bluuebunny/crossref_metadata_2025 huggingface dataset:
18-jähriger Patient mit rezidivierenden tonisch-klonischen
Anfällen?
Authors: Schulze Frank , Dafotakis Manuel
Published: June 2020

Die Einlieferung des 18-jährigen Studenten mittels Rettungsdienst erfolgte
unter dem Verdacht eines tonisch-klonischen Krampfanfalls. Der Patient habe an
seinem ersten Tag an der Universität einen plötzlichen
Bewusstseinsverlust mit fremdbeobachteten tonisch-klonischen
Entäußerungen für eine Minute erlitten. Anschließend
sei er binnen kürzester Zeit komplett reorientiert und beschwerdefrei
gewesen. Ein Zungenbiss oder eine Enuresis ließen sich nicht eruieren.
Prodromale Symptome hätten nicht bestanden. Er habe den Tag über
lediglich wenig gegessen und getrunken. Ähnliche Ereignisse hätten
sich vergangenes Jahr schon insgesamt 3 Mal ereignet. Hier sei es auch jeweils zu
kurzen Bewusstseinsverlusten über ein bis zwei Min. mit direkter
Reorientierung gekommen. Beim ersten Mal sei eine neurologische Abklärung in
einem anderen Krankenhaus erfolgt und habe unauffällige Befunde erbracht,
jedoch sei man von einem Krampfanfall ausgegangen und habe ihm gesagt, dass er
mindestens ein halbes Jahr warten solle, bis er mit seinem
„Führerschein beginne“. Die Familienanamnese erbrachte
lediglich einen stattgehabten Myokardinfarkt des Vaters. Neurologische Erkrankungen
in der Familie wurden verneint.
Wissenswertes zu Dystonien
Authors: Dresel Christian
Published: June 2020

Die Latenz zwischen Manifestation und Diagnose einer primären Dystonie beträgt durchschnittlich mehrere Jahre. Die Diagnose einer primären Dystonie wird durch die Seltenheit der Erkrankung, die Variabilität der klinischen Symptome, die in der Praxis wenig hilfreichen Diagnosekriterien und die Überlappung mit anderen Bewegungsstörungen erschwert. Dieser Artikel gibt einen Überblick über klinische Phänotypen, Pathophysiologie und Therapien primärer Dystonien. Er soll dem Einsteiger und nicht auf Bewegungsstörungen spezialisierten Neurologen Hilfestellungen für den klinischen Alltag geben, um Dystonien frühzeitig zu erkennen und einer Therapie zuzuführen.

Der Artikel stellt die 2013 revidierten Diagnosekriterien und die wichtigsten primären Dystonien vor. Pathophysiologisch sind Dystonien durch eine Disinhibition und maladaptive Plastizität in sensomotorischen Hirnnetzwerken charakterisiert. Es ist wichtig, die Dystonie klinisch von anderen Bewegungsstörungen zu differenzieren. Insbesondere eine asymmetrische dystone Haltung der Arme kann ein Frühsymptom einer beginnenden Parkinson-Erkrankung darstellen.

Dystonie-Patienten leiden häufig an funktionellen Defiziten, Schmerzen und einer sozialen Stigmatisierung, die zu einer Abnahme der Lebensqualität führen. Therapie der Wahl sind bei fokalen Formen lokale Injektionen von Botulinumtoxin in die dystonen Muskeln und bei multisegmentalen, generalisierten oder therapierefraktären Formen eine Tiefenhirnstimulation des Globus pallidus internus. Beide Therapien führen meist zu einer deutlichen Besserung der dystonen Symptome, einer Linderung der funktionellen Einschränkungen und einer Verbesserung der Lebensqualität. Orale Medikamente haben nur einen geringen Effekt bei ungünstigem Nebenwirkungsprofil und werden nur selten eingesetzt. Begleitend werden Physiotherapie und muskelentspannende Therapien empfohlen, aber der Nachweis für die Wirksamkeit dieser Therapien steht noch aus. Bessere Kenntnisse von Neurologen und Ärzten anderer Fachrichtungen können zu einer früheren Diagnosestellung und effektiveren Therapie von Dystonie-Patienten führen. Ein intensiveres Interesse der Ärzteschaft an diesem Krankheitsbild und eine zunehmende Anzahl an Behandlern und Behandlungszentren können die Versorgung dieser Patienten verbessern.
Psychoonkologie
Authors: Mehnert Anja , Lehmann-Laue Antje
Published: June 2020

Krebs gehört zu den häufigsten Erkrankungen bei Erwachsenen. Trotz einer weltweit steigenden Inzidenz überleben viele Menschen heute die Krankheit. Die multimodalen Therapien, die das Leben verlängern, beeinträchtigen die Lebensqualität von Patienten. Überleben bedeutet deshalb für viele Betroffene auch ein Leben mit körperlichen und psychosozialen Folgeproblemen. Die Psychoonkologie bietet eine evidenzbasierte Versorgung für Patienten und Angehörige an.
Best supportive care bei einer jungen Patientin mit lokal fortgeschrittenem MSI-high-Kolonkarzinom?
Authors: Welland Sabrina , De Castro Tiago , Wirth Thomas , Kleine Moritz , Ringe Kristina Imeen , Saborowski Anna , Vogel Arndt
Published: June 2020

Die molekularpathologische Diagnostik ist von zunehmender Bedeutung für die Therapiesteuerung bei Patienten mit onkologischen Erkrankungen, sowohl hinsichtlich personalisierter als auch hinsichtlich immunonkologischer Konzepte. Ein Beispiel dafür ist die Testung der Tumoren auf den Mikrosatellitenstatus; und der Nachweis einer hochgradigen Mikrosatelliteninstabilität (MSI-high) gilt bereits heute als etablierter, positiv prädiktiver Marker für das Ansprechen auf die Therapie mit Immuncheckpointinhibitoren bei Patienten mit soliden Tumoren. Beeindruckende Daten in diesem Patientenkollektiv haben dazu geführt, dass die amerikanische Food and Drug Administration (FDA) für die Immuntherapie bereits 2017 eine organunabhängige Zulassung bei Patienten mit vorbehandelten MSI-high-Tumoren ausgesprochen hat.

Am Beispiel einer jungen Patientin mit Kolonkarzinom demonstrieren wir, dass die Hürde für die Kostenübernahme einer Immuntherapie bei MSI-high-Patienten in Deutschland trotz der überzeugenden Datenlage weiterhin sehr hoch liegt, was zu einem therapeutischen und ethischen Dilemma in der Behandlung onkologischer Patienten führt.
Surgical Treatment of Anterior Communicating Artery Aneurysms: Hints and Precautions for Young Cerebrovascular Surgeons
Authors: Sturiale Carmelo Lucio , Ricciardi Luca , Marchese Enrico , Puca Alfredo , Olivi Alessandro , Albanese Alessio
Published: June 2020

Background Anterior communicating artery (AComA) aneurysms are the most common intracranial aneurysm, accounting for 25 to 38% of all cases. In spite of the advent of modern neurointerventional treatments, they still represent a strong indication for clipping in certain anatomical and clinical conditions. However, AComA aneurysms are the deepest located aneurysms of the anastomotic circle of Willis, with a complex spatial orientation, and they are fed by bilateral branches of the anterior circulations. Although, on one hand, these aneurysms represent the most complex ones of the anterior circulation, on the other hand, the experience of young neurosurgeons is increasingly limited. Therefore, respecting operative guidelines is crucial to achieve the best aneurysm exclusion and avoid fatal intraoperative complications.

Study Objective We describe the technical algorithm we use to teach young neurosurgeons how to approach AComA aneurysms and help them to develop a procedural memory needed to perform an efficient and safe surgery.

Materials and Methods We reviewed our last 10 years of institutional experience of > 200 cases of clipping ruptured and unruptured AComA aneurysms, analyzing our technical refinements and the difficulties in teaching residents and young neurosurgeons how to establish fundamental key points and design a didactic algorithm that includes operative instructions and safety rules.

Results We identified seven pragmatic technical key points regarding craniotomy, cisternostomy, gyrus rectus corticectomy, proximal control, perforators and Heubner preservation, aneurysm neck dissection, and clipping to use in a didactic algorithm for teaching residents and as operative instructions for inexperienced neurosurgeons.

Conclusion In the setting of clipping AComA aneurysms, respect for surgical rules is of paramount importance to perform an efficacious and safe procedure and ensure the best aneurysm exclusion and preservation of neurovascular structures.
Acute Respiratory Decompensation Requiring Intubation in Pregnant Women with SARS-CoV-2 (COVID-19)
Authors: Silverstein Jenna S. , Limaye Meghana A. , Brubaker Sara G. , Roman Ashley S. , Bautista Judita , Chervenak Judith , Ratner Adam J. , Sommer Philip M. , Roselli Nicole M. , Gibson Charlisa D. , Ellenberg David , Penfield Christina A.
Published: June 2020

There is a current paucity of information about the obstetric and perinatal outcomes of pregnant novel coronavirus disease 2019 (COVID-19) patients in North America. Data from China suggest that pregnant women with COVID-19 have favorable maternal and neonatal outcomes, with rare cases of critical illness or respiratory compromise. However, we report two cases of pregnant women diagnosed with COVID-19 in the late preterm period admitted to tertiary care hospitals in New York City for respiratory indications. After presenting with mild symptoms, both quickly developed worsening respiratory distress requiring intubation, and both delivered preterm via caesarean delivery. These cases highlight the potential for rapid respiratory decompensation in pregnant COVID-19 patients and the maternal-fetal considerations in managing these cases.
Elektronische Patientenakte: Einfache Abrechnung für Klinik und Patient
Authors: Uhr Agnes Eva
Published: June 2020

An der elektronischen Patientenakte (ePA) führt in Zukunft kein Weg mehr vorbei. Sie bietet nicht nur viele Vorteile für Kliniken und Ärzte, sondern auch für Patienten. Externe Abrechnungsdienstleister müssen daher performante, zukunftsfähige und vor allem kostenattraktive Lösungen für Kliniken anbieten.
Technische Due Diligence: Klinikgebäude auf Herz und Nieren prüfen
Authors: Kucera Martin
Published: June 2020

Der Gebäudebestand in Deutschlands Kliniken wird immer älter. Wer über notwendige Sanierungs- und Umbaumaßnahmen entscheiden muss, steht durch medizinische Entwicklungen, bautechnische und strukturelle Anforderungen und zunehmenden Kostendruck vor großen Herausforderungen. Im Interview erklären die Experten Mathias Heiser und Lucas Pfeiffert, wie das Analyseinstrument Technische Due Diligence (TDD) Investoren und Bauherren bei diesen Entscheidungen maßgeblich unterstützt.
Humor ist, wenn man trotzdem lacht
Authors: Ehrhardt-Joswig Jana
Published: June 2020

In Zeiten einer Pandemie durch ein neues, hochansteckendes Virus ist es nicht ganz einfach, sich von seinen Ängsten frei zu machen.
Machine learning yields new candidates for layered superconductors
Authors: Liebendorfer Adam
Published: June 2020

Maximum difference of electronegativity appears to play major role when using molecular attributes to find potential novel superconconducting materials over a wide range of critical temperatures.
Growth and development of the brush-tailed rabbit-rat (
Authors: Kemper Catherine M.
Published: June 2020

Knowledge of life history can reveal much about phylogeny, behaviour and ecology, all of which are essential for managing threatened species. Conilurus penicillatus has declined over its range and there is little information on its biology, including growth and development. Weight and four body measurements were recorded using 87 progeny of Mitchell Plateau stock, from birth to >150 days. Developmental features were recorded in animals less than 3 months old. Morgan–Mercer–Flodin, 4-Parameter Richards and Exponential growth models were applied to metric data. Neonatal development was rapid (pinnae were unfolded at birth, ears opened at 7–10 days, eyes opened at 11–14 days). An almost-complete juvenile pelage developed by 14 days. Weaning occurred at 23–40 days and adult size was attained by 100 days. At birth, males were significantly heavier than females but this difference was not evident in adults (mean = 168 g, combined sexes), when only head length was greater. Lack of sexual size dimorphism may be associated with a monogamous social structure. Conilurus penicillatus is more precocial but grows more slowly than the closely related Mesembriomys gouldii. Variation in growth and development strategies among tree-rats may be related to differences in diet, habitat and other life-history characteristics.
Corrigendum to: Extension of the historic range of Pristis pristis on the east coast of Australia
Authors: Hudgins Jessica L. , Bell Michael C. , Wueringer Barbara E.
Published: June 2020

Populations of all species of sawfish have been depleted worldwide, and sawfish are now absent from much of their historic range. Much of the historic sawfish capture and encounter data does not provide information useful for species identification, and so cannot be used to reconstruct the historic ranges of the different species. For a long time, these data were also not easily accessible, as they were not digitised. Thus historic populations and distribution ranges of the different species could have been underestimated. Here, we examine historical newspaper articles (n=237) from the Australian National Library's online database ‘Trove', that were found by searching for the generic term ‘sawfish'. Articles were examined for information that could be relevant to sawfish biology and distribution, as outlined in the IUCN's Sawfish Conservation Strategy, such as date of capture, circumstance of capture, location, animals' weight and length, and potential species identifiers. One of the articles is presented in detail as it outlines a capture of Pristis pristis outside of the currently described range of this species, by over 800km. This evidence highlights the need for a global examination of historical print resources, which use generic terminology to report sawfish encounters. Examination of global news resources may help provide greater understanding of the full historic range of sawfishes, and allow a more accurate estimation of areas in which they no longer occur.
Assessment of survey protocol for estimates of abundance for elusive nocturnal primates
Authors: Oliver Katie , Ngoprasert Dusit , Savini Tommaso
Published: June 2020

Abstract
ContextEstimates of a species abundance and habitat preferences provide vital information on their status and the appropriate conservation management. For nocturnal arboreal primates, obtaining reliable estimates of these parameters is particularly challenging because of their cryptic behaviour, often resulting in a small number of detections. Although techniques are available for assessing the abundance of species with a low probability of detection, most require strict assumptions that are difficult to meet.
AimsHere, we aimed to explore the possibility of improving nocturnal-primate abundance estimates when detection probability is low and to determine the minimal effort required to calculate reasonable estimates of their overall abundance and the effect of habitat type on abundance estimates.
MethodsWe used count data obtained from spotlighting along line transects for estimating density of Bengal slow loris (Nycticebus bengalensis) in north-eastern Thailand with N-mixture hierarchical modelling, to run simulations of varying survey parameters and asses the effort needed to produce robust estimates based on the relative bias from each simulation.
Key resultsN-mixture analysis showed that the data obtained from our study were still biased (9%), with a lambda of 1.79 lorises, detection probability of 0.11, 50 survey sites and a maximum of 12 sample occasions. The simulation results found that increasing the number of sample occasions to 14 per transect would produce an acceptable bias (<5%).
ConclusionsWe recommend that future studies on nocturnal arboreal species should use preliminary surveys to gauge the specific lambda and probability of detection so as to establish the effort needed to produce reasonable estimates of abundance.
ImplicationsOur study showed that count data obtained from spotlighting can be used to produce robust abundance estimates of nocturnal arboreal species. Unlike simple encounter rate, this method incorporates detection probability and habitat preferences, yet does not require additional trained field technicians.
The emergence of functional case marking in initial varieties of Polish L2
Authors: Saturno Jacopo , Watorek Marzena
Published: June 2020

This paper addresses the acquisition of L2 inflectional morphology after only a few hours of exposure. Eighty-nine
participants with five different L1s and no experience of the L2 took part in a specially designed 14-hour L2 Polish course, during which
they were tested on their developing morphosyntactic skills at various times. The present paper uses a Comprehension task and an Elicited
Imitation task to probe learners’ ability to use nominative and accusative case markings to infer and express the subject and object. The
study is designed to isolate variables such as the task employed to elicit L2 data, target sentence word order, time of exposure to the L2
input, and learners’ L1. The results show that while the majority of learners stick to a word order principle, some managed to identify and
systematically apply the target-like use of inflectional morphology. Various intermediate strategies make it possible to identify a
hierarchy of task difficulty. Both time of exposure and the learner’s L1 proved to be significant predictors of performance.
Potential Use of Pomalaa Nickel Slag as a Substitute for Sand in Brick Making
Authors: Ngii E , Mursidi B , Umar Y Y
Published: June 2020

The latest variance of nickel slag from PT. Antam Pomalaa has that material gradation size equivalent to sand has, so it has potentially as a sand substitute material. The study aims to determine the use of fine nickel slag as a substitute for sand in brick making. Nickel slag used is variation of 0%, 25%, 50%, 75% and 100% against of total weight of sand. The brick is designed with a cement – sand ratio of 1 : 7. The exprimental is a hollow brick with dimension of 40 cm×18 cm×10 cm. Compressive test is done after brick curing along 28 days. The maximum result of compressive test is obtained in the use of 50 % nickel slag of 19.58 kg/cm2compared to the brick without nickel slag of 12.92 kg/cm2. The conclusion that by using a fine nickel slag type of FeNi 4 up to 50 % on production, it can reduce sand use and improve the strength up to 51%.
Carbon Stocks Mapping of Mangrove Forest in North Buton Indonesia using Combination of Landsat and ALOS PALSAR Images in the Perspective of Climate Change Mitigation
Authors: Golok Jaya La Ode Muh. , Yamin Muhammad , Ningrum Ika Purwanti , Safani Jamhir , Wikantika Ketut
Published: June 2020

Mapping of carbon stocks, distribution and its changes become one of the important strategies in climate change mitigation. This study aims to map the carbon stocks of mangrove forests and analyze the changes using a combination of Landsat and ALOS PALSAR images in North Buton, South East Sulawesi Province, Indonesia. Carbon stocks in mangrove forests are known stores several times more than forests in the mainland. Mangrove forest at coast of North Buton is one of the largest area of mangrove forest in south east Sulawesi. The research conducted using backscatter coefficient of HH and HV polarization from ALOS PALSAR and Normalized Difference Vegetation Index (NDVI) from Landsat. The results showed that Landsat image provided information about the distribution, density and change of the carbon stocks during year 2001-2017 while ALOS PALSAR provided the volume of carbon stocks in this region.
Experimental Study on the Performance Characteristics of a Microwave - Solar Heating Dryer
Authors: Mangalla Lukas Kano , Ahmad L O , Lolok A , Delly Jenny , Kadir  , Samhuddin  , Kadir Abdul , Sudia B , Pagiling dan L
Published: June 2020

The use of microwave energy for drying of agricultural products is recently developed due to the advantageous of heating the product much faster and more effective than conventional methods. Moisture content of agricultural product should be evaporated immediately after harvesting in order to inhibit microbial growth and decrease enzymes activity. This work aim to investigate characteristics of microwave-solar hot air drying of agricultural products such as rice grain and potato using a commercial microwave oven and hot air from a can solar collector. A domestic microwave oven was modified in order to operate as a microwave dryer device. The state of the art of microwave-solar heating was developed for investigation on drying performance of agricultural products such as grains and potato slices. Measurements on the temperature of drying chamber and moisture content of the product were conducted under different power inputs of microwave (low, middle and high) and intensity of solar drying. It was observed that microwave-solar air dryer proposed good heating performance and quality of products. Furthermore, temperature, moisture changes and drying rate could be controlled during the drying process.
Floating Houses Technology as Alternative Living on The Water
Authors: Endangsih Tri , Ikaputra
Published: June 2020

Increasing population has resulted in increased housing needs, but currently the available land for housing is decreasing. In addition, climate change has resulted in rising sea levels. With these three problems, it is necessary to develop a place to live with limited land and utilize the potential of Indonesian waters. The efforts that have been made by the current government by building settlements vertically, but have not been able to meet the needs of the residence. One type of house that can be developed by utilizing the potential of the waters is floating houses. A floating house is a residential building that is built on water by applying floating structures, materials, and shapes to suit the construction site. The floating house will function properly with proper planning, especially in the selection of technology at the bottom, floats, and the stability of the building above the water. Besides technology, other things that need to be taken into consideration are the selection of materials and the selection of the type of structure that will be applied. This technological innovation is expected to be able to meet the needs of residences that can utilize the territorial waters.
Design Concept Long Span Bridge with Floating Foundation
Authors: Kadir Abdul , Mursidi Baso
Published: June 2020

Indonesia is a maritime country where the sea area is larger than the land area and consists of a group of islands stretching from west to east. Inter-territorial accsebility can become faster and smoother by structur long span bridges. In the deep sea and tidy ground conditions allow use of pile foundatio, however the floating foundation is an option that can be taken. The purpose of this paper is to propose the concept of a long-span bridge floating foundation that is capable and stable to support the load or forces that work.
Characteristics of Solid State Sintered Silica Ceramic Derived from Rice Husk Ash
Authors: Sudiana I N , Aba L , Lestari L , Aripin H , Suastika K G , Firihu M Z , Mitsudo S
Published: June 2020

Silica xerogel produced from rice husk ash (RHA) taken from South East Sulawesi Indonesia has been successfully sintered by using a microwave oven 2.45 GHz as well as a millimeter waves (MMW) heating system with a 28 GHz gyrotron. The samples were also heated by using an electric furnace where served as a comparison. Physical characterization of the samples before and after sintering were then investigated by using an Archimedes densification measurement method device, a X-ray diffraction (XRD) and a Scanning Electron Microscopy (SEM), respectively. Effect of microwave energy on the characteristics of silica ceramic after processing were analyzed and compared to conventionally sintered results. The effect of frequency to properties of the silica was also revealed and reported previously in separated paper. In this paper, depedency of microwave power and heating rate to grain growth and density of the ceramic are reported. The results suggested that the microwave power affect to grain growth rate of silica xerogel as well as to their density. In other hand, grain growth is also strongly depend on heating rate during fabrication.
Bulk-edge correspondence and topological phases in periodically driven spin-orbit coupled materials in the low-frequency limit
Authors: Saxena Ruchi , Rao Sumathi , Kundu Arijit
Published: June 2020

We study the topological phase transitions induced in spin-orbit coupled materials with buckling like silicene, germanene, stanene, etc, by circularly polarised light, beyond the high-frequency regime, and unearth many additional topological phases. We also study the robustness of these phases in the presence of uniform disorder. These phases are characterised by the spin-resolved topological invariants,

C

0

↑

,

C

0

↓

,

C

π

↑

and

C

π

↓

, which specify the spin-resolved edge states traversing the gaps at zero quasi-energy and the Floquet zone boundaries respectively. We show that for each phase boundary, and independently for each spin sector, the gap closure in the Brillouin zone occurs at a high symmetry point.
Time to Face Language: Embodied Mechanisms Underpin the Inception of Face-Related Meanings in the Human Brain
Authors: García Adolfo M , Hesse Eugenia , Birba Agustina , Adolfi Federico , Mikulan Ezequiel , Caro Miguel Martorell , Petroni Agustín , Bekinschtein Tristan A , del Carmen García María , Silva Walter , Ciraolo Carlos , Vaucheret Esteban , Sedeño Lucas , Ibáñez Agustín
Published: June 2020

In construing meaning, the brain recruits multimodal (conceptual) systems and embodied (modality-specific) mechanisms. Yet, no consensus exists on how crucial the latter are for the inception of semantic distinctions. To address this issue, we combined electroencephalographic (EEG) and intracranial EEG (iEEG) to examine when nouns denoting facial body parts (FBPs) and nonFBPs are discriminated in face-processing and multimodal networks. First, FBP words increased N170 amplitude (a hallmark of early facial processing). Second, they triggered fast (~100 ms) activity boosts within the face-processing network, alongside later (~275 ms) effects in multimodal circuits. Third, iEEG recordings from face-processing hubs allowed decoding ~80% of items before 200 ms, while classification based on multimodal-network activity only surpassed ~70% after 250 ms. Finally, EEG and iEEG connectivity between both networks proved greater in early (0–200 ms) than later (200–400 ms) windows. Collectively, our findings indicate that, at least for some lexico-semantic categories, meaning is construed through fast reenactments of modality-specific experience.
Who needs acetylsalicylic acid? Some order after many studies
Authors: Borghi Claudio , Ventura Fulvio
Published: June 2020

The role of acetylsalicylic acid (ASA) in cardiovascular prevention is essentially consequence of its ability to inhibit platelet aggregation, thus reducing the impact of atherosclerotic disease. The preventive power of this drug is clear when used in patients with previous cardiovascular event (myocardial infarction, stroke, etc.), but the data are less dependable when considering patients who did not experienced a cardiovascular event or in the diabetic population, in whom recent studies reported neutral results in term of efficacy, in face of an increase in the risk of bleeding. Furthermore, the interpretation of the efficacy results of ASA should be reconsidered in light of the increasing clinical complexity, not addressed in the clinical studies on which current evidences are based. Accordingly the rationale for ASA use in cardiovascular prevention is ever more of current interest, and requires a particular attention, considering the crucial role of antithrombotic therapy in the foreseeable future. What could be learned on the use of ASA in cardiovascular prevention after a century since its chemical synthesis? In secondary prevention, supporting evidences have now a couple of decades of history, and the use of the drug appears to be firmly established: in this setting, the benefits clearly surpass the risks. On the other hand, in primary prevention, where age and diabetes are among the main risk factors, the risk/benefit ratio for prophylactic therapy with ASA does not support its widespread use. Deciding when this treatment should be implemented should require a case-by-case evaluation, considering, first, the correction of each risk factor, whose control has led to a reduction of global cardiovascular mortality. The other fundamental aspect is the compliance to the treatment, particularly in patients subjected to multiple drugs regimens, in whom the physician should take into account the specific needs of the patient, as not to provide a mere prescription service.
Long-term monotherapy with ticagrelor after coronary stenting: the GLOBAL LEADERS study
Authors: Greco Antonio , Capodanno Davide
Published: June 2020

Dual antiplatelet treatment is currently the mainstay of pharmacologic treatment for patients after coronary percutaneous interventions for stable or acute coronary syndrome. The treatment decreases the incidence of thrombotic complications, but is responsible for an increased risk of bleeding. The advances in interventional cardiology and the development of new coronary stents, allow for a significant reduction of haemorrhagic complications secondary to antithrombotic treatment by either decreasing their dose or limiting their duration. The GLOBAL LEADERS study failed to demonstrate, after 2 years of follow-up, an advantage for the monotherapy with ticagrelor as compared to standard dual antiplatelet regimen. Nevertheless, focused appraisal of the study results, provide for some positive and promising new considerations. In fact, even though the results of the GLOBAL LEADER trial have not changed the current clinical practice, they provide the starting point for the design of new trials aiming at comparing new antithrombotic regimens which could be not inferior in terms of efficacy, but superior in terms of safety.
Is there a connection among atrial fibrillation, anticoagulant treatment, and dementia?
Authors: Ferri Claudio , Del Pinto Rita
Published: June 2020

It is well-known that atrial fibrillation carries an increased risk of stroke and dementia. The connecting pathogenic common mechanism is the thromboembolic state provided by atrial fibrillation, which is responsible for the acute cerebral events, as well as more saddle anatomic lesions, which accumulating over time, could lead to a progressive cognitive decline. It is plausible, instinctively, that oral anticoagulation could decrease this risk, although the possibility of micro-haemorrhages, which cannot be ignored, could make anticoagulation in this contest even dangerous. In this regard, whether there are firm, well established, evidences documenting a significant reduction in stroke occurrence with anticoagulant treatment in atrial fibrillation, the same level of evidences are not supporting the treatment in preventing dementia. Bringing some more clarity to this issue could have some considerable advantages, also in term of healthcare cost containment, considering the high prevalence of atrial fibrillation and dementia in the elderly.
Rivaroxaban in patients with ischaemic chronic cardiomyopathy and obstructive peripheral arterial disease: rationale for treatment and results
Authors: Savonitto Stefano , Pelizzoli Silvia , Selva Antonia Maria
Published: June 2020

Patients with overt clinical atherosclerosis (ATS) or with previous peripheral vascular events have a high risk of ischaemic complications. A careful control of cardiovascular (CV) risk factors has been shown to improve prognosis, likely driven by a decrease progression of ATS. Prevention of occlusive complications is, on the other hand, based on antithrombotic therapy. So far, this therapeutic goal has been pursued through antiplatelet therapy with aspirin and P2Y12 receptor inhibitors. Anticoagulant therapy with full-dose vitamin K inhibitors, although effective in some arterial conditions, is burdened by high bleeding risk, and by low long-term compliance. In the COMPASS study, the association of aspirin with the factor Xa inhibitor, rivaroxaban, in a dose of one-fourth of the dose used in atrial fibrillation, decreased by more than 20% the incidence of CV events in patients with multi-district ATS. The positive effect was also observed as far as major peripheral complications, the like of critical limb ischaemia or limb amputations. This positive preventive effect was in addition to the effect of other preventive measures, such as the use of statins, ACE inhibitors, and aspirin itself. As compared to the aspirin-only treatment, the association with low-dose rivaroxaban had a significantly higher bleeding risk, which should be carefully considered when evaluating the individual risk/benefit ratio of the combined treatment.
Acid-adapted microalgae exhibit phenotypic changes for their survival in acid mine drainage samples
Authors: Abinandan Sudharsanam , Perera Isiri Adhiwarie , Subashchandrabose Suresh R , Venkateswarlu Kadiyala , Cole Nicole , Megharaj Mallavarapu
Published: June 2020

Phenotypic plasticity or genetic adaptation in an organism provides phenotypic changes when exposed to the extreme environmental conditions. The resultant physiological and metabolic changes greatly enhance the organism's potential for its survival in such harsh environments. In the present novel approach, we tested the hypothesis whether acid-adapted microalgae, initially isolated from non-acidophilic environments, can survive and grow in acid-mine-drainage (AMD) samples. Two acid-adapted microalgal strains, Desmodesmus sp. MAS1 and Heterochlorella sp. MAS3, were tested individually or in combination (co-culture) for phenotypic changes during their growth in samples collected from AMD. The acid-adapted microalgae in AMD exhibited a two-fold increase in growth when compared with those grown at pH 3.5 in BBM up to 48 h and then declined. Furthermore, oxidative stress triggered several alterations such as increased cell size, granularity, and enhanced lipid accumulation in AMD-grown microalgae. Especially, the apparent limitation of phosphate in AMD inhibited the uptake of copper and iron in the cultures. Interestingly, growth of the acid-adapted microalgae in AMD downregulated amino acid metabolic pathways as a survival mechanism. This study demonstrates for the first time that acid-adapted microalgae can survive under extreme environmental conditions as exist in AMD by effecting significant phenotypic changes.
A Hyperbolic Counterpart to Rokhlin’s Cobordism Theorem
Authors: Chu Michelle , Kolpakov Alexander
Published: June 2020

The purpose of the present paper is to prove existence of super-exponentially many compact orientable hyperbolic arithmetic $n$-manifolds that are geometric boundaries of compact orientable hyperbolic $(n+1)$-manifolds, for any $n \geq 2$, thereby establishing that these classes of manifolds have the same growth rate with respect to volume as all compact orientable hyperbolic arithmetic $n$-manifolds. An analogous result holds for non-compact orientable hyperbolic arithmetic $n$-manifolds of finite volume that are geometric boundaries for $n \geq 2$.
Household motor vehicle ownership and obesity among Indian females and males: 2005–2016
Authors: Kellstedt Debra K , Washburn David J , Lee Shinduk , Gwarzo Ibrahim , Ahenda Petronella , Maddock Jay E
Published: June 2020

Background

To determine associations between household motor vehicle ownership and obesity among Indian adults.

Methods

Bivariate and multivariable analyses were conducted using the 2005–2006 and 2015–2016 Indian Demographic and Health surveys, with over 800 000 respondents.

Results

Obesity prevalence (body mass index ≥25 kg/m2) rose in females (16.87% to 20.35%) and in males (12.55% to 18.74%). In 2005, having both types of vehicles (motorcycle/motor scooter and car) significantly increased the odds of obesity in females (OR, 1.63; 95% CI 1.50 to 1.76) and males (OR, 2.49; 95% CI 2.24 to 2.77) as well as in 2015 (OR, 1.10; 95% CI 1.07 to 1.13 and OR, 1.56; 95% CI 1.45 to 1.68, respectively). The wealthiest were more likely to be obese in 2005 (OR, 14.95; 95% CI 16.06 to 17.12 for females; OR, 12.69; 95% CI 10.17 to 15.70 for males) and in 2015 (OR, 7.69; 95% CI 7.43 to 7.95 for females and OR, 6.40; 95% CI 5.40 to 7.01 for males). Higher education levels, being younger and rural residence were significant protective factors in 2005 and 2015.

Conclusions

After adjusting for confounders, motor vehicle ownership was significantly associated with obesity at both time points, but the effect of vehicle ownership presents differently by gender. With obesity prevalence increasing in India, policies promoting active vs motorized transport could attenuate this problem.
Optimal Income Taxation with Composition Effects
Authors: Jacquet Laurence , Lehmann Etienne
Published: June 2020

Providing estimable sufficient statistics to give policy prescriptions has become a widespread approach, a well-known limitation of which is the endogeneity of sufficient statistics to the policy. Using optimal tax policy as our field of application, we highlight a new source of endogeneity. It arises under multidimensional heterogeneity, because optimal tax formulas are then expressed as functions of weighted means of sufficient statistics computed at the individual level and the weights are endogenous to the tax policy. We analytically show that ignoring these composition effects leads to underestimate the optimal linear tax and, under a restrictive set of assumptions, the optimal nonlinear tax as well. In the latter case, we use an improved tax perturbation approach to study composition effects without these assumptions. Numerical simulations on US data suggest the optimal tax rate may be underestimated by 6 p.p. for high incomes levels. We also relate our tax perturbation method to the first-order mechanism design method, both methods having hitherto been used separately to derive optimal tax schedules.
Global Trends in Survival From Astrocytic Tumors in Adolescents and Young Adults: A Systematic Review
Authors: Girardi Fabio , Allemani Claudia , Coleman Michel P
Published: June 2020

Background

Brain tumors represent an important cause of cancer-related death in adolescents and young adults. Most are diagnosed in low-income and middle-income countries. We aimed to conduct the first, to our knowledge, systematic review of time trends and geographical variation in survival in this age group.

Methods

We included observational studies describing population-based survival from astrocytic tumors in patients aged 15-39 years. We queried 6 electronic databases from database inception to December 31, 2019. This review is registered with PROSPERO, number CRD42018111981.

Results

Among 5640 retrieved records, 20 studies fulfilled the inclusion criteria. All but 1 study focused on high-income countries. Five-year survival from astrocytoma (broad morphology group) mostly varied between 48.0% and 71.0% (1973-2004) without clear trends or geographic differences. Adolescents with astrocytoma had better outcomes than young adults, but survival values were similar when nonmalignant tumors were excluded. During 2002-2007, 5-year survival for World Health Organization grade I-II tumors was in the range of 72.6%-89.1% in England, Germany, and the United States but lower in Southeastern Europe (59.0%). Five-year survival for anaplastic astrocytoma varied between 39.6% and 55.4% (2002-2007). Five-year survival from glioblastoma was in the range of 14.2%-23.1% (1991-2009).

Conclusions

Survival from astrocytic tumors remained somewhat steady over time, with little change between 1973 and 2009. Survival disparities were difficult to examine, because nearly all the studies were conducted in affluent countries. Studies often adopted the International Classification of Childhood Cancer, which, however, did not allow to accurately describe variation in survival. Larger studies are warranted, including underrepresented populations and providing more recent survival estimates.
Relationship between thyroid tumor radiosensitivity and nuclear localization of DNA-dependent protein kinase catalytic subunit
Authors: Ihara Makoto , Shichijo Kazuko , Ashizawa Kiyoto , Matsuda Katsuya , Otsubo Ryota , Horie Ichiro , Nakashima Masahiro , Kudo Takashi
Published: June 2020

Thyroid tumors are the most common types of endocrine malignancies and are commonly treated with radioactive iodine (RAI) to destroy remaining cancer cells following surgical intervention. We previously reported that the expression levels of double-stranded DNA-dependent protein kinase catalytic subunit (DNA-PKcs), which plays a key role in non-homologous end joining, are correlated with the radiosensitivity of cancer cells. Specifically, cells expressing high levels of DNA-PKcs exhibited radiation resistance, whereas cells expressing low levels were sensitive to radiation treatment. In this study, we observed full-length native DNA-PKcs (460 kDa) in radiation-resistant FRO and KTC-2 cells through western blot analysis using an antibody against the C-terminus of DNA-PKcs. In contrast, cleaved DNA-PKcs (175 kDa) were observed in radiation-sensitive TPC-1 and KTC-1 cells. Almost equal amounts of DNA-PKcs were observed in moderately radiation-sensitive WRO cells. We also describe a simple method for the prediction of radiation therapy efficacy in individual cases of thyroid cancers based on staining for DNA-PKcs in human cancer cell lines. Immunofluorescent staining showed that native DNA-PKcs was localized largely in the cytoplasm and only rarely localized in the nuclei of radiation-resistant thyroid cancer cells, whereas in radiation-sensitive cancer cells a 175-kDa cleaved C-terminal fragment of DNA-PKcs was localized mainly inside the nuclei. Therefore, DNA-PKcs moved to the nucleus after γ-ray irradiation. Our results suggest a new method for classifying human thyroid tumors based on their cellular distribution patterns of DNA-PKcs in combination with their radiosensitivity.
Relativistic accretion disc in tidal disruption events
Authors: Mageshwaran T , Bhattacharyya Sudip
Published: June 2020

We construct a time-dependent relativistic accretion model for tidal disruption events (TDEs) with an α-viscosity and the pressure dominated by gas pressure. We also include the mass fallback rate $\dot{M}_\mathrm{ f}$ for both full and partial disruption TDEs, and assume that the infalling debris forms a seed disc in time tc, which evolves due to the mass addition from the infalling debris and the mass-loss via accretion on to the black hole. Besides, we derive an explicit form for the disc height that depends on the angular momentum parameter in the disc. We show that the surface density of the disc increases at an initial time due to mass addition, and then decreases as the mass fallback rate decreases, which results in a decrease in the disc mass Md with a late-time evolution of Md ∝ t−1.05 and t−1.38 for full and partial disruption TDEs, respectively, where t is the time parameter. The bolometric luminosity L shows a rise and decline that follows a power law at late times given by L ∝ t−1.8 and t−2.3 for full and partial disruption TDEs, respectively. Our obtained luminosity declines faster than the luminosity inferred using $L \propto \dot{M}_\mathrm{ f}$. We also compute the light curves in various spectral bands.
A Novel Classification and Its Clinical Significance in Spinal Schwannoma Based on the Membranous Hierarchy
Authors: Xin Zong , Orazmyradov Berdimyrat , Li Junjie , Zhou Qiang , Peng Lin , Li Hong , Chen Lei , Weng Zhijian , Shi Linyong , Ma Liyi , Qi Songtao , Lu Yuntao
Published: June 2020

BACKGROUND

Spinal schwannoma is a common benign tumor. However, the high recurrence rate and incidence of surgical complications are unsolved problems.

OBJECTIVE

To propose a morphological classification of spinal schwannoma based on tumor-membrane relationships to increase the gross total resection (GTR) rate and to decrease the incidence of surgical complications.

METHODS

Histological techniques were used to study 7 adult cadavers. Following picrosirius staining, the membranes around the nerve root were observed under a microscope. Data from 101 patients with spinal schwannoma were also collected for clinical analysis.

RESULTS

The sleeve around the spinal nerve root consisted of dura and arachnoid tissues. The space between them gradually narrowed and fused at the proximal pole of the nerve root ganglion. Spinal schwannomas were divided into 4 types based on membranous structure: intrapial (type I), subarachnoidal (type II), intra- and extradural (type III), and extradural growth (type IV). Types II and III were further subdivided into 2 subtypes. GTR was achieved in all patients (100%), with no tumor recurrence during follow-up. Overall functional status significantly improved postoperatively. A total of 59 patients (92%) showed improvement or significant improvement postoperatively. There was no difference in surgical outcomes among the tumor classifications (P = .618). No intraoperative vertebral artery injuries or postoperative cerebrospinal fluid fistula occurred.

CONCLUSION

Spinal schwannoma classification based on a membranous hierarchy provides an intuitive platform for preoperative planning and intraoperative safety. This classification scheme may help surgeons better define surgical goals and anticipate or even avoid complications from resection.
Determinants of long-term care insurance applications in South Korea
Authors: Park Sunhee , Kim Heejung , Park Chang Gi
Published: June 2020

Background

South Korea established universal long-term care insurance (LTCI) in 2008. However, actual requests for LTCI remain lower than government estimates because some eligible candidates never apply despite their strong care needs. This study aimed to examine factors affecting LTCI applications for older, community-dwelling Koreans.

Methods

Both individual- and community-level data were obtained from a national dataset from the Korea Health Panel Survey and the Korea National Statistical Office (N = 523). Data were analyzed using multilevel modeling.

Results

Only 16.4% of older adults in need of care applied for LTCI. Those who applied were more likely to be older, report poor self-rated health, receive care from non-family caregivers, and have caregivers experiencing high levels of caregiving burden. Regional differences in LTCI applications existed concerning the financial condition of one’s community.

Conclusions

Our study findings emphasize that Korean LTCI should implement both individual and community strategies to better assist older adults in properly acquiring LTCI. The government should make comprehensive efforts to increase access to LTCI in terms of availability, quality, cost, and information by collaborating with local centers.
Diversion in the Criminal Justice System
Authors: Mueller-Smith Michael , T. Schnepel Kevin
Published: June 2020

This article provides the first causal estimates on the popular, cost-saving practice of diversion in the criminal justice system, an intervention that provides offenders with a second chance to avoid a criminal record. We exploit two natural experiments in Harris County, Texas where first-time felony defendants faced abrupt changes in the probability of diversion. Using administrative data and regression discontinuity methods, we find robust evidence across both experiments that diversion cuts reoffending rates in half and grows quarterly employment rates by nearly 50% over 10 years. The change in trajectory persists even 20 years out and is concentrated among young black men. An investigation of mechanisms strongly suggests that stigma associated with a felony conviction plays a key role in generating these results. Other possible mechanisms including changes in incarceration, other universal adjustments in policy or practice, and differences in criminal processing are ruled out empirically.