bluuebunny/crossref_metadata_2025 huggingface dataset:
Research on steam flow excited vibration of nuclear power condenser based on full three-dimensional numerical simulation technology
Authors: Zu Shuai , Chen Jie , Che Yinhui , Wang Guoshan , Wu Zhenpeng , Wang Jiasheng , Zhu Caihua , Zhang Qiang , Dong Bowen
Published: March 2022

Numerical calculation is regarded as the most effective research method for studying problems about a condenser due to the experimental difficulty caused by the huge size. However, almost all numerical research studies about condensers are two-dimensional, which severely reduce the reliability of the research about a three-dimensional problem. In this case, a full three-dimensional computational fluid dynamics (CFD) method based on a porous medium model was first used to study the seawater leakage event in a condenser. The steam flow field of the condenser under a series of operation conditions was obtained. The distribution of a risk coefficient of steam flow excited vibration (SFEV) was obtained as well. The results show that the sweep velocity of steam across a titanium tube was the primary factor determining the risk coefficient of SFEV. The risk of SFEV of the outer layer in the upper finger joint region is relatively high. It is necessary to install anti-abrasive strips or implement preventive tube plugging. According to the calculated results, the recommended values of electric power limits for a nuclear power unit were given, which was 840 MW under half-side condenser operation conditions in summer. Through comparing the simulated flow field before and after tube plugging, it is found that local tube plugging in the high-risk area will transfer the position of the high-risk point of SFEV.
The early history of clicks in Nguni
Authors: Gunnink Hilde
Published: March 2022

Language contact between migrating Bantu speakers and resident Khoisan speakers has resulted in the adoption of clicks in various southern African Bantu languages. This paper uses the comparative method to show that for one particular cluster of Bantu click languages, the Nguni languages, a large number of phonemic clicks can be reconstructed to its putative ancestor Proto-Nguni, including a palatal click rarely found in Bantu languages and no longer used as such in any living Nguni language. Although clicks have undergone subsequent developments in individual Nguni languages, no new click phonemes were acquired through language contact, showing that clicks were already present very early in the history of the Nguni languages. This relative chronology provides new insights into how the relations between Bantu- and Khoisan-speaking communities in southern Africa developed over time.
The hapax / type ratio
Authors: Van Wettere Niek
Published: March 2022

This article addresses one of the lesser-known productivity measures, namely the hapax / type ratio (HTR). Through a case study involving the Dutch semi-copularaken(“attain”), it is shown that the HTR more or less stabilizes from a certain sample size onwards. Moreover, this point of stabilization seems to coincide with an increased permanency of the hapaxes, i.e. the share of hapaxes that convert quickly to non-hapaxes is not as large as was the case at the beginning of the sampling process. Therefore, the stabilization of the HTR might be a good indicator of minimally required sample size in productivity studies, suggesting that the hapaxes are ‘non-incidental’ from this sample size onwards. However, I did not find a clear link between the onset of the stabilization of the HTR and the extent to which the inventory of types accounted for at the top of the frequency distribution is (quasi-)complete.
Aspects ofvæ(‘and’) as a discourse marker in Persian
Authors: Kazemian Reza , Amouzadeh Mohammad
Published: March 2022

This study investigates the functions ofvæ(‘and’) as a discourse marker in Persian. More specifically, this study accounts for certain aspects ofvæco-occurrences and their linearization order. Fraser’s model (forthcoming) was mainly employed to classify the multiple functions conveyed byvæ. A corpus-based approach was taken to provide an overview ofvæco-occurrences with other discourse markers. The data were collected from both written and spoken corpora. Quantitative and qualitative analyses were conducted to examine the frequency and the functional differences in the use ofvæin the data – namely, elaboration, inferential, contrast, and alternation. The results of the study indicate the mobile nature ofvæin its co-occurrences with other DMs. The findings also show that some modifications toFraser’s (forthcoming)DM co-occurrence principles are required to handle certain cases of language-specific behavior ofvæin Persian. The configuration suggested forvæuses and its multi-functionality will also shed some lights on cross-linguistic studies of its counterparts in other languages.
On affine iterated function systems which robustly admit an invariant affine subspace
Authors: Morris Ian
Published: March 2022

In this note we give a simple sufficient condition for an affine iterated function system to admit an invariant affine subspace persistently with respect to changes in the translation parameters. This yields further examples of tuples of contracting linear maps which do not satisfy the conclusions of Falconer’s theorem on the Hausdorff dimension of almost every self-affine set. We also obtain new examples of iterated function systems of similarity transformations which cannot satisfy the open set condition for any choice of translation parameters, and resolve a related question of Peres and Solomyak.
Christoffel-Minkowski flows
Authors: Bryan Paul , Ivaki Mohammad , Scheuer Julian
Published: March 2022

We provide a curvature flow approach to the regular Christoffel–Minkowski problem. The speed of our curvature flow is of an entropy preserving type and contains a global term.
Necessary and sufficient conditions to Bernstein theorem of a Hessian equation
Authors: Du Shi-Zhong
Published: March 2022

The Hessian quotient equations
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Two quadratic growth conditions were found by Bao-Cheng-Guan-Ji [American J. Math. 125 (2013), pp. 301–316] ensuring the Bernstein properties of (0.1) and (0.2) respectively. In this paper, we will drop the point wise quadratic growth condition of Bao-Cheng-Guan-Ji and prove three necessary and sufficient conditions to Bernstein property of (0.1) and (0.2), using a reverse isoperimetric type inequality, volume growth or

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Who killed Bruce Lee? The hyponatraemia hypothesis
Authors: Villalvazo Priscila , Fernandez-Prado Raul , Niño Maria Dolores Sánchez , Carriazo Sol , Fernández-Fernández Beatriz , Ortiz Alberto , Perez-Gomez Maria Vanessa
Published: March 2022

Bruce Lee brought attention to martial arts in the Western world and popularized the quote ‘Be water, my friend’. Lee died at the age of 32 years in Hong Kong on 20 July 1973, under mysterious circumstances. The cause of death is unknown, although numerous hypotheses have been proposed, from assassination by gangsters to the more recent suggestion in 2018 that he died from heatstroke. The necropsy showed cerebral oedema. A prior episode was diagnosed as cerebral oedema 2 months earlier. We now propose, based on an analysis of publicly available information, that the cause of death was cerebral oedema due to hyponatraemia. In other words, we propose that the kidney’s inability to excrete excess water killed Bruce Lee. In this regard, Lee had multiple risk factors for hyponatraemia that may have included high chronic fluid intake, factors that acutely increase thirst (marijuana) and factors that decrease the ability of the kidneys to excrete water by either promoting secretion of antidiuretic hormone (ADH) or interfering with water excretion mechanisms in kidney tubules: prescription drugs (diuretics, non-steroidal anti-inflammatory drugs, opioids, antiepileptic drugs), alcohol, chronic low solute intake, a past history of acute kidney injury and exercise.
Innovate to eliminate: a prerequisite in NTD programmes
Authors: Rust Jennifer , Clark Amy , Woodgate Mary , Koch Christina , Mohammed Taylor , Steinmann Peter , Krentel Alison , Torres-Vitolas Carlos A , Carlin Alexandra , Pavluck Alexandre
Published: March 2022

Innovation plays a critical role in progress towards achievement of the World Health Organization's road map for neglected tropical diseases 2021–2030. As disease prevalence decreases, the cost to identify and treat remaining cases goes up. Additionally, as programmes move to the surveillance phase, diagnostic tests need to be highly sensitive and affordable. Until the early end to the Ascend West and Central Africa programme, the Ascend Learning and Innovation Fund supported five projects from 2019 to 2021. Designed for innovation, the fund encompassed a range of activities, including operational research, product development and social behavioural change. This flexibility allowed innovation to bridge the gap between strategic policy and practical implementation, piloting and proving business models to respond to information found through Ascend.
Lubabegron fumarate acts as a β-adrenergic receptor antagonist in cultured bovine intramuscular and subcutaneous adipocytes
Authors: Hwang Jinhee H , Kube John C , Smith Stephen B
Published: March 2022

We hypothesized that lubabegron fumarate (LUB) (Experior, Elanco Animal Health, Greenfield, IN) would act as an antagonist to β-adrenergic receptor (β-AR) subtypes in primary bovine subcutaneous (s.c.) and intramuscular (i.m.) adipocytes differentiated in culture. This study employed LUB, dobutamine (DOB, a selective β1-agonist), salbutamol (SAL, a selective β2-agonist), and propranolol (PRO, a non-selective β-AR antagonist). Preadipocytes were isolated by standard techniques from bovine longissimus muscle and overlying s.c. adipose tissue and differentiated to adipocytes for 14 d. The adipocyte source x stage of differentiation interaction was significant for β-adrenergic receptors-1 (ADRB1) (P = 0.001) and ADRB2 (P = 0.01) in that expression of ADRB1 and ADRB2 was greater in s.c. adipocytes than in s.c. preadipocytes; expression of the ADRB1-3 did not change after differentiation of i.m. adipocytes. CCATT/enhancer-binding protein alpha (CEBPA) expression increased upon differentiation in both s.c. and i.m. adipocytes (P = 0.006). The source x stage of differentiation interaction was significant for peroxisome proliferator-activated receptor gamma (PPARG) (P ≤ 0.001) and fatty acid binding protein-4 (FABP4) (P = 0.004). Expression of PPARG increased after differentiation of s.c. preadipocytes to adipocytes, but PPARG expression did not change with differentiation of i.m. preadipocytes to adipocytes. FABP4 expression increased after differentiation of both s.c. and i.m. adipocytes, but FABP4 expression increased to a greater extent in s.c. adipocytes. In s.c. adipocytes, DOB elevated cAMP and glycerol production and protein kinase A (PKA) activity, and SAL increased PKA activity; these effects were abolished by LUB and PRO (P < 0.001). Incubation of i.m. adipocytes with SAL increased cAMP production and PKA activity, which was attenuated by LUB and PRO (P ≤ 0.006). In s.c. adipocytes, SAL, LUB + SAL, and LUB + DOB upregulated hormone sensitive lipase (HSL) (P < 0.001) and perilipin (P = 0.002) gene expression. In i.m. adipocytes, DOB and LUB + DOB increased HSL gene expression (P = 0.001) and LUB + SAL depressed adipose triglyceride lipase expression below control levels (P = 0.001). These results demonstrate that LUB is a β-AR antagonist at the β1-AR and β2-AR subtypes in s.c. adipocytes, and that s.c. and i.m. exhibit different responses to β-AA and LUB.
Technical Note: A method for determination of titanium dioxide concentration in fecal samples
Authors: Fowler Ashley L , Hayes Susan H , Crum Andrea D , Lawrence Laurie M
Published: March 2022

Titanium dioxide has been used as a marker for determining diet digestibility indirectly, but some authors have expressed difficulty in measuring TiO2 concentrations in fecal material. We developed an accurate and precise method to determine TiO2 concentrations in equine feces. The method includes dry-ashing samples, digestion with (NH4)2SO4 in concentrated sulfuric acid, followed by the addition of H2O2 to produce a yellow to orange color that can be read spectrophotometrically. Accuracy was tested by spike recovery, and precision was tested by examining the coefficient of variation (CV) between duplicates of 449 individual samples. The method described here was compared with a previously published method by examining CV between duplicates of samples analyzed using both methods and comparing them using a paired t-test. Titanium dioxide spike recovery averaged 106%, and the CV between duplicates averaged 4.0%, with 79% of sample pairs having a CV of <5%. When compared with a previously published method, the method described here had a lower CV between duplicates (P < 0.0001). The method described here provides an accurate and precise quantitative analytical procedure for TiO2 in equine fecal samples.
Effect of tofacitinib in a patient with inflammatory bowel disease–related arthritis
Authors: Lomborg Niels , Jensen Michael Dam
Published: March 2022

Extraintestinal manifestations are common in patients with chronic inflammatory bowel disease (IBD). Peripheral arthritis occurs in ∼10% of patients with IBD. Treatment of both arthritis and the IBD disease is challenging, and involvement of both the rheumatologist and the gastroenterologist is essential. We present a case with concomitant polyarthritis and ulcerative colitis successfully treated with tofacitinib. A 32-year-old woman with ulcerative colitis currently treated with azathioprine and adalimumab was referred to our rheumatology clinic due to pain and swelling in her knees and finger joints. The patient was diagnosed with IBD-related arthritis. Intra-articular injection with steroid was initially effective, but the arthritis was persistent. Treatment attempts with salazopyrine and golimumab were discontinued due to drug-induced pancreatitis and urticaria, respectively. Subsequently treatment with tofacitinib 10 mg twice daily was effective within weeks, and apart from a mild folliculitis, there were no side effects. With this case report, we would like to draw attention to the fact that treatment with tofacitinib may constitute a good treatment option in refractory cases of IBD-related arthritis.
Combined Clinical, Epidemiological, and Genome-Based Analysis Identified a Nationwide Outbreak of Burkholderia cepacia Complex Infections Caused by Contaminated Mouthwash Solutions
Authors: Bender Jennifer K , Haller Sebastian , Pfeifer Yvonne , Hogardt Michael , Hunfeld Klaus-Peter , Thürmer Andrea , Zanuzdana Arina , Werner Markus , Kunz Bernd , Eisenberger David , Pfennigwerth Niels , Kempf Volkhard A J , Werner Guido , Eckmanns Tim
Published: March 2022

Background

In September 2018, Burkholderia cepacia complex (BCC) infections in 3 patients associated with exposure to a mouthwash solution (MWS) were reported to the Robert Koch Institute (RKI). As the product was still on the market and the scale of the outbreak was unclear, a nation-wide investigation was initiated.

Methods

We aimed to investigate BCC infections/colonizations associated with MWS. Hospitals, laboratories, and public health services were informed that BCC isolates should be sent to the RKI. These isolates were typed by pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing (WGS) including development of an ad hoc core genome MLST (cgMLST) scheme.

Results

In total, 36 patients from 6 hospitals met the case definition, the last patient in November 2018. Twenty-nine isolates from 26 of these patients were available for typing. WGS analysis revealed 2 distinct cgMLST clusters. Cluster 1 (Burkholderia arboris) contained isolates from patients and MWS obtained from 4 hospitals and isolates provided by the manufacturer. Patient and MWS isolates from another hospital were assigned to cluster 2 (B. cepacia).

Conclusions

The combined clinical, epidemiological, and microbiological investigation, including whole-genome analysis, allowed for uncovering a supraregional BCC outbreak in health care settings. Strains of B. arboris and B. cepacia were identified as contaminating species of MWS bottles and subsequent colonization and putative infection of patients in several hospitals. Despite a recall of the product by the manufacturer in August 2018, the outbreak lasted until December 2018. Reporting of contaminated medical products and recalls should be optimized to protect patients.
Alfalfa biotypes with putative enhanced cell wall digestibility and effects on performance of growing beef steers
Authors: Karls Caleb W , Combs David K , Liou M , Schaefer Daniel M
Published: March 2022

Three alfalfa biotypes were chosen based on the presumption that they would be sources of alfalfa herbage that differed in lignin concentration and therefore cell wall digestibility. The hypothesis was that a lesser lignin concentration would result in greater alfalfa neutral detergent fiber (NDF) digestibility and greater beef steer growth performance. The three alfalfa biotypes were HarvXtra (Forage Genetics International), Hi-Gest 360 (Alforex Seeds), and a control alfalfa, LegenDairy XHD (Winfield Solutions LLC). High-moisture wrapped bales were prepared from second-harvest, d 30 crops. Digestibility of NDF was determined using in vitro incubations and a steer digestibility trial. Alfalfa baleage and trace mineral salt were fed to Angus steers (300 kg initial body weight, 4 pens/treatment) in an 83-day growing-phase trial. Alfalfa acid detergent lignin concentrations were 75.6, 71.8, and 63.0 g/kg dry matter (P = 0.34) for LegenDairy, Hi-Gest and HarvXtra, respectively. Based on in vitro total-tract NDF digestibility coefficients, HarvXtra tended (P ≥ 0.09) to have the highest NDF digestibility. Alfalfa biotype affected in vivo apparent total tract digestibility of NDF (P < 0.001) and there was a trend for an effect on acid detergent fiber digestibility (P = 0.051). Hi-Gest and HarvXtra had similar in vivo apparent NDF digestibilities, which were greater than for LegenDairy (P < 0.05). There was no alfalfa biotype effect on daily alfalfa dry matter intake (DMI; P = 0.51) or average daily gain (P = 0.25) by growing steers. The absence of an effect by the novel alfalfa biotypes on DMI by growing steers suggests that the compositional and digestibility differences of the novel alfalfa biotypes compared to LegenDairy were not sufficient to alleviate the limitation of physical fill (if evident) on DMI. If more disparity in cell wall composition and NDF digestibility were to exist between control and reduced-lignin biotypes, then perhaps an advantage in cattle growth performance for a reduced-lignin alfalfa biotype would be detectable.
The Virtual CTSA Visiting Scholar Program to Support Early-Stage Clinical and Translational Researchers: Implementation and Outcomes
Authors: Bredella Miriam A. , Rubio Doris M. , Attia Jacqueline , Kelly Thomas H. , McIntosh Scott , Meagher Emma A. , Pusek Susan , Rubio Mercedes , Tsevat Joel , Umans Jason G.
Published: March 2022

In addition to restrictions on conducting research, COVID-19-related travel bans and scientific meeting cancellations have negatively affected scholars in the Clinical and Translational Science Award (CTSA) Mentored Career Development Award (KL2) program. In response, a national virtual visiting scholar program was developed to provide opportunity for KL2 scholars to be virtual visiting professors at another CTSA hub, meet faculty and scholars, and expand networks and build collaborations. This article describes the design and short-term outcomes of the virtual CTSA Visiting Scholar Program. In 2020, a working group designed core program elements and developed an application and selection process. Anonymized surveys were sent to scholars post visit and to scholars and program directors 6 months post visit to evaluate their experience and solicit suggestions for improvements. Between November 2020 and May 2021, 56 KL2 scholars and 27 hubs participated. Forty-five (80.4%) participating scholars responded to the initial survey. Nearly all scholars (44, 97.7%) agreed their experience was valuable. All respondents indicated they would recommend the program to other KL2 scholars. For the 6-month survey, the response rate was 87.5% (49/56). Within 6 months of their visit, 36 (73.5%) respondents had contacted at least one person at the host hub and for 17 (34.7%) respondents, new collaborations with the host hub ensued. Twenty-five of 27 (92.6%) host hubs responded to the survey. Most (21, 84.0%) agreed that hearing visiting scholar talks was valuable to their own scholars and 23 (92%) indicated likelihood of their hub participating in future round of the program. The virtual Visiting Scholar Program provided KL2 scholars an opportunity to virtually visit another CTSA hub, present their research, and meet with faculty and other scholars to expand their networks. Although geared to KL2 scholars, this model is potentially generalizable to other nationally coordinated career development programs.
A Call to Action From the California Consortium for the Assessment of Clinical Competence: Making the Case for Regional Collaboration
Authors: Nevins Andrew B. , Boscardin Christy K. , Kahn Daniel , May Win , Murdock-Vlautin Theresa , Pau Candace Y. , Phillips Abigail , Racataian-Gavan Rebeca , Shankel Tamara , Wilkerson Luann , Wray Alisa , Charat Stacy
Published: March 2022

The discontinuation of the United States Medical Licensing Examination Step 2 Clinical Skills Examination emphasizes the need for other reliable standardized assessments of medical student clinical skills. For 30 years, the California Consortium for the Assessment of Clinical Competence (CCACC) has collaborated in the development of clinical skills assessments and has become a valuable resource for clinicians, standardized patient educators, psychometricians, and medical educators. There are many merits to strong multi-institutional partnerships, including the integration of data across multiple schools to provide feedback to both students and curricula, pooled test performance statistics for analysis and quality assurance, shared best practices and resources, individual professional development, and opportunities for research and scholarship. The infrastructure of the CCACC allows member schools to adapt to a changing medical landscape, from emerging trends in clinical medicine to the limitations imposed by a global pandemic. In the absence of a national examination, there is now a greater need for all medical schools to develop a comprehensive, dynamic, and psychometrically sound assessment that accurately evaluates clinical skills. Medical schools working together in regional consortia have the opportunity to create and implement innovative and robust assessments that evaluate a wide range of clinical skills, ensure that medical students have met an expected level of clinical competency before graduation, and provide a framework that contributes to ongoing efforts for the development of new national clinical skills standards.
Quality metrics and outcomes among critically ill patients in China: results of the national clinical quality control indicators for critical care medicine survey 2015–2019
Authors: Rui Xi , Dong Fen , Ma Xudong , Su Longxiang , Shan Guangliang , Guo Yanhong , Long Yun , Liu Dawei , Zhou Xiang ,   on behalf of China-NCCQC Group
Published: March 2022

Background:

It is crucial to improve the quality of care provided to ICU patient, therefore a national survey of the medical quality of intensive care units (ICUs) was conducted to analyze adherence to quality metrics and outcomes among critically ill patients in China from 2015 to 2019.

Methods:

This was an ICU-level study based on a 15-indicator online survey conducted in China. Considering that ICU care quality may vary between secondary and tertiary hospitals, direct standardization was adopted to compare the rates of ICU quality indicators among provinces/regions. Multivariate analysis was performed to identify potential factors for in-hospital mortality and factors related to ventilator-associated pneumonia (VAP), catheter-related bloodstream infections (CRBSIs), and catheter-associated urinary tract infections (CAUTIs).

Results:

From the survey, the proportions of structural indicators were 1.83% for the number of ICU inpatients relative to the total number of inpatients, 1.44% for ICU bed occupancy relative to the total inpatient bed occupancy, and 51.08% for inpatients with Acute Physiology and Chronic Health Evaluation II scores ≥15. The proportions of procedural indicators were 74.37% and 76.60% for 3-hour and 6-hour surviving sepsis campaign bundle compliance, respectively, 62.93% for microbiology detection, 58.24% for deep vein thrombosis prophylaxis, 1.49% for unplanned endotracheal extubations, 1.99% for extubated inpatients reintubated within 48 hours, 6.38% for unplanned transfer to the ICU, and 1.20% for 48-hour ICU readmission. The proportions of outcome indicators were 1.28‰ for VAP, 3.06‰ for CRBSI, 3.65‰ for CAUTI, and 10.19% for in-hospital mortality. Although the indicators varied greatly across provinces and regions, the treatment level of ICUs in China has been stable and improved based on various quality control indicators in the past 5 years. The overall mortality rate has dropped from 10.19% to approximately 8%.

Conclusions:

The quality indicators of medical care in China's ICUs are heterogeneous, which is reflected in geographic disparities and grades of hospitals. This study is of great significance for improving the homogeneity of ICUs in China.
Multicenter study of the clinicopathological features and recurrence risk prediction model of early-stage breast cancer with low-positive human epidermal growth factor receptor 2 expression in China (Chinese Society of Breast Surgery 021)
Authors: Xin Ling , Wu Qian , Zhan Chongming , Qin Hongyan , Xiang Hongyu , Xu Ling , Ye Jingming , Duan Xuening , Liu Yinhua
Published: March 2022

Background

: Breast cancer with low-positive human epidermal growth factor receptor 2 (HER2) expression has triggered further refinement of evaluation criteria for HER2 expression. We studied the clinicopathological features of early-stage breast cancer with low-positive HER2 expression in China and analyzed prognostic factors.

Methods

: Clinical and pathological data and prognostic information of patients with early-stage breast cancer with low-positive HER2 expression treated by the member units of the Chinese Society of Breast Surgery and Chinese Society of Surgery of Chinese Medical Association, from January 2015 to December 2016 were collected. The prognostic factors of these patients were analyzed.

Results

: Twenty-nine hospitals provided valid cases. From 2015 to 2016, a total of 25,096 cases of early-stage breast cancer were treated, 7642 (30.5%) of which had low-positive HER2 expression and were included in the study. After ineligible cases were excluded, 6486 patients were included in the study. The median follow-up time was 57 months (4–76 months). The disease-free survival rate was 92.1% at 5 years, and the overall survival rate was 97.4% at 5 years. At the follow-up, 506 (7.8%) cases of metastasis and 167 (2.6%) deaths were noted. Multivariate Cox regression analysis showed that tumor stage, lymphvascular invasion, and the Ki67 index were related to recurrence and metastasis (P < 0.05). The recurrence risk prediction model was established using a machine learning model and showed that the area under the receiving operator characteristic curve was 0.815 (95% confidence interval: 0.750–0.880).

Conclusions

: Early-stage breast cancer patients with low-positive HER2 expression account for 30.5% of all patients. Tumor stage, lymphvascular invasion, and the Ki67 index are factors affecting prognosis. The recurrence prediction model for breast cancer with low-positive HER2 expression based on a machine learning model had a good clinical reference value for predicting the recurrence risk at 5 years.

Trial registration

: ChiCTR.org.cn, ChiCTR2100046766.
VITRECTOMY FOR DIABETIC COMPLICATIONS
Authors: Rush Ryan B. , Rush Sloan W. , Reinauer Robert M. , Bastar Pedro Gomez , Browning David J.
Published: March 2022

Purpose:

To report updated clinical outcomes in subjects undergoing pars plana vitrectomy (PPV) using modern techniques and equipment for the treatment of proliferative diabetic retinopathy–related complications. Pooled analysis of five randomized clinical trials conducted at the same institution and included both study and control subjects from the trials.

Methods:

There were 943 subjects who prospectively underwent small-gauge PPV with antivascular endothelial growth factor pretreatment for proliferative diabetic retinopathy–related complications and completed 6-month follow-up.

Results:

The visual acuity of the study population improved from median 2.00 (interquartile range 1.3, 2.3) at baseline to median 1.00 (interquartile range 0.5, 1.3) at 6 months. One hundred and eighty-four patients (19.5%) achieved 20/50 or better acuity, and 652 patients (69.1%) achieved 20/200 or better acuity at 6 months. The vision improved or remained stable in 901 patients (95.5%), and 11 patients (1.2%) developed no light perception at 6 months. Intraoperative complications occurred in 343 cases (36.4%), and 199 cases (21.1%) experienced a postoperative complication. The most common postoperative complication was vitreous hemorrhage in 124 cases (62.3% of all complications). Unplanned secondary PPV was necessary in 86 cases (9.1%).

Conclusion:

This study reports updated clinical outcomes in patients undergoing PPV for proliferative diabetic retinopathy–related complications which compares favorably with the age before small-gauge PPV and antivascular endothelial growth factor pretreatment.
Anterior segment OCT findings and atypical refractive changes secondary to Epstein-Barr virus–associated nummular keratitis
Authors: Khan Asher , Murphy David A. , John Finny T. , Dastjerdi Mohammad H. , Riaz Kamran M.
Published: March 2022

Introduction:

This case study described refractive changes that can occur in the setting of Epstein-Barr virus (EBV)-associated nummular keratitis (NK) and highlighted the role that anterior segment optical coherence tomography can serve in diagnosis and management of this disease.

Patient and Clinical Findings:

A 15-year-old girl developed subepithelial and anterior stromal corneal lesions and experienced progressive decline in the corrected distance visual acuity. She also developed a significant myopic shift with increased keratometric and refractive astigmatism.

Diagnosis, Intervention, and Outcomes

Targeted laboratory testing was performed. A diagnosis of chronic EBV-associated NK was made, and the patient was treated with systemic valacyclovir and topical steroids. Clinical appearance of lesions and corrected distance visual acuity improved, although refractive and keratometric changes persisted.

Conclusions:

Significant and persistent refractive changes can occur in the setting of EBV-associated NK, similar to those seen after conductive keratoplasty. Anterior segment optical coherence tomography can be a potentially helpful supplementary diagnostic imaging modality to avoid invasive testing in such cases.
The Pennsylvania Rural Health Model: Hospitals’ Early Experiences With Global Payment for Rural Communities
Authors: Scanlon Dennis , Sciegaj Mark , Wolf Laura J. , Vanderbrink Jocelyn , Johannes Bobbie , Shaw Bethany , Shumaker Kassidy , Farley Diane , Kitt-Lewis Erin , Davis Lisa
Published: March 2022

Goal:

In January 2019, the first cohort of rural hospitals began to operate under the Pennsylvania Rural Health Model for all-payer prospective global budget reimbursement as part of a demonstration funded by the Center for Medicare and Medicaid Innovation. Using information from primary source documents and interviews with key stakeholders, we sought to identify challenges and lessons learned throughout the design, development, and early implementation stages of the model.

Methods:

We relied on two qualitative research approaches: (1) review of primary source documents such as peer-reviewed publications and news accounts related to the model and (2) semistructured interviews with key staff and stakeholders, including current and former members of the Pennsylvania Department of Health, first-year applicant hospitals, technical assistance providers, and members of state and federal organizations and agencies familiar with the Pennsylvania and Maryland payment reform efforts for rural health and rural hospitals (N = 20).

Principal Findings:

We identified four primary attributes that innovative projects such as the model need: (1) a champion at the state and hospital level, significant cooperation across state agencies and between federal and state agencies, and support from nongovernment stakeholders; (2) ongoing engagement and education of all stakeholders, particularly related to rural health disparities, the challenges faced by rural hospitals (especially resource limitations), and the differences between rural and urban health and health service delivery; (3) realistic time lines, noting that stakeholder relationships with hospital leadership develop over many months; and (4) multistakeholder collaboration, because participating hospitals must have ongoing engagement with community members (i.e., consumers of healthcare), nonacute community partners, and other rural hospitals to foster a “rural health movement.”

Applications to Practice:

A successful Pennsylvania model holds promise for other states seeking to address the needs of rural populations and the hospitals that are vital to those communities. The lessons in this article can assist others in making the transition from volume to value in rural healthcare.
Is Maximum Available Hip Extension Range of Motion of the Residual Limb Reached During Passive Prone Lying in the Acute Stage After Dysvascular Transtibial Amputation?
Authors: Shaw Jason L. , Hackney James M. , Vandeloecht Kristi Shook , Newton Sean C. , Rainey Matthew A. , Reed Joshua J. , Suess Dani J. , Tinker Jennifer N.
Published: March 2022

Introduction

Individuals after a transtibial amputation (TTA) are at risk to develop a hip flexion contracture, which may adversely affect future ambulation with a prosthesis. Although patients have traditionally been advised to lie prone to maintain or improve hip extension, compensatory pelvic tilting may occur in prone lying (PL). We sought to compare hip extension range of motion (ROM) in PL to the modified Thomas test (MTT) position, because research implies that, in the MTT, patients are better able to control for compensatory pelvic tilting. We hypothesized that individuals after a TTA would have a greater peak hip extension angle in the MTT position compared with the PL position.

Methods

Ten individuals after a dysvascular TTA, mean age of 60 ± 8.42 years, participated in this study. The same physical therapist marked the femur and pelvis for goniometric measurement of peak hip extension angle by 12 raters blinded to each other's measurements. The markers remained unchanged as six raters measured all participants in PL and six different raters measured all participants in the MTT position.

Results and Discussion

The intraclass correlation (ICC) indicated high interrater reliability between the raters for the PL and MTT positions (ICC = 0.985 for PL and 0.976 for MTT). The average peak hip extension angle in PL was −14.0° ± 13.3°, standard error of mean = 4.3°; and in the MTT position was −8.6° ± 15.3°, standard error of mean = 4.8° (the negative mean connotes that, on average, participants did not have hip extension to neutral for either condition). We found a mean of 5.4° ± 6.6° more hip extension ROM for the MTT position compared with PL (P = 0.028).

Conclusions

Our findings show that, on average, patients after a TTA have significantly greater peak hip extension angle in the MTT position compared with the PL position. Thus, passive PL may not be as effective of a stretching position for preventing a hip flexion contracture after a TTA, because PL does not always extend the patient's hip to its maximum available ROM, due to the reduced ability to control the pelvis from tilting anteriorly.

Clinical Relevance

Adequate hip flexor length is positively correlated with gait parameters, which include increased velocity and step length in people using a prosthesis after transtibial amputation. This study implies that the MTT position may be a better method for improving and maintaining hip flexor length over the traditional strategy of passive PL.
Development of a Length-Actuated Lower Limb Prosthesis: Functional Prototype and Pilot Study
Authors: Parr Therese E. , Hippensteal Alan R. , DesJardins John D.
Published: March 2022

Introduction

The functional goal for unilateral transfemoral prosthesis users during ambulation is to restore the proper biomechanics and minimize the compensatory actions caused by limb asymmetries. These goals can often lead to embedded design elements that assume the prosthetic limb to look and move like the intact limb. An unconventional artificial limb design can transfer the focus from mimicking the skeletal structure to producing functional symmetry between limbs. In this pilot study, we introduce a length-actuated prosthesis design with the goal of functional biomimicry and collect qualitative feedback from two prosthesis users.

Materials and Methods

The length-actuated apparatus is attached to the distal end of a transfemoral prosthetic socket and consists of an external motor and a cam and Bowden cable system for powering and dynamically adjusting the prosthesis' length in synchronization with the gait cycle. Two transfemoral prosthesis users ambulated on a treadmill with the length-actuated prosthesis and gave anecdotal feedback.

Results

The prosthesis was able to support the patient's full weight and adjust to the lengths needed during the gait cycle, including toe clearance. The overall response to the prosthesis and concept was positive; prosthesis users stated that the prosthesis and the action of the knee seemed “comfortable,” and physicians concluded a sufficient and confident ambulation by the prosthesis users. The next iteration will address specific concerns of the prosthesis users by incorporating a more compact electromechanical system with sensors. This will aid in matching and continuously adjusting the prosthesis' length change timing with the cadence of the user's ambulation.

Conclusions

Overall, the prototype and study proved that linear motion could replace the leg shortening functions of lower-joint rotations, with anecdotal improvements in kinematics and comfort. Future work will consist of a quantitative evaluation of center of gravity displacement, ground reaction forces, toe clearance distance, and the possibilities of knee buckling.

Clinical Relevance

There are no commercially available lower-limb prostheses that control leg length with dynamic linear motion rather than user flexion and extension of a knee joint. Possible benefits that may come from a length-actuated prosthesis include improved loading symmetry and balance, as well as decreased muscle activity.
Evaluation of Hepatitis in Pediatric Patients With Presumed Nonalcoholic Fatty Liver Disease
Authors: Al-Harthy Fat’hiya , Kamath Neha , Hill Lee , Popov Jelena , Bossert Allison , Brill Herbert , Pai Nikhil
Published: March 2022

Objectives:

In 2017, the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition published clinical practice guidelines for the assessment and diagnosis of nonalcoholic fatty liver disease (NAFLD). We determined how frequently these investigations suggest an alternate etiology for chronic hepatitis in 8- to 17-year-old patients with body mass index >85%, elevated alanine aminotransferase and radiographic steatosis, and rates of adherence to 2017 guidelines.

Methods:

We conducted a retrospective chart review of patients presenting to McMaster Children’s Hospital from 2017–2020 for evaluation of suspected NAFLD. Bloodwork was reviewed.

Results:

Ninety-five patients met inclusion criteria. Abnormal bloodwork that required further testing was found in 28.4%; a different chronic liver disease was ultimately diagnosed in 11.6%. Only 9.5% received comprehensive, additional bloodwork for other causes of liver disease.

Conclusion:

A high proportion of patients evaluated for suspected NAFLD had bloodwork possibly suggesting an alternate diagnosis. Comprehensive testing was infrequently performed. These results reinforce the importance of maintaining a differential diagnosis among children presumed to have NAFLD.
Extensive Biventricular Cardiac Sarcoidosis Detected on FDG PET/CT Using a 72-Hour Ketogenic Diet Preparation Protocol
Authors: Lu Yang
Published: March 2022

A 49-year-old man had right bundle-branch block, with decreased left ventricle ejection fraction of 43%. Cardiac MRI demonstrated abnormal multifocal delayed gadolinium enhancement involving both ventricles. Cardiac sarcoidosis was further confirmed at cardiac biopsy. Dedicated FDG PET/CT with 72-hour ketogenic diet preparation to suppress physiological myocardial uptake of FDG was performed for disease evaluation. PET/CT revealed multifocal abnormal uptake in both ventricles concordant with cardiac MRI findings, in addition to hypermetabolic lymphadenopathy. Six months later, posttreatment PET/CT with the same 72-hour ketogenic diet preparation showed good response with resolution of active inflammation.
Application of Deep Learning Techniques for Automated Diagnosis of Non–Syndromic Craniosynostosis Using Skull
Authors: Mizutani Katsuhiro , Miwa Tomoru , Sakamoto Yoshiaki , Toda Masahiro
Published: March 2022

Non–syndromic craniosynostosis (NSCS) is a disease, in which a single cranial bone suture is prematurely fused. The early intervention of the disease is associated with a favorable outcome at a later age, so appropriate screening of NSCS is essential for its clinical management. The present study aims to develop a classification and detection system of NSCS using skull X-ray images and a convolutional neural network (CNN) deep learning framework. A total of 56 NSCS cases (scaphocephaly [n = 17], trigonocephaly [n = 28], anterior plagiocephaly [n = 8], and posterior plagiocephaly [n = 3]) and 25 healthy control infants were included in the study. All the cases underwent skull X-rays and computed tomography scan for diagnosis in our institution. The lateral views obtained from the patients were retrospectively examined using a CNN framework. Our CNN model classified the 4 NSCS types and control with high accuracy (100%). All the cases were correctly classified. The proposed CNN model may offer a safe and high–sensitivity screening of NSCS and facilitate early diagnosis of the disease and better neurocognitive outcome for patients.
Mameliella sediminis sp. nov., a novel polyhydroxyalkanoate-accumulating bacterium
Authors: Zheng Wei-shuang , Zhai Sheng-qiang , Zhang Meng-jun , Huang Yi
Published: March 2022

A Gram-stain-negative, strictly aerobic, non-motile, rod-shaped bacterium, capable of producing poly-β-hydroxyalkanoate, designated DP3N28-2T, was isolated from the sediment collected from Daya Bay, Guangdong, PR China. Optimal growth occurred at 37–40 °C, pH 6.0 and in the presence of 4 % NaCl. The 16S rRNA gene sequences analysis revealed that DP3N28-2T showed highest similarities with

Mameliella alba

DSM 23384T (98.3 %),

Antarctobacter jejuensis

13–2-B6T (97.2 %),

Antarctobacter heliothermu

s El-219T (96.8 %),

Maliponia aquimaris

MM-10T (96.7 %),

Ponticoccus litoralis

CL-GR66T (96.4 %) and

Aquicoccus porphyridii

L1 8-17T (96.1 %). The predominant fatty acids (>10 %) were summed feature 8 (C18 : 1ω6c and/or C18 : 1ω7c; 72.1 %) and C16 : 0 (11.0 %). The polar lipids contain phosphatidylethanolamine, phosphatidylmonomethylethanolamine, phosphatidylglycerol, one aminophosphlipid, one phospholipid and three unidentified lipids. The respiratory quinone was Q-10. The DNA G+C content was 63.0 mol% (data from the genome sequence). The estimated genome size was 5.12 Mb. The average nucleotide identity values between the DP3N28-2T genome and the genome of

M. alba

was 81.1 %, while the digital DNA–DNA hybridization value was 23.4 %. The phenotypic, genotypic and chemotaxonomic differences between DP3N28-2T and its phylogenetic relatives indicates that DP3N28-2T should be regarded as representing a novel species of the genus

Mameliella

, for which the name Mameliella sediminis sp. nov. is proposed. The type strain is DP3N28-2T (=MCCC 1K06218T=KCTC 82804T).
Assessment of an AI-based triage and notification system in detecting clinical signs of retinal diseases
Authors: Agarwal Manisha , Shrivastav Ankita , Koundanya Vikram , Jain Tanya , Katre Prashant , Dutt Shibjash , Maitra Ritobroto
Published: March 2022

Purpose

This study evaluates the performance of an artificial intelligence based triage and notification system that analyzes fundus photographs for nine signs: cotton wool spots, dot & blot hemorrhages, drusens, flame shaped hemorrhages, glaucomatous disc, hard exudates, retinal neovascularization, preretinal hemorrhage and vascular tortuosity. These signs may be present in multiple retinal diseases.

Methods

In a blinded and adjudicated study, a set of 3484 photographs of unique eyes from 3305 patients, from 15 fundus cameras, were graded by retina specialists, and the results compared with an AI-based system.

Results

The AI performed at a mean sensitivity of 90.19% and a mean specificity of 88.38% across all signs. The best performance was in detecting glaucomatous disc with a sensitivity of 94.65% and a specificity of 95.36%. The worst performance for sensitivity was for detecting vascular tortuosity at 85.06% and that for specificity was for detecting drusens 85.21%.

Conclusion

The AI-based system performs at acceptable sensitivity and specificity levels in comparison to retina specialists in a large sample pooled across 15 fundus cameras for 9 different clinical signs.