bluuebunny/crossref_metadata_2025 huggingface dataset:
Differentiation of Pituitary Adenoma from Rathke Cleft Cyst: Combining MR Image Features with Texture Features
Authors: Zhang Yang , Chen Chaoyue , Tian Zerong , Cheng Yangfan , Xu Jianguo
Published: October 2019

Objectives. To differentiate pituitary adenoma from Rathke cleft cyst in magnetic resonance (MR) scan by combing MR image features with texture features. Methods. A total number of 133 patients were included in this study, 83 with pituitary adenoma and 50 with Rathke cleft cyst. Qualitative MR image features and quantitative texture features were evaluated by using the chi-square tests or Mann–Whitney U test. Binary logistic regression analysis was conducted to investigate their ability as independent predictors. ROC analysis was conducted subsequently on the independent predictors to assess their practical value in discrimination and was used to investigate the association between two types of features. Results. Signal intensity on the contrast-enhanced image was found to be the only significantly different MR image feature between the two lesions. Two texture features from the contrast-enhanced images (Histo-Skewness and GLCM-Correlation) were found to be the independent predictors in discrimination, of which AUC values were 0.80 and 0.75, respectively. Besides, the above two texture features (Histo-Skewness and GLCM-Contrast) were suggested to be associated with signal intensity on the contrast-enhanced image. Conclusion. Signal intensity on the contrast-enhanced image was the most significant MR image feature in differentiation between pituitary adenoma and Rathke cleft cyst, and texture features also showed promising and practical ability in discrimination. Moreover, two types of features could be coordinated with each other.
Adaptive Robust Blind Watermarking Scheme Improved by Entropy‐Based SVM and Optimized Quantum Genetic Algorithm
Authors: Zhang Jun , Zhou Xiaoyi , Yang Jilin , Cao Chunjie , Ma Jixin
Published: October 2019

With the intensive study of machine learning in digital watermarking, its ability to balance the robustness and transparency of watermarking technology has attracted researchers’ attention. Therefore, quantum genetic algorithm, which serves as an intelligent optimized scheme combined with biological genetic mechanism and quantum computing, is widely used in various fields. In this study, an adaptive robust blind watermarking algorithm by means of optimized quantum genetics (OQGA) and entropy classification‐based SVM (support vector machine) is proposed. The host image was divided into two parts according to the odd and even rows of the host image. One part was transformed by DCT (discrete cosine transform), and then the embedding intensity and position were separately trained by entropy‐based SVM and OQGA; the other part was by DWT (discrete wavelet transform), in which the key fusion was achieved by an ergodic matrix to embed the watermark. Simulation results indicate the proposed algorithm ensures the watermark scheme transparency as well as having better resistance to common attacks such as lossy JPEG compression, image darken, Gaussian low‐pass filtering, contrast decreasing, salt‐pepper noise, and geometric attacks such as rotation and cropping.
The Importance of Land Use Definition in Human Health Risk Assessment Related to Lead in Soils
Authors: Urrutia-Goyes Ricardo , Ornelas-Soto Nancy
Published: October 2019

In many countries, soil contamination and lead exposure is a persistent human and environmental health issue, while in others, it is an emerging concern. Defining the extent of lead contamination and assessing human health risk allow for efficient prevention agendas. The different types of land uses delimit the exposure frequency and hence can influence the evaluation of possible threats. In this study, human health risk assessment is performed under different land use scenarios, after determining the concentration of lead in topsoil of a rehabilitated space. An analytical hybrid method was used to determine the concentrations of the heavy metal. Human health risk indicators, hazard quotient and cancer risk, were subsequently calculated and compared under such scenarios of varying population exposure by land use. Results indicate that an increasing exposure can set health risk indicators above the tolerable levels. Correctly defining the exposure frequency by land use is very important to determine the actual risk levels of a site. Local regulators should take this information into account before designing prevention plans, especially in localities where migration and urbanization are major development factors and since the land use of a public place could change over time and alter the exposure frequency to soil.
Therapeutic Breast Reconstruction Using Gene Therapy–Delivered IFNγ Immunotherapy
Authors: Davis Christopher R. , Than Peter A. , Khong Sacha M.L. , Rodrigues Melanie , Findlay Michael W. , Navarrete Daniel J. , Ghali Shadi , Vaidya Jayant S. , Gurtner Geoffrey C.
Published: October 2019

After mastectomy, breast reconstruction is increasingly performed using autologous tissue with the aim of improving quality of life. During this procedure, autologous tissue is excised, relocated, and reattached using microvascular anastomoses at the site of the extirpated breast. The period during which the tissue is ex vivo may allow genetic modification without any systemic exposure to the vector. Could such access permit delivery of therapeutic agents using the tissue flap as a vehicle? Such delivery may be more targeted and oncologically efficient than systemic therapy, and avoid systemic complications. The cytokine IFNγ has antitumor effects, and systemic toxicity could be circumvented by localized delivery of the IFNγ gene via gene therapy to autologous tissue used for breast reconstruction, which then releases IFNγ and exerts antitumor effects. In a rat model of loco-regional recurrence (LRR) with MADB-106-Luc and MAD-MB-231-Luc breast cancer cells, autologous tissue was transduced ex vivo with an adeno-associated viral vector encoding IFNγ. The “Therapeutic Reconstruction” released IFNγ at the LRR site and eliminated cancer cells, significantly decreased tumor burden, and increased survival compared with sham reconstruction (P <0.05). Mechanistically, localized IFNγ immunotherapy stimulated M1 macrophages to target cancer cells within the regional confines of the modified tumor environment. This concept of “Therapeutic Breast Reconstruction” using ex vivo gene therapy of autologous tissue offers a new application for immunotherapy in breast cancer with a dual therapeutic effect of both reconstructing the ablative defect and delivering local adjuvant immunotherapy.
Antibody–Drug Conjugates: A Comprehensive Review
Authors: Khongorzul Puregmaa , Ling Cai Jia , Khan Farhan Ullah , Ihsan Awais Ullah , Zhang Juan
Published: October 2019

Antibody–drug conjugates (ADC) are one of the fastest growing anticancer drugs. This approach comprises a mAb conjugated to the cytotoxic payload via a chemical linker that directed toward a target antigen expressed on the cancer cell surface, reducing systemic exposure and therefore toxicity. ADCs are complex molecules that require careful attention to various components. Selection of an appropriate target, an mAb, cytotoxic payload, and the manner in which the antibody is linked to the payload are key determinants of the safety and efficacy of ADCs. This review provides an overview of the systemic evaluation of each component of an ADC design, improved understanding of the mechanism of action of ADC, and mechanistic pathways involved in ADC resistance and various strategies to optimize ADC design. Moreover, this review also shed light on the current status of ADCs that have gained regulatory approval from the FDA including a description of biology and chemistry, metabolic profiles, adverse events, drug interactions, and the future perspective on combination strategies with other agents, including immunotherapy.
Phase II Trial of Ipilimumab with Stereotactic Radiation Therapy for Metastatic Disease: Outcomes, Toxicities, and Low-Dose Radiation–Related Abscopal Responses
Authors: Welsh James W. , Tang Chad , de Groot Patricia , Naing Aung , Hess Kenneth R. , Heymach John V. , Papadimitrakopoulou Vassiliki A. , Cushman Taylor R. , Subbiah Vivek , Chang Joe Y. , Simon George R. , Ramapriyan Rishab , Barsoumian Hampartsoum B. , Menon Hari , Cortez Maria Angelica , Massarelli Erminia , Nguyen Quynh , Sharma Padmanee , Allison James P. , Diab Adi , Verma Vivek , Raju Uma , Shaaban Sherif G. , Dadu Ramona , Cabanillas Maria E. , Wang Kelvin , Anderson Clark , Gomez Daniel R. , Hahn Stephen , Komaki Ritsuko , Hong David S.
Published: October 2019

Ipilimumab is effective for patients with melanoma, but not for those with less immunogenic tumors. We report a phase II trial of ipilimumab with concurrent or sequential stereotactic ablative radiotherapy to metastatic lesions in the liver or lung (NCT02239900). Ipilimumab (every 3 weeks for 4 doses) was given with radiotherapy begun during the first dose (concurrent) or 1 week after the second dose (sequential) and delivered as 50 Gy in 4 fractions or 60 Gy in 10 fractions to metastatic liver or lung lesions. In total, 106 patients received ≥1 cycle of ipilimumab with radiation. Median follow-up was 10.5 months. Median progression-free survival time was 2.9 months (95% confidence interval, 2.45–3.40), and median overall survival time was not reached. Rates of clinical benefit of nonirradiated tumor volume were 26% overall, 28% for sequential versus 20% for concurrent therapy (P = 0.250), and 31% for lung versus 14% for liver metastases (P = 0.061). The sequential lung group had the highest rate of clinical benefit at 42%. There were no differences in treatment-related adverse events between groups. Exploratory analysis of nontargeted lesions revealed that lesions receiving low-dose radiation were more likely to respond than those that received no radiation (31% vs. 5%, P = 0.0091). This phase II trial of ipilimumab with stereotactic radiotherapy describes satisfactory outcomes and low toxicities, lending support to further investigation of combined-modality therapy for metastatic cancers.
Efficacy and Safety of Sodium Zirconium Cyclosilicate for Treatment of Hyperkalemia: An 11-Month Open-Label Extension of HARMONIZE
Authors: Roger Simon D. , Spinowitz Bruce S. , Lerma Edgar V. , Singh Bhupinder , Packham David K. , Al-Shurbaji Ayman , Kosiborod Mikhail
Published: October 2019

Background: Sodium zirconium cyclosilicate (SZC; formerly ZS-9) is a selective potassium (K+) binder for treatment of hyperkalemia. An open-label extension (OLE) of the ­HARMONIZE study evaluated efficacy and safety of SZC for ≤11 months. Methods: Patients from HARMONIZE with point-of-care device i-STAT K+ 3.5–6.2 mmol/L received once-daily SZC 5–10 g for ≤337 days. End points included achievement of mean serum K+ ≤5.1 mmol/L (primary) or ≤5.5 mmol/L (secondary). Results: Of 123 patients who entered the extension (mean serum K+ 4.8 mmol/L), 79 (64.2%) completed the study. The median daily dose of SZC was 10 g (range 2.5–15 g). The primary end point was achieved by 88.3% of patients, and 100% achieved the secondary end point. SZC was well tolerated with no new safety concerns. Conclusion: In the HARMONIZE OLE, most patients maintained mean serum K+ within the normokalemic range for ≤11 months during ongoing SZC treatment.
Germline Missense Mutation of Deleted in Malignant Brain Tumor 1 (DMBT1) in Familial Mediastinal Neuroendocrine Cancer and in vitro Effects in Thyroid Cancer Cells
Authors: Qu Ning , Shi Rong-Liang , Liao Tian , Huang Sheng-Lin , Wen Duo , Hu Jia-Qian , Zhang Ting-ting , Han Li-Tao , Ma Ben , Wang Jian , Wang Yu-Long , Wang Yu , Ji Qing-Hai
Published: October 2019

Background: Neuroendocrine tumors (NETs) rarely occur in the mediastinum and their etiology and pathogenesis are still unclear. Objectives: This study assessed inherited or de novo mutations in familial mediastinal NETs. Method: DNA samples from 4 patients were subjected to the whole-exome sequencing, and Sanger sequencing was used to identify Deleted in malignant brain tumor 1 (DMBT1) mutations in all 45 family members. Results: All patients showed a germline DMBT1 mutation at 4971C. Sanger sequencing data showed that 4 NETs and 2 carriers in the first patient’s family and 2 NETs and 4 carriers in the second patient’s family, respectively, had this DMBT1 mutation. The in vitro data showed that the ectopic expression of DMBT1 reduced tumor cell viability and migration by arresting the G1/S phase of the cell cycle. Conclusions: We identified a germline missense mutation in DMBT1D1657E as a susceptibility gene for familial mediastinal NETs.
Diagnostic Approaches to Neuroendocrine Neoplasms of Unknown Primary Site
Authors: Berner Alison May , Pipinikas Christodoulos , Ryan Anna , Dibra Harpreet , Moghul Ismail , Webster Amy , Luong Tu Vinh , Thirlwell Christina
Published: October 2019

Neuroendocrine neoplasms (NENs) arise from cells of neuronal and endocrine differentiation. While they are a rare entity, an increasing proportion of patients with NEN present with metastatic disease and no evident primary site using routine imaging or histopathology. NENs of unknown primary site have a poorer prognosis, often due to the challenge of selecting appropriate evidence-based management. We review the available literature and guidelines for the management of NENs of unknown primary site including clinical features, biochemical tests, histopathology, imaging, surgical exploration and localised and systemic treatments. We also discuss novel molecular techniques currently under investigation to aid primary site identification.
A Common Tag Nucleotide Variant in
MMP7
Promoter Increases Risk for Hypertension via Enhanced Interactions With CREB (Cyclic AMP Response Element-Binding Protein) Transcription Factor
Authors: Subramanian Lakshmi , Maghajothi Sakthisree , Singh Mrityunjay , Kesh Kousik , Kalyani Ananthamohan , Sharma Saurabh , Khullar Madhu , Victor Suma M. , Swarnakar Snehasikta , Asthana Shailendra , Mullasari Ajit S. , Mahapatra Nitish R.
Published: October 2019

MMP (matrix metalloproteinase)-7—a potent extracellular matrix degrading enzyme—is emerging as a new regulator of cardiovascular diseases. However, potential contributions of
MMP7
genetic variations to hypertension remain unknown. In this study, we probed for the association of a tag single-nucleotide polymorphism in the
MMP7
promoter (−181A/G; rs11568818) with hypertension in an urban South Indian population (n=1501). The heterozygous AG genotype significantly increased risk for hypertension as compared with the wild-type AA genotype (odds ratio, 1.60 [95% CI, 1.25–2.06];
P
=2.4×10
−4
); AG genotype carriers also displayed significantly higher diastolic blood pressure and mean arterial pressure than wild-type AA individuals. The study was replicated in a North Indian population (n=949) (odds ratio, 1.52 [95% CI, 1.11–2.09];
P
=0.01). Transient transfection experiments using
MMP7
promoter-luciferase reporter constructs revealed that the variant −181G allele conferred greater promoter activity than the −181A allele. Computational prediction and structure-based conformational and molecular dynamics simulation studies suggested higher binding affinity for the CREB (cyclic AMP response element-binding protein) to the −181G promoter. In corroboration, overexpression/downregulation of CREB and chromatin immunoprecipitation experiments provided convincing evidence for stronger binding of CREB with the −181G promoter. The −181G promoter also displayed enhanced responses to hypoxia and epinephrine treatment. The higher promoter activity of −181G allele translated to increased MMP7 protein level, and
MMP7
−
181AG
heterozygous individuals displayed elevated plasma MMP7 levels, which positively correlated with blood pressure. In conclusion, the
MMP7
A-181G promoter polymorphism increased MMP7 expression under pathophysiological conditions (hypoxic stress and catecholamine excess) via increased interactions with CREB and enhanced the risk for hypertension in its carriers.
Resistant Hypertension and Atherosclerotic Renal Artery Stenosis
Authors: Courand Pierre-Yves , Dinic Miriana , Lorthioir Aurélien , Bobrie Guillaume , Grataloup Christine , Denarié Nicolas , Soulat Gilles , Mousseaux Elie , Sapoval Marc , Azizi Michel , Amar Laurence
Published: October 2019

The effect of renal artery angioplasty on blood pressure in patients with true resistant hypertension and atherosclerotic renal artery stenosis has not been fully investigated due to the exclusion of these patients from most trials. In this study, we assessed the benefits of renal angioplasty on daytime ambulatory blood pressure (dABP) in this subgroup of patients. Medical records of our hypertension department were retrospectively analyzed from 2000 to 2016. Seventy-two patients were identified with resistant hypertension (dABP >135 or 85 mm Hg despite at least 3 antihypertensive drugs, including a diuretic) and atherosclerotic renal artery stenosis treated by angioplasty. Atherosclerotic renal artery stenosis was unilateral in 57 patients and bilateral in 15 patients. The mean age of the patients was 67.8±11.2 years; dABP was 157±16/82±10 mm Hg despite 4.0±1.0 antihypertensive treatments; estimated glomerular filtration rate was 52 (41–63) mL/min. After renal angioplasty, dABPM decreased by 14.0±17.3/6.4±8.7 mm Hg (
P
<0.001 for both), and the number of antihypertensive treatments decreased to 3.6±1.4 (
P
=0.002) with no significant change in estimated glomerular filtration rate. A high baseline systolic dABP and a low body mass index were independent predictors of systolic dABP changes. The decrease in dABP was confirmed in a subgroup of patients at one and 3 years of follow-up (N=31 and N=18 respectively,
P
≤0.001 for systolic and diastolic blood pressure at both visits). In this retrospective uncontrolled single-center study, angioplasty in patients with atherosclerotic renal artery stenosis and with true resistant hypertension significantly decreased dABP, reducing the need for antihypertensive treatment with no change in estimated glomerular filtration rate.
Leptin Restores Endothelial Function via Endothelial PPARγ-Nox1–Mediated Mechanisms in a Mouse Model of Congenital Generalized Lipodystrophy
Authors: Bruder-Nascimento Thiago , Faulkner Jessica L. , Haigh Stephen , Kennard Simone , Antonova Galina , Patel Vijay S. , Fulton David J.R. , Chen Weiqin , Belin de Chantemèle Eric J.
Published: October 2019

Leptin is the current treatment for metabolic disorders associated with acquired and congenital generalized lipodystrophy (CGL). Although excess leptin levels have been associated with vascular inflammation and cardiovascular disease in the context of obesity, the effects of chronic leptin treatment on vascular function remain unknown in CGL. Here, we hypothesized that leptin treatment will improve endothelial function via direct vascular mechanisms. We investigated the cardiovascular consequences of leptin deficiency and supplementation in male gBscl2
−/−
(
Berardinelli-Seip 2
gene–deficient) mice—a mouse model of CGL. CGL mice exhibited reduced adipose mass and leptin levels, as well as impaired endothelium-dependent relaxation. Blood vessels from CGL mice had increased NADPH Oxidase 1 (Nox1) expression and reactive oxygen species production, and selective Nox1 inhibition restored endothelial function. Remarkably, chronic and acute leptin supplementation restored endothelial function via a PPARγ-dependent mechanism that decreased Nox1 expression and reactive oxygen species production. Selective ablation of leptin receptors in endothelial cells promoted endothelial dysfunction, which was restored by Nox1 inhibition. Lastly, we confirmed in aortic tissue from older patients undergoing cardiac bypass surgery that acute leptin can promote signaling in human blood vessels. In conclusion, in gBscl2
−/−
mice, leptin restores endothelial function via peroxisome proliferator activated receptor gamma-dependent decreases in Nox1. Furthermore, we provide the first evidence that vessels from aged patients remain leptin sensitive. These data reveal a new direct role of leptin receptors in the control of vascular homeostasis and present leptin as a potential therapy for the treatment of vascular disease associated with low leptin levels.
Screening Glucose Challenge Test in Pregnancy Can Identify Women With an Adverse Postpartum Cardiovascular Risk Factor Profile: Implications for Cardiovascular Risk Reduction
Authors: Retnakaran Ravi , Ye Chang , Hanley Anthony J. , Connelly Philip W. , Sermer Mathew , Zinman Bernard
Published: October 2019

Background

The 1‐hour glucose challenge test (
GCT
) is routinely performed in pregnancy to screen for gestational diabetes mellitus. Remarkably, it has recently emerged that the
GCT
can also predict a woman's future risk of cardiovascular disease, although the mechanistic basis of this relationship is unclear. In this context we hypothesized that a higher
GCT
may identify women with an otherwise unrecognized adverse cardiovascular phenotype. Thus, we sought to evaluate the relationship between the antepartum
GCT
and subsequent postpartum cardiovascular risk factor profile.

Methods and Results

In this study 503 women completed a screening
GCT
in late second trimester and then underwent cardiometabolic characterization at 3 months postpartum, whereupon traditional (blood pressure, glucose, lipids) and nontraditional (apolipoprotein B, C‐reactive protein, adiponectin) cardiovascular risk factors were compared across
GCT
tertiles. At 3 months postpartum, each of the following risk factors progressively worsened from the lowest to middle to highest
GCT
tertile: fasting glucose (
P
=0.0002), 2‐hour glucose (
P
<0.0001), total cholesterol:high‐density lipoprotein cholesterol (
P
=0.0004), high‐density lipoprotein cholesterol (
P
=0.004), triglycerides (
P
=0.001), apolipoprotein B (
P
=0.001), and adiponectin (
P
=0.02). On multiple linear regression analyses, the
GCT
emerged as a significant independent predictor of higher fasting glucose (
P
=0.0006), 2‐hour glucose (
P
<0.0001), total cholesterol: high‐density lipoprotein cholesterol (
P
=0.0004), triglycerides (
P
=0.001), low‐density lipoprotein cholesterol (
P
=0.01), and apolipoprotein B (
P
=0.004) and of lower high‐density lipoprotein cholesterol (
P
=0.02) and adiponectin (
P
=0.0099). Moreover, these independent associations persisted after excluding women who had gestational diabetes mellitus.

Conclusions

The antepartum
GCT
can identify women with an adverse underlying cardiovascular risk factor phenotype.
Dangerous Confidence? Chinese Views on Nuclear Escalation
Authors: Cunningham Fiona S. , Fravel M. Taylor
Published: October 2019

Chinese views of nuclear escalation are key to assessing the potential for nuclear escalation in a crisis or armed conflict between the United States and China, but they have not been examined systematically. A review of original Chinese-language sources and interviews with members of China's strategic community suggest that China is skeptical that nuclear escalation could be controlled once nuclear weapons are used and, thus, leaders would be restrained from pursuing even limited use. These views are reflected in China's nuclear operational doctrine (which outlines plans for retaliatory strikes only and lacks any clear plans for limited nuclear use) and its force structure (which lacks tactical nuclear weapons). The long-standing decoupling of Chinese nuclear and conventional strategy, organizational biases within China's strategic community, and the availability of space, cyber, and conventional missile weapons as alternative sources of strategic leverage best explain Chinese views toward nuclear escalation. China's confidence that a U.S.-China conflict would not escalate to the use of nuclear weapons may hamper its ability to identify nuclear escalation risks in such a scenario. Meanwhile, U.S. scholars and policymakers emphasize the risk of inadvertent escalation in a conflict with China, but they are more confident than their Chinese counterparts that the use of nuclear weapons could remain limited. When combined, these contrasting views could create pressure for a U.S.-China conflict to escalate rapidly into an unlimited nuclear war.
A Case Study of Stratospheric Ozone Transport to the Northern San Francisco Bay Area and Sacramento Valley during CABOTS 2016
Authors: Clark Jodie , Chiao Sen
Published: October 2019

The California Baseline Ozone Transport Study (CABOTS) was a major air quality study that collected ozone measurements aloft between mid-May and mid-August of 2016. Aircraft measurements, ground-based lidar measurements, and balloon-borne ozonesondes collected precise upper-air ozone measurements across the central and Southern California valley. Utilizing daily ozonesonde data from Bodega Bay, California, and Modern-Era Retrospective Analysis for Research and Applications, version 2 (MERRA-2), reanalysis data for 25 July to 14 August 2016, three stratospheric intrusion events are identified over Northern California influencing air masses above Bodega Bay and Sacramento simultaneously. Calculated percent daily changes in afternoon ozonesonde observations indicate increasing ozone concentrations from the point of likely stratospheric air injection with the arrival of higher potential vorticity, confirmed by ensemble back trajectories. An analysis of the onsite surface monitoring ozone data indicates ozone increases in the observations for dates of plausible low-level stratospheric air influence. Further, a comparison of Bodega Bay surface ozone observations and 14 Sacramento Valley nonattainment zone surface sites show that the surface ozone observed at the higher-elevation surface sites in the lower Sierra Nevada foothills were positively correlated with elevated ozone captured by the ozonesondes within the lowest 0.5–1 km. The strongest correlations observed (~0.61) were between elevated Bodega Bay ozonesonde data and the Placerville (~612 m) afternoon surface ozone data, an indication that these regions separated by 200 km would be influence by the same ozone source. A comparison of daily changes in afternoon ozone show that the two locales often experience similar daily ozone increases or decreases. While this study leads to a basic quantification of stratospheric influence on surface ozone in the Sacramento nonattainment zone, a future campaign that examines ozone and winds aloft at both locales is suggested to improve the quantification of stratospheric ozone.
Regional Differences in Hourly Precipitation Characteristics along the Western Coast of South China
Authors: Li Jian , Li Nina , Yu Rucong
Published: October 2019

The regional differences in hourly precipitation characteristics along the western coast of South China are investigated. The coastal area can be divided into three regions: two regions with large precipitation amounts to the west and east of the Leizhou Peninsula and another region with less precipitation over the Leizhou Peninsula. The precipitation center west of the Leizhou Peninsula (Dongxing station) is dominated by heavy precipitation, which frequently peaks in the early morning and has a long duration. The precipitation center east of the Leizhou Peninsula (Yangjiang station) has a high frequency of weak precipitation. There are two kinds of precipitation that occur at Yangjiang: short-duration precipitation in the afternoon and long-lasting precipitation in the morning. Over the Leizhou Peninsula (Zhanjiang station), precipitation mainly occurs over a short duration in the afternoon. The possible reasons for the different precipitation features are discussed. The morning precipitation at Dongxing is usually caused by deep convection. A large proportion of the morning precipitation events are locally generated events, which are closely related to the southerly winds and topographic barriers. Among the many possible factors affecting the morning precipitation at Yangjiang, the convergence between the land breeze and prevailing onshore airflow is an important one. The afternoon precipitation events affecting Yangjiang mostly originate over the mountains northwest of Yangjiang. Influenced by the curvature of the coastline and the relatively flat terrain over the Leizhou Peninsula, there is no convergence and less convection in the morning. However, the Leizhou Peninsula is prone to being influenced by daytime thermal forcings, which trigger afternoon precipitation.
A Look at the Relationship between the Large-Scale Tropospheric Static Stability and the Tropical Cyclone Maximum Intensity
Authors: Downs Alexandria , Kieu Chanh
Published: October 2019

Various modeling and observational studies have suggested that tropical cyclone (TC) intensity tends to increase in the future due to projected warmer sea surface temperature (SST). This study examines the effects of the tropospheric stratification that could potentially offset the direct increase of TC intensity associated with the warmer SST. Using reanalysis datasets and TC records in the northwestern Pacific and the North Atlantic basins, it is shown that there exists a consistently negative correlation between the annually averaged TC intensity and the basinwide average of the tropospheric static stability. This negative correlation is more robust in the northwestern Pacific basin when using the TC lifetime maximum intensity but is somewhat less significant in the North Atlantic basin. Further separation of the troposphere into a lower (1000–500 hPa) and an upper layer (500–200 hPa) reveals that it is the upper-tropospheric static stability that plays a more dominant role in governing the TC intensity variability. The negating effects of a stable troposphere on TC intensity as found in this study suggest a partial offset of the projected increase in the TC potential intensity due to the future warmer SST. Thus, the tropospheric static stability is one of the key large-scale factors that need to be properly taken into account in studies of long-term TC intensity change.
Teacher stress: Balancing demands and resources
Authors: McCarthy Christopher Jay
Published: October 2019

Teacher stress takes a measurable toll the teaching workforce, as many teachers become burned out and decide to leave the profession. Christopher McCarthy explains that stress is a psychological process that results from how teachers appraise the balance between the demands in their classrooms and the resources they have to meet those demands. Understanding this imbalance may provide avenues for intervention for those 20-25% of teachers most vulnerable to stress. Such interventions include upstream structural efforts to calibrate demands across the school to better suit each teacher’s capacity and more targeted interventions aimed at teachers who are most at risk of stress.
First Person: Memories of the Teacher Corps
Authors: Woll Dan
Published: October 2019

In the 1970s, the American Teacher Corps gave young people willing to work in troubled schools two years of sink-or-swim training, a small stipend, a master’s’ degree, and a teaching certificate. Not sure what he wanted to do with his life, Dan Woll joined the program after his college graduation in 1970. Woll and his roommate stood out as two of the only White people in their inner-city neighborhood and school. Woll reflects on how it felt to be part of a school and community where he was a member of the racial group that helped perpetuate the inequalities that left the school in such poor condition.
Washington View: A caring society?
Authors: Ferguson Maria
Published: October 2019

A new report from the National Academies of Sciences, Engineering, and Medicine looks at how the science of adolescent development can inform efforts to improve adolescent well-being and overcome structural barriers to opportunity and equality. Maria Ferguson describes these findings and considers whether the United States does or does not care for its children as well as it should. Many young Americans face significant disadvantages that affect their brains in ways that amplify these challenges over time. These inequities are rooted in a winner-take-all economic system in which those who have a lot benefit as while those who have little continue to suffer.
Staff perceptions of barriers that lesbian, gay and bisexual residents face in long-term care settings
Authors: Villar Feliciano , Serrat Rodrigo , Celdrán Montserrat , Fabà Josep , Genover Mònica , Martínez Teresa
Published: October 2019

This study explores the difficulties that older lesbian, gay and bisexual residents may encounter when attempting to express their sexuality while living in long-term care facilities (LTCF), as perceived by staff. The sample was made up of 1714 staff members working in 152 Spanish long-term care institutions for older people. Answers to an open-ended question regarding barriers that older lesbian, gay and bisexual people living in residential institutions may face when attempting to express their sexuality were content-analysed. The results suggest that the barriers are almost exclusively caused by other people’s views on non-heterosexual issues, including both heterosexist assumptions (e.g. the lack of awareness of sexual diversity in LTC settings, something that is particularly frequent among care assistants) and homophobic attitudes and behaviours generally attributed by technical staff and managers to heterosexual residents. Practical and policy implications, which should take into account job role as a key factor, are discussed.
The HEART score in the era of the European Society of Cardiology 0/1-hour algorithm
Authors: Cortés Marcia , Haseeb Sohaib , Lambardi Florencia , Arbucci Rosina , Ariznavarreta Paula , Resi Silvana , Vergara Juan M , Katib Cristina , Campos Roberto , Trivi Marcelo , Costabel Juan P
Published: October 2019

Background:

The European Society of Cardiology’s 0/1-hour algorithm improves the early triage of patients towards “rule-out” or “rule-in” of non-ST-segment elevation myocardial infarction. The HEART score is a risk stratification tool for patients with undifferentiated chest pain. We sought to evaluate the performance of the European Society of Cardiology 0/1-hour algorithm and the HEART score to evaluate chest pain patients in the emergency department.

Methods:

In this prospective study, we applied the European Society of Cardiology 0/1-hour algorithm and the HEART score in 1355 consecutive patients who presented to the emergency department with symptoms suggestive of acute coronary syndrome without ST-segment elevation. Patients were followed for non-ST-segment elevation myocardial infarctions and major adverse cardiac events at 30 days: death, non-ST-segment elevation myocardial infarction, or unplanned coronary revascularization.

Results:

The European Society of Cardiology 0/1-hour algorithm classified 921 (68.0%) patients as “rule-out” and the HEART score classified 686 (50.6%) patients as “low-risk”. The 30-day incidence of non-ST-segment elevation myocardial infarctions was 0.32% in the European Society of Cardiology 0/1-hour algorithm “rule-out” patients versus 0.29% in the HEART score “low-risk” patients ( p=0.75). The rate of major adverse cardiac events was 7.7% in the European Society of Cardiology 0/1-hour algorithm “rule-out” patients versus 1.1% in the HEART score “low-risk” patients ( p<0.001).

Conclusion:

The European Society of Cardiology 0/1-hour algorithm identified more patients with low risk of non-ST-segment elevation myocardial infarctions at 30 days whereas for major adverse cardiac events, the HEART score had a greater capacity to detect low-risk patients.
How Should We Evaluate Syndesmosis Reduction on CT Scan?
Authors: Abdelaziz Mohamed E. , Hagemeijer Noortje , Guss Daniel , El-Hawary Ahmed , El-Mowafi Hani , DiGiovanni Christopher W.
Published: October 2019

Category:

Ankle, Sports, Trauma, Syndesmosis.

Introduction/Purpose:

Accurate reduction of the syndesmosis is essential to the restoration of normal ankle mechanics, but radiographic evaluation of reduction quality has been demonstrably unreliable. CT imaging has traditionally been considered the gold standard, but there is no uniformly accepted method by which to assess syndesmotic reduction on CT. The aim of this study was to evaluate intra- and interobserver reliability of published measurements for evaluation of syndesmosis reduction using weight-bearing CT scan.

Methods:

Medical records were reviewed to identify patients who underwent surgical stabilization of a unilateral syndesmotic injury. Exclusion criteria included patients less than 18 years old, ipsilateral pilon fracture, history of contralateral ankle or pilon fracture or syndesmosis injury, BMI >40, and any neurological impairment. Twenty eligible patients were recruited to participate in the study and underwent weight-bearing CT evaluation for both ankles simultaneously. The quality of syndesmotic reduction was evaluated using axial CT images at a level 1 cm proximal to the tibial plafond using nine published radiological measurements (Figure 1). Inter- and intraobserver reliability were assessed for each evaluation method. Side by side method (qualitatively observing the repaired laterality side by side with the contralateral control) was assessed using Kappa interrater agreement, while the reliabilities for all other continuous methods were assessed with interclass correlation coefficients (ICC).

Results:

The study cohort consisted of ten males and ten females with mean age of 43 years (range, 23-67 years). The intraobserver reliability of the side by side method was 0.49 and 0.24 for the first and second observers respectively, and the interobserver reliability was 0.24. The syndesmotic area showed the highest interobserver reliability (0.96), the highest intraobserver reliability for observer 2 (0.97), and the second highest intraobserver reliability for observer 1 (0.92). Fibular rotation had the second highest interobserver reliability in our results (0.84), with high intraobserver reliability of 0.91 and 0.8 for first and second observers, respectively. The other six radiological measurements had interobserver reliability that ranged between 0.62 and 0.83.

Conclusion:

Qualitatively assessing syndesmotic reduction via side by side comparison with the uninjured ankle had the least intra- and interobserver reliability and should not be relied upon to determine syndesmotic reduction quality. In contradistinction, syndesmotic area calculation showed the highest reliability for evaluating syndesmosis reduction, followed by fibular rotation. Additional efforts should be considered to standardize such measurements within CT image viewers, so they become seamlessly accessible in the clinical setting.
Open Lift, Drill, Fill and Fix (LDFF) for Talar OCDs: 2 to 4 Year Results in 16 Patients
Authors: Altink Nienke , Lambers Kaj , Dahmen Jari , Dahmen Jari , Kerkhoffs Gino
Published: October 2019

Category:

Ankle

Introduction/Purpose:

The purpose of this study was to describe the mid to long-term clinical and radiological outcomes of an open fixation technique for large primary talar osteochondral defects (OCD): Lift, Drill, Fill and Fix (LDFF).

Methods:

Nineteen patients underwent an open LDFF surgery. Mean follow-up was 35 months (SD 3.6). Pre-and postoperative clinical assessment included the Foot and Ankle Outcome Score (FAOS) and a numeric rating scale (NRS) on pain at rest and during weight-bearing. Remodeling and bone ingrowth were analyzed on CT at one year post-operatively.

Results:

15 out of 19 patients showed remodeling and bone ingrowth after the open LDFF procedure. Patients who did not show remodeling and bone ingrowth were treated by means of an OATS procedure. In the remaining 15 patients available at mid to long-term follow-up, LDFF led to a significant improvement of all FAOS subscales; FAOS-pain improved from 65 to 74 (p=0.014), FAOS-symptoms improved from 60 to 80 (p=0.005), FAOS-ADL improved from 80 to 85 (p=001), FAOS-sport improved from 38 to 61 (p=0.017) and FAOS-QoL improved from 38 to 64 (p=0.025). The NRS of pain at rest significantly improved from 3.2 to 1.2 (p=0.009), and pain during walking significantly improved from 6.5 to 1.6 (p<0.001). No complications occurred.

Conclusion:

Open LDFF of a talar OCDs show promising mid to long-term clinical and radiological results. A longer follow-up period with more study power is a subsequent necessary step in order to draw firmer conclusions about the longevity of this present procedure.
Pes Cavus and Hindfoot Varus Alignment Are Associated with Increased Rates of Peroneal Tendon Pathology
Authors: Coleman Michelle , Aziz Hibba , Deveza Lorenzo , Bradley Hallie , Pettit Rowland , Bahouth Sarah , Ahuero Jason , Palisch Andrew , Granberry William
Published: October 2019

Category:

Hindfoot, Midfoot/Forefoot

Introduction/Purpose:

Cavovarus foot alignment has been significantly associated with increased rates of chronic ankle instability and osteochondral lesions of the talus. Clinical wisdom suggests that cavovarus foot alignment causes varus stress to the ankle and also predisposes individuals to peroneal tendon pathology. However, no studies have specifically explored this relationship. The purpose of this research is to investigate the association between foot alignment and peroneal tendon pathology.

Methods:

A retrospective case-control study was conducted of all adult patients in whom a magnetic resonance image (MRI) of the ankle was obtained for any reason at a single institution from 2015-2017. Patients were excluded if they had a charcot foot deformity or if they had undergone prior peroneal tendon, ankle, or hindfoot surgery. Arch alignment was evaluated on lateral weightbearing radiographs of the foot by measuring the adjusted navicular height. Hindfoot alignment was assessed using the Saltzman apparent moment arm method. Peroneal tendon pathology including tears, tendinosis, and tenosynovitis was documented by a fellowship-trained musculoskeletal radiologist using the MRI scan. All numerical variables were converted to categorical variables (e.g. varus, valgus, and normal alignment). Chi-square testing was utilized to determine the association between variables.

Results:

195 patients were included in the study (average age 47 years, 61% female). Patients with hindfoot varus had significantly higher rates of peroneus longus (PL) and peroneus brevis (PB) tendon pathology than patients with neutral or valgus alignment (Figure 1 A, B)(PL 39% vs. 31% vs. 20%, p=0.01; PB 44% vs 27% vs. 27%, p=0.04). Patients with pes cavus demonstrated extremely high rates of peroneal tendon pathology, which was significantly higher than patients with neutral or pes planus alignment (Figure 1 C, D)(PL 71% vs. 28% vs. 9%, p<0.0001; PB 75% vs 30% vs. 26%, p<0.0001). Amongst patients with peroneal tendon pathology, there was no difference in the rates of symptomatic vs. asymptomatic findings based on hindfoot or pes alignment.

Conclusion:

This is the first study to demonstrate a statistically significant association between cavus foot alignment, hindfoot varus alignment, and peroneal tendon pathology. Interestingly, this study demonstrates that patients with cavovarus alignment are not more likely to be symptomatic than patients with normal and planovalgus alignment. This study also reinforces the idea that peroneal pathology found on MRI may not necessarily need surgery, as it is frequently seen in patients without symptoms. This information may be useful in counseling patients considering operative treatment for peroneal tendon pathology and alignment abnormalities.
PROMIS Patient Reported Pain Outcomes Compared With Numerical Pain Score Before and After Ankle Surgery
Authors: Haskell Andrew , Kim Todd
Published: October 2019

Category:

Patient Reported Outcomes

Introduction/Purpose:

Patient reported outcomes (PRO) are important for measuring clinical changes after surgical intervention. This study compares PROMIS pain intensity, PROMIS pain interference, and a zero-to-ten numerical pain score (NPS) before and after three common ankle surgeries to test the hypothesis that pain improvement is measurable by each scale. In addition, the effects size (ES) of each scale is compared to help determine which scale may provide the most power to detect an improvement in pain.

Methods:

PRO scores were routinely collected during clinic visits between 2015 and 2018. Over 175 patients who had undergone total ankle replacement, subtalar fusion, or lateral ankle ligament stabilization were identified in the electronic health record using the surgical billing codes for these procedures. The most recent preoperative and postoperative PROs for these patients were compared by Mann-Whitney U, and effect size was calculated using Cohen’s d.

Results:

For total ankle replacement, NPS, pain intensity, and pain interference all improved (p<0.05) with ES 1.29, 0.95, and 0.63 respectively. For subtalar fusion, NPS, and pain interference improved (p<0.05) with ES 0.86 and 0.54; pain intensity (p=0.21) was unchanged with ES 0.30. For lateral ankle ligament stabilization, NPS, and pain interference improved (p<0.05) with ES 0.49 and 0.59; pain intensity (p=0.49) was unchanged with ES 0.19.

Conclusion:

While both NPS and PROMIS pain interference consistently demonstrated improvements after common ankle surgeries, NPS is preferable given its single question format and greater effect size in two of the three procedures studies. PROMIS pain intensity did not routinely measure changes in our surgical population questioning its utility.
Retrograde Drilling for Osteochondral Lesion of the Talar Dome in Juvenile Patients
Authors: Ikuta Yasunari , Nakasa Tomoyuki , Tsuyuguchi Yusuke , Ota Yuki , Kanemitsu Munekazu , Adachi Nobuo
Published: October 2019

Category:

Ankle, Arthroscopy

Introduction/Purpose:

Osteochondral lesion of the talar dome (OLT) is common condition that causes pain of ankle joint in juvenile patients. Several surgical options have been available such as excision of detached cartilage fragment, microfracture, autologous cancellous bone graft and osteochondral autografting depending on the status of OLT. Arthroscopic drilling including transmalleolar or retrograde technique could be a good option for OLT patients with stable osteochondral fragment with normal articular surface. Retrograde drilling has an advantage in preventing the iatrogenic articular cartilage injury. This study aimed to clarify the clinical outcome of the retrograde drilling for OLT in juvenile patients.

Methods:

Our retrospective analysis included 8 patients who underwent retrograde drilling for OLT, in 5 boys and 3 girls, with a mean age of 14.9 years (range, 11-19). Range of motion (ROM) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle- hindfoot score were evaluated as the clinical outcomes. OLTs were classified into 4 grades according to arthroscopic findings by international cartilage research society (ICRS) classification. Radiographic analysis was performed using preoperative and postoperative images. Growth plate was evaluated on plane radiographs, and the location and size of OLT were assessed on computed tomography. The high intensity area of the talus was also measured on T2 fat suppression images.

Results:

All 8 patients were followed with a mean follow-up period of 2 years, and they had no complication or revision surgery. The mean total ROM were 65.6° preoperatively and 67.1° postoperatively. AOFAS scale improved from 69.3 to 96.7 (p = 0.012). The ICRS 1 and 2 OLT lesions were identified arthroscopically in 5 and 3 patients, respectively. Growth plate remained open in 4 patients, and OLTs were located on the posteromedial in 7 patients, center in 1 patient. The mean size of OLT fragment was 9.8 mm, 6.8 mm and 3.5 mm in length, width and height. Coronal and sagittal T2 fat suppression images demonstrated that the high intensity area of 241.3 mm2, 554.5 mm2 at preoperative status and 190.9 mm2, 302.6 mm2 at final follow-up status.

Conclusion:

These findings revealed that the retrograde drilling remarkably improved clinical status in juvenile OLT patients. The high intensity area at the talus remained postoperatively, however, that did not affect clinical results. Retrograde drilling procedure should be considered for treating juvenile patients in the early period after detection of the OLT.