bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and Phylogenetic Diversity of Pathogenic Fusarium Species in Genotypes of Wheat Seeds in Three Rift Valley Regions, Kenya
Authors: Kheseli Otieno P. , Susan Imbahale S. , Sheila Okoth , Otipa Miriam , Wafula Wekesa V.
Published: January 2021

Wheat is a source of nutrients for around 40% world’s population and the second most important cereal crop in Kenya. However, Fusarium head blight (FHB) hinders sustainable sufficient production of the crop, causing both economic and health losses. With the emerging unfavorable climatic changes, effective disease management strategies and adequate seed system are necessary to meet the deficiency. Current information on prevalence of the causative pathogens in varieties of wheat genotypes is a critical prerequisite to such strategies. This study aimed at determining the prevalence of pathogenic Fusarium species in seeds of developed varieties of wheat genotypes in three major wheat-producing regions in Kenya. A total of 260 samples of 18 wheat genotypes from 123 farms were collected. Peptone pentachloronitrobenze agar was used for fungal isolation, while identification of Fusarium spp. was based on the gene encoding translation elongation factor 1-α (tef1-alpha) sequence analysis. Fusarium spp. isolated include Fusarium poae, F. tricinctum, F. heterosporum, F. culmorum, F. equiseti, Fusarium sp., F. verticillioides, and F. oxysporum. There was no significant difference in prevalence of Fusarium spp. pathogens among the three regions studied. Fusarium spp. diversity index for Nakuru was 2.008, Narok was 1.4603, and Uasin Gishu was 1.2337. Wheat produce from farm-saved seeds yielded 66.25% of the isolates, while the produce from certified commercial wheat seeds yielded 33.75% of the isolates. The significant finding of the study is that Fusarium spp. associated with mycotoxins that contaminate the wheat food chain seem to be flourishing in all the sampled wheat seed genotypes from the regions studied. Information on the prevalence and diversity of the pathogens on persistence of the disease in the crop is critical in advancing integrative FHB control measures.
Anticancer Activities of Ginsenosides, the Main Active Components of Ginseng
Authors: Hong Heeok , Baatar Delgerzul , Hwang Seong Gu
Published: February 2021

Cancer incidence rate has been increasing drastically in recent years. One of the many cancer treatment methods is chemotherapy. Traditional medicine, in the form of complementary and alternative therapy, is actively used to treat cancer, and many herbs and active ingredients of such therapies are being intensely studied to integrate them into modern medicine. Ginseng is traditionally used as a nourishing tonic and for treating various diseases in Asian countries. The therapeutic potential of ginseng in modern medicine has been studied extensively; the main bioactive component of ginseng is ginsenosides, which have gathered attention, particularly for their prospects in the treatment of fatal diseases such as cancer. Ginsenosides displayed their anticancer and antimetastatic properties not only via restricting cancer cell proliferation, viability, invasion, and migration but also by promoting apoptosis, cell cycle arrest, and autophagy in several cancers, such as breast, brain, liver, gastric, and lung cancer. Additionally, ginsenosides can work synergistically with already existing cancer therapies. Thus, ginsenosides may be used alone or in combination with other pharmaceutical agents in new therapeutic strategies for cancer. To date however, there is little systematic summary available for the anticancer effects and therapeutic potential of ginsenosides. Therefore, we have reviewed and discussed all available literature in order to facilitate further research of ginsenosides in this manuscript.
Deep Belief Network‐Based Multifeature Fusion Music Classification Algorithm and Simulation
Authors: Gong Tianzhuo
Published: January 2021

In this paper, the multifeature fusion music classification algorithm and its simulation results are studied by deep confidence networks, the multifeature fusion music database is established and preprocessed, and then features are extracted. The simulation is carried out using multifeature fusion music data. The multifeature fusion music preprocessing includes endpoint detection, framing, windowing, and pre‐emphasis. In this paper, we extracted the rhythm features, sound quality features, and spectral features, including energy, cross‐zero rate, fundamental frequency, harmonic noise ratio, and 12 statistical features, including maximum value, mean value, and linear slope. A total of 384‐dimensional statistical features was extracted and compared with the classification ability of different emotional features. The deficiencies of the traditional classification algorithm are first studied, and then by introducing confusion, constructing multilevel classifiers, and tuning each level of the classifier, better recognition rates than traditional primary classification are obtained. This paper introduces label information for supervised training to further improve the features of multifunctional fusion music. Experiments show that this information has excellent performance in multifunctional fusion music recognition. The experiments compare the multilevel classifier with primary classification, and the multilevel classification with the primary classification and the classification performance is improved, and the recognition rate of the multilevel classification algorithm is also improved over the multilevel classification algorithm, proving that the excellent performance with multiple levels of classification.
Effects and Mechanisms of Cutting Upper Thoracic Sympathetic Trunk on Ventricular Rate in Ambulatory Canines with Persistent Atrial Fibrillation
Authors: Cai Jie , Tang Min , Liu Hao , Ding Shiao , Lu Rongxin , Wang Wei , Ma Nan , Mei Ju , Jiang Zhaolei
Published: February 2021

Objective. The purpose is to observe the effects and neural mechanism of cutting upper thoracic sympathetic trunk (TST) on the ventricular rate (VR) during persistent atrial fibrillation (AF). Methods. Twelve beagle dogs were halving to the control group and experimental group, 6 dogs for each group. Both groups were performed with left atrial rapid pacing (600 beats/min) to induce sustained AF. The experimental group underwent cutting upper TST  after a sustained AF model was established, while the control group received thoracotomy without cutting TST. Bilateral stellate ganglion (SG) and left atrial myocardium were harvested for tyrosine-hydroxylase (TH) immunohistochemical staining. Results. After cutting upper TST for 30 minutes, the average VR was 121.5 ± 8.7 bpm (95% CI, 114.8 to 128.0) in the experimental group, which was significantly slower than that of the control group (144.5 ± 4.2 bpm (95% CI, 141.5 to 148.0)) (

P
<
0.001

). After cutting upper TST for 1 month, the average VR of the experimental group (106.5 ± 4.9 bpm (95% CI, 102.0 to 110.0)) was also significantly slower versus that of the control group (139.2 ± 5.6 bpm (95% CI, 135.0 to 143.8)) (

P
<
0.001

). Compared with the control group, both left stellate ganglion (LSG) and right stellate ganglion (RSG) of the experimental group caused neural remodeling characterized by decreased ganglionic cell density and reduced TH staining. TH-positive component was significantly decreased in the left atrium of the experimental group compared with the control group. Conclusions. Cutting upper TST could reduce fast VR during persistent AF. Cutting upper TST induced bilateral SG neural remodeling and reduced sympathetic nerve density in the left atrium, which could contribute to the underlying mechanism of VR control during AF.
Prevalence and Associated Factors of Depression among Admitted Adult Patients in Surgical and Medical Wards of Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
Authors: Siyoum Merga , Assfaw Getachew , Yitbark Henok , Tesfaw Getachew
Published: January 2021

Background. Depression is a leading cause of major public health problems globally, and its prevalence has been increasing, particularly in low- and middle-income countries including our country. Therefore, this study is aimed at exploring depression symptoms and their determinants among admitted medical and surgical patients which is important to get optimal care for patients. Methods. An institution-based cross-sectional study was conducted from May to June 2019, on adults’ medical and surgical admitted patients at Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. The systematic random sampling technique was used to get a total of 590 samples. The standardized hospital anxiety and depression scale (HADS) was used to assess individual depression symptoms. We computed the bivariate and multivariate binary logistic regression analyses to identify factors associated with depression symptoms. Statistical significance was declared at

P
<
0.05

. Result. The prevalence of depression symptoms was found to be 53.9% (95% CI: 50.2, 57.0). In the multivariable logistic regression, female sex (

AOR
=
2.04

, 95% CI: 1.35, 3.09), being single (

AOR
=
3.65

, 95% CI: 3.48, 2.10, 5.78), widowed (

AOR
=
2.82

, 95% CI: 1.27, 6.30), unable to read and write (

AOR
=
2.71

, 95% CI: 1.14, 6.47), admission at medical ward (

AOR
=
1.59

, 95% CI: 1.02, 2.46), history of mental illness (

AOR
=
1.59

, 95% CI: 1.02, 2.46), and poor social support (

AOR
=
2.82

, 95% CI: 1.57, 5.11) were factors significantly associated with depression symptoms. Conclusion. The prevalence of depression symptoms among admitted patients was high. Female sex, being single, widowed, unable to read and write, admission at medical ward, history of mental illness, and poor social support were factors significantly associated with depression symptoms. It is better for the Ministry of Health to give training on how to screen depression among medical and surgical patients, and interventions that would be addressing the awareness of the above factors would be beneficial to prevent further complications.
On Soft Separation Axioms and Their Applications on Decision-Making Problem
Authors: Al-shami T. M.
Published: January 2021

In this work, we introduce new types of soft separation axioms calledpt-softαregular andpt-softαTi-spacesi=0,1,2,3,4using partial belong and total nonbelong relations between ordinary points and softα-open sets. These soft separation axioms enable us to initiate new families of soft spaces and then obtain new interesting properties. We provide several examples to elucidate the relationships between them as well as their relationships withe-softTi, softαTi, andtt-softαTi-spaces. Also, we determine the conditions under which they are equivalent and link them with their counterparts on topological spaces. Furthermore, we prove thatpt-softαTi-spacesi=0,1,2,3,4are additive and topological properties and demonstrate thatpt-softαTi-spacesi=0,1,2are preserved under finite product of soft spaces. Finally, we discuss an application of optimal choices using the idea ofpt-softTi-spacesi=0,1,2on the content of soft weak structure. We provide an algorithm of this application with an example showing how this algorithm is carried out. In fact, this study represents the first investigation of real applications of soft separation axioms.
A Review of Traffic Congestion Prediction Using Artificial Intelligence
Authors: Akhtar Mahmuda , Moridpour Sara
Published: January 2021

In recent years, traffic congestion prediction has led to a growing research area, especially of machine learning of artificial intelligence (AI). With the introduction of big data by stationary sensors or probe vehicle data and the development of new AI models in the last few decades, this research area has expanded extensively. Traffic congestion prediction, especially short-term traffic congestion prediction is made by evaluating different traffic parameters. Most of the researches focus on historical data in forecasting traffic congestion. However, a few articles made real-time traffic congestion prediction. This paper systematically summarises the existing research conducted by applying the various methodologies of AI, notably different machine learning models. The paper accumulates the models under respective branches of AI, and the strength and weaknesses of the models are summarised.
Ultrasound Imaging Algorithm: Half-Matrix Focusing Method Based on Reciprocity
Authors: Guo Xufei , Han Yan , Nie Pengfei
Published: February 2021

The ultrasonic phased array total focusing method (TFM) has the advantages of high imaging signal-to-noise ratio (SNR) and high defect resolution, but the problem of large amount data capturing and processing limits its practical industrial applications. To reduce the imaging calculation demand of the total focusing method, a half-matrix focusing method (HFM) is proposed based on the acoustic reciprocity. The method simplifies the calculation process of full-matrix data capturing (FMC) and total focus imaging. The experimental results show that the signal obtained by the linear array transceiver sensor is highly consistent, and the imaging resolution and signal-to-noise ratio of the half-matrix focusing method are slightly lower than those of full-matrix focusing method and higher than those of the B-scan imaging. However, compared with TFM, data acquisition and computational efficiency using the HFM have been improved significantly.
Boswellic acid acetate induces apoptosis through caspase-mediated pathways in myeloid leukemia cells
Authors: Xia Lijuan , Chen Duo , Han Rui , Fang Qicheng , Waxman Samuel , Jing Yongkui
Published: February 2021

The mechanism of the cytotoxic effect of boswellic acid acetate, a 1:1 mixture of α-boswellic acid acetate and β-boswellic acid acetate, isolated from Boswellia carterri Birdw on myeloid leukemia cells was investigated in six human myeloid leukemia cell lines (NB4, SKNO-1, K562, U937, ML-1, and HL-60 cells). Morphologic and DNA fragmentation assays indicated that the cytotoxic effect of boswellic acid acetate was mediated by induction of apoptosis. More than 50% of the cells underwent apoptosis after treatment with 20 μg/mL boswellic acid for 24 hours. This apoptotic process was p53 independent. The levels of apoptosis-related proteins Bcl-2, Bax, and Bcl-XL were not modulated by boswellic acid acetate. Boswellic acid acetate induced Bid cleavage and decreased mitochondrial membrane potential without production of hydrogen peroxide. A general caspase inhibitor (Z-VAD-FMK) and a specific caspase-8 inhibitor II (Z-IETD-FMK) blocked boswellic acid acetate–induced apoptosis. The mRNAs of death receptors 4 and 5 (DR4 and DR5) were induced in leukemia cells undergoing apoptosis after boswellic acid acetate treatment. These data taken together suggest that boswellic acid acetate induces myeloid leukemia cell apoptosis through activation of caspase-8 by induced expression of DR4 and DR5, and that the activated caspase-8 either directly activates caspase-3 by cleavage or indirectly by cleaving Bid, which in turn decreases mitochondria membrane potential.
Small interfering RNA targeting of S phase kinase–interacting protein 2 inhibits cell growth of oral cancer cells by inhibiting p27 degradation
Authors: Kudo Yasusei , Kitajima Shojiro , Ogawa Ikuko , Kitagawa Masae , Miyauchi Mutsumi , Takata Takashi
Published: February 2021

S phase kinase–interacting protein 2 (Skp2), an F box protein, is required for the ubiquitination and consequent degradation of p27. It is well known that reduced expression of p27 is frequently observed in various cancers including oral squamous cell carcinoma and is due to an enhancement of its protein degradation. Our previous study showed that overexpression of Skp2 was frequently found in oral squamous cell carcinoma and inversely correlated with p27 expression. Recently, a technique known as RNA interference has been successfully adapted to mammalian cells. In the present study, we investigated if small interfering RNA (siRNA)-mediated gene silencing of Skp2 can be employed in order to inhibit p27 down-regulation in oral squamous cell carcinoma. We used a siRNA plasmid vector, which has an advantage over synthetic siRNAs in determining the effects of decreasing the high constitutive levels of Skp2 protein in oral squamous cell carcinoma. We showed that Skp2 siRNA transfection decreased Skp2 protein and induced the accumulation of p27 protein in oral squamous cell carcinoma cells. Moreover, p27 protein in Skp2 siRNA-transfected cells is more stabilized than that in control siRNA-transfected cells. Interestingly, Skp2 siRNA inhibited the cell proliferation of oral squamous cell carcinoma cells both in vitro and in vivo. Our findings suggest that siRNA-mediated gene silencing of Skp2 can be a novel modality of cancer gene therapy for suppression of p27 down-regulation.
A recombinant, fully human, bispecific antibody neutralizes the biological activities mediated by both vascular endothelial growth factor receptors 2 and 3
Authors: Jimenez Xenia , Lu Dan , Brennan Laura , Persaud Kris , Liu Meilin , Miao Huaquan , Witte Larry , Zhu Zhenping
Published: February 2021

Vascular endothelial growth factors (VEGF) and their receptors (VEGFR) have been implicated to play important roles in tumor-associated angiogenesis and lymphangiogenesis, and hence in tumor growth and metastasis. We previously produced a number of fully human antibodies directed against VEGF receptor 2 (VEGFR2) and VEGF receptor 3 (VEGFR3) and showed that these antibodies are capable of inhibiting growth factor (VEGF and VEGF-C)-induced receptor activation, migration, and proliferation of human endothelial cells. In this report, we constructed and produced a bispecific antibody, a diabody, using the variable domain genes of two neutralizing antibodies, IMC-1121 to VEGFR2 and hF4-3C5 to VEGFR3. The diabody binds to both VEGFR2 and VEGFR3 in a dose-dependent manner, and blocks interaction between VEGF/VEGFR2, VEGF-C/VEGFR2, and VEGF-C/VEGFR3. In cell-based assays, the diabody neutralized both VEGF and VEGF-C-stimulated activation of VEGFR2, VEGFR3, and p44/p42 mitogen-activated protein kinase in endothelial cells. Furthermore, the diabody was able to inhibit both VEGF and VEGF-C-induced migration of endothelial cells. Taken together, our results suggest that a dual blockade of both VEGFR2 and VEGFR3 simultaneously may represent a more potent approach to effective cancer therapy.
The Use of Supra-Hemodiafiltration in Traumatic Rhabdomyolysis and Acute Kidney Injury: A Case Report
Authors: Donati Gabriele , Cappuccilli Maria , Di Filippo Federica , Nicoletti Simone , Ruggeri Marco , Scrivo Anna , Angeletti Andrea , La Manna Gaetano
Published: February 2021

Oliguric acute kidney injury due to traumatic rhabdomyolysis can be potentially lethal if the proper medical therapy combined with extracorporeal detoxification is not performed. Different extracorporeal techniques are available to overcome this syndrome. Here, we report the first case of removal of myoglobin and successful recovery from acute kidney injury in an elderly septic patient using supra-hemodiafiltration with endogenous reinfusion technique (HFR-Supra) combined with the medical therapy.
Suggested Gestational Weight Gain for Chinese Women and Comparison with Institute of Medicine Criteria: A Large Population-Based Study
Authors: Zheng Wei , Huang Wenyu , Zhang Li , Tian Zhihong , Yan Qi , Wang Teng , Li Guanghui , Zhang Weiyuan
Published: February 2021

Objective: To establish suggested gestational weight gain (GWG) using several distinct methods in a Chinese population. Methods: This study analyzed data from the medical records of singleton pregnancy women during 2011–2017 in Beijing, China. Suggested GWG was calculated using four distinct methods. In method 1, suggested GWG was identified by the interquartile method. Subsequently, risk models for small for gestational age (SGA) and large for gestational age (LGA) with respect to GWG were constructed. GWG was treated as a continuous variable in method 2, and as a categorized variable in methods 3 and 4. Results: An average GWG of 15.78 kg with a prevalence of LGA at 19.34% and SGA at 2.12% was observed among the 34,470 participants. Methods 1 and 2 did not yield clinically applicable results. The suggested GWGs were 11–17/11–16 kg, 9–19/9–15 kg, 4–12/4–10 kg, and 0–12/0–6 kg by method 3/method 4 for underweight, normal-weight, overweight, and obese women, respectively. The GWG range suggested by method 3 resulted in a larger proportion of participants (62.03%) within range, while the suggested GWG range by method 4 was associated with a lower risk of LGA compared to that conferred by the Institute of Medicine (IOM) criteria. Conclusion: This study suggests a modest GWG goal compared to IOM recommendations based on a large Chinese cohort.
Pancreatic Metastasis from Malignant Melanoma: Not All That Glitters Is Gold
Authors: Vargas-Jiménez Jose , Vargas-Madrigal Jorge , Arias-Mora Roberto , Ulate-Ovares Diana , Solis-Ugalde Bruno
Published: February 2021

Pancreatic adenocarcinoma is the most common malignancy of the pancreas; on rare occasions, metastatic tumors are present. Differentiating a primary neoplasm from a metastatic one is important for ensuring adequate treatment for the patient. We present a case of metastatic melanoma to the pancreas. A 60-year-old man presented with a history of weight loss, vague abdominal pain, jaundice, and pruritus. Laboratory tests showed increased total bilirubin, with a direct fraction predominance, as well as increased alkaline phosphatase and gamma glutamyl transferase. Imaging studies revealed a mass in the head of the pancreas. Endoscopic ultrasound (EUS)-guided fine needle biopsy was performed, and histologic examination confirmed the diagnosis of metastatic melanoma. This case report illustrates the invaluable use of EUS-guided tissue acquisition in the study of pancreatic solid lesions to obtain an accurate diagnosis. Melanomas should always be part of a differential diagnosis when evaluating patients with pancreatic masses.
Two Patients with Complex Rearrangements Suggestive of Germline Chromoanagenesis
Authors: Arya Priyanka , Hodge Jennelle C. , Matlock Peggy A. , Vance Gail H. , Breman Amy M.
Published: February 2021

Chromoanagenesis, a phenomenon characterized by complex chromosomal rearrangement and reorganization events localized to a limited number of genomic regions, includes the subcategories chromothripsis, chromoanasynthesis, and chromoplexy. Although definitions of these terms are evolving, constitutional chromoanagenesis events have been reported in a limited number of patients with variable phenotypes. We report on 2 cases with complex genomic events characterized by multiple copy number gains and losses confined to a single chromosome region, which are suggestive of constitutional chromoanagenesis. Case 1 is a 43-year-old male with intellectual disability and recently developed generalized tonic-clonic seizures. Chromosomal microarray analysis identified a complex rearrangement involving chromosome region 14q31.1q32.2, consisting of 16 breakpoints ranging in size from 0.2 to 6.2 Mb, with 5 segments of normal copy number present between these alterations. Interestingly, this case represents the oldest known patient with a complex rearrangement indicative of constitutional chromoanagenesis. Case 2 is a 2-year-old female with developmental delay, speech delay, low muscle tone, and seizures. Chromosomal microarray analysis identified a complex rearrangement consisting of 28 breakpoints localized to 18q21.32q23. The size of the copy number alterations ranged from 0.042 to 5.1 Mb, flanked by 12 small segments of normal copy number. These cases add to a growing body of literature demonstrating complex chromosomal rearrangements as a disease mechanism for congenital anomalies.
First-Line Biologic Therapy and Obesity in Moderate-to-Severe Psoriasis: Results from the Prospective Multicenter Cohort Psobioteq
Authors: Assan Florence , Tubach Florence , Arlegui Hugo , Viguier Manuelle , Beylot-Barry Marie , Dupuy Alain , Beneton Nathalie , Joly Pascal , Jullien Denis , Mahé Emmanuel , Paul Carle , Richard Marie-Aleth , Bachelez Hervé , Giboin Caroline , Chosidow Olivier , Sbidian Emilie ,   and Psobioteq
Published: February 2021

Background: Obesity is associated with an increased risk of psoriasis. Objective: In this study, we examined whether body mass index (BMI) is taken into account when choosing first-line biologic therapy for psoriasis. Methods: In this cohort study, we compared obese (BMI ≥30 kg/m2) and non-obese patients for the first-line biologic therapy prescribed, its survival, reasons for discontinuation, therapy optimization, co-prescription of methotrexate and factors associated with long drug survival. Results: A total of 931 patients were included: 594 (64%) were male, median age was 46 years (interquartile range 36–56). The most-prescribed biologic agents as first-line treatment were adalimumab (ADA; 42.7%), ustekinumab (UST; 29.9%) and etanercept (ETA; 22.9%); only frequency of infliximab (IFX) prescription differed between groups. Drug survival was significantly shorter for obese than non-obese patients (p < 2.10–4) and was worse for obese than non-obese patients for UST (p = 0.009) and ETA (p = 0.02), with no difference for ADA (p = 0.11). The main reason for discontinuation was primary inefficacy (62%), which was more frequent in obese than non-obese patients. The cumulative incidence of optimization did not significantly differ between the groups, except for ADA (SHR 1.91, 95% CI [1.23–2.96], p = 0.005). On multivariate analysis, risk of discontinuation was associated with only ETA as first-line biologic therapy (HR 1.51, 95% CI 1.04–2.19). Conclusion: This study highlighted the lack of difference in prescription of first-line biologic treatment, except for IFX, between obese and non-obese patients presenting moderate-to-severe psoriasis. Drug survival in obese patients is shorter, mainly because of inefficacy, than in non-obese patients. This highlights the need for targeted pharmacological studies in obese individuals to find optimal administration schemes.
Radiotherapy for Hidradenitis Suppurativa: A Systematic Review
Authors: Thompson Alyssa M. , Seivright Justine , Atluri Swetha , Ederle Amanda , Jaros Joanna , Hsiao Jennifer L. , Shi Vivian Y.
Published: February 2021

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory dermatosis characterized by painful nodules, abscesses, sinus tracts, and scarring mainly in the intertriginous areas. Patients with HS often experience inadequate responses to traditional treatment consisting of lifestyle modification, topical and systemic antibiotics, hormonal modulators, biologics, and procedural modalities. Low-dose radiotherapy has been used in benign cutaneous conditions, including HS; however, there is a paucity of literature summarizing its evidence. Herein, we systematically review the current literature on the efficacy of radiotherapy for patients with HS. Summary: This systematic review of the published literature reports the patient demographics, treatment regimens, efficacy, and adverse effects of radiotherapy in the treatment of HS. The historic timeline of these publications highlights the changes in management recommendations, introduction of more standardized outcome measures, and enhancements in treatment options. Radiotherapy appears to be an option for patients with treatment-resistant HS or who are poor surgical candidates. However, there remains a paucity of consensus on proper candidate selection, dosing, efficacy, and safety of the short- and long-term effects of radiotherapy.
Is Reduction Mammoplasty Cost-Effective? A Cost-Utility Analysis of Surgical Treatment for Macromastia in Germany
Authors: Lux Michael P. , Brendle-Behnisch Anne , Hack Carolin C. , Preuss Caroline , Arkudas Andreas , Horch Raymund E. , Beckmann Matthias W. , Jud Sebastian M.
Published: February 2021

Background/Aims: Macromastia can cause physical and psychological problems. Conservative treatments such as physiotherapy and painkillers lead to substantial long-term costs, without any proven medical benefit. In contrast, surgical treatment with reduction mammoplasty leads to improvements in nearly all respects. This study analyzed the costs of reduction mammoplasty and calculated an incremental cost-utility ratio for the treatment. Patients and Methods: The data on 76 patients who underwent reduction mammoplasty between 2008 and 2016 were collected using a two-part questionnaire (preoperative and postoperative) as well as the patients’ files. Topics examined besides demographic data included physician visits, medical imaging, integrative medical procedures, remedial procedures, rehabilitation and convalescent measures, drug intake, medical aids, exercise activity, and sick leave days before and after surgery. The data were used to calculate costs per year after surgical treatment for symptomatic macromastia. Costs of surgery, including the process of obtaining insurance reimbursement and postoperative complications, were taken into account to calculate the one-time costs of reduction mammoplasty. Results: The patients’ quality of life and satisfaction with the breasts improve after surgery. The one-time costs of reduction mammoplasty per patient amount to EUR 5,885, and the annual costs after surgery are EUR 200. The incremental cost-utility ratio for surgical treatments shows a saving of EUR 380 per quality-adjusted life-year (QALY) gained. Conclusions: These results show that reduction mammoplasty is a treatment that not only improves a patient’s quality of life but also saves money in the longer term in comparison with expensive and ineffective conservative treatment for macromastia.
Microfibrillar-Associated Protein 4 Regulates Stress-Induced Cardiac Remodeling
Authors: Dorn Lisa E. , Lawrence William , Petrosino Jennifer M. , Xu Xianyao , Hund Thomas J. , Whitson Bryan A. , Stratton Matthew S. , Janssen Paul M. L. , Mohler Peter J. , Schlosser Anders , Sorensen Grith L. , Accornero Federica
Published: February 2021

Rationale:

Cardiac hypertrophy, a major risk factor for heart failure, occurs when cardiomyocytes remodel in response to complex signaling induced by injury or cell stress. Although cardiomyocytes are the ultimate effectors of cardiac hypertrophy, nonmyocyte populations play a large yet understudied role in determining how cardiomyocytes respond to stress.

Objective:

To identify novel paracrine regulators of cardiomyocyte hypertrophic remodeling.

Methods and Results:

We have identified a novel role for a nonmyocyte-derived and TGFβ1 (transforming growth factor β1)–induced extracellular matrix protein MFAP4 (microfibrillar-associated protein 4) in the pathophysiology of cardiac remodeling. We have determined that nonmyocyte cells are the primary sources of MFAP4 in the heart in response to TGFβ1 stimulation. Furthermore, we have demonstrated a crucial role of MFAP4 in the cardiac adaptation to stress. Global knockout of MFAP4 led to increased cardiac hypertrophy and worsened cardiac function following chronic pressure overload. Also, one week of angiotensin-mediated neurohumoral stimulation was sufficient to exacerbate cardiomyocyte hypertrophy in MFAP4 null mice. In contrast, administration of exogenous MFAP4 to isolated cardiomyocytes blunted their phenylephrine-induced hypertrophic growth through an integrin-dependent mechanism. Finally, MFAP4 deficiency leads to dysregulated integration of G protein-coupled receptor and integrin signaling in the heart.

Conclusions:

Altogether, our results demonstrate a critical paracrine role of MFAP4 in the development of cardiac hypertrophy and could inform future treatment options for patients with heart failure.
Atherosclerosis Regression and Cholesterol Efflux in Hypertriglyceridemic Mice
Authors: Josefs Tatjana , Basu Debapriya , Vaisar Tomas , Arets Britt , Kanter Jenny E. , Huggins Lesley-Ann , Hu Yunying , Liu Jianhua , Clouet-Foraison Noemie , Heinecke Jay W. , Bornfeldt Karin E. , Goldberg Ira J. , Fisher Edward A.
Published: February 2021

Rationale:

Hypertriglyceridemia and low HDL-C (high-density lipoprotein cholesterol), both of which are regulated by LpL (lipoprotein lipase) activity, associate with increased cardiovascular disease. Genetic regulators of LpL actions track with cardiovascular disease risk in humans. Whether this is due to changes in HDL-C or function or circulating triglyceride levels is unresolved.

Objective:

We created hypertriglyceridemia and HDL-C reduction in atherosclerotic mice to allow the assessment of how hypertriglyceridemia and reduced HDL-C affect regression of atherosclerosis and the phenotype of plaque macrophages.

Methods and Results:

Atherosclerosis regression was studied in control LpL floxed (
Lpl

fl/fl

) mice and tamoxifen-inducible whole-body LpL knockout (
iLpl
−/−
) mice with hypertriglyceridemia (≈500 mg/dL) and reduced HDL-C (≈50% reduction). Atherosclerosis regression was studied using 2 models in which advanced plaques resulting from hypercholesterolemia are exposed to normal LDL-C (low-density lipoprotein cholesterol) levels using aortic transplantation or treatments with oligonucleotides. In a subset of mice, we expressed hCETP (human cholesterol ester transfer protein) to humanize the relationship between apoB-lipoproteins and HDL. HDL particle number, cholesterol efflux capacity, and HDL proteome were measured in hypertriglyceridemia mice and humans. Surprisingly, hypertriglyceridemia and reduced HDL-C levels due to loss of LpL did not affect atherosclerosis lesion size or macrophage content (CD68+cells) in either model. Expression of hCETP and further reduction of HDL-C did not alter lesions. Sera from
iLpl
−/−
mice had a decrease in total cholesterol efflux capacity, but not ABCA1 (ATP-binding cassette transporter A1)-mediated cholesterol efflux capacity. Hypertriglyceridemic humans, including those with LpL deficiency, had greater ABCA1-mediated cholesterol efflux capacity and total cholesterol efflux capacity per HDL particle number.

Conclusions:

Atherosclerosis regression in mice is driven by LDL-C reduction and is not affected by hypertriglyceridemia and plasma HDL-C levels.
Checklist of Lycopodiaceae in Vietnam with three new records and one lectotypification. Phytotaxa 452 (1): 19–32.

Authors: LU NGAN THI , DUY HUNG NGUYEN , SENNIKOV ALEXANDER N. , AVERYANOV LEONID V. , DO TRUONG VAN , ANDREY N. ANDREY N. , KUZNETSOVA SVETLANA P. , NURALIEV MAXIM S.
Published: February 2021

N/A
Pandea, a new replacement name for Udaria D.K. Singh, S. Majumdar & D. Singh (Marchantiophyta, Lophocoleaceae)
Authors: DESHMUKH UMAKANT  BHOOPATI
Published: February 2021

The generic name Udaria Gupta (1996:103) was established by Gupta (1996) with two fossil fungi species Udaria singhii Gupta (1996:103) and U. saxenae Gupta (1996:104) from Lower Tertiary sediments of Himachal Pradesh, India. Later on, Singh et al. (2018) described the new genus of liverworts, Udaria Singh, Majumdar & Singh (2018: 1537)   with the single species Udaria lamellicaulis Singh, Majumdar & Singh (2018: 1537) to the family Lophocoleaceae Vanden Berghen (1956: 208) from Arunachal Pradesh and Sikkim in Eastern Himalaya, India. After a thorough scrutiny of literature and type specimens, it was found that the liverwort genus name, Udaria Singh, Majumdar & Singh (2018: 1537) is illegitimate as it is a later homonym of the fossil fungi genus Udaria Gupta (1996:103). Therefore, a new replacement name Pandea U. B. Deshmukh is proposed with a new combination for the type species here in accordance with article 53.1 of Shenzhen Code (Turland et al. 2018).
Constructing High-Resolution, Bias-Corrected Climate Products: A Comparison of Methods
Authors: Holthuijzen Maike F. , Beckage Brian , Clemins Patrick J. , Higdon Dave , Winter Jonathan M.
Published: February 2021

High-resolution, bias-corrected climate data are necessary for climate impact studies at local scales. Gridded historical data are convenient for bias correction but may contain biases resulting from interpolation. Long-term, quality-controlled station data are generally superior climatological measurements, but because the distribution of climate stations is irregular, station data are challenging to incorporate into downscaling and bias-correction approaches. Here, we compared six novel methods for constructing full-coverage, high-resolution, bias-corrected climate products using daily maximum temperature simulations from a regional climate model (RCM). Only station data were used for bias correction. We quantified performance of the six methods with the root-mean-square-error (RMSE) and Perkins skill score (PSS) and used two ANOVA models to analyze how performance varied among methods. We validated the six methods using two calibration periods of observed data (1980–89 and 1980–2014) and two testing sets of RCM data (1990–2014 and 1980–2014). RMSE for all methods varied throughout the year and was larger in cold months, whereas PSS was more consistent. Quantile-mapping bias-correction techniques substantially improved PSS, while simple linear transfer functions performed best in improving RMSE. For the 1980–89 calibration period, simple quantile-mapping techniques outperformed empirical quantile mapping (EQM) in improving PSS. When calibration and testing time periods were equivalent, EQM resulted in the largest improvements in PSS. No one method performed best in both RMSE and PSS. Our results indicate that simple quantile-mapping techniques are less prone to overfitting than EQM and are suitable for processing future climate model output, whereas EQM is ideal for bias correcting historical climate model output.
Tropical Cyclone Resistance to Strong Environmental Shear
Authors: Dai Yi , Majumdar Sharanya J. , Nolan David S.
Published: February 2021

It is widely known that strong vertical wind shear (exceeding 10 m s−1) often weakens tropical cyclones (TCs). However, in some circumstances, a TC is able to resist this strong shear and even restrengthen. To better understand this phenomenon, a series of idealized simulations are conducted, followed by a statistical investigation of 40 years of Northern Hemisphere TCs. In the idealized simulations, a TC is embedded within a time-varying point-downscaling framework, which is used to gradually increase the environmental vertical wind shear to 14 m s−1 and then hold it constant. This controlled framework also allows for the separation of the TC-induced flow from the prescribed environmental flow. The TC-induced outflow is found to withstand the strong upper-tropospheric environmental flow, and this is manifested in the TC-induced shear difference (TCSD) vector. The TCSD vector, together with the environmental shear vector, defines an azimuthal range within which most of the asymmetric convection is located. The statistical analysis confirms the findings from the idealized simulations, and the results are not strongly sensitive to the TC intensity or basin. Moreover, compared with total shear, the inclusion of TCSD information creates a slightly better correlation with TC intensity change. Overall, the TCSD vector serves as a diagnostic to explain the ability of a TC to resist strong environmental shear through its outflow, and it could potentially be used as a parameter to predict future intensity change.
Risk Factors Associated With Readmission After Pancreatectomy: A Single-Institution Retrospective Cohort Study
Authors: Bonds Morgan , Garwe Tabitha , Rozich Noah , Oluborode Babawale , Sarwar Zoona , Postier Russell G , Morris Katherine T
Published: January 2021

Background

Pancreatectomy has a significant rate of procedure-specific morbidity which can result in readmission. Readmission has been proposed as a measure of quality. The goal of this study is to determine what factors are associated with readmission after pancreatectomy and whether readmission can be prevented.

Methods

A retrospective review of a single institution’s pancreatectomies between January 2011 and April 2015 was performed. Demographic, perioperative, and outpatient data were collected from the medical record. Primary outcome was 90-day readmission. Univariate and multivariable analyses were performed to determine which factors were associated with increased risk for readmission.

Results

A total of 257 patients met inclusion criteria; the 90-day readmission rate was 32.7%. The median time to readmission was 13 days. Readmitted patients were more likely to have a postoperative pancreatic fistula (POPF) on univariate analysis. Surgical site infections were more common in readmitted patients (18% vs 6.4%, P = .0138). Upon multivariable adjustment, only POPF ( P = .0005) remained significant. A positive dose-response relationship was noted between POPF grade and the odds of readmission with odds ratios (ORs) ranging from 1.6 (95% Confidence Interval (CI): .6-4.1) for grade A to 16.7 (95% CI: 1.8-156.8) for grade C, albeit with limited precision.

Conclusions

Readmission after pancreatectomy is a common occurrence despite the many advancements in perioperative care. Our data suggest that POPF is a risk factor for readmission after pancreatectomy. Presently, this factor is not clearly preventable. This suggests that readmission may not be the best measure of quality to utilize in the evaluation of pancreatic surgery.
Emergency Medical Service Transport Time and Trauma Outcomes at an Urban Level 1 Trauma Center: Evaluation of Prehospital Emergency Medical Service Response
Authors: Elkbuli Adel , Dowd Brianna , Sanchez Carol , Shaikh Saamia , Sutherland Mason , McKenney Mark
Published: January 2021

Background

The use of helicopter emergency medical services (HEMS) for trauma patients has been debated since its introduction. We aim to compare outcomes for trauma patients transported by ground EMS (GEMS) vs. HEMS using raw and adjusted mortality in a level 1 trauma center.

Methods

A 6-year retrospective cohort study utilizing our level 1 trauma center registry for patients transferred by GEMS or HEMS was performed. Demographics and outcome measures were compared. Raw and adjusted mortality was evaluated. Adjusted mortality was determined incorporating confounders, including patient demographics, comorbid conditions, mechanism of injury, injury severity score (ISS), Glasgow Coma Scale score, and EMS transport time. Chi-square, multivariable logistic regression, and independent sample T-test were utilized with significance, defined as P < .05.

Results

Of 12 633 patients, 10 656 were transported via GEMS and 1977 with HEMS. Mean age was 55 for GEMS and 40 for HEMS ( P < .001). Mean ISS was 9.29 and 11.73 for GEMS and HEMS ( P < .001). Mean Revised Trauma Score was higher (less severe) for GEMS vs. HEMS (7.6 vs. 7.12, P < .001). Mean transport times for GEMS and HEMS was 39.45 vs. 47.29 minutes ( P = .02). Raw mortality was 2.55% (307/10 656) for GEMS and 6.78% (134/1977) for HEMS. Adjusted mortality revealed a 16.6% increased mortality for GEMS compared to HEMS (adjusted odds ratio = 1.166, 95% CI: .815-1.668).

Conclusions

Air-lifted trauma patients were younger, more severely injured, and more hemodynamically unstable and required longer transport time but experienced lower adjusted mortality. Future research is needed to investigate whether reducing transport times and augmenting the advanced care already implemented by HEMS crews can improve outcomes.
Change in Neutrophil-to-Lymphocyte Ratio During Neoadjuvant Treatment Does Not Predict Pathological Response and Survival in Resectable Pancreatic Ductal Adenocarcinoma
Authors: Strong James S. , Vos Elvira L. , Mcintyre Caitlin A. , Chou Joanne F. , Gonen Mithat , Tang Laura H. , Soares Kevin C. , Balachandran Vinod P. , Kingham T. Peter , D'Angelica Michael I. , Jarnagin William R. , Drebin Jeffrey , Kunstman John W. , Allen Peter J. , Wei Alice C.
Published: January 2021

Background

Neutrophil-to-lymphocyte ratio (NLR) has been reported as prognostic in pancreatic ductal adenocarcinoma (PDAC). Data about NLR changes during neoadjuvant therapy (NAT) and its relationship with pathological tumor response and survival are lacking.

Methods

Pancreatic ductal adenocarcinoma patients with NAT followed by resection between 2009 and 2015 were identified from a prospective database. Neutrophil-to-lymphocyte ratio was collected prior to NAT (baseline), on chemotherapy (prior to cycle 3), and prior to surgery. Baseline NLR, and changes in NLR between baseline and on chemotherapy (delta 1) and between baseline and surgery (delta 2) were compared with pathologic response (<90% and ≥90% defined as poor and good), overall (OS), and disease-free survival (DFS) using Wilcoxon rank-sum and Cox proportional hazard models.

Results

Of 93 patients, 17% had good pathological response. Median (interquartile range) NLR at baseline, third cycle, and surgery were 2.7 (2.0-3.7), 2.5 (1.9-4.1), and 3.1 (2.1-5.3), respectively. Median change in NLR from baseline to third cycle was .06 ( P = .72), and .6 from baseline to surgery ( P < .01). Baseline NLR, delta 1, and delta 2 were not associated with pathological response, OS, or DFS.

Discussion

Neutrophil-to-lymphocyte ratio increased after NAT, but a significant association between NLR and pathological response, OS, and DFS in resected PDAC patients was not observed.
The Accuracy of Point-of-Care Ultrasound in the Diagnosis of Acute Cholecystitis
Authors: Wehrle Chase J. , Talukder Asif , Tien Lillie , Parikh Soham , Devarakonda Aditya , Holsten Steven B. , Fox Elizabeth D. , Lawson Andrew
Published: January 2021

Purpose

Acute cholecystitis (AC) affects 50-200 000 patients per year. Early surgery is the treatment of choice for AC. Therefore, timely diagnosis is important to begin proper management. Recently, emergency departments have adopted point-of-care ultrasound (POCUS) for the initial evaluation of AC. The accuracy of POCUS for AC has not been well studied.

Methods

Patients receiving POCUS for evaluation of AC in the emergency department at our tertiary care institution for 2 years were considered. Patients with previous biliary diagnoses were excluded. Patients were deemed to have AC from a recorded POCUS result or 2/3 of the following POCUS findings: pericholecystic fluid, gallbladder wall hyperemia, and sonographic Murphy’s sign. Formal ultrasound and final diagnosis from surgical and pathology reports were used as gold standards for comparison.

Results

In total, 147 patients met inclusion criteria. POCUS had a sensitivity and specificity of .4 (95% CI: .1216-.7376) and .99 (.9483-.9982), respectively, when compared to a final diagnosis and .33 (.0749-.7007) and .94 (.8134-.9932) when compared to formal US. The modified Tokyo guidelines for suspicion of AC had a sensitivity of .2 (.0252-.5561) and specificity of .88 (.8173-.931) compared to the final diagnosis.

Conclusion

Point-of-care ultrasound was not a better screening test than the modified Tokyo guidelines. We recommend a simplified screening approach for AC using clinical findings and laboratory data, followed by confirmatory formal imaging. This strategy could prevent unnecessary delays in surgical management and use of physician resources.