bluuebunny/crossref_metadata_2025 huggingface dataset:
In Vitro Study of Endotoxin Adsorption by a Polymyxin B-Immobilized Fiber Column
Authors: Yamashita Chizuru , Moriyama Kazuhiro , Hasegawa Daisuke , Kato Yu , Sakai Toshikazu , Kawaji Takahiro , Shimomura Yasuyo , Kurimoto Yasuyoshi , Nagata Mariko , Nishida Osamu
Published: July 2018

Background: Polymyxin B-immobilized fiber (PMX-F) columns are used as therapeutic interventions for septic shock. The clinical efficacy has been reported for 2-h applications, but their ability to adsorb endotoxin over longer treatments has not been fully elucidated. We hypothesized that PMX-F columns are capable of endotoxin removal for more than 2 h. Method: We designed closed circuits incorporating either a PMX-F column with an 8.5-mL priming volume (PMX-01R) or a sham-control column, and used inactivated fetal bovine serum as the circulating perfusate. Endotoxin was continuously injected at a fixed rate for 24 h, and perfusate endotoxin concentrations were measured at fixed time points. PMX-01R endotoxin adsorption was calculated from the difference in the endotoxin concentrations. Results: PMX-01R endotoxin adsorption increased continuously in a virtually linear manner. Conclusions: The PMX-01R column showed sustained endotoxin adsorption for at least 24 h. This indicated that PMX-F columns would be capable of clinical endotoxin removal for 24 h.
Gamma Knife Radiosurgery for Metastatic Brain Tumors from Malignant Melanomas: A Japanese Multi-Institutional Cooperative and Retrospective Cohort Study (JLGK1501)
Authors: Matsunaga Shigeo , Shuto Takashi , Yamamoto Masaaki , Yomo Shoji , Kondoh Takeshi , Kobayashi Tatsuya , Sato Manabu , Okamoto Hisayo , Serizawa Toru , Nagano Osamu , Kenai Hiroyuki , Obara Takuma , Iwai Yoshiyasu , Yasuda Soichiro , Hasegawa Toshinori , Kubo Kenji , Shidoh Satoka , Mori Katsuharu , Hayashi Motohiro , Inoue Akira , Onoue Shinji , Gondo Masazumi
Published: July 2018

Background: The incidences of metastatic brain tumors from malignant melanomas have increased and survival has been prolonged by novel molecular targeted agents and immunotherapy. However, malignant melanomas are uncommon in Asian populations. Objectives: We retrospectively analyzed treatment efficacy and identified prognostic factors impacting tumor control and survival in Japanese melanoma patients with brain metastases treated with gamma knife radiosurgery (GKRS). Methods: We retrospectively reviewed the medical records of 177 patients with 1,500 tumors who underwent GKRS for brain metastases from malignant melanomas. This study was conducted by the Japanese Leksell Gamma Knife Society (JLGK1501). Results: Six and 12 months after GKRS, the cumulative incidences of local tumor recurrence were 9.2 and 13.8%. Intratumoral hemorrhage (p < 0.0001) and larger tumor volume (p = 0.001) in GKRS were associated with significantly poorer local control outcomes. The use of immune checkpoint inhibitors before GKRS was significantly associated with symptomatic adverse events (p = 0.037). The median overall survival time after the initial GKRS was 7.3 months. Lower Karnofsky performance status scores (p = 0.016), uncontrolled primary cancer (p < 0.0001), and multiple brain metastases (p = 0.014) significantly influenced unfavorable overall survival outcomes. The cumulative incidences of neurological death 6 and 12 months after GKRS were 9.7 and 17.4%, those of neurological deterioration were 14.2 and 19.6%, and those of new tumor appearance were 34.5 and 40.5%. Conclusions: The results of the present multicenter study suggest that GKRS is a relatively effective and safe modality for control of tumor progression in Japanese patients with brain metastases from malignant melanomas.
The Trajectories of the Number of Pain Sites and Their Associated Factors in Older Adults: Results from the Korean Longitudinal Study of Ageing
Authors: Lee Jiae , Jang Soong-Nang , Cho Sung-Il
Published: July 2018

Background: The aging of the population will result in an increase in demand for pain management. Pain adversely affects physical and mental functioning in older adults and accounts for a considerable proportion of all medical expenses. Objectives: This study was performed to investigate the patterns of changes in the trajectories of the number of pain sites in older adults and the factors that affect these patterns according to gender. Methods: Data were extracted for subjects that participated in the Korean Longitudinal Study of Ageing from 2006 to 2014. The study population consisted of 2,839 individuals (1,190 men and 1,649 women) ≥60 years old. A group-based trajectory model was used to determine the optimal number of subgroups and the trajectories of the number of pain sites according to gender. A multinomial regression analysis was conducted to identify factors that affect the probability of inclusion in each trajectory group. Results: The trajectories of the number of pain sites were consistent in both genders. Almost all women had one or more pain symptom, and a greater number of pain sites than men. Older age, longest-duration occupation requiring manual labor, lack of physical activity, depressive symptoms, and poor self-rated health were associated with a greater number of pain sites in both genders. A lower level of education, married status, and experience of injury were associated with the number of pain sites in men but not in women, while household income and chronic diseases were associated with the number of pain sites only in women. Conclusions: The pain status at the early stage is predictive of future pain. In this study, we identified gender differences in the trends of the number of pain sites and associated factors. Further comprehensive studies on pain intensity and duration are required.
Host MICA Polymorphism as a Potential Predictive Marker in Response to Chemotherapy for Colorectal Liver Metastases
Authors: Nishioka Yujiro , Shindoh Junichi , Inagaki Yoshinori , Gonoi Wataru , Mitsui Jun , Abe Hiroyuki , Yoshioka Ryuji , Yoshida Shuntaro  , Fukayama Masashi , Tsuji Shoji , Hashimoto Masaji , Hasegawa Kiyoshi , Kokudo Norihiro
Published: July 2018

Background: Understanding the genetic background of a tumor is important to better stratify patient prognosis and select optimal treatment. For colorectal liver metastases (CLM), however, clinically available biomarkers remain limited. Methods: After a comprehensive sequencing of 578 cancer-related genes in 10 patients exhibiting very good/poor responses to chemotherapy, the A5.1 variant of the MICA gene was selected as a potential biomarker for CLM. The clinical relevance of MICA A5.1 was then investigated in 58 patients who underwent CLM resection after chemotherapy. Results: The A5.1 variant was observed in 16 (27.6%) patients examined using direct DNA sequencing, and a very high concordance rate (56/58, 96.6%) for the MICA variant was confirmed between tumor tissues and normal liver parenchyma. A multivariate analysis of 38 patients with no history of treatment with anti-EGFR antibodies confirmed that MICA A5.1 was significantly correlated with an optimal CT morphologic response (OR 11.67; 95% CI 2.08–65.60; p = 0.005) and tended to be correlated with a tumor viability of < 20% after chemotherapy (OR 5.91; 95% CI 0.97–36.02; p = 0.054). MICA A5.1 was also associated with a decreased risk of progression after CLM resection. Conclusion: The MICA A5.1 polymorphism was associated with a better CT morphologic response to chemotherapy and a reduced risk of relapse after CLM resection. Given the high concordance rate in MICA variants between normal liver tissue and CLM, the genetic background of the host could be a new biomarker for CLM.
Applying Regional Citrate Anticoagulation in Continuous Renal Replacement Therapy for Acute Kidney Injury Patients with Acute Liver Dysfunction: a Retrospective Observational Study
Authors: Yu Ying , Peng Sheng , Cen Zhongran , Cai Jing , Wang Wei , Tang Ying , Du Meng , Liu Zhanguo , Chang Ping
Published: July 2018

Background/Aims: Continuous renal replacement therapy (CRRT) is a treatment for acute kidney injury (AKI) patients. It has become a controversy about whether patients with liver dysfunction should perform CRRT with regional citrate anticoagulation (RCA). Methods: This retrospective observational study enrolled 145 AKI patients (275 CRRT sessions) who received CRRT with RCA and had no history of chronic liver disease. Circuit survival time, blood pressure, trans-membrane pressure (TMP), acid-base and electrolyte status were recorded and analyzed. The severity of liver dysfunction was determined by total bilirubin (TBil) and international normalized ratio (INR), while the accumulation degree of citrates was quantified by total/ ionized calcium (tCa/iCa) raito. Results: Our results showed that there was no correlation of tCa/iCa ratio with TBil or INR. And tCa/iCa ratio was not related to the disturbances of pH, lactates, sodium, magnesium, blood pressure or TMP despite that high tCa/iCa ratios might be related to the decrease of circuit survival time. TBil did not correlate with the above indexes, except for lactates levels. INR did not correlate with the above indexes except for lactates levels and blood pressure. In addition, neither was TBil, INR, nor tCa/iCa ratio, related with fatal outcomes (22.76% of the patients). Conclusion: The present study demonstrated that, with proper monitoring and adjustment of citrates and calcium infusion, applying RCA in CRRT is reasonably safe for AKI patients with acute liver dysfunction, as long as circuit time stays below roughly 50 hours.
Nrf2 Pathway in Age-Related Neurological Disorders: Insights into MicroRNAs
Authors: Paladino Simona , Conte Andrea , Caggiano Rocco , Pierantoni Giovanna Maria , Faraonio Raffaella
Published: July 2018

A general hallmark of neurological diseases is the loss of redox homeostasis that triggers oxidative damages to biomolecules compromising neuronal function. Under physiological conditions the steady-state concentrations of reactive oxygen species (ROS) and reactive nitrogen species (RNS) are finely regulated for proper cellular functions. Reduced surveillance of endogenous antioxidant defenses and/or increased ROS/RNS production leads to oxidative stress with consequent alteration of physiological processes. Neuronal cells are particularly susceptible to ROS/RNS due to their biochemical composition. Overwhelming evidences indicate that nuclear factor (erythroid-derived 2)-like 2 (Nrf2)-linked pathways are involved in protective mechanisms against oxidative stress by regulating antioxidant and phase II detoxifying genes. As such, Nrf2 deregulation has been linked to both aging and pathogenesis of many human chronic diseases, including neurodegenerative ones such as Parkinson’s disease, Alzheimer’s disease and amyotrophic lateral sclerosis. Nrf2 activity is tightly regulated by a fine balance between positive and negative modulators. A better understanding of the regulatory mechanisms underlying Nrf2 activity could help to develop novel therapeutic interventions to prevent, slow down or possibly reverse various pathological states. To this end, microRNAs (miRs) are attractive candidates because they are linked to intracellular redox status being regulated and, post-transcriptionally, regulating key components of ROS/RNS pathways, including Nrf2.
Circ-ANAPC7 is Upregulated in Acute Myeloid Leukemia and Appears to Target the MiR-181 Family
Authors: Chen Hongli , Liu Tian , Liu Jing , Feng Yuandong , Wang Baiyan , Wang Jianli , Bai Ju , Zhao Wanhong , Shen Ying , Wang Xiaman , Yang Juan , Ji Yuqiang , He Aili , Yang Yun
Published: July 2018

Background/Aims: Circular RNAs (circRNAs) are a family of novel non-coding RNAs associated with various diseases, especially cancer. Recent studies have demonstrated that circRNAs participate in pathogenesis mainly by acting as microRNA (miRNA) sponges. The expression profile of circRNAs in acute myeloid leukemia (AML) has rarely been reported. Methods: Profiles of circRNAs were analyzed using an Arraystar human circRNA microarray with 5 bone marrow samples from patients with newly diagnosed AML and 5 from patients with iron-deficiency anemia. Quantitative reverse transcription PCR was used to validate the expression pattern of circRNAs. Furthermore, circRNA–miRNA network, Gene Ontology (GO), and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were applied. Results: CircRNA microarray analysis revealed that 698 circRNAs were differentially expressed in AML patients, with 282 circRNAs found to be upregulated and 416 to be downregulated. Quantitative reverse transcription PCR showed that circ-ANAPC7 was significantly upregulated in AML. Bioinformatics analysis predicted that circ-ANAPC7 acts as a sponge for the miR-181 family, KEGG analysis revealed that it is associated with cancer-related pathways, and GO analysis indicated that most of its target genes are involved in biological processes. Conclusions: These findings show that circ-ANAPC7 is a promising biomarker for AML, and that it might participate in AML pathogenesis by acting as a sponge for the miR-181 family.
Focus Association by Movement: Evidence from Tanglewood
Authors: Erlewine Michael Yoshitaka , Kotek Hadas
Published: July 2018

We argue for the existence of covert focus movement in English focus association with only. Our evidence comes from Tanglewood configurations of the form in Kratzer 1991 . We show that Tanglewood configurations are sensitive to syntactic islands, contrary to Kratzer’s claims and predictions. We propose that Tanglewood configurations always involve covert movement of the focused constituent—possibly with covert pied-piping—to bind a bound variable in the ellipsis site. This availability of covert pied-piping explains examples such as Kratzer’s where the Tanglewood construction appears to be island-insensitive. We show that covert focus movement is long-distance and not simply Quantifier Raising. Kratzer’s proposal that ellipsis enforces the identity of focus indices and several other previous approaches are shown to overgenerate Tanglewood readings.
Attraction at a Distance: Ā-Movement and Case
Authors: Branan Kenyon
Published: July 2018

Some languages allow extraction of possessors from only a subset of nominals. I show that a juxtaposition of two proposals about Case and Agree (made by Rackowski and Richards (2005) and Bobaljik (2008) ) correctly predicts these crosslinguistic restrictions on possessor extraction.
A New Megophrys Kuhl and Van Hasselt (Amphibia: Megophryidae) from southwestern Sumatra, Indonesia
Authors: MUNIR MISBAHUL , HAMIDY AMIR , FARAJALLAH ACHMAD , SMITH ERIC N.
Published: July 2018

Megophrys lancip sp. nov., from the Bukit Barisan mountain range of southwestern Sumatra, Indonesia, is described on the basis of molecular and morphological evidence. The new species is distinguished from its congeners in Sumatra, Java, Borneo, and the Philippines by having a medium-sized body, snout with an extremely pointed rostral appendage, a medium-sized triangular eyelid appendage, a dorsolateral fold extending from just behind the eye to the groin, vomerine teeth, vocal slits, nuptial pads on the dorsomedial surface of the first and second fingers in males, and in lacking a Y, X, or H-shaped fold on the dorsum. Morphologically, the new species is most similar to M. montana, but it has a longer rostral appendage, shorter eyelid appendages, and less developed toe webbing. We also evaluate the taxonomic status of M. parallela and comment on the occurrence of M. aceras in Sumatra.
Lyrodus mersinensis sp. nov. (Bivalvia: Teredinidae) another cryptic species in the Lyrodus pedicellatus (Quatrefages, 1849) complex
Authors: BORGES LUÍSA M. S. , MERCKELBACH LUCAS M.
Published: July 2018

New data from barcode index numbers (BINs) and 28S rRNA gene sequences confirm a cryptic species pair in Lyrodus pedicellatus from the eastern Mediterranean and European Atlantic coasts. Therefore, it is paramount to associate the new species to a scientific name for a reliable reference system of biological information. To this end, we describe Lyrodus mersinensis sp. nov., another cryptic species in the L. pedicellatus complex, and redescribe the `true´ L. pedicellatus. Both the description and redescription are based on molecular diagnostic characters obtained from sequences of the mitochondrial cytochrome c oxidase subunit I (COI) and nuclear 28S rRNA genes. The 18S rRNA gene sequences did not yield diagnostic characters to distinguish these species. A morphological diagnosis of pedicellatus-like Lyrodus species is also provided.
Stenope, a new euphorine genus from the Philippines (Hymenoptera: Braconidae)
Authors: VAN ACHTERBERG CORNELIS , ANG YUCHEN , RESHCHIKOV ALEXEY , YUE QI
Published: July 2018

A new genus (Stenope gen. nov.; type species: Allophrys falcatus) is described for the aberrant type species from the Philippines accidently described as an ichneumonid species.
Surface-Based Microwave Humidity Retrievals over the Equatorial Indian Ocean: Applications and Challenges
Authors: Zhang Jianhao , Zuidema Paquita , Turner David D. , Cadeddu Maria P.
Published: July 2018

The interactions between equatorial convection and humidity as a function of height, at a range of time scales, remain an important research frontier. The ability of surface-based microwave radiometry to contribute to such research is assessed using retrievals of the vertical structure of atmospheric humidity above the equatorial Indian Ocean, developed as part of the Dynamics of Madden–Julian Oscillation field campaign. The optimally estimated humidity retrievals are based on radiances at five frequencies spanning 20–30 GHz and are constrained by radiometer-derived water vapor paths that compare well to radiosonde values except in highly convective conditions. The moisture retrievals possess a robust 2 degrees of freedom, allowing the atmosphere to be treated as two independent layers. A mean bias of 1 g kg−1 contains a vertical structure that is removed in the assessments. The retrieved moisture profiles are able to capture humidity variability within two layer averages at intraseasonal, synoptic, and daily time scales. The retrieved humidity profiles at hourly scales are qualitatively correct under synoptically suppressed conditions but with an exaggerated vertical bimodality. The retrievals do not match radiosonde profiles within most of the day prior to/after convection. This analysis serves to better delineate applications for radiometers. Radiometers can usefully augment more expensive radiosonde networks for longer-term monitoring given careful cross-instrument calibration. At shorter time scales, a synergism with additional instruments can likely increase the realism of the retrievals.
Simulated Kelvin–Helmholtz Waves over Terrain and Their Microphysical Implications
Authors: Conrick Robert , Mass Clifford F. , Zhong Qi
Published: July 2018

Two Kelvin–Helmholtz (KH) wave events over western Washington State were simulated and evaluated using observations from the Olympic Mountains Experiment (OLYMPEX) field campaign. The events, 12 and 17 December 2015, were simulated realistically by the WRF-ARW Model, duplicating the mesoscale environment, location, and structure of embedded KH waves, which had observed wavelengths of approximately 5 km. In simulations of both cases, waves developed from instability within an intense shear layer, caused by low-level easterly flow surmounted by westerly winds aloft. The low-level easterlies resulted from blocking by the Olympic Mountains in the 12 December case, while in the 17 December event, the easterly flow was produced by the synoptic environment. Simulated microphysics were evaluated for both cases using OLYMPEX observations. When the KH waves were within the melting level, simulated microphysical fields, such as hydrometeor mixing ratios, evinced considerable oscillatory behavior. In contrast, when waves were located below the melting level, the microphysical response was attenuated. Turning off the model’s microphysics scheme and latent heating resulted in weakened KH wave activity, while removing the Olympic Mountains eliminated KH waves in the 12 December event but not the 17 December case. Finally, the impact of several microphysics parameterizations on KH activity was evaluated for both events.
Downscaling of ERA-Interim Temperature in the Contiguous United States and Its Implications for Rain–Snow Partitioning
Authors: Tang Guoqiang , Behrangi Ali , Ma Ziqiang , Long Di , Hong Yang
Published: July 2018

Precipitation phase has an important influence on hydrological processes. The Integrated Multisatellite Retrievals for Global Precipitation Measurement (IMERG) uses temperature data from reanalysis products to implement rain–snow classification. However, the coarse resolution of reanalysis data may not reveal the spatiotemporal variabilities of temperature, necessitating appropriate downscaling methods. This study compares the performance of eight air temperature Ta downscaling methods in the contiguous United States and six mountain ranges using temperature from the Parameter-Elevation Regressions on Independent Slopes Model (PRISM) as the benchmark. ERA-Interim Ta is downscaled from the original 0.75° to 0.1°. The results suggest that the two purely statistical downscaling methods [nearest neighbor (NN) and bilinear interpolation (BI)] show similar performance with each other. The five downscaling methods based on the free-air temperature lapse rate (TLR), which is calculated using temperature and geopotential heights at different pressure levels, notably improves the accuracy of Ta. The improvement is particularly obvious in mountainous regions. We further calculated wet-bulb temperature Tw, for rain–snow classification, using Ta and dewpoint temperature from ERA-Interim and PRISM. TLR-based downscaling methods result in more accurate Tw compared to NN and BI in the western United States, whereas the improvement is limited in the eastern United States. Rain–snow partitioning is conducted using a critical threshold of Tw with Snow Data Assimilation System (SNODAS) snowfall data serving as the benchmark. ERA-Interim-based Tw using TLR downscaling methods is better than that using NN/BI and IMERG precipitation phase. In conclusion, TLR-based downscaling methods show promising prospects in acquiring high-quality Ta and Tw with high resolution and improving rain–snow partitioning, particularly in mountainous regions.
How procedural experiences shape citizens' perceptions of and orientations toward legal institutions: evidence from a household survey in Bangladesh
Authors: Young Kim A. , Hassan Shahidul
Published: July 2018

Integrating theories and research on procedural justice and policy design, this article provides insight about how institutional context and experiences shape citizens' perceptions about procedural fairness and trust and confidence in legal institutions. We address this question with data collected through a household survey in Bangladesh. The analysis shows that citizens' experiences with legal institutions vary across four separate justice venues. We find that openness of decision processes, perceived competency of the decision maker, and whether citizens needed to pay a bribe to obtain legal service affect procedural fairness perceptions. Moreover, the results show that perceptions of procedural fairness relate positively with citizens’ willingness to return to that justice institution but not with complying with authorities. Implications for research on effective governance are discussed.
X-ray micro-computed tomography analysis of impact damage morphology in composite sandwich structures due to cold temperature arctic condition
Authors: Khan MH , Elamin Mohammed , Li Bing , Tan KT
Published: July 2018

In this study, X-ray micro-computed tomography is employed to characterize the impact damage mechanisms in foam core sandwiched composites, paying particular attention to the influence of extreme low temperature effects. Investigation on impact response reveals that more energy absorption with lower impact damage force occurs at lower temperature. Results evidently show that test temperature has a significant influence on the impact damage behavior. Post-mortem inspection portrays clear relationships between damages in both foam core and carbon fiber reinforced polymer facesheets, as well as exposed test temperature. Specimens impacted at extreme low temperature (−70℃) exhibit less strength, and higher susceptibility to damage, verified by severer penetration of the impactor. Micro-computed tomography is exploited to examine cross-sectional views of the impacted specimens, showing detailed damage mechanisms of the carbon fiber-reinforced polymer facesheets and the foam core, thereby evidently revealing multiple complex impact damage modes such as fiber breakage, delamination, core shearing and crushing, facesheet-core debonding, which are all strongly influenced by arctic low temperature. The findings of this work will lead to improved design for advanced composite structures with enhanced impact resistance and damage tolerance in extreme cold environment particularly in the arctic region.
Tensile behaviour of open hole flax/epoxy composites: Influence of fibre lay-up and drilling parameters
Authors: Abdul Nasir Aiman Akmal , Azmi Azwan Iskandar , Chye Lih Tan , Mohd. Khalil Ahmad Nabil , Kyeun Kim Nam
Published: July 2018

The present study reports on a systematic experimental test that evaluates the effect of drilling parameters on the open-hole tensile properties of flax fibre epoxy reinforced laminates. Additionally, three lay-up configurations of the flax fibre, namely, [0°/90°]6, [0°]6 and [±45°]6, were investigated and compared. The results demonstrated that the [0°]6 lay-up configuration was superior in terms of mechanical or tensile strength retention of the composites given an 8 mm hole. Conversely, damage due to delamination was not significant due to the changes in feed rate and cutting speed. This suggests that the drilling parameters were less sensitive towards the mechanical strength of the flax fibre composites with the drilled hole. The less severity of the delamination can be attributed to the high fracture toughness (high mode I critical strain energy release) of the flax fibre when compared with that of the synthetic fibre reinforced composite counterparts. The use of the step drill bit design also potentially contributes to the reduced severity of the delamination damage to the flax fibre composites.
Opinion formation with time-varying bounded confidence related to the node degree
Authors: Yunhong Zhang , Qipeng Liu , Lin Ding , Siying Zhang
Published: July 2018

People like to communicate with others who have similar opinions in daily life. “Open” individuals are willing to accept peers’ opinions, whereas “conservative” individuals are more closed to others’ opinions. Based on this reality, an opinion dynamic model is proposed with a time-varying trust threshold related to the node degree, which refers to the number of individuals that can be communicated directly. Similar opinions within the trust thresholds at the beginning will eventually form a consensus opinion. Individuals who have common neighbors converge to consensus faster than ones who have no common neighbors. The network size impacts the convergent speed of the opinion cluster and the trust threshold cluster. Individuals in small groups are more stressed than in large ones when they try to insist their opinions. A group with half of the individuals categorized as doubting and the other half categorized as trusting exhibits consistent confidence but experiences difficulty in reaching a consensus: “harmony but difference” may be a criterion for unifying a group.
Preparing Antiracist School Leaders in a School Choice Context
Authors: Diem Sarah , Carpenter Bradley W. , Lewis-Durham Tiffanie
Published: July 2018

Aspiring school leaders must be equipped with skill sets to facilitate the critical examination of district policies that reproduce inequities. Policies such as school choice, which have racial and socioeconomic implications for educational opportunity, require leaders to operate from a social justice identity while seeking to enhance their sense of efficacy in antiracist leadership behaviors. In this study, we examined how graduate students in a leadership preparation program developed their racially aware identities while professionally embedded in a district that utilizes school choice policies and practices. Our findings illustrate the intentional work necessary to develop school leaders with antiracist identities.
SOLD: A node-Splitting algorithm for R-tree based on Objects’ Locations Distribution
Authors: Al-Nsour Esam , Sleit Azzam , Alshraideh Mohammad
Published: July 2018

Spatial data indexing methods are of extreme importance as they massively build up as a result of the explosive growth in capturing data with spatial features. No matter how much the data size is, eventually it will reside on disk pages. Disk pages have to be properly indexed to preserve spatial properties of objects, optimise disk space usage and improve objects’ retrieval performance. One of the most popular spatial data indexes is the R-tree which is a height balanced tree data structure, where leaf nodes resemble disk pages and contain pointers to objects’ locations. A single tree node can host up to a maximum number of objects, where any more insertion makes it an overflown node and it has to be split. Better splits lead to better index performance and more utilisation of disk space. In this work, we introduce a new way of finding the most proper split for an overflown node in the R-tree index. The proposed work scans – in a linear cost – the overflown node’s objects once to identify the distribution of objects’ locations (minimum bounding rectangles (MBRs)) in relative to its node’s bounding rectangle (node’s MBR). It uses objects’ locations to calculate – for each main axis – the split quality factors: expected overlap between resulting nodes, objects distribution evenness among resulting nodes and the perimeter of resulting nodes. The axis with better combined quality factors values is selected as the split axis. The Splitting based on Objects’ Locations Distribution (SOLD) algorithm was implemented and tested against two other splitting algorithms, experiments using synthetic and real data files showed good results and it outperformed both algorithms in index creation tests and data retrieval tests.
Ultrasound Supplemented by Sialendoscopy: Diagnostic Value in Sialolithiasis
Authors: Goncalves Miguel , Mantsopoulos Konstantinos , Schapher Mirco , Iro Heinrich , Koch Michael
Published: July 2018

Objective

To assess the value of ultrasound, if indicated, supplemented by sialendoscopy, in the diagnosis of sialolithiasis.

Study Design

Retrospective study.

Setting

Referring center for salivary gland diseases.

Subjects and Methods

All patients who presented with a suspected diagnosis of obstructive sialopathy between January 2011 and April 2017 and had not undergone any treatment were retrospectively evaluated. A total of 2052 patients and 2277 glands were included in the study. Ultrasound examinations were carried out initially and followed by sialendoscopy in all cases. Direct demonstration of sialothiasis by sialendoscopy, transoral ductal surgery, and discharge of concrements/observation of fragments during sialendoscopy after extracorporeal shock‐wave lithotripsy were regarded as definitive evidence of sialolithiasis.

Results

Ultrasound had an accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 94.77%, 94.91%, 94.57%, 96.14%, and 92.89%, respectively, for the diagnosis of sialolithiasis. All false‐positive findings were correctly diagnosed, and in all false‐negative findings, stones/fragments were visualized by sialendoscopy. Over 95% of the false‐negative findings in major salivary glands (64/67) had visible ductal dilation in sonography, and in 73.1%, the stones not detected on ultrasound were located in the distal part of the duct, which is easily accessible with the sialendoscope.

Conclusion

This study shows that sialolithiasis can be diagnosed using ultrasonography with a high degree of certainty. If supplemented by sialendoscopy, the correct diagnosis could be established in virtually all cases of sialolithiasis. Ultrasound supplemented by sialendoscopy has the potential to serve as an alternative diagnostic standard in the future.
Tinnitus: A Stepchild in Our Specialty
Authors: Lee K. J. , Liu Keyu
Published: July 2018

Many patients are not satisfied with their doctor's answer when they complain about tinnitus. The proposed classification can be used to communicate with patients as well as guide future research. Type A itemizes the treatable causes of tinnitus. Type B itemizes tinnitus with a lack of medical explanation. Type C tinnitus is caused by diagnosable and treatable conditions, as listed in tinnitus type A, but the tinnitus persists after the successful treatment of the other symptoms.
Spontaneous Labyrinthine Hemorrhage: A Case Series
Authors: Vivas Esther X. , Panella Nicholas J. , Baugnon Kristen L.
Published: July 2018

Objectives

To describe patient characteristics, audiometric outcomes, and magnetic resonance imaging (MRI) signal patterns in patients with suspected labyrinthine hemorrhage.

Study Design

Retrospective review.

Setting

Tertiary medical center.

Subjects and Methods

Radiology database was queried for terms related to labyrinth hemorrhage or labyrinthitis and then selected for patients in which labyrinthine hemorrhage was suspected in the report. Eleven patients were identified and all treated at our institution. Blinded assessment of temporal bone MRI by 2 experienced neuroradiologists was performed and interrater reliability assessed. Patient demographics, medical comorbidities, and audiometric outcomes are described.

Results

Of the 11 patients identified, the median patient age was 60 years; 7 were female and 4 male. Ten of 11 patients presented with unilateral sudden sensorineural hearing loss (SNHL), and 8 of 11 had associated vertigo. One patient experienced vertigo without hearing loss. Of those presenting with sudden SNHL, 82% were left with nonserviceable American Academy of Otolaryngology—Head and Neck Surgery class D hearing. Interrater reliability for detecting T1 signal abnormalities was moderate but very good for detecting fluid attenuation inversion recovery (FLAIR) signal abnormalities. Most patients had existing hypertension. Average follow‐up was 13.3 months.

Conclusion

We present the largest cohort of patients with radiographic diagnosis of labyrinthine hemorrhage using T1 and FLAIR signal abnormalities on MRI. Most patients presented with a profound unilateral sudden SNHL that did not recover. Our findings are consistent with prior reports that abnormal FLAIR signal on MRI is a reliable marker for detecting inner ear injury and can potentially be used as a marker for poor prognosis.
Amiloride modulation of carbon dioxide hypersensitivity and thermal nociceptive hypersensitivity induced by interference with early maternal environment
Authors: Battaglia Marco , Rossignol Orlane , Bachand Karine , D’Amato Francesca R , Koninck Yves De
Published: July 2018

Background:

Early life adversities are risk factors for anxiety disorders and for pain syndromes, which are, in turn, highly comorbid with anxiety disorders. Repeated cross-fostering mouse pups to adoptive lactating females induces epigenetic modification and heightened mRNA-expression of the acid-sensing-ion-channel-1 gene, altered nociception, and hypersensitivity to 6% carbon dioxide air mixtures, a trait marker of specific human anxiety disorders such as, most clearly and prominently, panic disorder.

Aims:

We hypothesized that the acid-sensing ion channel inhibitor amiloride can modulate repeated cross-fostering animals’ exaggerated responses to carbon dioxide and nociceptive thermal stimulation.

Methods:

Respiratory carbon dioxide sensitivity was assessed by plethysmography during 6% carbon dioxide air mixture challenges, and nociception was assessed by latency of paw withdrawal to thermal stimulation, in repeated cross-fostering and control animals. To circumvent the blood-brain barrier, prior to testing, amiloride was nebulized in a plethysmograph. Data were analyzed by general linear models.

Results:

Analyses of tidal volume responses to 6% carbon dioxide of animals pre-treated with nebulized amiloride/saline in a randomized crossover design showed significant modulatory effect of amiloride, and amiloride×repeated cross-fostering interaction. In contrast, repeated cross-fostering animals’ responses to 6% carbon dioxide after intraperitoneal amiloride, saline, or no treatment, were no different. Analyses of responses to thermal stimuli showed a significant modulatory effect of nebulized amiloride, and repeated cross-fostering×amiloride interaction.

Conclusions:

Single-dose nebulized amiloride decreased repeated cross-fostering animals’ carbon dioxide sensitivity and nociception indices to levels that were no different from those of control animals. Inasmuch as these results pertain to human anxiety and/or pain hypersensitivity, our findings provide a rationale for studying inhaled amiloride in some anxiety disorders and/or pain syndromes.
Geographic Access to International Board-Certified Lactation Consultants in Pennsylvania
Authors: Ray Kristin N. , Demirci Jill R. , Uscher-Pines Lori , Bogen Debra L.
Published: July 2018

Background:

Availability of professional lactation support has been associated with increased breastfeeding rates; however, data about access to international board-certified lactation consultants are limited.

Research Aims:

The aims were (a) to assess geographic access to international board-certified lactation consultants in Pennsylvania, (b) to compare access in rural/urban counties, and (c) to compare access by county-level breastfeeding initiation rates.

Methods:

Using geographic information systems methodology and a cross-sectional observational design, we calculated the proportion of young children living within 15, 30, and 60 miles of international board-certified lactation consultants in Pennsylvania. We calculated these proportions for all children in Pennsylvania, for children in urban and rural counties, and for children in counties with low, medium, and high breastfeeding initiation rates. Comparisons were done to answer the research aims.

Results:

Over 90% of young children live within 30 miles of an international board-certified lactation consultant. Compared to children in urban counties, fewer children in rural counties live within 15 and 30 miles of these providers. In counties with high breastfeeding initiation rates, a larger percentage of children live within 15 miles of an international board-certified lactation consultant than in counties with low breastfeeding initiation rates.

Conclusion:

While most Pennsylvania children live in proximity of an international board-certified lactation consultant, this was true for a lower percentage of children in rural counties and in counties with lower breastfeeding rates.
Maleated soybean oil as coupling agent in recycled polypropylene/wood flour composites: Mechanical, thermal, and morphological properties
Authors: Poletto Matheus
Published: July 2018

In this study, composites with interesting mechanical and thermal properties were prepared using chemically modified vegetable oil as coupling agent in wood-fibers-reinforced recycled polypropylene. Soybean oil was reacted with maleic anhydride to produce maleated soybean oil (MASO). The mechanical, thermal, and morphological properties of the composite were evaluated. The usage of MASO as a coupling agent clearly improved the interfacial adhesion between wood fibers and the polypropylene matrix and increased the mechanical and thermal properties evaluated. Based on the obtained results, it is concluded that MASO can act as an alternative source of coupling agent dispensing with the addition of petroleum-based compatibilizers to improve the mechanical and thermal properties of composites reinforced with natural fibers.
A Bayesian model to estimate the cutoff and the clinical utility of a biomarker assay
Authors: Vradi Eleni , Jaki Thomas , Vonk Richardus , Brannath Werner
Published: July 2018

To enable targeted therapies and enhance medical decision-making, biomarkers are increasingly used as screening and diagnostic tests. When using quantitative biomarkers for classification purposes, this often implies that an appropriate cutoff for the biomarker has to be determined and its clinical utility must be assessed. In the context of drug development, it is of interest how the probability of response changes with increasing values of the biomarker. Unlike sensitivity and specificity, predictive values are functions of the accuracy of the test, depend on the prevalence of the disease and therefore are a useful tool in this setting. In this paper, we propose a Bayesian method to not only estimate the cutoff value using the negative and positive predictive values, but also estimate the uncertainty around this estimate. Using Bayesian inference allows us to incorporate prior information, and obtain posterior estimates and credible intervals for the cut-off and associated predictive values. The performance of the Bayesian approach is compared with alternative methods via simulation studies of bias, interval coverage and width and illustrations on real data with binary and time-to-event outcomes are provided.
Epstein-Barr Virus–Positive CD20- and CD45-Negative Diffuse Large B-Cell Lymphoma: A Diagnostic Challenge
Authors: Starr Amy , Kwon Dong Hyang , Kallakury Bhaskar
Published: July 2018

Diffuse large B-cell lymphoma (DLBCL) is characterized by medium- to large-sized neoplastic cells that express a wide range of B-cell markers including CD19, CD20, CD22, and CD79a. Also, as this is a hematopoietic malignancy, there is expression of the leukocyte common antigen CD45. Lack of CD20 expression occurs in a specific rare heterogeneous subgroup of DLBCL including primary effusion lymphoma, plasmablastic lymphoma, ALK-positive large B-cell lymphoma, and large B-cell lymphoma arising in HHV8+ multicentric Castleman disease. In this article, we report a rare case of CD20- and CD45-negative Epstein-Barr virus–positive DLBCL in which the entities listed above were ruled out, thereby posing a significant diagnostic challenge. Arriving at the correct diagnosis of Epstein-Barr virus–positive DLBCL was supported by immunoreactivity for the B-cell transcription factor Oct-2 and the pan-B cell marker CD79a.
Laparoscopic ligation of Type II endoleaks following endovascular aneurysm repair: A systematic review
Authors: Wee Ian , Marjot Thomas , Patel Kirtan , Bhrugubanda Vamsee , MTL Choong Andrew
Published: July 2018

Introduction

The clinical significance of Type II endoleak remains contentious; the strategies used for its management have continued to expand. We systematically review the literature and comprehensively appraise the effectiveness of laparoscopic intervention in the management of this common complication.

Methods

A systematic search was performed in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines on MEDLINE, EMBASE and Cochrane Library for relevant articles reporting laparoscopic surgery of Type II endoleak post-endovascular aortic repair.

Results

Thirteen studies representing 40 patients were investigated. Mean age was 72.7 years, and proportion of males was 90.0%. All patients were American Society of Anesthesiologists grade II and above and underwent standard infrarenal endovascular aneurysm repair. The mean duration of operation was 130.2 min, with a mean blood loss across of 173.8 mL. The overall technical success rate was 90% (27/30). Two patients required reoperation within 24 h, with further lumbar ligations that were successful. One other patient required conversion to open surgery due to significant bleeding at the dorsal aorta. The perioperative and 30-day mortality rate was 2.5% (1/40). The mean length of hospital stay was 3.7 days (range 1 to 10 days). The mean length of follow-up was 36.7 months (range 3 to 103.2 months), where the rate of recurrence was 22.5% (9/40).

Conclusions

Laparoscopic ligation of feeding vessels causing Type II endoleak is potentially an alternative treatment after failed standard endovascular embolization, particularly in select centres with necessary resources and capabilities.
The secondary prevention of venous thromboembolism: Towards an individual therapeutic strategy
Authors: Elmi Giovanna , Pizzini Attilia M , Silingardi Mauro
Published: July 2018

After the anticoagulant withdrawal, a substantial proportion of patients with venous thromboembolism will develop recurrent events. Whether to consider an extended treatment depends on the risk of recurrence and bleeding risk. The assessment of the individual risk profile remains a difficult task. Several basal and post-basal factors modulate the risk of recurrence and may help clinicians to select patients who can benefit from the extended therapy. During the year 2017, new evidence regarding the post-basal factors was provided by the Morgagni and Scope studies. Another interesting novelty was the VTE-BLEED score, the first bleeding risk score that obtained the external validation in venous thromboembolism setting. In secondary prevention, the use of direct oral anticoagulants is growing instead of vitamin K antagonist. Even at lower doses, direct oral anticoagulants showed to be effective and safe, to reduce all-cause mortality and seemed to be superior to placebo for the composite outcome of fatal bleeding and fatal recurrence. After the recently published Einstein-Choice trial, the role of aspirin has become truly marginal as rivaroxaban 10 mg showed a bleeding risk similar to aspirin 100 mg but a greater effectiveness reducing the relative risk of recurrence by about 70%. Another option for secondary prevention could be sulodexide, with a lower protective effect than direct oral anticoagulants but an interesting safety profile. In conclusion, in our opinion, an individual strategy taking into account the risk of recurrence, bleeding risk, therapeutic options and patient preferences is the most appropriate approach to secondary prevention of venous thromboembolism.