bluuebunny/crossref_metadata_2025 huggingface dataset:
Mechanical and microstructural properties of cameroonian bauxite ceramics for ballistic applications
Authors: Tchamba Arlin Bruno , Mbessa Michel , Sontia Metekong Jordan V. , Yang Liuhua , Ntchayi Tankeu Solange , Elambo Nkeng George , Njopwouo Daniele , Bier Thomas A.
Published: September 2019

Thermal reactions of bauxite, kaolin, and talc compound were investigated at 1550°C to obtain high rigidity ceramic for ballistic applications. The compressed strength and density of the bauxite ceramics with kaolin and talc substitutions varied from 195 to 455 MPa and density from 2.85 to 4.05 g/cm3. The Young’s modulus varied from 107 GPa to 222 GPa with water absorption varying from 1.4 wt% to 5.9 wt% for 0 wt% and 15 wt% substitution of kaolin. The substitution of bauxite‐kaolin by talc up to 7.5 wt% contributes to the resorption of microporosity and increase the Young's modulus from 107 to 195 GPa. The XRD of bauxite ceramic with kaolin substitution showed the presence of corundum and mullite; whereas the XRD of bauxite ceramic with kaolin and talc substitution showed the presence of corundum, mullite, and spinel. The ballistic simulation with abaqus dassult SIMULA using the JH‐2 model predict that an impact with velocity of 525 to 810 m/s on the 10 mm thick bauxite ceramic does not erode or damage for a projectile consisting of tungsten alloy with dimensions: 12 mm in diameter, 61.5 mm length, and 72 g of mass. The bauxite ceramics can be used for ballistic applications.
Understanding psychocutaneous disease: psychosocial & psychoneuroimmunologic perspectives
Authors: Jafferany Mohammad , Patel Arsh
Published: September 2019

The study of psychocutaneous disease involves a comprehensive understanding of the complex and often neglected psychoneuroimmunologic components and pathways. Patients suffering from the many disorders that blur the interface between the fields of psychiatry and dermatology are often misdiagnosed and mistreated because of the lack of knowledge and awareness of the underlying disease‐causing mechanisms. Individuals with psychodermatologic disease also experience a general lower overall quality of life as it has negative implications on psychosocial, emotional, and cognitive well‐being. Factors like early life interactions, body image dissatisfaction, and societal stigma play a crucial role in the development of psychosocial stress experienced by individuals with visible skin conditions. This heightened level of stress serves as a trigger in the activation of the hypothalamic‐pituitary‐axis (HPA), mediating immune responses that influence cutaneous disease severity and exacerbation. In order to improve the quality of life and treatment outcomes of the patient population impacted by psychodermatologic disease, it is essential to better understand the complex interplay between the various psychosocial factors and pathophysiologic pathways involved.
Phase evolution and microwave dielectric properties of novel LiAl5−xZnxO8−0.5x‐based (0 ≤ x ≤ 0.5) ceramics
Authors: Lan Xue‐Kai , Li Jie , Li Jia‐Pu , Wang Fei , Lu Wen‐Zhong , Wang Xiao‐Chuan , Lei Wen
Published: September 2019

Novel LiAl5−xZnxO8−0.5x microwave dielectric ceramics were synthesized through a solid‐state reaction route. Phase evolution of LiAl5−xZnxO8−0.5x was determined by XRD analysis. The XRD results indicated that the phase compositions had a P4332 space group when 0 ≤ x ≤ 0.2 and a spinel structure when 0.3 ≤ x ≤ 0.5. The dielectric constant (εr) of this series’ solid solutions decreased with the increase in Zn doping content, which was in good agreement with the Clausius‐Mossotti relation. Oxygen vacancy and the decreased degree of order degraded the quality factor (Q × f) of the two structures. The deterioration in quality factor was further verified by impedance spectroscopy. The temperature coefficient of the resonant frequency (τf) decreased with the increase in x and was correlated with the unit cell volume. Finally, CaTiO3 was used as a compensation material to obtain a near‐zero τf of the LiAl5O8 ceramic.
High permittivity and excellent high‐temperature energy storage properties of X9R BaTiO3–(Bi0.5Na0.5)TiO3 ceramics
Authors: Chen Lingling , Wang Hongxian , Zhao Peiyao , Hui Kezhen , Guo Limin , Li Longtu , Wang Xiaohui
Published: September 2019

We fabricated x(Bi0.5Na0.5)TiO3–(1−x)[BaTiO3–(Bi0.5Na0.5)TiO3–Nb] (BNT‐doped BTBNT‐Nb) dielectric materials with high permittivity and excellent high‐temperature energy storage properties. The initial powder of Nb‐modified BTBNT was first calcined and then modified with different stoichiometric ratios of (Bi0.5Na0.5)TiO3 (BNT). Variable‐temperature X‐ray diffraction (XRD) results showed that the ceramics with a small amount of BNT doping consisted of coexisting tetragonal and pseudocubic phases, which transformed into the pseudocubic phase as the test temperature increased. The results of transmission electron microscopy (TEM) showed that the ceramic grain was the core‐shell structure. The permittivity of the 5 mol% BNT‐doped BTBNT‐Nb ceramic reached up to 2343, meeting the X9R specification. The discharge energy densities of all samples were 1.70‐1.91 J/cm3 at room temperature. The discharge energy densities of all samples fluctuated by only ±5% over the wide temperature range from 25°C to 175°C and ±8% from 25°C to 200°C. The discharge energy density of the 50 mol% BNT‐doped BTBNT‐Nb ceramic was 2.01 J/cm3 at 210 kV/cm and 175°C. The maximum energy efficiencies of all ceramics were up to ~91% at high temperatures and were much better than those at room temperature. The stable dielectric properties within a wide temperature window and excellent high‐temperature energy storage properties of this BNT‐doped BTBNT‐Nb system make it promising to provide candidate materials for multilayer ceramic capacitor applications.
RIsk Stratification prior to lead Extraction and impact on major intraprocedural complications (RISE protocol)
Authors: Afzal Muhammad R. , Daoud Emile G. , Matre Nancy , Shoben Abigail , Burnside Melissa , Gilliam Courtney , Pinkhas Daniel , Okabe Toshimasa , Tyler Jaret , Houmsse Mahmoud , Kalbfleisch Steven S. , Crestanello Juan A. , Turner Katja , Weiss Raul , Hummel John D. , Love Charles J. , Augostini Ralph S.
Published: September 2019

Background

An internal risk stratification algorithm was developed to decrease the risk of major adverse cardiac events (MACEs) during lead extractions (LEs).

Objective

To report upon the impact of a risk stratification algorithm (RISE [RIsk Stratification prior to lead Extraction] protocol) on outcomes of LEs in a high‐volume center.

Methods

A retrospective review of a prospectively maintained LEs database was performed to identify features associated with MACEs. On the basis of the retrospective data, the RISE protocol differentiated LEs procedures into “High” and “Low” risk for occurrence of MACEs. High‐risk LEs included dual‐coil defibrillator lead (≥3 years), pacemaker and single‐coil lead (≥5 years), and any StarFix coronary sinus lead. During the prospective evaluation of the RISE protocol, “High‐risk” LEs were performed in an operating room (OR) or hybrid laboratory with the cardiac anesthesiologist, OR nursing team, perfusionist in the room, and a cardiac surgeon on the premises. “Low‐risk” LEs were performed in the electrophysiology (EP) laboratory with anesthesia provided by EP nursing team. The preintervention (pre‐RISE) and postintervention (post‐RISE) group spanned 19 and 40 months and consisted of 449 (632 leads) and 751 patients (1055 leads), respectively. The primary outcome of MACEs in the two groups was compared.

Results

Protocol compliance was 100%. The primary outcome of MACEs occurred in 15 patients (3.34%) before and 12 (1.6%) after implementation of the RISE protocol (P = .04).

Conclusion

RISE identified a low‐risk group where minimal resources are needed and allowed for rapid intervention in the high‐risk group that reduced the consequences of MACEs.
Twelve‐lead electrocardiographic localization of idiopathic premature ventricular contraction origins
Authors: Yamada Takumi
Published: September 2019

The major sites of origins of idiopathic ventricular arrhythmias have been elucidated. Idiopathic ventricular arrhythmias most often present as premature ventricular contractions (PVCs) with a focal mechanism, and commonly occur without structural heart disease. Idiopathic ventricular arrhythmias usually originate from specific anatomical structures, commonly endocardial but sometimes epicardial and exhibit characteristic electrocardiograms (ECGs) based on their anatomical background. There are general and specific ECG characteristics that can localize the site of idiopathic PVC origins. The general ECG characteristics include the bundle branch block pattern, axis, QRS polarity in lead V6, QRS duration, precordial transition, maximal deflection index, and so forth. They can roughly localize the site of idiopathic PVC origins. Several major sites of idiopathic PVC origins are located close to each other, and specific ECG characteristics are helpful for localizing the site of origins more accurately in those PVCs. Twelve‐lead surface ECG algorithms usually can localize the site of idiopathic PVC origins with a high accuracy, but their accuracy can be limited by the patients’ physique, heart rotation, specific conduction properties, presence of structural heart disease, and so forth. This review describes an overview of the approaches to the 12‐lead surface ECG localization of idiopathic PVCs, and also discusses their caveats and limitations.
Potential cost‐effectiveness of wearable cardioverter‐defibrillator for patients with implantable cardioverter‐defibrillator explant in a high‐income city of China
Authors: Jiang Xinchan , Ming Wai‐Kit , You Joyce H. S.
Published: September 2019

Introduction

Wearable cardioverter‐defibrillator (WCD) is recommended for patients with implantable cardioverter‐defibrillator (ICD) removal. This study aimed to investigate the potential cost‐effectiveness of WCD for patients with ICD explant in a high‐income city of China.

Methods and Results

A 5‐year decision‐analytic model was developed to simulate outcomes of three strategies during the period between ICD explant and reimplantation: discharge‐to‐home without WCD (home group), discharge‐to‐home with WCD (WCD group), and stay‐in‐hospital (hospital group). Outcome measures were mortality rates (during the period between ICD explant and reimplantation), direct medical costs, quality‐adjusted life years (QALYs), and incremental cost per QALY saved (ICER). Model inputs were derived from literature and public data. Base‐case analysis was performed at four cost levels of WCD. Robustness of model results was examined by sensitivity analyses. In base‐case analysis, the 8‐week mortality rates of WCD, hospital, and home groups were 7.3%, 8.1%, and 9.4%, respectively. WCD group gained the highest QALYs (3.0990 QALYs), followed by hospital group (3.0553 QALYs) and home group (3.0132 QALYs). The WCD group was the cost‐effective option with ICERs less than willingness‐to‐pay (WTP) threshold (57 315 USD/QALY) at WCD daily cost ≤USD48. In probabilistic sensitivity analysis, the WCD group at daily cost of USD24, USD48, USD72, and USD96 were cost‐effective in 100%, 94.16%, 22.08%, and 0.16% of 10 000 Monte Carlo simulations, respectively.

Conclusions

Use of WCD during the period between ICD explant and reimplantation is likely to save life and gain higher QALYs. Cost‐effectiveness of WCD is highly subject to the daily cost of WCD in China.
Cavotricuspid isthmus ablation using ablation index in typical right atrial flutter
Authors: Zhang Tao , Wang Yunlong , Han Zhihong , Zhao Hua , Liang Zhuo , Wang Ye , Wu Yongquan , Ren Xuejun
Published: September 2019

Background

Ablation index (AI) has been evaluated as guidance quality marker for pulmonary vein isolation, but not for linear ablation of the cavotricuspid isthmus (CTI) for typical right atrial flutter (AFL). We thus studied the feasibility and effectiveness of AI‐guided CTI for AFL.

Methods

Procedural and 6‐month outcomes of ablation for AFL were retrospectively compared between consecutive patients undergoing either AI‐guided ablation of CTI (n = 43; AI target of 500 for anterior 2/3 segments and 400 for posterior 1/3 segments) or contact force (CF)‐guided ablation (n = 42) at a single center. Each Visitag dataset from all patients in each group was analyzed.

Results

AI guidance vs CF guidance was associated with: higher first‐pass conduction block of CTI (93.0% vs 76.2%, P = .03) with similar ablation time; similar acute spontaneous CTI reconnection 2.3% vs 9.5%, P = .343); fewer radiofrequency (RF) applications (10.1 ± 2.8 vs 11.5 ± 3.0, P = .031) needed to achieve CTI directional block; significantly higher mean ablation time, impedance drop, force time integral and AI and similar mean CF and power of each VisiTag point. One inguinal hematoma and one pseudoaneurysm developed in the AI and CF groups, respectively. Recurrent AFL was recorded in two (4.7%) AI‐group patients and four (9.5%) CF‐group patients (P = .650).

Conclusion

AI‐guided ablation of CTI line for AFL appears feasible and effective with similar ablation time, fewer RF applications, a higher rate of first‐pass conduction block, and no additional complications.
Retrograde aortic access during ventricular tachycardia ablation: Indications, techniques, and challenges
Authors: Adlan Ahmed M. , Campbell Timothy , Fairbairn Timothy , Aggarwal Suneil , Nawaytou Omar , Penha Diana , Todd Derick , Mahida Saagar
Published: September 2019

The retrograde aortic (RA) route is a widely used access route for mapping and ablation of ventricular tachycardias (VT) arising from the left ventricular endocardium. With the expanding role of VT ablation in patients with significant comorbidity, the choice between the RA and transseptal access routes is an increasingly important consideration. An individualized decision based on the location of the arrhythmogenic substrate, vascular anatomy, aortic valve morphology, and operator experience is necessary when deciding on the optimal access route. Among patients with challenging vascular anatomy, growing experience from structural interventions such as transcatheter aortic valve replacements and peripheral vascular interventions has provided valuable insights into techniques for safe retrograde access. The present review focuses on patient selection for RA access, potential complications associated with the technique, and optimal approaches for access in patients with challenging vascular or aortic valve anatomy.
Chagas disease is associated with a worse prognosis at 1‐year follow‐up after implantable cardioverter‐defibrillator for secondary prevention in heart failure patients
Authors: Vieira de Melo Rodrigo M. , de Azevedo Diogo F. C. , Lira Yasmin M. , Cardoso de Oliveira Natalia F. , Passos Luiz C. S.
Published: September 2019

Introduction

There are conflicting data regarding the efficacy of implantable cardioverter‐defibrillator (ICD) in Chagas disease (CD) patients. This study aims to evaluate the short‐term outcome after ICD for secondary prevention, in a population where CD is a prevalent cause of heart failure (HF).

Methods and Results

Consecutive patients with HF and reduced left ventricular ejection fraction (LVEF), who underwent ICD implantation for secondary prevention of SCD. Clinical and demographic data were collected to investigate mortality predictors at 1 year. During the study period, 117 patients underwent ICD implantation, of which 108 were included. The most frequent causes of HF was CD: 52 (48.1%) and ischemic cardiomyopathy: 20 (18.5%). Chagas and non‐Chagas patients were well balanced—male: 32 (61.5%) vs 38 (67.9%), P = .548; age: 59.2 (±10.9) vs 56.8 (±13.4), P = .681; and LVEF: 34.1 (±0.2) vs 31.3 (±8.7), P = .064, respectively. At the mean follow‐up of 15.7 months, overall mortality occurred in 14 (12.9%) patients, with a higher incidence in patients with CD cardiomyopathy, 11 (21.2%) vs 3 (5.4%), P = .021 (log‐rank). In the multivariate analysis, CD remained as an independent predictor for death (hazard ratio: 4.62, confidence interval [95% CI]: 1.27‐16.81, P = .021).

Conclusion

CD was associated with a poor short‐term outcome in patients with HF submitted to ICD implantation for secondary prevention when compared with other HF etiologies. In this specific HF population, ICD indication should be individualized, considering the worst prognosis of these patients.
GSK‐3β inhibition protects the rat heart from the lipopolysaccharide‐induced inflammation injury via suppressing FOXO3A activity
Authors: Li Zhigang , Zhu Huifang , Liu Chang , Wang Yumei , Wang Duo , Liu Huan , Cao Wenze , Hu Yi , Lin Qin , Tong Chang , Lu Min , Sachinidis Agapios , Li Li , Peng Luying
Published: September 2019

Sepsis‐induced cardiac dysfunction represents a main cause of death in intensive care units. Previous studies have indicated that GSK‐3β is involved in the modulation of sepsis. However, the signalling details of GSK‐3β regulation in endotoxin lipopolysaccharide (LPS)‐induced septic myocardial dysfunction are still unclear. Here, based on the rat septic myocardial injury model, we found that LPS could induce GSK‐3β phosphorylation at its active site (Y216) and up‐regulate FOXO3A level in primary cardiomyocytes. The FOXO3A expression was significantly reduced by GSK‐3β inhibitors and further reversed through β‐catenin knock‐down. This pharmacological inhibition of GSK‐3β attenuated the LPS‐induced cell injury via mediating β‐catenin signalling, which could be abolished by FOXO3A activation. In vivo, GSK‐3β suppression consistently improved cardiac function and relieved heart injury induced by LPS. In addition, the increase in inflammatory cytokines in LPS‐induced model was also blocked by inhibition of GSK‐3β, which curbed both ERK and NF‐κB pathways, and suppressed cardiomyocyte apoptosis via activating the AMP‐activated protein kinase (AMPK). Our results demonstrate that GSK‐3β inhibition attenuates myocardial injury induced by endotoxin that mediates the activation of FOXO3A, which suggests a potential target for the therapy of septic cardiac dysfunction.
Comments to the letter to the editor by Dr Sweta Subhadarshani
Authors: Naafs B. , Alemu Belachew W.
Published: September 2019

Linked article: S. Subhadarshani et al. J Eur Acad Dermatol Venereol 2020; 34: e72–e73. https://doi.org/10.1111/jdv.15948.
Estimating the costs and benefits of stroke rehabilitation in South Africa
Authors: Louw Quinette , Twizeyemariya Asterie , Grimmer Karen , Leibbrandt Dominique
Published: September 2019

Objective

This paper explores the economic value of rehabilitation to South Africa, using a costed example of cerebrovascular accident (CVA) (stroke) rehabilitation.

Design

We report an economic modelling approach using a worked cost‐effectiveness to validate the argument for the cost‐saving benefits of stroke rehabilitation.

Setting

South African health care, employing analysis of available secondary data from South African research and government reports.

Participants

In line with international trends in stroke epidemiology, we focused on people who were employed prior to having their stroke, with return‐to‐work as the desired rehabilitation outcome.

Interventions

Not applicable.

Main outcome measure(s)

We used information on stroke rehabilitation and secondary data derived from grey and published literature, to determine if early stroke rehabilitation represents value for money from the government perspective. For our worked example, we used return‐to‐work rates, intervention costs, and the cost of rehabilitation services to estimate cost‐savings as a result of an individualized workplace intervention.

Results

The cost of delivering the individualized intervention was estimated at R5633/patient. Combining survivor rates, return‐to‐work rate, and costs of the programme, a work intervention programme could result in a net saving of R133.1 million over 5 years (or about R26.6 per year (discount 3%).

Conclusion

The value of rehabilitation should not be considered in terms of cost‐effectiveness alone, but also as an investment for the country. A staged, prioritized approach should be considered in future South African national health budget.
Scale‐up of extraction processes: Dimensionless modeling and virtualization via lattice Boltzmann method
Authors: Rabi José A. , de Lima Caneppele Fernando , Ribeiro Rogers , Dacanal Gustavo C.
Published: September 2019

While modeling and virtualization pose challenges and opportunities to food engineering, lattice Boltzmann method (LBM) is a recent computational technique. By relying on existing dynamic one‐dimensional models, in‐house LBM simulators have been developed toward extraction processes in agitated‐batch or continuous‐flow equipment. In view of supporting process scale‐up, this work aimed at casting the aforesaid extraction models (and related LBM simulators) in dimensionless form. Together with available experimental data for validation, pectin extraction from fruit peels in agitated reactor and essential oil extraction from gorse in fixed bed were taken as case studies. Primitive influencing parameters (e.g., intraparticle diffusivity, solid–fluid partition coefficient, fluid‐phase diffusivity, bed length, and interstitial fluid velocity) were fruitfully lumped into fewer dimensionless parameters (e.g., mass‐transfer Biot, Péclet and Damköhler numbers). In‐house LBM simulators remained operational in their dimensionless versions, with a reduced amount of dimensionless numbers indeed grouping the influence of different process parameters, which may help future sensitivity analyses and scale‐up procedures.

Practical Applications

Initially used for academic purposes, computational modeling has experienced notable evolution and has become strategic to research, development, and innovation (RD&I) in food processing. Computational modeling can support novel food processes as different parameters and scenarios can be quickly simulated toward scale‐up and cost‐effectiveness. Accordingly, computational modeling may save valuable material, energy, water, and human resources in RD&I activities at industrial scale. The present work casts in‐house computer codes to numerically simulate extraction processes in either agitated‐batch or continuous‐flow equipment into dimensionless form. Related process parameters in primitive form were fruitfully lumped into fewer dimensionless numbers, which may ease scale‐up as well as sensitivity analysis.
Low‐Interventional Approaches to Intrapartum Care: Hospital Variation in Practice and Associated Factors
Authors: Lundsberg Lisbet S. , Main Elliott K. , Lee Henry C. , Lin Haiqun , Illuzzi Jessica L. , Xu Xiao
Published: September 2019

Introduction

Despite evidence supporting the safety of low‐interventional approaches to intrapartum care, defined by the American College of Obstetricians and Gynecologists as “practices that facilitate a physiologic labor process and minimize intervention,” little is known about how frequently such practices are utilized. We examined hospital use of low‐interventional practices, as well as variation in utilization across hospitals.

Methods

Data came from 185 California hospitals completing a survey of intrapartum care, including 9 questions indicating use of low‐ versus high‐interventional practices (eg, use of intermittent auscultation, nonpharmacologic pain relief, and admission of women in latent labor). We performed a group‐based latent class analysis to identify distinct groups of hospitals exhibiting different levels of utilization on these 9 measures. Multivariable logistic regression identified institutional characteristics associated with a hospital's likelihood of using low‐interventional practices. Procedure rates and patient outcomes were compared between the hospital groups using bivariate analysis.

Results

We identified 2 distinct groups of hospitals that tended to use low‐interventional (n = 44, 23.8%) and high‐interventional (n = 141, 76.2%) practices, respectively. Hospitals more likely to use low‐interventional practices included those with midwife‐led or physician‐midwife collaborative labor management (adjusted odds ratio [aOR], 7.52; 95% CI, 2.53‐22.37; P < .001) and those in rural locations (aOR, 3.73; 95% CI, 1.03‐13.60; P = .04). Hospitals with a higher proportion of women covered by Medicaid or other safety‐net programs were less likely to use low‐interventional practices (aOR, 0.96; 95% CI, 0.93‐0.99; P = .004), as were hospitals in counties with higher medical liability insurance premiums (aOR, 0.53; 95% CI, 0.33‐0.85; P = .008). Hospitals in the low‐intervention group had comparable rates of severe maternal and newborn morbidities but lower rates of cesarean birth and episiotomy compared with hospitals in the high‐intervention group.

Discussion

Only one‐quarter of hospitals used low‐interventional practices. Attention to hospital culture of care, incorporating the midwifery model of care, and addressing medical‐legal concerns may help promote utilization of low‐interventional intrapartum practices.
Topical metformin in the treatment of melasma: A preliminary clinical trial
Authors: Banavase Channakeshavaiah Ravikumar , Andanooru Chandrappa Naveen Kumar
Published: September 2019

Background

Melasma is a common acquired pigmentary disorder characterized by symmetric hyperpigmented macules on the face. Triple combination cream (TCC) remains the gold standard treatment but its prolonged use often causes adverse effects. Recently, studies have shown that topical metformin has melanopenic action.

Aims

To evaluate the safety and efficacy of topical metformin in the treatment of melasma and to compare its efficacy with TCC (hydroquinone 2% + tretinoin 0.025% + fluocinolone acetonide 0.01%).

Methods

This was a randomized controlled study conducted on 40 patients with melasma aged more than 18 years. Patients in group 1 (n = 20) were treated with 30% metformin lotion, whereas group 2 patients (n = 20) were treated with TCC for 8 weeks. Pigmentation was assessed using Melasma Area and Severity Index (MASI) at baseline and after 8 weeks. Outcome measures included global improvement scale (grades 1‐4) and patient satisfaction. Safety was assessed according to adverse events and patch testing.

Results

All 40 patients completed the study. Out of 20 patients in group 1, 11 showed grade 1 improvement (1% to <25%) and grade 2 (25%‐50%) and grade 3 (>50%‐75%) improvements were seen in one patient each. In group 2, grades 1, 2, 3, and 4 improvements were seen in 14, 2, 1, and 1 patients, respectively. However, the difference was not statistically significant. Adverse events were noted in three patients in group 2 and none in group 1.

Conclusion

Topical metformin is a novel, safe, and almost as effective modality as TCC to treat melasma.
Decreased cytokeratin 7 expression correlates with the progression of cervical squamous cell carcinoma and poor patient outcomes
Authors: Hashiguchi Mariko , Masuda Masanori , Kai Keita , Nakao Yoshifumi , Kawaguchi Atsushi , Yokoyama Masatoshi , Aishima Shinichi
Published: September 2019

Aim

To identify potential biomarkers for tumor progression and patient outcomes in cervical squamous cell carcinoma.

Methods

We examined the expressions of CK7 and CK17 as potential markers of the squamo‐columnar junction, and podoplanin as a basal cell marker using surgical and biopsy samples of patients in grade 3 cervical intraepithelial neoplasia (n = 30), operable invasive carcinoma (OP group, n = 53) and inoperable invasive carcinoma before radiotherapy and/or chemotherapy (RC group, n = 76).

Results

The positive rates of CK7 and podoplanin in invasive carcinoma were significantly lower than those in grade 3 cervical intraepithelial neoplasia (P = 0.001, P < 0.0001). The positive rates of CK7 and podoplanin in the RC group were significantly lower than those in the OP group (P < 0.0001, P = 0.04), while CK17 expression showed significantly higher positivity in the RC group than in the OP group (P < 0.0001). Negative CK7 expression showed a potential impact on overall survival in early‐stage patients. In the RC group, the prevalence of cases with post‐therapeutic residual carcinoma cells was higher in the CK7‐negative group than in the positive group (P = 0.003). We found that decreased expression of CK7 could be a prognostic factor in early‐stage cervical cancer patients.

Conclusion

This result may provide strategies and suggestions for new treatment options and follow‐up practices in managing patients with cervical cancer.
Preferred way of delivery of the impacted fetal head in cesarean sections during second stage of labor
Authors: Gil Moran , Chill Henry H. , Kogan Liron , Porat Shay , Levitt Lorinne , Eliasi Elior , Dior Uri
Published: September 2019

Aim

To compare maternal and neonatal outcomes between the ‘head first’ and ‘legs first’ delivery methods during a second stage cesarean section.

Methods

We conducted a retrospective study between January 2009 and May 2015 at a large public university tertiary referral center. Included were all women who underwent cesarean delivery with a fully dilated cervix and a fetal head at the level of the ischial spines or below. The study population was divided into two groups according to way of fetal delivery: The ‘legs first’ (reverse breech) method and the ‘head first’ method. Demographics and maternal and fetal outcomes were retrieved for both groups.

Results

During the study period 447 women underwent a cesarean section while their cervix was fully dilated. Of them, 321 met the inclusion criteria: One hundred and twenty‐one (38%) were delivered using the ‘legs first’ method and 200 (62%) were delivered using the ‘head first’ method. Indication for surgery and fetal head station was similar for both groups. While no difference in overall intraoperative uterine incision extension rate was observed, a higher rate of uterine incision extension was demonstrated in the ‘head first’ group in cases in which the second stage was longer than 180 min (33 vs 8 cases, P = 0.02). No differences in maternal postoperative complication rates and neonatal outcomes were observed.

Conclusion

Fetal extraction via the ‘legs first’ method during prolonged second stage of labor may lower maternal morbidity. Method of delivery does not seem to have an effect on neonatal outcomes.
Prenatally diagnosed congenital hemangioma with elevated middle cerebral artery peak systolic velocity mimicking the Kasabach‐Merritt phenomenon: A case report
Authors: Someya Masayuki , Sasahara Jun , Yamamoto Satoshi , Sawada Akihisa , Nishikawa Masanori , Ishii Keisuke
Published: September 2019

Congenital hemangioma is a rare vascular tumor that develops prenatally, and a large congenital hemangioma may be accompanied by the Kasabach‐Merritt phenomenon. We present a case of prenatally diagnosed fetal congenital hemangioma through ultrasound and maternal anti‐Jr(a) antibody alloimmunization with elevated middle cerebral artery peak systolic velocity. To investigate fetal anemia and hemostatic condition, we performed percutaneous umbilical blood sampling, which revealed no symptom of either Kasabach‐Merritt phenomenon or sensitization to anti‐Jr(a) antibody. Consequently, pregnancy could be continued without further intervention. After birth, congenital hemangioma was found on the infant's left thigh, and Kasabach‐Merritt phenomenon was not shown. Percutaneous umbilical blood sampling could provide precise information prenatally in case of congenital hemangioma with maternal alloimmunization.
Biofilm production by pathogens associated with canine otitis externa, and the antibiofilm activity of ionophores and antimicrobial adjuvants
Authors: Chan Wei Yee , Hickey Elizabeth E. , Page Stephen W. , Trott Darren J. , Hill Peter B.
Published: September 2019

Otitis externa (OE) is a frequently reported disorder in dogs associated with secondary infections by Staphylococcus, Pseudomonas and yeast pathogens. The presence of biofilms may play an important role in the resistance of otic pathogens to antimicrobial agents. Biofilm production of twenty Staphylococcus pseudintermedius and twenty Pseudomonas aeruginosa canine otic isolates was determined quantitatively using a microtiter plate assay, and each isolate was classified as a strong, moderate, weak or nonbiofilm producer. Minimum biofilm eradication concentration (MBEC) of two ionophores (narasin and monensin) and three adjuvants (N‐acetylcysteine (NAC), Tris‐EDTA and disodium EDTA) were investigated spectrophotometrically (OD570nm) and quantitatively (CFU/ml) against selected Staphylococcus and Pseudomonas biofilm cultures. Concurrently, minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of planktonic cultures were assessed. 16/20 of the S. pseudintermedius clinical isolates were weak biofilm producers. 19/20 P. aeruginosa clinical isolates produced biofilms and were distributed almost equally as weak, moderate and strong biofilm producers. While significant antibiofilm activity was observed, no MBEC was achieved with narasin or monensin. The MBEC for NAC ranged from 5,000–10,000 µg/ml and from 20,000–80,000 µg/ml against S. pseudintermedius and P. aeruginosa, respectively. Tris‐EDTA eradicated P. aeruginosa biofilms at concentrations ranging from 6,000/1,900 to 12,000/3,800 µg/ml. The MBEC was up to 16‐fold and eightfold higher than the MIC/MBC of NAC and Tris‐EDTA, respectively. Disodium EDTA reduced biofilm growth of both strains at concentrations of 470 µg/ml and higher. It can be concluded that biofilm production is common in pathogens associated with canine OE. NAC and Tris‐EDTA are effective antibiofilm agents in vitro that could be considered for the treatment of biofilm‐associated OE in dogs.
Drivers of the growth–survival trade‐off in a tropical forest
Authors: Meira‐Neto João Augusto Alves , Nunes Cândido Hélder Marcos , Miazaki Ângela , Pontara Vanessa , Bueno Marcelo Leandro , Solar Ricardo , Gastauer Markus
Published: September 2019

Questions

The growth–survival trade‐off is a central concept for the conflicting strategies of acquisitive species that grow quicker and conservative species that grow slower. Understanding which, and how, cross‐species functional traits contribute to the growth–survival trade‐off is a key topic for understanding the functioning of tropical forests. The present study aimed to: (a) determine if leaf traits, wood density and fruit size influence the growth–survival trade‐off at the community level; and (b) test the hypothesis that averaged leaf traits, averaged wood density and averaged fruit size among all trees of subplots explain tree height in a 50‐ha plot of secondary Atlantic Forest in Brazil.

Methods

All trees with DBH > 3 cm had their heights estimated and were taxonomically identified. The functional traits used were leaf length (LL), leaf width (LW), petiole length (PL), petiole width (PW), leaf width/petiole width (LW/PW), leaf length × leaf width (LL*LW), wood density (WD), fruit length (FL) and fruit width (FW).

Results

A total of 74,335 trees of 178 species were recorded in 5,076 subplots of 100 m2. Associations between functional traits and mean height (Hmean) and height mode (Hmode) were congruent with expected trends of LW, LL, LW/PW, WD and FW with the top‐ranked global model explaining most of the found variance suggesting that Hmean and Hmode are the best averaged response variables. The growth response represented by Hmean and Hmode had the most distinctive, congruent and consistent association with LW/PW, WD and FW.

Conclusions

Higher LW and higher LW/PW indicated higher dependence of leaf blade on local microclimatic conditions, and lower dependence on petiole support for plant growth, which is beneficial for the acquisitive strategy. Smaller fruits and higher WD were also associated with the acquisitive strategy. Therefore, LW, LW/PW, WD and FW influenced the growth–survival trade‐off at the community level and explained tree height variation in the studied tropical forest.
The medical impact of hepatitis D virus infection in Uzbekistan
Authors: Khodjaeva Malika , Ibadullaeva Nargiz , Khikmatullaeva Aziza , Joldasova Elizaveta , Ismoilov Umed , Colombo Massimo , Caviglia Gian Paolo , Rizzetto Mario , Musabaev Erkin
Published: September 2019

Background & Aims

The hepatitis B virus (HBV) is endemic in Uzbekistan but the medical impact of infection with the HBV‐dependent hepatitis D virus (HDV) is unknown in the Country. An Hepatology Center was recently established at the Institute of Virology in Tashkent, which has set up a database enlisting patients with chronic viral liver disorders from all over Uzbekistan; it provides an observatory on the current scenario of viral hepatitis in the Country.

Methods

The prevalence of HBV monoinfection, hepatitis C virus (HCV) infection and HDV superinfection on hepatitis B surface antigen (HBsAg)‐positive cirrhosis was determined in 6589 patients with viral cirrhosis collected in the last 3 years.

Results

Of 1089, 1150 and 1455 carriers of the HBsAg with cirrhosis recruited in 2016, 2017 and 2018, 834 (76.5%), 926 (80.5%) and 1224 (84%) respectively, had antibody to the HDV. In 2016, 2017 and 2018, the prevalence of HDV infection has been 41%, 45% and 49.1% respectively, largely exceeding the prevalence of HBV monoinfection (12.5%, 11% and 9.3% respectively) and surpassing the prevalence of HCV in 2017 and 2018 (44% and 41.5% respectively). The median age of the patients with HDV cirrhosis was 39 years, distinctly lower than that of HBV and HCV patients (46 and 55).

Conclusions

Superinfection with the HDV is present in over 80% of the HBsAg‐positive cirrhosis in Uzbekistan. The HDV appears to be the major cause of advanced viral liver disease and of juvenile cirrhosis in the Country.
Management of portal hypertension and ascites in polycystic liver disease
Authors: Bernts Lucas H. P. , Drenth Joost P. H. , Tjwa Eric T. T. L.
Published: September 2019

Patients suffering from polycystic liver disease may develop Hepatic Venous Outflow Obstruction, Portal Vein Obstruction and/or Inferior Caval Vein Syndrome because of cystic mass effect. This can cause portal hypertension, leading to ascites, variceal haemorrhage or splenomegaly. For this review, we evaluate the evidence to provide clinical guidance for physicians faced with this complication. Diagnosis is made with imaging such as ultrasound, computed tomography or magnetic resonance imaging. Therapy includes conventional therapy with diuretics and paracentesis, and medical therapy using somatostatin analogues. Based on disease phenotype various (non‐)surgical liver‐volume reducing therapies, hepatic or portal venous stenting, transjugular intrahepatic portosystemic shunts and liver transplantation may be considered. Because of complicated anatomy, use of high‐risk interventions and lack of empirical evidence, patients should be treated in expert centres.
Long‐term outcomes after liver transplantation in the Hispanic population
Authors: Ochoa‐Allemant Pedro , Ezaz Ghideon , Trivedi Hirsh D. , Sanchez‐Fernandez Lady , Bonder Alan
Published: September 2019

Background & Aims

Racial/ethnic disparities in liver transplantation (LT) are well‐recognized. Although Hispanics represent the largest and youngest minority group in the United States, limited data exist on long‐term outcomes. We aimed to investigate long‐term post‐liver transplant outcomes in Hispanic patients and identify potential disparities compared to a baseline demographic of non‐Hispanic white patients.

Methods

We performed a retrospective cohort study of first‐time liver transplant recipients using the United Network for Organ Sharing database from 2002 to 2013, with follow‐up through 2018. The primary outcomes of interest were overall patient and graft survival after LT.

Results

45 767 patients underwent LT (85.0% non‐Hispanic white, 15.0% Hispanic). Hispanics had lower socioeconomic status, higher prevalence of pretransplant comorbidities and more severe liver disease compared to non‐Hispanic whites. Hispanics had similar patient (76.6% vs 75.6%;P = .12) and graft (71.7% vs 70.8%;P = .28) survival at 5 years and significantly better patient (62.9% vs 59.7%;P < .001) and graft (58.6% vs 55.6%;P = .002) survival at 10 years. In multivariable analysis, Hispanics had lower associated all‐cause mortality (HR 0.86, 95% CI, 0.82‐0.91;P < .001) and graft failure (HR 0.89, 95% CI, 0.85‐0.93;P < .001) compared to non‐Hispanic whites. In etiology‐specific subanalysis, Hispanics transplanted for ALD, NASH and HCV had lower all‐cause mortality compared to non‐Hispanic whites.

Conclusions

Hispanics have similar or better long‐term post‐LT outcomes compared to non‐Hispanic whites despite a worse pretransplant risk factor profile. Further research is needed to clarify if this survival advantage reflects uncaptured protective factors or more stringent transplant selection in the Hispanic population.
PAOLO MANTEGAZZA'S VISION: The Science of Man behind the World's First Museum of Anthropology (Florence, Italy, 1869)
Authors: Taylor Paul Michael , Marino Cesare
Published: September 2019

This article examines some significant yet little‐known early anthropological achievements in Italy. These include the world's first museum of anthropology, founded in 1869 by Paolo Mantegazza (1831–1910) at Florence (Firenze), Italy, where that same year he also established Italy's (and the world's) first cattedra (university professorship) of anthropology. Mantegazza sought to develop a unified “science of man,” with a broad definition of the new discipline that brought together human physiological, ethnographic, and “comparative psychology” collections within his new anthropology museum, later complemented by a companion “psychological” museum. Even though Mantegazza's Florentine school of anthropology ended under Fascism, today the surviving Museum of Anthropology in Florence is still the repository of important ethnographic collections from early Italian traveler‐explorers and other contributors. Their study was an important component of Mantegazza's science, which is receiving new attention by modern Italian anthropologists.
AT HOME AND ABROAD: Reflections on Collaborative Museum Ethnography at the Mathers Museum of World Cultures
Authors: Jackson Jason Baird
Published: September 2019

In a reflective essay, the author draws upon experiences in two ongoing projects to suggest ways in which the literatures on museum‐based ethnographic collaboration might be enriched and extended. One illustrative project is a binational, multi‐institutional endeavor linking six museums within a larger program of cooperation led by two national scholarly societies. The other case is the work of an ethnographically oriented, museum‐based public arts program working on a statewide basis in a midwestern state in the United States. The author concludes with a call to develop frameworks for fostering partnership activities between museums of ethnography.
Nippostrongylus brasiliensis infection inhibits hippocampal neurogenesis in mice
Authors: Sakurai Masashi , Kurachi Junya , Sakai Yusuke , Morimoto Masahiro
Published: September 2019

The brain has long been considered a site of “immune privilege”; however, recent evidence indicates the presence of brain–immune interactions in physiological and pathological conditions. Neurogenesis, a process of generating functionally integrated neurons, occurs in the adult brain of mammals. The adult neurogenesis predominantly takes place in the subgranular zone (SGZ) of the hippocampal dentate gyrus and the subventricular zone (SVZ). Several studies have shown that an immune reaction or alteration could affect adult neurogenesis activity, suggesting a link between the immune system and adult neurogenesis. Helminth infection is one of the activators of Th2 immune response. However, the influence of this type of immune reaction on adult neurogenesis is not well studied. In this study, we evaluated adult neurogenesis in mice infected with the helminth Nippostrongylus brasiliensis (Nb). Immunohistochemically, the number of both doublecortin‐positive cells and doublecortin/5‐bromodeoxyuridine (BrdU)‐double‐positive cells was decreased in the SGZ of Nb‐infected mice by day 9 after infection. However, the total number of BrdU‐positive newborn cells in the SGZ did not change. In no significant alterations were detected in the SVZ of infected mice. In addition, using reverse transcription‐quantitative polymerase chain reaction, we observed no significant changes in the expression levels of neurotropic factors important for neurogenesis in the hippocampus. In conclusion, our results indicate that adult neurogenesis in SGZ, but not in SVZ, is inhibited by Nb infection. Th2 immune response might have a suppressive effect on hippocampal neurogenesis.
Epidemiology, etiology, and outcomes of out‐of‐hospital cardiac arrest in young patients in lebanon
Authors: Refaat Marwan M. , Kozhaya Karim , Abou‐Zeid Farah , Abdulhai Farah , Faour Kawthar , Mourani Sara Catherine , Abi‐Gerges Carine , Bachir Rana , Musharrafieh Umayya , El Sayed Mazen
Published: September 2019

Background

The burden of out‐of‐hospital cardiac arrest (OHCA) on different population segments in developing countries is not well studied. Previous studies from Lebanon report poor survival to hospital discharge (4.8%‐5.5%). This study describes characteristics and outcomes of young OHCA victims in Beirut, Lebanon

Methods

This retrospective observational study included young patients (<35 years of age) with OHCA admitted to the emergency department (ED) of a tertiary care center in Lebanon over a 10‐year period.

Results

Fifty‐four patients with OHCA were identified. Most were males (74.1%, n = 40) and the mean age was 17.9 ± 10.9 years. The most common arrest location was home (44.4%, n = 24). The majority were witnessed (78.8%, n = 41) with 15.4% (n = 8) witnessed by emergency medical services (EMS). Prehospital cardiopulmonary resuscitation was done for 22 patients (41.5%) mostly by EMS (n = 19, 86.4%), 9.1% (n = 2) by a bystander, and 4.5% (n = 1) by a family member. Prehospital automated external defibrillator use was documented in 13% (n = 7) of cases. Most patients (n = 48, 88.9%) were resuscitated in the ED where the most common rhythm was asystole (55.6%, n = 30). Half of the patients (50%, n = 27) survived to hospital admission. Overall survival to hospital discharge was 16.7% (n = 9). Good neurologic outcome (cerebral performance category 1 or 2) was documented in seven patients (9.3%).

Conclusion

Survival rate of young OHCA victims in Lebanon (16.7%) is higher than previously reported rates of OHCA in the overall population. Targeted community activities and medical oversight of EMS activities are needed to link EMS activities to clinical outcomes.