bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between nutritional risk index and outcomes for head and neck cancer patients receiving concurrent chemo‐radiotherapy
Authors: Oh Justin , Liu Alvin , Tran Eric , Berthelet Eric , Wu Jonn , Olson Robert A. , Chau Nicole , Bowman Angie , Hamilton Sarah N.
Published: June 2020

Background

Patients receiving chemoradiotherapy for head and neck cancer (HNC) are often malnourished. We assessed the utility of nutritional risk index (NRI) in HNC patients undergoing chemoradiotherapy.

Methods

A population‐based retrospective review of HNC patients treated with curative chemoradiation was performed. Demographics, anthropometrics, overall survival (OS), and the composite treatment complication rate (G‐tube dependence, radiation incompletion, 90‐day mortality, and unplanned hospitalization) were collected.

Results

Two hundred ninety‐two patients were identified. Average pretreatment and posttreatment NRI were 110 (SD 3) and 99 (SD 12), respectively (P < .01). Pretreatment NRI risk category, age, ECOG status, and tumor subsites were associated with OS on multivariate analysis. Pretreatment NRI risk category was associated with risk of treatment related complications.

Conclusions

There was a significant decrease between pretreatment and posttreatment NRI in HNC patients receiving chemoradiation. Pretreatment NRI risk category may predict OS and composite treatment complications. Investigation of NRI as a prognostic factor is warranted.
COVID‐19 pandemic and health care disparities in head and neck cancer: Scanning the horizon
Authors: Graboyes Evan , Cramer John , Balakrishnan Karthik , Cognetti David M. , López‐Cevallos Daniel , de Almeida John R. , Megwalu Uchechukwu C. , Moore Charles E. , Nathan Cherie‐Ann , Spector Matthew E. , Lewis Carol M. , Brenner Michael J.
Published: June 2020

The COVID‐19 pandemic has profoundly disrupted head and neck cancer (HNC) care delivery in ways that will likely persist long term. As we scan the horizon, this crisis has the potential to amplify preexisting racial/ethnic disparities for patients with HNC. Potential drivers of disparate HNC survival resulting from the pandemic include (a) differential access to telemedicine, timely diagnosis, and treatment; (b) implicit bias in initiatives to triage, prioritize, and schedule HNC‐directed therapy; and (c) the marked changes in employment, health insurance, and dependent care. We present four strategies to mitigate these disparities: (a) collect detailed data on access to care by race/ethnicity, income, education, and community; (b) raise awareness of HNC disparities; (c) engage stakeholders in developing culturally appropriate solutions; and (d) ensure that surgical prioritization protocols minimize risk of racial/ethnic bias. Collectively, these measures address social determinants of health and the moral imperative to provide equitable, high‐quality HNC care.
Oriented distance regularized level set evolution for image segmentation
Authors: Liu Panpan , Xu Xianze
Published: June 2020

The conventional distance regularized level set evolution method has been very popular in image segmentation, but usually it cannot converge to the desired boundary when there are multiple and unwanted boundaries in the image. By observation, the gradient direction between the target boundaries and the unwanted boundaries are usually different in one image. The gradient direction information of the boundaries can guide the orientation of the level set function evolution. In this study, the authors improved the conventional distance regularized level set evolution method, introduced new edge indicator functions and proposed an oriented distance regularized level set evolution method for image segmentation. The experiment results show the proposed method has a better segmentation result in images with multiple boundaries. Moreover, alternately selecting the edge indicator functions we proposed during the level set evolution can lead the zero level set contour to converge to the desired boundaries in complicated images.
Robust political economy correlates of major product and labor market reforms in advanced economies: Evidence from BAMLE for logit models
Authors: Duval Romain , Furceri Davide , Miethe Jakob
Published: June 2020

The political economy literature has put forward a multitude of hypotheses regarding the drivers of structural reforms, but few, if any, empirically robust findings have emerged thus far. To make progress, we draw a parallel with model uncertainty in the growth literature and provide a new version of the Bayesian averaging of maximum likelihood estimates (BAMLE) technique tailored to binary logit models. Relying on a new database of major past labor and product market reforms in advanced countries, we test a large set of variables for robust correlation with reform in each area. We find widespread support for the crisis‐induces‐reform hypothesis, as high unemployment and economic crises are robustly correlated to structural reforms. We also find evidence of reform convergence—that is, countries with tighter regulation are more prone to liberalize. Reforms are more likely when other countries also undertake them and when there is formal pressure to implement them. Other robust correlates are more specific to certain areas—for example, international pressure and political factors are most relevant for product market and job protection reforms, respectively.
4‐O‐methylascochlorin activates autophagy by activating AMPK and suppressing c‐Myc in glioblastoma
Authors: Hwang Soon‐Kyung , Han Si‐Yoon , Jeong Yun‐Jeong , Magae Junji , Bae Young‐Seuk , Chang Young‐Chae
Published: June 2020

A prior study identified that 4‐O‐methylascochlorin (MAC), a methylated derivative of ascochlorin (ASC) from the fungus Ascochyta viciae, activates autophagy in leukemia cells by suppressing c‐Myc phosphorylation. However, the effects of MAC on autophagy in other cancer cells remain unknown. In the present study, we demonstrated that MAC activated autophagy in human glioblastoma. MAC increased expression of autophagy‐related proteins, such as LC3‐II and Beclin‐1. Moreover, MAC stimulated AMP‐activated protein kinase (AMPK) phosphorylation and suppressed phosphorylation of the mTOR, p70S6K, and 4EBP1. The well‐known AMPK activator metformin increased LC3‐II levels, which were augmented by MAC cotreatment. AMPK knockdown decreased LC3‐II levels and inhibited MAC activation of autophagy. Furthermore, MAC suppression of c‐Myc expression activated autophagy. Treatment with the c‐MYC inhibitor, 10058‐FA, induced autophagy, as did c‐Myc small interfering RNA knockdown. These effects were augmented by MAC cotreatment. Taken together, these findings indicated that MAC induces autophagy in human glioblastoma by activating AMPK signaling and inhibiting c‐Myc protein expression in human glioblastoma.
Hsa_circ_0023642 promotes proliferation, invasion, and migration of gastric cancer by sponging microRNA‐223
Authors: Zhang Yi , Xia Lei , Wu Jing , Xu Xinyu , Li Gang
Published: June 2020

Background

Circular RNAs (circRNAs) have a closed‐loop structure and are associated with various cellular biological processes, including carcinogenesis and cancer development. However, our knowledge of circRNAs in gastric cancer (GC) remains limited. Thus, this study aimed to investigate the role and underlying molecular mechanisms of hsa_circ_0023642 in GC.

Materials and methods

Bioinformatic analysis revealed that hsa_circ_0023642 was upregulated in GC. Chromogenic in situ hybridization (CISH) chips was used to explore the relationship between the expression of hsa_circ_0023642 and the malignant degree, clinical stage, and prognosis of patients with GC. The role of hsa_circ_0023642 in GC was assessed in vitro, and biotin‐coupled RNA pull‐down was conducted to evaluate the interaction in between hsa_circ_0023642 and miR‐223.

Results

The current study showed that hsa_circ_0023642 was upregulated in GC and presented a high positive correlation with the malignant progression of GC. In addition, in vitro experiments showed that the silencing of hsa_circ_0023642 in GC cell lines MKN‐45 and SGC‐7901 significantly reduced the proliferation, invasion, and migration of GC cells. We confirmed that hsa_circ_0023642 could serve as a sponge of miR‐223, subsequently promoting GC progression.

Conclusion

This study shows that the upregulation of hsa_circ_0023642 affects the malignant progression, clinical stage, and prognosis of GC which provides a new molecular target for the therapy of GC.
A Pilot Study of the Maternal‐Fetal Pharmacokinetics of Furosemide in Plasma, Urine, and Amniotic Fluid of Hypertensive Parturient Women Under Cesarean Section
Authors: Gonçalves Paulo Vinicius Bernardes , Moreira Fernanda de Lima , Benzi Jhohann Richard de Lima , Duarte Geraldo , Lanchote Vera Lucia
Published: June 2020

The third trimester of pregnancy is related to physiological changes that can modify the process of absorption, distribution, metabolism, and excretion and, consequently, the efficacy and toxicity of drugs. However, little is known about furosemide pharmacokinetics and placental transfer in pregnancy. This study evaluated the maternal‐fetal pharmacokinetics and distribution to amniotic fluid of furosemide in hypertensive parturient women under cesarean section. Twelve hypertensive parturient women under methyldopa (250 mg/8 h) and/or pindolol (10 mg/12 h) treatment received a 40‐mg single oral dose of furosemide 1 to 10 hours before delivery by cesarean section. Blood and urine samples were collected for 12 hours after furosemide administration. At delivery, samples were obtained from maternal and umbilical cord blood (n = 8) to assess the transplacental transfer. Amniotic fluid (n = 4) was collected at the time of delivery. The following furosemide pharmacokinetic parameters were obtained as median (interquartile range): Cmax, 403 ng/mL (229 to 715 ng/mL); Tmax, 2.00 hours (1.50 to 4.83 hours); elimination half‐life (t1/2), 2.50 hours (1.77 to 2.97 hours); AUC0‐12 h, 1366 ng⋅h/mL (927 to 2531 ng⋅h/mL); AUC0‐∞, 1580 ng⋅h/mL (1270 to 2881 ng⋅h/mL); CL/F 25.3 L/h (13.8 to 31.4 L/h); CLR, 2.50 L/h (1.77 to 2.97 L/h); CLNR, 22.7 L/h (12.1 to 25.6 L/h); and Vd/F 82.8 L (34.4 to 173 L). The transplacental transfer of furosemide was 0.43 (0.10 to 0.73), and the amniotic fluid concentration was 11.0 ng/mL (5.51 to 14.6 ng/mL). From a clinical point of view, these results suggest that substrates of uridine diphosphate‐glucuronosyltransferase isoenzymes such as furosemide may have increased clearance during pregnancy and could require dose adjustment in this population.
Activation of persulfate by biochar from spent malt rootlets for the degradation of trimethoprim in the presence of inorganic ions
Authors: Grilla Eleni , Vakros John , Konstantinou Ioannis , Manariotis Ioannis D , Mantzavinos Dionissios
Published: June 2020

BACKGROUND

Antibiotics such as trimethoprim (TMP) are used in large quantities and recent studies show that TMP is not eliminated completely in wastewater from municipal treatment plants. Advanced oxidation processes (AOPs), especially sulfate radical‐based AOPs, are highly reactive in the presence of a catalyst. Biochar, a green and low‐cost carbon material, is an excellent catalyst to degrade persistent pollutants. In this work, the degradation of TMP is studied using biochar from spent malt rootlets.

RESULTS

The biochar has a specific surface area of 62 m2 g–1, point of zero charge 6.8, contains aromatics and is rich in –OH surface groups. The effect of sodium persulfate (SPS) (100–500 mg L–1), TMP (150–500 μg L–1), biochar (BC) concentration (45–180 mg L–1), solution pH (4–9) and water quality on degradation was investigated. The degradation rate increased with increasing SPS and BC concentration, decreasing TMP concentration and water matrix complexity, but remained insensitive to pH changes. Seven transformation products were identified and quantified, including hydroxylated and oxidized keto derivatives, and reaction pathways/mechanisms are proposed. The BC activation was coupled with low‐frequency ultrasound (20 kHz), which plays a synergistic role in degradation, but not when coupled with simulated solar irradiation.

CONCLUSION

The occurrence of various ions in bottle water (BW) impact negatively TMP degradation and so does the existence of organic matter in treated wastewaters. The studied reaction seems to be a surface process where the biochar serves as a platform to generate sulfate and –OH radicals, as well as an electron transfer mediator. © 2020 Society of Chemical Industry
Clinical impact of pancreaticoduodenectomy for pancreatic cancer with resection of the secondary or later branches of the superior mesenteric vein
Authors: Honda Masayuki , Nagakawa Yuichi , Akashi Masanori , Hosokawa Yuichi , Osakabe Hiroaki , Takishita Chie , Nishino Hitoe , Tsuchida Akihiko
Published: June 2020

Purpose

To evaluate the feasibility of pancreaticoduodenectomy with resection of the second jejunal vein (J2V) for pancreatic ductal adenocarcinoma (PDAC).

Methods

Among 114 patients with PDAC undergoing pancreaticoduodenectomy with portal‐superior mesenteric vein resection (PVR), surgical outcomes, and prognoses of 10 patients with resection of J2V or later branches of the superior mesenteric vein (J2VR) were compared to 104 patients with PVR above J2V (standard PVR). The reconstruction methods in the J2VR group were reviewed.

Results

There were no significant differences in the operative time (470 vs 435 min), morbidity (30% vs 27%), presence of portal vein stenosis (10% vs 5%) or thrombosis (10% vs 1%), and induction of adjuvant therapy (80% vs 88%) between the J2VR and standard PVR groups, although blood loss was higher in the J2VR group (1184 vs 494 ml; P = .002). R0 proportion and 2‐year survival rates were not significantly worse in the J2VR group compared to the standard PVR group (90 and 88%; 67 and 45%, respectively). At least one branch of the superior mesenteric vein was reconstructed in the J2VR group.

Conclusion

Pancreaticoduodenectomy with J2VR for PDAC can be safely performed with a satisfactory overall survival rate.
Statins for atherosclerotic cardiovascular disease prevention in people living with HIV in Thailand: a cost‐effectiveness analysis
Authors: Boettiger David C , Newall Anthony T , Chattranukulchai Pairoj , Chaiwarith Romanee , Khusuwan Suwimon , Avihingsanon Anchalee , Phillips Andrew , Bendavid Eran , Law Matthew G , Kahn James G , Ross Jeremy , Bautista‐Arredondo Sergio , Kiertiburanakul Sasisopin
Published: June 2020

Introduction

People living with HIV (PLHIV) have an elevated risk of atherosclerotic cardiovascular disease (CVD) compared to their HIV‐negative peers. Expanding statin use may help alleviate this burden. However, the choice of statin in the context of antiretroviral therapy is challenging. Pravastatin and pitavastatin improve cholesterol levels in PLHIV without interacting substantially with antiretroviral therapy. They are also more expensive than most statins. We evaluated the cost‐effectiveness of pravastatin and pitavastatin for the primary prevention of CVD among PLHIV in Thailand who are not currently using lipid‐lowering therapy.

Methods

We developed a discrete‐state microsimulation model that randomly selected (with replacement) individuals from the TREAT Asia HIV Observational Database cohort who were aged 40 to 75 years, receiving antiretroviral therapy in Thailand, and not using lipid‐lowering therapy. The model simulated each individual’s probability of experiencing CVD. We evaluated: (1) treating no one with statins; (2) treating everyone with pravastatin 20mg/day (drug cost 7568 Thai Baht ($US243)/year) and (3) treating everyone with pitavastatin 2 mg/day (drug cost 8182 Baht ($US263)/year). Direct medical costs and quality‐adjusted life‐years (QALYs) were assigned in annual cycles over a 20‐year time horizon and discounted at 3% per year. We assumed the Thai healthcare sector perspective.

Results

Pravastatin was estimated to be less effective and less cost‐effective than pitavastatin and was therefore dominated (extended) by pitavastatin. Patients receiving pitavastatin accumulated 0.042 additional QALYs compared with those not using a statin, at an extra cost of 96,442 Baht ($US3095), giving an incremental cost‐effectiveness ratio of 2,300,000 Baht ($US73,812)/QALY gained. These findings were sensitive to statin costs and statin efficacy, pill burden, and targeting of PLHIV based on CVD risk. At a willingness‐to‐pay threshold of 160,000 Baht ($US5135)/QALY gained, we estimated that pravastatin would become cost‐effective at an annual cost of 415 Baht ($US13.30)/year and pitavastatin would become cost‐effective at an annual cost of 600 Baht ($US19.30)/year.

Conclusions

Neither pravastatin nor pitavastatin were projected to be cost‐effective for the primary prevention of CVD among PLHIV in Thailand who are not currently using lipid‐lowering therapy. We do not recommend expanding current use of these drugs among PLHIV in Thailand without substantial price reduction.
Layering and scaling up chronic non‐communicable disease care on existing HIV care systems and acute care settings in Kenya: a cost and budget impact analysis
Authors: Osetinsky Brianna , Mwangi Ann , Pastakia Sonak , Wilson‐Barthes Marta , Kimetto Joan , Rono Kimutai , Laktabai Jeremiah , Galárraga Omar
Published: June 2020

Introduction

Like many countries in sub‐Saharan Africa, Kenya is experiencing a rapid rise in the burden of non‐communicable diseases (NCDs): NCDs now contribute to over 50% of inpatient admissions and 40% of hospital deaths in the country. The Academic Model Providing Access to Healthcare (AMPATH) Chronic Disease Management (CDM) programme builds on lessons and capacity of HIV care to deliver chronic NCD care layered into both HIV and primary care platforms to over 24,000 patients across 69 health facilities in western Kenya. We conducted a cost and budget impact analysis of scaling up the AMPATH CDM programme in western Kenya using the International Society for Pharmacoeconomics and Outcomes Research guidelines.

Methods

Costs of the CDM programme for the health system were measured retrospectively for 69 AMPATH clinics from 2014 to 2018 using programmatic records and clinic schedules to assign per clinic monthly costs. We quantified the additional costs to provide NCD care above those associated with existing HIV or acute care services, including clinician, staff, training, travel and equipment costs, but do not include drugs or consumables as they would be paid by the patient. We projected the budget impact of increasing CDM coverage to 50% of the eligible population from 2021 to 2025, and compared it with the county budgets from 2019.

Results

The per visit cost of providing CDM care was $10.42 (SD $2.26), with costs at facilities added to HIV clinics $1.00 (95% CI: −$2:11 to $0.11) lower than at primary care facilities. The budget impact of adding 26,765 patients from 2021 to 2025 to the CDM programme was 3,088,928 under constant percent growth, and 3,451,732 under steady‐state enrolment. Scaling up under the constant percent growth scenario resulted in 12% cost savings in the budget impact. The county programmatic CDM cost in 2025 was <1% of the county healthcare budgets from 2019.

Conclusions

The budget impact of scaling up AMPATH’s CDM programme will be driven by annual growth scenarios, and facility/provider mix. By leveraging task shifting, referral systems and partnering with public and non‐profit clinics without NCD services, AMPATH’s CDM programme can provide critical NCD care to new, rural populations with minimal financial impact.
Recommendations for the use of mathematical modelling to support decision‐making on integration of non‐communicable diseases into HIV care
Authors: Kibachio Joseph , Mwenda Valerian , Ombiro Oren , Kamano Jamima H , Perez‐Guzman Pablo N , Mutai Kennedy K , Guessous Idris , Beran David , Kasaie Paratsu , Weir Brian , Beecroft Blythe , Kilonzo Nduku , Kupfer Linda , Smit Mikaela
Published: June 2020

Introduction

Integrating services for non‐communicable diseases (NCDs) into existing primary care platforms such as HIV programmes has been recommended as a way of strengthening health systems, reducing redundancies and leveraging existing systems to rapidly scale‐up underdeveloped programmes. Mathematical modelling provides a powerful tool to address questions around priorities, optimization and implementation of such programmes. In this study, we examine the case for NCD‐HIV integration, use Kenya as a case‐study to highlight how modelling has supported wider policy formulation and decision‐making in healthcare and to collate stakeholders’ recommendations on use of models for NCD‐HIV integration decision‐making.

Discussion

Across Africa, NCDs are increasingly posing challenges for health systems, which historically focused on the care of acute and infectious conditions. Pilot programmes using integrated care services have generated advantages for both provider and user, been cost‐effective, practical and achieve rapid coverage scale‐up. The shared chronic nature of NCDs and HIV means that many operational approaches and infrastructure developed for HIV programmes apply to NCDs, suggesting this to be a cost‐effective and sustainable policy option for countries with large HIV programmes and small, un‐resourced NCD programmes. However, the vertical nature of current disease programmes, policy financing and operations operate as barriers to NCD‐HIV integration. Modelling has successfully been used to inform health decision‐making across a number of disease areas and in a number of ways. Examples from Kenya include (i) estimating current and future disease burden to set priorities for public health interventions, (ii) forecasting the requisite investments by government, (iii) comparing the impact of different integration approaches, (iv) performing cost‐benefit analysis for integration and (v) evaluating health system capacity needs.

Conclusions

Modelling can and should play an integral part in the decision‐making processes for health in general and NCD‐HIV integration specifically. It is especially useful where little data is available. The successful use of modelling to inform decision‐making will depend on several factors including policy makers’ comfort with and understanding of models and their uncertainties, modellers understanding of national priorities, funding opportunities and building local modelling capacity to ensure sustainability.
Integrating care for non‐communicable diseases into routine HIV services: key considerations for policy design in sub‐Saharan Africa
Authors: Kintu Alexander , Sando David , Okello Samson , Mutungi Gerald , Guwatudde David , Menzies Nicolas A , Danaei Goodarz , Verguet Stéphane
Published: June 2020

Introduction

There is great interest for integrating care for non‐communicable diseases (NCDs) into routine HIV services in sub‐Saharan Africa (SSA) due to the steady rise of the number of people who are ageing with HIV. Suggested health system approaches for intervening on these comorbidities have mostly been normative, with little actionable guidance on implementation, and on the practical, economic and ethical considerations of favouring people living with HIV (PLHIV) versus targeting the general population. We summarize opportunities and challenges related to leveraging HIV treatment platforms to address NCDs among PLHIV. We emphasize key considerations that can guide integrated care in SSA and point to possible interventions for implementation.

Discussion

Integrating care offers an opportunity for effective delivery of NCD services to PLHIV, but may be viewed to unfairly ignore the larger number of NCD cases in the general population. Integration can also help maintain the substantial health and economic benefits that have been achieved by the global HIV/AIDS response. Implementing interventions for integrated care will require assessing the prevalence of common NCDs among PLHIV, which can be achieved via increased screening during routine HIV care. Successful integration will also necessitate earmarking funds for NCD interventions in national budgets.

Conclusions

An expanded agenda for addressing HIV‐NCD comorbidities in SSA may require adding selected NCDs to conditions that are routinely monitored in PLHIV. Attention should be given to mitigating potential tradeoffs in the quality of HIV services that may result from the extra responsibilities borne by HIV health workers. Integrated care will more likely be effective in the context of concurrent health system reforms that address NCDs in the general population, and with synergies with other HIV investments that have been used to strengthen health systems.
Asymmetry in the cytoplasm of oocytes of largescale yellowfish Labeobarbus marequensis Smith 1841 (Teleostei: Cypriniformes: Cyprinidae)
Authors: Żelazowska Monika , Halajian Ali
Published: June 2020

The ovaries of the largescale yellowfish, Labeobarbus marequensis (Teleostei: Cypriniformes: Cyprinidae), are made up of the germinal epithelium, nests of late chromatin nucleolus stage oocytes, and ovarian follicles. Each follicle is composed of a single oocyte, which is surrounded by somatic follicular cells and a basal lamina covered by thecal cells. We describe polarization and ultrastructure of oocytes during the primary growth stage. The oocyte nucleus contains lampbrush chromosomes, nuclear bodies and fibrillar material in which multiple nucleoli arise. Nuage aggregations composed of material of a nuclear origin are present in the perinuclear cytoplasm. The Balbiani body (Bb) contains aggregations of nuage, rough endoplasmic reticulum, individual mitochondria and complexes of mitochondria with nuage (cement). Some mitochondria in the Bb come into close contact with endoplasmic reticulum cisternae and vesicles that contain granular material. At the start of primary growth, the Bb is present in the cytoplasm close to the nucleus. Next, it expands towards the oocyte plasma membrane. In these oocytes, a spherical structure, the so‐called yolk nucleus, arises in the Bb. It consists of granular nuage in which mitochondria and vesicles containing granular material are immersed. Later, the Bb becomes fragmented and a fully grown yolk nucleus is present in the vegetal region. It contains numerous threads composed of granular nuage, mitochondria, lysosome‐like organelles and autophagosomes. We discuss the formation of autophagosomes in the cytoplasm of primary growth oocytes. During the final step of primary growth, the cortical alveoli arise in the cytoplasm and are distributed evenly. The eggshell is deposited on the external surface of the oocyte plasma membrane and is made up of two egg envelopes that are pierced by numerous pore canals. The external egg envelope is covered in protuberances. During primary growth no lipid droplets are synthesized or stored in the oocytes.
Interannual to millennial‐scale variability of River Ammer floods and its relationship with solar forcing
Authors: Rimbu N. , Lohmann G. , Ionita M. , Czymzik M. , Brauer A.
Published: June 2020

The relationship between River Ammer flood frequency variability, extreme summer climate over Europe, and solar forcing is investigated. First, we used observational data to evaluate extreme weather and climate anomaly patterns associated with flood and solar forcing as well as the possible dynamical mechanisms behind them. Then, the annual resolution flood layer record from the Lake Ammer sediments is analysed to evaluate millennial‐scale variability of floods and possible related extreme climate patterns back to 5,500 years BP. A composite analysis reveals that observed River Ammer flood frequency variability at interannual to multidecadal time scales is connected to large‐scale extreme precipitation and temperature patterns. From a synoptic‐scale perspective, the extreme precipitation pattern associated with floods is related to an increase in the frequency of high upper‐level potential vorticity (PV) events over western Europe and a decrease over eastern Europe and western Russia. Increased (decreased) frequency of upper‐level high PV events is related to more (less) surface extreme precipitation occurrence. Furthermore, we show that increased frequency of upper‐level high PV events over western Europe is associated with enhanced blocking activity over eastern Europe. Therefore, the out of phase interannual to millennial‐scale variations of River Ammer flood frequency and solar irradiance, as presented in previous studies, can be explained by a solar modulation of eastern European‐western Russia summer blocking and associated upstream upper‐level wave breaking activity. In addition, we identify two distinct quasi‐periodic signals in both frequency of Lake Ammer flood layer and solar irradiance records with periods of ~900 years and ~2,300 years. We argue that similar cycles should dominate millennial‐scale variations of blocking activity in eastern Europe‐western Russia as well as extreme precipitation and flood frequency variability over central and western Europe during the last ~5,500 years.
Decreased survival and increased recurrence in Merkel cell carcinoma significantly linked with immunosuppression
Authors: Bryant Mary K. , Ward Christine , Gaber Charles E. , Strassle Paula D. , Ollila David W. , Laks Shachar
Published: June 2020

Background

Merkel cell carcinoma (MCC) is a rare and aggressive form of skin cancer. It is an immunogenic tumor as evident by its association with Polyomavirus, immunotherapy response, and increased prevalence in the immunosuppressed population.

Objective

We sought to evaluate the impact of known clinicopathological determinants and immunosuppression on the risk of recurrence and mortality of MCC patients.

Methods

A retrospective, observational cohort study of patients diagnosed and/or treated with MCC at two tertiary academic institutions. We compared clinicopathological determinants, treatment modalities, and immunosuppression status on clinical outcomes of recurrence, disease‐specific survival, and overall survival.

Results

We evaluated 90 patients within our study and 34% had a cancer recurrence during follow‐up. Patients with recurrence were significantly more likely to be immunosuppressed (32% vs 5%; P = .001). Estimated 5‐year recurrence was 43%, and immunosuppressed patients were significantly more likely to recur (Hazard ratio [HR] 3.67 [1.80‐7.51]; P < .0001). Immunosuppressed patients had significantly elevated cancer‐specific mortality (HR 6.11[1.61‐23.26]; P = .008).

Limitations

Retrospective review with a prolonged observation period and changing treatment modalities.

Conclusion

Immunocompromised patients had a threefold increased incidence of 5‐year mortality and over twofold increased incidence of any recurrence as non–immunocompromised patients. Patients’ immunosuppressive status should be considered when making decisions regarding treatment, surveillance, and prognostication.
Acute pain after breast surgery and reconstruction: A two‐institution study of surgical factors influencing short‐term pain outcomes
Authors: Azad Amee D. , Bozkurt Selen , Wheeler Amanda J. , Curtin Catherine , Wagner Todd H. , Hernandez‐Boussard Tina
Published: June 2020

Background and Objectives

Acute postoperative pain following surgery is known to be associated with chronic pain development and lower quality of life. We sought to analyze the relationship between differing breast cancer excisional procedures, reconstruction, and short‐term pain outcomes.

Methods

Women undergoing breast cancer excisional procedures with or without reconstruction at two systems: an academic hospital (AH) and Veterans Health Administration (VHA) were included. Average pain scores at the time of discharge and at 30‐day follow‐up were analyzed across demographic and clinical characteristics. Linear mixed effects modeling was used to assess the relationship between patient/clinical characteristics and interval pain scores with a random slope to account for differences in baseline pain.

Results

Our study included 1402 patients at AH and 1435 at VHA, of which 426 AH and 165 patients with VHA underwent reconstruction. Pain scores improved over time and were found to be highest at discharge. Time at discharge, 30‐day follow‐up, and preoperative opioid use were the strongest predictors of high pain scores. Younger age and longer length of stay were independently associated with worse pain scores.

Conclusions

Younger age, preoperative opioid use, and longer length of stay were associated with higher levels of postoperative pain across both sites.
Functional outcomes over time following perineal pseudocontinent colostomy reconstruction after abdominoperineal resection for ultralow rectal adenocarcinoma
Authors: Souadka Amine , Majbar Mohammed Anass , Essangri Hajar , Amrani Laila , Benkabbou Amine , Mohsine Raouf , Souadka Abdelilah
Published: June 2020

Background and Objectives

Pseudocontinent‐perineal colostomy (PCPC) following abdominoperineal resection (APR) is a promising technique associated with good quality of life. This study evaluates over time the functional results after PCPC using the Kirwan score.

Methods

All PCPC patients operated on from January 2001 to January 2016 were followed with their functional results assessed at four checkpoints. A/B Kirwan scores and a 48 to 72 hours colonic irrigation rhythm were considered “good” and “convenient” and their overall variations over time were assessed by means of Cochran's Q test corrected by Bonferroni post hoc test.

Results

Fifty‐seven eligible patients were included in the study with 33 (58%) women. We noted a significant difference in both Kirwan score and colic irrigation rhythm during the four checkpoints in follow‐up with Q(1) = 85.01 and Q(2) = 69. 86. By the fourth checkpoint, 86% of patients had a Kirwan score of A/B. Concerning the rhythm of colonic irrigation, there was a significant improvement between 6 months and other checkpoints. In the second year, 63% of patients reduced their colonic irrigation rhythm.

Conclusions

The functional results of PCPC after APR improve and stabilize from 6 months to 1 year after surgery thus making PCPC a good alternative that surgeons can present to their patients.
Predictors of hemodynamic instability in patients with pheochromocytoma and paraganglioma
Authors: Ma Lulu , Shen Le , Zhang Xiuhua , Huang Yuguang
Published: June 2020

Background and Objectives

Intraoperative hemodynamic instability is common in patients with pheochromocytoma and paraganglioma. The aim of this study was to identify the predictive risk factors of intraoperative hemodynamic instability.

Methods

A total of 428 patients having elective resection of pheochromocytoma and/or paraganglioma at Peking Union Medical College Hospital between January 2014 and July 2019 were included. The association between preoperative parameters and the incidence of intraoperative hemodynamic instability were evaluated. Binary logistic regression was used to assess the predictive risk factors of hemodynamic instability.

Results

Patients with intraoperative hemodynamic instability were more prone to have elevated levels of norepinephrine and epinephrine. Binary Logistic regression showed the risk factors of hemodynamic instability were tumor size >5.0 cm (odds ratio [OR], 1.889; 95% confidence interval [CI], 1.243‐2.870; P = .003) and five‐fold increases of urine epinephrine (OR, 2.195; 95% CI, 1.242‐3.880; P = .007).

Conclusions

Intraoperative hemodynamic instability is common despite adequate preoperative medical treatment. Tumor size and high level of urinary epinephrine are tumor‐related factors for intraoperative hemodynamic instability. Identifying these factors can help clinicians to manage patients more effectively and improve patients' outcomes.
Identification of Specific Endobronchial Ultrasound Features to Differentiate Sarcoidosis From Other Causes of Lymphadenopathy
Authors: Cheng Wen‐Chien , Shen Meng‐Fang , Wu Biing‐Ru , Liao Wei‐Chih , Chen Chih‐Yu , Chen Wei‐Chun , Chen Chia‐Hung , Tu Chih‐Yen
Published: June 2020

Objectives

We hypothesized that specific endobronchial ultrasound (EBUS) features may differentiate sarcoidosis from other causes of lymphadenopathy.

Methods

We conducted this retrospective observational study from January 2014 to January 2019 to analyze patients with intrathoracic lymphadenopathy who underwent EBUS‐guided transbronchial needle aspiration. Ultrasound features, including nodal size, margin, echogenicity, the presence or absence of calcification, a central hilar structure, the coagulation necrosis sign, nodal conglomeration, and the septal vessel sign in the color Doppler mode were recorded and compared between 3 groups.

Results

Of the 90 included patients, 15 had a diagnosis of tuberculosis; 56 had a diagnosis of sarcoidosis; and 19 had a diagnosis of malignant lymph nodes by EBUS‐guided transbronchial needle aspiration. The presence of nodal conglomeration (94.6% versus 60.0% versus 5.3%; P < .001), the septal vessel sign in the color Doppler mode (55.4% versus 13.3% versus 15.8%; P = .002), and a distinct margin (73.2% versus 13.3% versus 47.4%; P < .001) were significantly higher in the sarcoidosis group than in the tuberculosis lymphadenopathy and malignant lymph node groups. The presence of the coagulation necrosis sign (8.9% versus 93.3% versus 31.6%; P < .001) was significantly lower in the sarcoidosis group than in tuberculosis lymphadenopathy and malignant lymph node groups. A multivariate analysis showed that the presence of nodal conglomeration, the absence of coagulation necrosis, and the presence of the septal vessel sign in the color Doppler mode were independent predictive factors for the diagnosis of sarcoidosis.

Conclusions

The presence of nodal conglomeration, the absence of coagulation necrosis, and the presence of the septal vessel sign in the color Doppler mode in lymph nodes on EBUS are predictive of sarcoidosis.
Intraoperative Neuromonitoring Using a Single Transcartilage Needle Electrode During Thyroidectomy
Authors: Lee Hyoung S. , Seo Sang G. , Kim Dong Y. , Kim Sung W. , Choi Young , Lee Kang D.
Published: June 2020

Objectives

Application of transcartilage needle electrode for intraoperative neuromonitoring (IONM) during thyroidectomy has been considered an alternative method of electromyography (EMG) tube recording. However, needle electrodes must be inserted into both sides of the thyroid cartilage with exposure of the cartilage lamina. We sought to evaluate the feasibility of applying a single ipsilateral transcartilage needle electrode for IONM during unilateral hemithyroidectomy.

Methods

Thirty‐four patients underwent IONM during unilateral thyroidectomy. A dual disposable needle electrode was inserted obliquely into the inferior lower third of the ipsilateral lamina of the thyroid cartilage. Patients were classified as deep (≥ 5 mm) or superficial (< 5 mm) by the depth of the needle electrode inserted into the thyroid cartilage. Without using an EMG tube, IONM was done according to the standardized procedure using a single needle electrode only.

Results

IONM was successful in all nerves at risk. Amplitude of the EMG signal was stable during the surgery, with no cases presenting loss of signal. Amplitude of the signal from vagal and recurrent laryngeal nerve stimulation was significantly lower when needle insertion was superficial (< 5 mm). None of the patients showed postoperative vocal cord paralysis, and complications related to needle electrode were not identified.

Conclusion

IONM using a single ipsilateral transcartilage needle electrode during unilateral hemithyroidectomy was feasible with no significant complications. It may serve as an alternative method of IONM with the advantage of minimal exposure of the thyroid cartilage lamina.

Level of Evidence

4 Laryngoscope, 131:448–452, 2021
Eosinophilic Granulomatosis With Polyangiitis: An Unusual Case of Pediatric Subglottic Stenosis
Authors: Mokhtari Tara E. , Miller Lauren E. , Jayawardena Asitha D. L. , Sadow Peter M. , Hardy Stephen C. , Rothman Deborah , Hartnick Christopher J.
Published: June 2020

Systemic disease is an uncommon cause of subglottic stenosis (SGS). We report a case of severe SGS due to underlying eosinophilic granulomatosis with polyangiitis (EGPA) in a child presenting with isolated stridor. EGPA is a rare systemic vasculitis with very limited cases reported in the pediatric population. While surgical intervention was required given the degree of stenosis in this case, medical management of the underlying systemic disease process is critical when there is clinical suspicion of SGS in the context of systemic vasculitis. Laryngoscope, 131:656–659, 2021
Quantitative and Qualitative Evaluation of Supercontinuum Laser‐Induced Cutaneous Thermal Injuries and Their Repair With OCT Images
Authors: Fan Yingwei , Ma Qiong , Xin Shenghai , Peng Ruiyun , Kang Hongxiang
Published: June 2020

Background and Objectives

Laser‐induced thermal injuries are a heavily researched topic in laser medicine and biomedicine. To explore the quantitative biological effects of laser‐induced injury repair, we propose an optical imaging‐based in vivo evaluation method and discuss the injury effect and repair characteristics of skin tissue.

Study Design/Materials and Methods

A supercontinumm laser (spectrum width ranged from 400 to 2400 nm) was used to irradiate live mice. The radiation doses were set as 32.85, 65.69, 98.4, and 197.08 J/cm2. Laser‐induced cutaneous thermal injuries were observed and measured after laser radiation. Optical coherence tomography (OCT) was used to image the injured spots. The optical attenuation coefficient (OAC) was computed using a Fourier‐domain algorithm. Three‐dimensional (3D) visualizations of the injured spots in the OCT images were constructed to qualitatively demonstrate the degree of the thermal injury at different times. The corresponding pathological changes of the skin injuries were observed dynamically.

Results

Under increasing radiation doses, the injured spots, which ranged in degree from mild to severe, appeared accordingly. The mean OAC value of normal skin was 1.15 ± 0.01 mm−1. The mean values of the OAC maps in the region of interests (ROIs) were 0.88 ± 0.05, 0.91 ± 0.02, 0.93 ± 0.04, and 0.98 ± 0.08 mm−1 at each of the four radiation levels, respectively. Additionally, the 3D OCT visualization showed a directed view of the injured spots and the healing process and was used as a qualitative evaluation method. The OCT images and pathological results showed that the damage tended to vary across all groups, but this trend tended to weaken as the radiation dose increased.

Conclusion

Optical imaging provides an in vivo noninvasive and real‐time evaluation method to comprehensively quantify supercontinuum laser‐induced thermal injuries and wound healing. The OACs and 3D visualizations of the OCT cubic data enable the areas of the direct injured spots to be measured and the inner structure to be viewed. The results obtained with these techniques indicate that the skin injuries are aggravated and tissue repair trends weaken as the radiation doses increase. This method would have a potential application for laser‐medicine and laser‐biological effects in the future. Lasers Surg. Med. © 2020 Wiley Periodicals LLC
A Novel Phenotype Associated with CaSR‐Related Familial Brain Calcifications
Authors: Scannapieco Sara , Picillo Marina , Del Gaudio Luigi , Barone Paolo , Erro Roberto
Published: June 2020

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Cardiopulmonary Function and Aerobic Exercise in Parkinson's: A Systematic Review of the Literature
Authors: Aburub Aseel , Ledger Sean J. , Sim Julius , Hunter Susan M.
Published: June 2020

Background

Cardiorespiratory impairments are considered the main cause of mortality in the late stages of Parkinson's. Aerobic exercise has been shown to improve pulmonary function in asthmatic patients and in healthy people. However, effects of aerobic exercise on cardiopulmonary function in people with Parkinson's have not been investigated. Therefore, this study aimed to review the effects of aerobic exercise on cardiopulmonary function in people with Parkinson's.

Methods

A systematic search was conducted using MEDLINE, AMED, CINHAL Plus, and relevant associated keywords, from January 1970 to January 2020. Inclusion criteria for the studies were: aerobic exercise as part of the intervention, pulmonary function test, and/or cardiopulmonary exercise test as outcome measures.

Results

In total, 329 citations were identified from the search, of which nine were included in this review. In general, aerobic exercise was found to have positive effects on cardiac function for people with Parkinson's, but there is a lack of studies on the effects of aerobic exercise on pulmonary function.

Conclusion

People with early stages of Parkinson's may experience positive effects of aerobic exercise on cardiac fitness. Further research is needed in this area, particularly into the effects of aerobic exercise on pulmonary function in early stages of the disease.
Viral filtration using carbon‐based materials
Authors: Matharu Rupy Kaur , Porwal Harshit , Chen Biqiong , Ciric Lena , Edirisinghe Mohan
Published: June 2020

Viral infections alone are a significant cause of morbidity and mortality worldwide and have a detrimental impact on global healthcare and socio‐economic development. The discovery of novel antiviral treatments has gained tremendous attention and support with the rising number of viral outbreaks. In this work, carbonaceous materials, including graphene nanoplatelets and graphene oxide nanosheets, were investigated for antiviral properties. The materials were characterized using scanning electron microscopy and transmission electron microscopy. Analysis showed the materials to be two‐dimensional with lateral dimensions ranging between 1 and 4 µm for graphene oxide and 110 ± 0.11 nm for graphene nanoplatelets. Antiviral properties were assessed against a DNA virus model microorganism at concentrations of 0.5, 1.0 and 2.0 wt/v%. Both carbonaceous nanomaterials exhibited potent antiviral properties and gave rise to a viral reduction of 100% across all concentrations tested. Graphene oxide nanosheets were then incorporated into polymeric fibres, and their antiviral behaviour was examined after 3 and 24 hr. A viral reduction of 39% was observed after 24 hr of exposure. The research presented here showcases, for the first time, the antiviral potential of several carbonaceous nanomaterials, also included in a carrier polymer. These outcomes can be translated and implemented in many fields and devices to prevent viral spread and infection.
Nonlocal boundary value problem for generalized Hilfer implicit fractional differential equations
Authors: Mali Ashwini D. , Kucche Kishor D.
Published: June 2020

In this paper, we derive the equivalent fractional integral equation to the nonlinear implicit fractional differential equations involving Ψ‐Hilfer fractional derivative subject to nonlocal fractional integral boundary conditions. The existence of a solution, Ulam–Hyers, and Ulam–Hyers–Rassias stability have been acquired by means of an equivalent fractional integral equation. Our investigations depend on the fixed‐point theorem due to Krasnoselskii and the Gronwall inequality involving Ψ‐Riemann–Liouville fractional integral. Finally, examples are provided to show the utilization of primary outcomes.
Compact K/Ka‐band dipole antenna element with ball grid array packaging
Authors: Liu Xiubo , Zhang Wei , Hao Dongning , Liu Yanyan
Published: June 2020

A compact K/Ka‐Band dipole antenna element with ball grid array packaging is proposed. The antenna is divided into two parts, one is a cuboid antenna element fabricated on a FR4 printed circuit board, and the other is a grounded coplanar waveguide feed line fabricated on a motherboard. To minimize the size of the antenna element, we use three‐dimensional structure to design the antenna element. The dipole patches are fabricated on the top layer of the antenna element, and the ball grid array is on the bottom layer of the antenna element. Plated through holes connect solder balls and dipole patches. Finally, the antenna element is mounted on the motherboard. We designed, manufactured and measured the antenna prototypes. The details of the antenna design and the measurement results are presented and discussed.