bluuebunny/crossref_metadata_2025 huggingface dataset:
Large Eddy Simulation of the Laminar Heat Transfer Augmentation on the Pressure Side of a Turbine Vane Under Freestream Turbulence
Authors: Kanani Yousef , Acharya Sumanta , Ames Forrest
Published: September 2018

Vane pressure side heat transfer is studied numerically using large eddy simulation (LES) on an aft-loaded vane with a large leading edge over a range of turbulence conditions. Numerical simulations are performed in a linear cascade at exit chord Reynolds number of Re = 5.1 × 105 at low (Tu ≈ 0.7%), moderate (Tu ≈ 7.9%), and high (Tu ≈ 12.4%) freestream turbulence with varying length scales as prescribed by the experimental measurements of Varty and Ames (2016, “Experimental Heat Transfer Distributions Over an Aft Loaded Vane With a Large Leading Edge at Very High Turbulence Levels,” ASME Paper No. IMECE2016-67029). Heat transfer predictions on the vane pressure side are in a very good agreement with the experimental measurements and the heat transfer augmentation due to the freestream turbulence is well captured. At Tu ≈ 12.4%, freestream turbulence enhances the Stanton number on the pressure surface without boundary layer transition to turbulence by a maximum of about 50% relative to the low freestream turbulence case. Higher freestream turbulence generates elongated structures and high-velocity streaks wrapped around the leading edge that contain significant energy. Amplification of the velocity streaks is observed further downstream with max rms of 0.3 near the trailing edge but no transition to turbulence or formation of turbulence spots is observed on the pressure side. The heat transfer augmentation at the higher freestream turbulence is primarily due to the initial amplification of the low-frequency velocity perturbations inside the boundary layer that persist along the entire chord of the airfoil. Stanton numbers appear to scale with the streamwise velocity fluctuations inside the boundary layer.
The Effect of Midplane Guide Vanes in a Biplane Wells Turbine
Authors: Das Tapas K. , Samad Abdus
Published: September 2018

Guide vanes (GVs) improve the performance of a turbine in terms of efficiency, torque, or operating range. In this work, a concept of different orientations of GVs in between a two-row biplane wells turbine (BWT) was introduced and analyzed for the performance improvement. The fluid flow was simulated numerically with a commercial software ANSYS CFX 16.1. The Reynolds-averaged Navier–Stokes equations with the k-ω turbulence closure model were solved for different designs and flow conditions. For the base model, the results from simulation and experiments are in close agreement. Among the designs considered, the configuration, where the blades are in one line (zero circumferential angle between blades of two plane) and the midplane guide vane has concave side to the leading edge of the blade, performed relatively better. However, the performance was still less compared to the base model. The reason behind the reduction in performance from the base model is attributed to the blockage of flow and the change of flow path occurring due to the presence of the midplane GVs. The flow analysis of different cases and the comparison with the base model are presented in the current study.
Vision-Based Modal Analysis Using Multiple Vibration Distribution Synthesis to Inspect Large-Scale Structures
Authors: Aoyama Tadayoshi , Li Liang , Jiang Mingjun , Takaki Takeshi , Ishii Idaku , Yang Hua , Umemoto Chikako , Matsuda Hiroshi , Chikaraishi Makoto , Fujiwara Akimasa
Published: September 2018

Previously, we proposed a multithread active vision system with virtual multiple pan-tilt tracking cameras by rapidly switching the viewpoints for the vibration sensing of large-scale structures. We also developed a system using a galvanometer mirror that can switch 500 different viewpoints in 1 s. However, the measurement rate of each observation point is low, and the time density is not always sufficient. In addition, strong multiple illuminations are required for the system owing to the retro reflective markers attached to the object being observed. In this study, we propose a multiple vibration distribution synthesis method for vibration analysis that increases the sampling rate of each observation point in the multi-thread active vision system, which is subsequently modified to a system that requires only one illumination by using corner cubes as markers. Several dynamics-based inspection experiments are conducted for a 4 m long truss-structure bridge model. The proposed method and system are verified via a high-order modal analysis, which was impossible to perform in the previous method and system.
Monogenic diabetes mellitus in cystic fibrosis
Authors: Gan Hoong-Wei , Bhatt Jayesh Mahendra , Denvir Louise , Randell Tabitha , Sachdev Pooja
Published: September 2018

We present a non-consanguineous family of three siblings who presented with diabetes mellitus (DM), two of whom had genetically confirmed cystic fibrosis (CF), with one pancreatic-sufficient mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene (ΔF508/R117H;IVS8-5T). A detailed history revealed family members from three successive generations diagnosed with ‘type 1’ or ‘type 2’ diabetes, leading to genetic investigations for monogenic DM. A heterozygous frameshift mutation in the hepatocyte nuclear factor 1 homeobox alpha (HNF1A) gene (c.404delA) was subsequently confirmed in all three siblings, which is known to cause monogenic diabetes and is exquisitely sensitive to sulfonylurea therapy. Following this diagnosis, both siblings with CF and HNF1A monogenic diabetes were started on gliclazide therapy, while their older brother who had been wrongly diagnosed with type 1 diabetes was switched from insulin to gliclazide, all with excellent therapeutic responses.
Neuromyelitis optica with unilateral diaphragmatic paralysis
Authors: Bennji Sami , Sagar Diaeddin , Brey Naeem , Koegelenberg Coenraad
Published: September 2018

In this case report, we describe the course of a female patient who is known to have neuromyelitis optica (NMO) and developed left hemiparesis and unilateral diaphragmatic paralysis. She was initially treated with intravenous methylprednisolone 1 g daily for 5 days without improvement. Subsequently, she received five sessions of a plasmapheresis. Her hemiparesis had improved after few days. however, the phrenic nerve palsy remained.
Adenoma mimicking hyponatremia of SIAD
Authors: Ilaiwy Amro , Thompson Novelette Elvia , Ameen Waheed Ahmed
Published: September 2018

Hyponatremia is a common electrolyte disorder, with prevalence as high as 20% in inpatient settings. It is classified based on volume status, urine sodium and osmolality results. While this approach might help narrow down the differential diagnoses, it can leave other diagnoses unentertained. In this case, we report recurrent and refractory hyponatremia secondary to hypocortisolism due to non-functioning pituitary macroadenoma. Interestingly, urine studies mimicked syndrome of inappropriate antidiuresis, but exclusively responded to hydrocortisone replacement. Hospital course was also complicated by hyponatremia-induced rhabdomyolysis, which is a rare complication of severe hyponatremia. We also discuss the role of anchoring heuristics and how they influence the physician’s decision leading to possible diagnostic errors. One way to minimise the effect of anchoring bias on physicians is their cognitive awareness of such bias. In addition, discussing complicated cases with all members of medical team can highlight the clinician’s thought processes, share uncertainty and help broaden differential diagnoses.
Kiloh-Nevin syndrome associated with humeral shaft fracture
Authors: Jain Mantu , Nayak Chandrakanta , Samal Barada Prasana , Tirpude Amit
Published: September 2018

Fracture humerus may be associated with nerve injuries. However, among them median nerve is uncommonly involved and clinical affection of the anterior branch of median nerve is rare which can be easily missed and could be under-reported. A 42-year-old man presented with closed fracture of shaft of humerus right sided following fall. He had isolated weakness of flexor pollicis longus and flexor digitorum profundus of index finger without any other sensorimotor dysfunction. The findings were consistent with isolated palsy of anterior interosseous nerve (AIN). The patient was operated with fixation of humerus without exploring the AIN. At 6-month follow-up, the patient had complete recovery of both the muscles. This case highlights the classical clinical presentation of a rare injury associated with humerus fracture. Awareness and knowledge of this entity is of paramount importance for the practitioners.
Photophobia and sensations of dryness in patients with migraine occur independent of baseline tear volume and improve following botulinum toxin A injections
Authors: Diel Ryan J , Hwang Jodi , Kroeger Zachary A , Levitt Roy C , Sarantopoulos Constantine D , Sered Heather , Felix Elizabeth R , Martinez-Barrizonte Jasmine , Galor Anat
Published: September 2018

Background

To evaluate the efficacy of botulinum toxin A (BoNT-A) in reducing photophobia and dry eye symptoms in individuals with chronic migraine. Additionally, we aimed to evaluate tear film volume as a potential contributor to symptoms in these patients.

Methods

Retrospective review of 76 patients who received BoNT-A for chronic migraine between 23 August 2017 and 13 December 2017 at the Miami Veterans Affairs Medical Center Neurotoxin Clinic. Demographic data and all comorbidities were queried via chart review. Standardised validated surveys were administered to assess symptoms prior to and after BoNT-A injection. Preinjection tear volumes were obtained using the phenol red thread (PRT) test.

Results

Preinjection migraine, photophobia and dry eye symptom scores were all significantly correlated, p<0.05, and none were associated with preinjection PRT results. After BoNT-A, improvements in migraine, photophobia and dry eye symptoms were also significantly correlated, p<0.05 and similarly did not associate with preinjection PRT results. Photophobia scores significantly improved following BoNT-A, while dry eye symptoms significantly improved in those with severe symptoms at baseline (DEQ-5 score ≥12), p=0.027. In logistic regression analysis of all individuals with dry eye symptoms (DEQ-5 ≥6), individuals with more severe dry eye symptoms were more likely improve, OR 1.27, 95% CI 1.06 to 1.51, p<0.01.

Conclusions

BoNT-A significantly improved photophobia in patients being treated for migraine and also improved dry eye symptoms in patients with severe symptoms at baseline, independent of baseline tear film volume. These improvements may be due to modulation of shared trigeminal neural pathways.
Health system governance following devolution: comparing experiences of decentralisation in Kenya and Indonesia
Authors: McCollum Rosalind , Limato Ralalicia , Otiso Lilian , Theobald Sally , Taegtmeyer Miriam
Published: September 2018

Introduction

Devolution reforms in Indonesia and Kenya have brought extensive changes to governance structures and mechanisms for financing and delivering healthcare. Community health approaches can contribute towards attaining many of devolution’s objectives, including community participation, responsiveness, accountability and improved equity. We set out to examine governance in two countries at different stages in the devolution journey: Indonesia at 15 years postdevolution and Kenya at 3 years.

Methods

We collected qualitative data across multiple levels of the health system in one district in Indonesia and ten counties in Kenya, through 80 interviews and six focus group discussions (FGD) in Indonesia and 269 interviews and 14 FGDs in Kenya. Qualitative data were digitally recorded, transcribed and coded before thematic framework analysis. Common themes between contexts were identified inductively and deductively, and similarities and differences critically analysed during an inter-country analysis workshop.

Results

Following devolution both Indonesia and Kenya experienced similar challenges ensuring good governance for health. Devolution reforms transformed power relationships, increasing responsibilities at subnational levels and introducing opportunities for citizen participation. In both contexts, the impact of these mechanisms has been undermined by insufficiently clear guidance; failure to address pre-existing negative contextual norms and practices varied decision-maker values, limited priority-setting capacity and limited genuine community accountability. As a consequence, priorities in both contexts are too often placed on curative rather than preventive health services.

Conclusion

We recommend consideration of increased intersectoral actions that address social determinants of health, challenge negative norms and practices and place emphasis on community-based primary health services.
Bone marrow-stimulating techniques in arthroscopic rotator cuff repair: a systematic review protocol
Authors: Kuo Liang-Tseng , Chen Chi-Lung , Yu Pei-An , Tsai Yu-Shiun , Hsu Wei-Hsiu , Chi Ching-Chi , Yoo Jae Chul
Published: September 2018

Introduction

Bone marrow-stimulating (BMS) techniques during arthroscopic rotator cuff repair surgery theoretically enhance the biological component for healing and hence improve tendon healing, but their efficacy remains unproven. The purpose of this review is to determine the effects and associated harms of BMS in arthroscopic rotator cuff repair surgery.

Methods and analysis

We will perform a systematic review and meta-analysis of randomised-controlled trials (RCTs) and retrospective cohort studies (RCS) that compare outcomes following BMS use against no use of BMS during arthroscopic rotator cuff repair surgery. We will search the databases including the Cochrane Central Register of Controlled Trials, Medline and Embase, and clinical trial registries for relevant studies. We will include studies published from start of indexing until 23 August 2018. Two reviewers will independently assess the eligibility for studies. For each included trial, we will conduct duplicate independent data extraction and risk of bias assessment. We will use the Cochrane Collaboration tool to assess the risk of bias of included RCTs, while we will use the Risk Of Bias In Non-randomised Studies - of Interventions tool to evaluate the risk of bias of RCS. We will perform a random-effects meta-analysis in calculating the pooled risk estimates when appropriate. We will assess the overall quality of the data for each individual outcome using the Grading of Recommendations, Assessments, Development and Evaluation approach. The primary outcomes are tendon healing rate, overall pain and shoulder functions. The secondary outcomes are the proportion of participants with adverse events related to interventions, the range of motion and the proportion of participants with return to previous activities.

Ethics and dissemination

We will report this review according to the guidance of the PRISMA statement. The results of this review will be disseminated through conference presentations and publications in peer-reviewed journals.

PROSPERO registration number

CRD42018087161.
Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance specialist access to care: a scoping review protocol
Authors: Osman Mohamed A , Schick-Makaroff Kara , Thompson Stephanie , Featherstone Robin , Bialy Liza , Kurzawa Julia , Okpechi Ikechi G , Habib Syed , Shojai Soroush , Jindal Kailash , Klarenbach Scott , Bello Aminu K
Published: September 2018

Introduction

Electronic consultations (eConsult), asynchronous exchanges of patient health information at a distance, are increasingly used as an option to facilitate patient care and collaboration between primary care providers and specialists. Although eConsult has demonstrated success in increasing efficiency in the referral process and enhancing access to care, little is known about the factors influencing its wider adoption and implementation by end users. In this paper, we describe a protocol to conduct a scoping review of the literature on the barriers and facilitators to a wider adoption and implementation of eConsult service.

Methods and analysis

This scoping review will be based on the framework pioneered by Arksey and O’Malley and later developed by Levacet al. We will use the guidance for scoping reviews developed by the Joanna Briggs Institute to report our findings. In addition to several electronic databases (Medline, Embase, Cochrane Library, CINAHL, EBSCOhost and PsycINFO) studies will be identified by including relevant grey literature. Two reviewers will independently screen titles and full texts for inclusion. Studies reporting on barriers and/or facilitators in settings similar to eConsult will be included. Data on study characteristics and key barriers and facilitators will be extracted. Data will be analysed thematically and classified using the Quadruple Aim framework.

Ethics and dissemination

Approval by research ethics board is not required since the review will only include published and publicly accessible data. Review findings will be used to inform future studies and the development of practice tools to support the wider adoption and success of eConsult implementation. We plan to publish our findings in a peer-reviewed journal and develop a useful and accessible summary of the results.
E-referrals: improving the routine interspecialty inpatient referral system
Authors: Shephard Emma , Stockdale Claire , May Felix , Brown Alistair , Lewis Hannah , Jabri Sara , Robertson Daniel , Moss Victoria , Bethune Rob
Published: September 2018

Interspecialty referrals are an essential part of most inpatient stays. With over 130 referrals occurring per week at the Royal Devon and Exeter Hospital, the process must be efficient and safe. The current paper-based ’white card' system was felt to be inefficient, and a Trust incident highlighted patient safety concerns. Questionnaires reinforced the need for improvement, with concerns such as a lack of referral traceability and delays in the referral delivery due to workload. The aims of the project were to improve patient safety and junior doctor efficiency in the referral process. Through appreciative enquiry and the PDSA (Plan-Do-Study-Act) model, an electronic referral system was developed, piloted within two specialties and later expanded to others with improvements made along the way based on user feedback. The system includes novel features including specialties ’acknowledging' a referral to allow referral progress to be tracked. The system stores all referrals, creating a fully auditable inpatient referral pathway. Qualitative data indicated improvement to patient safety and user experience (n=31). Timings for referrals were measured over a 6-month period; referrals became faster with the electronic system, with average time from decision to refer to referral submission improving from 2.1 hours to 1.9 hours, with a noted statistically significant improvement in timings on a statistical process control chart. An unexpected benefit was that patients were also reviewed faster by specialties. Measuring these changes presented a significant challenge due to the complexity of the referral process, and this was a big limitation. Overall, the re-design of a paper-based referral system into an electronic system has been proven to be more efficient and felt to be safer for patients. This is a sustainable change which is being rolled out Trust-wide. We hope that the reporting of this project will help others considering reviewing their inpatient referral pathways.
Hospitalisations for heart failure predict mortality in pulmonary hypertension related to congenital heart disease
Authors: Ntiloudi Despoina , Apostolopoulou Sotiria , Vasiliadis Konstantinos , Frogoudaki Alexandra , Tzifa Aphrodite , Ntellos Christos , Brili Styliani , Manginas Athanasios , Pitsis Antonios , Kolios Marios , Karvounis Haralambos , Tsioufis Costas , Goudevenos John , Rammos Spyridon , Giannakoulas George
Published: September 2018

Objective

Despite the progress in the management of patients with adult congenital heart disease (ACHD), a significant proportion of patients still develop pulmonary hypertension (PH). We aimed to highlight the rate of the complications in PH-ACHD and the predicting factors of cumulative mortality risk in this population.

Methods

Data were obtained from the cohort of the national registry of ACHD in Greece from February 2012 until January 2018.

Results

Overall, 65 patients receiving PH-specific therapy were included (mean age 46.1±14.4 years, 64.6% females). Heavily symptomatic (New York Heart Association (NYHA) class III/IV) were 53.8% of patients. The majority received monotherapy, while combination therapy was administered in 41.5% of patients. Cardiac arrhythmia was reported in 30.8%, endocarditis in 1.5%, stroke in 4.6%, pulmonary arterial thrombosis in 6.2%, haemoptysis in 3.1% and hospitalisation due to heart failure (HF) in 23.1%. Over a median follow-up of 3 years (range 1–6), 12 (18.5%) patients died. On univariate Cox regression analysis history of HF hospitalisation emerged as a strong predictor of mortality (HR 8.91, 95% CI 2.64 to 30.02, p<0.001), which remained significant after adjustment for age and for NYHA functional class.

Conclusions

Long-term complications are common among patients with PH-ACHD. Hospitalisations for HF predict mortality and should be considered in the risk stratification of this population.
Neighbourhood racial/ethnic residential segregation and cardiometabolic risk: the multiethnic study of atherosclerosis
Authors: Mayne Stephanie L , Hicken Margaret T , Merkin Sharon Stein , Seeman Teresa E , Kershaw Kiarri N , Do D Phuong , Hajat Anjum , Diez Roux Ana V
Published: September 2018

Background

Racial residential segregation has been linked to adverse health outcomes, but associations may operate through multiple pathways. Prior studies have not examined associations of neighbourhood-level racial segregation with an index of cardiometabolic risk (CMR) and whether associations differ by race/ethnicity.

Methods

We used data from the Multi-Ethnic Study of Atherosclerosis to estimate cross-sectional and longitudinal associations of baseline neighbourhood-level racial residential segregation with a composite measure of CMR. Participants included 5015 non-Hispanic black, non-Hispanic white and Hispanic participants aged 45–84 years old over 12 years of follow-up (2000–2012). We used linear mixed effects models to estimate race-stratified associations of own-group segregation with CMR at baseline and with the rate of annual change in CMR. Models were adjusted for sociodemographics, medication use and individual-level and neighbourhood-level socioeconomic status (SES).

Results

In models adjusted for sociodemographics and medication use, high baseline segregation was associated with higher baseline CMR among blacks and Hispanics but lower baseline CMR among whites. Individual and neighbourhood-level SES fully explained observed associations between segregation and CMR for whites and Hispanics. However, associations of segregation with CMR among blacks remained (high vs low segregation: mean difference 0.17 SD units, 95% CI 0.02 to 0.32; medium vs low segregation: mean difference 0.18 SD units, 95% CI 0.03 to 0.33). Baseline segregation was not associated with change in CMR index scores over time.

Conclusion

Associations of own-group racial residential segregation with CMR varied by race/ethnicity. After accounting for SES, living in a more segregated neighbourhood was associated with greater risk among black participants only.
In Vivo
Ryr
2 Editing Corrects Catecholaminergic Polymorphic Ventricular Tachycardia
Authors: Pan Xiaolu , Philippen Leonne , Lahiri Satadru K. , Lee Ciaran , Park So Hyun , Word Tarah A. , Li Na , Jarrett Kelsey E. , Gupta Rajat , Reynolds Julia O. , Lin Jean , Bao Gang , Lagor William R. , Wehrens Xander H.T.
Published: September 2018

Rationale:

Autosomal-dominant mutations in ryanodine receptor type 2 (
RYR2
) are responsible for ≈60% of all catecholaminergic polymorphic ventricular tachycardia. Dysfunctional RyR2 subunits trigger inappropriate calcium leak from the tetrameric channel resulting in potentially lethal ventricular tachycardia. In vivo CRISPR/Cas9-mediated gene editing is a promising strategy that could be used to eliminate the disease-causing Ryr2 allele and hence rescue catecholaminergic polymorphic ventricular tachycardia.

Objective:

To determine if somatic in vivo genome editing using the CRISPR/Cas9 system delivered by adeno-associated viral (AAV) vectors could correct catecholaminergic polymorphic ventricular tachycardia arrhythmias in mice heterozygous for RyR2 mutation R176Q (R176Q/+).

Methods and Results:

Guide RNAs were designed to specifically disrupt the R176Q allele in the R176Q/+ mice using the SaCas9 (
Staphylococcus aureus
Cas9) genome editing system. AAV serotype 9 was used to deliver Cas9 and guide RNA to neonatal mice by single subcutaneous injection at postnatal day 10. Strikingly, none of the R176Q/+ mice treated with AAV-CRISPR developed arrhythmias, compared with 71% of R176Q/+ mice receiving control AAV serotype 9. Total
Ryr2
mRNA and protein levels were significantly reduced in R176Q/+ mice, but not in wild-type littermates. Targeted deep sequencing confirmed successful and highly specific editing of the disease-causing R176Q allele. No detectable off-target mutagenesis was observed in the wild-type
Ryr2
allele or the predicted putative off-target site, confirming high specificity for SaCas9 in vivo. In addition, confocal imaging revealed that gene editing normalized the enhanced Ca
2+
spark frequency observed in untreated R176Q/+ mice without affecting systolic Ca
2+
transients.

Conclusions:

AAV serotype 9–based delivery of the SaCas9 system can efficiently disrupt a disease-causing allele in cardiomyocytes in vivo. This work highlights the potential of somatic genome editing approaches for the treatment of lethal autosomal-dominant inherited cardiac disorders, such as catecholaminergic polymorphic ventricular tachycardia.
Longitudinal Assessment of Outcome From Prenatal Diagnosis Through Fontan Operation for Over 500 Fetuses With Single Ventricle‐Type Congenital Heart Disease: The Philadelphia Fetus‐to‐Fontan Cohort Study
Authors: Liu Michael Y. , Zielonka Benjamin , Snarr Brian S. , Zhang Xuemei , Gaynor J. William , Rychik Jack
Published: September 2018

Background

Prenatal diagnosis of single ventricle‐type congenital heart disease is associated with improved clinical courses. Prenatal counseling allows for optimal delivery preparations and opportunity for prenatal intervention. Expectant parents frequently ask what the likelihood of survival through staged palliation is and the factors that influence outcome. Our goal was specifically to quantify peri‐ and postnatal outcomes in this population.

Methods and Results

We identified all patients with a prenatal diagnosis of single ventricle‐type congenital heart disease presenting between July 2004 and December 2011 at our institution. Maternal data, fetal characteristics, and data from the postnatal clinical course were collected for each patient. Kaplan–Meier curves and multivariate analysis with logistic regression were used to evaluate variables associated with decreased transplant‐free survival. Five hundred two patients were identified, consisting of 381 (76%) right ventricle– and 121 left ventricle–dominant lesions. After prenatal diagnosis, 42 patients did not follow up at our center; 79 (16%) chose termination of pregnancy, and 11 had intrauterine demise with 370 (74%) surviving to birth. Twenty‐two (6%) underwent palliative care at birth. Among 348 surviving to birth with intention to treat, 234 (67%) survived to at least 6 months post‐Fontan palliation. Presence of fetal hydrops, right ventricle dominance, presence of extracardiac anomalies, and low birthweight were significantly associated with decreased transplant‐free survival.

Conclusions

In patients with a prenatal diagnosis of single ventricle‐type congenital heart disease and intention to treat, 67% survive transplant‐free to at least 6 months beyond Fontan operation. An additional 5% survive to 4 years of age without transplant or Fontan completion. Fetuses with right ventricle–dominant lesions, extracardiac anomalies, hydrops, or low birthweights have decreased transplant‐free survival.
Sick Sinus Syndrome After the Maze Procedure Performed Concomitantly With Mitral Valve Surgery
Authors: Cho Min Soo , Heo Ran , Jin Xin , Lee Jung‐Bok , Lee Sahmin , Kim Dae‐Hee , Kim Joon Bum , Kim Jun , Jung Sung‐Ho , Choo Suk Jung , Song Jong‐Min , Nam Gi‐Byoung , Choi Kee‐Joon , Kang Duk‐Hyun , Chung Cheol Hyun , Lee Jae Won , Kim You‐Ho , Song Jae‐Kwan
Published: September 2018

Background

To characterize the development of sick sinus syndrome (
SSS
) after the additive maze procedure (
MP
) during mitral valve surgery.

Methods and Results

Follow‐up data (median, 3.6 years) of 750 patients with a prevalence of rheumatic cause of 57.6% were analyzed.
SSS
occurred in 35 patients with a time‐dependent increase: the incidence rates at 1, 2, and 4 years after surgery were 2.9%, 3.7%, and 4.3%, respectively. The additive
MP
showed higher risks of
SSS
development (hazard ratio, 7.44; 95% confidence interval, 3.45–16.05;
P
<0.001) and pacemaker implantation (hazard ratio, 3.61; 95% confidence interval, 1.95–6.67;
P
<0.001). Patients who developed
SSS
showed higher 4‐year rates of clinical events (death, stroke, and hospital admission) (67.5±8.5% versus 33.0±1.9%;
P
<0.001). After adjustment for age and preoperative peak systolic pulmonary artery pressure, the lesion extent (biatrial versus left atrial
MP
), not the underlying cause (rheumatic versus nonrheumatic), was independently associated with
SSS
development (hazard ratio, 3.58; 95% confidence interval, 1.08–11.86;
P
=0.037). The adverse effect of the biatrial
MP
was confirmed in patients with trivial or mild preoperative tricuspid regurgitation showing higher
SSS
incidence (4.6±1.4% versus 1.0±0.7%;
P
=0.023), not in those with moderate‐to‐severe tricuspid regurgitation (6.8±1.7% versus 3.8±3.8%;
P
=0.337). Recurrence of atrial fibrillation was not associated with the lesion extent of the
MP
.

Conclusions

After the additive
MP
, the ongoing risk of
SSS
development should be acknowledged irrespective of the underlying cause. Considering additive risk of biatrial
MP
with similar atrial fibrillation recurrence rate, minimizing lesion extent is warranted.
Sulfonylurea Drugs Do Not Influence Initial Stroke Severity and In-Hospital Outcome in Stroke Patients With Diabetes
Authors: Weih Markus , Amberger Nicola , Wegener Susanne , Dirnagl Ulrich , Reuter Thomas , Einhäupl Karl
Published: September 2018

Background and Purpose

—

Sulfonylurea drugs inhibit ATP-dependent potassium channels and may increase mortality after myocardial infarction. Sulfonylurea drugs also inhibit ischemic preconditioning in experimental models of brain ischemia and in clinical studies in the human heart.

Methods

—

In the present study we examined the impact of sulfonylurea drugs on in-hospital mortality and the immediate neurological deficit of diabetic stroke patients. From a larger stroke data bank, we studied 146 diabetic patients with acute hemispheric ischemic stroke. Sixty patients were using sulfonylurea drugs.

Results

—

Major baseline characteristics such as age, blood pressure, admission glucose level, HbA
1c
, distribution of cardiovascular risk factors, and presumed stroke etiology (Trial of Org 10172 in Acute Stroke Treatment [TOAST] criteria) were not different. Mortality (15% versus 14%;
P
=0.86) and initial stroke severity (Canadian Neurological Scale score, 7.4 versus 7.5;
P
=0.79) were not significantly different between patients with and without sulfonylurea drugs. Further end points such as Rankin Scale score, deteriorating stroke, duration of hospital stay, type of infarcts on CT/MRI, requirement of intensive care, and complications were not different. In a stepwise logistic regression model, sulfonylurea drugs were not independent predictors for increased mortality, deteriorating stroke, or stroke severity.

Conclusions

—

In the present hospital-based study, sulfonylurea drugs in patients with diabetes and stroke are not associated with increased stroke severity, mortality, or a worse in-hospital outcome.
Twenty-four–Hour Blood Pressure and MRI as Predictive Factors for Different Outcomes in Patients With Lacunar Infarct
Authors: Yamamoto Y. , Akiguchi I. , Oiwa K. , Hayashi M. , Kasai T. , Ozasa K.
Published: September 2018

Background and Purpose

—

A long-term follow-up study was conducted in patients with lacunar infarct to assess how 24-hour blood pressure monitoring values and MRI findings, in particular lacunar infarcts and diffuse white matter lesions, can predict subsequent development of dementia and vascular events, which include cerebrovascular and cardiovascular events.

Methods

—

One hundred seventy-seven patients were tracked for a mean of 8.9 years of follow-up. Documented events comprise the development of dementia and the occurrence of vascular events. The predictors for developing dementia and vascular events were separately evaluated by Cox proportional hazards analysis.

Results

—

Twenty-six patients developed dementia (0.17/100 patient-years). Male sex (relative risk [RR], 4.2; 95% CI, 1.2 to 14.7), cognitive impairment (RR, 3.0; 95% CI, 1.0 to 8.5), confluent DWML (moderate: RR, 7.1; 95% CI, 1.6 to 31.5; severe: RR, 35.8; 95% CI, 7.2 to 177.3), and nondipping status (RR, 7.1; 95% CI, 2.2 to 22.0) were independent predictors for dementia. Forty-six patients suffered from vascular events (3.11/100 patient-years). Diabetes mellitus (RR, 5.7; 95% CI, 2.7 to 11.9), multiple lacunae (moderate: RR, 6.4; 95% CI, 2.5 to 15.8; severe: RR, 8.5; 95% CI, 3.1 to 23.3), and high 24-hour systolic blood pressure (>145 mm Hg versus <130 mm Hg) (RR, 10.3; 95% CI, 1.3 to 81.3) were independent predictors for vascular events.

Conclusions

—

Predictors for developing dementia and vascular events appear to differ. Male sex, confluent diffuse white matter lesions, and nondipping status were independent predictors for subsequent development of dementia, while diabetes mellitus, multiple lacunae, and high 24-hour systolic blood pressure were independent predictors for vascular events.
Coming Home
Authors: Glants Musya
Published: September 2018

I recount the hardship of returning from evacuation to a Riga ravaged by war—and of citizens who were the victim of a constant, inner duality, i.e. of the contradiction between the external conventions of Soviet reality and the inner falsity of Bolshevik ideology. I describe how difficult it was for young people to overcome the nagging moral deterioration of the regime and then the complex process of spiritual liberation in the wake of destalinization.
Sex Differences in Time Trends on Incidence Rates of Oropharyngeal and Oral Cavity Cancers in Hong Kong
Authors: Chan Man Hin , Wang Feng , Mang Wai kong , Tse Lap Ah
Published: September 2018

Objectives:

Worldwide studies have shown an increasing trend of oropharyngeal squamous cell carcinoma (OPSCC) but a decreasing trend of oral cavity cancers over the past 2 decades, particularly in developed countries with successful tobacco control. This trend has been attributed to the increase in the incidence of human papillomavirus (HPV)–associated OPSCC. The aim of this study was to examine sex differences in incidence trends of oropharyngeal and oral cavity cancers in Hong Kong from 1983 to 2014.

Methods:

Using data from the Hong Kong Cancer Registry from 1983 to 2014, age-standardized incidence rates for potentially HPV-associated sites (oropharyngeal) and non-HPV-associated sites (oral cavity) were calculated, stratified by sex and age groups. Joinpoint regression and an age-period-cohort model were used to assess incidence trends.

Results:

A total of 1,972 cases of oropharyngeal cancer and 7,389 cases of oral cavity cancer were diagnosed from 1983 to 2014. The male/female ratios were 4.16:1 for oropharyngeal cancers and 1.63:1 for oral cavity cancers. A significant increasing trend was observed in oropharyngeal cancers from 1994 to 2014 (average annual percentage change = 2.66, P < .05). In contrast, a significant decreasing trend was observed in oral cavity cancers from 1983 to 1994 (average annual percentage change = −5.36, P < .05). The trends were more significant in men and in patients aged 45 to 69 years. A positive birth cohort effect was observed for oropharyngeal cancer in men.

Conclusions:

The rising trend of oropharyngeal cancer and decreasing trend of oral cavity cancer in Hong Kong from 1983 to 2014 are consistent with worldwide trends. Increase in high-risk sexual behaviors and oral HPV infection may influence the difference in trends.
Endoscopic Endonasal Approach to the Lateral Wall of the Cavernous Sinus: A Cadaveric Feasibility Study
Authors: Amin Sameh M. , Fathy Hesham , Hussein Ahmed , Kamel Mohamed , Hegazy Ahmed , Fathy Mohamed
Published: September 2018

Objective:

A transcranial extradural approach to the middle cranial fossa (MCF) requires separation of the dural layers of the lateral wall of the cavernous sinus. The authors tested the feasibility of an endonasal approach for this separation.

Methods:

A cadaveric feasibility study was conducted on the sides of 14 dry skulls and 10 fresh cadaveric heads. An endonasal, transsphenoidal, transpterygoid approach was taken to the MCF. The maxillary struts and medial greater wing of the sphenoid below the superior orbital fissure were drilled with transposition of the maxillary nerve. The lateral cavernous dural layers were split at the maxillary nerve with separation of the temporal lobe dura and exposure of the MCF bony base. The integrity of the cranial nerves and inner and outer dural layers of the lateral cavernous wall was checked. Different measurements of bony landmarks were obtained.

Results:

The integrity of the dural layers of the lateral cavernous wall and the cranial nerves were preserved in 10 heads. The mean area of the bony corridor was 4.68 ± 0.97 cm2, the V2-to-V3 distance was 15.21 ± 3.36 mm medially and 18.21 ± 3.45 mm laterally, and the vidian canal length was 13.01 ± 3.06 mm.

Conclusions:

Endonasal endoscopic separation of the lateral cavernous dural layers is feasible without crossing the motor cranial nerves, allowing better exposure of the MCF.
Surgical Treatment Modalities for Iatrogenic Anterior Glottic Stenosis
Authors: Cao Yitan , Sun Guangbin
Published: September 2018

Objectives:

The aim of this study was to describe common iatrogenic causes of anterior glottic stenosis and to investigate the surgical treatment outcomes of 3 different techniques aimed at repairing stenoses and preventing web reformation.

Methods:

Clinical information regarding patient demographics, presentation, etiology, treatment, and follow-up outcomes was obtained retrospectively through a review of patients’ records between April 2010 and April 2017. Voice quality was evaluated using grade, roughness, breathiness, asthenia, and strain scale and Voice Handicap Index scores. Objective acoustic parameters were collected using the Kay Elemetrics Multi-Speech program.

Results:

Twenty patients were included in the study. Causes of glottic web formation included chemoradiation therapy and previous laryngeal surgery for polyps or malignant tumors at the anterior commissure. Web lysis with a CO2 laser, intralaryngeal suturing, and keel placement were used in surgical treatment. Satisfactory results were achieved in 19 patients, and 1 recurrence was observed. Grade, roughness, breathiness, asthenia, and strain scale and Voice Handicap Index scores and objective voice variables for patients with Cohen type I or II webs improved significantly after the surgery.

Conclusions:

Treatment modalities for anterior glottic stenosis should be carefully chosen according to the etiology of the web, as well as the length and depth of the glottis involved.
Critically Ill Recipients of Weight-Based Fluconazole Meeting Drug-Induced Liver Injury Network Criteria
Authors: Joseph Merlyn , Brady Rebecca , Attridge Russell , Cota Jason , Horlen Cheryl , Lusk Kathleen , Attridge Rebecca L.
Published: September 2018

Background: Fluconazole-associated liver injury is estimated to occur in <10% of patients; however, effect of weight-based fluconazole dosing on liver injury is unknown. Furthermore, no studies have systematically applied the Drug-Induced Liver Injury Network (DILIN) Criteria to identify patients who may have drug-induced liver injury in an intensive care unit (ICU) setting. Objective: This study evaluated how often patients met DILIN criteria when receiving fluconazole daily doses of <6 mg/kg versus ⩾6 mg/kg. Methods: This dual-center, retrospective cohort study was performed in hospitalized critically ill fluconazole recipients. We compared liver function tests (LFTs) upon fluconazole initiation to peak LFTs within 2 weeks after discontinuation using DILIN criteria. The primary objective was to evaluate the number of patients meeting DILIN criteria when receiving fluconazole daily doses of <6 mg/kg versus ⩾6 mg/kg. Secondary objectives were to evaluate incidence of patients meeting DILIN criteria in patients with renal dysfunction, cirrhosis, septic shock, or those receiving a loading dose. Results: Of 248 patients included, 90% had a documented fungal infection or received empiric therapy for suspected invasive candidiasis. In patients receiving <6 mg/kg of fluconazole, 55% (110/199) met DILIN criteria versus 46.9% (23/49) in the ⩾6 mg/kg cohort ( P = .20). Only 14.5% of patients meeting DILIN criteria also met the definition for hepatocellular damage. Weight-based fluconazole dose and creatinine clearance <50 mL/min were not independent risk factors for meeting DILIN criteria. However, 77.3% of patients with cirrhosis met DILIN criteria (OR 4.84 [95% confidence interval, CI, 2.61-9.28]) and 76.3% with septic shock met DILIN criteria (OR 4.56 [95% CI, 2.44-8.88]). Conclusion: Weight-based fluconazole dosing did not affect the number of critically ill recipients who met DILIN criteria. However, DILIN criteria may overestimate the incidence of fluconazole-associated liver injury in critically ill patients.
Scale Development in Tourism Research: Advocating for a New Paradigm
Authors: Kock Florian , Josiassen Alexander , Assaf A. George
Published: September 2018

The authors advocate for a new paradigm in scale development practices to increase the impact of tourism research.
Effect of Threat and Social Identity on Reactions to Ingroup Criticism: Defensiveness, Openness, and a Remedy
Authors: Adelman Levi , Dasgupta Nilanjana
Published: September 2018

Openness to criticism and dissenting opinions is enormously important to group decision-making. Past research has found that people are more persuaded by criticism of their group when it comes from fellow ingroup members rather than outgroup members. But this ingroup advantage is not boundless. Three experiments demonstrate that the ingroup advantage related to openness to criticism is erased when perceivers feel their group is under threat. The results further suggest that the psychological mechanism underlying defensive responses to criticism is attributional—Threat elicits greater suspicion of ingroup critics’ motives, which eliminates the ingroup critic’s advantage relative to outgroup critics. A final experiment tests an intervention designed to increase openness to criticism and finds that reminders of the importance of dissent and free speech emerge as an effective remedy to increase the persuasiveness of criticism despite high threat.
A Two-Parameter Logistic Extension Model: An Efficient Variant of the Three-Parameter Logistic Model
Authors: Zhu Zhemin , Wang Chun , Tao Jian
Published: September 2018

A three-parameter logistic (3PL) model variant, named the two-parameter logistic extension (2PLE) model, was developed. This new model employs a function that integrates item features according to an examinee’s ability level instead of a fixed guessing parameter used in the 3PL model to quantify guessing behavior. Correct response probabilities from a solution behavior and guessing behavior increase as the level of ability increases. At extreme cases in which the level of ability is close to negative infinity, the 2PLE model degenerates into a 3PL model with a guessing probability at chance level (i.e., 1/ m, where m is the number of options). The properties of the 2PLE model were described and compared with those of other guessing models. Then, a simulation study comparing the performance of the 2PLE model with that of the 3PL model under three scenarios was conducted. Results showed that the 2PLE model generally outperforms the 3PL model. Finally, the application of the new model in comparison with several existing models was demonstrated by using two real data sets.
An Investigation of the Uncertainty of Handbook of Emission Factors for Road Transport (HBEFA) for Estimating Greenhouse Gas Emissions: A Case Study in Beijing
Authors: Lu Hongyu , Song Guohua , Zhao Qi , Wang Jingyi , He Weinan , Yu Lei
Published: September 2018

The reliability of estimation of emissions under the Handbook of Emission Factors for Road Transport (HBEFA) model has not been thoroughly studied and the mechanics of the model have not been fully investigated. The HBEFA structure of typical driving cycles is analyzed in this study regarding its uncertainty for estimating greenhouse gas (GHG) emissions. The key parameter of the HBEFA model, relative positive acceleration (RPA), is analyzed for its sensitivity to GHG emissions. The results indicate that uncertainties in estimation of GHG emissions do exist in the HBEFA model. The uncertainties are derived from the adoption of selected driving cycles and from the parameter of RPA. Given the uncertainties of estimating the GHG emission factors of driving cycles, it might be difficult for the selected driving cycles to represent all traffic situations. Uncertainties also exist in the selection of the top-20 driving cycles. For the selected samples of driving cycles, the sensitivity of RPA is found to be insufficient in describing the emission differences, due to the insensitivity of RPA to acceleration and deceleration. Different driving characteristics may still yield the same RPA, which indicates the potential inability of RPA to capture specific traffic scenarios such as intersections, ramps, and congestion.
The Relationship between College Major Prestige/Status and Post-baccalaureate Outcomes
Authors: Pitt Richard N. , Zhu Lin
Published: September 2018

Since Blau and Duncan’s seminal work on social mobility, researchers have used subjective measures of occupational prestige to understand either the change or stability in generational socioeconomic statuses. While subjective measures of occupational prestige have been developed, the creation of measures of educational status and prestige that might serve as parallels to these measures has received less attention. In this paper, we attempt to create such a measure and then use it to test the relationship between educational status (measured through the status of college majors) and three important post-baccalaureate outcomes: income, educational attainment, and occupational prestige. Our results, based on a survey of 718 undergraduate seniors, shows that majors differ in prestige just as occupations do. Then, using the National Survey of College Graduates, we confirm that those differences are meaningful in predicting early career incomes, the attainment of an advanced degree, and the prestige rating of college graduates’ occupations.