyan cartels in keeping alive the terror threat in Somalia. Very few scholars have followed up on the revelations of the role of the Central Intelligence Agency (CIA) in funding those who matured into what is now called terror groups in Somalia through the Alliance for the Restoration of Peace and Counter-Terrorism. The challenge for scholars for peace will be to penetrate the US Africa Command shibboleths on ‘failed states’ in order to work for a program of peace and reconstruction in Africa. In the conclusion, the paper will argue that the withdrawal of the Kenyan troops from Somalia and demilitarization of security will be a concrete step to break up the cartels that are in the business of terror.
Mariological Developments in the New Testament
Authors: Eurell John-Christian
Published: May 2020

The Christian views on the significance of Mary have developed over a long time. This article studies what Mariological developments can be detected in the canonical New Testament and what they might tell us concerning the significance of Mary in early Christian theology.
The End of Histories? Review Essay of Alexander Rosenberg’s How History Gets Things Wrong: the Neuroscience of Our Addiction to Stories
Authors: Imaz-Sheinbaum Mariana , Roth Paul A.
Published: May 2020

Alex Rosenberg’s latest book purports to establish that narrative history cannot have any epistemic value. Rosenberg argues not for the replacement of narrative history by something more science-like, but rather the end of histories understood as an account of human doings under a certain description. This review critiques three of his main arguments: 1) narrative history must root its explanations in folk psychology, 2) there are no beliefs nor desires guiding human action, and 3) historical narratives are morally and ethically pernicious. Rosenberg’s book reprises themes about action explanation he first rehearsed 40 years ago, albeit with neuroscience rather than sociobiology now “preempting” explanations that trade on folk psychological notions. Although Rosenberg’s argument strategy has not altered, the review develops a number of reasons as to why his approach now lacks any plausibility as a strategy for explaining histories, much less a successful one.
A New Look at Ṭūsī’s Awṣāf al-ashrāf
Authors: Lameer Joep
Published: May 2020

It is commonly stated that Naṣīr al-Dīn Ṭūsī’s (d. 672/1274) short treatise on mysticism, the Awṣāf al-ashrāf, was written for the Chancellor of the Exchequer of the Īlkhānid dynasty in Iran, Shams al-Dīn al-Juwaynī (in office 661–683/1262–1284). This is because all the surviving copies of this work were thus far believed to possess the same preamble featuring an elaborate dedication to him. The preamble of the copy preserved in MS Leiden Or. 683/1, possibly the oldest extant copy, tells us a different story. In it, al-Juwaynī is not mentioned at all. As will be argued below, there is every reason to believe that the Leiden copy of the Awṣāf al-ashrāf contains an earlier version of this work, written during Ṭūsī’s affiliation with the Nizārī Ismāʿīlīs, somewhere between 633/1235–1236 and 654/1256. Apparently little-circulated at the time, the work was then brushed up and offered to al-Juwaynī, reminiscent of what Ṭūsī had done with some of his other earlier works.
‮دلالات المصطلحات الواردة في مجالس السماع والقراءة في المخطوطات العربية‬‎
Authors: ‮الجوماني‬‎ ‮د. سعيد‬‎
Published: May 2020

‮الملخص‬‎

‮تناولت هذه الدراسة توضيح معاني ودلالات مصطلحات تكرر ظهورها في قيود السماعات والقراءات في المخطوطات العربية، وهي: مصطلح السماع حضوراً، ومصطلح السماع نقلاً/ أو منقولاً، ومصطلح السماع أصلاً، ومصطلح السماع أصلاً ونقلاً، ومصطلح إجازةً إن لم يكن سماعاً، ومصطلح القائمة وجمعها قوائم، ومصطلح وجهة. وبيَّنت أن بعض القيود المثبتة على النسخة تشكل عائلة واحدة، كل قيدٍ منها يُفضي إلى الآخر ويفسره. وأنَّ معرفة هذه المصطلحات تفتح باباً جديداً في دراسة المخطوطات العربية، وفي فهم سير الحركة الفكرية في القرون المتقدمة. كما أنها تُذكر للمرة الأولى.‬‎
The World as a Theological Problem
Authors: Koci Martin
Published: May 2020

We have no other experience of God but the human experience, claims Emmanuel Falque. We – human beings – are in the world. Whatever we do, whatever we think and whatever we experience happens in the world and is mediated by the manner of the world. This also includes religious experience. Reflection on the possibility of religious experience – the experience of God – suggests that the world is interrupted by someone or something that is not of the world. The Christian worldview makes the tension explicit, which is perhaps why theology neglects the concept and fails in any proper sense to address the world. Through following the phenomenologist Jan Patočka, critiquing the theologian Johann B. Metz and exploring the theological turn in phenomenology, I will face the challenge and argue for a genuine engagement with the world as a theological problem.
Nomenclatural notes on Piper (Piperaceae) from India III

Authors: MUKHERJEE PRASANTA KUMAR
Published: May 2020

This paper, in continuation of earlier ones (Mukherjee 2017, 2018), deals with the taxonomic studies of the genus Piper Linnaeus (Piperaceae) from India. It includes information on the identity, typification and nomenclature of ten additional species. The results report four new names: Piper courtallensis P. K. Mukh. nom. nov., Piper kurgianum P. K. Mukh. nom.nov, Piper lamarckianum P. K. Mukh. nom. nov., and Piper travancorianum P. K. Mukh. nom. nov. It also deals with the lectotypification and nomenclature of P. argyrophyllum Miquel, P. attenuatum Miquel and P. talbotii C. de Candolle in addition to supersession of previous lectotypification with new ones for P. leptostachyum Miquel and P. peepuloides Roxburgh. Additionally, new synonyms are added for P. obtusistigmum C.de Candolle and P. talbotii C. de Candolle. Identities of P. peepuloides Roxburgh, P. mullesua Don and P. rhytidocarpum J. D. Hooker as distinct species are reasserted. An overall evaluation of their identity and nomenclature including synonyms is included. Necessary explanatory notes are added for each of the species which are dealt alphabetically.
Morphological and molecular identification of specimens in the genus Euseius (Acari: Phytoseiidae) from the Republic of Congo
Authors: OKASSA MIREILLE BELLE MBOU , NTABI DOLLON MBAMA , LENGA ARSENE
Published: May 2020

The purpose of this study was to identify the taxonomic status of several individuals belonging to the genus Euseius, collected from three host plants (cassava, okra, and chilli) in the Republic of the Congo, using morphometric and molecular analysis. For this, hierarchical ascending classification on principal component analysis was performed using morphological measurements from 21 and 22 individuals of E. fustis and Euseius sp., respectively, with the original description of Euseius neodossei considered. For molecular analysis, two DNA fragments were amplified and sequenced: the mitochondrial 12S rRNA and the nuclear ribosomal region ITSS. This integrative approach found that (1) morphological differences existed between the Euseius sp. and both E. neodossei and E. fustis, and (2) both mitochondrial DNA fragments showed a clear delineation between Euseius sp. and E. fustis. The results obtained highlight the value of using integrative taxonomy to improve the identification of species in under-sampled areas and the need to increase the number of DNA sequences deposited in GenBank database from this region. This is the first time that DNA sequences of mites from the Congo (Brazzaville) have been deposited in this database.
The Role of Corporate Political Connections in Commercial Lawsuits: Evidence From Chinese Courts
Authors: Xu Jian
Published: May 2020

Like courts in democratic regimes, courts under authoritarianism play an important role in the regulation of complex economies. In particular, scholars suggest that authoritarian judiciaries are commonly encouraged to provide independent adjudication in the context of economic disputes between firms. Yet because regime insiders are often connected to firms, judges have strong incentives to consider the political implications of their decisions even in areas of the law where they are allegedly more independent. In this article, I propose a new theory about the role of corporations’ political background in commercial lawsuits. Using a data set on the litigation outcomes of firms in China, I find that the composition of a firm’s board membership is a significant predictor of its lawsuit outcomes. A higher percentage of corporate board members with political connections leads to a higher probability of lawsuit success. The results point to the limitations of the selective judicial independence theory.
Total hip arthroplasty combined with subtrochanteric shortening osteotomy for Crowe type IV hip dysplasia in dwarfism: a case report
Authors: Yao Mengxuan , Li Huijie
Published: May 2020

Dwarfism is a condition of extreme short stature. Total hip arthroplasty (THA) in patients with dwarfism is a very demanding procedure due to their specific joint deformity and small bone size, which increases the technical difficulty of the THA procedure in such patients with hip dysplasia. This current case report describes a 29-year-old female patient that was admitted due to shortening of the right lower limb, as compared with the contralateral side, which had been present for 18 years. She also complained of pain in the right hip that had been present for 2 months. The hip pain was aggravated by physical exertion, but relieved by rest. She had pituitary dwarfism without mental retardation or delayed sexual development and Crowe type IV dysplasia of the right hip. A THA combined with femoral shortening osteotomy was undertaken, which resolved the pain symptoms and improved her ability to undertake activities of daily living such as walking without pain. Dwarfism with hip dysplasia is a rare but extremely challenging problem that can be successfully treated with THA combined with femoral shortening osteotomy using an S-ROM stem.
Evaluation of cytotoxic and anticancer effect of Orobanche crenata methanolic extract on cancer cell lines
Authors: Hegazy Marwa GA , Imam Amal M , Abdelghany Bassem E
Published: May 2020

We aimed to assess the antitumor activity of Orobanche crenata methanolic extract and evaluate its cytotoxic effect on different cancer cell lines to develop an effective natural anticancer drug. Components of O. crenata methanolic extract were analyzed using gas chromatography–mass spectrometry. The extract’s antioxidant activity was assessed by 2,2-diphenyl-1-picrylhydrazyl and ferric reducing antioxidant power procedures and cytotoxicity of the extract was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and lactate dehydrogenase assays. Caspase-3 activity was also estimated. O. crenata methanolic extract shows powerful antioxidant activity. The extract inhibited the propagation of human hepatocellular carcinoma (HepG2), human prostate cancer (PC3), human breast adenocarcinoma (MCF-7), and human colon carcinoma (HCT-116) in a dose-dependent manner. O. crenata–treated cells displayed obvious morphological structures distinctive of apoptosis. MTT assay exposed that the extract presented prevention of cell persistence in a dose-dependent means and revealed extremely cytotoxic activity against HepG2, PC3, MCF-7, and HCT-116 with 50% inhibitory concentration values 30.3, 111, 89.6, and 28.6 µg/mL, respectively, after 24 h of incubation. In addition, treatment of HCT-116 with various concentrations of the extract caused the release of lactate dehydrogenase and induction of caspase-3 activity in a dose-dependent way. In conclusion, our findings suggested that the O. crenata extract possesses potent antioxidant, cytotoxic activity, and anticancer properties which are possibly due to the principal bioactive phytochemical composites existing in this plant. These results can be used to develop new drugs for cancer treatment.
Containing the Self-Interested Individual: Moral Scepticism of Political Parties in Myanmar
Authors: Walton Matthew J.
Published: May 2020

In this article, I examine a persistent set of concerns regarding the political party system in Myanmar that I read as emerging in response to a Theravāda Buddhist-grounded conception of human nature as inherently self-centred, biased, and morally ignorant. Although these critiques come from political actors anchored in different ideologies and situated in different historical periods (including the early twentieth-century politician U Ba Khaing, contemporary military leaders, and Daw Aung San Suu Kyi and her party, the National League for Democracy), I argue that the resonance of their critiques with this understanding of human beings has imparted a consistent disciplining and delegitimising effect on opposition and minority parties. However, the same conception of human nature has led other Burmese political commentators (including the independence hero General Aung San and the nineteenth-century minister U Hpo Hlaing) to construct opposing arguments that present collective, participatory political action or engagement as the necessary response to human moral deficiencies. Putting these arguments in conversation helps to reveal the disciplining aspects of the critiques of parties and offer alternative justification – still in accordance with this conception of human nature – for a robust and inclusive party system.
The intracranial vasculature of canines represents a model for neurovascular ischemia and training residents and fellows in endovascular neurosurgery
Authors: Lv Xianli , Li Chen , Jiang Weijian
Published: May 2020

Background

We describe use of a canine model to evaluate physiological effects and neuroprotective strategies in the setting of cerebral ischemia and endovascular neurosurgery training.

Methods

We performed transfemoral digital subtraction cerebral and cervical angiography on eight anesthetized dogs. Angiographic images of cerebral arteries were obtained following cannulation of the femoral artery. Cerebral ischemia models were made after angiography.

Results

The canine cerebral vasculature exhibited extensive tortuosity of the carotid and vertebral arteries. Conversely, the bilateral anterior spinal arteries were easily catheterized using microcatheters and microguidewires. The basilar artery and its branches were facilely cannulable. Circle of Willis continuity sans hypoplasia or aplasia of its constitutive segments was appreciated in all animals. The middle cerebral arteries could be easily accessed via the posterior communicating arteries. We generated an empirically evaluable therapeutically interventional experimental animal model of cerebral ischemia by occluding the middle cerebral artery using small coils for a duration between 15 and 60 min.

Conclusion

Unique amenability of the canine intracranial vasculature to selective and microcatheter cannulation renders experimentally induced cerebral, cerebellar, and brainstem via occlusion of the supratentorial and infratentorial arteries a simple matter. The neural vasculature irrigating the canine cerebrum, brainstem, and cerebellum may consequently prove useful in helping young and nascent endovascular neurosurgeons in developing and refining their skills of microcatheter navigation and manipulation and deployment of therapeutic devices to achieve effective occlusion of aneurysms, arteriovenous malformations, arteriovenous fistulas, and neoplasms of the intracranial cavity.
Digital transformation: Learning from Italy’s public administration
Authors: Datta Pratim , Walker Laurie , Amarilli Fabrizio
Published: May 2020

Companies and governments have embraced digital transformation as the elixir of the 21st century. But what impedes digital transformation? This case study article is based on data gathered from field research with the Italian Parliament and the Digital Transformation High Commissioner’s Office in the Ministry of the Interior. The case surfaces the context, challenges, and solutions for large-scale public administration digital transformation. The case study highlights how public administration digital transformation in a large democracy is never a technical but a sociotechnical solution. Successful digital transformation needs to understand, address, and change sociopolitical and sociotechnical mores that often define the culture. Underscoring this research is an analysis of digital transformation within the Italian public administration. Public administration encompasses all governmental and public services, including services provided by federal, regional (e.g. states and provinces), municipalities, and local agencies. The Italian public administration, with 60 million people, 8000 municipalities, and 22,000 local administrations, highlights how a digital renaissance is a preface for innovative disruption challenges. The Digital Transformation case uses Italy as the backdrop and Team Digitale, a team of talented individuals embarked on building public administration efficiencies and rebooting Italy’s digital innovation footprint, as the protagonist. For granularity, the case focuses on two digital transformation projects: ANPR, a unified public registry for all Italian residents, and PagoPA, a universal digital payment platform for public administration. This case surfaces the best practices and challenges faced when trying to tackle a mega-project across an entire economy. The case offers digital transformation recommendations, generalizable across any global democracy. The case analysis and recommendations bring to light how, contrary to private organizations, institutionalizing a disruptive innovation in a democratic country at a time of fiscal austerity highlights interesting decision-making issues and facets.
Platelets docking to VWF prevent leaks during leukocyte extravasation by stimulating Tie-2
Authors: Braun Laura J. , Stegmeyer Rebekka I. , Schäfer Kerstin , Volkery Stefan , Currie Silke M. , Kempe Birgit , Nottebaum Astrid F. , Vestweber Dietmar
Published: May 2020

Neutrophil extravasation requires opening of the endothelial barrier but does not necessarily cause plasma leakage. Leaks are prevented by contractile actin filaments surrounding the diapedesis pore, keeping this opening tightly closed around the transmigrating neutrophils. We have identified the receptor system that is responsible for this. We show that silencing, or gene inactivation, of endothelial Tie-2 results in leak formation in postcapillary venules of the inflamed cremaster muscle at sites of neutrophil extravasation, as visualized by fluorescent microspheres. Leakage was dependent on neutrophil extravasation, because it was absent upon neutrophil depletion. We identified the Cdc42 GTPase exchange factor FGD5 as a downstream target of Tie-2 that is essential for leakage prevention during neutrophil extravasation. Looking for the Tie-2 agonist and its source, we found that platelet-derived angiopoietin-1 (Angpt1) was required to prevent neutrophil-induced leaks. Intriguingly, blocking von Willebrand factor (VWF) resulted in vascular leaks during transmigration, indicating that platelets interacting with endothelial VWF activate Tie-2 by secreting Angpt1, thereby preventing diapedesis-induced leakiness.
Exploring the dynamics and interplay of human papillomavirus and cervical tumorigenesis by integrating biological data into a mathematical model
Authors: Wu Wenting , Song Lei , Yang Yongtao , Wang Jianxin , Liu Hongtu , Zhang Le
Published: May 2020

Background

Cervical cancer is the fourth most common tumor in women worldwide, mostly resulting from high-risk human papillomavirus (HR-HPV) with persistent infection.

Results

The present discoveries are comprised of the following: (i) A total of 16.64% of the individuals were positive for HR-HPV infection, with 13.04% having a single HR-HPV type and 3.60% having multiple HR-HPV types. (ii) Cluster analysis showed that the infection rate trends of HPV31 and HPV33 in all infections as well as HPV33 and HPV35 in single infections in precancerous stages were very similar. (iii) The single/multiple infection proportions of HR-HPV demonstrated a trend that the multiple infections rates of HR-HPV increased as the disease developed.

Conclusions

The HR-HPV prevalence in outpatients was 16.64%, and the predominant HR-HPV types in the study were HPV52, HPV58 and HPV16. HR-HPV subtypes with common biological properties had similar infection rate trends in precancerous stages. Especially, as the disease development of precancer evolved, defense against HPV infection broke, meanwhile, the potential of more HPV infection increased, which resulted in increase of multiple infections of HPV.
Insight to shape of soil microbiome during the ternary cropping system of Gastradia elata
Authors: Yuan Qing-Song , Xu Jiao , Jiang Weike , Ou Xiaohong , Wang Hui , Guo Lanping , Xiao Chenghong , Wang Yanhong , Wang Xiao , Kang Chuanzhi , Zhou Tao
Published: May 2020

Background

The ternary cropping system of Gastradia elata depends on a symbiotic relationship with the mycorrhizal fungi Armillaria mellea, which decays wood to assimilate nutrition for the growth of G. elata. The composition of microbe flora as key determinants of rhizoshere and mycorrhizoshere soil fertility and health was investigated to understand how G. elata and A. mellea impacted on its composition. The next generation pyrosequencing analysis was applied to assess the shift of structure of microbial community in rhizoshere of G. elata and mycorrhizoshere of A. mellea compared to the control sample under agriculture process.

Results

The root-associated microbe floras were significantly impacted by rhizocompartments (including rhizoshere and mycorrhizoshere) and agriculture process. Cropping process of G. elata enhanced the richness and diversity of the microbial community in rhizoshere and mycorrhizoshere soil. Furthermore, planting process of G. elata significantly reduced the abundance of phyla Basidiomycota, Firmicutes and Actinobacteria, while increased the abundance of phyla Ascomycota, Chloroflexi, Proteobacteria, Planctomycetes, and Gemmatimonadetes in rhizoshere and mycorrhizoshere. Besides, A. mellea and G. elata significantly enriched several members of saprophytoic and pathogenic fungus (i.e., Exophiala, Leptodontidium, Cosmospora, Cercophora, Metarhizium, Ilyonectria, and Sporothrix), which will enhance the possibility of G. elata disease incidence. At the same time, the ternary cropping system significantly deterred several members of beneficial ectomycorrhizal fungus (i.e., Russula, Sebacina, and Amanita), which will reduce the ability to protect G. elata from diseases.

Conclusions

In the ternary cropping system of G. elata, A. mellea and G. elata lead to imbalance of microbial community in rhizoshere and mycorrhizoshere soil, suggested that further studies on maintaining the balance of microbial community in A. mellea mycorrhizosphere and G. elata rhizosphere soil under field conditions may provide a promising avenue for high yield and high quality G. elata.
Evidence of an increased prevalence of multiple sclerosis: a population-based study of Tehran registry during 1999–2018
Authors: Almasi-Hashiani Amir , Sahraian Mohammad Ali , Eskandarieh Sharareh
Published: May 2020

Background

The epidemiological characteristics of multiple sclerosis (MS) have been investigated in various studies, which have revealed that the prevalence of MS varies across countries. The present study was conducted to investigate the longitudinal prevalence of MS in Tehran, Iran.

Methods

The present population-based study was conducted in Tehran, the capital of Iran from 1999 to 2018 based on the annual report data provided by the Iranian MS Society (IMSS) registry system. The age-standardized and crude prevalence were estimated using population data presented by the Statistical Centre of Iran.

Results

A total of 21,580 MS cases were registered and included in the analysis. Among the participant patients, 24.99% (5393) and 75.01% (16,187) of cases were male and female, respectively. The mean age of MS onset was 28.8 years (S.D: 8.7). The age-standardized prevalence (ASP) of MS increased from 73.7 (95%CI: 72.1–75.2) per 100,000 people in 2006 to 137.6 (95% CI: 135.7–139.5) per 100,000 people in 2018. The ASP of MS in 2018 was estimated to be 67.9 (95%CI: 66.0–69.8) and 207.3 (95%CI: 204.0–210.7) per 100,000 people among males and females, respectively. The age-standardized female-to-male ratio of MS ranged from 3.7 (in 2010) to 2.06 (in 2017).

Conclusion

The findings of this study suggested that the prevalence of MS in Tehran province is relatively high, and the occurrence of the disease is more common in the age groups under 40 years as compared with older-aged groups. In line with reports provided for various regions of the world, the prevalence of MS was higher among women. Similarly, the findings of this study revealed that the female-to-male ratio was 2.14 in 2018.
Changes in perceived knowledge about childbirth among pregnant women participating in the Senses of Birth intervention in Brazil: a cross-sectional study
Authors: Fernandes Luísa M. M. , Lansky Sônia , Oliveira Bernardo J. , Friche Amélia A. L. , Bozlak Christine T. , Shaw Benjamin A.
Published: May 2020

Background

Senses of Birth (SoB) is a health education intervention in Brazil that aims to reduce unnecessary cesareans in the country by providing information on reproductive rights, benefits and risks of childbirth, and use of intrapartum evidence-based practices (EBP) which are recommended by the World Health Organization (WHO) to improve childbirth outcomes and satisfaction. This study evaluates the impact of the SoB on pregnant women’s perceived knowledge about normal birth (NB), cesarean, and use of EBP.

Methods

1287 pregnant women answered a structured survey immediately after their visit to the intervention, between March 2015 and March 2016. To estimate the potential impact of the intervention on women’s perceived knowledge, and possible associations between sociodemographic characteristics and perceived knowledge, statistical analyses were performed, including paired T-tests, ANOVA, and logistic and linear regressions.

Results

The mean score (MS) of perceived knowledge after the intervention was higher than the MS before experiencing the intervention for all three knowledge domains: Normal Birth (MS Before = 3.71 x MS After = 4.49), Cesarean (MS Before = 3.54 x MS After = 4.26) and EBPs (MS Before = 3.14 x MS After = 4.14). The results suggest that perceived knowledge increased more for low-income women (B = 0.206; p < 0.001 for EBP), women without private health insurance (OR 2.47, 95% CI: 1.49–4.09 for NB), with private prenatal care (OR 2.42, 95% CI: 1.59–3.66 for NB), experiencing their first pregnancy (OR 1.92, 95% CI: 1.31–2.82 for EBP; OR 1.37, 95% CI: 1.03–1.84 for NB; OR 1.37, 95% CI: 1.03–1.84 for cesarean), and in their first or second trimester (OR 1.64, 95% CI: 1.13–2.39 for EBP; OR 1.48, 95% CI: 1.11–1.97 for NB; OR 1.85, 95% CI: 1.40–2.41 for cesarean).

Conclusion

The study showed that participation in the SoB was associated with an increase in perceived knowledge among Brazilian pregnant women. The intervention gains relevance considering the lack of evidence of the impact of non-clinical interventions to reduce unnecessary cesareans in middle and low-income countries.
The role of SRGN in the survival and immune infiltrates of skin cutaneous melanoma (SKCM) and SKCM-metastasis patients
Authors: Wang Xiaofang , Xiong Hui , Liang Daning , Chen Zhenzhen , Li Xiqing , Zhang Kun
Published: May 2020

Background

Skin cutaneous melanoma (SKCM) is one of most aggressive type of cancers worldwide. Serglycin (SRGN) is an intracellular proteoglycan that playing an important role in various tumors. However, its effect on immune infiltrates and whether it associates with survival of SKCM and SKCM-metastasis patients has not been explored.

Methods

We evaluated SRGN expression via the databases of Oncomine, Tumor Immune Estimation Resource (TIMER) and Gene Expression Profiling Interactive Analysis (GEPIA). The influence of SRGN expression on survival of SKCM and SKCM-metastasis patients was analyzed using TIMER database. Furthermore, the correlations between SRGN expression and immune infiltrates or gene marker sets of immune infiltrates were also analyzed via TIMER database.

Results

We found that the expression of SRGN in SKCM and SKCM-metastasis tissues was significantly increased compared to the normal skin tissues (P < 0.001). Interestingly, it was showed that lower level of SRGN expression and lower immune infiltrates of B cell, CD8+ T cell, Neutrophil, and Dendritic cell were correlated with poor survival rate of SKCM and SKCM-metastasis patients (P < 0.001) but not SKCM primary patients. We also demonstrated that SRGN expression was positively associated with the immune infiltrates and diverse immune marker sets in SKCM and SKCM-metastasis.

Conclusions

Our findings indicated that SRGN was associated with the survival of SKCM and SKCM-metastasis patients. SRGN may be a new immune therapy target for treating SKCM and SKCM-metastasis.
Pre-operative hemoglobin level and use of sedative-hypnotics are independent risk factors for post-operative delirium following total knee arthroplasty
Authors: Kijima Eiji , Kayama Tomohiro , Saito Mitsuru , Kurosaka Daisaburo , Ikeda Ryo , Hayashi Hiroteru , Kubota Daisuke , Hyakutake Takashi , Marumo Keishi
Published: May 2020

Background

Delirium is a well-known complication following surgery, especially with the increasing age of patients undergoing surgery. The increasing demands resulting from a prolonged healthy life expectancy has resulted in more arthroplasties despite their age and existing comorbidities. The purpose of this study is to explore the various risk factors that may contribute to delirium in unilateral and bilateral total knee arthroplasties in the elderly population.

Methods

170 patients who underwent unilateral or bilateral total knee arthroplasties were analyzed retrospectively for delirium. Age, sex, comorbidities, use of sedative-hypnotics, peri-operative blood loss, pre- and post-operative laboratory blood test results were investigated and analyzed.

Results

The incidence of post-operative delirium was 6.5% (11 out of 170 patients) with a mean age of 79.5 (± 6.9) years, compared to 73.0 (± 9.0) years in the non-delirium group. Higher age, use of sedative-hypnotics, low pre-operative Hb and Ht, low post-operative Hb, Ht and BUN were observed in the delirium group. Multivariate logistic regression analysis identified that the use of sedative-hypnotics and pre-operative Hb level were independent risk factors for post-operative delirium after TKA. The odds ratios for the use of sedative-hypnotics and pre-operative Hb level were 4.6 and 0.53, respectively. Receiver operating characteristic curve analysis showed that pre-operative Hb of less than 11.1 g/dL was a predictor for the development of delirium, with a sensitivity of 54.6% and a specificity of 91.6%.

Conclusion

Patients with a pre-operative Hb level of < 11.1 g/dL or those using sedative-hypnotics are associated with post-operative delirium. Peri-operative management and preventative measures are therefore needed to reduce the risks of post-operative delirium in such patients.
Infected Schmorl’s node: a case report
Authors: Kim Hyeun Sung , Raorane Harshavardhan Dilip , Sharma Sagar Bhupendra , Wu Pang Hung , Jang Il-Tae
Published: May 2020

Background

Schmorls node (SN) are mostly asymptomatic and incidental findings on MRI. However, sometimes they present like acute onset low back pain or acute exacerbation of chronic back pain after minor trauma.

Case presentation

We present rare case of symptomatic infected SN in 67 years female patient presented with complains of low back pain radiating to right buttock. After initial conservative treatment failed subsequent imaging showed significant increase in size of lesion with focal signal changes in disc space gave suspicion of underlying secondary pathology. Patient operated for complete excision of lesion. Histopathological report was suggestive of pyogenic vertebral osteomyelitis. Patient improved well postoperatively.

Conclusion

Most of the time acute SN responds well to conservative treatment; however rapid deterioration of symptoms or persistent severe pain should give suspicion of underlying secondary pathology.
Medical physics challenges in clinical MR-guided radiotherapy
Authors: Kurz Christopher , Buizza Giulia , Landry Guillaume , Kamp Florian , Rabe Moritz , Paganelli Chiara , Baroni Guido , Reiner Michael , Keall Paul J. , van den Berg Cornelis A. T. , Riboldi Marco
Published: May 2020

The integration of magnetic resonance imaging (MRI) for guidance in external beam radiotherapy has faced significant research and development efforts in recent years. The current availability of linear accelerators with an embedded MRI unit, providing volumetric imaging at excellent soft tissue contrast, is expected to provide novel possibilities in the implementation of image-guided adaptive radiotherapy (IGART) protocols. This study reviews open medical physics issues in MR-guided radiotherapy (MRgRT) implementation, with a focus on current approaches and on the potential for innovation in IGART.

Daily imaging in MRgRT provides the ability to visualize the static anatomy, to capture internal tumor motion and to extract quantitative image features for treatment verification and monitoring. Those capabilities enable the use of treatment adaptation, with potential benefits in terms of personalized medicine. The use of online MRI requires dedicated efforts to perform accurate dose measurements and calculations, due to the presence of magnetic fields. Likewise, MRgRT requires dedicated quality assurance (QA) protocols for safe clinical implementation.

Reaction to anatomical changes in MRgRT, as visualized on daily images, demands for treatment adaptation concepts, with stringent requirements in terms of fast and accurate validation before the treatment fraction can be delivered. This entails specific challenges in terms of treatment workflow optimization, QA, and verification of the expected delivered dose while the patient is in treatment position. Those challenges require specialized medical physics developments towards the aim of fully exploiting MRI capabilities. Conversely, the use of MRgRT allows for higher confidence in tumor targeting and organs-at-risk (OAR) sparing.

The systematic use of MRgRT brings the possibility of leveraging IGART methods for the optimization of tumor targeting and quantitative treatment verification. Although several challenges exist, the intrinsic benefits of MRgRT will provide a deeper understanding of dose delivery effects on an individual basis, with the potential for further treatment personalization.