bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypercalcaemia, adrenal insufficiency and bilateral adrenal histoplasmosis in a middle-aged man: a diagnostic dilemma
Authors: Agrawal Sweety , Goyal Alpesh , Agarwal Shipra , Khadgawat Rajesh
Published: August 2019

A 45-year-old man presented with a 3-month history of involuntary weight loss, anorexia, postural dizziness and intermittent fever. On investigation, he was found to have parathyroid hormone (PTH)-independent hypercalcaemia, with negative workup for 25-hydroxyvitamin D or 1,25-dihydroxyvitamin D excess, thyrotoxicosis, multiple myeloma and bony metastases. On further evaluation, he was detected to have primary hypoadrenalism with bilateral adrenal enlargement, secondary to adrenal histoplasmosis. Hypercalcaemia improved with hydration and physiological steroid replacement even before initiation of antifungal therapy, confirming adrenal insufficiency as the cause for hypercalcaemia. Hypercalcaemia resulting from hypoadrenalism secondary to adrenal histoplasmosis is rare and should be suspected whenever evaluating a patient with PTH-independent hypercalcaemia.
An unusual presentation of chronic sclerosing sialadenitis of submandibular gland (Kuttner’s tumour)
Authors: Lakshmanan Somu , Manimaran Vinoth , Valliappan Valliammai , Arumugam Vasugi
Published: August 2019

Kuttner’s tumour, also known as chronic sclerosing sialadenitis, is a localised form of IgG4 disease which presents as asymptomatic submandibular gland swelling. The diagnosis is usually based on histopathology and immunohistochemistry. A 33-year-old woman presented with acute-onset pain and swelling in the right submandibular region. Clinical examination showed an enlarged submandibular gland, and CT showed a calculus in the Wharton’s duct. After treating the acute phase with antibiotics, the patient underwent submandibular gland excision and calculus removal. Histopathology of the specimen showed areas of periductal sclerosis, acinar atrophy and intense lymphoplasmacytic infiltrates with occasional eosinophils. The IgG4 to IgG plasma cell ratio was >40%, suggestive of an IgG4-related disease. The authors have chosen to report this case because of the unusual presentation of IgG4 disease as acute sialadenitis.
Ischaemic stroke in a patient with myasthaenic crisis and antiphospholipid antibody syndrome
Authors: Diestro Jose Danilo B , Dorotan Maria Kristina C , Andal Vida Margarette D , Tomas Arnolfo B , Geocadin Romergryko G , Collantes Ma Epifania V
Published: August 2019

While autoimmune diseases have been frequently found to coexist in the same patients, the co-occurrence of myasthaeniagravis and antiphospholipid antibody syndrome (APAS) has only been reported in eight cases. We present a case of a 46-year-old Filipina who developed ischaemic stroke while admitted at the neurocritical unit for myasthaenic crisis. She was successfully thrombolysed with intravenous recombinant tissue plasminogen activator (rTPA), given a regimen of intravenous Ig and a dose of cyclophosphamide prior to discharge. Extensive workup revealed APAS to be the aetiology of her stroke. Twenty-one months into her follow-up, she is doing well with a modified Rankin Score of 0. Our case suggests that rTPA followed by immunomodulators may be given safely in myasthaenic crisis patients who develop ischaemic stroke. We emphasise the importance of doing a comprehensive neurological evaluation in agitated patients in the critical care unit.
An abnormal capnography trace due to air embolism in the lateral position
Authors: Lee Yi Lin , Hwang Kai Yin , Yew Woon Si , Ng Shin Yi
Published: August 2019

Venous air embolism occurs when air is entrained into the venous system and travels to the right heart and pulmonary circulation, and commonly occurs as a complication in laparoscopic, neurosurgical and cardiac surgeries. We present a case of abnormal end-tidal carbon dioxide capnography tracing in the lateral position in a laparoscopic major liver procedure and discuss the potential novel use of this as a red flag in aiding the medical practitioner to diagnose air embolism.
Developing a fully automated evidence synthesis tool for identifying, assessing and collating the evidence
Authors: Brassey Jon , Price Christopher , Edwards Jonny , Zlabinger Markus , Bampoulidis Alexandros , Hanbury Allan
Published: August 2019

Evidence synthesis is a key element of evidence-based medicine. However, it is currently hampered by being labour intensive meaning that many trials are not incorporated into robust evidence syntheses and that many are out of date. To overcome this, a variety of techniques are being explored, including using automation technology. Here, we describe a fully automated evidence synthesis system for intervention studies, one that identifies all the relevant evidence, assesses the evidence for reliability and collates it to estimate the relative effectiveness of an intervention. Techniques used include machine learning, natural language processing and rule-based systems. Results are visualised using modern visualisation techniques. We believe this to be the first, publicly available, automated evidence synthesis system: an evidence mapping tool that synthesises evidence on the fly.
Efficacy of adaptive e-learning for health professionals and students: a systematic review and meta-analysis
Authors: Fontaine Guillaume , Cossette Sylvie , Maheu-Cadotte Marc-André , Mailhot Tanya , Deschênes Marie-France , Mathieu-Dupuis Gabrielle , Côté José , Gagnon Marie-Pierre , Dubé Veronique
Published: August 2019

Objective

Although adaptive e-learning environments (AEEs) can provide personalised instruction to health professional and students, their efficacy remains unclear. Therefore, this review aimed to identify, appraise and synthesise the evidence regarding the efficacy of AEEs in improving knowledge, skills and clinical behaviour in health professionals and students.

Design

Systematic review and meta-analysis.

Data sources

CINAHL, EMBASE, ERIC, PsycINFO, PubMed and Web of Science from the first year of records to February 2019.

Eligibility criteria

Controlled studies that evaluated the effect of an AEE on knowledge, skills or clinical behaviour in health professionals or students.

Screening, data extraction and synthesis

Two authors screened studies, extracted data, assessed risk of bias and coded quality of evidence independently. AEEs were reviewed with regard to their topic, theoretical framework and adaptivity process. Studies were included in the meta-analysis if they had a non-adaptive e-learning environment control group and had no missing data. Effect sizes (ES) were pooled using a random effects model.

Results

From a pool of 10 569 articles, we included 21 eligible studies enrolling 3684 health professionals and students. Clinical topics were mostly related to diagnostic testing, theoretical frameworks were varied and the adaptivity process was characterised by five subdomains: method, goals, timing, factors and types. The pooled ES was 0.70 for knowledge (95% CI −0.08 to 1.49; p.08) and 1.19 for skills (95% CI 0.59 to 1.79; p<0.00001). Risk of bias was generally high. Heterogeneity was large in all analyses.

Conclusions

AEEs appear particularly effective in improving skills in health professionals and students. The adaptivity process within AEEs may be more beneficial for learning skills rather than factual knowledge, which generates less cognitive load. Future research should report more clearly on the design and adaptivity process of AEEs, and target higher-level outcomes, such as clinical behaviour.

PROSPERO registration number

CRD42017065585
Factors associated with maternity waiting home use among women in Jimma Zone, Ethiopia: a multilevel cross-sectional analysis
Authors: Kurji Jaameeta , Gebretsadik Lakew Abebe , Wordofa Muluemebet Abera , Sudhakar Morankar , Asefa Yisalemush , Kiros Getachew , Mamo Abebe , Bergen Nicole , Asfaw Shifera , Bedru Kunuz Haji , Bulcha Gebeyehu , Labonte Ronald , Taljaard Monica , Kulkarni Manisha
Published: August 2019

Objective

To identify individual-, household- and community-level factors associated with maternity waiting home (MWH) use in Ethiopia.

Design

Cross-sectional analysis of baseline household survey data from an ongoing cluster-randomised controlled trial using multilevel analyses.

Setting

Twenty-four rural primary care facility catchment areas in Jimma Zone, Ethiopia.

Participants

3784 women who had a pregnancy outcome (live birth, stillbirth, spontaneous/induced abortion) 12 months prior to September 2016.

Outcome measure

The primary outcome was self-reported MWH use for any pregnancy; hypothesised factors associated with MWH use included woman’s education, woman’s occupation, household wealth, involvement in health-related decision-making, companion support, travel time to health facility and community-levels of institutional births.

Results

Overall, 7% of women reported past MWH use. Housewives (OR: 1.74, 95% CI 1.20 to 2.52), women with companions for facility visits (OR: 2.15, 95% CI 1.44 to 3.23), wealthier households (fourth vs first quintile OR: 3.20, 95% CI 1.93 to 5.33) and those with no health facility nearby or living >30 min from a health facility (OR: 2.37, 95% CI 1.80 to 3.13) had significantly higher odds of MWH use. Education, decision-making autonomy and community-level institutional births were not significantly associated with MWH use.

Conclusions

Utilisation inequities exist; women with less wealth and companion support experienced more difficulties in accessing MWHs. Short duration of stay and failure to consider MWH as part of birth preparedness planning suggests local referral and promotion practices need investigation to ensure that women who would benefit the most are linked to MWH services.
Association between maternal education and breast feeding practices in China: a population-based cross-sectional study
Authors: Tang Kun , Wang Hanyu , Tan Shi Hui , Xin Tong , Qu Xueqi , Tang Tianyu , Wang Yuqi , Liu Yuning , Gaoshan Junjian
Published: August 2019

Objective

To investigate the association between maternal education and breast feeding in the Chinese population, with a consideration of household income and health-seeking behaviours.

Design

A nationally representative population-based cross-sectional study.

Setting

77 counties from 12 geographically distinct regions in China.

Participants

10 408 mothers with children from 0 to 12 months of age, aged 15–53 years old (mean: 29.15, SD: 5.11) were classified into primary school or below group (n=781), middle school group (n=3842), high school/vocational school group (n=1990), college or above group (n=3795), according to their highest completed education.

Outcomes

Five breastfeeding outcomes, including early initiation of breast feeding (EIB), exclusive breast feeding (EBF) under 6 months, predominant breast feeding under 6 months, current breast feeding and children ever breast fed, were calculated based on the standardised questionnaire from the WHO and Wellstart International’s toolkit for monitoring and evaluating breastfeeding activities.

Results

The absolute risk of EIB and EBF in the lowest maternal education level was 64.85% and 26.53%, respectively, whereas the absolute risk of EIB and EBF in the highest maternal education level was 77.21% and 14.06%, respectively. A higher level of maternal education was positively associated with EIB (risk ratio (RR): 1.22; 95% CI: 1.12 to 1.30) and was inversely associated with EBF (RR: 0.59; 95% CI: 0.38 to 0.88). Stratified by household income, a positive association with EIB was observed only in the group with the highest household income and an inverse association with EBF was found in both low household and high household income groups.

Conclusions

Mothers with a higher education were more likely to initiate early breast feeding when they were also from a high-income household while also being less likely to exclusively breast feed their babies. Routine and successful nursing is crucial for the health of infants and is influenced by maternal education. Future public health interventions to promote breast feeding should consider the issues related to the educational level of mothers.
Efficacy of Xuebijing Injection for Sepsis (EXIT-SEP): protocol for a randomised controlled trial
Authors: Liu Songqiao , Yao Chen , Zhang Junhua , Yang Yi , Qiu Haibo
Published: August 2019

Introduction

Sepsis is a major challenge with high incidence and is associated with high mortality worldwide. Current management of sepsis remains mainly supportive except for treatment with antibiotics. Both basic research and clinical investigation have shown that the Chinese herbal-derived therapeutic Xuebijing (XBJ) injection is beneficial for patients with sepsis. However, the quality of evidence supporting the therapeutic use of XBJ in sepsis is limited. The aim of this trial is to evaluate the Efficacy of Xuebijing Injection for Sepsis, compared with a placebo, on the outcome of patients with sepsis in the intensive care unit (ICU).

Methods and analysis

In this multicentre, blinded randomised controlled trial, we are recruiting a total of 1800 subjects who met Sepsis 3.0 criteria. Subjects will be randomised (1:1) to receive XBJ, every 12 hours for 5 days or a matching placebo and usual care. The primary outcome is 28 days all-cause mortality. Secondary outcomes will be the improvement of Sequential Organ Failure Assessment scores, the improvement of the Acute Physiology and Chronic Health Evaluation II score, duration of mechanical ventilation, mortality in ICU and duration of stay in the ICU. Investigators, participants and statisticians will be blinded to the allocated treatment.

Ethics and dissemination

This trial has been approved by all ethics committees of the centres that will participate in this trial. The findings of the study will be disseminated in peer-reviewed journals and present at conferences. Once this study is complete, the results of this trial may help provide evidence-based recommendations for complementary therapeutic options for patients with sepsis.

Trial registration number

NCT03238742and ChiCTR-IPR-17012713.
The Uppsala–Stockholm Assisted Reproductive Techniques (UppStART) study
Authors: Iliadou Anastasia N , Öberg Anna Sara , Pege Jessica , Rodriguez-Wallberg Kenny A , Olofsson Jan I , Holte Jan , Wramsby Håkan , Wramsby Margaretha , Cnattingius Sven , Cesta Carolyn E
Published: August 2019

Purpose

The Uppsala–Stockholm Assisted Reproductive Techniques (UppStART) study is a prospectively recruited sample of couples undergoing assisted reproduction in Stockholm and Uppsala county in Sweden. The study was initiated to (1) investigate possible changes in the epigenetic profile of infants inferred through the ART procedures and their consequence and (2) to assess the impact of lifestyle and health exposures on treatment outcome.

Participants

Recruitment took place between September 2011 and December 2013, and in vitro fertilisation (IVF) cycles initiated and pregnancies conceived during this time were followed until December 2014. The cohort includes 971 participants (n= 514 women; n= 457 men), and 129 pregnancies were achieved from the first IVF cycle included in the study.

Findings to date

Self-reported demographic, health and lifestyle data were collected from a baseline questionnaire, and to assess changes to lifestyle, a follow-up questionnaire was issued at the time of oocyte retrieval, and at subsequent IVF cycles. Questionnaire data were linked to data extracted from medical records. Biological samples were collected at baseline: blood for extraction of serum, plasma and DNA, morning and evening saliva samples for cortisol measurement and at delivery including samples of maternal blood, placenta and amniotic fluid, and cord blood for epigenetic analysis.

Future plans

Through the unique identification number assigned to each Swedish citizen at birth or immigration, UppStART study participants will be linked to the Swedish population-based national and quality registers to provide data from prenatal, obstetrical, neonatal and infant care, and subsequent updates will provide data on childhood health and educational outcomes. Collaboration and use of UppStART data is encouraged, and more information about access can be found atwww.ki.se/meb/uppstart
EBN perspectives: nursing issues
Authors: Kidd Lisa , Twycross Alison
Published: August 2019

EBN Perspectives brings together key issues from the commentaries in one of our nursing topic themes
Alcohol outlets and firearm violence: a place-based case–control study using satellite imagery and machine learning
Authors: Jay Jonathan
Published: August 2019

Introduction

This article proposes a novel method for matching places based on visual similarity, using high-resolution satellite imagery and machine learning. This approach strengthens comparisons when the built environment is a potential confounder, as in many injury research studies.

Methods

As an example, I apply this method to study the spatial influence of alcohol outlets (AOs) on firearm violence in Philadelphia, Pennsylvania, specifically beer stores and bar/restaurants. Using a case–control framework, city blocks with shootings in 2017–2018 were matched with similar-looking blocks with no shootings, based on analysis with a pretrained convolutional neural network andt-distributed stochastic neighbour embedding. Logistic regression was used to estimate the OR of a shooting on the same block as an AO and within one-block and two-block distances, conditional on additional factors such as land use, demographic composition and illegal drug activity.

Results

The case–control matches were similar in visual appearance, on human inspection, and were well balanced on covariate measures. The fully adjusted model estimated an increased shootings risk for locations with beer stores within one block,OR=1.5, 95% CI 1.1 to 2.1, p=0.02, and locations with bar/restaurants on the same block,OR=1.6, 95% CI 1.1 to 2.4, p=0.02.

Conclusion

These findings align with previous study findings while addressing the concern that AOs might systematically be located in certain kinds of environments, providing stronger evidence of a causal effect on nearby firearm violence. Matching on visual similarity can improve observational injury studies involving place-based risks.
Consistent control of disease activity with fingolimod versus IFN β-1a in paediatric-onset multiple sclerosis: further insights from PARADIGMS
Authors: Deiva Kumaran , Huppke Peter , Banwell Brenda , Chitnis Tanuja , Gärtner Jutta , Krupp Lauren , Waubant Emmanuelle , Stites Tracy , Pearce Gregory Lewis , Merschhemke Martin
Published: August 2019

Background

In PARADIGMS, a double-blind phase III trial in 215 paediatric patients with multiple sclerosis (MS) (10 to <18 years), fingolimod administered for up to 2 years significantly reduced the annualised relapse rate (ARR) and rate of new/newly enlarged T2 (n/neT2) lesions compared with interferon (IFN) β-1a.

Objectives

To investigate (1) differences between treatment groups across subpopulations (treatment-naïve, younger/prepubertal patients); (2) disability progression.

Methods

ARRs at 10, 11 and 12 years were estimated based on predefined modelling extrapolations. Changes in Expanded Disability Status Scale (EDSS), and in 3 month (3M) and 6 month (6M) confirmed disability progression (CDP) were evaluated post hoc.

Results

In the treatment-naïve subpopulation, fingolimod reduced ARR and n/neT2 lesions by 85.8% and 53.4%, respectively versus INF β-1a (both p<0.001), compared with 81.9% and 52.6% in the overall population. Model-based ARR reductions in younger patients (≤12 years) were 91.9%–94.6%. Twice as many IFN β-1a-treated than fingolimod-treated patients had worse EDSS scores at study end (20.6% vs 10.5%, p=0.043). Risk reductions in 3M-CDP and 6M-CDP were 77.2% (p=0.007) and 80.2% (p=0.040), respectively.

Conclusions

Fingolimod in paediatric MS was associated with consistent control of disease activity versus IFN β-1a (including treatment-naïve and younger patients) and resulted in less disability progression for up to 2 years.

Trial registration number

NCT01892722.
Epstein–Barr virus associated CNS lymphoproliferative disorder after long-term immunosuppression
Authors: Lee Andrew , Bridges Leslie R , Lloyd Mark , Barker Robert , Wren Damian R , Galtrey Clare M
Published: August 2019

The incidence of Epstein–Barr virus (EBV)associated lymphoproliferative disorders has increased with greater use of immunomodulatory therapies. We present a woman who developed subacute cognitive decline and unilateral weakness while taking long-term mycophenolate mofetil for granulomatosis with polyangiitis; her postmortem brain histopathology confirmed an EBV-driven lymphoproliferative disorder. Clinicians must have a high index of suspicion for EBV-driven lymphoma in people taking long-term immunosuppression who develop new neurological problems. We review the role of mycophenolate mofetil in EBV-driven lymphoproliferative disorders, and discuss checking EBV status in all patients starting immunosuppression and in older people already taking immunosuppression.
Determining the bearing capacity factor due to nonlinear matric suction distribution in the soil
Authors: Ghasemzadeh Hasan , Akbari Fereshteh
Published: August 2019

Bearing capacity is often calculated in dry or saturated conditions, leading to overconservative designs, for a wide range of climates in the world. Extensive researches show that bearing capacity is significantly affected by the soil matric suction. However, in most of the presented models, uniform (and sometimes linear) suction distributions are taken into account for computing the bearing capacity. Also, there is no exact solution in the residual zone of unsaturation. In the present study, a simple method is proposed to predict the bearing capacity of footings placed on unsaturated soil, using the limit equilibrium concept. Linear and uniform variations of matric suction are considered in computations, as well as the nonlinear suction distribution. The framework of the proposed model is analogous to Terzaghi’s equation, and a novel factor is developed, during calculations, as the suction bearing capacity factor. In the case of full saturation, the proposed model is simplified to the Terzaghi’s equation. Estimated results are compared with the experimental and theoretical data available in the literature. Predicted values are in a good agreement with the measured data in the transition zone and residual zone of unsaturation.
Quasi-periodic solutions of the negative-order Jaulent–Miodek hierarchy
Authors: Chen Jinbing
Published: August 2019

A uniform construction of quasi-periodic solutions to the negative-order Jaulent–Miodek (nJM) hierarchy is presented by using a family of backward Neumann type systems. From the backward Lenard gradients, the nJM hierarchy is put into the zero-curvature setting and the bi-Hamiltonian structure displaying its integrability. The nonlinearization of Lax pair is generalized to the nJM hierarchy such that it can be reduced to a sequence of backward Neumann type systems, whose involutive solutions yield finite parametric solutions of the nJM hierarchy. The negative [Formula: see text]-order stationary JM equation is given to specify a finite-dimensional invariant subspace for the nJM flows. With a spectral curve determined by the Lax matrix, the nJM flows are linearized on the Jacobi variety of a Riemann surface. Finally, the Riemann–Jacobi inversion is applied to Abel–Jacobi solutions of the nJM flows, by which some quasi-periodic solutions are obtained for the nJM hierarchy.
DEVELOPMENT AND VALIDATION OF A METHOD TO ENHANCE AUDITORY ATTENTION DURING CONTINUOUS SPEECH-SHAPED NOISE ENVIRONMENT
Authors: DU YIHANG , FANG WEINING , QIU HANZHAO
Published: August 2019

Auditory training (AT) may strengthen auditory skills that help human not only in on-task auditory perception performance but in continuous speech-shaped noise (SSN) environment. AT based on musical material has provided some evidence for an “auditory advantage” in understanding speech-in-noise (SIN), but with a long period training and complex procedure. Experimental research is essential to develop a simplified method named auditory target tracking training (ATT) which refined from musical material is necessary to determine the benefits of training. We developed two kinds of refined AT method: basic auditory target tracking (BAT) training and enhanced auditory target tracking (EAT) training to adult participants ([Formula: see text]) separately for 20 units, assessing performance to perceive speech in noise environment after training. The EAT group presented better speech perception performance than the other groups and no significant differences between BAT group and control group. The training effect of EAT is the most significant when uni-gender SSN and [Formula: see text] dB. Outcomes suggest that efficacy of trained EAT can improve speech perception performance and selective attention during SSN environment. These findings provide an important link between musical-based training and auditory selective attention in real-world, and extended to special vocational training.
INK-JET PRINTED STRETCHABLE SENSORS FOR CELL MONITORING UNDER MECHANICAL STIMULI: A FEASIBILITY STUDY
Authors: TONELLO SARAH , BORGHETTI MICHELA , LOPOMO NICOLA F. , SERPELLONI MAURO , SARDINI EMILIO , MARZIANO MARIAGRAZIA , SERZANTI MARIALAURA , UBERTI DANIELA , DELL’ERA PATRIZIA , INVERARDI NICOLETTA , GUALANDI CHIARA , FOCARETE MARIA LETIZIA
Published: August 2019

Impedance-based sensors represent a promising tool for cell monitoring to improve current invasive biological assays. A novel research field is represented by measurements performed in dynamic conditions, monitoring cells (e.g., myocytes) for which the mechanical stimulus plays an important role for promoting maturation. In this picture, we applied printed and stretchable electronics principles, developing a system able to evaluate cells adhesion during substrate cyclic strain. Cytocompatible and stretchable sensors were ink-jet printed using carbon-based ink on crosslinked poly([Formula: see text]-caprolactone) electrospun mats. Moreover, a customized stretching device was produced, with a complete user interface to control testing condition, validated in order to correlate impedance changes with myoblasts — i.e., myocytes precursors — adhesion. Overall system sensitivity was evaluated using three different cell concentrations and DAPI imaging assay was performed to confirm myoblast adhesion. Preliminary results showed the possibility to correlate an average increase of impedance magnitude of 1[Formula: see text]k[Formula: see text] every 15,000 cells/cm2 seeded, suggesting the possibility to discriminate between different cell concentrations, with a sensitivity of 80[Formula: see text]m[Formula: see text]/(cells/cm2). In conclusion, the present system might be generalized in the development of future applications, including the differentiation process of cardiac myocytes with the aid of mechanical stimuli.
A MECHANICS-BASED MODEL FOR SIMULATING THE NEEDLE DEFLECTION IN TRANSVERSE ISOTROPIC TISSUE FOR A PERCUTANEOUS PUNCTURE
Authors: LIU WANYU , YANG ZHIYONG , JIANG SHAN
Published: August 2019

During the percutaneous puncture for robot-assisted brachytherapy, a medical needle is usually inserted into fiber-structured soft tissue which has transverse isotropic elasticity, such as muscle and skin, to deliver radioactive seeds that kill cancer cells. To place the radioactive seeds more accurately, it is necessary to assess the effect of the transverse isotropic elasticity on the needle deflection. A mechanics-based model for simulating the needle deflection in transverse isotropic tissue is developed in this paper. The anisotropic needle–tissue interaction forces are estimated and used as inputs to drive the model for simulating needle deflections for different insertion orientation angles. Automatic insertion experiments were performed on a single-layered porcine muscle at five different insertion orientation angles. The results show that the maximum difference in the tip deflection for the different insertion orientation angles is 2.99[Formula: see text]mm when the insertion depth is 50[Formula: see text]mm. The maximum simulated error of the needle axis deflection is 0.62[Formula: see text]mm for all insertion orientation angles. The developed model can successfully simulate the needle deflections inside transverse isotropic tissue for different insertion orientation angles. This work is useful for predicting and compensating for the deflection error for automatic needle insertion.
Research on the Deformation Characteristics and Support Technology of a Bottom Gas Extraction Roadway under Repeated Interference
Authors: Pan Rongkun , Ma Zhihui , Yu Minggao , Wu Shuaidong
Published: August 2019

Taking Pingbao Coal Mine as the engineering background, the stress distribution, surrounding rock displacement, and plastic zone distribution characteristics of a bottom gas extraction roadway are simulated by FLAC3D under multiple disturbances. The mining disturbance due to the overlying coal seam is obtained: the deformation of the roof subsidence and lower rib closure of the bottom gas extraction roadway are larger than the floor heave and upper rib closure, respectively. According to the mechanical analysis of the bottom gas extraction roadway, the equations for calculating the displacement at each point on the surface of the bottom gas extraction roadway and the methods for calculating the maximum displacement, the maximum normal stress, and the maximum shear stress are obtained to reasonably explain the deformation of the bottom gas extraction roadway under multiple disturbances. Then, the bolt‐mesh‐anchor and ladder beam support mode are designed. After onsite observation of the bottom gas extraction roadway of the 12030 coal mining face of the Pingbao Coal Mine, it is concluded that the deformation characteristics of the bottom gas extraction roadway basically conform to the abovementioned equations and that the support is effective. This paper can provide a reference for the optimization of bottom gas extraction roadway positioning, the determination of support parameters, and the deformation prediction around a bottom gas extraction roadway under similar conditions.
Connection between Two Leading Modes of Autumn Rainfall Interannual Variability in Southeast China and Two Types of ENSO-Like SSTA
Authors: Liu Kui , Chen Jilong , Yang Ruowen
Published: August 2019

The interannual variability of autumn rainfall in Southeast China (SEC) is significant, with two major modes, namely, monopole and dipole modes. It is found that the monopole mode is closely related to EP ENSO-like sea surface temperature anomaly (SSTA), and the dipole mode is related to CP ENSO-like SSTA. During the warm phase of EP ENSO-like SSTA, an anomalous anti-Walker circulation emerges in the tropical Pacific, with an anomalous subsiding during 110°E–120°E and an anomalous ascending branch in SEC. These two branches of anomalous current are in the same longitude and form a closed meridional circulation. Besides, there also exists an anticyclone anomaly in the Northwest Pacific (NWP), transporting water vapor into SEC. These circulation configurations induced by the warm phase of EP ENSO-like SSTA are consistent with those of monopole mode positive anomaly year. The good correspondence between EP ENSO warm event and the positive monopole mode also helps to support the corresponding relationship between the EP ENSO-like SSTA and monopole mode of SEC autumn rainfall. After the diagnosis of the perturbation omega equation, the anomalous subsiding branch over SEC, as the key link of EP ENSO-like warm phase SSTA exerting impact on the monopole mode during positive anomaly year, is mainly related with the anomalous relative vorticity advection transported by basic zonal wind and temperature advection transported by meridional wind anomaly. As for the dipole mode, it is related to the CP ENSO-like SSTA, but the corresponding relationship is weaker than that of the monopole mode and EP ENSO-like SSTA. In special, during the warm phase of CP ENSO-like SSTA, an anomalous cyclone appears in the NWP and prevailing sinking motion over SEC, both of which favors the appearance of positive anomaly of the dipole mode. Specially, the local anomalous vertical motion mainly depends on anomalous relative vorticity transported by basic meridional wind. Generally speaking, the monopole (dipole) mode is closely associated with the EP (CP) ENSO-like SSTA, demonstrating some correspondence.
Comparative Studies on Chemical Contents and Effect in Kidney-Yang Deficiency Rats of Salt-Processed Product and Wine-Processed Product of Cuscutae Semen
Authors: Zhang Ying , Xu Shu-ya , Liu Meng-nan , Jia Tian-ying , Qu Wen-jia , Han Ting , Jia Zhe , Xu Xin-fang , Li Xiang-ri
Published: August 2019

Cuscutae Semen mainly includes salt-processed product (SPP) and wine-processed product (WPP), which are most commonly used in traditional Chinese medicine. However, the differences between SPP and WPP have not been reported. In this paper, comparative studies between SPP and WPP on chemical contents and effect in kidney-yang deficiency rats have been investigated. UPLC-MS/MS was used to study the differences in chemical components. Kidney-yang deficiency was induced by hydrocortisone in rats. Rats were orally administrated with different doses of Jinkui Shenqi Pills, SPP, and WPP for 28 days. The average organ coefficients, renal function indexes, sex hormone levels, and testicular morphology were detected. As a result, the contents of flavonoids and chlorogenic acids were higher in SPP than in WPP, which may be caused by different processing methods. The improvement on reproduction of SPP was reflected in organ coefficients, renal function indexes, and biochemical properties of seminal plasma; furthermore, WPP was in sex hormone levels and morphology of testis. As a conclusion, these results indicated that both SPP and WPP can improve the reproductive function of kidney-yang deficiency rats with different mechanisms, which may be due to the differences in chemical contents between WPP and SPP as well as different processing methods. It is the first time that the differences between SPP and WPP have been studied in reproductive function in rats with kidney-yang deficiency.
Outcomes of MyoRing Implantation in Eyes with Keratoconus in the Eastern Province of Saudi Arabia: “A Single-Arm Cohort Study”
Authors: Alshammari Yousef Saad , Al Somali Abdulaziz Ismail
Published: August 2019

Purpose. To evaluate the efficacy and safety of MyoRing implantation in eyes with keratoconus managed at a tertiary eye hospital in the Eastern Province of Saudi Arabia. Methods. This one-armed historical cohort study included keratoconus patients operated for MyoRing implant. The cases were assessed before and 6 months after surgery. Uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), spherical equivalent (SE), central corneal thickness (CCT), and corneal curvature (Kmean) were noted and measured before and 6 months after the intervention. Intra- and postoperative complications were noted. Result. We studied 12 eyes of 12 patients with moderate keratoconus. The median of Kmean was 50.6 mm (IQR 47.54; 52.5) and 44.5 mm (IQR 42.5; 46.8) before and 6 months after surgery. The change in Kmean was significant (P=0.002). The median spherical equivalent (SE) was −5.1D (interquartile range (IQR) 7.1; −3.6) and −0.6 (IQR −2.1; 0.8) before and 6 months after surgery. The difference in SE was significant (Wilcoxon signed-rank test P=0.004). The CCT was 447 ± 34 μm and 444 ± 30 μm before and 6 months after surgery, respectively. The CCT change was not significant (P=0.26). The UCVA and BCVA improved by 2 or more lines in 9 (75%) eyes, remained stable in 2 (16.7%) eyes, and decreased in 2 (16.7%) eyes. Conclusion. MyoRing implant seems to be a safe and effective procedure to manage low and moderate keratoconus. The outcomes could be further enhanced by additional procedures such as collagen cross-linkage and photorefractive keratectomy if warranted.
MRI Tracking of SPIO- and Fth1-Labeled Bone Marrow Mesenchymal Stromal Cell Transplantation for Treatment of Stroke
Authors: Huang Xiaolei , Xue Yang , Wu Jinliang , Zhan Qing , Zhao Jiangmin
Published: August 2019

We aimed to identify a suitable method for long-term monitoring of the migration and proliferation of mesenchymal stromal cells in stroke models of rats using ferritin transgene expression by magnetic resonance imaging (MRI). Bone marrow mesenchymal stromal cells (BMSCs) were transduced with a lentivirus containing a shuttle plasmid (pCDH-CMV-MCS-EF1-copGFP) carrying the ferritin heavy chain 1 (Fth1) gene. Ferritin expression in stromal cells was evaluated with western blotting and immunofluorescent staining. The iron uptake of Fth1-BMSCs was measured with Prussian blue staining. Following surgical introduction of middle cerebral artery occlusion, Fth1-BMSCs and superparamagnetic iron oxide- (SPIO-) labeled BMSCs were injected through the internal jugular vein. The imaging and signal intensities were monitored by diffusion-weighted imaging (DWI), T2-weighted imaging (T2WI), and susceptibility-weighted imaging (SWI) in vitro and in vivo. Pathology was performed for comparison. We observed that the MRI signal intensity of SPIO-BMSCs gradually reduced over time. Fth1-BMSCs showed the same signal intensity between 10 and 60 days. SWI showed hypointense lesions in the SPIO-BMSC (traceable for 30 d) and Fth1-BMSC groups. T2WI was not sensitive enough to trace Fth1-BMSCs. After transplantation, Prussian blue-stained cells were observed around the infarction area and in the infarction center in both transplantation models. Fth1-BMSCs transplanted for treating focal cerebral infarction were safe, reliable, and traceable by MRI. Fth1 labeling was more stable and suitable than SPIO labeling for long-term tracking. SWI was more sensitive than T2W1 and suitable as the optimal MRI-tracking sequence.
A Multiplicative Coordinated Stealthy Attack for Nonlinear Cyber‐Physical Systems with Homogeneous Property
Authors: Na Gyujin , Lee Hanbit , Eun Yongsoon
Published: August 2019

Stealthy attacks to cyber‐physical systems (CPS) refer to the ones that avoid attack detection mechanisms augmented to the systems typically in the form of anomaly detectors. Various types of stealthy attacks have been reported in the literature. Among the attacks with stealthy property, a recently reported multiplicative coordinated attack is particularly dangerous in that it corrupts sensor and actuator data in a coordinated manner, and it does not require precise system knowledge in order to be stealthy. It must be noted that most of these attacks are applicable to CPS, the physical counterparts of which are of linear dynamics. This could be a limitation since most of the physical dynamic systems that are encountered from CPS perspective are of nonlinear nature. In this work, we present a version of multiplicative coordinated stealthy attack for a class of CPS, the physical counterpart of which possesses nonlinear dynamics. Specifically, for the physical systems with homogeneous property, the attack is constructed and the effect is analyzed. Various simulations are carried out to illustrate the effect of the attack.
An Unusual Cause of Fetal Stroke: Secondary HSV Infection
Authors: Daming Tara Banaszek , Jackson Sherri
Published: August 2019

Herpes simplex virus (HSV) is a recognized cause of neonatal infection, with hematologic vertical spread usually only during a primary infection. This is an unusual case with hematologic spread of an HSV 2 infection resulting in a fetal stroke, not associated with a primary outbreak during pregnancy. A 25-year-old multigravida at 26 weeks was diagnosed with a large fetal stroke. Previous ultrasounds showed normal anatomy. She had preterm labor and delivery, with unsuccessful neonatal resuscitation. Vesicular lesions were noted on the infant. Both the lesions and the cerebral spinal fluid were positive for HSV 2. She had documented HSV infection prior to pregnancy, indicating that this was due to a hematologic secondary infection, as there was no rupture of membranes or evidence of other modes of transmission. This case shows that, while unusual, HSV hematologic vertical transmission can occur in both primary and secondary infection during pregnancy. Infection screening is worthwhile in unexplained fetal strokes.
Preparation and Characterization of Coaxial Electrospinning rhBMP2-Loaded Nanofiber Membranes
Authors: Zhao He , Ma Yali , Sun Dahui , Ma Wendi , Yao Jihang , Zhang Mei
Published: August 2019

DEX and rhBMP2-loaded core-shell nanofiber membranes were synthesized by electrospinning method in one step. Zein/PLLA, Zein-DEX/PLLA, Zein/PLLA-rhBMP2, and Zein-DEX/PLLA-rhBMP2 were fabricated; and morphology, hydrophilicity, mechanics properties, in vitro drug release behavior, cell proliferation, and osteogenic differentiation were investigated. The results showed that the dual-release system containing rhBMP2 and DEX prepared by electrospinning had rough surface, constant drug release behavior, and could also significantly promote cell proliferation and osteogenic differentiation of RMSCs, indicating that the scaffolds we fabricated might be suitable for bone tissue engineering.
Dry Eye Indexes Estimated by Keratograph 5M of Systemic Lupus Erythematosus Patients without Secondary Sjögren’s Syndrome Correlate with Lupus Activity
Authors: Wang An , Gu Zhengyu , Liao Rongfeng , Shuai Zongwen
Published: August 2019

Purpose. To investigate the incidence, severity, and influencing factors of dry eye in systemic lupus erythematosus (SLE) patients without secondary Sjögren’s syndrome (sSS). Methods. A total of 78 patients who were diagnosed with systemic lupus erythematosus and met inclusion criteria were selected as the study subjects in this cross-sectional study. Tear meniscus height (TMH) and noninvasive Keratograph tear breakup time (NIKBUT) including NIKBUT-first and NIKBUT-average of the subjects were measured using a noninvasive ocular analyzer, the Keratograph 5M (Oculus, Wetzlar, Germany). Symptoms related to dry eye were assessed using the Ocular Surface Disease Index (OSDI). The severity of SLE was evaluated by Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K). Results of the levels of 4 serum antibodies were collected from the patients’ medical records. Correlations between SLEDAI and various ocular surface parameters were analyzed, and multiple-factor binary logistic regression analysis was conducted. Results. In the study subjects, mean TMH was 0.22 mm, mean NIKBUT-first was 9.12 s, and mean OSDI was 13.14. The subjects (19 eyes) whose NIKBUT-average was < 10 s and OSDI was ≥ 13 accounted for 24.36% of all the included patients. SLEDAI showed a statistically significant correlation with TMH (r = −0.233, p=0.040), NIKBUT-first (r = −0.254, p=0.025), NIKBUT-average (r = −0.343, p=0.002), and OSDI (r = 0.256, p=0.024). According to multiple-factor binary logistic regression analysis, SLEDAI could be considered as a risk factor of the incidence of dry eye in SLE patients without sSS. Conclusions. One-fourth of the SLE patients without sSS suffered from dry eye, and the severity of dry eye correlated with the activity of SLE.
The Clinical Impact of Using 18F-FDG-PET/CT in the Diagnosis of Suspected Vasculitis: The Effect of Dose and Timing of Glucocorticoid Treatment
Authors: Taimen Kirsi , Salomäki Soile P. , Hohenthal Ulla , Mali Markku , Kajander Sami , Seppänen Marko , Nuutila Pirjo , Palomäki Antti , Roivainen Anne , Pirilä Laura , Kemppainen Jukka
Published: August 2019

18F-Fluorodeoxyglucose positron-emission tomography (18F-FDG-PET) with computed tomography (CT) is effective for diagnosing large vessel vasculitis, but its usefulness in accurately diagnosing suspected, unselected vasculitis remains unknown. We evaluated the feasibility of 18F-FDG-PET/CT in real-life cohort of patients with suspicion of vasculitis. The effect of the dose and the timing of glucocorticoid (GC) medication on imaging findings were in special interest. 82 patients with suspected vasculitis were evaluated by whole-body 18F-FDG-PET/CT. GC treatment as prednisolone equivalent doses at the scanning moment and before imaging was evaluated. 38/82 patients were diagnosed with vasculitis. Twenty-one out of 38 patients had increased 18F-FDG accumulation in blood vessel walls indicating vasculitis in various sized vessels. Vasculitis patients with a positive vasculitis finding in 18F-FDG-PET/CT had a significantly shorter duration of GC use (median = 4.0 vs 7.0 days, P=0.034), and they used lower GC dose during the PET scan (median dose = 15.0 mg/day vs 40.0 mg/day, p=0.004) compared to 18F-FDG-PET/CT-negative patients. Vasculitis patients with a positive 18F-FDG-PET/CT result had significantly higher C-reactive protein (CRP) than patients with a negative 18F-FDG-PET/CT finding (mean value = 154.5 vs 90.4 mg/L, p=0.018). We found that 18F-FDG-PET/CT positivity was significantly associated with a lower dose and shorter duration of GC medication and higher CRP level in vasculitis patients. 18F-FDG-PET/CT revealed clinically significant information in over half of the patients and was effective in confirming the final diagnosis.
Role of Simulations in the Treatment Planning of Radiofrequency Hyperthermia Therapy in Clinics
Authors: Prasad Bibin , Kim Jung Kyung , Kim Suzy
Published: August 2019

Hyperthermia therapy is a treatment modality in which tumor temperatures are elevated to higher temperatures to cause damage to cancerous tissues. Numerical simulations are integral in the development of hyperthermia treatment systems and in clinical treatment planning. In this study, simulations in radiofrequency hyperthermia therapy are reviewed in terms of their technical development and clinical aspects for effective clinical use. This review offers an overview of mathematical models and the importance of tissue properties; locoregional mild hyperthermia therapy, including phantom and realistic human anatomy models; phase array systems; tissue damage; thermal dose analysis; and thermoradiotherapy planning. This review details the improvements in numerical approaches in treatment planning and their application for effective clinical use. Furthermore, the modeling of thermoradiotherapy planning, which can be integrated with radiotherapy to provide combined hyperthermia and radiotherapy treatment planning strategies, are also discussed. This review may contribute to the effective development of thermoradiotherapy planning in clinics.