bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficient evaluation of bridge deformation for running safety of railway vehicles using simplified models
Authors: Jin Zhibin , Yuan Ligang , Pei Shiling
Published: September 2019

The running safety of high-speed trains over bridges is a great concern in bridge design. Typically, the running safety of vehicles is evaluated by vehicle–track simulations that are computationally expensive and unfamiliar to bridge designers. This study investigates simplified vehicle–track models for assessing the running safety of vehicles on deformed bridges. Four types of simplified vehicle models along with four types of simplified wheel–track models are investigated. The predicted wheel–rail forces are compared with those simulated by the detailed vehicle–track program. In these simulations, typical bridge deformations are taken as excitations to the dynamic system. It is found that omitting the rail vibration leads to large wheel–rail response errors. The wheel–rail constraint model gives similar wheel–rail responses to those obtained by the Hertz contact model. A vehicle–track model with five degrees-of-freedom is adequate for assessing wheel–rail forces. Furthermore, an analytical solution to the wheel–rail forces running over an angular rotation was obtained. These simplified vehicle–track models provide an efficient way to assess the running safety of vehicles on deformed bridges when using probabilistic or optimal analyses that require a large number of simulations.
Numerical iteration for nonlinear oscillators by Elzaki transform
Authors: Anjum Naveed , Suleman Muhammad , Lu Dianchen , He Ji-Huan , Ramzan Muhammad
Published: September 2019

Iteration methods are widely used in numerical simulation. This paper suggests the Elzaki transform in the variational iteration method for simple identification of the Lagrange multiplier. The Elzaki transform is a modification of the Laplace transform, and it is extremely useful for treating with nonlinear oscillators as illustrated in this paper, a single iteration leads to a high accuracy of the solution.
Release oscillation in a hollow fiber – Part 2: The effect of its frequency on ions release and experimental verification
Authors: Lin Ling , Li Huigai , Liu Yanping
Published: September 2019

The capillary oscillation in a hollow fiber greatly affects the process of ions release. Its approximate frequency is obtained, revealing a lower frequency predicts a longer release process, and the main factor affecting the frequency is studied theoretically and verified experimentally. The oscillation release can be also extended to drug release in tissue engineering.
Liquid chromatography–tandem mass spectrometry method for determination of rivaroxaban in human plasma and its application to a pharmacokinetic study
Authors: Shaikh Khurshid , Mungantiwar Ashish , Halde Supriya , Pandita Nancy
Published: September 2019

A high-performance liquid chromatography tandem mass spectrometric method for the determination of Rivaroxaban in human plasma has been developed and validated using Rivaroxaban D4 as an internal standard. The extraction of analyte and internal standard was accomplished by solid phase extraction technique. The method has been validated over a concentration range of 5.96–801 ng/mL. Chromatographic separations were achieved using Gemini C18, 150 mm × 4.6 mm, 5 µm, column eluted at flow rate of 1.5 mL/min with mobile phase (acetonitrile: ammonium acetate buffer (80:20 v/v)). The overall run time of method was about 1.8 min with elution times of Rivaroxaban and its internal standard Rivaroxaban D4 at around 1.18 min. The multiple reaction monitoring transitions were set at 436/145 (m/z) and 440/145 (m/z) for Rivaroxaban and Rivaroxaban D4, respectively. The calibration curves were linear (r2 ≥ 0.99) over the range of 5.96–801 ng/mL with lower limit of quantitation validated at 5.96 ng/mL. Extraction recoveries were >88% for both rivaroxaban and its stable labeled internal standard rivaroxaban D4. The inter-day/between run precisions were ranged from 1.08% to 3.75%, while accuracy ranged from 96.3% to 102%. The presented method was used in pharmacokinetic study in healthy volunteers. Results of incurred sample reanalysis were within the acceptance range of ±20% of original value, for 98.3% of samples reanalyzed. This indicated good assay precision of target analytes in their real matrix at the employed experimental conditions. The applicability of the assay for the determination of the pharmacokinetic parameters was demonstrated.
Analysis of 3 Different Operative Techniques for Extra-articular Fractures of the Phalanges and Metacarpals
Authors: Esteban-Feliu Ignacio , Gallardo-Calero Irene , Barrera-Ochoa Sergi , Lluch-Bergadà Alex , Alabau-Rodriguez Sergi , Mir-Bulló Xavier
Published: September 2019

Background: Several techniques have been described for treating metacarpal and phalangeal fractures. We sought to compare the 3 techniques most frequently used for extra-articular metacarpal and phalangeal fractures: plate screw (PS), Kirschner wire (KW), and retrograde intramedullary screw (RIS) fixation. We aimed to determine whether using an RIS provides better clinical outcomes than using either a PS or a KW fixation. Methods: We conducted a retrospective review of patients who underwent surgical treatment of metacarpal and phalangeal fractures from January 2011 to December 2017 in our department. Only patients with an acutely displaced short oblique or transverse extra-articular metacarpal or phalangeal fracture were included. Patients were classified into 3 groups depending on the treatment they received: PS, KW, or RIS fixation. The duration of each procedure was recorded. Clinical assessments included measuring total active motion (TAM), grip strength, and an evaluation of plain radiographs through to ultimate healing. A Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was collected on all patients. Data were analyzed by analysis of variance or Kruskal-Wallis rank test, as indicated. Results: A total of 253 fractures (202 metacarpal and 51 phalangeal) in 230 patients were included in analysis. In all, 135 fractures (53.3%) underwent PS fixation; 53 (20.9%), KW fixation; and 65 (25.6%), RIS fixation. In the KW fixation group, Bouquet pinning was performed for metacarpal fractures and cross pinning for phalangeal fractures. When more than 1 fracture coexisted in the same patient, they were considered separate instances. No differences among the 3 groups were observed when evaluating mean time to radiological union, grip strength, TAM, or QuickDASH score. Mean surgery time was significantly shorter with KW (20 minutes) and RIS (25 minutes), than with PS (32 minutes). Mean return to work or routine activities time was significantly less in the RIS (7.8 weeks) group than in the PS and KW groups (8.3 and 9.2 weeks, respectively). Conclusions: Surgical treatment is recommended in patients with unstable metacarpal and phalangeal fractures. The use of RIS was associated with shorter mean surgery duration and return to work times than PS and KW, respectively.
Existential anxiety and religiosity
Authors: Peters Frederic
Published: September 2019

Analysis of the psychological processes involved in generating the sense of supernatural agency, as well as social scientific research into the factors most directly associated with the prevalence of religious belief and practice (religiosity), both support a common finding: the direct correlation between levels of existential anxiety and the prevalence and intensity of religiosity (religious belief and practice). All functional elements of religion (beliefs, rituals, prayers) involve efforts to invoke, activate, and deploy supernatural causal agency of one sort or another. But religiosity varies throughout the world. This paper reviews psychological evidence that existential anxiety is the core factor activating the intra-psychic mechanisms that give rise to and constitute the nature of religiosity, and that variations in physical and socio-cultural pressures impinging on the individual give rise to variations in anxiety. This combination of intrinsic psychological mechanisms driven though existential anxiety by extrinsic physical, economic, and social pressures indicates that religiosity is best understood as a social–psychological process: socio-cultural factors activating anxiety which in turn drives the intra-psychic mechanisms generating the sense of supernatural agency expressed in belief and practice. By the same token, for analytical purposes, religions are most effectively viewed as social–psychological organisms: social organisms driven by intra-psychic mechanisms that constitute religious convictions and practices in the way that we find them—dedicated to and engaged with supernatural agency in its various forms.
Linear and whorled nevoid hypermelanosis and Joubert syndrome: a novel association: A case report and literature review
Authors: Fernandes Carolina , Waddell Andréanne , Jean Sara-Élizabeth
Published: September 2019

This report discusses a case of linear and whorled nevoid hypermelanosis associated with cerebellar atrophy, ocular and developmental anomalies compatible with Joubert syndrome. Linear and whorled nevoid hypermelanosis is a rare disorder of skin pigmentation characterized by swirls and whorls of hyperpigmented macules in a reticulate pattern along Blaschko’s lines. Neurologic, cardiac, skeletal and developmental anomalies have been reported. We present a case of linear and whorled nevoid hypermelanosis on an 18-year-old woman who also presented with cerebellar atrophy, jerk nystagmus, macrocephaly and developmental delay. Those symptoms were compatible with Joubert syndrome. A complete work-up failed to reveal other systemic or skeletal anomalies. No chromosomal alteration was found on karyotyping carried out on a skin specimen. Much remains to be known about linear and whorled nevoid hypermelanosis. It is generally a benign condition but association with various congenital anomalies have been reported. Proper work-up is advised in order to exclude congenital anomalies.
Subcutaneous extraskeletal chondroblastic osteosarcoma in a cat
Authors: Verdes José Manuel , Menéndez Cecilia , Yamasaki Kanji
Published: September 2019

Case summary

An 11-year-old neutered male cat was presented with a fixed, subcutaneous mass in the left hindlimb. The neoplasm was surgically removed and determined to be a 2 × 2 × 9 cm mass that extended over the plantar surface of the left hindlimb from the tarsus to the phalanges. It was independent from the skeletal system but firmly attached to the adjacent connective tissue. Microscopically, the neoplasm was composed of highly proliferative mesenchymal neoplastic cells that formed both osseous and cartilaginous tissues with associated production of chondroid, osteoid and associated matrixes. This neoplasia was diagnosed as an extraskeletal chondroblastic osteosarcoma. Extraskeletal osteosarcomas, especially the chondroblastic subtype, are extremely rare in cats. Consequently, little is known concerning their course and prognosis. In this case, excision with wide margins appeared to be successful as, at the time of writing, 24 months after limbectomy, the cat is healthy with no evidence of recurrence or metastasis.

Relevance and novel information

To our knowledge, this is the first report of an appendicular large extraskeletal chondroblastic osteosarcoma occurring in a domestic cat. As these neoplasms are rare, it should be considered as a less likely cause of soft tissue appendicular neoplasms in domestic cats.
On the Servant Leadership Behaviors Perceived in Voluntary Settings: The Influences on Volunteers’ Motivation and Organizational Commitment
Authors: Erdurmazlı Eser
Published: September 2019

Building on the functional approach theory, the current study empirically examined the influences of servant leadership behaviors on volunteers’ motivations and on their organizational commitment feelings. In addition, it also examined servant leadership’s indirect influences via those motivations on volunteers’ commitment feelings. To test its hypotheses, the study used the data collected from 385 volunteers. The research has found out that the degree of perceived servant leadership behaviors affected both participants’ motivation to volunteer and their affective and normative commitments feelings toward their organizations. Furthermore, as one of the six dimensions of the motivation concept suggested by the functional approach theory, only the protective motive partially mediated the influences of perceived servant leadership behaviors on the volunteers’ normative commitment attitudes. The study discussed the possible rationales under these research findings and made some future research proposals. The study hopes that its findings, through responding to expectations of their voluntary members, help voluntary organizations to be more effective and efficient in their recruiting and sustaining efforts.
How Korean Leadership Style Cultivates Employees’ Creativity and Voice in Hierarchical Organizations
Authors: Kim Hai Kyong , Baik Kibok , Kim Najung
Published: September 2019

This article examines how Korean leaders in a hierarchical society would trigger employees’ creativity and voice behavior through an indigenous leadership style: Korean leadership style (KLS). KLS exhibits heavily relationship-oriented behaviors, including attending to superiors’ needs and requests, building a positive reputation and trust of peers, and embracing and sheltering subordinates. Jeong, a shared group affect ingrained in Korean society, and woori, a shared feeling of belongingness dedifferentiating individuals constituting the collective, provide a fertile ground for this unique leadership style. Building upon the literature on group affect and collective energy, we explore how the affective mechanism mediates the positive relationships between KLS and employees’ creativity and voice behaviors. The findings from the empirical study of 340 leader–follower paired data points confirm the positive relationships between relationship-oriented Korean leader behaviors and employees’ creativity and voice behavior and that, for creativity, the link is partially mediated by positive affect with high energy.
Lethal haemorrhage due to erosion of external iliac artery in a patient with ureterovaginal fistula following endometriosis surgery
Authors: Widschwendter Peter , Janni Wolfgang , Benckendorff Julian , de Gregorio Nikolaus
Published: September 2019

We present a case report of a patient with laparoscopic surgery of a deep infiltrating endometriosis with a complicative course. In addition to a postoperatively diagnosed ureteral fistula with local inflammation, acute perforation and ultimately lethal bleeding from the adjacent external iliac artery occurred more than 3 weeks after surgery. To the best of our knowledge, a case with the same constellation has not yet been published. A literature review on the rare and comparable complication of a ureteroarterial fistula is discussed in connection with the case.
The Parallel Auditory Brainstem Response
Authors: Polonenko Melissa J. , Maddox Ross K.
Published: September 2019

The frequency-specific tone-evoked auditory brainstem response (ABR) is an indispensable tool in both the audiology clinic and research laboratory. Most frequently, the toneburst ABR is used to estimate hearing thresholds in infants, toddlers, and other patients for whom behavioral testing is not feasible. Therefore, results of the ABR exam form the basis for decisions regarding interventions and hearing habilitation with implications extending far into the child’s future. Currently, responses are elicited by periodic sequences of toneburst stimuli presented serially to one ear at a time, which take a long time to measure multiple frequencies and intensities, and provide incomplete information if the infant wakes up early. Here, we describe a new method, the parallel ABR (pABR), which uses randomly timed toneburst stimuli to simultaneously acquire ABR waveforms to five frequencies in both ears. Here, we describe the pABR and quantify its effectiveness in addressing the greatest drawback of current methods: test duration. We show that in adults with normal hearing the pABR yields high-quality waveforms over a range of intensities, with similar morphology to the standard ABR in a fraction of the recording time. Furthermore, longer latencies and smaller amplitudes for low frequencies at a high intensity evoked by the pABR versus serial ABR suggest that responses may have better place specificity due to the masking provided by the other simultaneous toneburst sequences. Thus, the pABR has substantial potential for facilitating faster accumulation of more diagnostic information that is important for timely identification and treatment of hearing loss.
No Effect of Interstimulus Interval on Acoustic Reflex Thresholds
Authors: Guest Hannah , Munro Kevin J. , Couth Samuel , Millman Rebecca E. , Prendergast Garreth , Kluk Karolina , Murray Carlyn , Plack Chris
Published: September 2019

The acoustic reflex (AR), a longstanding component of the audiological test battery, has received renewed attention in the context of noise-induced cochlear synaptopathy—the destruction of synapses between inner hair cells and auditory nerve fibers. Noninvasive proxy measures of synaptopathy are widely sought, and AR thresholds (ARTs) correlate closely with synaptic survival in rodents. However, measurement in humans at high stimulus frequencies—likely important when testing for noise-induced pathology—can be challenging; reflexes at 4 kHz are frequently absent or occur only at high stimulus levels, even in young people with clinically normal audiograms. This phenomenon may partly reflect differences across stimulus frequency in the temporal characteristics of the response; later onset of the response, earlier onset of adaptation, and higher rate of adaptation have been observed at 4 kHz than at 1 kHz. One temporal aspect of the response that has received little attention is the interstimulus interval (ISI); inadequate duration of ISI might lead to incomplete recovery of the response between successive presentations and consequent response fatigue. This research aimed to test for effects of ISI on ARTs in normally hearing young humans, measured at 1 and 4 kHz. Contrary to our hypotheses, increasing ISIs from 2.5 to 8.5 s did not reduce ART level, nor raise ART reliability. Results confirm that clinically measured ARTs—including those at 4 kHz—can exhibit excellent reliability and that relatively short (2.5 s) ISIs are adequate for the measurement of sensitive and reliable ARTs.
Ethnographic conversations with Wittfogel’s ghost: An introduction
Authors: Ley Lukas , Krause Franz
Published: September 2019

This theme issue re-engages the ghost of Wittfogel in ethnographically grounded conversations around the imbrication of water, power, and infrastructure. It examines social and political relations in ways that take their tensions and correspondences with water seriously, as Wittfogel did half a century ago, but in a less monolithic and totalizing manner. Instead, the contributions pay attention to the situated, partial, multiple, and open-ended encounters that (un)make these links. Together, the papers collected in this theme issue build a critical conversation around the role of water in configuring and reproducing power. Its major threads are the construction of authority through water, the social complexity of water relations, and the interrelationships between water, infrastructure, and political rule.
Women’s risk and well-being at the intersection of dowry, patriarchy, and conservation: The gendering of human–wildlife conflict
Authors: Doubleday Kalli F , Adams Paul C
Published: September 2019

Drawing on work in feminist political ecologies and employing a grounded theory approach, this article examines the socio-spatial links between the patriarchal tradition of dowry, tigers, and women’s well-being. It shows how a landscape governed for conservation purposes can produce embodied and material harm for women living under a patriarchal system. Focus groups conducted in eastern Rajasthan, India, reveal how human–tiger interaction, even if primarily potential rather than actual, initiates a chain of social impacts that presents severe risks to women’s well-being, mental health, and life itself. Analysis connecting the pressures of dowry (financial, physical, and psychological) to tiger presence helps expose the presumptions of unfairness, intra-household power dynamics, and hidden costs of human–wildlife cohabitation while supporting calls for the inclusion of women’s perspectives in environmental theory and management.
The Role of Social Media in Intrastakeholder Strategies to Influence Decision Making in a UK Infrastructure Megaproject: Crossrail 2
Authors: Lobo Sunila , Abid Agha Farhan
Published: September 2019

This article examines the role of social media in public stakeholder and intrastakeholder group strategies to influence decision making in the consultation stage of UK infrastructure megaprojects. The context is the consultation process on the construction of a new Crossrail 2 station in Chelsea, London, where there is resistance. Analysis of social media communication by the affected public groups and interviews with the opposing group shows different intragroup concerns, with stakeholders developing a strong identity enabled by social media. To reduce perceived lack of responsiveness, we recommend that project managers harness social media marketing principles for ongoing relationship building.
Early negative affect in males and females with fragile X syndrome: implications for anxiety and autism
Authors: Wall Carla A. , Hogan Abigail L. , Will Elizabeth A. , McQuillin Samuel , Kelleher Bridgette L. , Roberts Jane E.
Published: September 2019

Background

Fragile X syndrome (FXS) is a genetic disorder that is highly comorbid with anxiety and autism spectrum disorder (ASD). Elevated negative affect in young children has been associated with increased risk for both anxiety and ASD; however, these relations remain poorly understood in FXS.

Methods

The present prospective longitudinal study examined the trajectory of negative affect from infancy through preschool in males and females with FXS and typical development and its relation to anxiety and ASD.

Results

Results indicate a complex association reflecting group, developmental, and sex effects. Specifically, the group with FXS displayed a trajectory of increasing negative affect across age that was distinct from the typical controls. This atypical trajectory of negative affect in FXS was driven by sex effects in that males showed lower negative affect during infancy followed by steep increases across the toddler and preschool years whereas the females displayed a flatter trajectory. Finally, elevated negative affect predicted anxiety symptoms in males, but not females, with no relationship to ASD in males or females with FXS.

Conclusions

The current work addresses the importance of studying the development of psychopathology in a specific neurogenetic population. Temperamental negative affect was shown to be an important early marker for anxiety in young children with FXS, with subtle differences observed between males and females.
Comparison between transcriptomic responses to short-term stress exposures of a common Holarctic and endemic Lake Baikal amphipods
Authors: Drozdova Polina , Rivarola-Duarte Lorena , Bedulina Daria , Axenov-Gribanov Denis , Schreiber Stephan , Gurkov Anton , Shatilina Zhanna , Vereshchagina Kseniya , Lubyaga Yulia , Madyarova Ekaterina , Otto Christian , Jühling Frank , Busch Wibke , Jakob Lena , Lucassen Magnus , Sartoris Franz Josef , Hackermüller Jörg , Hoffmann Steve , Pörtner Hans-Otto , Luckenbach Till , Timofeyev Maxim , Stadler Peter F.
Published: September 2019

Background

Lake Baikal is one of the oldest freshwater lakes and has constituted a stable environment for millions of years, in stark contrast to small, transient bodies of water in its immediate vicinity. A highly diverse endemic endemic amphipod fauna is found in one, but not the other habitat. We ask here whether differences in stress response can explain the immiscibility barrier between Lake Baikal and non-Baikal faunas. To this end, we conducted exposure experiments to increased temperature and the toxic heavy metal cadmium as stressors.

Results

Here we obtained high-quality de novo transcriptome assemblies, covering mutiple conditions, of three amphipod species, and compared their transcriptomic stress responses. Two of these species,Eulimnogammarus verrucosusandE. cyaneus, are endemic to Lake Baikal, while the HolarcticGammarus lacustrisis a potential invader.

Conclusions

Both Baikal species possess intact stress response systems and respond to elevated temperature with relatively similar changes in their expression profiles.G. lacustrisreacts less strongly to the same stressors, possibly because its transcriptome is already perturbed by acclimation conditions.
Chlorophyll fluorescence analysis in diverse rice varieties reveals the positive correlation between the seedlings salt tolerance and photosynthetic efficiency
Authors: Tsai Yu-Chang , Chen Kuan-Chuan , Cheng Tung-Shan , Lee Chuan , Lin Shih-Hung , Tung Chih-Wei
Published: September 2019

Background

Photosynthetic efficiency might be a key factor determining plant resistance to abiotic stresses. Plants can sense when growing conditions are not favorable and trigger an internal response at an early stage before showing external symptoms. When a high amount of salt enters the plant cell, the membrane system and function of thylakoids in chloroplasts could be destroyed and affect photosynthetic performance if the salt concentration is not regulated to optimal values.Oryzaspecies have salt-tolerant and salt-sensitive genotypes; however, very few studies have investigated the genetic architecture responsible for photosynthetic efficiency under salinity stress in cultivated rice.

Results

We used an imaging-based chlorophyll fluorometer to monitor eight rice varieties that showed different salt tolerance levels for four consecutive days under control and salt conditions. An analysis of the changes in chlorophyll fluorescence parameters clearly showed the maximum quantum efficiency of PSII in sensitive varieties was significantly reduced after NaCl treatment when compared to tolerant varieties. A panel of 232 diverse rice accessions was then analyzed for chlorophyll fluorescence under salt conditions, the results showed that chlorophyll fluorescence parameters such as F0and NPQ were higher inJaponicasubspecies, ΦPSII ofIndicavarieties was higher than that in other subgroups, which suggested that the variation in photosynthetic efficiency was extensively regulated under salt treatment in diverse cultivated rice. Two significant regions on chromosome 5 were identified to associate with the fraction of open PSII centers (qL) and the minimum chlorophyll fluorescence (F0). These regions harbored genes related to senescence, chloroplast biogenesis and response to salt stress are of interest for future functional characterization to determine their roles in regulating photosynthesis.

Conclusions

Rice plant is very sensitive to salinity stress, especially at young seedling stage. Our work identified the distribution pattern of chlorophyll fluorescence parameters in seedlings leaf and their correlations with salt tolerance level in a diverse gene pool. We also revealed the complexity of the genetic architecture regulating rice seedling photosynthetic performance under salinity stress, the germplasm analyzed in this study and the associated genetic information could be utilized in rice breeding program.
Case report of rhabdomyosarcomatous transformation of a primary gastrointestinal stromal tumor (GIST)
Authors: Li Li , Khalili Marian , Johannes Gregg , Baratam Praneeth , Morano William F. , Styler Michael , Bowne Wilbur B. , Hou J. Steve
Published: September 2019

Background

Gastrointestinal stromal tumor (GIST) is the most common primary mesenchymal neoplasm of the gastrointestinal tract. Mutations of KIT and platelet-derived growth factor receptor alpha have been well characterized in GISTs. Patients with KIT mutations are generally sensitive to treatment with tyrosine kinase inhibitors. However, some patients with GIST, while initially sensitive to TKIs, gain resistance in later stages of treatment. Heterologous rhabdomyomsarcomatous dedifferentiation of advanced GISTs after long-term imatinib mesylate (IM) therapy has been reported. In these cases, the underlying molecular mechanism of tumor progression and transformation is unclear.

Case presentation

We report one such patient with rhabdomyosarcomatous dedifferentiation of a GIST without metastatic disease after brief 3-month therapy with IM. The tumor was composed of two distinct phenotypes, a CD117 negative region with rhabdomyosarcomatous differentiation directly adjacent to a CD117 positive classic GIST region. Molecular analysis identified the activating KIT exon 11 mutation in both regions, indicating a common origin for both phenotypes. Additionally, the dedifferentiated component contained two synonymous variants in platelet-derived growth factor receptor alpha and KIT. The increased number of synonymous variants in the rhabdomyosarcomatous region may reflect increased genetic instability of this tumor that may have resulted in the loss of CD117 expression in the dedifferentiated component.

Conclusion

This study adds to the growing consensus that rhabdomyosarcomatous GIST progresses from a common GIST primary tumor. The role of IM in this progression is uncertain; however short duration of IM treatment in this study supports the hypothesis that rhabdomyosarcomatous GIST progression is not a consequence of IM therapy. Furthermore, we provide additional information supporting the observation that CD117 negative rhabdomyosarcomatous transformation maintains the activating KIT variant without KIT expression.
Fibrin-associated large B-cell lymphoma: first case report within a cerebral artery aneurysm and literature review
Authors: Zanelli Magda , Zizzo Maurizio , Montanaro Marco , Gomes Vito , Martino Giovanni , De Marco Loredana , Fraternali Orcioni Giulio , Martelli Maria Paola , Ascani Stefano
Published: September 2019

Background

Fibrin-associated diffuse large B-cell lymphoma (FA-DLBCL) is a rare Epstein-Barr virus (EBV) positive lymphoproliferative disorder included in the current World Health Organization (WHO) classification. It arises within fibrinous material in the context of hematomas, pseudocysts, cardiac myxoma or in relation with prosthetic devices. In these clinical settings the diagnosis requires an high index of suspicion, because it does not form a mass itself, being composed of small foci of neoplastic cells. Despite overlapping features with diffuse large B-cell lymphoma associated with chronic inflammation, it deserves a separate classification, being not mass-forming and often following an indolent course.

Case presentation

A 64-year-old immunocompetent woman required medical care for cerebral hemorrhage. Computed Tomography (CT) angiography identified an aneurysm in the left middle cerebral artery. A FA-DLBCL was incidentally identified within thrombotic material in the context of the arterial aneurysm. After surgical removal, it followed a benign course with no further treatment.

Conclusions

The current case represents the first report of FA-DLBCL identified in a cerebral artery aneurysm, expanding the clinicopathologic spectrum of this rare entity. A complete literature review is additionally made.
Descriptive epidemiology of cholera outbreak in Nigeria, January–November, 2018: implications for the global roadmap strategy
Authors: Elimian Kelly Osezele , Musah Anwar , Mezue Somto , Oyebanji Oyeronke , Yennan Sebastian , Jinadu Arisekola , Williams Nanpring , Ogunleye Adesola , Fall Ibrahima Soce , Yao Michel , Eteng Womi-Eteng , Abok Patrick , Popoola Michael , Chukwuji Martin , Omar Linda Haj , Ekeng Eme , Balde Thieno , Mamadu Ibrahim , Adeyemo Ayodele , Namara Geoffrey , Okudo Ifeanyi , Alemu Wondimagegnehu , Peter Clement , Ihekweazu Chikwe
Published: September 2019

Background

The cholera outbreak in 2018 in Nigeria reaffirms its public health threat to the country. Evidence on the current epidemiology of cholera required for the design and implementation of appropriate interventions towards attaining the global roadmap strategic goals for cholera elimination however seems lacking. Thus, this study aimed at addressing this gap by describing the epidemiology of the 2018 cholera outbreak in Nigeria.

Methods

This was a retrospective analysis of surveillance data collected between January 1st and November 19th, 2018. A cholera case was defined as an individual aged 2 years or older presenting with acute watery diarrhoea and severe dehydration or dying from acute watery diarrhoea. Descriptive analyses were performed and presented with respect to person, time and place using appropriate statistics.

Results

There were 43,996 cholera cases and 836 cholera deaths across 20 states in Nigeria during the outbreak period, with an attack rate (AR) of 127.43/100,000 population and a case fatality rate (CFR) of 1.90%. Individuals aged 15 years or older (47.76%) were the most affected age group, but the proportion of affected males and females was about the same (49.00 and 51.00% respectively). The outbreak was characterised by four distinct epidemic waves, with higher number of deaths recorded in the third and fourth waves. States from the north-west and north-east regions of the country recorded the highest ARs while those from the north-central recorded the highest CFRs.

Conclusion

The severity and wide-geographical distribution of cholera cases and deaths during the 2018 outbreak are indicative of an elevated burden, which was more notable in the northern region of the country. Overall, the findings reaffirm the strategic role of a multi-sectoral approach in the design and implementation of public health interventions aimed at preventing and controlling cholera in Nigeria.
Physical activity profile of the Iranian population: STEPS survey, 2016
Authors: Mohebi Farnam , Mohajer Bahram , Yoosefi Moein , Sheidaei Ali , Zokaei Hossein , Damerchilu Bahman , Mehregan Ashkan , Shahbal Nazila , Rezaee Kamyar , Khezrian Maryam , Nematollahi Dehmoosa Ali , Momen Nia Rankohi Ezzatollah , Darman Mahboobeh , Moghisi Alireza , Farzadfar Farshad
Published: September 2019

Background

Insufficient physical activity (IPA) is one of the leading causes of premature mortality through the increased burden of non-communicable diseases. From 1990 to 2017, the percentage of low physical activity attributable disability-adjusted life years (DALY) increased globally by 1.5 times and 2-fold in Iran, causing more than 1.2 million deaths worldwide and 18,000 deaths in Iran in 2017. Reports suggest that Iran, a developing middle-income country, suffers from a high level of IPA. Socioeconomic and cultural alterations along with the country’s developments expose the population to IPA risk. We aimed to describe IPA prevalence in Iran’s adult population, categorized by demographics, geographical region, and activity domains to assess the present pattern of physical inactivity and its domains in the country.

Methods

In 2016, in order to represent Iran’s adult population, adult participants (n: 30541) from 30 provinces were selected using systematic proportional to size cluster sampling. Physical activity (PA) was assessed via the Global Physical Activity Questionnaire, calculating the Metabolic Equivalent of Task (MET) value in minutes per week for work, recreation, and transport domains. Insufficient physical activity (IPA) was defined according to WHO’s recommendation (less than 600 METs per week). Adjusted odds ratios of IPA associates for sociodemographic, lifestyle related variables, and metabolic risk factors were reported.

Results

A high prevalence of IPA was seen in the total population (54.7%, 95%CI: 54.0–55.3) with a considerable difference between the two genders (males: 45.3% (95%CI: 44.3–46.3); females: 61.9% (95%CI: 61.0–62.7)). Work-related activity was the domain with the greatest percentage of total PA, whereas, both genders lacked recreational activities. In our findings, being female, a housekeeper, younger and living in urban areas were significantly associated with higher levels of IPA. Moreover, insufficient fruit and vegetable consumption, lack of alcohol consumption, having a personal vehicle, and finally, having a medical history of diabetes were significantly associated with the presence of IPA in our population. Among the study population, 33.6% (95%CI: 33.0–34.2) had at least 4 h of sedentary behavior in a typical day.

Conclusions

Widespread IPA among the Iranian adult population is of major concern. In our findings, we observed a considerable gap in the prevalence and pattern of IPA between the two genders. Additionally, IPA was associated with living in urban areas, unhealthy lifestyle habits and a history of other metabolic risk factors. Thus, a prompt initiative for population-specific actions should be taken.
Clinical ethics dilemmas in a low-income setting - a national survey among physicians in Ethiopia
Authors: Miljeteig Ingrid , Defaye Frehiwot , Desalegn Dawit , Danis Marion
Published: September 2019

Background

Ethical dilemmas are part of medicine, but the type of challenges, the frequency of their occurrence and the nuances in the difficulties have not been systematically studied in low-income settings. The objective of this paper was to map out the ethical dilemmas from the perspective of Ethiopian physicians working in public hospitals.

Method

A national survey of physicians from 49 public hospitals using stratified, multi-stage sampling was conducted in six of the 11 regions in Ethiopia. Descriptive statistics were used and the responses to the open-ended question “If you have experienced any ethical dilemma, can you please describe a dilemma you have encountered in your own words?” were analyzed using a template analysis process.

Results

A total of 587 physicians responded (response rate 91,7%), and 565 met the inclusion criteria. Twelve of 24 specified ethically challenging situations were reported to be experienced often or sometimes by more than 50% of the physicians. The most frequently reported challenge concerned resource distribution: 93% agreed that they often or sometimes had to make difficult choices due to resource limitation, and 83% often or sometimes encountered difficulties because patients were unable to pay for the preferred course of treatment. Other frequently reported difficulties were doubts about doing good or harming the patient, relating to conflicting views, concern for family welfare, disclosure issues and caring for patients not able to consent. Few reported dilemmas related to end-of-life issues. The 200 responses to the open-ended question mirrored the quantitative results.

Discussion

Ethiopian physicians report ethical challenges related more to bedside rationing and fairness concerns than futility discussions and conflicts about autonomy as described in studies from high-income countries. In addition to the high report of experienced challenges, gravity of the dilemmas that are present in their narratives are striking. Recognition of the everyday experiences of physicians in low-income settings should prompt the development of ethics teaching and support mechanisms, discussion of ethical guidelines as well as increase our focus on how to improve the grave resource scarcity they describe.
Molecular detection of respiratory pathogens and typing of human rhinovirus of adults hospitalized for exacerbation of asthma and chronic obstructive pulmonary disease
Authors: Ko Fanny Wai-san , Chan Paul Kay-sheung , Chan Renee W. Y. , Chan Ka-Pang , Ip April , Kwok Angela , Ngai Jenny Chun-li , Ng So-Shan , On Chan Tat , Hui David Shu-cheong
Published: September 2019

Background

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and asthma are associated with a variety of precipitating factors including infection. This study assessed the infective viral etiologies by real-time multiplex polymerase chain reaction of patients hospitalized with AECOPD and asthma exacerbations. In addition, infective etiologies were assessed for association with the clinical outcome of the patients.

Methods

Adults admitted with AECOPD and asthma exacerbations between August 2016 and July 2017 were recruited. Nasopharyngeal aspirate (NPA) samples were obtained from the patients within 1–2 days of admission and subjected to pathogen detection and human rhinovirus (HRV) typing.

Results

Altogether 402 patients with AECOPD, 80 stable COPD, 100 asthma exacerbation and 21 stable asthma subjects were recruited. Among those admitted for AECOPD and asthma exacerbations, 141(35.1%) and 45(45.0%) respectively had pathogens identified in the NPA specimens. The commonest virus identified was influenza A followed by HRV. HRV typing identified HRV-A and HRV-C as the more common HRV with a wide variety of genotypes. Identification of pathogens in NPA or HRV typing otherwise did not affect clinical outcomes including the hospital length of stay, readmission rates and mortality except that identification of pathogens in asthma exacerbation was associated with a lower rate of readmissions at 30 and 60 days.

Conclusions

Many respiratory viruses were associated with AECOPD and asthma exacerbation. HRV-A and HRV-C were the more common HRV associated with exacerbations. Identification of pathogens in NPA was associated with less readmissions for asthma patients at 30 and 60 days.

Trial registration

ClinicalTrials.gov NCT02866357.
Heart defibrillation: relationship between pacing threshold and defibrillation probability
Authors: Antoneli Priscila C. , Goulart Jair T. , Bonilha Isabella , de Carvalho Daniela D. , de Oliveira Pedro X.
Published: September 2019

Background

Considering the clinical importance of the ventricular fibrillation and that the most used therapy to reverse it has a critical side effect on the cardiac tissue, it is desirable to optimize defibrillation parameters to increase its efficiency. In this study, we investigated the influence of stimuli duration on the relationship between pacing threshold and defibrillation probability.

Results

We found out that 0.5-ms-long pulses had a lower ratio of defibrillation probability to the pacing threshold, although the higher the pulse duration the lower is the electric field intensity required to defibrillate the hearts.

Conclusion

The appropriate choice of defibrillatory shock parameters is able to increase the efficiency of the defibrillation improving the survival chances after the occurrence of a severe arrhythmia. The relationship between pulse duration and the probability of reversal of fibrillation shows that this parameter cannot be underestimated in defibrillator design since different pulse durations have different levels of safety.
Comparison of efficacy of robotic surgery, laparoscopy, and laparotomy in the treatment of ovarian cancer: a meta-analysis
Authors: Shi Can , Gao Yingchun , Yang Yijun , Zhang Lei , Yu Juanpeng , Zhang Ting
Published: September 2019

Background

We intended to compare the clinical effect of robotic surgery with laparoscopy and laparotomy in ovarian cancer treatment.

Methods

The included studies were retrieved from PubMed, Embase, and the Cochrane Library databases. The Methodological Index for Nonrandomized Studies (MINORS) was used to evaluate the study quality. Effect measures were presented with weighted mean difference (WMD)/odds ratio (OR) and 95% confidence interval (CI), and heterogeneity test was assessed using Q test and I2 statistics to determine the use of the random effects model or fixed effects model. Egger’s test was used to assess the publication bias.

Results

A total of eight studies was included in this meta-analysis with a MINORS score of 16–18. In the random effects model, estimated blood loss (EBL) of robotic surgery was significantly less compared with laparotomy (WMD = − 521.7027, 95% CI − 809.7816; − 233.6238). In the fixed effects model, length of hospital stay (LHS) (WMD = − 5.2225, 95% CI − 6.1485; − 4.2965) and postoperative complication (PC) (OR = 0.4710, 95% CI 0.2537; 0.8747) of robotic surgery were significantly less, and overall survival (OS) rate (OR = 6.4355, 95% CI 1.6722; 24.7678, P = 0.0070) of robotic surgery was significantly higher compared with laparotomy. There was no difference in the effect size of all variables between robotic surgery and laparoscopy. Meanwhile, a publication bias (t = 6.8290, P = 0.002405) was only identified for PC in robotic surgery and laparotomy groups; no publication bias was identified for the other variables.

Conclusions

Despite the above results, it failed to show oncological safety and recurrence by pathological stages or histologic types in this meta-analysis, and those confounding factors might affect the clinical outcome. Future meta-analyses with a larger number of eligible randomized controlled trial studies were needed to determine the most suitable treatment method for patients with different stages and types of ovarian cancer.
Prevalence and patterns of cigarette smoking before and during early and late pregnancy according to maternal characteristics: the first national data based on the 2003 birth certificate revision, United States, 2016
Authors: Kondracki Anthony J.
Published: September 2019

Background

The objective of this study was to examine the prevalence of smoking by intensity status before pregnancy and during early (first and second trimester) and late (third trimester) pregnancy according to race/ethnicity, age, and educational attainment of women who gave birth in the United States in 2016.

Methods

This cross-sectional study was based on the 2016 National Center for Health Statistics (NCHS) Natality File of 3,956,112 live births, the first year that it became 100% nationally representative. Self-reported smoking data were used to create new seven smoking intensity status categories to capture natural variability in smoking patterns during pregnancy and to identify maternal smokers by race/ethnicity, age, and educational attainment. The risk of smoking at low and high intensity in early pregnancy was estimated in multivariable logistic regression analyses.

Results

Nearly 9.4% of women reported smoking before pregnancy and 7.1% during pregnancy, both at high and low intensity, and smoking rates were higher in the first trimester (7.1%) than in the second (6.1%) or the third (5.7%) trimester. Non-Hispanic White women, women 20–24 years old, and women with less than a high school education were the strongest predictors of smoking anytime during pregnancy. The odds of smoking in early pregnancy at high intensity were 88% lower (aOR 0.12, 95% CI: 0.11, 0.13) for Hispanic women, compared to non-Hispanic White women; 16% higher (aOR 1.16, 95% CI: 1.12, 1.21) for women 20–24 years old and 16% lower (aOR 0.84, 95% CI: 0.80, 0.89) for women ≥35 years old, compared to women 25–29 years old; as well as 13% higher (aOR 1.13, 95% CI: 1.09, 1.18) for women with less than a high school education and 92% lower (aOR 0.08, 95% CI: 0.08, 0.09) for women with a bachelor’s degree or higher, compared to women with a high school diploma.

Conclusions

Despite the high prevalence of high intensity smoking before and during pregnancy, future intervention strategies need to focus on the proportion of low intensity quitters and reducers, who are ready to stop smoking. Continual monitoring of trends in smoking intensity patterns is necessary, including neonatal outcomes over time.