bluuebunny/crossref_metadata_2025 huggingface dataset:
Stretchable multifunctional dielectric nanocomposites based on polydimethylsiloxane mixed with metal nanoparticles
Authors: Feng Pengdong , Zhong Mao , Zhao Weiwei
Published: November 2019

Next generation wearable electronics require stretchable dielectrics. There has been significant effort to characterize and improve the components of dielectric composites for use in these devices. In this work, a new stretchable dielectric material, composited by silver nanoparticles (Ag NPs), nickel nanoparticles (Ni NPs), and polydimethylsiloxane (PDMS), is prepared and characterized. The alternating arrays of Ag NPs groups and Ni NPs groups in the three-dimensional matrix of PDMS function as micro capacitors and prevent current percolation. Compared with PDMS alone, the alternating arrays exhibit a dielectric constant (
k
) that is increased by 1146% and can reach 35.13, with dielectric loss as low as 0.009. Slightly lower
k
and larger dielectric loss appear at high frequencies. The material exhibits negative temperature dependence, and the composition ratio affects the dielectric properties. The strain at break is 139.68% and the elastic modulus is as low as 3.57 kPa. By controlling the type, size and dispersion of metal nanoparticles in PDMS matrix, a parallel-plate capacitor with constant capacitance is achieved, demonstrating the dependence of the dielectric constant on the applied strain. Moreover, by replacing the parallel plates with cylindrical fibers, a capacitive strain sensor was demonstrated. After hundreds of stretching-releasing cycles, the dielectrics work normally. The excellent properties of this material suggest its significant potential for use in wearable electronics.
Textile band electrodes as an alternative to spot Ag/AgCl electrodes for calf bioimpedance measurements
Authors: Wang Ke , Zelko Dylan , Delano Maggie
Published: November 2019

Objective:
To evaluate the performance of five different types of textiles as band electrodes for calf bioimpedance measurements in comparison with conventional spot Ag/AgCl electrodes.
Approach:
Calf bioimpedance measurements were performed in 10 healthy volunteers with five different textile materials cut into bands and Ag/AgCl spot electrodes as a baseline. Collected bioimpedance data were analyzed in terms of precision, fit error and presence of measurement artifacts. Each textile material was also evaluated for participant comfort.
Main Results:
Bioimpedance values for spot electrodes were higher at low frequencies as compared with band electrodes but not at high frequencies. This suggests that spot electrodes have frequency dependent current distributions that adversely impact their use for volume measurements and band electrodes are preferable. The SMP130T-B fabric had the highest precision and the lowest best fit error to the Cole model of the tested textile materials. However, it was the least comfortable textile and most expensive. The Stretch material performed slightly worse than the SMP130T-B fabric, but was half the cost and the most comfortable.
Significance:
These results suggest that there are suitable textile materials for use as dry, band electrodes for calf bioimpedance measurements and that these band electrodes enable greater current uniformity. These textiles could be integrated into a compression sock for remote monitoring of diseases such as Congestive Heart Failure.
Cytokine Network and Sexual Human Immunodeficiency Virus Transmission in Men Who Have Sex With Men
Authors: Vanpouille Christophe , Frick Andrew , Rawlings Stephen A , Hoenigl Martin , Lisco Andrea , Margolis Leonid , Gianella Sara
Published: November 2019

Background

Seminal human immunodeficiency virus (HIV) transmission from men to their partners remains the main driver of HIV epidemics worldwide. Semen is not merely a carrier of the virus, but also provides an immunological milieu that affects HIV transmission.

Methods

We collected blood and semen from people with HIV whose epidemiologically linked sexual partners either did or did not acquire HIV. Viral transmission was confirmed by phylogenetic linkage (HIV pol). We measured the concentration of 34 cytokines/chemokines by Luminex in the blood and semen of 21 source partners who transmitted HIV (transmitters) and 22 who did not transmit HIV (nontransmitters) to their sexual partners. Differences between cytokine profiles in transmitters versus nontransmitters were analyzed using the multivariate statistical technique of partial least square discriminant analysis.

Results

The cytokine profile in seminal fluid, but not in peripheral blood, was significantly different between men who have sex with men (MSM) who transmitted HIV and those who did not transmit HIV to their sexual partners (E = 19.77; P < .01). This difference persisted after excluding people with undetectable HIV RNA levels in nontransmitters.

Conclusions

Seminal cytokine profiles correlated with transmission or nontransmission of HIV from the infected MSM to their partners, independently from seminal viral load. Seminal cytokine spectra might be a contributing determinant of sexual HIV transmission, thus providing new directions for the development of strategies aimed at preventing HIV transmission.
The antioxidant and physicochemical properties of microencapsulated bioactive compounds in Securigera securidaca (L.) seed extract by co-crystallization
Authors: Nik Ali Behnam , Vazifedoost Mohsen , Didar Zohreh , Hajirostamloo Bahareh
Published: November 2019

Securigera securidaca seed is a good source of phenolic compounds with high antioxidant properties. Preservation and maintenance of natural antioxidants have always been a challenge and microencapsulation is a suitable method for this purpose. In this study, the chemical compounds of the plant seed extract were identified by GC/MS device. Bioactive compounds from the seed ethanolic extract were microencapsulated in the sucrose matrix during the co-crystallization process. The evaluations included total phenolic compounds, radical scavenging ability, production efficiency, moisture content, and flowability characteristics of the produced powders, such as compressibility index, Hausner ratio, and angle of repose. The results showed significant differences in the phenolic compounds and the radical scavenging ability between the control sample and the co-crystallized powder (P < 0.05). The production efficiency and the moisture content of extract-containing co-crystallized powder were 84% and 0.14%, respectively. The particle size difference of the microencapsulated powder could significantly affect the powder flowability characteristics (P < 0.05), and particles with a size of 1 mm showed better flowability behaviour. FT-IR charts for samples revealed chemical bonds specific to saccharose molecule indicating no changes in covalent bonds present in saccharose molecule structure after the process. Scanning electron microscope images showed the presence of vacant spaces and porosity in the structure of saccharose crystals formed during the process of crystallization. As a result, the co-crystallized powder obtained from the plant extract can be used as an appropriate antioxidant in the food and pharmaceutical formulations.
Childlessness and Health Among Older Adults: Variation Across Five Outcomes and 20 Countries
Authors: Quashie Nekehia T , Arpino Bruno , Antczak Radoslaw , Mair Christine A
Published: November 2019

Objectives

No previous study to the best of our knowledge has examined the association between childlessness and health using a wide range of countries and health outcomes. This study improves previous literature by examining the relationship between “childlessness” (1 = childless for any reason, 0 = parent of biological, step, or adopted child) and health across 20 countries and five health outcomes.

Methods

Drawing on cross-sectional harmonized data from the family of Health and Retirement Surveys across the United States (HRS, Wave 11), Europe (SHARE, Waves 4 and 5), Mexico (MHAS, Wave 3), and China (CHARLS, Wave 2), we use logistic regression models to estimate the association between childlessness and poor health (poor self-rated health, 1 or more ADL limitations, 1 or more IADL limitations, 1 or more chronic conditions, and depression) in a sample of adults aged 50 and older across 20 countries (N = 109,648).

Results

Our results point to an absence of associations between childlessness and health, and suggest that childlessness may be associated with better (e.g., Mexico, Hungary) or worse health (e.g., Austria, Estonia, Netherlands, Poland) in certain contexts and for certain measures.

Discussion

We discuss these findings in light of the meaning of childlessness, as well as cross-national economic, social, and cultural contexts to provide suggestions for aging policy and future research.
Considerations on the Acceptance of German neologisms from the 1990s
Authors: Klosa-Kückelhaus Annette , Wolfer Sascha
Published: November 2019

Are borrowed neologisms accepted more slowly into the German language than German words resulting from the application of wrd formation rules? This study addresses this question by focusing on two possible indicators for the acceptance of neologisms: a) frequency development of 239 German neologisms from the 1990s (loanwords as well as new words resulting from the application of word formation rules) in the German reference corpus DeReKo and b) frequency development in the use of pragmatic markers (‘flags’, namely quotation marks and phrases such as sogenannt ‘so-called’) with these words. In the second part of the article, a psycholinguistic approach to evaluating the (psychological) status of different neologisms and non-words in an experimentally controlled study and plans to carry out interviews in a field test to collect speakers’ opinions on the acceptance of the analysed neologisms are outlined. Finally, implications for the lexicographic treatment of both types of neologisms are discussed.
Does Government Pay Attention to the Public? The Dynamics of Public Opinion and Government Attention in Posthandover Hong Kong
Authors: Xia Chuanli , Shen Fei
Published: November 2019

Government response to public opinion is essential to democratic theory and practice. However, previous research on the relationship between public opinion and government attention predominantly focuses on western societies. Little is known about such relationship in nonwestern or nondemocratic societies. Drawing upon time-series data of public opinion polls and government press releases, this study examines the dynamic relationships between public opinion and government attention in posthandover Hong Kong. The findings reveal that the responsiveness of the Hong Kong government to public opinion varies across issue domains and is constrained by the political power from the central government in Beijing.
Discordant Zika Virus Findings in Twin Pregnancies Complicated by Antenatal Zika Virus Exposure: A Prospective Cohort
Authors: Sobhani Nasim C , Avvad-Portari Elyzabeth , Nascimento Aline C M , Machado Heloisa N , Lobato Daniel S S , Pereira Jose Paulo , Esquivel Mikaela S , Vasconcelos Zilton C , Zin Andrea A , Tsui Irena , Adachi Kristina , Brickley Elizabeth B , Fisher Susan J , Nielsen-Saines Karin , Brasil Patricia , Moreira Maria E , Gaw Stephanie L
Published: November 2019

Background

There are limited data on the natural history of antenatal Zika virus (ZIKV) exposure in twin pregnancies, especially regarding intertwin concordance of prenatal, placental, and infant outcomes.

Methods

This prospective cohort study included twin pregnancies referred to a single institution from September 2015 to June 2016 with maternal ZIKV. Polymerase chain reaction (PCR) testing of maternal, placental, and neonatal samples was performed. Prenatal ultrasounds were completed for each twin, and histomorphologic analysis was performed for each placenta. Abnormal neonatal outcome was defined as abnormal exam and/or abnormal imaging. Two- to three-year follow-up of infants included physical exams, neuroimaging, and Bayley-III developmental assessment.

Results

Among 244 pregnancies, 4 twin gestations without coinfection were identified. Zika virus infection occurred at 16–33 weeks gestation. Zika virus PCR testing revealed discordance between dichorionic twins, between placentas in a dichorionic pair, between portions of a monochorionic placenta, and between a neonate and its associated placenta. Of the 8 infants, 3 (38%) had an abnormal neonatal outcome. Of 6 infants with long-term follow-up, 3 (50%) have demonstrated ZIKV-related abnormalities.

Conclusions

Neonatal PCR testing, placental findings, and infant outcomes can be discordant between co-twins with antenatal ZIKV exposure. These findings demonstrate that each twin should be evaluated independently for vertical transmission.
CAFE2: an upgrade to the CAFE high-resolution spectrograph. Commissioning results and new public pipeline
Authors: Lillo-Box J , Aceituno J , Pedraz S , Bergond G , Galadí-Enríquez D , Azzaro M , Arroyo-Torres B , Fernández-Martín A , Guijarro A , Hedrosa R P , Hermelo I , Hoyo F , Martín-Fernández P
Published: November 2019

CAFE is a high-resolution spectrograph with high-precision radial velocity capabilities mounted at the 2.2 m telescope of Calar Alto Observatory. It suffered from strong degradation after 4 yr of operations and it has now been upgraded. The upgrades of the instrument (now named CAFE2) aimed at recovering the throughput and improving the stability due to the installation of a new grating, an active temperature control in the isolated coudé room, and a new scrambling system. In this paper, we present the results of the new commissioning of the instrument and a new pipeline (CAFExtractor) that provides the user with fully reduced data including radial velocity measurements of FGK dwarf stars. The commissioning results show a clear improvement in the instrument performance. The room temperature is now stabilized down to 5 mK during one night and below 50 mK over two months. CAFE2 now provides 3 m s−1 precision on the reference ThAr frames and the on-sky tests provide a radial velocity precision of 8 m s−1 during one night (for S/N > 50). The throughput of the instrument is now back to nominal values with an efficiency of around 15 per cent at 550 nm. The limiting magnitude of the instrument for a 1 h exposure and S/N = 20 is V = 15. With all these properties, CAFE enters into the small family of high-resolution spectrographs at 2–4 m telescopes capable of reaching radial velocity precisions below 10 m s−1.
Blue galaxies: modelling nebular He ii emission in high redshift galaxies
Authors: Barrow Kirk S S
Published: November 2019

Using cosmological simulations to make useful, scientifically relevant emission line predictions is a relatively new and rapidly evolving field. However, nebular emission lines have been particularly challenging to model because they are extremely sensitive to the local photoionization balance, which can be driven by a spatially dispersed distribution of stars amidst an inhomogeneous absorbing medium of dust and gas. As such, several unmodelled mysteries in observed emission line patterns exist in the literature. For example, there is some question as to why He ii λ4686/H β ratios in observations of lower metallicity dwarf galaxies tend to be higher than model predictions. Since hydrodynamic cosmological simulations are best suited to this mass and metallicity regime, this question presents a good test case for the development of a robust emission line modelling pipeline. The pipeline described in this work can model a process that produces high He ii λ4686/H β ratios and eliminate some of the modelling discrepancy for ratios below 3 per cent without including AGNs, X-ray binaries, high mass binaries, or a top-heavy stellar initial mass function. These ratios are found to be more sensitive to the presence of 15 Myr or longer gaps in the star formation histories than to extraordinary ionization parameters or specific star formation rates. They also closely correspond to the WR phase of massive stars. In addition to the investigation into He ii λ4686/H β ratios, this work charts a general path forward for the next generation of nebular emission line modelling studies.
The Acute Kidney Outreach to Prevent Deterioration and Death trial: a large pilot study for a cluster-randomized trial
Authors: Thomas Mark E , Abdelaziz Tarek S , Perkins Gavin D , Sitch Alice J , Baharani Jyoti , Temple R Mark
Published: November 2019

Background and Objectives

The Acute Kidney Outreach to Reduce Deterioration and Death trial was a large pilot study for a cluster-randomized trial of acute kidney injury (AKI) outreach.

Methods

An observational control (before) phase was conducted in two teaching hospitals (9 miles apart) and their respective catchment areas. In the intervention (after) phase, a working-hours AKI outreach service operated for the intervention hospital/area for 20 weeks, with the other site acting as a control. All AKI alerts in both hospital and community patients were screened for inclusion. Major exclusion criteria were patients who were at the end of life, unlikely to benefit from outreach, lacking mental capacity or already referred to the renal team. The intervention arm included a model of escalation of renal care to AKI patients, depending on AKI stage. The 30-day primary outcome was a combination of death, or deterioration, as shown by any need for dialysis or progression in AKI stage. A total of 1762 adult patients were recruited; 744 at the intervention site during the after phase.

Results

A median of 3.0 non-medication recommendations and 0.5 medication-related recommendations per patient were made by the outreach team a median of 15.7 h after the AKI alert. Relatively low rates of the primary outcomes of death within 30 days (11–15%) or requirement for dialysis (0.4–3.7%) were seen across all four groups. In an exploratory analysis, at the intervention hospital during the after phase, there was an odds ratio for the combined primary outcome of 0.73 (95% confidence interval 0.42–1.26; P = 0.26).

Conclusions

An AKI outreach service can provide standardized specialist care to those with AKI across a healthcare economy. Trials assessing AKI outreach may benefit from focusing on those patients with ‘mid-range’ prognosis, where nephrological intervention could have the most impact.
Prognostic Utility of the New Definition of Difficult-to-Treat Resistance Among Patients With Gram-Negative Bloodstream Infections
Authors: Giannella Maddalena , Bussini Linda , Pascale Renato , Bartoletti Michele , Malagrinò Matteo , Pancaldi Livia , Toschi Alice , Ferraro Giuseppe , Marconi Lorenzo , Ambretti Simone , Lewis Russell , Viale Pierluigi
Published: November 2019

Background

To compare the prognostic utility of the new definition of difficult-to-treat resistance (DTR) vs established definitions in a cohort of patients with Gram-negative bloodstream infections (GNBSIs).

Methods

This was a retrospective single-center study of adult patients with monomicrobial GNBSI, hospitalized from 2013 to 2016. DTR was defined as isolate demonstrating intermediate or resistant phenotype to all reported agents in the carbapenem, beta-lactam, and fluoroquinolone classes. Carbapenem resistance (CR) was defined according to 2015 Centers for Disease Control and Prevention criteria. Each isolate was further classified according to the Magiorakos et al. criteria as non-multidrug-resistant (non-MDR), MDR, extensively drug-resistant (XDR), or pan-drug-resistant (PDR). The primary outcome was all-cause 30-day mortality.

Results

Overall, 1576 patients were analyzed. Enterobacteriaceae accounted for 88.7% of BSIs, with Escherichia coli (n = 941) and Klebsiella pneumoniae (n = 326) being the most common pathogens. Pseudomonas aeruginosa was the most common nonfermentative bacteria (n = 130, 8.2%). Overall, 11% of strains were defined as DTR and 13% as CR. Episodes were further classified as non-MDR (68.8%), MDR (21.9%), XDR (8.8%), and PDR (0.4%). The prevalence rates of DTR, CR, and XDR were similar among Enterobacteriaceae and Acinetobacter baumannii, whereas they differed in P. aeruginosa. All the analyzed resistance definitions significantly improved prediction of 30-day mortality when introduced into a baseline multivariate model, to a similar degree: 9%, 10%, and 11% for DTR, Magiorakos, and CR definitions, respectively.

Conclusions

DTR seems a promising tool to identify challenging GNBSIs, mainly those due to P. aeruginosa. With the availability of new agents for CR infections, further multicenter assessments of DTR are needed.
Exchange Rate Policies at the Zero Lower Bound
Authors: Amador Manuel , Bianchi Javier , Bocola Luigi , Perri Fabrizio
Published: November 2019

We study the problem of a monetary authority pursuing an exchange rate policy that is inconsistent with interest rate parity because of a binding zero lower bound constraint. The resulting violation in interest rate parity generates an inflow of capital that the monetary authority needs to absorb by accumulating foreign reserves. We show that these interventions by the monetary authority are costly, and we derive a simple measure of these costs: they are proportional to deviations from the covered interest parity (CIP) condition and the amount of accumulated foreign reserves. Our framework can account for the recent experiences of “safe-haven” currencies and the sign of their observed deviations from CIP.
Managing Pain During an Opioid Epidemic
Authors: Ortelli Tracy A.
Published: November 2019

Resources for nurses, patients, and the public.
The Power of Silence
Authors: Collins Amy M.
Published: November 2019

‘The Pause’ honors patients who have passed and the medical team that cared for them.
The Way of Johnson Tower
Authors: Darby Mark
Published: November 2019

An NP is reminded by clinic patients and their community that caring is a two-way street.
Mindfulness & hypertension
Authors: Stewart Amy , Zimmerman Ashleigh , Tutterow Courtney , Manna John , Meletis Stephanie , Conner Ruth S.
Published: November 2019

BP control is important for overall health and reduced mortality secondary to cardiovascular disease. Find out how teaching your patients about mindfulness can help.
Leveraging the Medical School Admissions Process to Foster a Smart, Humanistic, and Diverse Physician Workforce
Authors: Schwartzstein Richard M.
Published: November 2019

An excellent physician has a range of talents, including the knowledge and critical thinking abilities to work with the rapidly changing biomedical and social science content of the profession as well as the interpersonal and communication skills to build meaningful relationships with patients and families. The Medical College Admission Test (MCAT) was revised in 2015 to focus more on analytical reasoning skills and behavioral and social sciences knowledge to ensure that future physicians have the capabilities needed to care for patients in the 21st century and to allow admissions committees to identify applicants who have demonstrated proficiency in these areas. With these changes, scores continue to be predictive of student performance in the preclerkship curriculum.

In this Invited Commentary, the author argues that, as educators struggle to define the characteristics of the “right” candidates for medical school and design processes to identify and admit those applicants, it is important to consider the message being sent by calls for the MCAT exam to play a reduced role in admissions decisions. Educators must avoid diminishing the importance of intellectual rigor and, while pursuing goals for a more diverse physician workforce, maintain standards that ensure medicine’s commitment to patients. The author concludes with suggestions for how educators can work with under-resourced colleges and premedical programs to help disadvantaged students get the preparation they need to succeed in medical school and throughout their careers. Taking these steps will allow educators to support students, prepare them for practice, and fulfill their obligation to the public to produce excellent physicians.
Parents Reliably Identify Pain Dismissal by Pediatric Providers
Authors: Igler Eva , Lang Amy , Balistreri Kathryn , Sejkora Ellen , Drendel Amy , Davies William H.
Published: November 2019

Objectives:

Approximately 40% of children and adolescents with chronic pain report at least 1 dismissal experience, citing medical providers and parents as the primary and most distressing dismissers. Previous research indicates sex differences in pain dismissal experience and observer pain perception. This study examined parental reactions to dismissive provider-child scenarios and the influence of provider and patient sex on perceptions.

Methods:

Community parents (N=326) completed an online survey. Parents were randomized to listen to 1 of 8 vignettes of a provider-child chronic pain scenario. Vignettes varied by type of scenario (appropriate vs. dismissive)×provider sex×patient sex.

Results:

Overall, parents rated the dismissive scenario more negatively. There was a significant interaction between provider sex and scenario regarding likelihood to bring their own child to this provider and a significant 3-way interaction regarding provider belief of the pain complaint. When asked how they would feel if this was their own child, parents who heard the dismissive scenario reported more negative reactions. When asked what they would say to the provider, parents in the dismissive condition were more likely to defend their child and request a second opinion.

Discussion:

Parents consistently identified the dismissive language in a child and provider scenario. Female providers and sex-matched dyads seem to be more polarizing in terms of likelihood to bring their child to the provider and belief of pain, respectively. Providers within these groups may need to be especially cautious with their language when responding to pediatric chronic pain complaints.
Neonatal Intensive Care Unit-Specific Lactation Support and Mother's Own Breast Milk Availability for Very Low Birth-Weight Infants
Authors: Mercado Kathryn , Vittner Dorothy , Drabant Bradlee , McGrath Jacqueline
Published: November 2019

Background:

Mother's own milk (MOM) is the preferred nutrition for premature infants, particularly for the very low birth-weight (VLBW) cohort. Benefits are well documented; yet, numerous barriers exist for provision of MOM in the neonatal intensive care unit (NICU). Lactation consultants (LCs) can optimize breastfeeding support for NICU mothers; however, understanding of the impact of NICU-dedicated LCs is limited.

Purpose:

Evaluate the effectiveness of NICU-dedicated LCs in improving breastfeeding outcomes and MOM provision in VLBW infants.

Methods:

A retrospective chart review of 167 VLBW infants comparing breastfeeding outcomes between 2 NICUs, one with NICU-dedicated LCs (hospital A; n = 48) and one without (hospital B; n = 119). Primary outcome measures included feeding percentages of MOM received by infants at 3 intervals, throughout hospitalization, and number of direct breastfeeding events. Secondary outcome measures included number of days to first enteral feed, days to reach full feeds, days of nil per os, days on total parenteral nutrition, and length of stay.

Findings:

Neonatal intensive care unit–specific lactation support increased the number of direct breastfeeding events on day of discharge (P = .048). No statistical significance was found at each of the 3 time intervals, or throughout hospitalization (week 1: P = .18; midpoint: P = .40; discharge: P = .16; total hospitalization: P = .19). No statistical significance was demonstrated in secondary outcome measures (days to first enteral feed: P = .22; days to full feeds: P = .25; nil per os days: P = .27; total parenteral nutrition days: P = .34; length of stay: P = .01). Length of stay not found to be significant after correcting for confounding variables.

Implication for Practice:

Increased direct breastfeeding events on day of discharge with exposure to NICU-dedicated LCs in the VLBW population.

Implication for Research:

Prospective studies regarding NICU-specific lactation support with larger samples are warranted.
Advances in the Preoperative Planning of Revision Trauma Surgery Using 3D Printing Technology
Authors: Horas Konstantin , Hoffmann Reinhard , Faulenbach Miriam , Heinz Simon M. , Langheinrich Alexander , Schweigkofler Uwe
Published: November 2019

The management of complex fractures at the time of revision surgery remains one of the most challenging tasks for orthopaedic trauma surgeons. As the major principle of treatment remains to achieve an anatomic reduction and a stable fixation, precise preoperative diagnostics and treatment planning are of utmost importance. Thus, knowledge of the 3-dimensional anatomy of the fracture site and its surrounding tissue is indispensable. However, radiographic tools have thus far mostly been unable to recapitulate the complexity of the fracture site in toto. In recent years, the development of 3-dimensional (3D) printers has led to novel opportunities in preoperative planning of complex operative procedures. Although the application of 3D printers has become increasingly popular in orthopaedic surgery, its implementation in trauma surgery is so far mostly limited to the preoperative planning of surgery in patients with pelvic and acetabular fractures/defects. Moreover, reports describing the advantages using this sophisticated methodology in revision trauma surgery are sparse. In this article, we report our experience using novel 3D printing technologies for the management of revision surgery in orthopaedic trauma. In particular, we describe the benefit of using 3D printing technologies in the preoperative planning of complex revision surgery of the proximal tibia, the elbow joint, the distal femur, the ankle joint, and several others. With the advantage to preoperatively plan the optimal surgical approach, implant placement, and contouring as well as the possibility to anticipate intraoperative difficulties, we believe that this emerging technology is of significant value for revision surgery in orthopaedic trauma.
The diagnostic efficiency of seven autoantibodies in lung cancer
Authors: Huang Hong , Luo Wenxin , Ni Yinyun , Sun Supeng , Wang Chuan , Zhang Li
Published: November 2019

This study aimed to evaluate the diagnostic efficacy of seven autoantibodies in all lung cancer, lung adenocarcinoma, lung squamous cell carcinoma and early-stage lung cancer patients. ELISA testing of a seven autoantibody panel was performed on 386 lung cancer patients and 238 normal controls. The sensitivity and specificity of each autoantibody were analyzed using the receiver operating characteristic curve analysis. The diagnostic efficacy of a combination of these seven autoantibodies was evaluated by binary logistic regression. The results indicated that six of the seven autoantibodies (p53, SOX2, GAGE7, GBU4-5, MAGEA1 and CAGE) had high specificity and low sensitivity, while PGP9.5 had high sensitivity and low specificity. Further analysis showed that all seven autoantibodies had better diagnostic value in lung squamous cell carcinoma patients when compared to lung adenocarcinoma or all lung cancer patients. Logistic regression showed that a combination of the seven autoantibodies resulted in more reliable detection of lung cancer than any individual autoantibody in early-stage lung cancer (sensitivity/specificity: 47.8%/81.4%, areas under the curve: 0.764, 95% confidence interval: 0.718–0.811). Additionally, this panel had a better sensitivity of 56.5% for detection of lung squamous cell carcinoma than for all lung cancer (50.1%) or adenocarcinoma (51.7%) (P < 0.05). Our results indicated that the seven autoantibody panel could be used for early lung cancer detection, and it had better sensitivity in diagnosis of lung squamous cell carcinoma.
Establishment and application of an artificial intelligence diagnosis system for pancreatic cancer with a faster region-based convolutional neural network
Authors: Liu Shang-Long , Li Shuo , Guo Yu-Ting , Zhou Yun-Peng , Zhang Zheng-Dong , Li Shuai , Lu Yun
Published: November 2019

Background:

Early diagnosis and accurate staging are important to improve the cure rate and prognosis for pancreatic cancer. This study was performed to develop an automatic and accurate imaging processing technique system, allowing this system to read computed tomography (CT) images correctly and make diagnosis of pancreatic cancer faster.

Methods:

The establishment of the artificial intelligence (AI) system for pancreatic cancer diagnosis based on sequential contrast-enhanced CT images were composed of two processes: training and verification. During training process, our study used all 4385 CT images from 238 pancreatic cancer patients in the database as the training data set. Additionally, we used VGG16, which was pre-trained in ImageNet and contained 13 convolutional layers and three fully connected layers, to initialize the feature extraction network. In the verification experiment, we used sequential clinical CT images from 238 pancreatic cancer patients as our experimental data and input these data into the faster region-based convolution network (Faster R-CNN) model that had completed training. Totally, 1699 images from 100 pancreatic cancer patients were included for clinical verification.

Results:

A total of 338 patients with pancreatic cancer were included in the study. The clinical characteristics (sex, age, tumor location, differentiation grade, and tumor-node-metastasis stage) between the two training and verification groups were insignificant. The mean average precision was 0.7664, indicating a good training effect of the Faster R-CNN. Sequential contrast-enhanced CT images of 100 pancreatic cancer patients were used for clinical verification. The area under the receiver operating characteristic curve calculated according to the trapezoidal rule was 0.9632. It took approximately 0.2 s for the Faster R-CNN AI to automatically process one CT image, which is much faster than the time required for diagnosis by an imaging specialist.

Conclusions:

Faster R-CNN AI is an effective and objective method with high accuracy for the diagnosis of pancreatic cancer.

Trial Registration:

ChiCTR1800017542; http://www.chictr.org.cn.
Utility of histone H3K27me3 and H4K20me as diagnostic indicators of melanoma
Authors: Davis Lauren E. , Shalin Sara C. , Tackett Alan J.
Published: November 2019

Histone posttranslational modifications (PTMs) have been shown to be dysregulated in multiple cancers including melanoma, and as they are abundant and easily detectable, they make ideal biomarkers. The aim of this study was to identify histone PTMs that could be potential biomarkers for melanoma diagnosis. Previously, we utilized mass spectrometry to identify histone PTMs that were dysregulated in matched melanoma cell lines and found two modifications, H3 lysine 27 trimethylation (histone H3K27me3) and H4 lysine 20 monomethylation (histone H4K20me), that were differentially expressed in the more aggressive compared to the less aggressive cell line. In this study, we performed immunohistochemistry on tissue microarrays containing 100 patient tissue spots; 18 benign nevi, 62 primary, and 20 metastatic melanoma tissues. We stained for histone H3K27me3 and histone H4K20me to ascertain whether these histone PTMs could be used to distinguish different stages of melanoma. Loss of histone H4K20me was observed in 66% of malignant patient tissues compared to 14% of benign nevi. A majority (79%) of benign nevi had low histone H3K27me3 staining, while 72% of malignant patient tissues showed either a complete loss or had strong histone H3K27me3 staining. When we analyzed the staining for both marks together, we found that we could identify 71% of the benign nevi and 89% of malignant melanomas. Histone H3K27me3 or histone H4K20me display differential expression patterns that can be used to distinguish benign nevi from melanoma; however, when considered together the diagnostic utility of these PTMs increased significantly. The work presented supports the use of combination immunohistochemistry of histone PTMs to increase accuracy and confidence in the diagnosis of melanoma.
Frozen-Section Tissue Processing in Mohs Surgery
Authors: Aslam Arif , Aasi Sumaira Z.
Published: November 2019

BACKGROUND

Mohs micrographic surgery (MMS) is the most reliable tissue-sparing technique in the management of cutaneous malignancies. Although the concept is simple, there is considerable variability in the mapping and processing techniques used by Mohs surgeons and histotechnicians.

OBJECTIVE

This review article aims to examine the frozen-section tissue processing techniques. Existing variations will be discussed and pearls offered to optimize the frozen processing technique.

METHODS

A PubMed search was performed for publications on methods of tissue processing in MMS.

RESULTS

Our review highlights variations in debulking, embedding, processing adipose tissue, cartilage, and wedge resections. We offer pearls on how to avoid false-positive and false-negative margins and discuss advances in immunohistochemistry.

CONCLUSION

Our article provides a how-to format on the different stages of tissue processing with pearls and techniques to optimize practice and improve accuracy.
Physical Activity and Pain in Youth With Sickle Cell Disease
Authors: Karlson Cynthia W. , Delozier Alexandria M. , Seals Samantha R. , Britt Anna B. , Stone Amanda L. , Reneker Jennifer C. , Jackson Erin A. , McNaull Melissa M. , Credeur Daniel P. , Welsch Michael A.
Published: November 2019

Study objectives were to examine the relationships between physical activity, pain, and psychological distress in youth 8 to 17 years of age with sickle cell disease. Participants were 206 youth with sickle cell disease (M = 11.73 years, 54.9% female, 99.5% African American). Caregivers and youth completed a clinical psychosocial screening battery. Results revealed frequent pain (37.6%), moderate median pain intensity, and elevated median pain interference in youth. Lower caregiver-reported physical activity was associated with worse pain outcomes. Increased anxiety was also associated with worse pain outcomes. A better understanding of the relationship between physical activity/inactivity and pain will guide multifactorial treatment interventions.
Trabecula: A Random Generator of Computational Phantoms for Bone Marrow Dosimetry
Authors: Shishkina E.A. , Timofeev Y.S. , Volchkova A.Y. , Sharagin P.A. , Zalyapin V.I. , Degteva M.O. , Smith M.A. , Napier B.A.
Published: November 2019

This study was motivated by the efforts to evaluate radiation risk for leukemia incidence in the Techa River cohort, where the main bone marrow dose contributors were 89,90Sr (bone-seeking beta emitters). Energy deposition in bone marrow targets was evaluated by simulating radiation particle transport using computational phantoms. The present paper describes the computer program Trabecula implementing an algorithm for parametric generation of computational phantoms, which serve as the basis for calculating bone marrow doses. Trabecula is a user-friendly tool that automatically converts analytical models into voxelized representations that are directly compatible as input to Monte Carlo N Particle code.
ANALYSIS OF THE VITREORETINAL SURGICAL FELLOWSHIP APPLICANT POOL
Authors: Yannuzzi Nicolas A. , Smith Logan , Yadegari Dan , Venincasa Michael J. , Al-Khersan Hasenin , Patel Nimesh A. , Albini Thomas , Berrocal Audina M. , Flynn Harry W. , Sridhar Jayanth
Published: November 2019

Purpose:

To evaluate characteristics associated with misrepresentation of publication record, future career placement, and subsequent academic output among vitreoretinal surgical fellowship applicants.

Methods:

A retrospective review of 337 vitreoretinal surgical applicants between 2015 and 2018 was conducted. Publications reported in the applications were verified using PubMed, Google, and Google Scholar. Applications were considered misrepresented if there was no record of the publication or if there was an inconsistency in authorship. Applicants were followed after graduation and their employment position and postgraduation publications were recorded. The main outcome measures were the number of unverifiable publications, postfellowship job placement, and postgraduate peer-reviewed publications.

Results:

Of the 377 applicants, 309 (82.0%) listed peer-reviewed publications. Of those with a publication, 32 (10.4%) had misrepresentations. A reported desire to pursue an academic career was associated with a future career in academic medicine, whereas Alpha Omega Alpha status was correlated with a future career in private practice. Alpha Omega Alpha status, a reported desire to pursue an academic career, and the number of peer-reviewed publications before fellowship were positively correlated with higher numbers of peer-reviewed publications after fellowship.

Conclusion:

Unverifiable authorship among vitreoretinal surgical fellowship applicants is significant, affecting nearly one in 10 applicants with peer-reviewed publications. A reported desire to pursue academic medicine as listed on the fellowship application is a useful indicator for a future career in academics, and for increased number of peer-reviewed publications after fellowship.
Corneal Cryopreservation Using Glycerylphosphorylcholine-Enriched Medium
Authors: Greiner Jack V. , Glonek Thomas , Korb Donald R. , Lindsay Michael E. , Oliver Paula J. , Olson Mary Catherine D.
Published: November 2019

Purpose:

To determine the effects of prolonged cryopreservation at subzero-degree temperatures on corneal transparency and histology after treatment with preservation medium containing the phosphodiester glycerylphosphorylcholine (GPC).

Methods:

Rabbit corneas (n = 30) were immersed for 3 hours in K-Sol preservation medium containing 30 mM GPC. Three groups with 6 corneas each were refrigerated at −8°C for 2 weeks and liquid nitrogen temperature for 2 and 6 weeks, respectively. Two groups with 6 corneas each immersed in K-Sol preservation medium only were refrigerated at −8°C for 2 weeks and liquid nitrogen temperature for 6 weeks, respectively. Postthawing corneal transparency was measured on a grading scale after which corneas were prepared for and analyzed by light and transmission electron microscopy.

Results:

All 3 groups of corneas preserved with GPC maintained a greater degree of corneal transparency compared with corneas preserved without GPC. The number of corneas retaining epithelial and endothelial layers increased in all groups where corneas were preserved in medium containing GPC, in contrast to corneas preserved in medium without GPC. Cytoplasmic vacuolization or nuclear damage was greater in corneas preserved without GPC. Similar findings were found in corneas stored at −8°C and liquid nitrogen temperatures.

Conclusions:

This study demonstrates a cryoprotective effect of corneas preserved in K-Sol containing the phosphodiester GPC at subzero-degree temperatures. In corneas immersed in preservation medium containing GPC, a higher degree of transparency is maintained and a lesser degree of histopathologic changes is observed with storage at both −8°C and in liquid nitrogen.
Evaluation of Peripapillary Choroidal Microvasculature to Detect Glaucomatous Damage in Eyes With High Myopia
Authors: Na Hyun-Min , Lee Eun Ji , Lee Seung Hyen , Kim Tae-Woo
Published: November 2019

Precis:

Parapapillary choroidal microvasculature dropout (MvD), as observed by optical coherence tomography (OCT) angiography, was useful to detect glaucomatous damage in highly myopic eyes with unreliable OCT results due to segmentation errors.

Purpose:

The purpose of this study was to evaluate the usefulness of optical coherence tomography angiography (OCTA) imaging of the peripapillary choroidal microvasculature in detecting glaucomatous damage in highly myopic eyes, in cases where evaluating the thickness of the retinal nerve fiber layer (RNFL) is unreliable due to OCT segmentation errors.

Materials and Methods:

Forty-five highly myopic eyes with primary open-angle glaucoma (POAG) with an axial length >26.5 mm, and 15 age-matched and axial length–matched 15 control eyes were included in this cross-sectional observational study. All participants had a segmentation error in OCT circumpapillary RNFL scanning. The peripapillary choroidal microvasculature was evaluated on en-face images obtained using swept-source OCTA. MvD was defined as a focal sectoral capillary dropout with no visible microvascular network identified in the choroidal layer. The topographic correlation between the MvD and a hemifield visual field (VF) defect was assessed using κ statistics. The MvD size was assessed by measuring both its area and circumferential extent.

Results:

Choroidal MvD was observed in 44 of the 45 (97.8%) POAG eyes with high myopia, while none of the control eyes showed a choroidal MvD. There was an excellent topographic relationship between the choroidal MvD and the hemifield VF defect (κ=0.863, P<0.001). The area (R
2=0.2619, P=0.0006) and circumferential extent (R
2=0.3088, P=0.0002) of the MvD have significantly associated with the VF mean deviation.

Conclusions:

Choroidal MvDs were observed in most of the highly myopic POAG eyes and were topographically correlated with the location of glaucomatous VF defects despite unreliable OCT RNFL thickness measurements. Using OCTA to investigate the choroidal microvasculature may facilitate diagnoses of glaucoma in highly myopic eyes.
Comparative Effectiveness and Tolerance of Subliminal Subthreshold Transscleral Cyclophotocoagulation With a Duty Factor of 25% Versus 31.3% for Advanced Glaucoma
Authors: Keilani Chafik , Benhatchi Nassima , Bensmail Djawed , Abitbol Olivia , Amara Amélie , Bluwol Elisa , Graber Martin , Lachkar Yves
Published: November 2019

Précis:

Subliminal subthreshold transscleral cyclophotocoagulation (SS-TSCPC) with duty cycles 25% and 31.3% seems to be an effective approach to reduce intraocular pressure (IOP) in glaucoma that is refractory to medical management.

Objective:

The objective of this study was to compare the effectiveness and the tolerance of SS-TSCPC with a duty cycle of 25% versus 31.3% with Supra 810 nm Subliminal Quantel Medical laser stimulation for advanced glaucoma.

Materials and Methods:

This was a retrospective, single-center, comparative case series of patients treated by SS-TSCPC between January 2017 and July 2017. The diagnostic and inclusion criteria were patients with advanced and refractory glaucoma, defined as IOP >21 mm Hg on maximal tolerated medical therapy with or without previous glaucoma surgical procedures, a minimum follow-up of 12 months, and patients who refused or were poor candidates for additional filtering surgery or implantation of glaucoma drainage devices. The primary endpoint was surgical success defined as an IOP of 6 to 21 mm Hg or a reduction of IOP by 20% from baseline without an increase in glaucoma medication from baseline. The secondary endpoints were the mean IOP and best visual corrected acuity best-corrected visual acuity at 12 months after surgery, retreatment outcomes, glaucoma medications, and complications such as inflammation, uveitis, cataract, mydriasis, and phthisis.

Results:

Forty eyes of 32 patients were included: 20 eyes were subjected to SS-TSCPC with 31.3% duty cycle and 20 eyes with a 25% duty cycle. The surgical success of the TSCPC 12 months after the first procedure was better in the 31.3% duty cycle group (83.5%) than in the 25% duty cycle group (65%). The most common complications were inflammation (50%, 1 mo after surgery) and IOP spikes (increase in IOP of >25% from baseline within 1 mo of laser) in both groups. Inflammation was higher in the 31.3% duty cycle group.

Conclusions:

SS-TSCPC at 31.3% and 25% duty cycle seems to be an effective approach to reduce IOP in glaucoma that is refractory to medical management. SS-TSCPC at 31.3% duty cycle is more effective than the 25% duty cycle SS-TSCPC. However, the 31.3% duty cycle SS-TSCPC induces more inflammation than the 25% duty cycle SS-TSCPC. Each procedure should be considered on a case by case basis.