bluuebunny/crossref_metadata_2025 huggingface dataset:
Shift of wear balance acting on CVD textured coatings and relation to workpiece materials
Authors: Bejjani R , Odelros S , Öhman S , Collin M
Published: May 2020

Innovative textured alumina coatings have been engineered to boost the performance of cutting tools. Different workpiece materials affect the wear inside the CVD textured alumina coating differently on the crater and flank side of the tools. How the balance in wear changes between the crater and flank side of the tool inside the alumina is not fully understood. Furthermore, any changes in steel elements in the workpiece can affect this balance differently. In this work, the wear of alumina coating has been studied after turning different workpiece materials (low alloy steel with and without Ca, ball bearing steel and stainless steel). The worn surfaces of the inserts were studied and their features related to the different materials. It was found that after machining under similar conditions, each workpiece material leaves a different signature, or worn surface, with unique features in the alumina coating layer. The transition between the sliding to the sticking region was studied in order to help understand the relation to wear when machining different workpiece materials. SEM and topography characteristics were identified on worn surfaces of the coated tools. The resulting worn volume and surface characteristics were related to different wear mechanisms acting on the rake and flank sides of the tool. This work studies the shift in balance between crater and flank wear by identifying different wear mechanisms acting inside the same alumina coating layer when machining different grades of steel. Such work can be a good resource for FEM wear modeling, where good simulation models must take into consideration the physics lying behind the wear types acting on each side of the tool.
Democratic Breakdown and the Hidden Perils of the Democratic Peace
Authors: Tschantret Joshua
Published: May 2020

One empirical regularity in International Relations appears consistent: democracies rarely fight one another. However, this article maintains that the democratic peace comes with hidden costs. Democratic regimes are more pacifistic toward each other, but regimes formed through democratic breakdown are more bellicose than other authoritarian regimes. I argue that autocracies established through democratic breakdown are especially aggressive because they select leaders who tend to be impatient with democratic norms, and these leaders can leverage nationalism and mass mobilization fomented during the democratic era to support international aggression. Additionally, I argue that these factors interact with important institutional features that vary across authoritarian regimes. Post-democratic leaders lacking institutional constraints on their executive authority should be more aggressive than constrained post-democratic leaders and other unconstrained autocrats. Statistical analysis of militarized interstate disputes demonstrates that autocracies are more belligerent following democratic breakdown, especially under institutional conditions favorable to leaders instigating the breakdown. We should therefore be wary of urging democratization based on democratic peace when democracy has a high chance of reverting and focus more effort on ensuring that current democracies do not break down.
Examining core self-management skills among adolescents with celiac disease
Authors: Meyer Sonya , Rosenblum Sara
Published: May 2020

A strict gluten-free diet is the only treatment for celiac disease, and it is especially challenging among adolescents. Participation in food-related activities and self-managing the chronic health condition involve use of cognitive skills. This cross-sectional study examined how executive functions might be associated with participation in food-related activities. Adolescents aged 12–18 years ( N = 65; Mage = 14.67) with celiac were interviewed about participation, and their parents completed an executive function questionnaire. Poorer participation significantly correlated with poorer executive abilities. Identifying executive function profiles may contribute to understanding and advancing resourceful daily functioning and participation in daily food-related activities.
Early childhood education and CARE: Won’t somebody think of the children?
Authors: Nolan Geraldine K
Published: May 2020

‘Won’t somebody think of the children’ is a battle cry calling into question the current positioning of the child and care within international/national childcare policy. This plea is constructed within a framework that recognizes that childcare policies may be guided, developed and implemented in good faith. Nevertheless, there are often (un)intended consequences. The documentary analysis traces the international and Irish quality, affordability and equality arguments underpinning childcare policies and reveals that we may have not only lost sight of the child, but the child is nowhere in sight ([un]intended consequence). While this documentary analysis makes specific reference to the Irish context, the discussion may nonetheless be relevant to the wider international Early Childhood Education and Care (ECEC) community. The analysis draws on my Irish study ( Nolan, 2019 ), a social feminism exploration of ECEC leadership that revealed the difficulty the stakeholders had in marrying their understanding of children and care within the constantly changing international/national conceptualizations of both. While the depiction of the child and the current state of care in the sector may appear bleak, there is the hope that by drawing attention to this situation, somebody (you and I) will answer the call to battle, and begin a dialogue/debate on the child and care in ECEC.
The electrical properties of poly(3,4-ethylenedioxythiophene)-poly(styrenesulfonate) films and its effect onto sensor yarn coating
Authors: Jerkovic Ivona , Grancaric Ana Marija , Koncar Vladan
Published: May 2020

In this study, the poly(3,4-ethylenedioxythiophene)-poly(styrenesulfonate) conductive dry films were observed in terms of their thicknesses versus electrical resistances measured and related electrical resistivities calculated. The evolution of their electrical resistances was monitored in 75 days. Three groups of sensor yarns were studied also where the percolation threshold of the polymer complex poly(3,4-ethylenedioxythiophene)-poly(styrenesulfonate) had a crucial role in their manufacture. More glass component in sensor yarns led to less coating thickness what is in correlation with their interface phenomena and adhesion.
State Policy and Lobbying in a Federal System: Evidence from the Production Tax Credit for Renewable Energy, 1998–2012
Authors: Kim Sung Eun , Urpelainen Johannes , Yang Joonseok
Published: May 2020

State policies shape firms’ incentives to lobby in the United States, but the existing lobbying literature mostly ignores these incentives. Using lobbying records for all electric utilities in the United States from 1998 to 2012, we examine how state policies affect federal lobbying by both proponents and opponents of federal support for the renewable energy policy. Our theory predicts that supportive state policies reduce the returns to lobbying by both proponents and opponents. Empirically, we show that when the federal production tax credit for renewable energy is about to expire, electric utilities from states without renewable portfolio standards become more likely to lobby than those from states with these policies. Because the timing of the expiration of the production tax credit is quasi-random, these findings carry a causal interpretation. Using text analysis techniques, we also show that the lobbying efforts are focused on energy and environmental issues while lobbying on unrelated topics remains unaffected.
Semaphorin 3F Serves as a Tumor Suppressor in Esophageal Squamous Cell Carcinoma and is Associated With Lymph Node Metastasis in Disease Progression
Authors: Xie Zhen , Li Tianyue , Huang Bingtao , Liu Shuai , Zhang Lianguo , Zhang Qingguang
Published: May 2020

Background:

Esophageal squamous cell carcinoma is one of the leading aggressive malignancies with high mortality. Semaphorin 3F has been reported to be involved in lymphangiogenesis by interacting the vascular endothelial growth factor C/neuropilin 2 axis. This study aimed to assess the clinical and functional role of semaphorin 3F and preliminarily evaluate the relationship between semaphorin 3F and lymph node metastasis in esophageal squamous cell carcinoma.

Methods:

The messenger RNA expression of semaphorin 3F was analyzed using quantitative real-time polymerase chain reaction. The expression differences of semaphorin 3F between patients having esophageal squamous cell carcinoma with and without lymph node metastasis were assessed, and the correlation of semaphorin 3F with vascular endothelial growth factor C and neuropilin 2 was estimated. The prognostic value of semaphorin 3F was evaluated using Kaplan-Meier survival curves and Cox regression analysis. Gain- and loss-functional cell experiments were performed to explore the biological function of semaphorin 3F, vascular endothelial growth factor C, and neuropilin 2.

Results:

The messenger RNA expression of semaphorin 3F was reduced in esophageal squamous cell carcinoma tissues compared with normal tissues, and lower semaphorin 3F expression was observed in patients having esophageal squamous cell carcinoma with positive lymph node metastasis. Semaphorin 3F expression was associated with lymph node metastasis and negatively correlated with vascular endothelial growth factor C and neuropilin 2. Lower semaphorin 3F expression was related to a poor overall survival of esophageal squamous cell carcinoma and served as an independent prognostic indicator. In esophageal squamous cell carcinoma cells, semaphorin 3F messenger RNA expression was also decreased compared with normal cells, and the overexpression of semaphorin 3F could significantly inhibit cell proliferation, migration, and invasion. The downregulation of vascular endothelial growth factor C and neuropilin 2 could inhibit cell proliferation, migration, and invasion of esophageal squamous cell carcinoma cells.

Conclusion:

All data indicate that semaphorin 3F serves as a potential prognostic biomarker and tumor suppressor of esophageal squamous cell carcinoma and may be involved in the lymph node metastasis development through regulating neuropilin 2.
Retinoid analogs and polyphenols as potential therapeutics for age-related macular degeneration
Authors: Parmar Tanu , Ortega Joseph T , Jastrzebska Beata
Published: May 2020

Progressive retinal degeneration manifesting as age-related macular degeneration (AMD) in the elderly affects millions of individuals worldwide. Among various blinding diseases, AMD is the leading cause of central vision impairment in developed countries. Poor understanding of AMD etiology hampers the development of therapeutics against this devastating ocular disease. Currently, daily intravitreal injections of anti-angiogenic drugs, preventing abnormal vessel growth are the only treatment option for wet AMD. However, for dry AMD associated with retinal atrophy, at present there is no cure available. Recent clinical research has demonstrated beneficial effects of plant-derived compounds for various eye disorders. Thus, the ongoing efforts toward discovering efficient treatments preventing or delaying AMD progression focus on implementing a healthy diet rich in vitamins, including vitamin A, E, and C, minerals and carotenoids, in particular lutein and zeaxanthin, to reduce the disease burden. In addition, studies in cell culture and animal models indicated therapeutic potential of dietary polyphenolic compounds present in fruits and vegetables. These natural compounds protect visual function and retinal morphology likely due to their anti-oxidant and anti-inflammatory properties. Although understanding of the exact mechanism of these compounds’ positive effects requires further investigation, they provide non-invasive alternative to battle AMD-like condition. Additionally, studies carried in animal models mimicking AMD-like pathology, examining the pharmacological potential of particular retinoid analogs, demonstrated promising results for their use, and thus they should be considered as an option in developing therapies for AMD. In here, we summarize the most current knowledge regarding developments of therapeutic options to maintain ocular health and prevent vision loss associated with aging.

Impact statement

Age-related macular degeneration (AMD) is a devastating retinal degenerative disease. Epidemiological reports showed an expected increasing prevalence of AMD in the near future. The only one existing FDA-approved pharmacological treatment involves an anti-vascular endothelial growth factor (VEGF) therapy with serious disadvantages. This limitation emphasizes an alarming need to develop new therapeutic approaches to prevent and treat AMD. In this review, we summarize scientific data unraveling the therapeutic potential of the specific retinoid and natural compounds. The experimental results reported by us and other research groups demonstrated that retinoid analogs and compounds with natural product scaffolds could serve as lead compounds for the development of new therapeutic agents with potential to prevent or slow down the pathogenesis of AMD.
Three-dimensional aerial base station location for sudden traffic with deep reinforcement learning in 5G mmWave networks
Authors: Yu Peng , Guo Jianli , Huo Yonghua , Shi Xiujuan , Wu Jiahui , Ding Yahui
Published: May 2020

Data volume demand has increased dramatically due to huge user device increasement along with the development of cellular networks. And macrocell in 5G networks may encounter sudden traffic due to dense users caused by sports or celebration activities. To resolve such temporal hotspot, additional network access point has become a new solution for it, and unmanned aerial vehicle equipped with base stations is taken as an effective solution for coverage and capacity improvement. How to plan the best three-dimensional location of the aerial base station according to the users’ business needs and service scenarios is a key issue to be solved. In this article, first, aiming at maximizing the spectral efficiency and considering the effects of line-of-sight and non-line-of-sight path loss for 5G mmWave networks, a mathematical optimization model for the location planning of the aerial base station is proposed. For this model, the model definition and training process of deep Q-learning are constructed, and through the large-scale pre-learning experience of different user layouts in the training process to gain experience, finally improve the timeliness of the training process. Through the simulation results, it points out that the optimization model can achieve more than 90% of the theoretical maximum spectral efficiency with acceptable service quality.
“It’s more than just a game”: NCCAA Division II student-athletes’ perceptions of coach caring
Authors: Schools Jordan A , Fisher Leslee A , Moore Matthew J , Morris Sierra V , Egli Trevor J , Knust Susannah K
Published: May 2020

The construct of care within the coach–athlete relationship has only recently been examined. However, this research has yet to include athletes’ perceptions of caring coaching practice. Thus, the primary purpose of the current study was to examine self-described Christian student-athletes’ perceptions of coach caring practices. Therefore, the guiding research questions were: (a) in what ways do student-athletes feel that their coaches demonstrate care? (b) In what ways have student-athletes’ religion/spirituality shaped the way they understand and perceive care? (c) Does proximity to a caring coach practice—that is, those who are still competing versus those who have graduated—influence the ways in which student-athletes view coach caring? Eleven current and former student-athletes (mean age = 26 years; seven males, four females) from four different sports (basketball, cross country, soccer, and tennis) at one NCCAA school were interviewed. Data analysis was conducted by a six-person research team using Consensual Qualitative Research. Five domains were constructed to represent Christian University 1 student-athlete perceptions of: (I) how they learned coach caring, (II) how they defined a lack of coach caring, (III) how they defined coach caring, (IV) how they perceived the expression of the caring climate, and (V) how they perceived the expression of the Christian caring climate.
Inter-observer variation of Syntax score among cardiac surgeons, clinical and interventional cardiologists
Authors: de Araujo Gustavo Neves , Leiria Tiago Luiz Luz , Furtado Mariana Vargas , Matte Bruno da Silva , Machado Guilherme Pinheiro , Krepsky Ana Maria , Bergoli Luiz Carlos Corsetti , Goncalves Sandro Cadaval , Wainstein Marco Vugman , Polanczyk Carisi Anne
Published: May 2020

Background:

Despite the complexity of SYNTAX score (SS), guidelines recommend this tool to help choosing between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with left main of three-vessel coronary artery disease. The aim of this study was to compare the inter-observer variation in SS performed by clinical cardiologists (CC), interventional cardiologists (IC), and cardiac surgeons (CS).

Methods:

Seven coronary angiographies from patients with left main and/or three-vessel disease chosen by a heart team were analyzed by 10 CC, 10 IC and 10 CS. SS was calculated via SYNTAX website.

Results:

Kappa concordance was very low between CC and CS (k = 0.176), moderate between CS and IC (k = 0.563), and moderate between CC and IC (0.553). There was a statistically significant difference between CC, who classified more cases as low complexity (70%), and CS, who classified more cases as moderate complexity (80%) ( p = 0.041).

Conclusion:

Concordance between SS analyzed by CC, CS and IC is low. The usefulness of SS in decision-making of revascularization strategy is undeniable and evidence supports its use. However, this study highlights the importance of well-trained professionals on calculating the SS. It could avoid misclassification of borderline cases.
The Correlation Between Visibility and Medical Staff Collaborative Communication in Emergency Departments
Authors: Gharaveis Arsalan , Pati Debajyoti , Hamilton D. Kirk , Shepley Mardelle , Rodiek Susan , Najarian Mohammad
Published: May 2020

Objectives:

This study empirically investigates the correlation between visibility and nurses and physicians’ collaborative communication in emergency departments (EDs). The researchers hypothesized that higher visibility levels in EDs are associated with higher collaborative communication among nurses and physicians.

Background:

The review of related literature addresses the role of communication in EDs, and more specifically, how visibility has been found to affect nurse and physician behavior in healthcare facilities.

Method:

The visibility levels in four EDs within the same hospital system were quantitatively measured in this study. Also, the communication levels among medical staff were explored by two methods. Data collection included computerized floor plan analyses, observations, and surveys.

Results:

The researchers found statistically significant relationships between several underlying dimensions of ED visibility and collaborative communication among the medical staff members.

Conclusion:

Understanding the role of visibility provides a critical design principle for future EDs. The enhancement of ED design helps nurses and physicians to benefit from supportive environments.
Severe Neovascular Glaucoma Exacerbation as a Complication of Carotid Artery Stenting: A Case Report
Authors: Mannava Sishir , Torres Luis F. , DeSousa Keith G. , Yavagal Dileep R. , Yannuzzi Nicolas A. , Flynn Harry W. , Malik Amer M.
Published: May 2020

Introduction:

Neovascular glaucoma (NVG) has been rarely reported as an acute complication of carotid endarterectomy, but there is scant literature available regarding this potential condition following carotid artery stenting (CAS). We present a case of severe worsening of NVG occurring after bilateral CAS with progressive deterioration of vision ultimately leading to blindness.

Case Description:

A 66-year-old male with multiple stroke risk factors, bilateral cataract extraction, proliferative diabetic retinopathy of left eye, and nonproliferative diabetic retinopathy of right eye, and prior left eye pars plana vitrectomy presented with episodes of transient right eye vision loss in context of bilateral high-grade internal carotid artery stenoses. He underwent right CAS with subsequent elevation of bilateral intraocular pressures (IOPs) concerning for acute NVG. Over time, the patient had some interval improvement in IOPs and underwent planned left CAS. After the procedure, he again developed elevated IOPs, concerning for acute NVG which eventually led to right eye pars plana vitrectomy for vitreous hemorrhage and refractory IOP elevation. At 6-month follow-up from initial stenting, the patient was blind in both eyes.

Discussion:

We present a case of recurrent IOP elevations following CAS eventually resulting in bilateral eye blindness. This case is important not only as an illustration of an underrecognized postprocedural CAS complication but also as a demonstration of likely elevated risk of NVG following CAS for patients with other predisposing risk factors for ocular hypertension such as glaucoma, proliferative diabetic retinopathy, prior cataract extraction, and prior pars plana vitrectomy.
Disturbances in Metabolic Pathways and the Identification of a Potential Biomarker Panel for Early Cartilage Degeneration in a Rabbit Anterior Cruciate Ligament Transection Model
Authors: Hu Yiwen , Wu Qian , Qiao Yang , Zhang Peng , Dai Wentao , Tao Hongyue , Chen Shuang
Published: May 2020

Objective

This study aimed to assess the association between synovial fluid (SF) metabolites and magnetic resonance imaging (MRI) measurements of cartilage biochemical composition to identify potential SF biomarkers for detecting the early onset of cartilage degeneration in a rabbit model.

Methods

Both knees of 12 New Zealand White rabbits were used. The anterior cruciate ligament transection (ACLT) model was performed on right knees, and the sham surgery on left knees. MRI UTE-T2* scanning and SF sample collection were performed on ACLT knees at 4 and 8 weeks postsurgery and on sham surgery knees at 4 weeks postsurgery. Ultra-performance liquid chromatography–mass spectrometry and multivariate statistical analysis were used to distinguish samples in three groups. Pathway and receiver operating characteristic analyses were utilized to identify potential metabolite biomarkers.

Results

There were 12 knees in sham surgery models, 11 in ACLT models at 4 weeks postsurgery, and 10 in ACLT models at 8 weeks postsurgery. UTE-T2* values for the lateral tibia cartilage showed significant decreases over the study period. Levels of 103 identified metabolites in SF were markedly different among three groups. Furthermore, 24 metabolites were inversely correlated with UTE-T2* values of the lateral tibia cartilage, while hippuric acid was positively correlated with UTE-T2* values of the lateral tibia cartilage. Among 25 potential markers, N1-acetylspermidine, 2-amino-1,3,4-octadecanetriol, l-phenylalanine, 5-hydroxy-l-tryptophan, and l-tryptophan were identified as potential biomarkers with high area under the curve values and Pearson correlation coefficients.

Conclusion

Five differential metabolites in SF were found as potential biomarkers for the early detection of cartilage degeneration in the rabbit ACLT model.
Impact of COVID‐19 pandemic on the daily management of biotechnological therapy in inflammatory bowel disease patients: Reorganisational response in a high‐volume Italian inflammatory bowel disease centre
Authors: Scaldaferri Franco , Pugliese Daniela , Privitera Giuseppe , Onali Sara , Lopetuso Loris Riccardo , Rizzatti Gianenrico , Settanni Carlo Romano , Pizzoferrato Marco , Schiavoni Elisa , Turchini Laura , Amatucci Valeria , Napolitano Daniele , Bernabei Tiziana , Mora Vincenzina , Laterza Lucrezia , Papa Alfredo , Guidi Luisa , Rapaccini Gian Lodovico , Gasbarrini Antonio , Armuzzi Alessandro
Published: May 2020

The coronavirus disease 2019 (COVID‐19) pandemic is having a major clinical as well as organisational impact on the national health‐care system in Italy, particularly in high‐volume hospitals which are usually active for many essential clinical needs, including inflammatory bowel disease (IBD). Here, we report major clinical and organisational challenges at a high‐volume Italian IBD centre one month after the start of the Italian government’s restrictions due to the COVID‐19 pandemic. All routine follow‐up IBD visits of patients in remission were cancelled or rescheduled for 8–12 weeks’ time. However, access to the hospital for therapy or for unstable/relapsing patients was not considered postponable. Everyone attending the centre (e.g. physicians, nurses, administrative personnel and patients) were advised to respect the general recommended rules for hand hygiene and social distancing, to disclose if they had a fever or cough or flu‐like symptoms and to wear a surgical mask and gloves. At the entrance of the therapy area, a control station was set up in order to double‐check all patients with a clinical interview and conduct thermal scanning. A total of 1451 IBD patients under biotechnological or experimental therapy actively followed in the CEMAD IBD centre were included in the study. About 65% of patients maintained their appointment schedules without major problems, while in 20% of cases planned infusions were delayed because of the patient’s decision or practical issues. About 10% of patients receiving subcutaneous therapy were allowed to collect their medicine without a follow‐up visit. Finally, 10% of patients living outside the Lazio region requested access to their therapy at a local centre closer to their home. At present, five patients have been found to be positive for SARS‐CoV‐2 infection but with minimal symptoms, 22 are in ‘quarantine’ for contact considered to be ‘at risk’ for the infection. Up to now, none of them has experienced significant symptoms. This study represents the first observational detailed report about short‐term impact of the COVID‐19 pandemic on patient organisation and management in a high‐volume IBD centre.
Reverse intermittent androgen deprivation therapy: Prostate cancer and hypopituitarism
Authors: Hill George , Persad Raj , Bolomytis Stefanos
Published: May 2020

Testosterone replacement in the context of untreated prostate cancer is a controversial topic, where the symptomatic benefits of testosterone therapy contrast with the risk of disease progression. We report the case of a 76-year-old gentleman, under watchful waiting for known prostate cancer, who underwent a transsphenoidal resection of a pituitary macroadenoma. The adenoma and subsequent surgical treatment resulted in secondary testosterone deficiency, effectively ‘self-commencing’ endogenous androgen deprivation therapy. After discussion with the endocrine team, careful intermittent testosterone supplementation was undertaken to address his symptoms, with the patient undergoing prostate-specific antigen surveillance. This was felt to be similar to intermittent androgen deprivation therapy in reverse. Here, we review current evidence regarding testosterone therapy in the context of prostate cancer.

Level of Evidence: 5
What does consolidation mean for performance? Concentration, competition, and defense contracting outcomes
Authors: Sanders Gregory , Huitink Zachary
Published: May 2020

How does industrial concentration influence performance outcomes in government contracting? This paper hypothesizes that concentration influences contract performance directly, as well as indirectly through reducing competition for contract awards. Tests of these hypotheses on a large dataset of US defense contracts reveal nuanced results. Increasing concentration is directly associated with a higher likelihood of contract terminations, and remains the same even after accounting for levels of competition (suggesting competition does not mediate the influence of concentration on this performance indicator). Contrary to expectations, higher competition is associated with a higher rather than a lower likelihood of terminations. Concentration is not associated with the incidence of cost ceiling breaches, and competition resulting in single (rather than multiple) offers is associated with a lower likelihood of a breach. When a breach has occurred, however, higher concentration is associated with larger breaches sizes, and higher competition with smaller breach sizes. Combined, these results partially support concerns about a connection between concentration, market power, and diminished performance incentives but suggest that the nature of these relationships depends upon the indicator of contract performance being considered.
Volatility Spillover Among Equity and Commodity Markets
Authors: Aziz Tariq , Sadhwani Ranjeeta , Habibah Ume , Al Janabi Mazin A. M.
Published: May 2020

This study aims to examine volatility spillover among equity and commodity markets of the United States. The analysis focuses on crude oil (Brent and WTI [West Texas Intermediate]), rice, and gasoline. For the analysis, generalized autoregressive conditional heteroscedasticity (GARCH) (1, 1) model is applied on monthly data for the period of February 2005 to December 2016. Results show that there is no volatility spillover from commodity market (gold, oil, gas, and rice) to equity market, whereas it only exists in few commodity markets, from oil to rice and gas. The study also finds that there is neither mean spillover nor volatility spillover among gold and equity market; therefore, investor can invest in equity and gold to diversify risk of portfolio.
Clinical-pathological review of 14 cases of merkel cell carcinoma
Authors: Quttainah Adel , Thoma Achilles , Salama Samih
Published: May 2020

Merkel cell carcinoma (MCC) is a rare, primary, cutaneous, neuroendocrine skin tumour that occurs commonly in the head, neck or extremities of elderly white people. Fourteen cases of MCC in the Hamilton Regional Cancer Centre between 1992 and 2000 have been reviewed. Seven cases required a panel of immunohistochemical markers and two cases required electron microscopy for confirmation. Seven men and seven women were treated, and ranged from 67 to 96 years of age (mean 77.7 years). The primary tumour was located in the head and neck in seven patients (50%), in the extremities in four patients (29%) and on the trunk in two patients (14%). One patient had an unknown primary tumour location. Ten patients had stage Ia disease at presentation, three had stage Ib disease, and one presented with stage II disease. Primary treatment consisted of wide local excision in nine patients, wide local excision and radiotherapy in four patients and radiotherapy only in one patient. Seven patients had recurrence, five were disease free up to their most recent follow-up, one died of unrelated causes, and one was lost to follow-up after primary treatment. Of the seven patients with recurrence, two had local recurrence, two had lymph node recurrence and three developed metastases. Disease-free intervals were 69% and 50% for six-month and one-year follow-up, respectively. No difference in outcome was observed between stage Ia and Ib disease. The patient with stage II disease at presentation developed metastases. Longer duration of disease before presentation had a higher incidence of recurrence with distant metastases. Extremity lesions had the best prognosis associated with disease-free interval. Early management with excision and radiotherapy improved the disease-free interval.
Malignant Fibrous Histiocytoma Arising in a Paraffinoma of the Breast
Authors: Addison Patrick D , Beausang Eamon S , Neligan Peter C
Published: May 2020

Breast augmentation by means of paraffin injection was not an uncommon practice, particularly in the Far East, in the 1950s and 1960s. Tracking of the injected material into surrounding tissues gives rise to an irregular appearance and the formation of tumours called paraffinomas. In the present report, a case of malignant fibrous histiocytoma arising in a breast paraffinoma 50 years after the original paraffin injection is described.
The Impact of Combined Risk-Reducing Gynecological Surgeries on Outcomes in DIEP Flap and Tissue-Expander Breast Reconstruction
Authors: Jayaraman Avinash P. , Boyd Travis , Hampton Savannah N. , Haddock Nicholas T. , Teotia Sumeet S.
Published: May 2020

Introduction:

In addition to prophylactic mastectomies, BRCA1 and BRCA2 mutation carriers are increasingly choosing to undergo risk-reducing procedures such as hysterectomies and salpingo-oophorectomies. Sometimes these surgeries are performed in the same visit as a mastectomy or a revisionary reconstruction procedure. Literature lacks descriptions of complications and trends for these combined surgeries.

Methods:

Group 1 patients (n = 10, flaps = 20) had abdominal gynecologic procedures at the time of deep inferior epigastric artery perforator flap (DIEP flap) reconstruction. Group 2 patients (n = 29, breasts = 58) had gynecologic procedures at the time of mastectomy and tissue-expander placement. Group 3 patients (n = 141, breasts = 257) had mastectomy and tissue-expander reconstruction without gynecologic procedures and were used as a control group for group 2. Group 4 patients (n = 357, flaps = 673) had autologous breast reconstruction without gynecologic procedures and were used as a control for group 1. Categorical variables such as complications and flap loss were analyzed using χ2 tests. Continuous variables such as age, body mass index (BMI), operative time, length of stay were analyzed with 2-tailed t tests. Multivariate analyses were run to control for group differences.

Results:

Groups 1 and 4 were equivalent in age and comorbidities, except group 1 (32.8 kg/m2) had significantly higher BMI than group 4 (31.4 kg/m2), P = .028. Average operating time was statistically equivalent for group 1 patients (610 minutes) and group 4 patients (503 minutes), P = .289. Average hospital stay was equivalent as well (group 1 = 4.4 days, group 4 = 4.1 days, P = .676). Operative times for group 2 patients (457 minutes) were significantly longer than for group 3 patients (288 minutes), P < .01. Group 2 patients (3 nights) had significantly longer hospital stays than group 3 patients (2 nights), P < .01. Group 1 patients (2/20 flaps, 10%) had a significantly higher rate of flap loss than group 4 patients (8/673 flaps, 1%), P < .01. There were no differences in other flap complications. Additionally, there were no significant differences in postoperative tissue-expander complications between group 2 and group 3.

Discussion:

Both flap losses in Group 1 patients occurred in a single patient with BMI = 39.3 kg/m2 and a personal history of recurrent DVTs. Additionally, the rates of complications across other measures were equivalent between groups. Thus, despite the increased rate of flap loss in Group 1 (10%) vs Group 4 (1.3%), along with the increased operative times and hospital stays, certain patients can be advised that a prophylactic gynecological procedure is safe to combine with breast reconstruction.
School-Based Resources as Protective Factors from the Influence of Parental Incarceration on Depressive Symptoms
Authors: Finkeldey Jessica G. , Dennison Christopher R.
Published: May 2020

Although research on the deleterious effects of parental incarceration is extensive, few studies have examined factors that may attenuate these consequences. This study uses data from the National Longitudinal Study of Adolescent to Adult Health to examine the relationship between experiencing parental incarceration during childhood and depressive symptoms in young adulthood. Most importantly, it considers the degree to which this relationship is moderated by the availability of secondary-school-based resources. Results suggest that the consequences of parental incarceration on depressive symptoms are weaker for adolescents who attend schools that provide emotional counseling or nursing services on school premises or employ at least 50 percent of teachers with a master’s degree or higher. These findings suggest that the availability of school resources contributes to adolescents’ long-term resilience despite facing adverse circumstances.
The importance of wavelength for tight temperature control during μ-laser-assisted machining
Authors: Dennis Ashley , Goel Saurav , Al-Sayegh Rajab , O’Neill William
Published: May 2020

The area of single point diamond turning of brittle materials like semiconductors and ceramics is significantly benefitted by incorporation of laser assistance. In a new developmental technology that is now recognized as micro-laser-assisted machining (μ-LAM), a laser is shone through a diamond tool to soften the high-pressure phase transformed ductile machining phases that in turn allows thermal softening and thereby enables a higher material removal rate during ductile mode machining. One of the lasers currently used in μ-LAM is the neodymium-doped yttrium aluminum garnet (Nd:YAG) laser operating at 100 W (continuous wave) at the wavelength of 1064 nm. Although this configuration has worked to the benefit of the technology, here we report futuristic developments that will significantly enhance temperature control by selecting a laser wavelength according to the material being machined, allowing tunable machining properties. The concept is illustrated with sample calculations for μ-LAM of silicon, and it appears to offer better target temperatures, thus enhancing the performance of the μ-LAM process.
Suboptimal treatment response to anti-IL-5 monoclonal antibodies in severe eosinophilic asthmatics with airway autoimmune phenomena
Authors: Mukherjee Manali , Forero David Felipe , Tran Stephanie , Boulay Marie-Eve , Bertrand Mylène , Bhalla Anurag , Cherukat Jayant , Al-Hayyan Hajar , Ayoub Anmar , Revill Spencer D. , Javkar Tanvi , Radford Katherine , Kjarsgaard Melanie , Huang Chynna , Dvorkin-Gheva Anna , Ask Kjetil , Olivenstein Ronald , Dendukuri Nandini , Lemiere Catherine , Boulet Louis-Philippe , Martin James G. , Nair Parameswaran
Published: May 2020

Background

In clinical trials, the two anti-interleukin (IL)-5 monoclonal antibodies (mAbs: mepolizumab and reslizumab) approved to treat severe eosinophilic asthma reduce exacerbations by ∼50–60%.

Objective

To observe response to anti-IL-5 mAbs in a real-life clinical setting, and to evaluate predictors of suboptimal response.

Methods

In four Canadian academic centres, predefined clinical end-points in 250 carefully characterised moderate-to-severe asthmatic patients were collected prospectively to assess response to the two anti-IL-5 mAbs. Suboptimal response was determined based on failure to reduce maintenance corticosteroid (MCS) or asthma symptoms scores (Asthma Control Questionnaire (ACQ)) or exacerbations, in addition to persistence of sputum/blood eosinophils. Worsening in suboptimal responders was assessed based on reduced lung function by 25% or increase in MCS/ACQ. A representative subset of 39 patients was evaluated for inflammatory mediators, autoantibodies and complement activation in sputum (by ELISA) and for immune-complex deposition by immunostaining formalin-fixed paraffin-embedded sputum plugs.

Results

Suboptimal responses were observed in 42.8% (107 out of 250) patients treated with either mepolizumab or reslizumab. Daily prednisone requirement, sinus disease and late-onset asthma diagnoses were the strongest predictors of suboptimal response. Asthma worsened in 13.6% (34 out of 250) of these patients. The majority (79%) of them were prednisone-dependent. Presence of sputum anti-eosinophil peroxidase immunoglobulin (Ig)G was a predictor of suboptimal response to an anti-IL-5 mAb. An increase in sputum C3c (marker of complement activation) and deposition of C1q-bound/IL-5-bound IgG were observed in the sputa of those patients who worsened on therapy, suggesting an underlying autoimmune-mediated pathology.

Conclusion

A significant number of patients who meet currently approved indications for anti-IL5 mAbs show suboptimal response to them in real-life clinical practice, particularly if they are on high doses of prednisone. Monitoring blood eosinophil count is not helpful to identify these patients. The concern of worsening of symptoms associated with immune-complex mediated complement activation in a small proportion of these patients highlights the relevance of recognising airway autoimmune phenomena and this requires further evaluation.
A fully automatic deep learning system for COVID-19 diagnostic and prognostic analysis
Authors: Wang Shuo , Zha Yunfei , Li Weimin , Wu Qingxia , Li Xiaohu , Niu Meng , Wang Meiyun , Qiu Xiaoming , Li Hongjun , Yu He , Gong Wei , Bai Yan , Li Li , Zhu Yongbei , Wang Liusu , Tian Jie
Published: May 2020

Coronavirus disease 2019 (COVID-19) has spread globally, and medical resources become insufficient in many regions. Fast diagnosis of COVID-19 and finding high-risk patients with worse prognosis for early prevention and medical resource optimisation is important. Here, we proposed a fully automatic deep learning system for COVID-19 diagnostic and prognostic analysis by routinely used computed tomography.

We retrospectively collected 5372 patients with computed tomography images from seven cities or provinces. Firstly, 4106 patients with computed tomography images were used to pre-train the deep learning system, making it learn lung features. Following this, 1266 patients (924 with COVID-19 (471 had follow-up for >5 days) and 342 with other pneumonia) from six cities or provinces were enrolled to train and externally validate the performance of the deep learning system.

In the four external validation sets, the deep learning system achieved good performance in identifying COVID-19 from other pneumonia (AUC 0.87 and 0.88, respectively) and viral pneumonia (AUC 0.86). Moreover, the deep learning system succeeded to stratify patients into high- and low-risk groups whose hospital-stay time had significant difference (p=0.013 and p=0.014, respectively). Without human assistance, the deep learning system automatically focused on abnormal areas that showed consistent characteristics with reported radiological findings.

Deep learning provides a convenient tool for fast screening of COVID-19 and identifying potential high-risk patients, which may be helpful for medical resource optimisation and early prevention before patients show severe symptoms.
Predicting extubation outcomes using the Heart Rate Characteristics index in preterm infants: a cohort study
Authors: Chakraborty Mallinath , Watkins William John , Tansey Katherine , King William E. , Banerjee Sujoy
Published: May 2020

A strategy of early extubation to noninvasive respiratory support in preterm infants could be boosted by the availability of a decision support tool for clinicians. Using the Heart Rate Characteristics index (HRCi) with clinical parameters, we derived and validated predictive models for extubation readiness and success.

Peri-extubation demographic, clinical and HRCi data for up to 96 h were collected from mechanically ventilated infants in the control arm of a randomised trial involving eight neonatal centres, where clinicians were blinded to the HRCi scores. The data were used to produce a multivariable regression model for the probability of subsequent re-intubation. Additionally, a survival model was produced to estimate the probability of re-intubation in the period after extubation.

Of the 577 eligible infants, data from 397 infants (69%) were used to derive the pre-extubation model and 180 infants (31%) for validation. The model was also fitted and validated using all combinations of training (five centres) and test (three centres) centres. The estimated probability for the validation episodes showed discrimination with high statistical significance, with an area under the curve of 0.72 (95% CI 0.71–0.74; p<0.001). Data from all infants were used to derive models of the predictive instantaneous hazard of re-intubation adjusted for clinical parameters.

Predictive models of extubation readiness and success in real-time can be derived using physiological and clinical variables. The models from our analyses can be accessed using an online tool available atwww.heroscore.com/extubation, and have the potential to inform and supplement the confidence of the clinician considering extubation in preterm infants.
First-line carboplatin plus pemetrexed with pemetrexed maintenance in HIV-positive patients with advanced non-squamous non-small cell lung cancer: the phase II IFCT-1001 CHIVA trial
Authors: Lavole Armelle , Greillier Laurent , Mazières Julien , Monnet Isabelle , Kiakouama-Maleka Lize , Quantin Xavier , Spano Jean Philippe , Lena Herve , Fraisse Philippe , Janicot Henri , Audigier-Valette Clarisse , Langlais Alexandra , Morin Franck , Makinson Alain , Cadranel Jacques
Published: May 2020

HIV infection is an exclusion criterion in lung cancer trials. This multicentre phase II trial aimed to assess feasibility, efficacy and safety of first-line carboplatin plus pemetrexed (CaP) followed by pemetrexed (P) maintenance in people living with HIV (PLHIV) with advanced non-squamous non-small cell lung cancer (NS-NSCLC).

Four cycles of CaP were followed by P-maintenance therapy in patients with Eastern Cooperative Oncology Group performance status ≤2. The primary objective was a disease control rate (DCR) ≥30% after 12 weeks.

Of the 61 PLHIV enrolled, 49 (80%) had a performance status of 0–1, and 19 (31%) had brain metastases. Median CD4 lymphocyte count was 418 cells·µL−1(range 18–1230), median CD4 lymphocyte nadir was 169.5 cells·µL−1(1–822); 48 (80%) patients were virologically controlled. Four-cycle inductions were achieved by 38 (62%) patients, and 31 (51%) started P-maintenance (median of 4.1 cycles (range 1–19)). The 12-week DCR was 50.8% (95% CI 38.3–63.4) and partial response rate 21.3%. Median progression-free survival and overall survival were 3.5 (95% CI 2.7–4.4) and 7.6 months (5.7–12.8), respectively. Patients with a performance status of 0–1 had the longest median progression-free survival (4.3 months, 95% CI 3.1–5.2) and overall survival (11.9 months, 95% CI 6.4–14.3). During induction, CaP doublet was well tolerated apart from grade 3–4 haematological toxicities (neutropenia 53.8%; thrombocytopenia 35.0%; anaemia 30.0%). Two fatal treatment-related sepses were reported. No opportunistic infections were experienced.

In PLHIV with advanced NS-NSCLC, first-line four-cycle CaP induction followed by P-maintenance was effective and reasonably well-tolerated. Further studies should evaluate combination strategies of CaP with immunotherapy in PLHIV.