bluuebunny/crossref_metadata_2025 huggingface dataset:
Global Geriatric Assessment and In-Hospital Bleeding Risk in Elderly Patients with Acute Coronary Syndromes: Insights from the LONGEVO-SCA Registry
Authors: Ariza-Solé Albert , Guerrero Carme , Formiga Francesc , Aboal Jaime , Abu-Assi Emad , Marín Francisco , Bueno Héctor , Alegre Oriol , López-Palop Ramón , Vidán María , Martínez-Sellés Manuel , Díez-Villanueva Pablo , Vilardell Pau , Sionis Alessandro , Vives-Borrás Miquel , Sanchís Juan , Bañeras Jordi , Rafecas Agnès , Llibre Cinta , López Javier , González-Salvado Violeta , Cequier Àngel ,   On Behalf of the LONGEVO-SCA Registry Investigators
Published: October 2018

Background Bleeding risk scores have shown a limited predictive ability in elderly patients with acute coronary syndromes (ACS). No study explored the role of a comprehensive geriatric assessment to predict in-hospital bleeding in this clinical setting.

Methods The prospective multicentre LONGEVO-SCA registry included 532 unselected patients with non-ST segment elevation ACS (NSTEACS) aged 80 years or older. Comorbidity (Charlson index), frailty (FRAIL scale), disability (Barthel index and Lawton–Brody index), cognitive status (Pfeiffer test) and nutritional risk (mini nutritional assessment-short form test) were assessed during hospitalization. CRUSADE score was prospectively calculated for each patient. In-hospital major bleeding was defined by the CRUSADE classification. The association between geriatric syndromes and in-hospital major bleeding was assessed by logistic regression method and the area under the receiver operating characteristic curves (AUC).

Results Mean age was 84.3 years (SD 4.1), 61.7% male. Most patients had increased troponin levels (84%). Mean CRUSADE bleeding score was 41 (SD 13). A total of 416 patients (78%) underwent an invasive strategy, and major bleeding was observed in 37 cases (7%). The ability of the CRUSADE score for predicting major bleeding was modest (AUC 0.64). From all aging-related variables, only comorbidity (Charlson index) was independently associated with major bleeding (per point, odds ratio: 1.23, p = 0.021). The addition of comorbidity to CRUSADE score slightly improved the ability for predicting major bleeding (AUC: 0.68).

Conclusion Comorbidity was associated with major bleeding in very elderly patients with NSTEACS. The contribution of frailty, disability or nutritional risk for predicting in-hospital major bleeding was marginal.
Implementing Software Development Guidelines in a Medical Informatics Research Project
Authors: Spreckelsen C. , Weßel C. , Ißler L.
Published: October 2018

Objectives
: Due to the non-commercial, researchoriented context, software in medical informatics research projects is often developed by researchers as a proof-of-concept without applying structured software development process models. A guideline for software development can bring sufficient structure to the development process while avoiding the complexity of industry-standard methods.

Methods
: We adapted the common evidence-based guideline development process from medicine to build a guideline for software development in our medical informatics teaching and research project.

Results
: Our guideline development used the six steps of problem identification, first proposal, review, revision, gaining consensus and periodic guideline review. Since the developers had taken part in guideline development, our guideline clearly states the consensus of the development team over critical topics. The guideline improved the quality of our source code in structure and understandability.

Conclusions
: A software development guideline that is developed following a consensus panel approach is a good instrument for basic software quality assurance in domains where complex, industry-standard software development methods cannot be applied. This is especially the case in non-commercial, research- oriented medical informatics projectswhere mainly non-software engineers like students do the development work.
Direct oral anticoagulants for the treatment of cancer-associated venous thromboembolism
Authors: Voigtlaender M. , Langer F.
Published: October 2018

Cancer patients with venous thromboembolism (VTE) are at increased risk for both bleeding and VTE recurrence. Anticoagulation with low-molecular-weight heparin (LMWH) is the standard of care during the initial and longterm treatment phase (i.e. during the first 3–6 months of therapy) based on its overall beneficial safety and efficacy profile compared to vitamin K antagonists (VKAs). The direct oral anticoagulants (DOACs) rivaroxaban, apixaban, edoxaban, and dabigatran are approved for the treatment of acute VTE, and the combined six phase-3 trials have included > 1 500 patients with active cancer, as defined by variable selection criteria. Subgroup analyses of these patients, either pooled or separately reported, suggest that DOACs could be a safe and efficacious alternative to VKA therapy for the treatment of cancer-associated VTE. However, the populations of cancer patients included in the DOAC and LMWH trials are not comparable with regard to mortality and VTE risk, and no specific data from direct head-to-head comparisons of DOACs with LMWHs are currently available. The use of DOACs for the management of VTE in cancer is thus not recommended by clinical practice guidelines.
Image Analysis and Modeling in Medical Image Computing
Authors: Deserno T. M. , Meinzer H.-P. , Tolxdorff T. , Handels H.
Published: October 2018

Background: Medical image computing is of growing importance in medical diagnostics and image-guided therapy. Nowadays, image analysis systems integrating advanced image computing methods are used in practice e.g. to extract quantitative image parameters or to support the surgeon during a navigated intervention. However, the grade of automation, accuracy, reproducibility and robustness of medical image computing methods has to be increased to meet the requirements in clinical routine.

Objectives: In the focus theme, recent developments and advances in the field of modeling and model-based image analysis are described. The introduction of models in the image analysis process enables improvements of image analysis algorithms in terms of automation, accuracy, reproducibility and robustness. Furthermore, model-based image computing techniques open up new perspectives for prediction of organ changes and risk analysis of patients.

Methods: Selected contributions are assembled to present latest advances in the field. The authors were invited to present their recent work and results based on their outstanding contributions to the Conference on Medical Image Computing BVM 2011 held at the University of Lübeck, Germany. All manuscripts had to pass a comprehensive peer review.

Results: Modeling approaches and model-based image analysis methods showing new trends and perspectives in model-based medical image computing are described. Complex models are used in different medical applications and medical images like radiographic images, dual-energy CT images, MR images, diffusion tensor images as well as microscopic images are analyzed. The applications emphasize the high potential and the wide application range of these methods.

Conclusions: The use of model-based image analysis methods can improve segmentation quality as well as the accuracy and reproducibility of quantitative image analysis. Furthermore, image-based models enable new insights and can lead to a deeper understanding of complex dynamic mechanisms in the human body. Hence, model-based image computing methods are important tools to improve medical diagnostics and patient treatment in future.
The World Health Assembly Resolutions on eHealth: eHealth in Support of Universal Health Coverage
Authors: Al-Shorbaji N.
Published: October 2018

The World Health Assembly (WHA) of the World Health Organization (WHO) and three of the six WHO Regional Committees adopted a number of resolutions on eHealth: the use of information and communication technology for health. These resolutions have given legitimacy to eHealth as an area of work for WHO and its member states. The implementation of these resolutions will contribute to the achievement of the Millennium Development Goals (MDGs) and the Universal Health Coverage. eHealth has been per -ceived as reducing the cost of healthcare, improving quality and equitable access to health services.
Understanding the Value of Real-World Evidence: Focus on Stroke Prevention in Atrial Fibrillation with Rivaroxaban
Authors: Coleman Craig , Larsen Torben , Nielsen Peter , Tamayo CAPT , Camm A.
Published: October 2018

Real-world data are a well-recognized component within the drug lifecycle, and such data are generated from a range of sources and study designs, including claims databases, electronic health records, non-interventional studies (NIS) and registries. While this information can be of vital clinical importance, there may be challenges in understanding the relevance of the differing study designs, endpoints and populations. Here, we summarize the value of real-world evidence and considerations pertinent to their use in clinical research. Owing to the variety of analyses being conducted using real-world data, it is important for researchers and clinicians to have a clear understanding of the nature and origin of those data, and to ensure they are valid, reliable and robust in terms of extrapolating meaningful findings. There are crucial questions to address when evaluating real-world studies, and we introduce a checklist to meet these objectives. In addition to advice for appraising data quality and study designs, several updates will be covered from real-world studies of rivaroxaban for stroke prevention in patients with atrial fibrillation (AF): the nationwide Danish cohort study, U.S. Department of Defense Military Health System database, retrospective claim database study REAFFIRM and a pooled analysis from the global NIS XArelto on preveNtion of sTroke and non-central nervoUS system systemic embolism in patients with non-valvular atrial fibrillation (XANTUS). Real-world studies consistently show that rivaroxaban is an effective treatment option with acceptable safety when used for stroke prevention in a large number of patients with AF across the globe.
Beyond Stroke Prevention in Atrial Fibrillation: Exploring Further Unmet Needs with Rivaroxaban
Authors: Hankey G. , Nafee T. , Welsh R. , Gibson C.
Published: October 2018

With improved life expectancy and the aging population, the global burden of atrial fibrillation (AF) continues to increase, and with AF comes an estimated fivefold increased risk of ischaemic stroke. Prophylactic anticoagulant therapy is more effective in reducing the risk of ischaemic stroke in AF patients than acetylsalicylic acid or dual-antiplatelet therapy combining ASA with clopidogrel. Non-vitamin K antagonist oral anticoagulants are the standard of care for stroke prevention in patients with non-valvular AF. The optimal anticoagulant strategy to prevent thromboembolism in AF patients who are undergoing percutaneous coronary intervention and stenting, those who have undergone successful transcatheter aortic valve replacement and those with embolic stroke of undetermined source are areas of ongoing research. This article provides an update on three randomized controlled trials of rivaroxaban, a direct, oral factor Xa inhibitor, that are complete or are ongoing, in these unmet areas of stroke prevention: oPen-label, randomized, controlled, multicentre study explorIng twO treatmeNt stratEgiEs of Rivaroxaban and a dose-adjusted oral vitamin K antagonist treatment strategy in patients with Atrial Fibrillation who undergo Percutaneous Coronary Intervention (PIONEER AF-PCI) trial; the New Approach riVaroxaban Inhibition of factor Xa in a Global trial vs Aspirin to prevenT Embolism in Embolic Stroke of Undetermined Source (NAVIGATE ESUS) trial and the Global study comparing a rivAroxaban-based antithrombotic strategy to an antipLatelet-based strategy after transcatheter aortIc vaLve rEplacement to Optimize clinical outcomes (GALILEO) trial. The data from these studies are anticipated to help address continuing challenges for a range of patients at risk of stroke.
Rivaroxaban: A New Treatment Paradigm in the Setting of Vascular Protection?
Authors: Zannad Faiez , Bauersachs Rupert
Published: October 2018

The pathophysiology of atherosclerosis involves a diseased endothelium, lipid accumulation and low-grade inflammation. In later stages of coronary artery disease (CAD) and peripheral arterial disease (PAD), plaque rupture may induce atherothrombosis caused by fibrin formation and platelet activation, leading to vessel occlusion with subsequent organ damage such as myocardial infarction, stroke or limb ischaemia. Because of the high disease burden associated with CAD and PAD, there is a need for continuous vascular protection beyond currently available treatments including antiplatelet agents. Due to its central role in the coagulation cascade, inhibition of factor Xa, with the subsequent reduced thrombin formation that impacts not only fibrin but also platelets, may provide additional benefit over using antiplatelets alone. Evidence from Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Standard Therapy in Subjects with Acute Coronary Syndrome-Thrombolysis In Myocardial Infarction-51 (ATLAS-ACS 2-TIMI 51) supports the use of the direct, oral, factor Xa inhibitor rivaroxaban (2.5 mg twice-daily [bid] and 5 mg bid) in reducing mortality and morbidity in patients with acute coronary syndrome, when combined with antiplatelets. Here, we review the role of rivaroxaban in three clinical trials of CAD and/or PAD: Cardiovascular OutcoMes for People using Anticoagulation StrategieS (COMPASS), Vascular Outcomes studY of ASA alonG with rivaroxaban in Endovascular or surgical limb Revascularization for PAD (VOYAGER PAD) and Cardiovascular Outcome Modification, Measurement AND Evaluation of Rivaroxaban in patients with Heart Failure (COMMANDER HF).
Reperfusion Treatment for Acute Pulmonary Embolism
Authors: Engelberger Rolf , Kucher Nils
Published: October 2018

Due to the manifold treatment options for the management of acute pulmonary embolism, state-of-the-art management requires risk stratification for choosing the adapted treatment for each patient. Reperfusion therapy is an integral part of therapy for patients with pulmonary embolism at high risk for mortality, but its role in patients with intermediate risk pulmonary embolism is more debated. The largest amount of evidence exists for systemic thrombolysis, which is an efficient therapy, but at the prize of an increased bleeding risk. In recent years, various types of catheter-based reperfusion therapies have been introduced, and evidence is growing that this therapy is as efficient as systemic thrombolysis, but with a more favourable safety profile. Surgical embolectomy remains a good alternative for unstable patients, especially for those with absolute contraindications for thrombolysis or after failed systemic thrombolysis. While the early benefits of reperfusion therapy are well documented, evidence for long-term benefit is still scarce. The scope of this review is to summarize the evidence for the currently available reperfusion therapies in the management of acute pulmonary embolism.
Effect of Incudostapedial Reconstruction Using Conchal Cartilage Interposition Graft on Hearing Outcome
Authors: Hameed Nazrin , Alexander Arun , Saxena Sunil Kumar , Ganesan Sivaraman , Hegde Jyotirmay S.
Published: October 2018

Introduction Chronic otitis media is a widely prevalent condition in developing countries and is a cause of correctable hearing loss. The most frequent ossicular chain defect found during surgery for chronic otitis media has been a discontinuity of the incudostapedial joint. This study observes the effect of incudostapedial reconstruction using conchal cartilage on the hearing of the patient.

Objectives To evaluate improvement in hearing by incudostapedial reconstruction using conchal cartilage interposition graft in tympanoplasty and to identify the independent factors associated with erosion of the long process of incus among patients with chronic suppurative otitis media tubotympanic type.

Methods This study was conducted in the department of ear, nose and throat (ENT) amongst 22 patients with tubotympanic-type chronic suppurative otitis media who were found to have erosion of the long process during tympanoplasty. These patients underwent incudostapedial reconstruction using conchal cartilage. Their hearing was again reassessed at 12 weeks postsurgery, and the changes were observed.

Results A statistically significant improvement in air conduction by 15.14 dB was found after undergoing incudostapedial reconstruction using conchal cartilage (p < 0.001). There was no statistically significant change in bone conduction (p value > 0.05). A total of 59.1% of patients in the study had an improvement in hearing ranging from 11 to 20 dB. It was also found that 50% of the patients had a postoperative hearing of 10 to 20 dB.

Conclusion Conchal cartilage interposition graft effectively improved hearing when used for the reconstruction of the incudostapedial joint during tympanoplasty in patients of chronic suppurative otitis media.
Surgical Treatment of Chronic Parotitis
Authors: van der Lans Rik , Lohuis Peter , van Gorp Joost , Quak Jasper
Published: October 2018

Introduction chronic parotitis (CP) is a hindering, recurring inflammatory ailment that eventually leads to the destruction of the parotid gland. When conservative measures and sialendoscopy fail, parotidectomy can be indicated.

Objective to evaluate the efficacy and safety of parotidectomy as a treatment for CP unresponsive to conservative therapy, and to compare superficial and near-total parotidectomy (SP and NTP).

Methods retrospective consecutive case series of patients who underwent parotidectomy for CP between January 1999 and May 2012. The primary outcome variables were recurrence, patient contentment, transient and permanent facial nerve palsy and Frey syndrome. The categorical variables were analyzed using the two-sided Fisher exact test. Alongside, an elaborate review of the current literature was conducted.

Results a total of 46 parotidectomies were performed on 37 patients with CP. Near-total parotidectomy was performed in 41 and SP in 5 cases. Eighty-four percent of patients was available for the telephone questionnaire (31 patients, 40 parotidectomies) with a mean follow-up period of 6,2 years. Treatment was successful in 40/46 parotidectomies (87%) and 95% of the patients were content with the result. The incidence of permanent and transient facial nerve palsy was 0 (0%) and 12 (26.1%), respectively. Frey syndrome manifested in 20 (43.5%) patients. Neither this study nor careful review of the current literature resulted in evident difference between SP and NTP regarding the primary outcome variables.

Conclusion parotidectomy is a safe and effective treatment for CP in case conservative therapy fails. There is no evidence of a distinct difference between SP and NTP regarding efficiency, facial nerve palsy or Frey syndrome.
ABCB4 Gene Aberrations in Human Liver Disease: An Evolving Spectrum
Authors: Reichert Matthias , Lammert Frank
Published: October 2018

ATP-binding cassette subfamily B member 4 (ABCB4) is a phospholipid translocator at the canalicular membrane of the hepatocyte, which “flops” phosphatidylcholine into bile. Dysfunction of this transporter due to ABCB4 gene variants can cause liver diseases and has been called ABCB4 deficiency. Several diseases including progressive familial intrahepatic cholestasis type 3 (PFIC3), low phospholipid-associated cholelithiasis (LPAC), a subgroup of patients developing intrahepatic cholestasis of pregnancy (ICP), drug-induced liver injury and chronic cholangiopathy with biliary fibrosis and cirrhosis were attributed to ABCB4 deficiency and characterized in the past decade. LPAC and ICP are usually caused by monoallelic variants, whereas patients affected by PFIC3 are homozygous or compound heterozygous carriers of ABCB4 variants. Treatment with ursodeoxycholic acid is often effective, but as the more severe forms of ABCB4 deficiency progress, nevertheless, new diagnostic and therapeutic approaches are warranted. Current functional classifications for ABCB4 deficiency–associated mutations can guide the development of novel genotype–based targeted pharmacotherapies for these conditions. Recently, increasing evidence from genome-wide association studies is emerging on associations of ABCB4 variants with hepatobiliary malignancies.
Homeostatic Role of Autophagy in Hepatocytes
Authors: Khambu Bilon , Yan Shengmin , Huda Nazmul , Liu Gang , Yin Xiao-Ming
Published: October 2018

Autophagy actively participates in the physiological process of the liver. While the direct effect of autophagy may be limited to the sequestration and degradation of a selective cargo, its overall impact can be broad, affecting many more physiological processes regulated by the particular cargo. This review will discuss two aspects of the importance of autophagy in the liver: metabolic regulation in response to feeding and starvation, and pathological consequences in the absence of autophagy. These two aspects illustrate the homeostatic functions of autophagy in the liver, one in a more direct fashion, regulating the cellular nutrient supply, and the other in a more indirect fashion, controlling the pathological signaling triggered by the abnormal accumulation of cargos. Remarkably, the hepatic pathology in autophagy-deficient livers does not seem different from that presented in other chronic liver diseases. Autophagy deficiency can be a model for the study of the relevant molecular mechanisms.
Liver Injury Associated with Sporting Activities
Authors: Hassan Ammar , Fontana Robert
Published: October 2018

Exertional heat stroke most commonly develops following prolonged levels of aerobic activity in a warm or humid environment. Hypoperfusion of the vital organs along with activation of the inflammasome can lead to progressive and potentially fatal multiorgan failure including acute liver failure. In the United States, herbal and dietary supplements that are marketed to improve performance, strength, and weight loss are increasingly being used by both amateur and professional athletes. Consumption of bodybuilding supplements that contain androgenic anabolic steroids can lead to adverse hepatic effects ranging from asymptomatic serum aminotransferase elevations to severe cholestatic hepatitis with prolonged jaundice. Various non-bodybuilding nutritional supplements that contain a mixture of botanicals, caffeine, and chemicals have also been associated with idiosyncratic hepatotoxicity. In particular, green tea extract derivatives that contain epigallocatechin gallate are hepatotoxic in animal models and have been associated with severe acute hepatocellular injury in humans.
Regulation of Hepatic Inflammation via Macrophage Cell Death
Authors: Li Zhuan , Weinman Steven
Published: October 2018

Macrophages are innate immune cells with diverse functions including clearing infectious agents, inducing inflammation and fibrosis, resolving fibrosis, and restoring tissue integrity. Liver macrophages consist of both resident Kupffer cells and infiltrating macrophages. They have heterogeneous highly plastic phenotypes, and they change their phenotypes rapidly in response to a diverse array of signals present in the injured or recovering liver. Cell death by apoptosis, necroptosis, or pyroptosis is a common response of liver macrophages to infectious and toxic insults. At the same time, the uptake of apoptotic and other dead cells, efferocytosis, is mediated by a series of dead cell receptors including MerTK, TIM4, and Stablin-1. These generate a critical signal that determines macrophage phenotype evolution. This review discusses the processes that lead to macrophage apoptosis and efferocytosis, and how these alter the course of liver diseases.
Immunomodulatory Effects of Current Targeted Therapies on Hepatocellular Carcinoma: Implication for the Future of Immunotherapy
Authors: Lin Yu-Yang , Tan Ching-Ting , Chen Chia-Wei , Ou Da-Liang , Cheng Ann-Lii , Hsu Chiun
Published: October 2018

Multikinase inhibitors with antiangiogenic properties used to be standard therapy for patients with advanced hepatocellular carcinoma (HCC). Recently, several antiangiogenic agents (lenvatinib, cabozantinib, and ramucirumab) have demonstrated antitumor activity for advanced HCC in randomized controlled trials. However, the landscape of drug development for HCC may change dramatically with the advent of immune checkpoint inhibitor therapy, particularly the anti–programmed cell death-1 (anti-PD1) agents. In addition, early-phase clinical trials of combination of anti–PD-1 and antiangiogenic agents have shown very promising anti-tumor activity in patients with advanced HCC. Therefore, the critical research questions at present are whether this combination strategy will be the next generation of standard therapy and which antiangiogenic agents will be the optimal partner for the combination. All of the 4 multikinase inhibitors for HCC (sorafenib, regorafenib, lenvatinib, and cabozantinib) have been reported to have immune modulatory effects. The authors systematically reviewed the pre-clinical evidence of their immune modulatory effects to explore whether these effects were mediated by angiogenesis inhibition or by other “off-target” effects on the tumor microenvironment. Studies of sorafenib comprised the majority (58 of the 71) of the research articles reviewed. Potentially beneficial effects on anti-tumor immunity may result from increased M1 polarization of macrophages and stimulation of CD8 T cell function. On the other hand, high dosage of the kinase inhibitors in pre-clinical models and hypoxia associated with angiogenesis may contribute to immune suppression in the tumor microenvironment. Sorafenib and other multikinase inhibitors may promote anti-tumor immunity through modulation of multiple immune cell types as well as the tumor microenvironment. The optimal immune modulatory dosage should be defined to facilitate design of future combination regimens.
Effectiveness and Safety of Apixaban versus Warfarin as Outpatient Treatment of Venous Thromboembolism in U.S. Clinical Practice
Authors: Weycker Derek , Li Xiaoyan , Wygant Gail DeVecchis , Lee Theodore , Hamilton Melissa , Luo Xuemei , Vo Lien , Mardekian Jack , Pan Xianying , Burns Leah , Atwood Mark , Hanau Ahuva , Cohen Alexander T.
Published: October 2018

In the AMPLIFY clinical trial, apixaban was non-inferior to warfarin plus subcutaneous enoxaparin bridge therapy in the treatment of acute venous thromboembolism (VTE) and was associated with significantly less bleeding. This study evaluated their comparative effectiveness and safety in routine clinical practice. A matched-cohort design and data from four U.S. private health care claims databases were employed. Study population comprised patients who initiated outpatient treatment with apixaban versus warfarin (plus parenteral anticoagulant bridge therapy) within 30 days of their initial VTE episode; apixaban and warfarin patients were matched on age, characteristics of VTE episode, study database and propensity score. Major bleeding, clinically relevant non-major (CRNM) bleeding and recurrent VTE during the 180-day (maximum) follow-up period were compared using shared frailty models. During mean follow-up of 143 days among apixaban patients (n = 17,878) and 152 days among warfarin patients (n = 17,878), incidence proportions for apixaban versus warfarin, respectively, were 1.7% versus 2.3% for major bleeding, 7.0% versus 9.4% for CRNM bleeding and 2.3% versus 2.9% for recurrent VTE. In shared frailty models, risks of major bleeding (hazard ratio [HR] = 0.75, 95% confidence interval [CI] = 0.64–0.87), CRNM bleeding (HR = 0.77, 95% CI = 0.71–0.83) and recurrent VTE (HR = 0.80, 95% CI = 0.70–0.91) were lower for apixaban versus warfarin. In this large-scale evaluation of VTE patients receiving outpatient treatment with apixaban or warfarin in U.S. clinical practice, risks of major bleeding, CRNM bleeding and recurrent VTE were significantly lower among patients who received apixaban.
Flap Reconstruction of Sarcoma Defects in the Setting of Neoadjuvant and Adjuvant Radiation
Authors: Kadle Rohini , Motosko Catherine , Zakhem George , Stranix John , Rapp Timothy , Saadeh Pierre
Published: October 2018

Background Limb-sparing treatment of extremity soft tissue sarcomas requires wide resections and radiation therapy. The resulting complex composite defects necessitate reconstructions using either muscle or fasciocutaneous flaps, often in irradiated wound beds.

Methods A retrospective chart review was performed of all limb-sparing soft tissue sarcoma resections requiring immediate flap reconstruction from 2012 through 2016.

Results Forty-four patients with 51 flaps were identified: 25 fasciocutaneous and 26 muscle-based flaps. Mean defect size, radiation treatment, and follow-up length were similar between groups. More often, muscle-based flaps were performed in younger patients and in the lower extremity. Seventeen flaps were exposed to neoadjuvant radiation, 12 to adjuvant radiation, 5 to both, and 17 to no radiation therapy. Regardless of radiation treatment, complication rates were comparable, with 28% in fasciocutaneous and 31% in muscle-based groups (p < 0.775). Muscle-based flaps performed within 6 weeks of undergoing radiotherapy were less likely to result in complications than those performed after greater than 6 weeks (p < 0.048). At time of follow-up, Musculoskeletal Tumor Society scores for fasciocutaneous and muscle-based reconstructions, with or without radiation, showed no significant differences between groups (mean [SD]: 91% [8%] vs. 89% [13%]).

Conclusion The similar complication rates and functional outcomes in this study support the safety and efficacy of both fasciocutaneous flaps and muscle-based flaps in reconstructing limb-sparing sarcoma resection defects, with or without radiotherapy.
Percutaneous Removal of a Cardiac Mass in a Patient with Infective Endocarditis: A Case Report
Authors: Koney Nii , Benmessaoud Chelsea , Cole Kalonji , Bulut Yonca , Yang Eric , Moriarty John
Published: October 2018

Infective endocarditis (IE) in the pediatric population is uncommon and presents with nonspecific signs. Nonetheless, prompt diagnosis and management are critical given its high mortality rate. We present the case of a 15-year-old boy who initially presented with bilateral multifocal pneumonia and was found to have IE with a right ventricular vegetation. The vegetation was removed percutaneously, obviating a more invasive surgical approach. The patient tolerated the procedure well and rapidly improved following removal of the vegetation. This case report highlights the utility of a novel, minimally invasive approach for the management of cardiac masses.
Perspective: Emergent topologies in oxide superlattices
Authors: Das Sujit , Ghosh Anirban , McCarter Margaret R. , Hsu Shang-Lin , Tang Yun-Long , Damodaran Anoop R. , Ramesh R. , Martin Lane W.
Published: October 2018

The ability to synthesize high-quality, complex-oxide heterostructures has created a veritable playground in which to explore emergent phenomena and exotic phases which arise from the interplay of spin, charge, orbital, and lattice degrees of freedom. Of particular interest is the creation of artificial heterostructures and superlattices built from two or more materials. Through such approaches, it is possible to observe new phases and phenomena that are not present in the parent materials alone. This is especially true in ferroelectric materials where the appropriate choice of superlattice constituents can lead to structures with complex phase diagrams and rich physics. In this article, we review and explore future directions in such ferroic superlattices wherein recent studies have revealed complex emergent polarization topologies, novel states of matter, and intriguing properties that arise from our ability to manipulate materials with epitaxial strain, interfacial coupling and interactions, size effects, and more. We focus our attention on recent work in (PbTiO3)n/(SrTiO3)n superlattices wherein exotic polar-vortex structures have been observed. We review the history of these observations and highlights of recent studies and conclude with an overview and prospectus of how the field may evolve in the coming years.
Broadband bias-tunable terahertz photodetector using asymmetric GaAs/AlGaAs step multi-quantum well
Authors: Wang H. X. , Fu Z. L. , Shao D. X. , Zhang Z. Z. , Wang C. , Tan Z. Y. , Guo X. G. , Cao J. C.
Published: October 2018

In this letter, a broadband bias-tunable terahertz (THz) quantum well infrared photodetector (QWIP) with a GaAs/AlGaAs asymmetric step multi-quantum well using the intersubband transition was proposed, designed, fabricated, and characterized. It is found that the THz QWIP has two photon response peaks at 4.5 THz and 6.5 THz and the bias-tunable photon response in the 4.0–6.5 THz frequency range of the device is attributed to the field-assisted tunneling of electrons in the second excitation subbands to continuum states.
Oblique propagating extraordinary spin-electron acoustic waves
Authors: Andreev Pavel A. , Kolesnikov S. V.
Published: October 2018

Spin-electron acoustic waves (SEAWs) are found in spin-polarized plasmas due to the separate spin evolution (SSE), where electrons with different spin projections are considered as two different species. The contribution of the transverse part of the electric field appears to be rather large in the extraordinary SEAW. Summing up all described above, we consider the extraordinary spin-electron acoustic waves at the oblique propagation relatively to the magnetic field direction. Our analysis shows that the SSE causes four oblique propagating waves. Two of them are reported earlier. Hence, we report about two extra waves which are purely oblique waves disappearing in the electrostatic limit. Extra solutions appear as the fine structure of two earlier reported waves.
SERS polarization-independent performance of two-dimensional sinusoidal silver grating
Authors: Xiao Cheng , Chen Zhi-bin , Qin Meng-ze , Zhang Dong-xiao , Wu Hao
Published: October 2018

This letter demonstrates a possibility to overcome the polarization-dependent problem in surface enhanced Raman scattering (SERS) performance by two-dimensional (2D) sinusoidal silver grating. A reproducible SERS substrate with a large area can be easily fabricated by maskless laser interference photolithography. The polarization-independent SERS performance and SERS enhancement factor (EF) of this substrate are deduced by finite difference time domain and demonstrated by R6G SERS detection experiments. SERS performance of 2D sinusoidal grating is polarization-independent over the whole 360° and EF can be 5 orders of magnitude as possible. Moreover, this long-range SERS substrate can realize label-free SERS detection of 2,4,6-Trinitrotoluene (TNT).
Intermetallic formation at deeply supercooled Ni/Al multilayer interfaces: A molecular dynamics study
Authors: Yi Peng , Falk Michael L. , Weihs Timothy P.
Published: October 2018

NiAl intermetallic formation occurs along the interfaces in the Ni/Al multilayer system during molecular dynamics simulations of deep (>50%) supercooling. The simulations begin with a crystalline solid solution at the Ni/Al interfaces that melts at 800 K, a supercooling of 56% of NiAl's simulated melting temperature (1800 K), and undergoes solid-state amorphization at 650 K, a supercooling of 64%. The intermetallic phase, NiAl, then forms at the interface from the melted/amorphous region through heterogeneous nucleation followed by growth in both lateral and normal directions. Upon nucleation, the intermetallic phase retains a fraction of the composition gradient present within the initial solid solution, and that fraction is always larger at 650 K, compared to 800 K, for the same initial composition gradient. Kinetics of the transformation follows the Johnson-Mehl-Avrami model, and an Avrami exponent of 0.5 was extracted at 800 K and 0.1 at 650 K. The NiAl formation is growth-controlled and the growth rate is found to increase with the decreasing initial composition gradient. Our finding supports a growth-competition mechanism of phase selection for interfacial reactions.
Linear analysis on the interfacial instability of a spherical liquid droplet subject to a radial vibration
Authors: Li Yikai , Zhang Peng , Kang Ning
Published: October 2018

Precursory surface standing waves for liquid atomization occur on a spherical droplet subjected to a radial time-periodic force. In this paper, we carried out a linear stability analysis on the spherical Faraday instability. With the Floquet analysis, a derived difference equation gives the dispersion relation between the Floquet exponent and the spherical modes. For inviscid instability, the problem can also be reduced to the standard Mathieu equation as the same as its planar counterpart, but the parameters in the equation correspond to different quantities due to the spherical configuration. The analysis shows that increasing the density ratio of the ambient fluid to the droplet narrows the range of possibly excited spherical modes under the same forcing condition. For viscous instability, an additional parameter corresponding to the viscous effects was introduced into the difference equation. With increasing the droplet viscosity, the surface waves with large mode numbers are stabilized and hence a larger forcing amplitude is required to cause instability. Furthermore, the most-unstable spherical mode of the largest growth rate excited in the experimental condition is determined and discussed for its physical interpretation for droplet atomization caused by Faraday instability.
Thickness dependence of ferrimagnetic compensation in amorphous rare-earth transition-metal thin films
Authors: Ma Chung Ting , Kirby Brian J. , Li Xiaopu , Poon S. Joseph
Published: October 2018

Magnetic compensation in ferrimagnets plays an important role in spintronic and magnetic recording devices. Experimental results have demonstrated a thickness dependence of the compensation temperature (Tcomp) in amorphous TbFeCo thin films. It was speculated that this thickness dependence originated from a variation in the short-range order. In this work, we have investigated the depth-resolved compositional and magnetization profiles using polarized neutron reflectometry. We find that although the composition is uniform across the film thickness, near the substrate interface, the magnetization exhibits a different temperature dependence from that of the rest of the sample. Monte Carlo simulations show that it is this difference in interfacial magnetization that causes the aforementioned thickness dependence of the compensation. These results demonstrate the critical role of the substrate interface in determining the magnetic properties of amorphous ferrimagnetic thin films for spintronic applications.
All-optical helicity-dependent magnetic switching by first-order azimuthally polarized vortex beams
Authors: Wang Sicong , Wei Chen , Feng Yuanhua , Cao Yaoyu , Wang Haiwei , Cheng Weiming , Xie Changsheng , Tsukamoto Arata , Kirilyuk Andrei , Rasing Theo , Kimel Alexey V. , Li Xiangping
Published: October 2018

In this letter, a method to realize all-optical helicity-dependent magnetic switching (AO-HDS) using a first-order azimuthally polarized vortex (FAPV) beam is demonstrated. Numerical calculations of the focal fields of FAPV beams reveal that left-handed and right-handed circular polarizations are generated due to the interaction between the polarization singularity and the helical wave front. Its feasibility for AO-HDS is experimentally demonstrated in Gd27Fe63.87Co9.13 under low numerical aperture (NA) conditions and within a narrow fluence window. It is numerically predicted that under high NA conditions, the lateral size of magnetic bits recorded by FAPV beams can be nearly 30% smaller than that obtained by circularly polarized beams, which opens a promising route to realize ultrafast and ultrahigh-density magnetic recording.
Effects of oxygen concentration on helium-oxygen dielectric barrier discharges: From multi-breakdowns to single-breakdown per half-cycle
Authors: Zhang Hong , Guo Yang , Liu Dingxin , Sun Bowen , Liu Yifan , Yang Aijun , Wang Xiaohua
Published: October 2018

In this paper, a one-dimensional fluid model of He + O2 dielectric barrier discharge is established. As the oxygen concentration increases from 0.2% to 0.7% and 1.2%, the plasma transforms from triple-breakdowns to single-breakdown per half-cycle. In the mode of multi-breakdowns, the first pulse produces more particles although dissipates more power, thus making remarkable differences in the energy efficiencies in producing charged species but can hardly affect neutral species. We also operate the model in another way that the plasma is held in the mode of single-breakdown, by changing the oxygen concentration and voltage amplitude at the same time, so the impact of mode transformation is removed. In this way, the production efficiency of the electron decreases significantly, probably owing to the enhanced electron attachment with O2 and O3. After analyzing the main chemistry process of both charged and neutral species, it is suggested that the decreasing efficiency of the electron and the increasing oxygen concentration impose opposite impacts on the energy efficiencies of other species. Almost all charged species decrease more or less in their efficiencies, but O3- is the exception. For neutral species, the efficiencies vary slightly for O and O* but increase more than 250% for O2* and O3.
Variation of the oscillator strengths for the α emission lines of the one- and two-electrons ions in dense plasma
Authors: Fang T. K. , Wu C. S. , Gao X. , Chang T. N.
Published: October 2018

We present the results of a detailed theoretical study on the variation of the oscillator strengths for the 1s→2p transition of the H-like ions and the 1s2 1S→1s2p 1P transition of the He-like ions (or, inversely, the Lyman-α and Heα emission lines, respectively) subject to external plasma which meet the spatial and temporal criteria of the Debye-Hückel (DH) approximation. Our study shows that the resulting oscillator strength decreases for the Heα line for He-like ions, similar to the Lyman-α emission lines for all H-like ions, as the effect of the external plasma increases with the decreasing Debye length D in terms of a reduced Debye length λD=ZeffD. A nearly universal feature is demonstrated for a scaled oscillator strength as a function of the reduced Debye length λD = (Z − 1)D for different He-like ions that meet the same criteria for the DH model. The percentage changes of the oscillator strengths from their plasma-free values are substantially greater than those for the corresponding change for the redshifts of the Lyman-α and Heα emission lines subject to outside dense plasma. Should these general features be demonstrated experimentally, the theoretical procedure presented in this study could easily be applied to extrapolate from a single calculation for one He-like ion to other He-like ions, which could offer an alternative to complement other diagnostic efforts of the dense plasma.
‘We can work together, talk together’: an Aboriginal Health Care Home
Authors: Smith Greg , Kirkham Renae , Gunabarra Charlie , Bokmakarray Valda , Burgess C. Paul
Published: October 2018

Objective The aim of this study was to identify an Aboriginal community’s aspirations for health service improvement during implementation of the Commonwealth’s Health Care Homes (HCH) reform. Methods This study was a qualitative study consisting of Aboriginal-controlled phenomenological enquiry in a large Aboriginal community in north-central Arnhem Land. Results A representative sample of 60 Aboriginal health service users identified shortcomings in their current experience of primary health care, including low cultural security. These shortcomings reduced access to care. Participants described several ways that care could be reorientated to match their needs during HCH implementation. Principally, patients voiced the need for: (1) restructuring care teams to foster culturally secure relationship-based care; and (2) reorientating the Aboriginal Health Practitioner role from acute care to strength-based competencies as the focal point of care continuity: self-management support, care coordination and navigation, health coaching and cultural mentorship for non-Aboriginal staff. Conclusions For HCH to be successful, service providers need to engage with service users to identify and implement patient-centred strategies to improve access, acceptability and patient activation. What is known about the topic? Success of the Commonwealth’s HCH reform is contingent on improving care access and patient activation to better manage chronic conditions What does this paper add? This is the first opportunity that this Aboriginal community has had to articulate their aspirations for high quality healthcare. Beyond the strong alignment with the HCH building blocks, their care preferences posit practical and achievable workforce and delivery system reforms that may improve primary health care in other remote Aboriginal communities. What are the implications for practitioners? The long-term success of the HCH reform will require iterative engagement with service users to identify and implement patient-centred strategies to improve access and acceptability of care. Service model alignment with patient care preferences will improve patient activation and is particularly important when working with vulnerable populations.
Genetic impacts of habitat loss on the rare Banded Ironstone Formation endemic Ricinocarpos brevis (Euphorbiaceae)
Authors: Krauss Siegfried L. , Anthony Janet
Published: October 2018

Ricinocarpos brevis (Euphorbiaceae) is a declared rare species currently known from only three Banded Ironstone Formation (BIF) ranges (Perrinvale, Johnston and Windarling Ranges) in the Yilgarn region of Western Australia. The present study assessed the potential impact of proposed mining on genetic diversity within R. brevis. Approximately 30 plants were sampled from each of 14 sites across the known distribution of R. brevis. Genetic variation and its spatial structure was assessed with 144 polymorphic AFLP markers that were generated by two independent primer pairs: M-CTG/P-AC (81 markers) and M-CTA/P-AC (63 markers). Hierarchical spatial genetic structure was assessed by an analysis of molecular variance (AMOVA), Mantel tests of association between genetic- and geographic-distance and ordination. Specific attention was given to the extent of genetic differentiation of the three populations on the Windarling Range W4 deposit, which was proposed for mining operations. Strong genetic differentiation (ΦPT=0.186–0.298) among the three ranges was found. Genetic differentiation of the Johnston Range populations from Windarling and Perrinvale was greater than expected under isolation by distance predictions, suggesting adaptive genetic differentiation driven by site environmental differences, reflected by differences in plant community, substrate and landscape features. In contrast, genetic differentiation among the three Windarling Range regions (W2, W3, W4) was weaker (ΦPT=0.055–0.096). Mean pairwise ΦPT=0.078 for the 10 Windarling sites, which was unchanged with the removal of the W4 populations. In addition, none of the markers scored were unique to the W4 populations. Thus, for this set of markers, the removal of plants on the Windarling Range W4 deposit had little impact on genetic diversity within R. brevis. Strong concordance in results from the independent datasets generated by the two AFLP primer pairs provides overall support for the conclusions drawn.