bluuebunny/crossref_metadata_2025 huggingface dataset:
Longitudinal assessment of optic nerve head changes using optical coherence tomography in a primate microbead model of ocular hypertension
Authors: Chan Anita S. Y. , Tun Tin Aung , Allen John C. , Lynn Myoe Naing , Tun Sai Bo Bo , Barathi Veluchamy Amutha , Girard Michaël J. A. , Aung Tin , Aihara Makoto
Published: September 2020

In humans, the longitudinal characterisation of early optic nerve head (ONH) damage in ocular hypertension (OHT) is difficult as patients with glaucoma usually have structural ONH damage at the time of diagnosis. Previous studies assessed glaucomatous ONH cupping by measuring the anterior lamina cribrosa depth (LCD) and minimal rim width (MRW) using optical coherence tomography (OCT). In this study, we induced OHT by repeated intracameral microbead injections in 16 cynomolgus primates (10 unilateral; 6 bilateral) and assessed the structural changes of the ONH longitudinally to observe early changes. Elevated intraocular pressure (IOP) in OHT eyes was maintained for 7 months and serial OCT measurements were performed during this period. The mean IOP was significantly elevated in OHT eyes when compared to baseline and compared to the control eyes. Thinner MRW and deeper LCD values from baseline were observed in OHT eyes with the greatest changes seen between month 1 and month 2 of OHT. Both the mean and maximum IOP values were significant predictors of MRW and LCD changes, although the maximum IOP was a slightly better predictor. We believe that this model could be useful to study IOP-induced early ONH structural damage which is important for understanding glaucoma pathogenesis.
Unravelling oxygen driven α to β phase transformation in tungsten
Authors: Chattaraj Ananya , Balal Mohammad , Yadav Ashok Kumar , Barman Sudipta Roy , Sinha Anil Kumar , Jha Shambhu Nath , Joulie Sebastien , Serin Virginie , Claverie Alain , Kumar Vijay , Kanjilal Aloke
Published: September 2020

Thin films of β-W are the most interesting for manipulating magnetic moments using spin–orbit torques, and a clear understanding of α to β phase transition in W by doping impurity, especially oxygen, is needed. Here we present a combined experimental and theoretical study using grazing incidence X-ray diffraction, photoelectron spectroscopy, electron microscopy, and ab initio calculations to explore atomic structure, bonding, and oxygen content for understanding the formation of β-W. It is found that the W films on SiO2/Si have 13–22 at.% oxygen in A15 β structure. Ab initio calculations show higher solution energy of oxygen in β-W, and a tendency to transform locally from α to β phase with increasing oxygen concentration. X-ray absorption spectroscopy also revealed local geometry of oxygen in β-W, in agreement with the simulated one. These results offer an opportunity for a fundamental understanding of the structural transition in α-W and further development of β-W phase for device applications.
Overexpression of OsF3H modulates WBPH stress by alteration of phenylpropanoid pathway at a transcriptomic and metabolomic level in Oryza sativa
Authors: Jan Rahmatullah , Khan Muhammad Aqil , Asaf Sajjad , Lee In-Jung , Kim Kyung-Min
Published: September 2020

The whitebacked planthopper (WBPH), has become a devastating pest for rice crops, causes serious yield losses each year, and urgently needs biological control. Here, we developed a WBPH-resistant rice cultivar by overexpressing the OsF3H gene. A genetic functional analysis of the OsF3H gene confirmed its role in facilitating flavonoid contents and have indicated that the expression of the OsF3H gene is involved in regulation of the downstream genes (OsDFR and OsFLS) of the flavonoid pathway and genes (OsSLR1 and OsWRKY13) involved in other physiological pathways. OxF3H (OsF3H transgenic) plants accumulated significant amounts of the flavonols kaempferol (Kr) and quercetin (Qu) and the anthocyanins delphinidin and cyanidin, compared to the wild type, in response to the stress induced by WBPH. Similarly, OsF3H-related proteins were significantly expressed in OxF3H lines after WBPH infestation. The present study, indicated that the regulation of JA in OxF3H plants was suppressed due the overexpression of the OsF3H gene, which induced the expression of downstream genes related to anthocyanin. Similarly, the OsWRKY13 transcriptional factor was significantly suppressed in OxF3H plants during WBPH infestation. Exogenous application of Kr and Qu increased the survival rates of susceptible TN1 lines in response to WBPH, while decreased the survival rate of first instar WBPHs, indicating that both flavonols exhibit pesticide activity. Phenotypic demonstration also affirms that OxF3H plants show strong resistance to WBPH compared with wild type. Collectively, our result suggested that OsF3H overexpression led to the up-regulation of defense related genes and enhanced rice resistance to WBPH infestation.
Comparing the tractability of young hand-raised wolves (Canis lupus) and dogs (Canis familiaris)
Authors: Ujfalussy Dorottya Júlia , Virányi Zsófia , Gácsi Márta , Faragó Tamás , Pogány Ákos , Bereczky Boróka Mária , Miklósi Ádám , Kubinyi Enikő
Published: September 2020

Dogs live in 45% of households, integrated into various human groups in various societies. This is certainly not true for wolves. We suggest that dogs’ increased tractability (meant as individual dogs being easier to control, handle and direct by humans, in contrast to trainability defined as performance increase due to training) makes a crucial contribution to this fundamental difference. In this study, we assessed the development of tractability in hand-raised wolves and similarly raised dogs. We combined a variety of behavioural tests: fetching, calling, obeying a sit signal, hair brushing and walking in a muzzle. Wolf (N = 16) and dog (N = 11) pups were tested repeatedly, between the ages of 3–24 weeks. In addition to hand-raised wolves and dogs, we also tested mother-raised family dogs (N = 12) for fetching and calling. Our results show that despite intensive socialization, wolves remained less tractable than dogs, especially in contexts involving access to a resource. Dogs’ tractability appeared to be less context dependent, as they followed human initiation of action in more contexts than wolves. We found no evidence that different rearing conditions (i.e. intensive socialization vs. mother rearing) would affect tractability in dogs. This suggests that during domestication dogs might have been selected for increased tractability, although based on the current data we cannot exclude that the differential speed of development of dogs and wolves or the earlier relocation of wolves to live as a group explains some of the differences we found.
Simultaneous integrated boost with stereotactic radiotherapy for dominant intraprostatic lesion of localized prostate cancer: a dosimetric planning study
Authors: Kim Yeon Joo , Yoon Kyoung Jun , Kim Young Seok
Published: September 2020

Dominant intraprostatic lesion (DIL) has been known as the most common local recurrence site of prostate cancer. We evaluated the feasibility of simultaneous integrated boost (SIB) to DIL with CyberKnife stereotactic body radiotherapy (CK-SBRT). We selected 15 patients with prostate cancer and visible DIL and compared 3 plans for each patient: 1) No boost plan of 35 Gy to prostate, 2) DIL_40 plan of SIB 40 Gy to DIL and 35 Gy to prostate, and 3) DIL_45 plan with 45 Gy to DIL and 35 Gy to the prostate in 5 fractions. All targets satisfied with the prescription coverage per protocol. However, some patients failed to meet the Dmax of the rectum in DIL_40 plans (n = 4), and DIL_45 plans (n = 6). Violations of bladder constraints occurred in four DIL_45 plans. Consequently, the DIL boost with SBRT was possible in 73% of patients with DIL_40 plans, and 60% of patients with DIL_45 plans without any violation of normal organ constraints. All patients who experienced constraint violations had DILs in posterior segments. DIL boost using CK-SBRT could be an option for localized prostate cancer patients. For patients who had DIL in posterior segments, a moderate dose escalation of 40 Gy seemed appropriate.
Effects of testosterone replacement on serotonin levels in the prostate and plasma in a murine model of hypogonadism
Authors: Mota Paulo , Barbosa-Martins João , Moura Rute S. , Lima Estêvão , Miranda Alice , Correia-Pinto Jorge , Carvalho-Dias Emanuel
Published: September 2020

Benign prostate hyperplasia is a dysfunctional disease with an elevated prevalence. Despite the accepted impact of aging and testosterone (TES) in its pathophysiology, its aetiology remains unknown. Recent studies described that serotonin (5-HT) inhibits benign prostate growth through the modulation of the androgen receptor, in the presence of TES. Accordingly, this work aimed to determine the impact of castration and TES replacement in plasmatic and prostatic 5-HT regulation. C57BL/6 mice were submitted to surgical castration and divided into three groups, continually exposed to either vehicle or different TES doses for 14 days. Plasmatic 5-HT concentration was measured before and after castration, and after TES reintroduction. Finally, total prostatic weight and intra-prostatic 5-HT were determined in the different groups. Our results demonstrate that mice prostate exhibits high 5-HT tissue levels and that intra-prostatic total 5-HT was independent of castration or TES reintroduction, in all studied groups. Also, 5-HT plasmatic concentration significantly increased after castration and then normalized after TES administration. Our findings revealed that mice prostate has a high 5-HT content and that total prostatic 5-HT levels do not depend on androgens’ action. On the other hand, castration induced a significant increase in plasmatic 5-HT concentration, raising the hypothesis that androgens might be regulating the production of extra-prostatic 5-HT.
Assessment of dysplasia in bone marrow smear with convolutional neural network
Authors: Mori Jinichi , Kaji Shizuo , Kawai Hiroki , Kida Satoshi , Tsubokura Masaharu , Fukatsu Masahiko , Harada Kayo , Noji Hideyoshi , Ikezoe Takayuki , Maeda Tomoya , Matsuda Akira
Published: September 2020

In this study, we developed the world's first artificial intelligence (AI) system that assesses the dysplasia of blood cells on bone marrow smears and presents the result of AI prediction for one of the most representative dysplasia—decreased granules (DG). We photographed field images from the bone marrow smears from patients with myelodysplastic syndrome (MDS) or non-MDS diseases and cropped each cell using an originally developed cell detector. Two morphologists labelled each cell. The degree of dysplasia was evaluated on a four-point scale: 0–3 (e.g., neutrophil with severely decreased granules were labelled DG3). We then constructed the classifier from the dataset of labelled images. The detector and classifier were based on a deep neural network pre-trained with natural images. We obtained 1797 labelled images, and the morphologists determined 134 DGs (DG1: 46, DG2: 77, DG3: 11). Subsequently, we performed a five-fold cross-validation to evaluate the performance of the classifier. For DG1–3 labelled by morphologists, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 91.0%, 97.7%, 76.3%, 99.3%, and 97.2%, respectively. When DG1 was excluded in the process, the sensitivity, specificity, PPV, NPV, and accuracy were 85.2%, 98.9%, 80.6%, and 99.2% and 98.2%, respectively.
Universal inherent fluctuations in statistical counting of large particles in slurry used for semiconductor manufacturing
Authors: Lee Manhee , Kim Dongwon , Heo Tae-Young , Park Taewon , Kim Wonjung , Choi Daejin , Kim Hyunwoo , Kim Jaehyun
Published: September 2020

In the chemical mechanical polishing process of semiconductor manufacturing, the concentration of ‘large’ particles ($$\ge $$
≥
0.5 μm) in the slurry, which is considerably larger in size than the main abrasives ($$\approx $$
≈
0.1 μm), is a critical parameter that strongly influences manufacturing defects, yields, and reliabilities of large-scale-integrated circuits. Various instruments, so-called particle counters, based on light scattering, light extinction, and holography techniques have been developed to measure and monitor the large particle concentration in semiconductor fabs in real time. However, sizeable fluctuation in the measured particle concentration complicates the statistical process control in the fabs worldwide. Here, we show that an inherent fluctuation exists in the counting of large particles, which is universal, independent of instrument type, and quantitatively determined by the instrument’s operation parameters. We analytically derive a statistical theory of the fluctuation based on Poisson statistics and validate the theory through experiments and Monte-Carlo simulation. Furthermore, we provide a strategy to enhance the measurement accuracy by statistically adjusting the instrumental parameters commonly involved in the particle counters. The present results and analyses could be useful for statistical process control in semiconductor fabs to prevent large particle-induced defects such as micro-scratches and pits on wafers.
Photooxidative stress-inducible orange and pink water-soluble astaxanthin-binding proteins in eukaryotic microalga
Authors: Kawasaki Shinji , Yamazaki Keita , Nishikata Tohya , Ishige Taichiro , Toyoshima Hiroki , Miyata Ami
Published: September 2020

Lipid astaxanthin, a potent antioxidant known as a natural sunscreen, accumulates in eukaryotic microalgae and confers photoprotection. We previously identified a photooxidative stress-inducible water-soluble astaxanthin-binding carotenoprotein (AstaP) in a eukaryotic microalga (Coelastrella astaxanthina Ki-4) isolated from an extreme environment. The distribution in eukaryotic microalgae remains unknown. Here we identified three novel AstaP orthologs in a eukaryotic microalga, Scenedesmus sp. Oki-4N. The purified proteins, named AstaP-orange2, AstaP-pink1, and AstaP-pink2, were identified as secreted fasciclin proteins with potent 1O2 quenching activity in aqueous solution, which are characteristics shared with Ki-4 AstaP. Nonetheless, the absence of glycosylation in the AstaP-pinks, the presence of a glycosylphosphatidylinositol (GPI) anchor motif in AstaP-orange2, and highly acidic isoelectric points (pI = 3.6–4.7), differed significantly from that of AstaP-orange1 (pI = 10.5). These results provide unique examples on the use of water-soluble forms of astaxanthin in photosynthetic organisms as novel strategies for protecting single cells against severe photooxidative stresses.
Correction: Facile preparation of phospholipid–amorphous calcium carbonate hybrid nanoparticles: toward controllable burst drug release and enhanced tumor penetration
Authors: Wang Cheng , Liu Xuerong , Chen Shaoqing , Hu Fuqiang , Sun Jihong , Yuan Hong
Published: September 2020

Correction for ‘Facile preparation of phospholipid–amorphous calcium carbonate hybrid nanoparticles: toward controllable burst drug release and enhanced tumor penetration’ by Cheng Wang et al., Chem. Commun., 2018, 54, 13080–13083, DOI: 10.1039/C8CC07694D.
Correction: Thermo- and electro-switchable Cs⊂{Fe4–Fe4} cubic cage: spin-transition and electrochromism
Authors: Glatz Jana , Chamoreau Lise-Marie , Flambard Alexandrine , Meunier Jean-Francois , Bousseksou Azzedine , Lescouëzec Rodrigue
Published: September 2020

Correction for ‘Thermo- and electro-switchable Cs⊂{Fe4–Fe4} cubic cage: spin-transition and electrochromism’ by Jana Glatz et al., Chem. Commun., 2020, DOI: 10.1039/d0cc04279j.
A chiral porous organic polymer as a heterogeneous ligand for enantioselective Pd-catalyzed C(sp3)–H functionalization
Authors: Bennedsen Niklas Rosendal , Kramer Søren , Kegnæs Søren
Published: September 2020

Catalytic enantioselective C(sp3)–H functionalization remains a difficult task, even more so using heterogeneous catalysts.
Oenothein B boosts antioxidant capacity and supports metabolic pathways that regulate antioxidant defense inCaenorhabditis elegans
Authors: Li Wei , Li Ziyin , Peng Ming-Jun , Zhang Xiaoying , Chen Yunjiao , Yang Yu-Yu , Zhai Xiao-Xiang , Liu Guo , Cao Yong
Published: September 2020

This study provides new insights into the effects of OEB treatment on antioxidant capacity and metabolism that suggest that OEB could be used as a good source of natural antioxidants.
Impact of high-pressure processing on the stability and bioaccessibility of bioactive compounds in Clementine mandarin juice and its cytoprotective effect on Caco-2 cells
Authors: Cilla Antonio , Rodrigo María J. , De Ancos Begoña , Sánchez-Moreno Concepción , Cano M. Pilar , Zacarías Lorenzo , Barberá Reyes , Alegría Amparo
Published: September 2020

HPP can be recommended as a suitable technology to retain or indeed increase antioxidant bioactives and their cytoprotective activity in Clementine mandarin juices after gastrointestinal digestion.
Vibrational signature of the graphene nanoribbon edge structure from high-resolution electron energy-loss spectroscopy
Authors: Cavani Nicola , De Corato Marzio , Ruini Alice , Prezzi Deborah , Molinari Elisa , Lodi Rizzini Alberto , Rosi Agnese , Biagi Roberto , Corradini Valdis , Wang Xiao-Ye , Feng Xinliang , Narita Akimitsu , Müllen Klaus , De Renzi Valentina
Published: September 2020

A combined experimental and theoretical investigation of the vibrational signatures of on-surface synthesized graphene nanoribbons demonstrates the potentiality of HREELS in disclosing the details of their edge structure.
Autonomous self-healing polyisoprene elastomers with high modulus and good toughness based on the synergy of dynamic ionic crosslinks and highly disordered crystals
Authors: Miwa Yohei , Yamada Mayu , Shinke Yu , Kutsumizu Shoichi
Published: September 2020

We designed a novel polyisoprene elastomer with high mechanical properties and autonomous self-healing capability at room temperature facilitated by the coexistence of dynamic ionic crosslinks and crystalline components that slowly reassembled.
Azopyridine: a smart photo- and chemo-responsive substituent for polymers and supramolecular assemblies
Authors: Ren Hao , Yang Peng , Winnik Françoise M.
Published: September 2020

This mini-review summarizes key features of the photoisomerization of polymer-tethered azopyridine in aqueous media and describes recent accomplishments on the fast thermal cis-to-trans relaxation of azopyridinium or H-bonded azopyridine.
Constructing [CoII6] hexagon-centered heterometallic {Ln6Co6} (Ln = Y, Eu and Dy) clusters with a calix[8]arene ligand
Authors: Han Haitao , Ding You-Song , Zhu Xiaofei , Han Tian , Zheng Yan-Zhen , Liao Wuping
Published: September 2020

Three isostructural 3d–4f polynuclear clusters {(LnIII6CoII6)(C8A)3} (Ln = Y, Eu, Dy; C8A = p-tert-butylcalix[8]arene) feature some tripod-like entities in which three Ln2-C8A SBUs bolster a [Co6] hexagon.
Enhancing the oxygen evolution activity of nitrogen-doped graphitic carbon shell-embedded nickel/nickel oxide nanoparticles by surface dissolution
Authors: Madan Chetna , Tiwary Chandra Sekhar , Halder Aditi
Published: September 2020

Surface dissolution modified nitrogen-doped graphitic carbon shell embeded nickel/nickel oxide nanoparticles for superior OER activity.
Total synthesis of dimeric Securinega alkaloids (−)-flueggenines D and I
Authors: Jeon Sangbin , Lee Jinwoo , Park Sangbin , Han Sunkyu
Published: September 2020

The first total synthesis of dimeric securinega alkaloids (−)-flueggenines D and I was completed by a dimerization strategy that involves Stille reaction and stereoselective conjugate reduction.
Effects of solids retention times on electro-selective fermentation using Scenedesmus acutus biomass
Authors: Liu Yuanzhe , Sean Lai Yen-Jung , Rittmann Bruce E.
Published: September 2020

Electro-Selective Fermentation (ESF) is a means to enhance lipid wet extraction from microalgal biomass.
Impact of systematics on cosmological parameters from future galaxy cluster surveys
Authors: Salvati Laura , Douspis Marian , Aghanim Nabila
Published: September 2020

Galaxy clusters are a recent cosmological probe. The precision and accuracy of the cosmological parameters inferred from these objects are affected by the knowledge of cluster physics, entering the analysis through the mass-observable scaling relations, and the theoretical description of their mass and redshift distribution, modelled by the mass function. In this work we forecast the impact of different modelling of these ingredients for clusters detected by future optical and near-IR surveys. We consider the standard cosmological scenario and the case with a time-dependent equation of state for dark energy. We analyse the effect of increasing precision on the scaling relation calibration, finding improved constraints on the cosmological parameters. This higher precision exposes the impact of the mass function evaluation, which is a subdominant source of systematics for current data. We compare two different evaluations for the mass function. In both cosmological scenarios the use of different mass functions leads to biases in the parameter constraints. For the ΛCDM model, we find a 1.6σ shift in the (Ωm, σ8) parameter plane and a discrepancy of ∼7σ for the redshift evolution of the scatter of the scaling relations. For the scenario with a time-evolving dark energy equation of state, the assumption of different mass functions results in a ∼8σ tension in the w0 parameter. These results show the impact, and the necessity for a precise modelling, of the interplay between the redshift evolution of the mass function and of the scaling relations in the cosmological analysis of galaxy clusters.
Asymptotic analysis for periodic perforated shells
Authors: Griso Georges , Hauck Michael , Orlik Julia
Published: September 2020

We consider a perforated half-cylindrical thin shell and investigate the limit behavior when the period and the thickness simultaneously go to zero. By using the decomposition of shell displacements presented in Griso [JMPA 89 (2008) 199–223] we obtain a priori estimates. With the unfolding and rescaling operator we transform the problem to a reference configuration. In the end this yields a homogenized limit problem for the shell.
Endoscopic ultrasound-guided, through-the-needle forceps biopsy for diagnosis of pancreatic cystic lesions: a systematic review
Authors: Guzmán-Calderón Edson , Martinez-Moreno Belen , Casellas Juan A. , de Madaria Enrique , Aparicio José Ramón
Published: September 2020

Background and study aims Pancreatic cystic lesions (PCL), are a heterogeneous group of cystic lesions. Some patients with PCLs have a significantly higher overall risk of pancreatic cancer and the only test that can differentiate benign and malignnat PCL is fine-needle aspiration plus cytological analysis, but its sensitivity is very low. Through-the-needle direct intracystic biopsy is a technique that allows acquisition of targeted tissue from PCLs and it may improve the diagnostic yield for them. The aim of this study was to review articles about endoscopic ultrasound (EUS)-guided through-the-needle intracystic biopsy for targeted tissue acquisition and diagnosis of PCLs.

Methods A systematic review of computerized bibliographic databases was carried out for studies of EUS-guided through-the-needle forceps biopsy (EUS-TTNB) of PCLs. The percentages and their 95 % confidence intervals (CIs) were calculated for all the considered endpoints (technical success, adequate specimens, adverse events (AEs), and overall diagnosis).

Results Overall, eight studies with a total of 423 patients were identified. Pooled technical success was 95.6 % of the cases (399/423), (95 % CI, 93.2 %–97.3 %). Technical failure rate was 5.1 % (24 cases). Frequency of adequate specimens was 82.2 %, (95 % CI, 78.5 %–85.8 %). Adverse events were reported in seven of the eight studies. Forty-two total adverse events were reported (10.1 %) (95 % CI, 7.3 %–13.6 %). The overall ability to provide a specific diagnosis with EUS-TTNB for diagnosis of pancreatic cystic lesions was 74.6 % (313 cases), (95 % CI: 70.2 %–78.7 %). The most frequent diagnoses found with EUS-TTNB were mucinous cystic neoplasms (MCN) in 96 cases (30.6 %), IPMN in 80 cases (25.5 %), and serous cystoadenoma neoplasm (SCN) in 48 cases (15.3 %).

Conclusions Through-the-needle forceps biopsy appears to be effective and safe, with few AE for diagnosis of pancreatic cystic lesions. This technique had acceptable rates of technical and clinical success and an excellent safety profile. TTNB is associated with a high tissue acquisition yield and provided additional diagnostic yield for mucinous pancreatic lesions. TTNB may be a useful adjunctive tool for EUS-guided assessment of PCLs.
Die Delegations-Vereinbarung und ihre Umsetzung innerhalb und außerhalb der hausärztlichen Praxis aus Sicht der Niedergelassenen
Authors: Dini Lorena , Koppelow Martha , Reuß Folker , Heintze Christoph
Published: September 2020

Hintergrund Der demografische Wandel trifft auch niedergelassene Hausärztinnen und Hausärzte (HÄ) in vielen Regionen Deutschlands. Die Delegations-Vereinbarung (D-V) von 2017 ermöglicht bundesweit die Delegation ärztlicher Tätigkeiten an nicht-ärztliches Praxispersonal (näPp).

Ziel der Studie Dieser Beitrag untersucht den Informationstand der HÄ zur Gesetzeslage und die tätigkeitsbezogene Delegation an näPp innerhalb und außerhalb der Praxis.

Methodik Die quantitative postalische anonyme Befragung einer randomisierten Stichprobe von 30% aller HÄ NRWs erreichte eine Responserate von 32%. Outcomes inkludieren: Einstellung, empfundener Informationsstand zur D-V und die tätigkeitsbezogene Haltung zur Delegierbarkeit für 34 ärztliche Tätigkeiten (wird delegiert/ist nicht delegierbar).

Ergebnisse Über zwei Drittel der HÄ waren gegenüber Delegation positiv eingestellt, jedoch schätzten nur 24% ihren Informationsstand als gut/sehr gut ein. Am häufigsten wurden diagnostische Tätigkeiten delegiert. Die Zustimmung bezüglich der Delegierbarkeit von Tätigkeiten der Bereiche „allgemeine Beurteilung“ und „Beratung/Schulungen“ zeigte statistisch signifikante Unterschiede hinsichtlich der Haltung nach Informationsstand. Fast alle Tätigkeiten im Bereich „Therapie und Behandlung“ wurden gleichermaßen von gut wie von schlecht informierten HÄ delegiert. Im Bereich „Diagnostik“ ließen sich 2 Gruppen von Tätigkeiten deutlich unterscheiden, die sich auf den Informationsstand zurückführen ließen.

Schlussfolgerung Die Liste delegierbarer Tätigkeiten im Bereich Diagnostik, Organisation/Administration und „allgemeine Praxis“ weist große Potentiale auf. Delegationsmöglichkeiten sollten durch gezielte und verbesserte Informationsvermittlung über die D-V an HÄ ausgeweitet werden.
Single-center experience demonstrating low adverse events and high efficacy with self-expandable metal esophageal and biliary stents for pseudocyst and walled off necrosis drainage
Authors: Ortizo Ronald Dungca , Jalali Farid , Thieu Daniel , Yu Allen , Bucayu Robert , Paiji Christopher , Fortinsky Kyle , Chang Kenneth , Lee John Gunn , Samarasena Jason Buddika
Published: September 2020

Background and study aims Lumen-apposing metal stents (LAMS) have been designed as proprietary stents for the management of pseudocysts (PC)/walled off necrosis (WON). There has been concern about adverse events (AEs) with LAMS including bleeding, buried stent syndrome and migration. Prior to LAMS becoming available, fully-covered self-expandable metal esophageal and biliary stents (FCSEMSs) were used off-label for management of PC/WON with many centers demonstrating low rates of AEs. The primary aim of this study was to study the safety and efficacy of FCSEMS for the management of pseudocysts/WON.

Patients and methods This was a retrospective review of all endoscopic ultrasound (EUS)-guided placement of FCSEMSs for drainage of PC/WON cases performed at our institution over 4-year period. The primary outcomes studied were technical success, AEs, PC/WON resolution, and salvage surgical/radiologic intervention.

Results Technical success achieved in 65 of 65 (100 %) study patients. An AE occurred 0 of 25 patients (0 %) with PC, and in 10 of 40 patients (25 %) with WON: bleeding (3 %), migration (5 %) and stent dysfunction/infection (18 %). There was resolution in 25 of 25 patients (100 %) with a PC and 31 of 40 patients (78 %) with a WON. Salvage therapy by interventional radiology or surgery was performed in nine of 40 patients (22 %).

Conclusions This single-center 4-year experience in the pre-LAMS era showed that FCSEMS was safe and effective in all patients with PC and over 75 % of patients with WON. Given the large cost differential between LAMS and FCSEMS and the efficacy and safety shown with FCSEMS, we believe that FCSEMS should still be considered a first-line option for patients with pancreatic fluid collections, particularly in patients with PCs.
Feasibility of endoscopic suturing to prevent adverse events and hospitalization after endoscopic submucosal dissection
Authors: Han Samuel , Wani Sachin , Edmundowicz Steven A. , Soetikno Roy , Hammad Hazem
Published: September 2020

Background and study aim Endoscopic submucosal dissection (ESD) enables en bloc removal of gastrointestinal epithelial lesions but can leave a large mucosal defect, which can lead to inpatient observation and delayed bleeding or perforation. The aim of this study was to examine the safety and effectiveness of endoscopic suturing in closing ESD defects to prevent adverse events.

Patients and methods In this single-center prospective cohort study, endoscopic suturing was performed to close ESD defects in the stomach or rectum. Suturing was performed in the antegrade position starting from the edge most distal to the endoscope insertion site, moving from right to left, left to right manner before ending at the edge most proximal to the endoscope insertion site.

Results In total, 31 patients (mean age 65.6, 71 % male) received endoscopic suturing after gastric (58.1 %) or rectal (41.9 %) ESD. Mean lesion size was 27.4 ± 16.2 mm and mean suturing time was 13.4 ± 5.9 min. Complete closure was achieved in all patients. Same-day discharge occurred in 58.1 % of patients; the remainder were hospitalized with mean length of stay of 1 ± 0.6 day. There were no instances of delayed bleeding or delayed perforation (0 %, 95 % CI: 0–11.5 %). No recurrences were found on surveillance endoscopy.

Conclusions Based on this small prospective study, endoscopic suturing of post-ESD defects in the stomach and rectum appears to be feasible, safe, and potentially effective in preventing bleeding or perforation. Further larger controlled studies, however, are needed to validate these findings.
Esophageal peroral endoscopic myotomy (POEM) for treatment of esophagogastric junction outflow obstruction: results from the first prospective trial
Authors: Ichkhanian Yervant , Sanaei Omid , Canakis Andrew , Vosoughi Kia , Almazan Erik , Ghandour Bachir , Khashab Mouen A
Published: September 2020

Background and study aims Esophagogastric junction outflow obstruction (EGJOO) is a rare esophageal dysmotility disease that is characterized by elevated integrated relaxation pressuse (IRP) with evidence of preserved peristalsis. The role of peroral endoscopic myotomy (POEM) in management of EGJOO is currently unknown.

Patients and methods This is a prospective trial conducted in a single US tertiary care center from June 2015 to June 2019. Symptomatic patients, diagnosed with EGJOO on both HRM and endoluminal functional lumen imaging probe (EndoFLIP), who were eligible for POEM were recruited. Primary outcome was clinical success, defined as Eckardt score (ES) ≤ 3, at 6 months post-POEM. Other outcomes included dysphagia score, quality of life as measured by 36-item Short Form health survey scales (SF-36), post-POEM HRM, EndoFLIP, and pH measurements, and adverse events.

Results A total of 15 patients (51.8 yr. 9 F) with EGJOO underwent POEM. Pre-POEM mean IRP on HRM and Distensibility index (DI) on EndoFLIP were 24.3 ± 2.2 mmHg and 1.1 ± 0.6 mm2/mmHg, respectively. Clinical success was achieved in 93 % at 6 months post-POEM. There was significant decrease in IRP (-17.6 mmHg) post-POEM. There was significant improvement at 6 months in two of the SF-36 subscales. Ten patients underwent post-POEM pH testing, seven of whom had abnormal DeMeester score. Seven patients underwent EGD evaluation revealing esophagitis in five (2 Los Angeles grade A and 3 grade B).

Conclusions POEM offers a high clinical success rate for patients with EGJOO confirmed by impedance planimetry.
Hochaltrigkeit und Intensivbehandlung – eine ethische Betrachtung
Authors: Haidinger Eduard
Published: September 2020

Auf deutschen Intensivstationen werden immer mehr Patienten behandelt, die 80 Jahre und älter sind. Unweigerlich treten bei den Behandlungsteams dadurch Fragen auf: Warum ist das so? Ist das sinnvoll? Und dahinterliegend: Welche ethischen Grundlagen und Herausforderungen sind dabei zu beachten? Der folgende Artikel möchte Möglichkeiten aufzeigen und zum persönlichen Nachdenken anregen.
A Comparative Evaluation of the Effect of Prone Positioning Methods on Blood Loss and Intra-Abdominal Pressure in Obese Patients Undergoing Spinal Surgery
Authors: Kundra Sandeep , Bansal Hanish , Gupta Vishnu , Gupta Rekha , Kaushal Sandeep , Grewal Anju , Chaudhary Ashwani K.
Published: September 2020

Background Improper prone positioning of obese patients for spine surgery can increase the intra-abdominal pressure (IAP), resulting in increased bleeding from epidural venous plexus. The choice of prone positioning frame can be an important determinant of the IAP.

Materials and Methods This prospective, randomized study was performed on obese patients (body mass index ≥ 30) scheduled for lumbar laminectomy. After administration of general anesthesia, patients were positioned prone either on Wilson’s frame (group W), or on horizontal bolsters (group H). IAP was recorded at three intervals: (1) in supine position, (2) 10 minutes after prone positioning, and (3) in prone position at the end of surgery. Intraoperative blood loss was measured quantitatively and assessed subjectively by the surgeon.

Results A total of 60 patients were enrolled with 30 patients in each group. IAP in supine position was similar in both groups. However, IAP 10 minutes after prone positioning was significantly higher at 11.44 ± 1.61 mm Hg in group W as compared to 9.56 ± 1.92 mm Hg in group H (p = 0.001). Similarly, IAP of 12.24 ± 1.45 mm Hg in group W, measured on completion of surgery was significantly higher than 9.96 ± 2.35 mm Hg in group H (p = 0.001). Mean total blood loss of 440.40 ± 176.98 mL in group W was significantly higher than 317.20 ± 91.04 mL in group H (p = 0.003).

Conclusion Obese patients positioned prone on Wilson’s frame had significantly higher IAP and blood loss compared to patients positioned on horizontal bolsters.
Anti-MOG Antibody Syndrome and Cerebral Sinovenous Thrombosis: A Cause–Effect Hypothesis
Authors: Fontana Alessandra , Greco Filippo , Smilari Pierluigi , Praticò Andrea D. , Fiumara Agata , Ruggieri Martino , Pavone Piero
Published: September 2020

Cerebral venous thrombosis is an uncommon event of stroke in childhood. Its origin is multifactorial and often it manifests with nonspecific symptoms that may overlap with underlying predisposing factors. Anti–myelin oligodendrocyte glycoprotein (MOG) antibody syndrome is a group of recently recognized acquired demyelinating diseases that occur more commonly in children, usually, with a favorable outcome. The association between cerebral venous thrombosis and demyelinating syndrome has been reported but their clinical relationship is matter of debate and various hypotheses have been advanced including intravenous (IV) steroid therapy and/or the consequence of a shared inflammatory-thrombotic process. Herein, we report the case of a child with anti-MOG antibody syndromes who developed a thrombosis of the superior sagittal sinus and of the right Trolard's vein.
Is Ocular Sonography a Reliable Method for the Assessment of Elevated Intracranial Pressure in Children?
Authors: Yildizdas Dincer , Aslan Nagehan
Published: September 2020

Point-of-care ultrasound has been widely used by clinicians at the bedside in recent years. Various types of point-of-care ultrasound practices are employed, especially in pediatric emergency rooms and intensive care units. Pediatric intensive care specialists perform point-of-care ultrasound virtually as a part of physical examination since it provides just-in-time vital clinical information, which could assist in acute management strategies in critically ill patients. Measurement of optic nerve sheath diameter using point-of-care ultrasound is a noninvasive and radiation-free technique to determine raised intracranial pressure. Ophthalmic artery and central retinal artery Doppler indices can be used as transcranial Doppler to assess raised intracranial pressure. The aim of this review was to provide detailed information on ultrasonographic measurements of optic nerve sheath diameter and central retinal artery Doppler indices as techniques of interest for predicting increased intracranial pressure in pediatric patients in view of the literature.
Practice Variability in Screening and Treating Pediatric Critical Illness Delirium: Survey
Authors: Aljabari Salim , Carter Cara , Waheed Shahzad , Anderson Jordan E.
Published: September 2020

The best practice in pediatric delirium (PD) screening and treatment is still unknown. Current recommendations come from small studies and adult data. In this article, we surveyed the Pediatric Critical Care Medicine fellowship directors on PD screening and treatment practices in their centers. We reported high variability in the screening and treatment practices for PD in large academic medical centers in the United States. The Cornell Assessment of Pediatric Delirium tool is the most commonly used tool for screening, and quetiapine is the most commonly used pharmacologic agent. A national guideline on PD screening, prevention, and treatment is needed to standardize practice and provide guidance.
Estimating of the costs of nonfatal occupational injuries and illnesses in agricultural works in Thailand
Authors: Yogyorn Densak , Slatin Craig , Siriruttanapruk Somkiat , Woskie Susan , Chantian Thanawadee , Chaladlerd Pusanisa , Kongtip Pornpimol
Published: September 2020

Thailand lacks occupational injury and illness (OII) surveillance for its agricultural sector, a sector that comprises 34% of the total Thai workforce but is not covered by the workers compensation system. This study used data from Thailand’s Universal Health Care System to estimate the medical costs of OIIs from agricultural work in Thailand. In 2017, OII medical costs totaled $47 million (USD), about ~ 0.2% of the gross domestic product produced by the Thai agricultural sector. We recommend that some of the national funds currently used for medical treatment of OIIs be used instead to develop and implement prevention programs in agriculture. This would improve not only worker health and safety, but also productivity. Availability of data on working conditions, injuries and illnesses, and especially lost time, lost income and productivity, and OII-related costs for the workers and their dependents might enable better public health policy formulation.
Comparison of three methods of estimating the population size of an arboreal mammal in a fragmented rural landscape
Authors: Crowther Mathew S. , Dargan Jessica R. , Madani George , Rus Adrian I. , Krockenberger Mark B. , McArthur Clare , Moore Ben D. , Lunney Daniel , Mella Valentina S. A.
Published: September 2020

Abstract Context Precise and accurate estimates of animal numbers are often essential for population and epidemiological models, as well as for guidance for population management and conservation. This is particularly true for threatened species in landscapes facing multiple threats. Estimates can be derived by different methods, but the question remains as to whether these estimates are comparable. Aims We compared three methods to estimate population numbers, namely, distance sampling, mark–recapture analysis, and home-range overlap analysis, for a population of the iconic threatened species, the koala (Phascolarctos cinereus). This population occupies a heavily fragmented forest and woodland habitat on the Liverpool Plains, north-western New South Wales, Australia, on a mosaic of agricultural and mining lands. Key resultsAll three methods produced similar estimates, with overlapping confidence intervals. Distance sampling required less expertise and time and had less impact on animals, but also had less precision; however, future estimates using the method could be improved by increasing both the number and expertise of the observers. ConclusionsWhen less intrusive methods are preferred, or fewer specialised practitioners are available, we recommend distance sampling to obtain reliable estimates of koala numbers. Although its precision is lower with a low number of sightings, it does produce estimates of numbers similar to those from the other methods. However, combining multiple methods can be useful when other material (genetic, health and demographic) is also needed, or when decisions based on estimates are for high-profile threatened species requiring greater confidence. We recommend that all estimates of population numbers, and their precision or variation, be recorded and reported so that future studies can use them as prior information, increasing the precision of future surveys through Bayesian analyses.
The role of milling time on the morphological and mechanical properties of wood flour and their polypropylene composites
Authors: Maria Hanna J , Ito Hirokazu , Kenta Sakamoto , Balqis Hanis , Okamoto Masaki , Volova Tatiana , Kalarickal Nandakumar , Thomas Sabu , Goda Koichi
Published: September 2020

Rendering unique properties by combining materials are stepping stones to innovate novel material with excellent properties. Although the combination technology has been used to obtain characteristic properties, recent new technologies develop materials with both lower density and higher strength, which are not attainable for single bulk materials. The light weight, easy availability, and biodegradability of natural fibers make them as one of the most acceptable materials for manufacturing various products. Most of the commodity plastics can be reinforced with wood flour which is one of the most abundantly available resources and can impart better properties to the composite materials. To support the industry while considering the product reliability and durability, the effect of more detailed processing factors is in demand. Thus, the present study focuses on clarifying the effects of particle size, morphology, diffraction pattern, particle size distribution of the wood flour on the final properties of the wood flour-based composites. Multiple factors like morphological, structural, interfacial interactions, and crystallinity index shows 1 h milled wood fluor to be the appropriate time to mill the wood flour particles. There is an optimal milling time, which make smaller wood flours without agglomerates, resulting in better property enhancement.
Functional consequences of flower curvature, orientation and perch position for nectar feeding by sunbirds
Authors: Johnson Steven D , Kiepiel Ian , Robertson Alastair W
Published: September 2020

Mutualisms between nectarivorous birds and the plants they pollinate are functionally diverse. Nectarivorous birds which hover while feeding (the majority of hummingbirds) tend to have straight bills, while those that perch while feeding (some hummingbirds and almost all passerine nectarivores) tend to have decurved bills. Sunbirds typically use their curved bills to feed in an arc from a perching position and we thus predicted that they would prefer, and feed most efficiently on, flowers that are curved towards a perching position. To test this, we examined the responses of sunbirds to model flowers differing in curvature (straight or curved), orientation (facing upwards or downwards), and availability of a top perch (present or absent). Birds did not show preferences among model flower types in terms of number of landings to feed or number of probes. In general they preferred to use perches above model flowers, particularly those that curved upwards, but they tended to perch below model flowers that curve downwards and in such cases also took the least time to insert their bills. These results are consistent with the idea that perching birds with curved beaks will feed most efficiently from flowers that are curved towards the perching position. We discuss the implications of these results for the evolution of floral architecture, including provision of perches.
Ablation for idiopathic left ventricular tachycardia in a patient with double outlet right ventricle who underwent Fontan operation: a case report
Authors: Miyamoto Masakazu , Nishii Nobuhiro , Morita Hiroshi , Ito Hiroshi
Published: September 2020

Background

The incidence of ventricular tachycardia (VT) in patients following Fontan operation is reported as 3.5%. Furthermore, in patients with repaired double outlet right ventricle (DORV), scar-related VT and outflow tract VT have been reported; however, Purkinje-related VT has not previously been reported. In this report, we present the case of idiopathic left VT (ILVT) in a patient with DORV who underwent Fontan operation.

Case summary

A 31-year-old man was diagnosed as having DORV with complete atrioventricular defect at birth. When he was 17 years old, he underwent surgical repair, including extracardiac Fontan operation and common atrioventricular valve replacement. Five years later, VT was detected. Since some medications were ineffective in suppressing VT, he was referred to our hospital for definitive treatment. Ventricular tachycardia was induced by atrial and ventricular programmed electrical stimulations. The mechanism of the VT was determined to be re-entry. The earliest activation site was located at the mid-inferior septum of the hypoplastic left ventricle, in which Purkinje potentials were observed before the local ventricular electrogram. Radiofrequency catheter ablation (RFCA) was performed at this site to eliminate VT.

Discussion

Most VTs originate from surgical scars in patients with congenital heart disease. Catheter ablation was feasible in scar-related VT. To the best of our knowledge, this is the first report of ILVT treated successfully with RFCA in a DORV patient who had undergone Fontan operation.
Managing acute pulmonary embolism in primary care in a patient declining emergency department transfer: a case report
Authors: Vinson David R , Isaacs Dayna J , Johnson Elizabeth J
Published: September 2020

Background

For patients with acute pulmonary embolism (PE) diagnosed in the primary care setting, transfer to a higher level of care, like the emergency department, has long been the convention. Evidence is growing that outpatient management, that is, care without hospitalization, is safe, effective, and feasible for selected low-risk patients with acute PE. Whether outpatient care can be provided entirely in the primary care setting has not been well-studied. We report a case of outpatient management of a low-risk patient with acute PE without emergency department transfer.

Case summary

A 74-year-old woman with a history of recent surgery and immobilization presented to a primary care physician with 10 days of mild, non-exertional pleuritic chest pain. Her D-dimer concentration was elevated. Computed tomography pulmonary angiography identified a lobar embolus without right ventricular dysfunction. She declined emergency department transfer but was classified as low risk (class II) on the PE Severity Index and met the criteria of the European Society of Cardiology (ESC) for outpatient care. Her physician provided comprehensive clinic-based PE management, discharging her to home with education, anticoagulation, and close follow-up. She completed her 3-month treatment course without complication.

Discussion

This case describes patient-centred, comprehensive, outpatient PE management in the primary care setting for a woman meeting explicit ESC outpatient criteria. This case illustrates the elements of care that clinics can put in place to facilitate PE management without having to transfer eligible low-risk patients to a higher level of care.