bluuebunny/crossref_metadata_2025 huggingface dataset:
370 LAPAROSCOPIC HIATAL HERNIA REPAIR: INSIGHTS FROM A HIGH-VOLUME CENTER
Authors: Giulini L , Razia D , Mittal S
Published: September 2020

When a hiatal hernia (HH) becomes symptomatic, surgical repair is indicated. The surgical procedure can be safely carried out laparoscopically with good results. However, it is unclear whether the size of the hernia affects perioperative outcomes. The aim of this study was to assess whether laparoscopic repair of large hiatal hernias (L-HH) has comparable results to laparoscopic repair of small hernias (S-HH).

Methods

After approval from the Institutional Review Board, a prospectively maintained database was reviewed for data on patients who underwent primary laparoscopic HH repair at our center between August 2016 and December 2019. All procedures were performed by a single surgeon (SKM). HHs were defined as “large” when at least 50% of the stomach was herniated through the hiatus. Data on perioperative results and mid-term follow-up were analyzed. The Clavien-Dindo (CD) classification was used to define complications.

Results

Of 170 identified patients, 55 had L-HH; 115 had S-HH. Mean ages were 72 ± 10 for L-HH and 61 ± 11.3 years for S-HH (p < 0.001). Median operative time was 95 (IQR, 80–110) and 75 minutes (IQR, 65–90) for L-HH and S-HH, respectively (p < 0.001). L-HH patients had longer hospital stays (median 2 vs 1 days, IQR 1–2 for both; p = 0.001) and more complications (12/55 [21.8%] vs 4/115 [3.5%]; p < 0.001) than S-HH patients. Two L-HH patients had CD grades IIIb and IVa. At follow-up (20.9 ± 8.7 months), gastroesophageal reflux disease quality of life scores were comparable between groups (6.4 ± 11.7 vs 5.2 ± 0; p = 0.9).

Conclusion

Laparoscopic HH repair is safe and feasible; however, is more technically challenging and is associated with longer operative time, longer hospital stay, and increased morbidity when performed as treatment for L-HH (ie, at least 50% of the stomach herniated through the hiatus). Nonetheless, good quality of life outcomes can be achieved at mid-term follow-up in both patients with S-HH and patients with L-HH who undergo treatment by an experienced surgeon.
386 LAPAROSCOPIC HELLERS MYOTOMY AND ANGLE OF HIS ACCENTUATION FOR ACHALASIA CARDIA: 10 YEARS EXPERIENCE FROM A SINGLE SURGICAL CENTRE.
Authors: Parshad R , Singla V , Suhani S , Bhattacharjee H , Makharia G , Sharma R
Published: September 2020

Achalasia is a rare disease with Laparoscopic Hellers cardio-myotomy (LHCM) being the gold standard surgical modality. An antireflux procedure is required along with myotomy to decrease the chances of reflux postoperatively. We have performed Angle of His Accentuation (AOH) as an anti-reflux procedure in 126 patients who underwent LHCM since 2010. This study presents the symptomatic and objective outcomes of LHCM with AOH.

Methods

Review of prospectively collected data of patients with Achalasia cardia undergoing LHCM with AOH from 2010–2019. Subjective symptoms were scored for dysphagia, heartburn, regurgitation and quality of life using scoring systems mentioned in table 1 and Achalasia specific health related Quality of life questionnaire (ASHRQoL). Objective tests included Timed Barium swallow, Endoscopy and high-resolution manometry. Patients were evaluated in pre and postoperative period at regular intervals. Success was defined as follows: Eckardt score of ≤3, Dysphagia score of 0/1, Regurgitation and heartburn score of 0, >50% clearance on timed barium swallow, IRP <15 and absence of esophagitis.

Results

126 patients were operated during the study period with no mortality or conversion. Mean age was 33.5(years), symptom duration 49.8(months), 31 had preoperative dilatation. The mean operative time was 131 (minutes). Subjective outcome was available in all patients & objective data in 66. At median follow of 31 months (IQR 15–59) outcomes significantly improved (Table 1) with 93% having dysphagia relief. 14 (11%) had new onset heartburn; 6(4.7%) needed regular proton pump inhibitors. ASHRQoL improved significantly (59.51 to 19.57). Pre&post-operative IRP, Timed Barium and endoscopy available in 66,39 and 62 patients improved significantly. 6(9.6%) patients had endoscopic evidence of esophagitis (LA-A 3, B/C 3).

Conclusion

Laparoscopic Heller myotomy with Angle of His accentuation is safe simple and effective procedure for Achalasia cardia. It provides significant relief of symptoms, improvement in quality of life and improvement in objective parameters. Post- operative heartburn and esophagitis is acceptable. We recommend Angle of His accentuation as an adjunct to Laparoscopic Heller myotomy.
387 LAPAROSCOPIC REDO HELLER’S MYOTOMY FOR ACHALASIA FOLLOWING WORSENING OF SYMPTOMS DUE TO AN INADEQUATE MYOTOMY AND INAPPROPRIATELY CHOSEN ANTIREFLUX PROCEDURE.
Authors: Parshad R , Verma E , Sharma R , Makharia G
Published: September 2020

This patient underwent Laparoscopic heller's cardiomyotomy and Nissen fundoplication for Achalasia cardia at another institute. Following surgery his dysphagia worsened. Dysphagia persisted despite balloon dilatation. Patient was evaluated at our institute with Barium swallow and CECT thorax which showed dilated oesophagus with tight wrap. Patient was planned for laparoscopic re exploration. At surgery he had a Nissen wrap and inadequate extension of myotomy across the GE junction.

Methods

The video describes the procedure of laparoscopic dismantling of the wrap with extension of Heller myotomy and a Toupet Fundoplication.

Results

Patient had an uneventful recovery and had significant improvement in dysphagia at a follow up of 7 months.

Conclusion

Nissen Fundoplication is not a good choice of antireflux procedure in achalasia cardia patients following Heller Myotomy and can contribute to dysphagia in the post operative period. Extension of myotomy across the GE junction is critical to the success of Heller myotomy. Re-do surgery is difficult but can be be accomplished through approach in experienced hands.

Video

https://drive.google.com/file/d/1dhs-PlUm-ahDGF63VxxM0htB0dRiAGYJ/view?usp=sharing
388 TREATMENT OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY (TENTACLE—ESOPHAGUS) STUDY: FACTORS ASSOCIATED WITH ANASTOMOTIC LEAKAGE SEVERITY
Authors: Ubels S , Verstegen M , Bouwense S , Hannink G , Siersema P , Klarenbeek B , van Workum F , Rosman C
Published: September 2020

Anastomotic leakage is a common and severe complication after esophagectomy. It is largely unknown which characteristics contribute to leakage severity. We aimed to investigate which factors are associated with leakage severity and to create an anastomotic leakage severity classification.

Methods

The TENTACLE—Esophagus is a multinational retrospective cohort study in which patients with anastomotic leakage after esophagectomy in the period 2011–2019 were included. Detailed data regarding casemix (e.g. age, sex, physical condition, comorbidity, tumor characteristics), surgical procedure (e.g. McKeown, Ivor Lewis, Orringer, anastomotic technique, omental wrap, pleural flap), leakage characteristics (e.g. contamination, drainage at leakage diagnosis, leak circumference) and treatment were collected. The primary outcome is 90-day mortality. Regression analysis will be used to analyze which leakage characteristics are associated with 90-day mortality and to compose an evidence-based anastomotic leakage severity score. The study protocol is accessible at www.tentaclestudy.com.

Results

Detailed data of 1407 patients with anastomotic leakage from 70 centers in 20 countries were collected. Anastomotic leakage occurred 0–43 days after surgery and 90-day mortality rate was 11.1%. The TENTACLE—Esophagus study data is currently being validated and it is awaiting full analysis. The results and the evidence based anastomotic leakage severity classification system will be ready for presentation at the ISDE meeting.

Conclusion

This is the largest study that investigates which factors contribute to anastomotic leakage severity after esophagectomy. The evidence-based anastomotic leakage severity classification system can be used by clinicians to grade severity of a given leak and might aid clinicians in choosing the most appropriate treatment.
391 P53 AS A UTILITY MARKER FOR RISK ASSESSMENT IN BARRETT’S OESOPHAGUS
Authors: Bondugula K , Bisht T , Dennis Joseph L , Sundaram S , Chandramohan S , Jeswanth J
Published: September 2020

Staging and prognosis of a case of Barrett's oesophagus is done by identifying the presence and grade of dysplasia. However, this method is highly subjective and can yield inaccurate diagnoses and prognoses. Demonstration of accumulation of p53 protein may be the most accurate and definitive approach to prognosticating cases of Barrett's oesophagus. This study focuses on p53 protein as a biomarker by immunohistochemistry staining in slides of different progression and demonstrates its promising clinical application.

Methods

Of 6175 endoscopies, from 970 cases of oesophagitis, a pilot study was performed on 6 cases of pathologically proven Barrett’s oesophagus, including a case with low-grade dysplasia, a case with high grade dysplasia and one case of poorly differentiated adenocarcinoma. Formalin fixed paraffin embedded tissue sections of the above cases were stained for anti p53 antibodies. The elevated immunohistochemical expression was quantified microscopically and a comparative analysis was done.

Results

p53 staining analysis showed significant immunoreactivity in the case of adenocarcinoma of oesophagus with diffuse strong nuclear staining. Low grade dysplasia and high grade dysplasia showed strong nuclear staining in the involved epithelium with focal and variable intensity positivity in the metaplastic epithelium. Those of reflux oesophagitis showed no nuclear staining in the epithelium. This pattern of staining with histological correlation is in concordance with other similar studies done supporting p53 as one of the crucial biomarkers for increased risk for carcinoma.

Conclusion

Increased p53 expression shows association with the higher risk of histological progression in the Barrett’s- carcinoma sequence. With the available literature p53 immunohistochemical staining along with other biomarkers will help us to predict the high risk patients and help treating clinician follow up the high risk patients. p53 shows promising utility as a part of panel for Barrett’s oesophagus and the spectrum.
Uniportal versus multiportal video-assisted thoracoscopic surgery does not compromise the outcome of segmentectomy
Authors: Xie Dong , Wu Junqi , Hu Xuefei , Gonzalez-Rivas Diego , She Yunlang , Chen Qiankun , Zhu Yuming , Jiang Gening , Chen Chang
Published: September 2020

OBJECTIVES

The goal of this study was to compare the feasibility and safety of uniportal thoracoscopic segmentectomy (UTS) with that of multiportal thoracoscopic segmentectomy (MTS).

METHODS

From January 2014 to December 2015, a total of 1056 patients who underwent thoracoscopic segmentectomy were identified, including 375 and 681 who had simple and complex segmentectomies, respectively. A propensity matched analysis was applied to compare perioperative indicators. Survival outcomes, which included disease-free survival and overall survival, were assessed by Kaplan–Meier estimates and Cox hazards regression analysis.

RESULTS

Propensity matching generated 454 paired patients for the UTS and MTS cohorts; the perioperative results were comparable. Survival analysis indicated that the surgical approach (UTS versus MTS) was not an independent risk factor in either disease-free survival (P = 0.247) or overall survival (P = 0.870) of patients with invasive adenocarcinoma. A shorter operative time was observed in patients who had a UTS (P < 0.001) or an MTS (P = 0.011) via a simple segmentectomy compared with those who had a complex segmentectomy. Moreover, 147 and 266 corresponding cases were selected to compare the UTS and MTS in the simple and complex segmentectomy groups, respectively. MTS showed slightly longer operative times (119 vs 108 min; P = 0.007) and drainage duration (P = 0.010) in the simple segmentectomy group. In contrast, UTS was associated with statistically longer operative times (141 vs 133 min; P = 0.016) in the complex segmentectomy group.

CONCLUSIONS

Although minor differences could be found in the simple and complex segmentectomy groups, respectively, these results were clinically irrelevant. Our study supports UTS as a feasible and safe surgical technique.
Markov chain models of refugee migration data
Authors: Huang Vincent , Unwin James
Published: September 2020

The application of Markov chains to modelling refugee crises is explored, focusing on local migration of individuals at the level of cities and days. As an explicit example, we apply the Markov chains migration model developed here to United Nations High Commissioner for Refugees data on the Burundi refugee crisis. We compare our method to a state-of-the-art ‘agent-based’ model of Burundi refugee movements, and highlight that Markov chain approaches presented here can improve the match to data while simultaneously being more algorithmically efficient.
The Tyranny of Distance: Assessing and Explaining the Apparent Decline in U.S. Military Performance
Authors: Hulme M Patrick , Gartzke Erik
Published: September 2020

There is a growing sense that US military effectiveness has been on the wane in recent years. Is this the case? If so, what are the reasons for the decay in American combat performance? We first examine the available systematic evidence for American military decline, showing that the United States has indeed experienced a drop in the quality of outcomes of its military contests. Observers have offered a number of explanations for declining American military success, most predominantly an increase in intrastate conflict after the Second World War. After showing that a decline in performance is observed even after fully excluding intrastate conflict, we propose an alternative explanation: the increasing distance from home at which the United States has been fighting. Distance is tyrannical: it saps military strength and increases the cost of contests, even as it reduces US expertise and motivations to prevail. We then show that the distance from home at which the United States fights is the best predictor of the outcome of the conflict. We conclude by noting some avenues for future research and policy implications as the world returns to great power competition.
Candidate serum metabolite biomarkers of residual feed intake and carcass merit in sheep
Authors: Goldansaz Seyed Ali , Markus Susan , Berjanskii Mark , Rout Manoj , Guo An Chi , Wang Zhiquan , Plastow Graham , Wishart David S
Published: September 2020

Mutton and lamb sales continue to grow globally at a rate of 5% per year. However, sheep farming struggles with low profit margins due to high feed costs and modest carcass yields. Selecting those sheep expected to convert feed efficiently and have high carcass merit, as early as possible in their life cycle, could significantly improve the profitability of sheep farming. Unfortunately, direct measurement of feed conversion efficiency (via residual feed intake [RFI]) and carcass merit is a labor-intensive and expensive procedure. Thus, indirect, marker-assisted evaluation of these traits has been explored as a means of reducing the cost of its direct measurement. One promising and potentially inexpensive route to discover biomarkers of RFI and/or carcass merit is metabolomics. Using quantitative metabolomics, we profiled the blood serum metabolome (i.e., the sum of all measurable metabolites) associated with sheep RFI and carcass merit and identified candidate biomarkers of these traits. The study included 165 crossbred ram-lambs that underwent direct measurement of feed consumption to determine their RFI classification (i.e., low vs. high) using the GrowSafe System over a period 40 d. Carcass merit was evaluated after slaughter using standardized methods. Prior to being sent to slaughter, one blood sample was drawn from each animal, and serum prepared and frozen at −80 °C to limit metabolite degradation. A subset of the serum samples was selected based on divergent RFI and carcass quality for further metabolomic analyses. The analyses were conducted using three analytical methods (nuclear magnetic resonance spectroscopy, liquid chromatography mass spectrometry, and inductively coupled mass spectrometry), which permitted the identification and quantification of 161 unique metabolites. Biomarker analyses identified three significant (P < 0.05) candidate biomarkers of sheep RFI (AUC = 0.80), seven candidate biomarkers of carcass yield grade (AUC = 0.77), and one candidate biomarker of carcass muscle-to-bone ratio (AUC = 0.74). The identified biomarkers appear to have roles in regulating energy metabolism and protein synthesis. These results suggest that serum metabolites could be used to categorize and predict sheep for their RFI and carcass merit. Further validation using a larger (3×) and more diverse cohort of sheep is required to confirm these findings.
Shiny Black and Layers of White: Japanned Papier Mâché, Race and the British Empire
Authors: Levy Haskell Gavi
Published: September 2020

Race, class and empire in nineteenth-century England inflected understandings of japanned papier mâché, influencing both its brief popularity and its abrupt demise in the 1860s. Although the material was rarely used as an explicit signifier in nineteenth-century literature or theory, or indeed mentioned at all, its inclusion in the Great Exhibition suggests its cultural and industrial centrality. This article proposes that this disparity results not from an absence of meaning, but from too great a complexity and too clear a set of implications. As an imitation of an East Asian form, japanned papier mâché represented an Orientalizing fantasy; as a shiny black surface, japanned papier mâché tapped into both desires and anxieties surrounding racial Blackness; as a backdrop for depictions of recognizably British landscapes and architecture; and as a distinctively British industry, japanned papier mâché offered a kind of national identity-fashioning. Tying a ubiquitous but understudied material of the English mid-nineteenth century to broader histories of the British empire, this article demonstrates the tidy encapsulation of the fraught and complex 1850s and 1860s into the materiality, forms and failure of japanned papier mâché.
Planetary candidates transiting cool dwarf stars from campaigns 12 to 15 of K2
Authors: Castro González A , Díez Alonso E , Menéndez Blanco J , Livingston John H , de Leon Jerome P , Suárez Gómez S L , González Gutiérrez C , García Riesgo F , Bonavera L , Iglesias Rodríguez F J , Muñiz R , Everett Mark E , Scott N J , Howell Steve B , Ciardi David R , Gonzales Erica J , Schlieder Joshua E , de Cos Juez F J
Published: September 2020

We analysed the photometry of 20 038 cool stars from campaigns 12, 13, 14, and 15 of the K2 mission in order to detect, characterize, and validate new planetary candidates transiting low-mass stars. We present a catalogue of 25 new periodic transit-like signals in 22 stars, of which we computed the parameters of the stellar host for 19 stars and the planetary parameters for 21 signals. We acquired speckle and AO images, and also inspected archival Pan-STARRS1 images and Gaia DR2 to discard the presence of close stellar companions and to check possible transit dilutions due to nearby stars. False positive probability (FPP) was computed for 22 signals, obtaining FPP < $1{{\ \rm per\ cent}}$ for 17. We consider 12 of them as statistically validated planets. One signal is a false positive and the remaining 12 signals are considered as planet candidates. 20 signals have an orbital period of P$_{\rm orb} \lt 10\,\mathrm{ d}$, 2 have $10\, \mathrm{ d} \lt $  P$_{\rm orb} \lt 20\, \mathrm{ d}$, and 3 have P$_{\rm orb} \gt 20\, \mathrm{ d}$. Regarding radii, 11 candidates and validated planets have computed radius R < 2R⊕, 9 have 2R⊕ < R < 4R⊕, and 1 has R > 4R⊕. Two validated planets and two candidates are located in moderately bright stars ($\rm \mathit{ m}_{kep}\lt 13$) and two validated planets and three candidates have derived orbital radius within the habitable zone according to optimistic models. Of special interest is the validated warm super-Earth K2-323 b (EPIC 248616368 b) with T$_{\rm eq} = 318^{+24}_{-43} \, \mathrm{ K}$, S$_{\rm p} = 1.7\pm 0.2 \, \mathrm{ S}_{\oplus }$, and R$_{\rm p} = 2.1\pm 0.1 \, \mathrm{ R}_{\oplus }$, located in an m$\rm _{kep}$ = 14.13 star.
Starbursting [O iii] emitters and quiescent [C ii] emitters in the reionization era
Authors: Arata Shohei , Yajima Hidenobu , Nagamine Kentaro , Abe Makito , Khochfar Sadegh
Published: September 2020

Recent observations have successfully detected [O iii] $88.3\, {\rm \mu m}$ and [C ii] $157.6\, {\rm \mu m}$ lines from galaxies in the early Universe with the Atacama Large Millimeter Array. Combining cosmological hydrodynamic simulations and radiative transfer calculations, we present relations between the metal line emission and galaxy evolution at z = 6–15. We find that galaxies during their starburst phases have high [O iii] luminosity of ${\sim}10^{42}~\rm erg~s^{-1}$. Once supernova feedback quenches star formation, [O iii] luminosities rapidly decrease and continue to be zero for ${\sim}100\, {\rm Myr}$. The slope of the relation between $\log {(\rm SFR/\rm M_{\odot }~ yr^{-1})}$ and $\log {(L_{\rm [O\, \small {III}]}/\mathrm{L}_{\odot })}$ at z = 6–9 is 1.03, and 1.43 for $\log {(L_{\rm [C\, \small {II}]}/\mathrm{L}_{\odot })}$. As gas metallicity increases from sub-solar to solar metallicity by metal enrichment from star formation and feedback, the line luminosity ratio $L_{\rm [O\, \small {III}]} / L_{\rm [C\, \small {II}]}$ decreases from ∼10 to ∼1 because the O/C abundance ratio decreases due to carbon-rich winds from AGB stars and the mass ratio of H ii to H i regions decreases due to rapid recombination. Therefore, we suggest that the combination of [O iii] and [C ii] lines is a good probe to investigate the relative distribution of ionized and neutral gas in high-z galaxies. In addition, we show that deep [C ii] observations with a sensitivity of ∼10−2 mJy arcsec−2 can probe the extended neutral gas discs of high-z galaxies.
The thousand-pulsar-array programme on MeerKAT IV: Polarization properties of young, energetic pulsars
Authors: Serylak M , Johnston S , Kramer M , Buchner S , Karastergiou A , Keith M J , Parthasarathy A , Weltevrede P , Bailes M , Barr E D , Camilo F , Geyer M , Hugo B V , Jameson A , Reardon D J , Shannon R M , Spiewak R , van Straten W , Venkatraman Krishnan V
Published: September 2020

We present observations of 35 high spin-down energy radio pulsars using the MeerKAT telescope. Polarization profiles and associated parameters are also presented. We derive the geometry for a selection of pulsars which show interpulse emission. We point out that, in several cases, these radio pulsars should also be seen in γ-rays but that improved radio timing is required to aid the high-energy detection. We discuss the relationship between the width of the radio profile and its high-energy detectability. Finally, we reflect on the correlation between the spin-down energy and the radio polarization fraction and the implications this may have for γ-ray emission.
The AGN contribution to the UV–FIR luminosities of interacting galaxies and its role in identifying the main sequence
Authors: Ramos Padilla Andrés F , Ashby M L N , Smith Howard A , Martínez-Galarza Juan R , Beverage Aliza G , Dietrich Jamie , Higuera-G. Mario-A , Weiner Aaron S
Published: September 2020

Emission from active galactic nuclei (AGNs) is known to play an important role in the evolution of many galaxies including luminous and ultraluminous systems (U/LIRGs), as well as merging systems. However, the extent, duration, and exact effects of its influence are still imperfectly understood. To assess the impact of AGNs on interacting systems, we present a spectral energy distribution (SED) analysis of a sample of 189 nearby galaxies. We gather and systematically re-reduce archival broad-band imaging mosaics from the ultraviolet to the far-infrared using data from GALEX, SDSS, 2MASS, IRAS, WISE, Spitzer, and Herschel. We use spectroscopy from Spitzer/IRS to obtain fluxes from fine-structure lines that trace star formation and AGN activity. Utilizing the SED modelling and fitting tool cigale, we derive the physical conditions of the interstellar medium, both in star-forming regions and in nuclear regions dominated by the AGN in these galaxies. We investigate how the star formation rates (SFRs) and the fractional AGN contributions (fAGN) depend on stellar mass, galaxy type, and merger stage. We find that luminous galaxies more massive than about $10^{10} \,\rm {M}_{*}$ are likely to deviate significantly from the conventional galaxy main-sequence relation. Interestingly, infrared AGN luminosity and stellar mass in this set of objects are much tighter than SFR and stellar mass. We find that buried AGNs may occupy a locus between bright starbursts and pure AGNs in the fAGN–[Ne v]/[Ne ii] plane. We identify a modest correlation between fAGN and mergers in their later stages.
A Longitudinal Study of Exposure to Tobacco-Related Toxicants and Subsequent Respiratory Symptoms Among U.S. Adults with Varying E-cigarette Use Status
Authors: Dai Hongying , Khan Ali S
Published: September 2020

Background

The link between e-cigarette use and subsequent development of respiratory diseases remains an open question.

Aims and Methods

A subset of a probability sample of U.S. adults from the Population Assessment of Tobacco and Health Study Waves 1 and 2 were selected for biospecimen analysis (n = 4614). Subjects were divided into three mutually exclusive groups at baseline: nonusers (n = 2849), exclusive e-cigarette users (n = 222), and poly e-cigarette/tobacco users (n = 1,543). Geometric mean concentrations of baseline biomarkers from five classes of harmful and potentially harmful constituents were reported. Multivariable linear regressions were conducted to examine the relationship between baseline biomarkers and subsequent respiratory symptoms among user groups.

Results

Baseline exclusive e-cigarette users (33.6%[confidence interval, CI: 26.7% to 41.4%]) and poly e-cigarette/tobacco users (50.8%[CI: 47.4% to 54.2%]) had higher prevalence of subsequent respiratory symptoms than nonusers (21.7%[19.2% to 24.4%]). As compared with nonusers, poly e-cigarette/tobacco users had higher concentrations in clinically relevant biomarkers at baseline than exclusive e-cigarette users. Among poly e-cigarette/tobacco users, baseline nicotine metabolites (TNE2, cotinine), tobacco-specific nitrosamine (NNAL), PAH (1-NAP, 3-FLU), and volatile organic compound (N-Acetyl-S-(2-carboxyethyl)-l-cysteine, N-acetyl-S-(2-cyanoethyl)-l-cysteine) were significantly higher among those reporting subsequent respiratory symptoms than those who did not. Among exclusive e-cigarette users, baseline NNAL was significantly higher among those reporting subsequent respiratory symptoms than those who did not. Within subjects with subsequent respiratory symptoms, NNAL was 2.5 times higher in exclusive e-cigarette users (10.7[6.5 to 17.5]) and 63.4 times higher in poly e-cigarette/tobacco users (199.6[176.7 to 225.4]) than nonusers (3.1[2.4 to 3.9]).

Conclusions

E-cigarette use is associated with higher concentrations of known tobacco-related toxicants and risks of subsequent respiratory symptoms than nonusers. Poly e-cigarette/tobacco users exhibit higher risk than exclusive e-cigarette users.

Implications

This longitudinal study identified positive associations between baseline urinary biomarkers of exposure to tobacco-related toxicants and increased risks of subsequent respiratory symptoms across varying e-cigarette use groups. E-cigarette use is associated with increased exposure to known tobacco-related toxicants, and certain toxicant exposure increases the risk of respiratory symptoms.
Perspectives on Pain, Engagement in HIV Care, and Behavioral Interventions for Chronic Pain Among Older Sexual Minority Men Living with HIV and Chronic Pain: A Qualitative Analysis
Authors: McKetchnie Samantha M , Beaugard Corinne , Taylor S Wade , O’Cleirigh Conall
Published: September 2020

Objective and Methods

The transition of HIV from an acute, fatal illness to a chronic health condition has shifted the treatment needs of people living with HIV (PLWH). PLWH, including sexual minority men (SMM), are living longer and are subject to health concerns often associated with aging. A major health concern of older SMM living with HIV who report problematic substance use is chronic pain. This qualitative analysis of 15 one-on-one interviews with older SMM living with HIV and chronic pain aimed to characterize this population’s experiences with pain, engagement in HIV care, and problematic substance use. This study was conducted in a community health center in Boston, MA. We also solicited suggestions for preferred intervention strategies.

Results

Three main themes emerged from the interview transcripts: 1) the impact of chronic pain and pain treatment on engagement in HIV clinical care; 2) the impact of substance use on chronic pain; and 3) response to interventions to address chronic pain and substance use.

Conclusions

These findings underscore the need for interventions that address the structural, physical, and psychological barriers to engagement in medical and self-care that affect older SMM living with HIV and chronic pain.
Academics’ societal engagement in ecologies of knowledge: A case study from Mozambique
Authors: Zavale Nelson Casimiro , Schneijderberg Christian
Published: September 2020

Sub-Saharan Africa’s (SSA) structural conditions are mostly considered unfavorable to foster academics’ societal engagement (ASE)—that is collaboration between higher education institutions and external stakeholders in general and university–industry linkages in particular. The received view is that ASE in SSA empirically studied only through macro-structural data related to approaches and metrics of national innovation system or knowledge-based economy will predictably display weak portrait and potentially not make visible specific patterns that ASE in SSA may have. This theory-led study reports findings from a case study examining the inputs, in-process, outputs, and impact/outcome of ASE in a university in Mozambique, an African low-income country. The article attempts to make visible specific patterns of ASE that occurs within the ecologies of knowledge in a country like Mozambique. However, we are far away from being able to suggest context adequate indicators. Instead, we provide insights into the qualities and patterns of ASE cooperation.
Creativity in Containing a Patient’s High-Output Fistula: A Case Report
Authors: Michel Marie , Sherfey Sally
Published: September 2020

A gastrogastric fistula is a rare complication of Roux-en-Y gastric bypass resulting from communication between the gastric pouch and gastric remnant. This case report describes the creative interprofessional management of this condition arising in a 48-year-old woman. During an elective Roux-en-Y gastric bypass surgery for morbid obesity, the patient developed respiratory complications. She was admitted to the ICU, but the following day she signed herself out against medical advice, stating she was “no longer staying here.” Within 24 hours, she returned to the ED for postoperative complications, and a week after the exploratory surgery, the patient developed an inoperable high-output fistula. The authors devised a creative solution to contain the effluent and achieved closure of the fistula after several weeks.
Results of Laboratory Testing for Immersion, Envelopment, and Horizontal Stiffness on Turn and Position Devices to Manage Pressure Injury
Authors: Call Evan , Tanner Laurel , Cheney Adam , Rappl Laurie , Santamaria Nick , Gefen Amit , Oberg Craig
Published: September 2020

Background

A continuing complication, pressure injuries are due to sustained mechanical loading and tissue deformations, which can then be exacerbated by additional intrinsic and extrinsic risk factors. Although support surfaces are designed to mitigate risk factors for pressure injuries, the presence of a turn and position device (TPD) between the patient and support surface may interfere with how support surfaces affect these risk factors.

Objective

Report the use of the NPIAP’s S3I standard test methods to characterize the performance of a support surface when used in conjunction with three different TPDs.

Design

Laboratory testing compared three TPDs for Immersion, Envelopment, and Horizontal Stiffness in each of five surface combinations.

Main outcome measure

Immersion test measures how far mannequin indenter immerses into surface. Envelopment test measures immersion and pressure distribution with hemispherical-indenter with mounted sensor rings. Horizontal Stiffness test measures the shear modulus of the support surface with epicondyle indenter.

Main results

For the specific TPDs tested here, the one with an adjustable integrated air bladder improved rather than compromised both the envelopment and the immersion of the support surface alone. Additionally, this TPD provided potential protection against sliding and the associated frictional shear forces.

Conclusions

This paper describes how TPDs should perform in order to help establish which features are needed in a new medical device of this type. Laboratory testing demonstrates it is possible to improve performance of a support surface by applying a TPD as an add-on, thus relieving tissue deformation exposure through more effective pressure redistribution.
A novel mutation in MYCN gene causing congenital absence of the flexor pollicis longus tendon as an unusual presentation of Feingold syndrome 1
Authors: Peleg Amir , Kurolap Alina , Sagi-Dain Lena , Larom-Khan G. , Adir V. , Mory Adi , Paperna Tamar , Shuldiner A.R. , Gonzaga-Jauregui C. , Adir Noam , Baris Feldman Hagit , Wollstein R.
Published: September 2020

Feingold syndrome 1 (FGLDS1) is an autosomal dominant malformation syndrome, characterized by skeletal anomalies, microcephaly, facial dysmorphism, gastrointestinal atresias and learning disabilities. Mutations in the MYCN gene are known to be the cause of this syndrome. Congenital absence of the flexor pollicis longus (CAFPL) tendon is a rare hand anomaly. Most cases are sporadic and no genetic variants have been described associated with this abnormality. We describe here a pedigree combining familial CAFPL tendon as a feature of FGLDS1. Molecular analyses of whole exome sequence data in five affected family members spanning three generations of this family revealed a novel mutation in the MYCN gene (c.1171C>T; p.Arg391Cys). Variants in MYCN have not been published in association with isolated or syndromic CAFPL tendon, nor has this been described as a skeletal feature of Feingold syndrome. This report expands on the clinical and molecular spectrum of MYCN-related disorders and highlights the importance of MYCN protein in normal human thumb and foramen development.
Safety of pertuzumab and trastuzumab administered in a single infusion bag in breast cancer
Authors: De Coucy Antoine , Ollivier Julien , Malifarge Laura , Deppenweiler Marine , Donamaria Catherine , Lortal Barbara
Published: September 2020

Purpose:

Biophysical and analytical assays have demonstrated the physical and chemical stabilities of an admixture of pertuzumab and trastuzumab co-administered via a single infusion bag. Few data are available concerning the use of this practice in real life. We report the safety of pertuzumab and trastuzumab co-administered via a single infusion bag for first-line treatment of human epidermal growth factor receptor 2 (HER2)-positive breast cancer.

Methods:

A cancer data registry was used to identify all patients with HER2-positive breast cancer. In cycle 1, patients received intravenous loading doses of pertuzumab and trastuzumab, and in cycle 2 and onward, patients received maintenance doses via a single infusion bag (cohort 1) or as separate infusions (cohort 2). Patients in cohort 3 received both regimens: separate infusions followed by a single infusion bag. Records were reviewed for general and cardiac safety

Results:

In total, 72 patients were eligible for analysis: 25 in cohort 1, 23 in cohort 2, and 24 in cohort 3. One patient (4%) in cohort 1 and 1 patient (4.3%) in cohort 2 had left ventricular dysfunction that led to treatment discontinuation, but this dysfunction was not observed in cohort 3. No significant differences in general or cardiac toxicities were observed between cohort 1 and cohort 2, or cohort 3 after switching to a single infusion bag.

Conclusion:

Pertuzumab and trastuzumab co-administered in a single infusion bag, in a non-clinical-trial setting, had acceptable general and cardiac tolerance profiles. This strategy could improve the comfort of patients while saving active healthcare professionals’ time.

Implications for practice:

Combined treatment of pertuzumab, trastuzumab, and a third chemotherapeutic agent is the standard of care for first-line HER2-positive locally advanced/metastatic breast cancer and can be used as (neo)adjuvant treatment for breast cancer. In practice, the 2 antibodies are administered separately, but this study supports co-administration of pertuzumab and trastuzumab via a single infusion bag. Co-administration has acceptable general and cardiac tolerances in a non-clinical-trial population. This strategy could improve the compliance and comfort of patients while saving active healthcare professionals’ time and medical resource utilization.
Review of advances in microwave and millimetre-wave NDT&E: principles and applications
Authors: Brinker Katelyn , Dvorsky Matthew , Al Qaseer Mohammad Tayeb , Zoughi Reza
Published: September 2020

Microwave and millimetre-wave non-destructive testing and evaluation (NDT&E) has a long history dating back to the late 1950s (Bahr 1982
Microwave non-destructive testing methods
; Zoughi 2000
Microwave Non-destructive testing and evaluation principles
; Feinstein 1967
Surface crack detection by microwave methods
; Ash 1973 In
3rd European Microwave Conference
; Auld 1981
Phys. Technol.
12
, 149–154; Case 2017
Mater. Eval.
75
). However, sustained activities in this field date back to the early 1980s (Zoughi 1995
Res. Nondestr. Eval.
7
, 71–74; Zoughi 2018
Mater. Eval.
76
, 1051–1057; Kharkovsky 2007
IEEE Instrumentation & Measurement Magazine
10
, 26–38). Owing to various limitations associated with using microwaves and millimetre waves for NDT&E, these techniques did not see much utility in the early days. However, with the advent and prevalence of composite materials and structures, in a wide range of applications, and technological advances in high-frequency component design and availability, these techniques are no longer considered as ‘emerging techniques’ (Zoughi 2018
Mater. Eval.
76
, 1051–1057; Schull 2002
Nondestructive evaluation: theory, techniques, and applications
). Currently, microwave and millimetre-wave NDT&E is a rapidly growing field and has been more widely acknowledged and accepted by practitioners over the last 25+ years (Case 2017
Mater. Eval.
75
; Bakhtiari 1994
IEEE Trans. Microwave Theory Tech
.
42
, 389–395; Bakhtiari 1993
Mater. Eval.
51
, 740–743; Bakhtiari 1993
IEEE Trans. Instrum. Meas.
42
, 19–24; Ganchev 1995
IEEE Trans. Instrum. Meas.
44
, 326–328; Bois 1999
IEEE Trans. Instrum. Meas.
48
, 1131–1140; Ghasr 2009
IEEE Trans. Instrum. Meas.
58
, 1505–1513). Microwave non-destructive testing was recently recognized and designated by the American Society for Nondestructive Testing (ASNT) as a ‘Method’ on its own (Case 2017
Mater. Eval.
75
). These techniques are well suited for materials characterization; layered composite inspection for thickness, disbond, delamination and corrosion under coatings; surface-breaking crack detection and evaluation; and cure-state monitoring in concrete and resin-rich composites, to name a few. This work reviews recent advances in four major areas of microwave and millimetre-wave NDT&E, namely materials characterization, surface crack detection, imaging and sensors. The techniques, principles and some of the applications in each of these areas are discussed.

This article is part of the theme issue ‘Advanced electromagnetic non-destructive evaluation and smart monitoring’.
Evaluation of detectability of differential type probe using directional eddy current for fibre waviness in CFRP
Authors: Kosukegawa Hiroyuki , Kiso Yuta , Hashimoto Mitsuo , Uchimoto Tetsuya , Takagi Toshiyuki
Published: September 2020

This paper describes the detectability of eddy current testing (ECT) using directional eddy current for detection of in-plane fibre waviness in unidirectional carbon fibre reinforced plastic (CFRP) laminate. Three different types of probes, such as circular driving, symmetrical driving and uniform driving probe, were proposed, and the waviness angle was extracted from the contour map of the ECT signal by applying a Canny filter and a Hough transform. By comparing both the waviness angle estimated by ECT and that obtained by an X-ray CT image, the standard deviation (precision) and root mean square error (accuracy) were evaluated to discuss the detectability of these probes. The directional uniform driving probe shows the best detectability and can detect fibre waviness with a waviness angle of more than 2° in unidirectional CFRP. The probe shows a root mean square error of 1.90° and a standard deviation of 4.49° between the actual waviness angle and the angle estimated by ECT.

This article is part of the theme issue ‘Advanced electromagnetic non-destructive evaluation and smart monitoring’.
Learning automata based energy-efficient AI hardware design for IoT applications
Authors: Wheeldon Adrian , Shafik Rishad , Rahman Tousif , Lei Jie , Yakovlev Alex , Granmo Ole-Christoffer
Published: September 2020

Energy efficiency continues to be the core design challenge for artificial intelligence (AI) hardware designers. In this paper, we propose a new AI hardware architecture targeting Internet of Things applications. The architecture is founded on the principle of learning automata, defined using propositional logic. The logic-based underpinning enables low-energy footprints as well as high learning accuracy during training and inference, which are crucial requirements for efficient AI with long operating life. We present the first insights into this new architecture in the form of a custom-designed integrated circuit for pervasive applications. Fundamental to this circuit is systematic encoding of binarized input data fed into maximally parallel logic blocks. The allocation of these blocks is optimized through a design exploration and automation flow using field programmable gate array-based fast prototypes and software simulations. The design flow allows for an expedited hyperparameter search for meeting the conflicting requirements of energy frugality and high accuracy. Extensive validations on the hardware implementation of the new architecture using single- and multi-class machine learning datasets show potential for significantly lower energy than the existing AI hardware architectures. In addition, we demonstrate test accuracy and robustness matching the software implementation, outperforming other state-of-the-art machine learning algorithms.

This article is part of the theme issue ‘Advanced electromagnetic non-destructive evaluation and smart monitoring’.
Evaluation of LAMP for detection of Shigella from stool samples in children
Authors: Raghavan Ramya , Wang Shouao , Dendukuri Nandini , Kar Sitanshu S. , Mahadevan Subramanian , Jagadisan Barath , Mandal Jharna
Published: September 2020

Background. To assess the diagnostic accuracy of loop-mediated isothermal amplification (LAMP) for the detection of

Shigella

from stool samples from children.

Methods. Consecutive stool samples from children aged <13 years old who presented with acute watery diarrhoea or dysentery to the Department of Paediatrics were collected and processed in the Department of Microbiology. All the stool samples were subjected to culture, conventional PCR and LAMP. Genomic sequencing was performed for samples that were positive by LAMP but negative by both culture and conventional PCR. The LAMP results were compared to those from culture and to a composite reference standard based on culture and conventional PCR.

Results. Amongst the 374 stool samples tested, 291 samples were positive by LAMP and 213 were positive by the composite reference standard. The sensitivity of LAMP was 100 % (98.3–100 %) and its specificity was 51.6 % (43.6–59.5 %) with a disease prevalence of 57 %. The sensitivity and specificity of LAMP improved to 99.3 % (94.2–100) and 98.2 % (94.5–99.9), respectively, using latent class analysis, while assuming that genomic sequencing has perfect specificity.

Discussion. The authors have standardized the LAMP procedure for direct application to clinical stool samples. LAMP is a sensitive and specific method for the diagnosis of

Shigella

from stool samples of children as compared to both culture and conventional PCR.
Sphingosinithalassobacter tenebrarum sp. nov., isolated from a deep-sea cold seep
Authors: Zheng Rikuan , Sun Chaomin
Published: September 2020

A Gram-stain-negative, facultatively anaerobic, yellow-pigmented, non-motile, rod-shaped bacterium, designated zrk23T, was isolated from a deep-sea cold seep. The strain was characterized by a polyphasic approach to clarify its taxonomic position. Phylogenetic analysis based on 16S rRNA gene sequences placed zrk23T within the genus

Sphingosinithalassobacter

and showed the highest similarity to

Sphingosinithalassobacter portus

FM6T (97.93 %). Growth occurs at temperatures from 16 to 45 °C (optimum, 30 °C), at pH values between pH 6.0 and 8.5 (optimum, pH 7.0) and in 0–5.0 % (w/v) NaCl (optimum, 1.5 %). The major fatty acids were C16 : 0, C14 : 0 2-OH and summed feature 8 (C18 : 1ω7c and/or C18 : 1ω6c). The major isoprenoid quinone was ubiquinone-10. Predominant polar lipids were diphosphatidylglycerol, phosphatidylglycerol, one unidentified phosphoglycolipid, three unidentified glycolipids and three unidentified phospholipids. The G+C content of the genomic DNA was 64.69 %. The average nucleotide identity values between zrk23T and the most closely related available genome, of

Sphingosinithalassobacter portus

FM6T, was 82.21 %, indicating that zrk23T was clearly distinguished from

S. portus

. The analysis of genome sequence of zrk23T revealed that there were many genes associated with degradation of aromatic compounds existing in the genome of zrk23T. As a result of the combination of the results of phylogenetic analysis and phenotypic and chemotaxonomic data, zrk23T was considered to represent a novel species of the genus

Sphingosinithalassobacter

, for which the name Sphingosinithalassobacter tenebrarum sp. nov. is proposed. The type strain is zrk23T (=KCTC 72896T=MCCC 1K04416T).