bluuebunny/crossref_metadata_2025 huggingface dataset:
Improve Inter-day Hand Gesture Recognition Via Convolutional Neural Network-based Feature Fusion
Authors: Fang Yinfeng , Zhang Xuguang , Zhou Dalin , Liu Honghai
Published: December 2020

The learning of inter-day representation of electromyographic (EMG) signals across multiple days remains a challenging topic and not fully accommodated yet. This study aims to improve the inter-day hand motion classification accuracy via convolutional neural network (CNN)-based data feature fusion. An EMG database (ISRMyo-I) was recorded from six subjects on 10 days via a low density electrode setting. This study investigated CNNs’ capability of feature learning, and found that the output of the first fully connected layer (CNNFeats) was a decent supplement feature set to the most prevalent Hudgins’ time domain features in combination with fourth-order autoregressive coefficients (TDAR). Through adding the automatically learned CNNFeats to the handcrafted TDAR feature set, both linear discriminant analysis (LDA) and support vector machine (SVM) classifiers received [Formula: see text]3% accuracy improvement. Similarly, taking TDAR as additional input to the CNN improved the accuracy by [Formula: see text]1% in the comparison with the basic CNN. Our results also demonstrated that the CNN approach outperformed conventional approaches when multiple subjects’ data were available for training, while traditional approaches were more adept at presenting motion patterns for single subject. A preliminary conclusion is drawn that substantial “common knowledge/features” can be learned by CNNs from the raw EMG signals across multiple days and multiple subjects, and thus it is believed that a pre-trained CNN model would contribute to higher accuracy as well as the reduction of learning burden.
A compartmental model to investigate the dynamics of the COVID-19 pandemic: A case study in five countries
Authors: Apenteng Ofosuhene O. , Oduro Bismark , Owusu-Mensah Isaac
Published: December 2020

Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, was declared a pandemic by the WHO on March 12, 2020. By April 10, 2020, it has spread to almost 215 UN Territories, affected more than 1,600,000 people, and become fatal to more than 100,000 people. We propose a compartmental model to investigate the dynamics of the COVID-19 pandemic and analyze the effects of governments and health officials’ intervention strategies, using data in the USA, Italy, Spain, Germany, and France. These are the countries with the most confirmed cases of the COVID-19 as of April 11, 2020. We perform parameter estimations, sensitivity, and predictive analysis and compare the COVID-19 trend in these understudy countries. Based on the model, we compute the basic reproduction number of the pandemic in these countries. The results indicate that the most sensitive parameters are the contact rate and degree of intervention; these parameters have high value in containing the pandemic. The basic reproduction number in each of the countries under study is more than unity. Based on our findings, the COVID-19 pandemic will continue to spread; but higher compliance with the intervention strategies will help minimize the disease’s spread.
Delayed fuzzy genetic regulatory networks: Novel results
Authors: Aouiti Chaouki , Dridi Farah
Published: December 2020

In this manuscript, we studied a class of delayed Fuzzy Genetic Regulatory Networks (FGRNs) with Stepanov-like weighted pseudo almost automorphic coefficients. New criteria for the existence, uniqueness and global exponential stability of its weighted pseudo almost automorphic solution are established. Our approach is based on Banach fixed point theorem and novel analysis techniques. Moreover, a numerical example is given to illustrate the validity of the obtained results.
Facile fabrication of PS-CHO@CeO2 core-shell composite microspheres via in-situ chemical deposition and their photocatalytic application on oxidative degradation of MO
Authors: Ni Jingbo , Liu Ruyi , Zhang Ming , Yan Changhao
Published: December 2020

In this study, the modified polystyrene aldehyde microspheres (PS-CHO) were first prepared via the copolymerization of the styrene and the acrolein, and then PS-CHO@CeO2 composite microspheres were fabricated through in-situ chemical deposition of CeO2 nanoparticles. These composite microspheres were used to catalyze the oxidative degradation of methyl orange (MO) by H2O2. The morphology of the products was observed by transmission electron microscopy (TEM). X-ray diffraction (XRD) and X-ray photoelectron spectroscopy (XPS) were employed to characterize the chemical state and structure. Optical absorption and band energy properties were investigated by ultraviolet-visible/near-infrared diffuse reflectance spectra (UV-Vis-NIR). The degradation process was monitored with ultraviolet-visible spectrometer (UV-Vis). The results revealed that when the mass ratio of PS-CHO and cerium nitrate was 1:0.26, highly-uniformed and well-dispersibility PS-CHO@CeO2 composite microspheres were obtained at pH 8.5 and the concentration of Ce[Formula: see text] ions was significantly increased compared with commercial CeO2 NPs. Under ultraviolet light irradiation, the degradation efficiency of MO by PS-CHO@CeO2 composite microspheres was increased up to 93.03%, which was 1.44 times that of commercial CeO2 NPs in 120 min. The reiteratively tests further proved that the activity of the composite microspheres maintained unchanged after four cycles. The formation and photocatalytic mechanisms of PS-CHO@CeO2 composite microspheres were proposed.
The inverse strong nonsplit domination in graphs
Authors: Packiarani D. Kiruba , Mary Y. Therese Sunitha
Published: December 2020

Let [Formula: see text] be a simple finite and connected graph. A dominating set [Formula: see text] is a strong nonsplit dominating set if the induced subgraph [Formula: see text] is complete. [Formula: see text] is an inverse strong nonsplit dominating set if [Formula: see text] is a strong nonsplit dominating set of [Formula: see text]. The cardinality of minimum inverse strong nonsplit dominating set is the inverse strong nonsplit domination number [Formula: see text]. In this paper, we initiated and introduced a new variant of strong nonsplit dominating set called inverse strong nonsplit dominating set. Also, we obtain the inverse strong nonsplit domination number and bounds of some standard graphs and its complement.
Proof of a conjecture on spectral distance between cycles, paths and certain trees
Authors: Abdollahi Alireza , Zakeri Niloufar
Published: December 2020

We confirm the following conjecture which has been proposed by Stanić in [I. Jovanović and Z. Stanić, Spectral distances of graphs, Linear Algebra Appl. 436(5) (2012) 1425–1435]: [Formula: see text] [Formula: see text] where [Formula: see text] is the spectral distance between [Formula: see text] vertex non-isomorphic graphs [Formula: see text] and [Formula: see text] with adjacency spectra [Formula: see text] for [Formula: see text], and [Formula: see text] and [Formula: see text] denote the path and cycle on [Formula: see text] vertices, respectively, [Formula: see text] denotes the coalescence of [Formula: see text] and [Formula: see text] on one of the vertices of degree 1 of [Formula: see text] and the vertex of degree [Formula: see text] of [Formula: see text], and [Formula: see text] denotes the coalescence of [Formula: see text] and [Formula: see text] on the vertex of degree 1 of [Formula: see text] which is adjacent to a vertex of degree [Formula: see text] and the vertex of degree [Formula: see text] of [Formula: see text].
Modeling and pricing with a random walk in random environment
Authors: Castro Isabel , Pacheco Carlos G.
Published: December 2020

We propose a parsimonious model for financial pricing that incorporates the existence of a random environment; such construction can be though as an extension of the Cox–Ross–Rubinstein (CRR) model. Our model is motivated from the Sinai random walk, but we mention the difficulty of applying such model if we try to use it with the CRR procedure. As it was done with Sinai’s walk, we provide a method to connect the most visited sites of the model with the minimum points of a function of the environment. We present some simulations and a numerical experiment to bring a new perspective.
On the spherical expansion for calculating the sound radiated by a baffled circular piston
Authors: Zhong Jiaxin , Qiu Xiaojun
Published: December 2020

An efficient and accurate method for calculating the sound radiated by a baffled circular rigid piston is using spherical harmonics, and the solution is a series containing the integral of spherical Bessel functions. The integral is usually calculated with the generalized hypergeometric functions in existing literatures, which shows poor convergence at middle and high frequencies due to the overflow and the loss of significant figures. A rigorous and closed form solution of the integral is derived in this paper based on the recurrence method, which is accurate in the whole frequency range and thousands of times faster than the existing methods. It is shown that the proposed method can be extended for the calculation of the sound radiated by a baffled piston and an unbaffled resilient disk with axisymmetric velocity and pressure profiles, respectively, and some baffled rotating sources where the velocity profile is asymmetric.
About this title - Archean Granitoids of India: Windows into Early Earth Tectonics
Authors: Dey S. , Moyen J.-F.
Published: December 2020

Granitoids form the bulk of the Archean continental crust and preserve key information on early Earth evolution. India hosts five main Archean cratonic blocks (Aravalli, Bundelkhand, Singhbhum, Bastar and Dharwar). This book summarizes the available information on Archean granitoids of Indian cratons. The chapters cover a broad spectrum of themes related to granitoid typology, emplacement mechanism, petrogenesis, phase-equilibria modelling, temporal distribution, tectonic setting, and their roles in fluid evolution, metal delivery and mineralizations. The book presents a broader picture incorporating regional- to cratons-scale comparisons, implications for Archean geodynamic processes, and temporal changes thereof. This synthesis work, integrating modern concepts on granite petrology and crustal evolution, offers an irreplaceable body of reference information for any geologist interested in Archean Indian granitoids.
Review—Research Needs for Photovoltaics in the 21st Century
Authors: Tao Meng , Hamada Hiroki , Druffel Thad , Lee Jae-Joon , Rajeshwar Krishnan
Published: December 2020

By 2050, the scale of installed solar panels must reach about 100 TWp in order to make a tangible impact on our energy mix and carbon emissions. Thin-film amorphous silicon panels are the only technology today capable of 100 TWp installation. Wafer silicon panels could reach 100 TWp if the silver in silicon panels is replaced with copper or aluminum. Cadmium telluride and copper indium gallium selenide would become technologies of insignificance in the big picture. For energy-efficient production of silicon panels, research is needed in energy-efficient purification of silicon, low kerf loss wafering of silicon, and an Earth-abundant top cell on silicon. Alternatively we can pursue a new cell technology which is more energy efficient than silicon and utilizes only Earth-abundant materials. For any cell technology, research is needed to improve the cost, efficiency, and sustainability including storage technologies for daily to multiyear storage and for regional and global trade of solar electricity, recycling technologies to minimize cost and maximize revenue from waste panels, and systems and applications for real-time and in situ consumption of solar electricity.
Screening of Concentration and Antimicrobial Effectiveness of Antimicrobial Preservative in Betastatin Besylate Nasal Spray
Authors: Sun Yanhong , Wang Yinhuan , Zhou Jianming , Zhou Qingxue , Dong Shilei
Published: December 2020

Objective. To explore the optimal concentration and antimicrobial effectiveness of antimicrobial preservative in betastatin besylate nasal spray. Methods. By using Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Candida albicans, and Aspergillus niger as test strains, the antimicrobial effectiveness of betastatin besylate nasal spray containing different concentrations of antimicrobial preservative (0.02%, 0.0125%, and 0.005% benzalkonium chloride, respectively) was determined by using bacteriostatic effect test (Chinese Pharmacopoeia, 2015 edition). Results. The antimicrobial effectiveness of betastatin besylate nasal spray containing 0.02% and 0.0125% benzalkonium chloride, respectively, complied with the regulations of Chinese Pharmacopoeia (2015 Edition) against five test strains. However, the antimicrobial effectiveness of betastatin besylate nasal spray containing 0.005% benzalkonium chloride against P. aeruginosa did not meet the requirements of Chinese Pharmacopoeia. Conclusion. Benzalkonium chloride at a concentration of 0.125% can be used as an added antimicrobial preservative in betastatin besylate nasal spray.
Coincidence Best Proximity Point Results in Branciari Metric Spaces with Applications
Authors: Saleem Naeem , De la Sen Manuel , Farooq Sadia
Published: December 2020

This paper is aimed at studying the uniqueness of coincidence best proximity point forϑ,α+,g-proximal contractions in complete Branciari metric space. Throughout this article, discontinuity of the Branciari metric space is used and we obtained the desired results without assuming it as a continuous. Some examples are provided to validate the results proved herein. As an application, we derive the best proximity point results in the setup of complete Branciari metric space endowed with graph. Further, our results extend and generalize the existing ones in literature.
Physicochemical Properties, Fatty Acid Composition, and the Effect of Heating on the Reduction of Cyclopropenoid Fatty Acids on Baobab (Adansonia digitata L.) Crude Seed Oil
Authors: Msalilwa Upendo L. , Makule Edna E. , Munishi Linus K. , Ndakidemi Patrick A.
Published: December 2020

The baobab seed oil has been consumed by humans due to its medicinal and nutrient values for many years. However, the consumption of baobab seed oil has been perceived by different communities as a health risk caused by cyclopropenoid fatty acids (CPFAs), which are carcinogenic ingredients present in the oil. This study investigated the physicochemical properties and fatty acid profile of baobab crude seed oil collected from semiarid areas in Tanzania and determined the effects of heating on the reduction of CPFAs. The baobab seed crude oil was extracted by Soxhlet using n-hexane, and the fatty acid composition of the baobab seed crude oil was determined by gas-liquid chromatography (GLC). Since CPFAs are resistant to lower temperatures, the effect of heating on the CPFA content of baobab crude seed oil was studied at 150°C, 200°C, and 250°C. The A. digitata crude seed oil was found to contain mainly twelve essential fatty acids and two different CPFAs. The most abundant fatty acids were palmitic acid, oleic acid, and linoleic acid in all the baobab population hotspots occurring in Tanzania. There was no significant difference in most physicochemical properties and fatty acid composition across the different semiarid areas in Tanzania. The major breakdown of CPFAs occurs at 200°C, and that would be the optimal temperature recommended for the refining process of the baobab crude oil. The study recommended refining of the baobab oil at higher temperatures ranging from 200 - 250°C as the best way of reducing CPFAs.
Overexpression of LMP-1 Decreases Apoptosis in Human Nucleus Pulposus Cells via Suppressing the NF-κB Signaling Pathway
Authors: Liu Yuan , Zhou Wei , Chen Fei-Fan , Xiao Fei , Zhu Hai-Yang , Zhou Yun , Guo Guan-Cheng
Published: December 2020

Intervertebral disc degeneration (IDD) is a prevalent disease characterized by low back pain. Increasing extracellular matrix (ECM) synthesis and decreasing nucleus pulposus cell (NPC) apoptosis are promising strategies to recover degenerated NP. LIM mineralization protein- (LMP-) 1 has anti-inflammatory potential and is a promising gene target for the treatment of NP degeneration. In this study, we measured the expression of LMP-1 in the NP of patients. Then, we constructed LMP-1-overexpressing NPCs using lentiviral vectors and investigated the effects of LMP-1 on cell proliferation, apoptosis, and ECM synthesis in NPCs. The results showed that LMP-1 was highly expressed in the NP of patients. LMP-1 overexpression significantly increased proliferation and decreased apoptosis in NPCs. The expression of collagen II and sulfated glycosaminoglycan (sGAG) in NPCs was also upregulated after LMP-1 was overexpressed. Moreover, we demonstrated that LMP-1 decreased apoptosis of NPCs by inhibiting NF-κB signaling activation. These findings suggest that LMP-1 plays an essential role in mediating apoptosis in NPCs by regulating NF-κB signaling and can be used as a gene target for the treatment of IDD.
Healthy Lifestyle Recommendations: Do the Beneficial Effects Originate from NAD+ Amount at the Cellular Level?
Authors: Poljsak Borut , Kovač Vito , Milisav Irina
Published: December 2020

In this review, we describe the role of oxidized forms of nicotinamide adenine dinucleotide (NAD+) as a molecule central to health benefits as the result from observing selected healthy lifestyle recommendations. Namely, NAD+ level can be regulated by lifestyle and nutrition approaches such as fasting, caloric restriction, sports activity, low glucose availability, and heat shocks. NAD+ is reduced with age at a cellular, tissue, and organismal level due to inflammation, defect in NAMPT-mediated NAD+ biosynthesis, and the PARP-mediated NAD+ depletion. This leads to a decrease in cellular energy production and DNA repair and modifies genomic signalling leading to an increased incidence of chronic diseases and ageing. By implementing healthy lifestyle approaches, endogenous intracellular NAD+ levels can be increased, which explains the molecular mechanisms underlying health benefits at the organismal level. Namely, adherence to here presented healthy lifestyle approaches is correlated with an extended life expectancy free of major chronic diseases.
Reduced Birth Weight, Decreased Early-Phase Insulin Secretion, and Increased Glucose Concentrations after Oral Glucose Tolerance Test in Japanese Women Aged 20 Years with Family History of Type 2 Diabetes
Authors: Honda Mari , Tsuboi Ayaka , Minato-Inokawa Satomi , Kitaoka Kaori , Takeuchi Mika , Yano Megumu , Kurata Miki , Wu Bin , Kazumi Tsutomu , Fukuo Keisuke
Published: December 2020

Introduction. We tested the hypothesis that family history of type 2 diabetes (FHD) is associated with reduced birth weight and reduced insulin secretion later in life. Materials and Methods. Birth weight, body composition by whole-body dual-energy X-ray absorptiometry, and homeostasis model assessment-insulin resistance were compared between Japanese women aged 20 years with positive (

n
=
73

) and negative (

n
=
258

) FHD. A subsample of 153 women (57 with positive FHD) underwent a 75 g oral glucose tolerance test. Multivariate logistic regression analyses were used to identify the most important determinants of FHD. Results. Women with positive as compared with negative FHD had lower birth weight (

3132
±
364

vs.

3238
±
418
 
g

,

p
=
0.04

). However, the current fat mass index and trunk/leg fat ratio, sophisticated measures of general and abdominal fat accumulation, respectively, did not differ. Women with positive FHD had a lower insulinogenic index (

2.4
±
7.3

vs.

6.2
±
16

,

p
=
0.007

) and higher area under the glucose curve (

217
±
47

vs.

198
±
36
 
mg

/dL/2 h,

p
=
0.006

). However, fasting and postload insulinemia, homeostasis model assessment-insulin resistance, and Matsuda index did not differ. In multivariate logistic regression analysis, birth weight was marginally associated with FHD (odds ratio, 0.999; 95% confidential interval, 0.98-1.00000;

p
=
0.0509

). Conclusions. FHD was associated not only with reduced birth weight but also with decreased early-phase insulin secretion and increased postload glucose concentrations in Japanese women aged 20 years. These findings may be in keeping with the fetal insulin hypothesis and provide some evidence that FHD can alter size at birth, probably through genetic and shared environmental components, which consequently resulted in decreased early-phase insulin secretion and increased glucose excursion in the early twenties. FHD was not related to sophisticated measures of general and abdominal adiposity and insulin resistance/sensitivity.
The Role of Interventional Radiology in the Management of Late Postpancreaticoduodenectomy Hemorrhage
Authors: Zhang Liang , Wang Jun , Jiang Jinhua , Shen Jialin
Published: December 2020

Objective. To explore the role of interventional radiology (IR) in the management of late postpancreaticoduodenectomy hemorrhage (PPH). Materials and Methods. Patients who had late PPH (occurring >24 h after index operation) managed by the IR procedure in our institution between 2013 and 2018 were retrospectively analyzed. Result. Hired patients who were diagnosed with grade B (n = 10) and C (n = 22) late PPH underwent 40 transcatheter arterial angiographies (TAA). The overall positive rate of angiography was 45.0% (18/40). Eighteen transcatheter arterial embolizations (TAEs) were performed, and the technical success rate was 88.89% (16/18). The rebleeding rate after embolization was 18.8% (3/16), and no severe procedure‐related complications were recorded. The overall mortality of late PPH was 25.0% (8/32). Conclusion. Nearly half of hemorrhagic sites in late PPH could be identified by TAA. TAE is an effective and safe method for the hemostasia of late PPH in patients with positive angiography results.
Effects of Physical Exercise on Neuroplasticity and Brain Function: A Systematic Review in Human and Animal Studies
Authors: de Sousa Fernandes Matheus Santos , Ordônio Tayrine Figueira , Santos Gabriela Carvalho Jurema , Santos Lucas Eduardo R. , Calazans Camila Tenório , Gomes Dayane Aparecida , Santos Tony Meireles
Published: December 2020

Background. Physical exercise (PE) has been associated with increase neuroplasticity, neurotrophic factors, and improvements in brain function. Objective. To evaluate the effects of different PE protocols on neuroplasticity components and brain function in a human and animal model. Methods. We conducted a systematic review process from November 2019 to January 2020 of the following databases: PubMed, ScienceDirect, SciELO, LILACS, and Scopus. A keyword combination referring to PE and neuroplasticity was included as part of a more thorough search process. From an initial number of 20,782 original articles, after reading the titles and abstracts, twenty-one original articles were included. Two investigators evaluated the abstract, the data of the study, the design, the sample size, the participant characteristics, and the PE protocol. Results. PE increases neuroplasticity via neurotrophic factors (BDNF, GDNF, and NGF) and receptor (TrkB and P75NTR) production providing improvements in neuroplasticity, and cognitive function (learning and memory) in human and animal models. Conclusion. PE was effective for increasing the production of neurotrophic factors, cell growth, and proliferation, as well as for improving brain functionality.
Use of Endemic Date Palm (Phoenix dactylifera L.) Seeds as an Insoluble Dietary Fiber: Effect on Turkey Meat Quality
Authors: Bouaziz Mohamed Ali , Bchir Brahim , Ben Salah Tayssir , Mokni Abir , Ben Hlima Hajer , Smaoui Slim , Attia Hamadi , Besbes Souhail
Published: December 2020

In order to enhance the quality of a meat product, turkey burgers with a low-fat and a high-fiber level were formulated by the incorporation of insoluble fibers from Tunisian Deglet Nour date seeds as insoluble fiber concentrate (IFC) at 3%, 5%, and 10% (w/w). Compared to Deglet Nour date seeds powder (DSP), physicochemical results revealed that IFC presented higher (

P

 < 0.05) levels in carbohydrates at 88.85% and lower values of fat (5.94%), protein (3.81%), and ash (2.35%). For the technofunctional properties, IFC improved the oil-holding capacity (OHC) by 57.14% compared to DSP. IFC addition into turkey burgers was also instrumentally investigated by color (L

∗

, a

∗

, and b

∗

) and textural parameters (hardness, cohesiveness, adhesiveness, and elasticity) and sensory attributes using a 5-point hedonic scale. Furthermore, IFC changed significantly the color of the formulated products. In addition, hardness and adhesiveness values of all experiments increased significantly (

P

 < 0.05) with the increase of the incorporation levels compared to the control sample. Regarding sensory analysis, formulated with 5 % IFC, turkey burger samples were most appreciated by the panel with higher (

P

 < 0.05) overall acceptability. Additionally, two multivariate exploratory techniques, namely, Principal Component Analysis (PCA) and Hierarchical Cluster Analysis (HCA), were used to all obtained data describing the main characteristics attributed to refrigerated turkey meat samples. The applied chemometric approaches were useful in discriminating meat samples and therefore offer an approach to rely interrelationships between meat quality traits. Overall, the findings demonstrate the potential functional and economic utility of IFC as a promising ingredient for future healthy meat applications.
Identifying Clear Cell Renal Cell Carcinoma Coexpression Networks Associated with Opioid Signaling and Survival
Authors: Scarpa Joseph R. , DiNatale Renzo G. , Mano Roy , Silagy Andrew W. , Kuo Fengshen , Irie Takeshi , McCormick Patrick J. , Fischer Gregory W. , Hakimi A. Ari , Mincer Joshua S.
Published: December 2020

While opioids constitute the major component of perioperative analgesic regimens for surgery in general, a variety of evidence points to an association between perioperative opioid exposure and longer term oncologic outcomes. The mechanistic details underlying these effects are not well understood. In this study, we focused on clear cell renal cell carcinoma (ccRCC) and utilized RNA sequencing and outcome data from both The Cancer Genome Atlas, as well as a local patient cohort to identify survival-associated gene coexpression networks. We then projected drug-induced transcriptional profiles from in vitro cancer cells to predict drug effects on these networks and recurrence-free, cancer-specific, and overall survival. The opioid receptor agonist, leu-enkephalin, was predicted to have antisurvival effects in ccRCC, primarily through Th2 immune- and NRF2-dependent macrophage networks. Conversely, the antagonist, naloxone, was predicted to have prosurvival effects, primarily through angiogenesis, fatty acid metabolism, and hemopoesis pathways. Eight coexpression networks associated with survival endpoints in ccRCC were identified, and master regulators of the transition from the normal to disease state were inferred, a number of which are linked to opioid pathways. These results are the first to suggest a mechanism for opioid effects on cancer outcomes through modulation of survival-associated coexpression networks. While we focus on ccRCC, this methodology may be employed to predict opioid effects on other cancer types and to personalize analgesic regimens in patients with cancer for optimal outcomes.

Significance:

This study suggests a possible molecular mechanism for opioid effects on cancer outcomes generally, with implications for personalization of analgesic regimens.
Streptococcus pneumoniae Meningitis and Intracranial Vasculopathy: Clinical Correlation with Improving Transcranial Doppler Hemodynamics
Authors: Idris Mohamad Imran , Tai Sharon Mei Ling , Tan Chong Tin , Tan Kay Sin
Published: December 2020

Streptococcus pneumoniae are Gram-positive bacteria that are responsible for many types of illnesses including pneumonia, sinus infections, and community-acquired meningitis. One important complication of bacterial meningitis is intracranial vasculopathy. Possible etiologies include vasculitis, vasospasm, endocarditis, or intra-arterial thrombosis. We present a case report of S. pneumoniae meningitis treated with antibiotics in which clinical improvement correlated with serial transcranial Doppler ultrasonography (TCD) improvement, suggesting vasospasm or vasculitis as a possible mechanism for intracranial vasculopathy.
Small Intracranial Aneurysms and Subarachnoid Hemorrhage: Is the Size Criterion for Risk of Rupture Relevant?
Authors: Daga Karan , Taneja Manish , Venketasubramanian Narayanaswamy
Published: December 2020

The current understanding is that small intracranial aneurysms (<7 mm) are not at a significant risk for rupture. However, there have been several published series of rupture and subarachnoid hemorrhage from aneurysms <5 mm. Three cases of intracranial aneurysms rupturing at <3 mm are presented in this paper. Patient age ranged between 38 and 57 years. The aneurysms were located in different parts of the circulation in the brain. This case series highlights that the size criterion alone is not adequate when evaluating patients with unruptured brain aneurysms for observational follow-up or treatment.
Post-Traumatic Carotid Artery Dissection Begins at the Skull Base: A Case Report
Authors: Venketasubramanian Narayanaswamy , Mundada Pravin , Hegde Amogh Narayan , Tan Marcus , Ng Darren
Published: December 2020

Cervical artery dissection is a rare complication of head and neck trauma. Though it is an infrequent cause of ischaemic stroke, it is more common among the young with cerebral ischaemia. The usual location of carotid dissection is just beyond the carotid bulb. We report a case of post-traumatic internal carotid dissection that began at the base of the skull after blunt head trauma from a road traffic accident. The patient is a 25-year-old right-handed lady who, 2 days after the accident, developed dysphasia and right-sided limb weakness. She had no significant past medical history. Magnetic resonance imaging (MRI) showed acute ischaemic stroke in the internal watershed regions of the left cerebral hemisphere. MR angiogram revealed focal near-occlusion of the left internal carotid artery at the base of the skull just prior to its entry into the petrous temporal bone. There were no skull fractures. She progressed despite anticoagulation. The location of the site of dissection at the base of the skull is likely due to stresses on the carotid intima at this point during flexion-extension-rotation that occurs during head injury, as this is where the internal carotid artery is tethered to the skull. Rapid recognition of symptoms of cerebral ischaemia among patients with blunt head trauma is needed to allow prompt investigation and institution of relevant therapies.
Late Diagnosis of Multiple Cerebral Aneurysms A Decade after Resection of Cardiac Myxoma
Authors: Jain Swati , Nga Vincent Diong Wen , Venketasubramanian Narayanaswamy
Published: December 2020

Cerebral embolism from a cardiac myxoma is a rare cause of ischaemic stroke. These emboli may later lead to the development of cerebral aneurysms. We report a case of delayed presentation of neurological manifestations in form of multiple intracranial aneurysms many years after treatment of a cardiac myxoma. Our patient, a 55-year-old right-handed female with a background history of hypertension, first presented at the age of 45 years with a sudden onset of right hemiplegia. A CT brain scan detected multiple infarcts in the territory of the left middle cerebral artery. Echocardiography revealed a cardiac myxoma for which she underwent immediate total surgical resection. Nearly 10 years after this diagnosis, she presented again with right-sided weakness and left ptosis. CT scan of the brain revealed bilateral acute superior cerebellar infarcts with interval evolution of previously known left cortical infarcts. MRI/MR angiogram showed multiple aneurysms arising from the bilateral middle, left anterior and left posterior cerebral arteries. She was managed conservatively. The management of multiple aneurysms with cardiac myxomas is highly debatable and dependent on the patient’s presentation. This case highlights the importance to follow up on potential late extra-cardiac manifestations of the myxomas despite adequate resection.
Cerebral Air Embolism and Vasospasm after Carotid Revascularization: A Case Report
Authors: Lee Tsong-Hai , Wong Ho-Fai
Published: December 2020

Cerebral air embolism can be of venous and arterial origin and cause severe medical complication. Vasospasm is a severe complication of carotid artery stenting. We report a 63-year-old male with severe carotid artery stenosis who suddenly died due to acute myocardial infarction during carotid artery stenting. His brain computed tomogram showed a remarkable amount of air in the gyriform spaces, and the cerebral angiogram showed vasospasm in the internal carotid artery resulting from stent manipulation. Presence of gyriform air could be caused by air entering the catheter due to sudden collapse after acute myocardial infarction and severe carotid vasospasm.
Diagnosis and Management of Moyamoya Disease
Authors: Uchiyama Shinichiro , Yamazaki Masako , Ishikawa Tatsuya , Yamaguchi Koji , Kawamata Takakazu
Published: December 2020

Moyamoya disease is an uncommon vascular disease, which causes obstruction and stenosis of arteries of the circle of Willis, and preferentially affects children and young adults. This disease is seen across the world, but is more common in East Asia. It may cause hemorrhagic or ischemic stroke, or transient ischemic attack. If symptoms or cerebral blood flow become worse, revascularization surgery is recommended. We present 2 cases of moyamoya disease who underwent bypass surgery. We also discuss the epidemiology, pathology, genomics, and symptomatology as well as diagnosis, and management of moyamoya disease.
Isolated Focal Basilar Artery Stenosis with Acute Stroke Treated with Emergency Thrombectomy and Stenting
Authors: Daga Karan , Taneja Manish , Ahmad Mohammad Taqueer , Venketasubramanian Narayanaswamy
Published: December 2020

Strokes due to basilar artery (BA) stenosis/occlusion are devastating. As it is an uncommon cause of stroke, its optimal management is not clearly defined. We present the case of a 68-year-old male with a background history of hypertension, hyperlipidaemia, and smoking who developed a sudden onset of reduced consciousness, myoclonic jerks, generalised weakness, and nausea due to an occluded mid-segment BA with right occipital and left cerebellar infarcts. Emergent cerebral angiography was performed and he was immediately treated by clot retrieval and, due to underlying arterial stenosis, the immediate placement of a stent within 3 h of symptom onset. He had complete neurological recovery within 1 week, with no neurological deficits. He remained well at follow-up 3 months later. Emergency revascularisation of stroke due to BA occlusion should be considered as a treatment option.
Mechanical Thrombectomy for Life-Threatening Cerebral Venous Thrombosis: A Case Report
Authors: Lau Kar Foo , Toh Tsun-Haw , Kadir Khairul Azmi Abdul , Tai  Mei-Ling Sharon , Tan Kay Sin
Published: December 2020

Cerebral venous thrombosis (CVT) is a rare cause of stroke worldwide with a wide range of clinical presentations. Anticoagulation therapy has been regarded as the first line of management of CVT to prevent the progression of thrombosis and to re-establish the venous flow. We present a case of severe CVT who did not respond to conventional anticoagulation therapy but responded well to mechanical thrombectomy (MT). This report highlights the features of CVT to consider for early MT.
Asymmetric TCD Findings in Malignant MCA Infarction, Resolution after Decompressive Hemicraniectomy: A Case Report
Authors: Barrozo Hazel Gaile  , De Guzman Maria Anna , Navarro Jose  , Venketasubramanian Narayanaswamy
Published: December 2020

Transcranial Doppler (TCD) is a non-invasive method for assessing cerebral hemodynamics in the acute phase of stroke. We report a case of a 33-year-old man who presented with a massive left hemispheric infarct developing into “malignant” MCA infarction. TCD was utilized to monitor intracranial hemodynamics while the clinical and neuroimaging findings were used to help us in the decision to proceed with decompressive craniectomy (DC). Pre-operatively, there was reduced mean flow velocities (MFV) of the middle cerebral artery (MCA) with increasing pulsatility index (PI) ipsilateral to the infarct. The subsequent but smaller rise in the PI in the contralateral MCA was suggestive of very high intracranial pressure (ICP) from massive brain swelling. Serial TCD examinations post-operatively showed normalization of the PI, and subsequent rise in the left MCA MFV. Clinical improvement was also noted as the TCD findings improved. The asymmetry in TCD findings can be attributed to occlusion of the MCA with subsequent spontaneous recanalisation, occlusion of the MCA with subsequent recanalisation due to the DC, or initial occlusion and subsequent pressure effects on the arterioles of the MCA due to the “malignant” edema of that hemisphere that was relieved by DC. This case illustrates the value of TCD as a useful modality in monitoring intracranial hemodynamics in acute stroke.
Use of Intravenous Immunoglobulin (Prevagen or Octagam) for the Treatment of COVID-19: Retrospective Case Series
Authors: Herth Felix J.F. , Sakoulas George , Haddad Fadi
Published: December 2020

Treatment with immunomodulators, such as intravenous immunoglobulin (IVIG), may attenuate inflammatory responses observed in the severe stages of acute respiratory distress syndrome (ARDS) caused by coronavirus disease 19 (COVID-19). We retrospectively evaluated the clinical courses of 12 COVID-19 patients who received IVIG at various stages of their illness, including within the first 72 h of clinical presentation, after initiation of mechanical ventilation, and after prolonged ventilation and ICU stay. The patients included 9 men and 3 women with a median age of 50 years (range 23–74), median Charlson Comorbidity Score of 2 (range 0–7), and median Acute Physiology and Chronic Health Evaluation Score of 13 (range 5–33) at the time of IVIG. The IVIG total dose ranged from 0.5 to 2.0 g/kg (median 1.25 g/kg) distributed over 1–4 daily doses. The most common regimen received was 0.5 g/kg daily for 3 days. The median time to IVIG administration was 9 days (range 0–48 days) after admission. The median time from first IVIG dose administration to hospital discharge was 14 days (range 3–48). The 5 patients who received IVIG ≤4 days of admission demonstrated a significantly shorter length of hospital stay after treatment (median 7 days, range 3–14 days) than the 7 patients who received it >7 days after admission (median 33 days, range 8–48 days, p = 0.03, Mann-Whitney U test). These cases demonstrate that IVIG may improve the clinical state of patients with moderate to severe COVID-19 infection. Despite very high illness severity scores, all patients survived hospital discharge. No thrombotic events occurred and IVIG was well tolerated, despite most cases demonstrating very elevated D-dimer suggestive of active intravascular fibrinolysis. We believe that IVIG warrants immediate clinical trial evaluation in COVID-19 to confirm its role as a mainstay treatment of moderate to severe COVID-19 infection as a means to reduce hospital stay and utilization of ICU resources, including mechanical ventilation, and potentially reduce mortality.
Collecting Valid and Reliable Data: Fieldwork Monitoring Strategies in a Health Examination Survey
Authors: Kislaya Irina , Santos Ana João , Lyshol Heidi , Antunes Liliana , Barreto Marta , Gaio Vânia , Gil Ana Paula , Namorado Sónia , Dias Carlos Matias , Tolonen Hanna , Nunes Baltazar
Published: December 2020

Introduction: Health surveys constitute a relevant information source to access the population’s health status. Given that survey errors can significantly influence estimates and invalidate study findings, it is crucial that the fieldwork progress is closely monitored to ensure data quality. The objective of this study was to describe the fieldwork monitoring conducted during the first Portuguese National Health Examination Survey (INSEF) regarding protocol deviations and key performance indicators (KPI). Methods: Data derived from interviewer observation and from the statistical quality control of selected KPI were used to monitor the four components of the INSEF survey (recruitment, physical examination, blood collection and health questionnaire). Survey KPI included response rate, average time distribution for procedures, distribution of the last digit in a specific measure, proportion of haemolysed blood samples and missing values. Results: Interviewer observation identified deviations from the established protocols, which were promptly corrected. During fieldwork monitoring through KPI, upon implementation of corrective measures, the participation rate increased 2.5-fold, and a 4.4-fold decrease in non-adherence to standardized survey procedures was observed in the average time distribution for blood pressure measurement. The proportion of measurements with the terminal digit of 0 or 5 decreased to 19.6 and 16.5%, respectively, after the pilot study. The proportion of haemolysed samples was at baseline level, below 2.5%. Missing data issues were minimized by promptly communicating them to the interviewer, who could recontact the participant and fill in the missing information. Discussion/Conclusion: Although the majority of the deviations from the established protocol occurred during the first weeks of the fieldwork, our results emphasize the importance of continuous monitoring of survey KPI to ensure data quality throughout the survey.
Low Vitamin D Status in a Cancer Patient Population from Franconia, Germany
Authors: Klement Rainer Johannes , Koebrunner Petra S. , Krage Kelley , Sweeney Reinhart A.
Published: December 2020

Background: Vitamin D has been shown to be associated with reduced risk and severity of COVID-19 and exerts regulating effects on all hallmarks of cancer. The goal of this study was to analyze the vitamin D status of a cancer patient cohort from our clinic in the Franconian region, Germany. Methods: 25-hydroxyvitamin D concentrations were available for 116 patients included in prospective trials in our clinic. Associations of vitamin D with anthropometric and blood parameters were investigated using Kendall’s τ correlation coefficients and linear regression. Results: A total of 57 patients (49.1%) were vitamin D deficient (<20 ng/mL), and 92.2% did not meet the recommended vitamin D level of 40 ng/mL. There was a strong negative association between vitamin D and leukocyte count (τ = –0.173, p = 0.007) and C-reactive protein concentration (τ = –0.172, p = 0.007). In linear regression, the most important variables for predicting vitamin D levels were (in order of decreasing importance) season, fat mass index, platelet, and leukocyte count. Conclusions: Despite appeals towards medical societies to target widespread vitamin D deficiency in Germany more than 10 years ago, our data indicate that these have been without avail. Low vitamin D levels in cancer patients should be corrected using reasonable sun exposure and supplements.
Exceptional Regression of Malignant Pleural Mesothelioma with Pembrolizumab Monotherapy
Authors: Hearon Bernard F. , Redelman Kyle N. , Elhomsy Georges C. , Moore, Jr. Dennis F.
Published: December 2020

The lead author with clinical stage I malignant pleural mesothelioma, epithelioid type, highly programmed cell death ligand 1 (PD-L1) positive, and BAP1 negative, experienced a prompt and exceptionally favorable response to pembrolizumab monotherapy. After cessation of treatment due to immune-related endocrinopathies, complete metabolic response on interim PET/CT scan was achieved. Two years after initial diagnosis, unifocal tumor reactivation was addressed with successful pembrolizumab monotherapy rechallenge. Immunotherapy, typically not used as frontline treatment for malignant pleural mesothelioma, may provide an effective and durable response for some patients. Based on this single case study, epithelioid type tumors with strongly positive PD-L1 and BAP1-negative immunohistochemical markers may be well suited for treatment with immune checkpoint inhibitors such as pembrolizumab.
Exploration of Everydayness in Schizophrenia: A Phenomenological Approach
Authors: Troubé Sarah
Published: December 2020

This article explores everydayness as a specific form of experience of the world and its alterations in schizophrenia. In the field of phenomenological psychopathology, the transformations of subjective experience in schizophrenia have been the subject of a great deal of work, but the relationship between these alterations of subjective experience and the experience of the everyday remains largely unexplored. A phenomenological point of view leads us to explore everydayness as a constitutive framework of experience, one that may be impeded in schizophrenia. The question of the everyday allows us to bridge the gap between the descriptions of subjective experience proposed by phenomenological psychopathology and what is at stake in therapeutic treatment. It seems to us that the work of constructing an individual narrative of the everyday may be a useful psychotherapeutic approach for helping patients rebuild the framework of everydayness.
Vergleichende Analysen des Lungenmikrobioms zwischen Patienten mit ANCA-assoziierten Vaskulitiden und Sarkoidose aus bronchoalveolärer Lavage
Authors: Kahn Nicolas Carlos
Published: December 2020

Microbial involvement in the pathogenesis have been suggested in both antineutrophil cytoplasmic antibody-associated vasculitis (AAV) and sarcoidosis, both of which have lung involvement. However, exhaustive research to assess the bacteria in the lung in AAV and in sarcoidosis have not been performed. We sought to elucidate the distinct dysbiotic lung microbiota between AAV and sarcoidosis. We used 16S rRNA gene high-throughput sequencing to obtain the bacterial community composition of bronchoalveolar lavage fluid (BALF) in patients with AAV (n = 16) compared to patients with sarcoidosis (n = 21). The patients had not undergone therapy with immunosuppressive medication when their BALF was acquired. No difference was observed in α-diversity between patients with AAV and patients with sarcoidosis when using all the detected taxa. We defined the taxa of the oral cavity by using the data of oral microbiota of healthy individuals from the Human Microbiome Project (HMP). The analysis using only oral taxa made the difference in α-diversity between AAV and sarcoidosis clearer compared with those using all the detected taxa. Besides, the analysis using detected taxa except for oral taxa also made the difference in α-diversity between AAV and sarcoidosis clearer compared with those using all the detected taxa. A linear negative relationship between the α-diversity and Birmingham vasculitis activity score (BVAS) was detected in the AAV group. The observed p-value for the effect of the disease groups on the ß-diversity was small while the effect of other factors including sex and smoking status did not have small p-values. By excluding oral taxa from all the detected taxa, we found a cluster mainly consisted of sarcoidosis patients which was characterized with microbial community monopolized by Erythrobacteraceae family. Our results suggested the importance of considering the influence of oral microbiota in evaluating lung microbiota.