bluuebunny/crossref_metadata_2025 huggingface dataset:
Fixman problem revisited: when fluctuations of inflated ideal polymer loop are non-Gaussian?
Authors: Nechaev Sergei , Valov Alexander
Published: October 2021

We consider statistics of a planar ideal polymer loop of length L in a large deviation regime, when a gyration radius, R
g, is slightly less than the radius of a fully inflated ring,

L

2
π

. Specifically, we study analytically and via off-lattice Monte-Carlo simulations relative fluctuations of chain monomers in an ensemble of Brownian loops. We have shown that these fluctuations in the regime with fixed large gyration radius are Gaussian with the critical exponent

γ
=

1

2

. However, if we insert inside the inflated loop the impenetrable disc of radius R
d = R
g, the fluctuations become non-Gaussian with the critical exponent

γ
=

1

3

typical for the Kardar–Parisi–Zhang universality class.
Phylogenomic analysis ofTibouchina s.s.(Melastomataceae) highlights the evolutionary complexity of Neotropical savannas
Authors: Jantzen Johanna R , Guimarães Paulo J F , Pederneiras Leandro C , Oliveira Ana L F , Soltis Douglas E , Soltis Pamela S
Published: October 2021

The origin of the high biodiversity in the Neotropics remains an unresolved but critical question, especially for the species-rich but understudied savannas of Brazil, such as the campos rupestres and Cerrado. To address this knowledge gap, we leveraged Tibouchina s.s., a clade of flowering plants in Melastomataceae found in the Cerrado and campos rupestres, to uncover the processes that generated the hyper-diverse flora of Neotropical savannas. We used a phylogenomic approach combined with ecological niche modelling and biogeographic analysis to infer the evolutionary processes that have influenced the diversification of Tibouchina s.s. We identified the importance of multiple interacting evolutionary forces, including geographical and ecological divergence, polyploidy and hybridization, and found that Tibouchina s.s. harbours greater diversity than once thought due to polyphyletic species, polyploid species and previously undocumented species. Taken together, these findings support a complex evolutionary history for Tibouchina and underscore the need for continued efforts to generate thoroughly sampled, robust phylogenetic trees for additional plant clades of these threatened Neotropical savannas and for intensive collecting and taxonomic work in these highly diverse but neglected regions.
Development of calciphylaxis in kidney transplant recipients with a functioning graft
Authors: Guillén-Olmos Elena , Torregrosa Jose Vicente , Garcia-Herrera Adriana , Ganau Sergi , Diekmann Fritz , Cucchiari David
Published: October 2021

Background

Calciphylaxis is not uniquely observed in uraemic patients, as some cases have also been reported in patients with normal renal function or moderate chronic kidney disease (CKD), in association with severe vasculopathy or systemic inflammation. A particular subset worthy of studying is represented by those patients who develop calciphylaxis after kidney transplantation (KT).

Methods

Analysis of the local series of calciphylaxis after KT (n = 14) along with all the other cases reported in the literature from 1969 to 2019 (n = 31), for a total population of 45 patients, is presented. Demographic data, CKD history, risk factors, immunosuppression, clinical presentation and management have been analysed both as a whole and according to the time period (before or after the year 2000).

Results

Calciphylaxis developed during the first year after KT in 43.2% of patients and median (interquartile range) creatinine at diagnosis was 2.4 (1.25–4.64) mg/dL. The most frequent presentation included distal purpura or ulcers in one-third of cases and 39.1% of patients were receiving vitamin K antagonists. PTH values were above 500 pg/mL and below 100 pg/mL in 50.0% and 25.0% of cases, respectively. Whole population mortality was 55.6%. As expected, clinical presentation, immunosuppression and management varied depending on the time period. Patients diagnosed after 2000 were older, with longer dialysis vintage, and treatment was usually multimodal; on the contrary, in patients diagnosed before 2000, parathyroidectomy was the treatment of choice in 61.9% of cases.

Conclusions

Calciphylaxis can still occur after KT, in many cases during the first year and in patients with a good renal function. Risk factors and management varied according to the time period studied.
Prognostic significance of plaque location in non-obstructive coronary artery disease: from the CONFIRM registry
Authors: Han Donghee , Chen Billy , Gransar Heidi , Achenbach Stephan , Al-Mallah Mouaz H , Budoff Matthew J , Cademartiri Filippo , Maffei Erica , Callister Tracy Q , Chinnaiyan Kavitha , Chow Benjamin J W , DeLago Augustin , Hadamitzky Martin , Hausleiter Joerg , Kaufmann Philipp A , Villines Todd C , Kim Yong Jin , Leipsic Jonathon , Feuchtner Gudrun , Cury Ricardo C , Pontone Gianluca , Andreini Daniele , Marques Hugo , Rubinshtein Ronen , Chang Hyuk Jae , Lin Fay Y , Shaw Leslee J , Min James K , Berman Daniel S
Published: October 2021

Aim

Obstructive coronary artery disease (CAD) in proximal coronary segments is associated with a poor prognosis. However, the relative importance of plaque location regarding the risk for major adverse cardiovascular events (MACE) in patients with non-obstructive CAD has not been well defined.

Methods and results

From the Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter (CONFIRM) registry, 4644 patients without obstructive CAD were included in this study. The degree of stenosis was classified as 0 (no) and 1–49% (non-obstructive). Proximal involvement was defined as any plaque present in the left main or the proximal segment of the left anterior descending artery, left circumflex artery, and right coronary artery. Extensive CAD was defined as segment involvement score of >4. During a median follow-up of 5.2 years (interquartile range 4.1–6.0), 340 (7.3%) MACE occurred. Within the non-obstructive CAD group (n = 2065), proximal involvement was observed in 1767 (85.6%) cases. When compared to non-obstructive CAD patients without proximal involvement, those with proximal involvement had an increased MACE risk (log-rank P = 0.033). Multivariate Cox analysis showed when compared to patients with no CAD, proximal non-obstructive CAD was associated with increased MACE risk [hazard ratio (HR) 1.90, 95% confidence interval (CI) 1.47–2.45, P < 0.001] after adjusting for extensive CAD and conventional cardiovascular risk factors; however, non-proximal non-obstructive CAD did not increase MACE risk (HR 1.26, 95% CI 0.79–2.01, P = 0.339).

Conclusions

Independent of plaque extent, proximal coronary involvement was associated with increased MACE risk in patients with non-obstructive CAD. The plaque location information by coronary computed tomography angiography may provide additional risk prediction over CAD extent in patients with non-obstructive CAD.
Anti-inflammatory therapy in ischaemic heart disease: from canakinumab to colchicine
Authors: Andreotti Felicita , Maggioni Aldo Pietro , Campeggi Alice , Iervolino Adelaide , Scambia Giovanni , Massetti Massimo
Published: October 2021

Four large trials have recently evaluated the effects of anti-inflammatory drugs in the secondary prevention of major cardiovascular events (MACE) in over 25 000 patients followed for 1.9–3.7 years. CANTOS tested subcutaneous canakinumab [an anti-interleukin (IL) 1β antibody] 300 mg every 3 months against placebo in patients with a history of myocardial infarction (MI) and serum C-reactive protein (CRP) >2 mg/L, demonstrating efficacy in preventing MACE but increased rates of fatal infections. COLCOT (in patients with recent MI) and LoDoCo2 (in patients with chronic coronary syndromes) tested oral colchicine (an NLRP3 inflammasome inhibitor) 0.5 mg daily vs. placebo, demonstrating prevention of MACE with a slightly increased risk of pneumonia in COLCOT (0.9 vs. 0.4%) but not in LoDoCo2. CIRT tested oral methotrexate (an anti-rheumatic anti-nuclear factor-kB) 15–20 mg per week against placebo in ischaemic heart disease patients with diabetes or metabolic syndrome, without significant reduction in MACE rates or in circulating IL6 or CRP levels, and with increased risk of skin cancers. In summary, canakinumab and colchicine have shown efficacy in preventing MACE in ischaemic heart disease patients, but only colchicine has acceptable safety (and cost) for use in secondary cardiovascular prevention. Clinical results are expected with the anti-IL6 ziltivekimab.
Back to the future: DCB use instead of DES for the treatment of complex, native coronary artery disease
Authors: Cortese Bernardo , Sanchez-Jimenez Erick
Published: October 2021

The increasing complexity of coronary artery lesions in patients with significant co-morbidities and the need for revascularization, but with the ineligibility for surgical approach, has turned the percutaneous coronary intervention a challenging task, especially in a setting in which short- and long-term complications after drug-eluting stent implantation are high. Drug-coated balloons (DCBs) have become an important tool to replace stent placement in specific situations such as small coronary artery disease and in-stent restenosis. Although preliminary data of DCB use in complex lesions is promising, the available data are still limited. Therefore, in this article, we review the most recent and relevant literature about the use of DCB in native vessel disease and in complex anatomies/patients, and pretend to justify the necessity to develop well design trials about the use of this therapy in such settings, also thinking at DCBs as a complementary tool to drug-eluting stents.
Ventricular fibrillation ablation in cardiomyopathies and arrhythmic storm
Authors: Pappone Carlo , Negro Gabriele , Ciconte Giuseppe
Published: October 2021

Sudden cardiac death (SCD) is a relevant contributor to cardiovascular mortality, often occurring as a dramatic event. It can be the consequence of a ventricular tachycardia/fibrillation (VT/VF), a common and life-threatening arrhythmia. The underlying mechanisms of this catastrophic arrhythmia are poorly known. In fact, it can occur in the presence of a structural heart condition which itself generates the suitable substrate for this arrhythmia. Nevertheless, a VF may cause SCD also in young and otherwise healthy individuals, without overt structural abnormalities, generating difficulties in the screening and prevention of these patients. The implantable cardioverter-defibrillator represents the only therapy to contrast SCD by treating a VT/VF; however, it cannot prevent the occurrence of such arrhythmias. Catheter ablation is emerging as an essential therapeutic tool in the management of patients experiencing ventricular arrhythmias.
Present and future of coronary risk assessment
Authors: Prati Francesco , Biccirè Flavio Giuseppe , Budassi Simone
Published: October 2021

The search for subclinical atherosclerosis is carried out in several arterial districts using ultrasonography and computed tomography (CT). Coronary calcium assessed by computerized tomography (calcium score) is a well-validated marker of atherosclerosis and able to correlate with the extent of coronary artery disease and the risk of cardiovascular events. The evaluation of carotid atherosclerosis by ultrasonography is a technically simple and low-cost solution. However, the literature does not provide a sufficient number of evidence to clarify the clinical impact of carotid atherosclerosis and in particular the risk of developing cardiac events. According to the researchers of the Progression of Early Subclinical Atherosclerosis (PESA) study, subclinical atherosclerosis research should preferably be carried out in the femoral district, which is more easily affected by atherosclerosis. Pending the data from the PESA study, which will better clarify the role of ultrasound applied in non-coronary districts, the coronary calcifications seems to be a reasonable solution. It is possible that in the future imaging techniques (CT-PET) capable of studying the extent and functional status of coronary atherosclerosis will further improve the identification of the risk of cardiovascular events.
Clinical research methodology process: what is changing with COVID-19?
Authors: Tavazzi Luigi
Published: October 2021

The repercussions of the pandemic in progress on clinical research have been the systematic interruption of ongoing research and the explosion of fragmented, uncoordinated, often technically insufficient anti-COVID-19 research. Networks of expert centres have emerged setting up well-structured research, adopting much more efficient and aggressive designs than traditional ones. Adaptive designs, characterized by flexibility and mouldability even in the course of studies, which is essential in an epidemic with thousands of simultaneous studies aimed at the same objectives. Some studies are structured with networks of hospitals around guidance centres, such as RECOVERY (Oxford University, UK) and SOLIDARITY (WHO, 30 countries); others with networks of expert centres mostly organized in a combined model: some expert centres test new molecules in Phase 2 in a limited number of patients, and orient promising ones towards connected networks for Phase 3. Cortisones and tentatively cytokines are acquired in the official recommendation. Another emerging model is the pragmatic trial, also called, more expressively, ‘remote’ or ‘virtual’. So it is in fact: the web replaces the direct link between patients and doctors/research operators (CROs included), behind which there will be omnipresent big-techs.
Is physical activity always good for you? The physical activity paradox
Authors: Temporelli Pier Luigi
Published: October 2021

Regular physical activity is a known protective factor for the prevention of non-communicable diseases such as cardiovascular disease, type 2 diabetes, breast, and colon cancer. Physical activity also has benefits for mental health, delays the onset of dementia, contributes to the maintenance of an adequate body weight and to general well-being. Research on physical activity has mainly focused on leisure and total time, and less on the activity in the workplace. The current guidelines actually recommend physical activity in any form and do not distinguish between the different areas, e.g. physical activity carried out during leisure time, at home or at work. However, new evidence suggests a contrast between the health effects of physical activity in leisure time vs. that in the workplace. In particular, while physical activity, even of high intensity in leisure time, has been associated with positive health outcomes, adverse consequences have been documented for physical activity in the workplace, both in terms of cardiovascular diseases, work absences due to illness and mortality from all causes. These contrasting effects of physical activity in leisure time compared to that in the workplace constitute the so-called ‘physical activity paradox’.
“It's like being involved in a car crash”: teen pregnancy narratives of adolescents and young adults in Jos, Nigeria
Authors: Olorunsaiye Comfort Z , Degge Hannah M , Ubanyi Tina O , Achema Timothy A , Yaya Sanni
Published: October 2021

Background

Adolescent pregnancy has serious public health implications, with far-reaching outcomes extending past the mother and child and affecting society. The purpose of this study was to explore the lived experience of adolescent pregnancy in Jos, Nigeria.

Methods

We conducted in-depth interviews with 17 adolescents and young women ages 16–24 y in Jos, Nigeria who had experienced at least one teenage pregnancy. Participants were purposively recruited; each provided written informed consent before interviewing. We identified codes and themes using an inductive analytic approach.

Results

Among the 17 participants, 14 had never been married and 10 had completed senior secondary school. Participants commonly associated adolescent pregnancy with inappropriate behaviour, immaturity and premarital childbearing. The main risk factors for adolescent pregnancy were lack of sexual and reproductive health education and parental communication. Pregnancy evoked feelings of fear, shame, anxiety and depression. Most pregnancies resulted in live births, while some participants had stillbirths or induced abortion. Some participants successfully completed their education post-pregnancy.

Conclusions

Adolescents in this study lacked adequate sexual and reproductive health education that could empower them to make informed decisions and take action regarding their sexual and reproductive health. Multifaceted actions to address reproductive health education gaps can contribute to reducing adolescent pregnancy in Nigeria.
Expression of Brown and Southern Black Widow Spider (Araneae: Theridiidae) Latrotoxins Is Tissue- and Life Stage-Specific for α-Latroinsectotoxins and δ-Latroinsectotoxins and Is Ubiquitous for α-Latrotoxins
Authors: Torres Sebastian L , Landeros Abraham , Penhallegon Eleanor J , Salazar Kaleth , Porter Lindsay M
Published: October 2021

Widow spiders are widely known for their potent venom toxins that make them among the few spiders of medical concern. The latrotoxins are the most well-studied widow toxins and include both the vertebrate-specific latrotoxins and the insect-specific latroinsectotoxins (LITs). Previous studies have shown that toxins are not limited to expression in the venom glands of adult spiders; however, gaps exist in latrotoxin screening across all life stages for brown widows, Latrodectus geometricus and southern black widows, Latrodectus mactans. In this study, we screened male and female venom gland, cephalothorax, and abdomen tissues, spiderling cephalothorax and abdomen tissues, and eggs of both L. geometricus and L. mactans, for the presence of three latrotoxins: α-latrotoxin (α-LTX), and α- and δ-latroinsectotoxins (α/δ-LITs). Widows were locally collected. Extracted RNA was used to prepare cDNA that was analyzed by PCR for the presence or absence of latrotoxin expression. Results show that expression profiles between the two species are very similar but not identical. Expression of α-LTX was found in all life stages in all tissues examined for both species. For both species, no LIT expression was detected in eggs and variable patterns of α-LIT expression were detected in spiderlings and adults. Notably, δ-LIT could only be detected in females for both species. Our results show that latrotoxin expression profiles differ within and between widow species. Data on their expression distribution provide further insight into the specific latrotoxins that contribute to toxicity profiles for each life stage in each species and their specific role in widow biology.
The Utility of Dynamic Movement Orthoses in the Management of Complex Regional Pain Syndrome—A Case Series
Authors: Powell Jordan E , Boehm Jamie O , Bicher Jessica H , Reece Christopher L , Davis Shelton A , Pasquina Paul F
Published: October 2021

Complex regional pain syndrome (CRPS) is a relatively rare, but debilitating condition that may occur after limb or peripheral nerve trauma. Typical symptoms of CRPS include swelling, allodynia, hyperalgesia, and skin temperature changes. Although a variety of pharmacological and non-pharmacological approaches are commonly used in caring for individuals with CRPS, they are frequently ineffective and often associated with side effects and/or additional risks. Previously, elastomeric orthotic garments have been shown to decrease neuropathic pain, reduce edema, and increase proprioception, but no previous reports have described their use in treating CRPS. Accordingly, this case series describes our experiences using a Lycra-based, custom-fabricated Dynamic Movement Orthosis (DMO) as a novel treatment to reduce the symptoms of CRPS and promote function. Four patients were included in this case series, all of whom had very different causes for their CRPS, including a combat-related gunshot injury resulting in multiple foot fractures with a partial nerve injury, a post-metatarsophalangeal fusion, an L5 radiculopathy, and a case of post-lower leg fasciotomies. These four patients all reported subjective improvement in their pain, function, and exercise tolerance in association with their DMO use. All patients demonstrated reduced use of analgesic medications. The pre- and post-DMO lower extremity functional scale showed clinically significant improvement in the two patients for which it was obtained.
Pre-supernova feedback mechanisms drive the destruction of molecular clouds in nearby star-forming disc galaxies
Authors: Chevance Mélanie , Kruijssen J M Diederik , Krumholz Mark R , Groves Brent , Keller Benjamin W , Hughes Annie , Glover Simon C O , Henshaw Jonathan D , Herrera Cinthya N , Kim Jaeyeon , Leroy Adam K , Pety Jérôme , Razza Alessandro , Rosolowsky Erik , Schinnerer Eva , Schruba Andreas , Barnes Ashley T , Bigiel Frank , Blanc Guillermo A , Dale Daniel A , Emsellem Eric , Faesi Christopher M , Grasha Kathryn , Klessen Ralf S , Kreckel Kathryn , Liu Daizhong , Longmore Steven N , Meidt Sharon E , Querejeta Miguel , Saito Toshiki , Sun Jiayi , Usero Antonio
Published: October 2021

It is a major open question which physical processes stop gas accretion on to giant molecular clouds (GMCs) and limit the efficiency at which gas is converted into stars. While feedback from supernova explosions has been the popular feedback mechanism included in simulations of galaxy formation and evolution, ‘early’ feedback mechanisms such as stellar winds, photoionization, and radiation pressure are expected to play an important role in dispersing the gas after the onset of star formation. These feedback processes typically take place on small scales (∼10–100 pc) and their effects have therefore been difficult to constrain in environments other than the Milky Way. We apply a novel statistical method to ∼1 arcsec resolution maps of CO and H α across a sample of nine nearby galaxies, to measure the time over which GMCs are dispersed by feedback from young, high-mass stars, as a function of the galactic environment. We find that GMCs are typically dispersed within ∼3 Myr on average after the emergence of unembedded high-mass stars, with variations within galaxies associated with morphological features rather than radial trends. Comparison with analytical predictions demonstrates that, independently of the environment, early feedback mechanisms (particularly photoionization and stellar winds) play a crucial role in dispersing GMCs and limiting their star formation efficiency in nearby galaxies. Finally, we show that the efficiency at which the energy injected by these early feedback mechanisms couples with the parent GMC is relatively low (a few tens of per cent), such that the vast majority of momentum and energy emitted by the young stellar populations escapes the parent GMC.
Investigating the spectra and physical nature of galaxy scale jets
Authors: Webster B , Croston J H , Harwood J J , Baldi R D , Hardcastle M J , Mingo B , Röttgering H J A
Published: October 2021

Previous studies have shown that physically small, low-luminosity radio galaxies, which we refer to as galaxy scale jets (GSJ), could potentially have a significant effect upon the host galaxy’s evolution. Using 6-arcsec resolution images taken from the first release of the LOFAR Two Metre Sky Survey (LoTSS DR1), we identified a representative sample of nine potential GSJ for which we obtained high-resolution, 2–4 GHz data using the Karl G. Jansky Very Large Array (VLA). Using these data, we aim to verify the GSJ nature of these sources as well as investigating the potential role of feedback. Our VLA images reveal a diversity of structures, confirm the hosts for four of the sources and find that a fifth is the first known example of a galaxy-scale remnant showing that some radio galaxies never grow beyond the GSJ stage. We also derive spectral ages and the first estimates of the lobe expansion speeds of GSJ. We find our GSJ have maximum spectral ages of 60 Myr with most between about 5 and 20 Myr, consistent with being located along an evolutionary path joining compact sources and larger radio galaxies. We find lobe advance speeds a few times the local sound speed, with most GSJ predicted to be driving strong shocks into their environment and having a significant impact upon the host’s evolution. Our discovery of a remnant GSJ, which will eventually transfer all of its energy directly into the local environment, represents an important and previously hidden aspect of AGN life cycles.
Epidemiological study of osteonecrosis of the femoral head using the national registry of designated intractable diseases in Japan
Authors: Sato Ryuichi , Ando Wataru , Fukushima Wakaba , Sakai Takashi , Hamada Hidetoshi , Takao Masaki , Ito Kazuya , Sugano Nobuhiko
Published: October 2021

Objectives

We aimed to investigate the epidemiological characteristics of osteonecrosis of the femoral head (ONFH) using the designated intractable diseases (DID) database in Japan.

Methods

Data on patients who had received public subsidies for medical costs due to ONFH from 2012 to 2013 were extracted from the DID database. The incidence and prevalence of ONFH, distribution of gender, age, and the prevalence of associated risk factors were assessed. These epidemiological characteristics were compared with those of another nationwide ONFH survey conducted during a similar period.

Results

Data on 3264 newly diagnosed patients (incident cases) and 20,042 patients registered until 2013 (prevalent cases) were evaluated. The corrected annual incidence and prevalence of ONFH per 100,000 were 3.0 and 18.2–19.2, respectively. The ratio of males to females was 1.4 in 2012 and 1.2 in 2013, respectively. Peak distribution was observed at ages 40s and 60s in males and females, respectively. The prevalence of the risk factors were steroid-associated: 39%, alcohol-associated: 30%, both: 4%, and none: 27%.

Conclusions

The DID database data showed a similar distribution of gender and age to that in other nationwide surveys but lower incidence and prevalence of ONFH. Sampling bias may affect the epidemiological characteristics of ONFH.
Geographical distribution of the associated factors of osteonecrosis of the femoral head, using the designated intractable disease database in Japan
Authors: Ando Wataru , Takao Masaki , Tani Tetsuro , Uemura Keisuke , Hamada Hidetoshi , Sugano Nobuhiko
Published: October 2021

Objectives

Osteonecrosis of the femoral head (ONFH) is a designated intractable disease (DID) in Japan. The Ministry of Health, Labour, and Welfare launched an online registry system for DIDs. We aimed to investigate the epidemiological characteristics of patients with ONFH using the DID database.

Methods

Data of patients with ONFH registered in the DID database between January 2004 and December 2013 were extracted. The incidence of new cases and distributions of sex, age, and associated risk factors were investigated. The prevalence of the two categories, ‘steroid-associated’ and ‘alcohol-associated’ risk factors, was estimated for each prefecture.

Results

New 15,049 cases of ONFH were investigated. The mean registration rate-corrected annual ONFH incidence per 100,000 individuals was 1.77. The male-to-female ratio was 1.33. Age distribution peaked in the 40s and 50s for male and 60s for female. The prevalence of steroid-associated ONFH was lower in males (28.6%) than in females (49.8%), while that of alcohol-associated ONFH was higher in males (47.2%) than in females (9.3%). No clear region was identified for the steroids. The incidence of alcohol-associated ONFH was significantly higher in Tokyo and Okinawa, regardless of sex.

Conclusions

Alcohol-associated ONFH incidence varies geographically across Japan, suggesting that it has regional characteristics.
Suboccipital Transhorizontal Fissure Approach for Posterior Cranial Fossa Lesions: A Cadaveric Study and First Clinical Experience
Authors: Tamura Ryota , Katayama Makoto , Yamamoto Kohsei , Horiguchi Takashi
Published: October 2021

BACKGROUND

Surgical treatment of pathological lesions in the deep cerebellar hemisphere, cerebellopontine angle (CPA), and fourth ventricle of the posterior cranial fossa (PCF) is challenging. Conventional neurosurgical approaches to these lesions are associated with risk of various complications. Mastery of efficient fissure dissection is imperative when approaching deep-seated lesions. The horizontal fissure (HF) is the largest and deepest fissure of the cerebellum.

OBJECTIVE

To conduct an anatomical study and introduce a novel suboccipital trans-HF (SOTHF) approach to access lesions of the deep cerebellar hemispheres, CPA, and upper fourth ventricle of the PCF.

METHODS

We performed a cadaveric dissection study focusing on anatomical landmarks and surgical feasibility of the SOTHF approach then implemented it in 2 patients with a deep cerebellar hemispheric tumor.

RESULTS

Anatomical feasibility of the SOTHF approach was demonstrated and compared with conventional approaches in the cadaveric study. Opening the suboccipital surface of the HF to create medial, intermediate, and lateral surgical corridors provided optimal viewing angles and wide access to the deep cerebellar hemispheres, CPA, and upper fourth ventricle without heavy cerebellar retraction. Sacrificing cerebellar neural structures and complex skull base techniques were not required to obtain adequate exposure. The SOTHF approach was successfully applied without complication in 2 patients with a deep cerebellar hemispheric tumor.

CONCLUSION

The HF is an important cerebellar fissure that provides a gateway to deep areas of the PCF. Further studies are needed to define and expand applications of the SOTHF approach.
Descriptivism and the Determination Thesis: an Untenable Marriage in the Metaontology of Art
Authors: Puy Nemesio G C
Published: October 2021

The determination thesis is the idea that art-ontological facts are determined by the folk ontological conception of artworks embedded in our artistic practices. From this thesis, descriptivism in the metaontology of art has been often characterized as the view that the task of art-ontology is to describe that folk conception. Amie Thomasson and Andrew Kania provide two paradigmatic accounts within this path. In this paper, I argue that this descriptivist approach is ungrounded because the determination thesis suffers from presupposition failure. It presupposes that, whenever there is a practice of producing and appreciating artworks, there is also a folk ontological conception about those artworks. This presupposition, an implicit premise in Thomasson's and Kania's accounts, will be revealed as false, paying attention to the way artistic practices have evolved. I will conclude that descriptivism should abandon this approach and embrace metaontological realism if it aims to be a plausible view.
Fast, simple and cheap: method modified from conventional cultivation for tuberculosis diagnosis allows seeding on Löwenstein–Jensen of any swab-embedded pulmonary samples decontaminated with sodium hydroxide
Authors: Rodrigues da Costa Ronaldo , Silva Marcio Roberto , Augusto Claudio Jose , Gonçalves Leite Isabel Cristina
Published: October 2021

Background

Few tuberculosis (TB) control programmes in low-income countries have access to culture facilities in their primary care diagnostic centres and this scenario may have worsened with the coronavirus disease 2019 pandemic. Thus the aim was to develop and evaluate a simpler TB test that allows seeding on Löwenstein–Jensen (LJ) medium of several swab-embedded samples decontaminated with sodium hydroxide (NaOH).

Methods

A cotton swab containing each sample was decontaminated in NaOH before being dipped into a slightly acidic solution to neutralize the pH in order to allow the culture to develop on LJ medium. Samples (n=543) from suspected or confirmed pulmonary TB were analysed in two phases: standardization (n=167) and evaluation of the study method (n=376).

Results

The study method showed sensitivity >95% and specificity >93% using Ogawa–Kudoh (OK) and modified Petroff (MP) as standards and was comparable to MP-LJ (p>0.05) and slightly superior to OK (p=0.03) for sputum culture and more comprehensive than the latter for other pulmonary specimens.

Conclusions

This article reports a more comprehensive, simpler and less costly method for diagnosing TB in the laboratory with fewer economic resources and biosafety equipment. Thus a patent application was filed (BR1020190103841).
Evaluation of Disease Severity and Molecular Relationships BetweenPeronospora variabilisIsolates onChenopodiumSpecies in New Hampshire
Authors: Nolen Haley , Smith Cheryl , Davis Thomas M. , Poleatewich Anissa
Published: October 2021

Quinoa is a potential new crop for New England; however, its susceptibility to downy mildew, caused by Peronospora variabilis, is a key obstacle for cultivation. The objectives of this study were to evaluate differential resistance within the Chenopodium genus, identify novel sources of resistance for use in future genetic studies or breeding programs, and investigate phylogenetic relationships of P. variabilis isolates from different Chenopodium hosts. The long-term goal of this research is to develop a resistant variety of quinoa to be grown in New England. Field trials conducted at the University of New Hampshire evaluated downy mildew disease severity on 10 Chenopodium accessions representing four species. Disease severity for each treatment was compared and significant differences in disease severity were observed between accessions. C. berlandieri var. macrocalycium ecotypes collected from Rye Beach, New Hampshire and Appledore Island, Maine exhibited the lowest disease severity over the growing season. P. variabilis was isolated from each accession, and COX2 sequences were compared. Phylogenetic analyses suggest no effect of host species on P. variabilis sequence similarity; however, isolates are shown to cluster by geographic location. This research provides the first step in identifying potential New England native sources of resistance to downy mildew within the genus Chenopodium and provides preliminary information needed to further investigate resistance at the genomic level in Chenopodium spp.
Subacromial Erosion After Hook Plate Fixation in Acute Acromioclavicular Joint Dislocation
Authors: Kim Jung Youn , Rhee Sung-Min , Ko Young Wan , Rhee Yong Girl
Published: October 2021

Objectives:

To determine the incidence of subacromial erosion, perform quantitative analysis, and identify risk factors after locking hook plate fixation for acute acromioclavicular joint injury.

Design:

A retrospective case series study.

Setting:

A single tertiary university hospital.

Patients/Participants:

The study was conducted on 35 patients who had acute acromioclavicular joint injury.

Intervention:

Patients underwent the locking hook plate fixation.

Main Outcome Measurements:

The computed tomography (CT) was conducted to measure the subacromial erosion. The acromioclavicular slope (AC slope) of the unaffected side, the acromion-hook angle, the acromioclavicular anteroposterior distance (AC-AP distance), and the preoperative acromioclavicular interval of the affected side were analyzed to identify the risk factors of subacromial erosion.

Results:

According to the CT findings, subacromial erosion was found in all cases, and the mean value was 5.0 mm, which is 53% of the entire acromion thickness. The AC slope (B = −0.159, P < 0.001) and AC-AP distance (B = 0.233, P = 0.004) were found to have a significant influence on postoperative subacromial erosion. The AC slope showed a negative correlation with the amount of erosion, whereas the AC-AP distance showed a positive correlation with erosion.

Conclusion:

The CT findings revealed that subacromial erosion occurred in all cases, and the mean erosion depth was about 50% of the acromial thickness. If the preoperative AC slope of the unaffected side was more acute and the AC-AP distance was larger, the incidence of subacromial erosion was higher.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
The Effect of Nursing Students' Smartphone Addiction and Phubbing Behaviors on Communication Skill
Authors: Ayar Dijle , Gürkan Kübra Pinar
Published: October 2021

The aim of the study was to examine the effect of nursing students' smartphone addiction and phubbing behaviors on their communication skills. This study was conducted with 587 undergraduate nursing students. Sociodemographic data were evaluated using percentages and means. The relationship between smartphone addiction and communication skills and the relationship between phubbing behaviors and communication skills were evaluated with Pearson's correlation analysis. The effect of nursing students' smartphone addiction and phubbing behaviors on their communication skills was evaluated using multiple regression analysis. The mean age of the nursing students in the study was 20.47 ± 1.91 years, and 69.3% (n = 407) of the students were female. When the relationship between the communication skills of undergraduate nursing students and other variables was analyzed, it was found that there was a moderate, significant, and negative correlation with smartphone addiction (β = −0.314, P < .001) as well as with the status of phubbing behaviors (β = −0.503, P < .001). It was determined that there was a significant negative relationship between the communication skills of undergraduate nursing students and their smartphone addiction and the status of phubbing behaviors.
Management and Outcomes of Diffuse Large B-cell Lymphoma Post-transplant Lymphoproliferative Disorder in the Era of PET and Rituximab: A Multicenter Study From the Australasian Lymphoma Alliance
Authors: Boyle Stephen , Tobin Joshua W. D. , Perram Jacinta , Hamad Nada , Gullapalli Veena , Barraclough Allison , Singaraveloo Lydia , Han Min-Hi , Blennerhassett Richard , Nelson Niles , Johnston Anna M. , Talaulikar Dipti , Karpe Krishna , Bhattacharyya Abir , Cheah Chan Yoon , Subramoniapillai Elango , Bokhari Waqas , Lee Cindy , Hawkes Eliza A. , Jabbour Andrew , Strasser Simone I. , Chadban Steven J. , Brown Christina , Mollee Peter , Hapgood Greg
Published: October 2021

There are limited data on post-transplant lymphoproliferative disorder (PTLD) in the era of positron emission tomography (PET) and rituximab (R). Furthermore, there is limited data on the risk of graft rejection with modern practices in reduction in immunosuppression (RIS). We studied 91 patients with monomorphic diffuse large B-cell lymphoma PTLD at 11 Australian centers: median age 52 years, diagnosed between 2004 and 2017, median follow-up 4.7 years (range, 0.5–14.5 y). RIS occurred in 88% of patients. For patients initially treated with R-monotherapy, 45% achieved complete remission, rising to 71% with the addition of rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone (R-CHOP) for those not in complete remission. For patients initially treated with R-CHOP, the complete remission rate was 76%. There was no difference in overall survival (OS) between R-monotherapy and R-chemotherapy patients. There was no difference in OS for patients with systemic lymphoma (n = 68) versus central nervous system (CNS) involvement (n = 23) (3-y OS 72% versus 73%; P = 0.78). Treatment-related mortality was 7%. End of treatment PET was prognostic for patients with systemic lymphoma with longer OS in the PET negative group (3-y OS 91% versus 57%; P = 0.01). Graft rejection occurred in 9% (n = 4 biopsy-proven; n = 4 suspected) during the entire follow-up period with no cases of graft loss. RIS and R-based treatments are safe and effective with a low likelihood of graft rejection and high cure rate for patients achieving complete remission with CNS or systemic PTLD.
Intratympanic Administration of OTO-313 Reduces Tinnitus in Patients With Moderate to Severe, Persistent Tinnitus: A Phase 1/2 Study
Authors: Maxwell Kenneth S. , Robinson James M. , Hoffmann Ines , Hou Huiying J. , Searchfield Grant , Baguley David M. , McMurry Gordon , Piu Fabrice , Anderson Jeffery J.
Published: October 2021

Objective:

To evaluate the safety and exploratory efficacy of intratympanic administration of OTO-313 in patients with tinnitus.

Study Design:

Single intratympanic injection of OTO-313 evaluated in a randomized, double-blind, placebo-controlled Phase 1/2 clinical study.

Setting:

Tertiary referral centers.

Patients:

Patients with unilateral tinnitus (moderate–severe) with tinnitus duration 1 to 6 months.

Interventions:

Intratympanic OTO-313.

Main Outcome Measures:

Safety and change from baseline in tinnitus functional index (TFI), daily ratings of tinnitus loudness and annoyance, and patient global impression of change (PGIC).

Results:

OTO-313 was well-tolerated with lower incidence of adverse events than placebo. Mean TFI reduction from baseline favored OTO-313 at Week 2, 4, and 8. A clinically meaningful, 13-point improvement on the TFI was observed in 43% (6/14) of OTO-313 patients at both Weeks 4 and 8 versus 13% (2/16) of placebo patients (ad hoc responder analysis, p-value < 0.05). Reductions in daily ratings of tinnitus loudness and annoyance favored OTO-313 compared with placebo. In OTO-313 responders, a strong correlation existed between change from baseline in TFI score and changes in tinnitus loudness, tinnitus annoyance, and PGIC.

Conclusions:

OTO-313 was well-tolerated and demonstrated a higher proportion of responders than placebo across consecutive visits (Weeks 4 and 8) supporting further clinical development of OTO-313 for the treatment of tinnitus.
Can prediction scores be used to identify patients at risk of Clostridioides difficile infection?
Authors: Rao Krishna , Dubberke Erik R.
Published: October 2021

Purpose of review

To describe the current state of literature on modeling risk of incident and recurrent Clostridioides difficile infection (iCDI and rCDI), to underscore limitations, and to propose a path forward for future research.

Recent findings

There are many published risk factors and models for both iCDI and rCDI. The approaches include scores with a limited list of variables designed to be used at the bedside, but more recently have also included automated tools that take advantage of the entire electronic health record. Recent attempts to externally validate scores have met with mixed success.

For iCDI, the performance largely hinges on the incidence, which even for hospitalized patients can be low (often <1%). Most scores fail to achieve high accuracy and/or are not externally validated. A challenge in predicting rCDI is the significant overlap with risk factors for iCDI, reducing the discriminatory ability of models. Automated electronic health record-based tools show promise but portability to other centers is challenging. Future studies should include external validation and consider biomarkers to augment performance.
Can SARS-CoV-2 be transmitted via faeces?
Authors: Moura Ines B. , Buckley Anthony M. , Wilcox Mark H.
Published: October 2021

Purpose of review

COVID-19 patients can present gastrointestinal symptoms, being diarrhoea one of the most frequent, suggesting intestinal health can be impacted by COVID-19. Here, we will discuss whether there is a correlation between the presence of SARS-CoV-2 RNA in faeces and diarrhoea, the relevance of gastrointestinal symptoms in disease diagnosis and transmission, and how COVID-19 can impact the gut microbial balance.

Recent findings

SARS-CoV-2 RNA has been reported in faeces or rectal swabs of COVID-19 patients with and without diarrhoea, suggesting faecal shedding can occur independently of gastrointestinal symptoms. However, the presence of the virus in the intestine can persist beyond its presence in the respiratory tract, with some reports suggesting that SARS-CoV-2 in the faeces can be infectious.

COVID-19 can impact the gut microbiota causing an enhancement of biosynthesis pathways that favour the expansion of bacterial pathogens in the inflamed gut, and causing a decline in commensals involved in the human immune response.

Gastrointestinal symptoms may be the first indication of COVID-19. SARS-CoV-2 in faeces can potentiate routes of disease transmission, particularly as the high viral loads reported in patients with severe illness suggest virus replication in the intestine may be possible.
Fatty Pancreas Represents a Risk Factor for Acute Pancreatitis
Authors: Sbeit Wisam , Khoury Tawfik
Published: October 2021

Objectives

Fatty pancreas (FP), previously believed to be without clinical significance, recently has been shown to be associated with comorbid diseases. We aimed to explore whether FP predispose to acute pancreatitis.

Methods

Patients who underwent endoscopic ultrasound for hepatobiliary indications were included. Patients with pathological pancreato-biliary findings other than FP were excluded. The cohort was divided into patients with a history of pancreatitis (within 6 months of endoscopic ultrasound, group A) and patients without (group B).

Results

Overall, 189 patients were included. Sixty-one (32.3%) patients were in group A, and 128 (67.7%) patients were in group B. The average age in group A was 55.5 (standard deviation, 17.7) versus 58.5 (standard deviation, 13.5) in group B. The prevalence of FP in group A (37.7%) was higher compared with group B (4.7%) (P = 0.001). On univariate analysis, FP showed significant correlation with a history of acute pancreatitis [odds ratio (OR), 5.14, P = 0.006] and hyperlipidemia (OR, 4.19; P = 0.002). On multivariate analysis, FP remained significantly associated with a history of acute pancreatitis after stratification for obesity and hyperlipidemia (OR, 10.78; 95% confidence interval, 3.75–30.89; P < 0.0001).

Conclusions

Fatty pancreas was associated with acute pancreatitis. Clinicians should be aware of this association.
Poorly Cohesive Carcinoma of the Nonampullary Small Intestine
Authors: Vanoli Alessandro , Guerini Camilla , Grillo Federica , Klersy Catherine , Fassan Matteo , Arpa Giovanni , Neri Giuseppe , Luinetti Ombretta , Lenti Marco V. , Ulivi Paola , Tedaldi Gianluca , Furlan Daniela , Quaquarini Erica , Ardizzone Sandro , Sampietro Gianluca , Biancone Livia , Monteleone Giovanni , Solcia Enrico , Sessa Fausto , Paulli Marco , Adsay Nazmi V. , Di Sabatino Antonio
Published: October 2021

Poorly cohesive carcinomas (PCCs) are neoplasms characterized by a dyshesive cell invasion pattern featuring single-cell or cord-like stromal infiltration. Although they have been extensively studied in the stomach and other digestive system organs, limited data regarding nonampullary small bowel poorly cohesive carcinomas (SB-PCCs) are hitherto available. The aims of our study were to analyze the clinicopathologic and immunophenotypical features of SB-PCCs (PCC pattern accounting for >50% of the neoplasm) and to compare them with small bowel adenocarcinomas (SBAs), not otherwise specified (SBAs-NOS) and with cancers with a histologically distinct PCC component accounting for 10% to 50% of the neoplasm (mixed-poorly-cohesive-glandular-SBAs). Fifteen SB-PCCs were identified and compared with 95 SBAs-NOS and 27 mixed-poorly-cohesive-glandular-SBAs. Most SB-PCCs (67%) were composed of <10% of signet-ring cells, and all but 1 SB-PCCs exhibited loss of membranous expression of E-cadherin. Compared with SBAs-NOS, SB-PCCs showed a significantly younger patient age at diagnosis, and a stronger association with Crohn disease, and both SB-PCCs and mixed-poorly-cohesive-glandular-SBAs featured a higher rate of lymphovascular and perineural invasion and a lower percentage of mismatch repair–deficient cases. Importantly, the cancer-specific survival of SB-PCC (hazard ratio: 3.81; 95% confidence interval: 1.90-7.64; P<0.001) and mixed-poorly-cohesive-glandular-SBA (4.12; 2.20-7.71; P<0.001) patients was significantly worse compared with SBAs-NOS cases. This study provides objective evidence to the World Health Organization (WHO) 2019 introduction of SB-PCC as a distinctive subtype of nonampullary SBA, by virtue of its unique clinical and histologic features, and suggests that both SB-PCCs and mixed-poorly-cohesive-glandular-SBAs should be separated from SBAs-NOS.