bluuebunny/crossref_metadata_2025 huggingface dataset:
Redescription of Paracrobeles laterellus Heyns, 1968 (Rhabditida: Cephalobidae) from Botswana
Authors: Abolafia Joaquín , Ruiz-Cuenca Alba N. , Shokoohi Ebrahim , Du Preez Gerhard , Fourie Hendrika
Published: September 2019

Paracrobeles laterellus is redescribed from the North-West District (Koanaka Hill), Botswana, which forms part of the Kalahari Desert. A scanning electron microscopy study of the species is presented for the first time. This population is characterised by its adult body length, lateral field with three longitudinal incisures, lips with three tines, the middle one being shorter, primary and secondary axils with two guard processes, labial probolae bifurcate with basal ridge and smooth prongs, pharynx with very swollen and elongate metacorpus, spermatheca swollen, post-vulval uterine sac well developed, vagina sigmoid, female and male tails conoid, and characters of the spicules and gubernaculum. Morphologically, P. laterellus is very similar to P. kelsodunensis and P. mojavicus according to the morphology of the lip region, i.e., with two guard processes at the primary axils and robust spicules.
The Relevance of the Inter-American Court of Human Rights’ Standards on the Right to Prior Consultation in the Domestic Sphere. A Review of the Peruvian Jurisprudence
Authors: Alva-Arévalo Amelia
Published: September 2019

This article discusses how the magistrates of the Constitutional Tribunal of Peru have interpreted the right to prior consultation and examines whether and/or to what extent these magistrates have been consistent with the case-law of the Inter-American Court of Human Rights (IACtHR). Taking into account that the jurisprudence of the Constitutional Tribunal has provided the first guidelines on how to legislate and how to conduct the prior consultation processes in Peru, this analysis is relevant to determine if these guidelines have been elaborated according to the IACtHR’s standards.
Adding the West-African riverine component: Revision of the Recent freshwater snails belonging to Pseudocleopatra Thiele, 1928 (Caenogastropoda, Cerithioidea, Paludomidae)
Authors: NEIBER MARCO T. , KAHL SANDRA M. , WIGGERING BENEDIKT , GLAUBRECHT MATTHIAS
Published: September 2019

While Africa’s lacustrine gastropod fauna, in particular of Lake Tanganyika, has received much attention, the continent’s riverine malacofauna has long been neglected. Pseudocleopatra is a relatively poorly known paludomid gastropod genus with species found throughout the lower reaches of the West African Volta and Congo rivers. In the course of ongoing systematic revisions of African paludomids, we present here a morphometric analysis and revision of the recent species assigned to the genus, i.e., P. togoensis, P. voltana, P. dartevellei and P. bennikei, to improve taxonomic acuity for this group. We use available museum material for geometric morphometrics, multivariate ratio analysis and comparisons of radular and opercular characters. Our results demonstrate that the four recent species of Pseudocleopatra are clearly distinguishable on the basis of ratios of shell measurements as well as radular and opercular characters. Pseudocleopatra has generic-level synapomorphies including: concentric opercula with relatively large paucispiral nuclei, and rachidian radular teeth with usually 13–20 cusps. On the basis of this characterisation, the nominal species Cleopatra broecki is transferred to Pseudocleopatra. Additionally, the nominal taxon P. bennikei is synonymized with P. broecki n. comb. The phylogenetic relationships of Pseudocleopatra are currently unknown, but the observed tendency of some fossil taxa assigned to Pseudocleopatra towards thalassoidism, i.e., the resemblance to marine gastropods, has led to the hypothesis that some of the thalassoid endemics in Lake Tanganyika may have originated from or be related to Pseudocleopatra. Should this hypothesis be correct, which is in need of testing by molecular genetic methods when suitable samples become available, Pseudocleopatra may play a crucial role in understanding of the evolution of thalassoidism in African Paludomidae.
The phylogenetic relationships of the two-winged South American Leptophlebiidae genera revisited with first description of the male imago of Bessierus Thomas & Orth (Insecta: Ephemeroptera)
Authors: DOMÍNGUEZ EDUARDO , CUEZZO MARÍA GABRIELA , CLAVIER SIMÓN
Published: September 2019

Four of the 43 genera of South American Leptophlebiidae are dipterous. A previous phylogenetic hypothesis supported that clade Askola+Hagenulopsis, and that Bessierus+Perissophlebiodes, are sister groups of the Farrodes complex. Adults of Bessierus and Perissophlebiodes were not known but posteriorly Perissophlebiodes male imago was described. Here, we describe the male imago of Bessierus for the first time. Both genera share, besides the absence of the hind wings, the asymmetrical fork of MA, symmetrical fork of MP, dissimilar tarsal claws, and forceps sockets fused. Along with the description of the imago, a new diagnosis for the genus Bessierus is presented, also updating the identification key with this new information. A new cladistics analysis is performed to test the stability of the proposed relationships of these four genera within Leptophlebiidae. We obtained a single cladistic hypothesis where the addition of Bessierus adult characters resulted in new synapomorphies for the (Bessierus, Perissophlebiodes) clade, and improved its clade statistical support. The fused forceps sockets resulted in a synapomorphy uniting Bessierus, Perissophlebiodes and Simothraulopsis. As a result of this new analysis, the hypothesis of independent losses of the hind wings in the two dipterous groups studied is supported. The Farrodes lineage is not supported as proposed in previous studies, being restricted only to (Farrodes (Simothraulopsis, Homothraulus)) while the identity of “Perissophlebiodes lineage” is supported. The sister group relationship of Rondophlebia is not clearly defined.
Evaluation of the protective performance of hydrophobic coatings applied on carbon-fibre epoxy composites
Authors: O'Connor Heather , Dowling Denis P
Published: September 2019

Carbon–fibre epoxy composites are widely used for high-performance structural applications, where they are often exposed to harsh environments. The result of moisture ingress has been extensively studied, causing significant deterioration in the mechanical properties of these composites. This study evaluates the performance of five commercial hydrophobic coatings as protective layers, to inhibit moisture ingress into the composite. The coatings evaluated were NeverWet, HydroBead, SHC, Aculon and LiquidGlass. These coatings were characterised and compared in terms of hydrophobicity, surface energy, roughness and chemical composition. This study also evaluated two atmospheric plasma pre-treatments as a means of enhancing the adhesion performance of these coatings. The pre-treatments involved the use of an air plasma for the activation of the epoxy, as well as the plasma deposition of a nanometre thick SiOx interlayer coating. The durability and protective performance of the coatings, with and without the pre-treatments were then compared using an abrasion test as well as a water immersion study.

The use of both plasma pre-treatments was found to enhance the adhesion and the abrasion performance of four out of the five coatings. Of the coatings and pre-treatments investigated, the LiquidGlass in conjunction with a SiOx-coating interlayer was found to exhibit the highest abrasion resistance. This was followed by the composite, which was plasma activated prior to the application of the Aculon coating. Only minor differences were observed when comparing the total moisture ingress (M%) of the epoxy, coated with the different hydrophobic layers. The composite coated with the Aculon and SiOx interlayer exhibited the least amount of moisture ingress, at 0.90%, compared to 1.08% of the uncoated specimen. The shear strength of epoxy composite, coated with the LiquidGlass, NeverWet and the activated Aculon combination, were within the range of the uncoated specimens, therefore the moisture ingress was reversible upon heating and no permanent damage to the epoxy–fibre interface was observed. It is concluded that, of the five coatings investigated, both the Aculon coating and LiquidGlass in combination with a SiOx interlayer coating, exhibit the greatest potential as protective layers for carbon fibre epoxy composites.
Possessing Extreme Pornography: Policing, Prosecutions and the Need for Reform
Authors: McGlynn Clare , Bows Hannah
Published: September 2019

The law criminalising the possession of extreme pornography, first enacted in 2008 and amended to include rape pornography in 2015, continues to generate considerable controversy and calls for reform. In order to inform these ongoing discussions, we undertook a study to find out information about who is being charged with extreme pornography offences and their characteristics in terms of gender, age and ethnicity, as well as data on the specific type of pornography forming the subject-matter of those charges. Utilising freedom of information requests, our study provides valuable new information to help inform debates over the policing of extreme pornography across England and Wales. Overall, we found that the vast majority of those charged were white men across all age groups; that bestiality images formed the most common basis for charging and that, in respect of the data provided, the majority of charges were brought together with other sexual offences.
A longitudinal trajectory tracking method with L1 adaptive control for hypersonic reentry vehicles
Authors: Han GenSen , Zhou Jun , Guo JianGuo , Lu Qing
Published: September 2019

This paper presents a longitudinal trajectory tracking scheme with [Formula: see text] adaptive control for hypersonic reentry vehicles (HRVs). A linear time-varying (LTV) multiple input multiple output (MIMO) model, in which influences of lateral states, earth rotation, and linearization are considered as model uncertainties, is derived based on state and input errors of longitudinal model. The normalization of error model is used to reduce differences of magnitude orders in state and input matrix elements which may affect the stability of [Formula: see text] adaptive controller. In order to achieve an accurate tracking performance, a linear quadratic regulator (LQR) controller is employed as the baseline controller, augmented with an [Formula: see text] adaptive controller to attenuate the matched and unmatched uncertainties. Based on the augmented controller, the optimization process is executed with the estimate of uncertainties at the same time. The simulation results of LQR controller, [Formula: see text] augmentation controller and robust [Formula: see text] controller show that the [Formula: see text] adaptive control method can reduce the terminal and integral of squared state errors validly. Terminal state errors in all simulation scenarios are less than 2.5m/s, 1e-3 and 10m, respectively, which reflects its effectiveness in increasing robustness of baseline controller.
A fractional super-twisting control of electrically driven mechanical systems
Authors: Muñoz-Vázquez Aldo Jonathan , Sánchez-Torres Juan Diego , Parra-Vega Vicente , Sánchez-Orta Anand , Martínez-Reyes Fernando
Published: September 2019

The Super Twisting Control Algorithm (STA) constitutes a powerful and robust technique for control and observation problems. The structure of the STA allows inducing second-order sliding modes, such that the sliding variable and its derivative remain at zero after some finite time. However, the STA requires the strong differentiability of the sliding variable and the weak differentiability of disturbances. Thus, the sliding variable should become from an adequate design, ensuring its strong differentiability. Nonetheless, in the more general case of not necessarily integer-order differentiable disturbances, a typical case in electromechanical systems due to non-smooth effects, alternative control methods need to be considered. For that reason, this paper proposes a structural modification of the STA, allowing the integral of the discontinuous function to assume a fractional order to compensate not necessarily integer-order differentiable disturbances. An experimental assessment is conducted, and comparisons to other sliding mode based controllers are presented to demonstrate the reliability of the proposed method.
What Color as an Integrated Pictorial Element in Himalayan Art Can Communicate: Cross-Cultural Congruence of Color-Emotion Conceptualizations in Himalayan Art
Authors: Dolese Melissa J. , Kacinik Natalie A.
Published: September 2019

The idea of art as a language of emotion has historical roots. This study asked if color, as an integrated pictorial element in Himalayan art, can communicate the intended emotions to North American viewers. To investigate the extent to which those emotions are congruent cross-culturally, participants were assigned to four conditions of varying levels of informativeness, based on whether they did or did not receive an informational brochure and a checklist of emotional terms to reference. Results were analyzed using Latent Semantic Analysis to assess the similarity of word meanings. Participant responses were compared to the emotions that should be conveyed according to Himalayan culture and curators of an exhibit on Himalayan art. Cosine values were generally high in all conditions, indicating that certain colors (i.e., red, black, and gold) can convey consistent emotional information to viewers from very different cultures, even with little or no corresponding verbal material.
Spontaneous rupture of the uterus following salpingectomy: a case report and literature review
Authors: Hua Zhifen , Wu Minjun
Published: September 2019

Laparoscopic salpingectomy (LPSC) is the main treatment for ectopic pregnancy, which leads to spontaneous uterine rupture (UR) during pregnancy. We report the characteristics of a woman who had spontaneous UR during pregnancy with a history of salpingectomy. We experienced a 31-year-old woman with a UR in pregnancy with a history of LPSC twice. The patient had a successful pregnancy. We also performed a literature review including cases with spontaneous UR after LPSC. Twenty-seven case reports of 48 women were included in our review. Thirty-five (83.33%, 35/42) women previously received LPSC and 15 (31.25%) developed interstitial pregnancies. The interval between pregnancy and the last surgery did not affect the frequency of interstitial pregnancy and gestational age. Fetal outcomes in patients with UR at the third trimester were better than those at the first and second trimesters. We suggest that close observation and timely treatment by experienced clinicians lead to good outcomes of pregnant women with suspected UR.
Mechanical structural design based on additive manufacturing and internal reinforcement
Authors: Lovo João Fiore Parreira , Camargo Italo Leite de , Araujo Luis Antonio Oliveira , Fortulan Carlos Alberto
Published: September 2019

The design of modern mechanical components often requires the use of low-density and high-strength parts. Additive manufacturing presents competence in obtaining format complexity internally (voids, ducts, channels) and externally (shape, holes). However, parts obtained by material extrusion additive manufacturing are highly anisotropic and relatively weak. This paper aims to present a new mechanical design technique that combines the high geometry flexibility of additive manufacturing with internal structuring reinforcement by high-strength materials, which enables optimized parts with reinforcement in the most mechanical stressed areas during service, through adopting structured internal geometry filled with reinforcement material. Dense test specimens and test specimens with internal structural canals filled with reinforcement material (epoxy resin and carbon fibers) were designed, fabricated and tested physically and virtually. The obtained results provide property values for 3D-printed acrylonitrile butadiene styrene (typical material of additive manufacturing) and for this polymer reinforced with various reinforcement material configurations (useful for mechanical design). The reinforcement decreased anisotropy and improved mechanical properties. Optimized parts filled with resin and long carbon fibers had maximum flexural resistance of 112 MPa, with a specific weight of 1.1 g/cm3. This reinforcement provided parts with specific flexural strength similar to structural aluminum alloys, preserving the geometry and external dimension of the printed parts. The technique presented here shows the possibility of new conceptions in mechanical components design and strength optimization by internal reinforcement canals in parts. The technique is useful for mechanical design activity and allows for new product conceptions based on additive manufacturing.
Transient influence of water injection on the flow field of a hot launch in a W-shaped silo
Authors: Shi Shaoyan , Jiang Yi , Li Xiang
Published: September 2019

This study attempts to determine the effect of and mechanisms for the suppression of the ignition pressure and back-flowing exhaust during a hot launch process in a W-shaped silo, considering the missile movement via dynamic mesh technology. The mixture model for the multiphase and the turbulent model employed were experimentally proved to be accurate and reliable. The numerical results show that the injection of water into a missile exhaust can effectively suppress the ignition overpressure, thereby reducing the time of oscillation and oscillation amplitude, and reducing the maximum pressure at missile bottom from 3.68 × 105 Pa to 2.39 × 105 Pa. In addition, water injection makes the back-flowing exhaust remain at the bottom of the launch duct instead of filling the duct, and it cools the missile bottom, thus leading to a reduction in the maximum temperature from 3000 K to approximately 500 K.
Global public interest in systemic lupus erythematosus: an investigation based on internet search data
Authors: Wu G C , Cao F , Shen H H , Hu L Q , Hu Y , Sam N B
Published: September 2019

Objective

This study aims at investigating the global public interest in seeking information about systemic lupus erythematosus (SLE) using Google Trends (GT).

Methods

An electronic search was performed using GT with the search term lupus as well as the option of disease from January 2004 to December 2018. Cosinor analysis was applied to detect the seasonality of SLE-related relative search volume (RSV). In addition, analysis on SLE-related topics including “hot topics” and “top rising topics” was also conducted.

Results

Overall, SLE-related RSV showed a decreasing trend from January 2004 to December 2013 and then demonstrated a slowly increasing trend from January 2014 to December 2018. Cosinor test showed no significant seasonal variation in SLE-related RSV ( p > .025). RSV peaked in May and reached the trough in November. The top seven rising topics were Selena Gomez, Sjögren syndrome, autoimmunity, rheumatoid arthritis, rheumatology, antinuclear antibody and autoimmune disease.

Conclusion

The results from GT analysis showed slowly increasing internet searches for SLE in recent years. This trend was followed by a peak of RSV in May and reached its lowest level in November. However, globally, the results did not reveal a significant seasonal variation in GT for SLE. Additionally, the top fast-growing topics regarding SLE may be valuable for doctors and nurses to provide timely education of the disease to patients, as well as promote the development of public health.
Women in oncology pharmacy leadership: A white paper
Authors: Shillingburg Alexandra , Michaud Laura B , Schwartz Rowena , Anderson Jaime , Henry David W ,   endorsed by the Hematology/Oncology Pharmacy Association (HOPA)
Published: September 2019

Gender disparity exists in leadership roles within healthcare. While the majority of the healthcare workforce is comprised of women, significantly fewer women occupy leadership positions, particularly at executive and board levels. As the field of oncology pharmacy continues to rapidly expand and evolve, an assessment of the current state of women in oncology pharmacy leadership roles is vital to the growth and development of the profession. In the fall of 2017, the Hematology/Oncology Pharmacy Association (HOPA) hosted a summit to explore leadership issues facing women in oncology pharmacy which have the potential to affect our membership and our profession. This meeting included invited participants from across the fields of oncology and pharmacy and was part of HOPA’s strategic leadership initiative developed through the work of the HOPA Leadership Development Committee in 2016. This promotes a primary goal of HOPA, which is to support oncology pharmacists as they assume leadership roles within their practices and within healthcare to assure oncology pharmacy is integrated into cancer care. The purpose of this white paper is to (1) summarize key issues that were identified through a membership survey; (2) review ongoing efforts to address the needs of female oncology pharmacists in leadership development; (3) serve as a call to action for individuals and professional organizations to assist with and disseminate these efforts and highlight available resources, and (4) to provide practical steps to meet the needs of individuals, training programs, and institutions/employers.
Hepatoblastoma and Pediatric Hepatocellular Carcinoma: An Update
Authors: Ranganathan Sarangarajan , Lopez-Terrada Dolores , Alaggio Rita
Published: September 2019

Hepatoblastomas (HBs) and pediatric hepatocellular carcinomas (HCCs) together account for almost 80% of primary malignant liver tumors in children and adolescents/young adults. Children’s Hepatic International Collaboration (CHIC), Children’s Oncology Group (COG), SociétéInternationale d’Oncologie Pédiatrique (SIOP), and International Childhood Liver Tumors Strategy Group trials have contributed to define prognostic factors and risk stratification in these tumors. The recently proposed histologic International Consensus classification of HB and HCC in children based on retrospective analysis from CHIC cases represents the base to define entities with homogeneous clinicopathologic and molecular features. This review will provide a morphologic guide for the upcoming International Liver Tumor treatment trial (Pediatric Hepatic International Tumour Trial) to be conducted through several continents. There will be an emphasis on molecular features and immunohistochemical markers for the definition of the individual histologic subtypes of HB and to better characterize the group of liver tumors in the provisional category of hepatocellular neoplasm—not otherwise specified. A brief overview of HCC in children will also be provided.
The travel motivations and experiences of female Vietnamese solo travellers
Authors: Osman Hanaa , Brown Lorraine , Phung Thi Minh Trang
Published: September 2019

Solo travel is a growing trend, a significant proportion made up of international students who take solo trips during their study abroad. However there is limited empirical research on the Asian proportion of this growing market. This study explores the main motivations and constraints of 10 female Vietnamese students’ solo travellers through in-depth interviews. The findings indicate that travel motivations can be categorised into personal factors, such as freedom and flexibility, self-empowerment, independence and exploration, and social interaction factors including a lack of companions and meeting new people. Travel constraints relate to being female and alone and being of Asian descent. This research extends understanding of this important market segment. As a result, tourism providers and destination marketing organisation (DMOs) can capitalise by developing their products and marketing.
Genome-Wide Transcriptome Analysis Reveals Intermittent Fasting-Induced Metabolic Rewiring in the Liver
Authors: Ng Gavin Yong-Quan , Kang Sung-Wook , Kim Joonki , Alli-Shaik Asfa , Baik Sang-Ha , Jo Dong-Gyu , Hande M. Prakash , Sobey Christopher G. , Gunaratne Jayantha , Fann David Yang-Wei , Arumugam Thiruma V.
Published: September 2019

Scope: Intermittent fasting (IF) has been extensively reported to promote improved energy homeostasis and metabolic switching. While IF may be a plausible strategy to ameliorate the epidemiological burden of disease in many societies, our understanding of the underlying molecular mechanisms behind such effects is still lacking. The present study has sought to investigate the relationship between IF and changes in gene expression. We focused on the liver, which is highly sensitive to metabolic changes due to energy status. Mice were randomly assigned to ad libitum feeding or IF for 16 hours per day or for 24 hours on alternate days for 3 months, after which genome-wide transcriptome analysis of the liver was performed using RNA sequencing. Our findings revealed that IF caused robust transcriptomic changes in the liver that led to a complex array of metabolic changes. We also observed that the IF regimen produced distinct profiles of transcriptomic changes, highlighting the significance of temporally different periods of energy restriction. Our results suggest that IF can regulate metabolism via transcriptomic mechanisms and provide insight into how genetic interactions within the liver might lead to the numerous metabolic benefits of IF.
The experiment research and engineering verification on the synergistic lubrication properties of silver and multiwalled carbon nanotubes
Authors: Yang Kang , Ma Hongru , Ma Ming , Lin Haibo , Li Xiaoxue
Published: September 2019

A synergistic lubrication of silver and multiwalled carbon nanotubes was studied to minimize friction and decrease wear in the rotating mechanical components. Samples of TiAl alloy (TA), TiAl–10 wt% Ag (TAA), and TiAl–10 wt% Ag–1.0 wt% multiwalled carbon nanotubes (TAAM) were prepared using spark plasma sintering. The method of experimental test and engineered verification was used to explore the synergistic lubrication of silver and multiwalled carbon nanotubes in the TAAM sliding against Si3N4 balls on the ball-on-disk tribometer of No. HT-1000. The results showed that the friction and wear behavior of the TAA was more excellent than that of a TA. The TAAM obtained the smaller friction coefficient and wear rate in comparison to the TAA. The multiwalled carbon nanotubes were pulled out of the TAAM during sliding, were exposed on a wear scar, and were tightly combined with the silver to form a lubrication film. The lubrication film with silver and multiwalled carbon nanotubes resulted in an excellent friction reduction and wear-resistant property, and it caused the TAAM to obtain smaller friction and lower wear than those of the TA and TAA.
Discrete-time predictive trajectory tracking control for nonholonomic mobile robots with obstacle avoidance
Authors: Zhang Jingjun , Zhang Shaobo , Gao Ruizhen
Published: September 2019

This article presents a tracking control approach with obstacle avoidance for a mobile robot. The control law is composed of two parts. The first is a discrete-time model predictive method-based trajectory tracking control law that is derived using an optimal quadratic algorithm. The second part is the obstacle avoidance strategies that switch according to two different designed obstacle avoidance regions. The controllability of the avoidance control law is analyzed. The simulation results validate the effectiveness of the proposed control law considering both trajectory tracking and obstacle avoidance.
Repetitive transcranial magnetic stimulation in stroke rehabilitation: review of the current evidence and pitfalls
Authors: Fisicaro Francesco , Lanza Giuseppe , Grasso Alfio Antonio , Pennisi Giovanni , Bella Rita , Paulus Walter , Pennisi Manuela
Published: September 2019

Acute brain ischemia causes changes in several neural networks and related cortico-subcortical excitability, both in the affected area and in the apparently spared contralateral hemisphere. The modulation of these processes through modern techniques of noninvasive brain stimulation, namely repetitive transcranial magnetic stimulation (rTMS), has been proposed as a viable intervention that could promote post-stroke clinical recovery and functional independence. This review provides a comprehensive summary of the current evidence from the literature on the efficacy of rTMS applied to different clinical and rehabilitative aspects of stroke patients. A total of 32 meta-analyses published until July 2019 were selected, focusing on the effects on motor function, manual dexterity, walking and balance, spasticity, dysphagia, aphasia, unilateral neglect, depression, and cognitive function after a stroke. Only conventional rTMS protocols were considered in this review, and meta-analyses focusing on theta burst stimulation only were excluded. Overall, both HF-rTMS and LF-rTMS have been shown to be safe and well-tolerated. In addition, the current literature converges on the positive effect of rTMS in the rehabilitation of all clinical manifestations of stroke, except for spasticity and cognitive impairment, where definitive evidence of efficacy cannot be drawn. However, routine use of a specific paradigm of stimulation cannot be recommended yet due to a significant level of heterogeneity of the studies in terms of protocols to be set and outcome measures that have to be used. Future studies need to preliminarily evaluate the most promising protocols before going on to multicenter studies with large cohorts of patients in order to achieve a definitive translation into daily clinical practice.
Extended treatment with fingolimod for relapsing multiple sclerosis: the 14-year LONGTERMS study results
Authors: Cohen Jeffrey A. , Tenenbaum Nadia , Bhatt Alit , Zhang Ying , Kappos Ludwig
Published: September 2019

Background:

Multiple sclerosis (MS) is a chronic disease that may require decades of ongoing treatment. Therefore, the long-term safety and efficacy of disease-modifying therapies is an important consideration.

Methods:

The LONGTERMS study evaluated the safety and efficacy of fingolimod in patients with relapsing MS (RMS) with up to 14 years of exposure. This phase IIIb, open-label extension study included patients aged ⩾ 18 years with confirmed RMS diagnosis who completed previous phase II/III/IIIb core/extension studies of fingolimod. Patients received fingolimod 0.5 mg orally once daily; safety and efficacy (clinical and magnetic resonance imaging) were the main outcomes.

Results:

Of 4086 patients from the core studies who entered LONGTERMS, 3480 (85.2%) completed the study. The median age (range) was 38 (17–65) years and median fingolimod exposure was 944.5 (range 75–4777) days. Overall, 85.5% of patients experienced at least one adverse event (AE); most common AEs (⩾10%) were viral upper respiratory tract infection (17.3%), headache (13.3%), hypertension (11.0%) and lymphopenia (10.7%). Among patients with serious AEs (12.6%), basal cell carcinoma and MS relapse (0.9% each) were most frequently reported. The aggregate annualized relapse rate decreased from 0.22 (in years 0–2) to 0.17 (years 0–10); 45.5% of patients remained relapse free after 10 years. At year 10, 63.2% of patients were free from 6-month confirmed disability worsening.

Conclusion:

This long-term observational study of patients treated for up to 14 years with fingolimod confirmed its established safety profile with no new safety concerns. Patients with RMS receiving fingolimod had sustained low levels of disease activity and progression.

Trial Registration:

ClinicalTrials.gov identifier: NCT01201356.
Clinical Outcomes of Decompression Alone Versus and Decompression and Fusion for First Episode Recurrent Disc Herniation
Authors: Carreon Leah Y. , Bisson Erica F. , Potts Eric A. , Brown Morgan E. , Gren Stacie , Cowan Rebecca Ruegg , Glassman Steven D.
Published: September 2019

Study Design:

Longitudinal cohort.

Objective:

It is unclear if patients with a recurrent disc herniation benefit from a concurrent fusion compared with a repeat decompression alone. We compared outcomes of decompression alone (D0) versus decompression and fusion (DF) for recurrent disc herniation.

Methods:

Patients enrolled in the Quality and Outcomes Database from 3 sites with a first episode of recurrent disc herniation were identified. Demographic, surgical, and radiographic data including the presence of listhesis and extent of facet resection on computed tomography or magnetic resonance imaging prior to the index surgery were collected. Patient-reported outcomes were collected preoperatively and at 3 and 12 months postoperatively.

Results:

Of 94 cases identified, 55 had D0 and 39 had DF. Patients were similar in age, sex distribution, smoking status, body mass index, American Society of Anesthesiologists grade and surgical levels. Presence of listhesis (D0 = 7, DF = 5, P = .800) and extent of facet resection (D0 = 19%, DF = 16%, P = .309) prior to index surgery were similar between the 2 groups. Estimated blood loss (D0 = 26 cm3, DF = 329 cm3, P < .001), operating room time (D0 = 79 minutes, DF = 241 minutes, P < .001) and length of stay (D0 <1 day, DF = 4 days, P < .001) were significantly less in the D0 group. Preoperative and 1-year postoperative patient-reported outcomes were similar in both groups. Three patients in the D0 group and 2 patients in the DF group required revision. Regression analysis showed that presence of listhesis, extent of facet resection and fusion were not associated with the 12-month Oswestry Disability Index (ODI) score.

Conclusion:

For a first episode recurrent disc herniation, surgeons can expect similar outcomes whether patients are treated with decompression alone or decompression and fusion.
Debridement, antibiotic pearls, and retention of the implant (DAPRI): A modified technique for implant retention in total knee arthroplasty PJI treatment
Authors: Calanna Filippo , Chen Foster , Risitano Salvatore , Vorhies John S , Franceschini Massimo , Giori Nicholas J , Indelli Pier Francesco
Published: September 2019

We describe a modified surgical technique developed to enhance the classical irrigation and debridement procedure to improve the possibilities of retaining an infected total knee arthroplasty. This technique, debridement antibiotic pearls and retention of the implant (DAPRI), aims to remove the intra-articular biofilm allowing a higher and prolonged local antibiotic concentration using calcium sulfate beads. The combination of three different surgical techniques (methylene blue staining, argon beam electrical stimulation, and chlorhexidine gluconate brushing) might enhance the identification, disruption, and finally removal of the bacterial biofilm, which is the main responsible of antibiotics and antibodies resistance. The DAPRI technique might represent a safe and more conservative treatment for acute and early hematogenous periprosthetic joint infection.
Demographics and clinical features of humeral shaft fractures: The Latin American multicentre prospective study (HSF-LAMPS)
Authors: Belangero William Dias , Zublin Carlos Miguel , Martinez Siekavizza Sergio Nicolas , Sánchez Rosenberg Guillermo F , Cardenas Quintero Renny Augusto , Azi Matheus Lemos , Suarez Romero Fabio Alfonso , Alvachian Fernandes Hélio Jorge , Elguezabal Igor Escalante , Badell Gerardo , Mouraria Guilherme , Kojima Kodi Edson , Triana Miguel , Prieto Mere Jose Antonio , Malaret Baldo Manuel Jose , Mariolani José Ricardo Lenzi
Published: September 2019

Purpose:

To present transversal data (demographic and clinical) on isolated humeral shaft fractures (HSFs) in Latin American countries.

Methods:

Patients were enrolled between December 2015 and April 2017 at 11 medical institutions from six Latin America countries.

Inclusion criteria:

Age ≥18 years and a closed, isolated 12A, 12B, or 12C fracture (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification). The patients’ demographic, comorbidity, and other baseline data were recorded. The outcome measures included the basal results of the research and the associations among the demographic factors, fracture features, and type of treatment applied.

Results:

A total of 123 patients were included. There was a preponderance of men (61.8%), whose mean age was significantly lower than that of the women (31.48 vs. 60.55). Overweight or obesity was present in 61.0% of women; 56.1% of patients were sedentary, 75.6% were nonsmokers, and 74.0% had no chronic disease. The type or treatment (operative/nonoperative) was not significantly associated with the patient’s or fracture’s characteristics. Falls and traffic accidents were the main causes of HSFs. Intramedullary nailing treatment was performed significantly more often in women, elderly patients, patients who did not participate in sports, and patients participating in only home activities. Minimally invasive plate osteosynthesis was performed significantly more frequently in men and in those who were self-employed. Open reduction internal fixation was performed significantly more often when the cause of the fracture was a traffic accident and when radial nerve palsy was present.

Conclusion:

The demographics and etiological differences observed in comparison to the current literature show the importance of regional studies for both preventive measures and educational guidance.
Sclerosing osteomyelitis of Garré: A confusing clinical diagnosis
Authors: Song Seungcheol , Jeong Hwa Jae , Shin Hun-Kyu , Kim Eegene , Park Se-Jin , Park Jai Hyung
Published: September 2019

We describe a rare case of sclerosing osteomyelitis of Garré in a 63-year-old woman with uncontrolled right thigh pain. She had suffered from lower back pain and radiating pain on the right lower leg for a year and 4 months and so had spine surgery 8 months ago. But the right thigh pain persisted, and the levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) remained abnormal. Right femur radiographs showed cortical thickening on the proximal femur. Magnetic resonance images showed T2 hypersignal intensity lesions in the proximal femur. Under suspicion of osteoid osteoma or sclerosing osteomyelitis, surgery was performed with biopsy, bone curettage, and drilling. The culture was negative, and the biopsy showed chronic osteomyelitis. Despite surgery, the levels of CRP and ESR still remained abnormal. After using venous antibiotics, the pain subsided and CRP and ESR levels turned to normal. Followed by 6 weeks of oral antibiotics, pain was relieved after 1-year follow-up.
Management of severe asthma: a European Respiratory Society/American Thoracic Society guideline
Authors: Holguin Fernando , Cardet Juan Carlos , Chung Kian Fan , Diver Sarah , Ferreira Diogenes S. , Fitzpatrick Anne , Gaga Mina , Kellermeyer Liz , Khurana Sandhya , Knight Shandra , McDonald Vanessa M. , Morgan Rebecca L. , Ortega Victor E. , Rigau David , Subbarao Padmaja , Tonia Thomy , Adcock Ian M. , Bleecker Eugene R. , Brightling Chris , Boulet Louis-Philippe , Cabana Michael , Castro Mario , Chanez Pascal , Custovic Adnan , Djukanovic Ratko , Frey Urs , Frankemölle Betty , Gibson Peter , Hamerlijnck Dominique , Jarjour Nizar , Konno Satoshi , Shen Huahao , Vitary Cathy , Bush Andy
Published: September 2019

This document provides clinical recommendations for the management of severe asthma. Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the European Respiratory Society/American Thoracic Society Task Force's questions. The evidence was appraised using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of asthma experts, who made specific recommendations on six specific questions. After considering the balance of desirable and undesirable consequences, quality of evidence, feasibility, and acceptability of various interventions, the Task Force made the following recommendations: 1) suggest using anti-interleukin (IL)-5 and anti-IL-5 receptor α for severe uncontrolled adult eosinophilic asthma phenotypes; 2) suggest using a blood eosinophil cut-point ≥150 μL−1to guide anti-IL-5 initiation in adult patients with severe asthma; 3) suggest considering specific eosinophil (≥260 μL−1) and exhaled nitric oxide fraction (≥19.5 ppb) cut-offs to identify adolescents or adults with the greatest likelihood of response to anti-IgE therapy; 4) suggest using inhaled tiotropium for adolescents and adults with severe uncontrolled asthma despite Global Initiative for Asthma (GINA) step 4–5 or National Asthma Education and Prevention Program (NAEPP) step 5 therapies; 5) suggest a trial of chronic macrolide therapy to reduce asthma exacerbations in persistently symptomatic or uncontrolled patients on GINA step 5 or NAEPP step 5 therapies, irrespective of asthma phenotype; and 6) suggest using anti-IL-4/13 for adult patients with severe eosinophilic asthma and for those with severe corticosteroid-dependent asthma regardless of blood eosinophil levels. These recommendations should be reconsidered as new evidence becomes available.
European Respiratory Society guideline on long-term management of children with bronchopulmonary dysplasia
Authors: Duijts Liesbeth , van Meel Evelien R. , Moschino Laura , Baraldi Eugenio , Barnhoorn Magda , Bramer Wichor M. , Bolton Charlotte E. , Boyd Jeanette , Buchvald Frederik , del Cerro Maria Jesus , Colin Andrew A. , Ersu Refika , Greenough Anne , Gremmen Christiaan , Halvorsen Thomas , Kamphuis Juliette , Kotecha Sailesh , Rooney-Otero Kathleen , Schulzke Sven , Wilson Andrew , Rigau David , Morgan Rebecca L. , Tonia Thomy , Roehr Charles C. , Pijnenburg Marielle W.
Published: September 2019

This document provides recommendations for monitoring and treatment of children in whom bronchopulmonary dysplasia (BPD) has been established and who have been discharged from the hospital, or who were >36 weeks of postmenstrual age. The guideline was based on predefined Population, Intervention, Comparison and Outcomes (PICO) questions relevant for clinical care, a systematic review of the literature and assessment of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. After considering the balance of desirable (benefits) and undesirable (burden, adverse effects) consequences of the intervention, the certainty of the evidence, and values, the task force made conditional recommendations for monitoring and treatment of BPD based on very low to low quality of evidence. We suggest monitoring with lung imaging using ionising radiation in a subgroup only, for example severe BPD or recurrent hospitalisations, and monitoring with lung function in all children. We suggest to give individual advice to parents regarding daycare attendance. With regards to treatment, we suggest the use of bronchodilators in a subgroup only, for example asthma-like symptoms, or reversibility in lung function; no treatment with inhaled or systemic corticosteroids; natural weaning of diuretics by the relative decrease in dose with increasing weight gain if diuretics are started in the neonatal period; and treatment with supplemental oxygen with a saturation target range of 90–95%. A multidisciplinary approach for children with established severe BPD after the neonatal period into adulthood is preferable. These recommendations should be considered until new and urgently needed evidence becomes available.
Thrombocytopenia according to antiretroviral drug combinations, viremia and CD4 lymphocytes among HIV-infected patients in Cameroon: a snapshot from the City of Yaoundé
Authors: Nka Alex Durand , Sosso Samuel Martin , Fokam Joseph , Bouba Yagai , Teto Georges , Simo Rachel Rachel , Tiga Aline , Yimga Junie , Nukenine Elias Nchiwan , Nanfack Aubin Joseph , Takou Désiré , Aroga Zélateur , Colizzi Vittorio , Ndjolo Alexis
Published: September 2019

Objective

Thrombocytopenia is an abnormal decrease in blood platelets, which can affect the prognosis of people living with HIV (PLHIV). In order to assess the burden of this haematological disorder, we evaluated the frequency of thrombocytopenia according to antiretroviral drug combinations, viremia and the immune status of PLHIV.

Results

A cross-sectional and analytical study was conducted from June to November 2016 among 310 PLHIV at the “Chantal BIYA” International Reference Centre, Yaoundé, Cameroon. Overall rate of thrombocytopenia was 19.0% (59/310). The rate of thrombocytopenia was 64.6% (42/65) versus 6.9% (17/245) in ART-naïve versus ART-treated patients respectively, p < 0.0001. Following viral load, rate of thrombocytopenia was 15.8% (20/130) in those with undetectable viral load, and 34.1% (27/79) with viral loads > 3 log10 RNA/ml (p = 0.03). As concerns CD4-count, rate of thrombocytopenia was 16.2% (42/259) in those with ≥ 200 CD4/mm3 versus 33.3% (17/51) with < 200 CD4/mm3 (p = 0.0003). After adjusting for sex, ART, viral load and CD4, Viral load and ART exposure were significantly associated with decreased risk of thrombocytopenia (p < 0.05). Thrombocytopenia occurs especially among ART-naïve, high viremia and severe immune-compromised patients. Interestingly, ART coverage appears as an independent factor in preventing the occurrence of thrombocytopenia.
Lights, camera, path splitter: a new approach for truly simultaneous dual optical mapping of the heart with a single camera
Authors: Jaimes Rafael , McCullough Damon , Siegel Bryan , Swift Luther , Hiebert James , McInerney Daniel , Posnack Nikki Gillum
Published: September 2019

Background

Optical mapping of transmembrane voltage and intracellular calcium is a powerful tool for investigating cardiac physiology and pathophysiology. However, simultaneous dual mapping of two fluorescent probes remains technically challenging. We introduce a novel, easy-to-use approach that requires a path splitter, single camera and excitation light to simultaneously acquire voltage and calcium signals from whole heart preparations, which can be applied to other physiological models – including neurons and isolated cardiomyocytes.

Results

Complementary probes were selected that could be excited with a single wavelength light source. Langendorff-perfused hearts (rat, swine) were stained and imaged using a sCMOS camera outfitted with an optical path splitter to simultaneously acquire two emission fields at high spatial and temporal resolution. Voltage (RH237) and calcium (Rhod2) signals were acquired concurrently on a single sensor, resulting in two 384 × 256 images at 814 frames per second. At this frame rate, the signal-to-noise ratio was 47 (RH237) and 85 (Rhod2). Imaging experiments were performed on small rodent hearts, as well as larger pig hearts with sufficient optical signals. In separate experiments, each dye was used independently to assess crosstalk and demonstrate signal specificity. Additionally, the effect of ryanodine on myocardial calcium transients was validated – with no measurable effect on the amplitude of optical action potentials. To demonstrate spatial resolution, ventricular tachycardia was induced –resulting in the novel finding that spatially discordant calcium alternans can be present in different regions of the heart, even when electrical alternans remain concordant. The described system excels in providing a wide field of view and high spatiotemporal resolution for a variety of cardiac preparations.

Conclusions

We report the first multiparametric mapping system that simultaneously acquires calcium and voltage signals from cardiac preparations, using a path splitter, single camera and excitation light. This approach eliminates the need for multiple cameras, excitation light patterning or frame interleaving. These features can aid in the adoption of dual mapping technology by the broader cardiovascular research community, and decrease the barrier of entry into panoramic heart imaging, as it reduces the number of required cameras.