bluuebunny/crossref_metadata_2025 huggingface dataset:
Coherent states for rational extensions and ladder operators related to infinite-dimensional representations
Authors: Hoffmann Scott E. , Hussin Véronique , Marquette Ian , Zhang Yao-Zhong
Published: December 2019

The systems we consider are rational extensions of the harmonic oscillator, the truncated oscillator and the radial oscillator. The wavefunctions for the extended states involve exceptional Hermite polynomials for the oscillator and truncated oscillator and exceptional Laguerre polynomials for the radial oscillator. In all cases it is possible to construct ladder operators that have infinite-dimensional representations of their polynomial Heisenberg algebras and couple all levels of the systems. We construct Barut-Girardello coherent states in all cases, eigenvectors of the respective annihilation operators with complex eigenvalues. Then we calculate their physical properties to look for classical or non-classical behaviour.
Confluent hypergeometric expansions of the confluent Heun function governed by two-term recurrence relations
Authors: Ishkhanyan T A , Krainov V P , Ishkhanyan A M
Published: December 2019

We show that there exist infinitely many nontrivial choices of parameters of the single confluent Heun equation for which the three-term recurrence relations governing the expansions of the solutions in terms of the confluent hypergeometric functions 1
F
1 and 0
F
1 are reduced to two-term ones. In such cases the expansion coefficients are explicitly calculated in terms of the Euler gamma functions.
Application of geometrical methods to study the systems of differential equations for quantum-mechanical problems
Authors: Krylova Nina , Voynova Yanina , Balan Vladimir
Published: December 2019

A geometrical method based on the structural stability theory is used to study systems of differential equations which arise in quantum-mechanical problems. We consider a 1/2-spin particle in external Coulomb field or in the presence of magnetic charge on the background of the de-Sitter space, and a free 3/2-spin particle in spherical coordinates of the flat space. It turns out that the first and the second Kosambi-Cartan-Chern invariants are nontrivial for the corresponding systems, while the 3-d, 4-th and 5-th invariants identically vanish. From physical point of view, the second invariant determines how rapidly the different branches of the solution diverge from or converge to the intersection points, while the most interesting are the singular points. The convergence (divergence) near the singular points r = 0, 1 are shown to correlate with the behavior of solutions for quantum mechanical states (discrete and continuous spectra). The vanishing of the 3-d, 4-th and 5-th invariants geometrically implies the existence of a nonlinear connection on the tangent bundle, having zero torsion and curvature.
Hidden Supersymmetries of Deformed Supersymmetric Mechanics
Authors: Sidorov Stepan
Published: December 2019

We consider quantum models corresponding to superymmetrizations of the two-dimensional harmonic oscillator based on worldline d = 1 realizations of the supergroup SU( N/2 |1), where the number of supersymmetries N is arbitrary even number. Constructed models possess the hidden supersymmetry SU( N/2 |2). Degeneracies of energy levels are spanned by representations of the hidden supersymmetry group.
The NSVZ relation and the NSVZ scheme for N = 1 non-Abelian supersymmetric theories, regularized by higher covariant derivatives
Authors: Stepanyantz Konstantin
Published: December 2019

We discuss, how the exact NSVZ -function appears in N = 1 supersymmetric non-Abelian gauge theories, regularized by higher covariant derivatives. In particular, we demonstrate that the renormalization group functions defined in terms of the bare couplings satisfy the NSVZ relation in the case of using this regularization. This occurs, because the loop integrals giving the -function are integrals of double total derivatives with respect to loop momenta. It is also shown that for the renormalization group functions standardly defined in terms of the renormalized couplings the NSVZ scheme can be obtained if the theory is regularized by higher covariant derivatives and only powers of ln/µ are included into the renormalization constants. These statements are confirmed by the explicit calculations in the three-loop approximation, where the scheme dependence is essential.
Topological Bounds from Label Translation Symmetry of Non-Barotropic MHD
Authors: Yahalom Asher
Published: December 2019

The theorem of Noether dictates that for every continuous symmetry group of an Action the system must possess a conservation law. In this paper we discuss some subgroups of Arnold’s labelling symmetry diffeomorphism related to non-barotropic magnetohydrodynamics (MHD) and the conservations laws associated with them. Furthermore, we will study the dynamical bounds resulting from the topological Noether currents associated with label translation symmetry groups.
PTC1 and PTC2: New Indices of Blood Pressure Waveforms and Cardiovascular Disease
Authors: Brumback Lyndia C , Jacobs David R , Duprez Daniel A
Published: December 2019

Systolic and diastolic blood pressures provide information about cardiovascular disease (CVD) but are only extremes of the pressure waveform during the cardiac cycle. We developed summaries of the pressure decay, called PTC1 and PTC2, that are related to arterial compliance and to an existing proprietary summary that has been shown to predict CVD. We derived the summaries from a Windkessel model (consisting of a decaying exponential plus a dampened cosine, with an intercept so they are independent of calibration with blood pressure, unlike the proprietary measures), and we estimated them using nonlinear least squares with standard, free software. Among 6,228 adults from the Multi-Ethnic Study of Atherosclerosis, initially free of CVD in 2000–2002, mean PTC2 was 94 (standard deviation, 46) milliseconds. During median 15-year follow-up, there were 911 CVD events (including 609 incidents of coronary heart disease and 270 strokes). One-standard-deviation higher PTC2 was associated with 17% (95% confidence interval: 10, 24) lower CVD risk, after adjustment for traditional risk factors. Results were similar for PTC1. PTC1 and PTC2 are relatively straightforward to compute and add information beyond traditional risk factors for prediction of CVD. Our work enables others to replicate and extend our results with waveforms from any suitable device.
AQUA-DUCT 1.0: structural and functional analysis of macromolecules from an intramolecular voids perspective
Authors: Magdziarz Tomasz , Mitusińska Karolina , Bzówka Maria , Raczyńska Agata , Stańczak Agnieszka , Banas Michał , Bagrowska Weronika , Góra Artur
Published: December 2019

Motivation

Tunnels, pores, channels, pockets and cavities contribute to proteins architecture and performance. However, analysis and characteristics of transportation pathways and internal binding cavities are performed separately. We aimed to provide universal tool for analysis of proteins integral interior with access to detailed information on the ligands transportation phenomena and binding preferences.

Results

AQUA-DUCT version 1.0 is a comprehensive method for macromolecules analysis from the intramolecular voids perspective using small ligands as molecular probes. This version gives insight into several properties of macromolecules and facilitates protein engineering and drug design by the combination of the tracking and local mapping approach to small ligands.

Availability and implementation

http://www.aquaduct.pl.

Supplementary information

Supplementary data are available at Bioinformatics online.
Incidence of Adverse Psychiatric Events During Treatment of Inflammatory Bowel Disease With Biologic Therapies: A Systematic Review
Authors: Jain Avni , Marrie Ruth Ann , Shafer Leigh Anne , Graff Lesley A , Patten Scott B , El-Gabalawy Renée , Sareen Jitender , Bolton James M , Fisk John D , Bernstein Charles N
Published: December 2019

We conducted a systematic review and a fixed-effects meta-analysis to determine whether incident adverse psychiatric events (APE) including depression, anxiety, psychosis, or suicide were associated with biologic therapy in IBD. Six randomized controlled trials and a cohort study met criteria, reporting an incidence of APE in 4,882 patients. The risk difference per 100 person-months of any APE with a biologic medication was 0.01 (95% confidence interval = 0.00–0.02). There was insufficient evidence available in randomized controlled trials to conclude that biologic therapy in IBD is associated with an increased incidence of APE.
Diagnosis and management of congenital absence of pericardium: a case report
Authors: Bouchard Melissa , Hoschtitzky A , Gatzoulis M
Published: December 2019

Background

Absence of the pericardium is a rare congenital defect with an approximate incidence of <1/10 000. We review a case of complete pericardial agenesis in a symptomatic patient with gross cardiac mobility, for which pericardial reconstruction was undertaken successfully.

Case summary

A 24-year-old otherwise fit and well patient, with debilitating exertional chest pain was found to have complete pericardial agenesis on the left side and on the diaphragmatic surface. There was gross cardiac mobility demonstrated on cardiac magnetic resonance imaging. His pericardium was reconstructed surgically using Gore-tex® patches. There were no complications, and the patient was discharged 8 days later. Three months later at follow-up, the patient required no analgesia and has had complete resolution of his chest pains.

Discussion

Congenital hemi-pericardial agenesis is a very rare condition which often remains undetected due to its asymptomatic nature. It is important to consider this as a differential diagnosis of exertional chest pains. Cardiac magnetic resonance imaging remains the investigation of gold standard. There is no consensus on whether surgical intervention in symptomatic or asymptomatic patients has any prognostic value. However, we have demonstrated that by reconstructing the pericardium in a highly symptomatic patient, there has been a resolution in size of a previously dilated right ventricle and most importantly an improvement in quality of life.
Cardiac magnetic resonance imaging in a patient with temporary external pacemaker: a case report
Authors: Chaudhry Uzma , Svensson Jonas , Mosén Henrik , Mörtsell David
Published: December 2019

Background 

Magnetic resonance imaging (MRI) is increasingly becoming the imaging modality of choice for many clinical disorders due to superior image quality and absence of radiation. However, access to MRI remains limited for most patients with cardiac implantable electronic devices due to potential safety concerns. In line with guidelines, there is no absolute contraindication to perform MRI, but warrants careful risk-benefit assessment.

Case summary 

A 59-year-old man was admitted with a 5-day history of central chest pain and few week’s history of general malaise, dry cough, and breathlessness. Electrocardiogram confirmed complete atrioventricular block (CAVB). A slight increase in cardiac enzyme was noted. Coronary angiogram revealed atheromatous changes, but no obstructive coronary lesion. A temporary transvenous pacemaker was inserted. Transthoracic echocardiogram confirmed a dilated left ventricle with severely reduced left ventricular function. To facilitate diagnosis (hence prognosis), management and mobilization, investigation with cardiovascular magnetic resonance (CMR) was warranted but contraindicated by the temporary transvenous pacemaker. An active fixation pacemaker lead was therefore placed in the right ventricle via percutaneous puncture of the right subclavian vein and connected to a pulse generator, both secured to the skin with sutures and adhesive medical dressing. Appropriate device programming and close patient monitoring ensured that CMR could be performed without any adverse effects. A diagnosis of acute myocarditis was confirmed. Regular device interrogation during an extended 3-week period with temporary pacing ruled out any device failure. As there was no resolution of CAVB, the patient received a dual-chamber pacemaker.

Discussion 

Cardiovascular magnetic resonance was feasible and safely performed on a patient with a temporary permanent external pacemaker system using a standard screw-in pacing lead and a regular pulse generator fixed to the skin. Although more studies are needed for generalizability, CMR may be used in highly selected patients with a temporary pacemaker.
The practical management of fluid retention in adults with right heart failure due to pulmonary arterial hypertension
Authors: Stickel Simone , Gin-Sing Wendy , Wagenaar Martha , Gibbs J Simon R
Published: December 2019

Our aim with this review is to provide practical advice and management support for nurses and other healthcare practitioners in managing fluid retention in adults with right heart failure (RHF) due to pulmonary arterial hypertension (PAH). Vigilant management of RHF is important for maintaining patient quality of life, as fluid overload can lead to abdominal bloating (ascites) and peripheral oedema, which also has a major impact on patients’ morbidity and mortality. Patients with RHF should be assessed regularly for signs of fluid retention. If fluid overload develops, it is important to determine whether it is caused by the progression of PAH, a side effect of PAH-specific treatment, or another drug or comorbid condition, as this affects both the prognosis and the management strategy. Right heart failure can be treated with both pharmacological and non-pharmacological interventions to reduce fluid retention; including altering fluid and salt intake, weight monitoring, and use of diuretics. All patients on diuretics should be regularly monitored for renal dysfunction and electrolyte imbalance and given advice on how to manage the side effects associated with diuretic use. Fluid retention is often assessed and treated in clinical practice by specialist nurses, who act as a key patient contact providing advice and information on symptom management. This review provides an overview of the challenges related to fluid retention, including strategies to help patients manage symptoms and side effects of treatment.
A Stage for the Unknown? Reconciling Postwar Communities through Theatre-Facilitated Dialogue
Authors: Dirnstorfer Anne , Saud Nar Bahadur
Published: December 2019

The article explores the potential of theatre art in transitional justice, particularly in the field of reconciliation and healing. Presenting the context of reconciliation in Nepal 10 years after the end of the armed conflict, the authors argue for complementary processes of top-down and community-based, bottom-up approaches by introducing the concept of ‘theatre-facilitated dialogue’ as a way to strategically integrate Playback Theatre in peacebuilding. Analyzing the project ‘EnActing Dialogue,’ the article elaborates on the learnings from theatre-facilitated dialogue work in communities where ex-combatants of the Nepali People’s Liberation Army have settled. Based on the theoretical overview of secondary resources, the authors’ participatory observations, on informal interviews and quantitative data, the study explores how artistically enacted storytelling supports bottom-up reconciliation. By staging a noncognitive dialogue through storytelling, music and theatre, Playback Theatre contributes to the deconstruction of war-related identities, an understanding of root causes, as well as personal healing and relationship building at community level.
Higher-Level Phylogeny and Reclassification of Lampyridae (Coleoptera: Elateroidea)
Authors: Martin Gavin J , Stanger-Hall Kathrin F , Branham Marc A , Da Silveira Luiz F L , Lower Sarah E , Hall David W , Li Xue-Yan , Lemmon Alan R , Moriarty Lemmon Emily , Bybee Seth M
Published: December 2019

Fireflies (Lampyridae Rafinesque) are a diverse family of beetles which exhibit an array of morphologies including varying antennal and photic organ features. Due in part to their morphological diversity, the classification within the Lampyridae has long been in flux. Here we use an anchored hybrid enrichment approach to reconstruct the most extensive molecular phylogeny of Lampyridae to date (436 loci and 98 taxa) and use this phylogeny to evaluate the higher-level classification of the group. None of the currently recognized subfamilies were recovered as monophyletic with high support. We propose several classification changes supported by both phylogenetic and morphological evidence: 1) Pollaclasis Newman, Vestini McDermott (incl. Vesta Laporte, Dodacles Olivier, Dryptelytra Laporte, and Ledocas Olivier), Photoctus McDermott, and Araucariocladus Silveira & Mermudes are transferred to Lampyridae incertae sedis, 2) Psilocladinae Mcdermott, 1964status novum is reestablished for the genus Psilocladus Blanchard, 3) Lamprohizini Kazantsev, 2010 is elevated to Lamprohizinae Kazantsev, 2010status novum and Phausis LeConte is transferred to Lamprohizinae, 4) Memoan Silveira and Mermudes is transferred to Amydetinae Olivier, and 5) Scissicauda McDermott is transferred to Lampyrinae Rafinesque.
Keeping salamanders off the streets: evaluating and modifying one of the first US amphibian road tunnels 30 years after installation
Authors: Hedrick Brandon P , Vander Linden Abby , Cordero Samantha A , Watt Edward , O’Roark Patrick M , Cox Samantha L , Sutherland Christopher
Published: December 2019

Wildlife tunnels are often installed under busy roads to help a variety of animals, from small frogs to bears, safely cross roads that bisect their habitats. One of the first roadway wildlife tunnel systems designed specifically for amphibian use in the USA was installed along Henry Street in Amherst, Massachusetts, in 1987 to protect spotted salamanders (Ambystoma maculatum). These salamanders cross Henry Street during their annual migration to their breeding pools. In recent years, volunteers monitoring the site suggested that salamanders were no longer using the tunnels. To evaluate this concern, we conducted salamander counts in 2016, 2017 and 2018 to quantify tunnel use. In 2016, 11% of observed salamanders used the tunnels—a substantial decrease from 68% in 1988, 1 year after tunnel installation, when the tunnels were last evaluated. Following 2016, we implemented two tunnel modifications: adding a light to the far end of tunnels (2017) and placing a ramp at tunnel entrances to reduce balking (2018). However, salamander tunnel use was not increased significantly by either the light modification or the ramp modification. Previous studies have demonstrated that salamanders prefer minimum tunnel apertures of >0.4 m, so it is likely that the 0.2 m apertures at Henry Street are too small. While many studies have evaluated amphibian tunnel use in laboratory and field settings, ours was one of the first studies to examine tunnel usage data long after initial installation. These long-term data are critical for evaluating factors necessary for maintaining wildlife tunnel effectiveness over decades.
A conceptual model to increase the visibility and usage of cultural heritage objects: The case of UNESCO’s Memory of the World list1
Authors: Akça Sümeyye
Published: December 2019

Cultural heritage connects the past with the future by forming an integral part of the identities of societies. Thus, countries must protect their cultural heritage and create policies to ensure that people benefit today and pass the heritage on to future generations. Beyond physical protection in the face of globalization, increasing access to cultural heritage is necessary to ensure participation and evaluate practices from an international perspective. Advances in computer and communication technologies are being exploited for these requirements. Acquiring knowledge about and interacting with cultural objects in any part of the world today is possible through the digital humanities approach. In this study, a conceptual model was formed to increase visibility and usage of Kandilli Observatory and Earthquake Research Institute Manuscripts, the Hittite cuneiform tablets from Bogazköy, the works of Ibn Sina at the Süleymaniye Manuscript Library, Evliya Çelebi’s ‘Book of Travels’, and the Old Assyrian Merchant Archives of Kültepe registered in UNESCO’s Memory of the World List. In this model, which is prepared with the digital humanities approach, best practices applied in the field are considered as examples in the literature. Suggestions are made on how to utilize digital humanities tools to increase access and visibility by revealing the economic, social, and cultural values of the works based on the model.
Novel pharmacological modulation of dystonic phenotypes caused by a gain-of-function mutation in the Na+ leak-current channel
Authors: Kasap Merve , Aamodt Eric J. , Sagrera Caroline E. , Dwyer Donard S.
Published: December 2019

The Na+ leak-current channel (NALCN) regulates the resting membrane potential in excitable cells, thus determining the likelihood of depolarization in response to incoming signals. Gain-of-function (gf) mutations in this channel are associated with severe dystonic movement disorders in man. Currently, there are no known pharmacological antagonists or selective modulators of this important channel. A gain-of-function mutation in NALCN of C. elegans [known as unc-77(e625)] causes uncoordinated, hyperactive locomotion. We hypothesized that this hyperactive phenotype can be rescued with pharmacological modulators. Here, we summarize the results of targeted drug screening aimed at identification of drugs that corrected locomotion deficits in unc-77(e625) animals. To assay hyperactive locomotion, animals were acutely removed from food and characteristic foraging movements were quantified. Drug screening revealed that 2-aminoethoxydiphenyl borate (2-ABP), nifedipine, nimodipine, flunarizine and ethoxzolamide significantly decreased abnormal movements in unc-77(e625) animals. 2-APB also corrected egg release and coiling deficits in this strain. In addition, serotonin and dopamine both reduced hyperactive locomotion, consistent with regulatory interactions between these systems and the NALCN. 2-APB induced movement phenotypes in wild-type animals that faithfully mimicked those observed in NALCN knockout strains, which suggested that this drug may directly block the channel. Moreover, 2-APB and flunarizine showed significant structural similarities suggestive of overlap in their mode of action. Together, these studies have revealed new insights into regulation of NALCN function and led to the discovery of a potential pharmacological antagonist of the NALCN.
Third Space Endoscopy
Authors: Bapaye Amol , Korrapati Sravan K. , Dharamsi Siddharth , Dubale Nachiket
Published: December 2019

The field of third space endoscopy (TSE), also called submucosal endoscopy using a mucosal flap valve, allows secure access to the submucosal and deeper layers of the gastrointestinal tract without the risk of a full-thickness perforation. Since the first description of per-oral endoscopic myotomy (POEM) for the treatment of achalasia cardia 10 years ago, this field has expanded rapidly. Several new procedures, submucosal tunneling endoscopic resection, gastric-POEM, Zenker POEM, per-rectal endoscopic myotomy, diverticular POEM, and recanalization for complete esophageal obstruction (per-oral endoscopic tunneling for restoration of the esophagus), have been performed. All TSE procedures employ a similar technique—after a mucosal incision, a submucosal tunnel is created, a myotomy is performed, or a subepithelial tumor is resected distal to the site of mucosal incision, after which the mucosal incision is closed. Potential indications for TSE include resection of subepithelial tumors in the esophagus, gastroesophageal junction, or stomach; refractory gastroparesis; Zenker diverticulum; Hirschsprung disease or other forms of megacolon; and recanalization for complete esophageal obstruction. Data are currently available for POEM, submucosal tunneling endoscopic resection, and gastric-POEM, although mainly in the form of retrospective studies, and randomized trials and long-term follow-up data are limited. Submucosal endoscopy has an excellent safety profile with very few intraoperative adverse events, the majority being related to insufflation, although bleeding, perforation, and sepsis have been reported. TSE procedures require special training and have demonstrated a learning curve.
No Barrett’s—No Cancer
Authors: Graham David Y. , Tan Mimi C.
Published: December 2019

Esophageal adenocarcinoma is inflammation-associated cancer with a recognizable preneoplastic stage, Barrett’s. Barrett’s describes the metaplastic transformation of esophageal squamous mucosa into columnar epithelium that typically results secondary to mucosal damage caused by acidic gastroduodenal reflux. Continued acid reflux may then result in mucosal inflammation which results in progressive inflammation-induced genetic instability that may eventuate in esophageal adenocarcinoma. Barrett’s is the only recognized precursor lesion to esophageal carcinoma. Barrett’s mucosa is unique among preneoplastic lesions; ablation therapy results in restitution of a squamous epithelium reducing or eliminating accumulated genetic instabilities and resetting the biological clock progressing toward invasive cancer. However, recurrence of Barrett’s after ablation is common. We propose that both Barrett’s and recurrence of Barrett’s after ablation can be prevented and discuss how current approaches to therapy for gastroesophageal reflux disease, for Barrett’s screening, chemoprevention, and ablation therapy all might be reconsidered. We propose (1) improved approaches to Barrett’s prevention, (2) universal Barrett’s screening by linking Barrett’s screening to colon cancer screening, (3) ablation of all Barrett’s mucosa along with (4) acid-suppressive–antireflux therapy tailored to prevent development of Barrett’s or the recurrence of Barrett’s after ablation therapy. We propose that ultimately, treatment decisions for gastroesophageal reflux disease and prevention of Barrett’s and esophageal carcinoma should be based on assessing and maintaining esophageal mucosal integrity. This will require development and verification of specific measurements that reliably correlate with prevention of Barrett’s. We outline the new research and technical advances needed to cost-effectively achieve these goals.
Effect of Helicobacter pylori infection on the risk of acute coronary syndrome: A systematic review and meta-analysis
Authors: Fang Yizhen , Fan Chunming , Xie Huabin
Published: December 2019

Background:

Numerous studies have illustrated the association between Helicobacter pylori (H pylori) infection and acute coronary syndrome (ACS). However, the results are contradictory. Therefore, we conducted the meta-analysis to identify the association between H pylori and ACS.

Methods:

We performed a systematic search through electronic databases (Excerpta Medica Database, PubMed, Cochrane Library, and Web of Science). Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with a random effect model. We also carried out the sensitivity analysis and publication bias.

Results:

Forty-four eligible studies involving 7522 cases and 8311 controls were included. The pooled result showed that H pylori infection was associated with an increase risk of ACS (OR = 2.03, 95% CI 1.66–2.47). In addition, similar results were obtained in subgroups of study quality, area, human development index, and H pylori detection method. The OR for developing countries was significantly higher than developed countries (OR = 2.58 vs OR = 1.69). Moreover, H pylori with cytotoxin-associated antigen A was also significantly associated with an increase risk of ACS (OR = 2.39, 95% CI 1.21–4.74).

Conclusion:

The meta-analysis suggested that H pylori infection was associated with an increased risk of ACS, especially in developing countries. H pylori is easily screened and can be treated with a wide range of drugs. Thus, more high-quality and well-designed studies are needed to confirm whether the treatment of H pylori is an effective way to reduce ACS risk.
Hamartoma of the breast in a man
Authors: Li Mengxin , Lin Gu , You Wu , Zhen Wang , Xu Chengzhao , Hong Jinghui , Ye Du , Dong Song
Published: December 2019

Rationale:

Mammary hamartoma is a rare benign breast tumor, composed of ducts, lobules, fibers, and adipose tissue. We describe a mammary hamartoma in a man; this is the fourth case being reported in the literature.

Patient concerns:

A 30-year-old man presented with a 1-month history of a painless mass in his right breast.

Diagnosis:

Ultrasound imaging and mammography revealed a lesion, approximately 2.0 cm × 2.0 cm in size, in the right breast, which was considered to be either a lipomyoma or an adenoma fibrosum.

Interventions:

The mass was surgically resected. Pathological examination confirmed the diagnosis of mammary hamartoma.

Outcomes:

The patient was discharged from the hospital after surgery. There was no sign of reoccurrence during a 1-year follow-up period.

Lessons:

At present, mammary hamartoma is considered to be a benign lesion, usually treated by surgical resection. Some reports have suggested a possible association between a hamartoma and the development of breast malignancy. The pathology and biology of an association between a mammary hamartoma and malignancy have not been defined to date.
A Decomposition Method to Assess the Contributions of Geographic and Nongeographic Factors to White-Black Disparities in Health Care
Authors: Huckfeldt Peter J. , Escarce José J. , Pane Joseph D. , Popescu Ioana
Published: December 2019

Background:

Black-white gaps in high-quality hospital use are documented, but the relative contributions of various factors are unclear. The objective of this study was to quantify the contributions of differences in geographic and nongeographic factors to the gap, using decomposition methods and data for coronary heart disease.

Research Design:

We identified white and black fee-for-service beneficiaries aged 65 or older who were hospitalized for acute myocardial infarction (AMI) or coronary artery bypass grafting (CABG) surgery during 2009–2011. We categorized hospitals with AMI mortality rates in the lowest quintile as high-quality hospitals. We first decomposed the white-black gap in high-quality hospital use into a component due to racial differences in region of residence and a within-region component. We then decomposed the within-region differences into contributions due to racial differences in geographic proximity to high-quality hospitals and due to nongeographic factors.

Results:

The white-black gap in high-quality hospital use was smaller for AMI than for CABG (1.7 percentage points vs. 7.5 percentage points). For AMI, region of residence contributed more to the gap than within-region differences (1.0 percentage point vs. 0.6 percentage points), while for CABG, within-region differences prevailed (2.0 percentage points vs. 5.4 percentage points). For both conditions, the within-region white-black difference in high-quality hospital use was mainly driven by nongeographic factors.

Conclusions:

Decomposition methods are a useful tool in quantifying the contributions of various factors to the white-black gap in high-quality hospital use and could inform local policy aimed at reducing disparities in hospital quality.
Copy Number Variations in Wilms Tumor: A Pilot Study From India
Authors: Rahiman Emine A. , Singh Minu , Bhatia Prateek , Kakkar Nandita , Trehan Amita , Bansal Deepak
Published: December 2019

Background:

The prognostic role of copy number variation is upcoming in Wilms tumor, and its identification will help in tailored therapy for improved cure.

Study Design:

This was a retrospective, nested case-control, pilot study.

Materials and Methods:

Formalin-fixed paraffin-embedded blocks of nephrectomy specimens were retrieved for the study and control groups (children with relapse and survivors for ≥2 y). Multiplex ligand probe amplification (MRC-Holland probe-mix P 380 A1) was performed, with 3 reference samples of normal kidney DNA run for every 7 cases.

Results:

At least 1 variation was detected in 41 (97.8%) specimens. Loss of heterozygosity 1p was not observed. Loss of 16q, 1q gain, and MYCN gain were observed in 5 (11.9%), 29 (69%), and 39 (92.9%) specimens, respectively. The occurrence of copy number variations was similar in both groups: 1q gain: 15 versus 14 (P=1.0), 16q loss: 4 versus 1 (P=0.34), MYCN gain: 19 versus 20 (P=1.0). The gain of 1q, 16p loss, and MYCN gain did not differ across stage or age.

Conclusions:

The gain of 1q, MYCN gain, and 16p loss were identified. A higher occurrence of 1q gain and MYCN gain and a lack of difference in the distribution of variations among survivors and those with a relapse suggest a different molecular profile of Wilms tumor in Indian children.
Expression of the Immune Checkpoints LAG-3 and PD-L1 in High-grade Serous Ovarian Carcinoma: Relationship to Tumor-associated Lymphocytes and Germline BRCA Status
Authors: Whitehair Rachel , Peres Lauren C. , Mills Anne M.
Published: December 2019

Ovarian high-grade serous carcinomas (HGSC) have shown lackluster responses to immunotherapies targeting the PD-1/PD-L1 axis, perhaps due to the coexistence of other mechanisms of immune evasion in this tumor type. Lymphocyte activation gene-3 (LAG-3) is another inhibitory immune checkpoint often expressed on tumor-associated lymphocytes which is targeted by drugs currently in clinical trials. Forty-eight HGSC with known germline BRCA mutation status were immunohistochemically stained for LAG-3, CD8, and FOXP3. Positive tumor-associated lymphocytes were enumerated and averaged over 10 high-power fields (HPF). PD-L1 immunostaining was also preformed and expression was evaluated on tumor cells and using the combined positive score (CPS). The average number of LAG-3-positve tumor-associated lymphocytes was 6/HPF (range: 0–25.6). Cytotoxic (CD8+) T cells averaged 30/HPF (range: 0–168.9), and regulatory (FOXP3) cells averaged 6.6/HPF (range: 0–76.3). Tumoral PD-L1 expression of ≥1% was observed in 27% (13/48) of cases, with only 8% (4/48) showing >5% staining; 81% (39/48) cases had a CPS ≥1. LAG-3-positive lymphocytes and PD-L1 expression were positively correlated, even after controlling for the overall level of CD8 and FOX3P+ lymphocyte infiltration. Germline BRCA status was not significantly associated with LAG-3, CD8, FOXP3, or PD-L1 expression. These findings indicate that immunotherapies targeting LAG-3 may benefit some ovarian HGSC patients, particularly when used in conjunction with anti-PD-1/PD-L1 approaches. The typically limited expression of LAG-3 and PD-L1 suggests that immunotherapeutic response may be muted in most HGSC even with a combination approach.
The Impact of Socioeconomic Deprivation on Clinical Outcomes for Pancreatic Adenocarcinoma at a High-volume Cancer Center
Authors: Powers Benjamin D. , Fulp William , Dhahri Amina , DePeralta Danielle K. , Ogami Takuya , Rothermel Luke , Permuth Jennifer B. , Vadaparampil Susan T. , Kim Joon-Kyung , Pimiento Jose , Hodul Pamela J. , Malafa Mokenge P. , Anaya Daniel A. , Fleming Jason B.
Published: December 2019

Objective:

To assess the impact of a granular measure of SED on pancreatic surgical and cancer-related outcomes at a high-volume cancer center that employs a standardized clinic pathway.

Summary of Background Data:

Prior research has shown that low socioeconomic status leads to less treatment and worse outcomes for PDAC. However, these studies employed inconsistent definitions and categorizations of socioeconomic status, aggregated individual socioeconomic data using large geographic areas, and lacked detailed clinicopathologic variables.

Methods:

We conducted a retrospective cohort study of 1552 PDAC patients between 2008 and 2015. Patients were stratified using the area deprivation index, a validated dataset that ranks census block groups based on SED. Multivariable models were used in the curative surgery cohort to predict the impact of SED on (1) grade 3/4 Clavien-Dindo complications, (2) initiation of adjuvant therapy, (3) completion of adjuvant therapy, and (4) overall survival

Results:

Patients from high SED neighborhoods constituted 29.9% of the cohort. Median overall survival was 28 months. The rate of Clavien-Dindo grade 3/4 complications was 14.2% and completion of adjuvant therapy was 65.6%. There was no evidence that SED impacted surgical evaluation, receipt of curative-intent surgery, postoperative complications, receipt of adjuvant therapy or overall survival.

Conclusions:

Although nearly one-quarter of curative-intent surgery patients were from high SED neighborhoods, this factor was not associated with measures of treatment quality or survival. These observations suggest that treatment at a high-volume cancer center employing a standardized clinical pathway may in part address socioeconomic disparities in pancreatic cancer.
Perioperative Lung Resection Outcomes After Implementation of a Multidisciplinary, Evidence-based Thoracic ERAS Program
Authors: Haro Greg J. , Sheu Bonnie , Marcus Sivan G. , Sarin Ankit , Campbell Lundy , Jablons David M. , Kratz Johannes R.
Published: December 2019

Objective:

This prospective study evaluated perioperative lung resection outcomes after implementation of a multidisciplinary, evidence-based Thoracic Enhanced Recovery After Surgery (ERAS) Program in an academic, quaternary-care center.

Background:

ERAS programs have the potential to improve outcomes, but have not been widely utilized in thoracic surgery.

Methods:

In all, 295 patients underwent elective lung resection for pulmonary malignancy from 2015 to 2019 PRE (n = 169) and POST (n = 126) implementation of an ERAS program containing all major ERAS Society guidelines. Propensity score-matched analysis, based upon patient, tumor, and surgical characteristics, was utilized to evaluate outcomes.

Results:

After ERAS implementation, there was increased minimally invasive surgery (PRE 39.6%→POST 62.7%), reduced intensive care unit utilization (PRE 70.4%→POST 21.4%), improved chest tube (PRE 24.3%→POST 54.8%) and urinary catheter (PRE 20.1%→POST 65.1%) removal by postoperative day 1, and increased ambulation ≥3× on postoperative day 1 (PRE 46.8%→POST 54.8%). Propensity score-matched analysis that accounted for minimally invasive surgery demonstrated that program implementation reduced length of stay by 1.2 days [95% confidence interval (CI) 0.3–2.0; PRE 4.4→POST 3.2), morbidity by 12.0% (95% CI 1.6%–22.5%; PRE 32.0%→POST 20.0%), opioid use by 19 oral morphine equivalents daily (95% CI 1–36; PRE 101→POST 82), and the direct costs of surgery and hospitalization by $3500 (95% CI $1100–5900; PRE $23,000→POST $19,500). Despite expedited discharge, readmission remained unchanged (PRE 6.3%→POST 6.6%; P = 0.94).

Conclusions:

The Thoracic ERAS Program for lung resection reduced length of stay, morbidity, opioid use, and direct costs without change in readmission. This is the first external validation of the ERAS Society thoracic guidelines; adoption by other centers may show similar benefit.
Comparison of Patient Outcomes of Surgeons Who Are US Versus International Medical Graduates
Authors: Tsugawa Yusuke , Dimick Justin B. , Jena Anupam B. , Maggard-Gibbons Melinda , Blumenthal Daniel M. , Gross Nate , Jha Ashish K.
Published: December 2019

Objective:

The aim of this study was to compare patient outcomes between International Medical Graduate (IMG) versus US medical graduate (USMG) surgeons.

Summary Background Data:

One in 7 surgeons practicing in the US graduated from a foreign medical school. However, it remains unknown whether patient outcomes differ between IMG versus USMG surgeons.

Methods:

Using 20% random sample of Medicare fee-for-service beneficiaries aged 65 to 99 years who underwent 1 of 13 common nonelective surgical procedures (as a “natural experiment” as surgeons are less likely to select patients in this context) in 2011 to 2014 (638,973 patients treated by 37,221 surgeons for the mortality analysis), we compared operative mortality, complications, and length of stay (LOS) between IMG and USMG surgeons, adjusting for patient and surgeon characteristics and hospital-specific fixed effects (effectively comparing IMG and USMG surgeons within the same hospital). We also conducted stratified analyses by patients’ severity of illness and procedure type.

Results:

We found no evidence that patient outcomes differ between IMG and USMG surgeons for operative mortality [adjusted mortality, 7.3% for IMGs vs 7.3% for USMGs; adjusted odds ratio (aOR), 1.01; 95% confidence interval (CI), 0.96–1.05; P = 0.79], complication rate (adjusted complication rate, 0.6% vs 0.6%; aOR, 0.95; 95% CI, 0.85–1.06; P = 0.43), and LOS (adjusted LOS, 6.6 days vs 6.6 days; adjusted difference, +0.02 days; 95% CI, −0.05 to +0.08; P = 0.54). We also found no difference when we stratified by severity of illness and procedures.

Conclusion:

Using national data of Medicare beneficiaries who underwent common surgical procedures, we found no evidence that outcomes differ between IMG and USMG surgeons.
Hospital-level Variation in the Management and Outcomes of Patients With Adhesive Small Bowel Obstruction
Authors: Behman Ramy , Karanicolas Paul J. , Nathens Avery , Gomez David
Published: December 2019

Objective:

Determine the association between the rate of early operative management for adhesive small bowel obstruction (aSBO) at the hospital-level and the incidence of morbidity and mortality.

Background:

Mounting evidence of the benefits of early operation in patients with aSBO has translated to both an increase in the proportion of patients treated operatively, and the proportion of patients who undergo early operative management. However, variation in practice remains.

Methods:

We identified a population-based cohort of patients (18–80 years) who were admitted with their first episode of aSBO (2005–2014). The exposures of interest were hospital characteristics and the primary outcome measure was 30-day mortality. Hierarchical logistic regression models were used to evaluate hospital-level variation on 30-day mortality, serious complications, and bowel resection.

Results:

A total of 27,026 patients were admitted to 122 hospitals, 23% (n = 6090) were managed operatively, 7% (n = 1845) had a serious complication, and 30-day mortality was 4.2% (n = 1146). The proportion of patients managed with early operation ranged from 0% to 33% [median 10% (interquartile range: 5%–14%)]. There was a 17% lower likelihood of 30-day mortality for every 10% increase in proportion of patients managed with an early operation at the hospital-level (odds ratio: 0.83, 95% confidence interval: 0.70–0.99).

Conclusions:

Hospitals with a higher proportion of aSBO patients treated with an early operation had a lower likelihood of serious complications, bowel resection, and death, independent of hospital type and volume of aSBO admissions. Early operative intervention rates likely are a proxy for additional structures and processes of care focused on aSBO patients that may facilitate patient selection.
Time to Surgery and Colon Cancer Survival in the United States
Authors: Kaltenmeier Christof , Shen Chengli , Medich David S. , Geller David A. , Bartlett David L. , Tsung Allan , Tohme Samer
Published: December 2019

Purpose:

Time to surgery (TTS) is of concern to patients diagnosed with cancer and their physicians. Controversy surrounds the impact of TTS on colon cancer survival. There are limited national data evaluating the association; thus, our aim was to estimate the overall survival (OS) impact from increasing TTS for patients with colon cancer.

Methods:

Using the National Cancer Data Base (NCDB), we assessed OS as a function of time between diagnosis and surgery by evaluating intervals encompassing <7, 7 to 30, 31 to 60, 61 to 90, 91 to 120, and 121 to 180 days in length. All patients were diagnosed with nonmetastatic colon cancer and underwent surgery as initial treatment. Our main outcome was OS as a function of time between diagnosis and surgery, after adjusting for patient, demographic, and tumor-related factors using Cox regression models and propensity score-based weighting.

Results:

A total of 514,103 patients diagnosed between 1998 and 2012 were included. Individuals having <7, 7 to 30, 31 to 60, 61 to 90, 91 to 120, and 121 to 180 days between diagnosis and surgery comprised 35.4%, 45%, 15.1%, 2.9%, 1%, and 0.6% of the patients, respectively. There was a steady increase in median TTS across the years. On multivariable analysis, TTS >30 days or within the first week independently increased mortality risk. There was a significant increase in mortality with TTS 31 to 60 [hazard ratio (HR) 1.13], 61 to 90 (HR 1.49), <7 (HR 1.56), 91 to 120 (HR 2.28), and 121 to 180 (HR 2.46) compared to surgery performed 7 to 30 days after diagnosis (P < 0.001).

Conclusions:

TTS is independently associated with OS and this represents a public health issue that should be addressed at a national level. Although time is required for evaluation before surgery, efforts to reduce TTS should be pursued.
Planning sEEG implantation using automated lesion detection: retrospective feasibility study
Authors: Wagstyl Konrad , Adler Sophie , Pimpel Birgit , Chari Aswin , Seunarine Kiran , Lorio Sara , Thornton Rachel , Baldeweg Torsten , Tisdall Martin
Published: December 2019

Objective

A retrospective, cross-sectional study to evaluate the feasibility and potential benefits of incorporating deep-learning on structural MRI into planning stereoelectroencephalography (sEEG) implantation in paediatric patients with diagnostically complex drug-resistant epilepsy. This study aims to assess the degree of co-localisation between automated lesion detection and the seizure onset zone (SOZ) as assessed by sEEG.

Methods

A neural network classifier was applied to cortical features from MRI data from three cohorts. 1) The network was trained and cross-validated using 34 patients with visible focal cortical dysplasias (FCDs). 2) Specificity was assessed in 20 paediatric healthy controls. 3) Feasibility for incorporation into sEEG implantation plans was evaluated in 38 sEEG patients. Coordinates of sEEG contacts were coregistered with classifier-predicted lesions. sEEG contacts in seizure onset and irritative tissue were identified by clinical neurophysiologists. A distance of <10mm between SOZ contacts and classifier-predicted lesions was considered co-localisation.

Results

In patients with radiologically-defined lesions, classifier sensitivity was 74% (25/34 lesions detected). No clusters were detected in the controls (specificity 100%). Of 34 sEEG patients, 21 patients had a focal cortical SOZ. Of these there was co-localisation between classifier output and SOZ contacts in 62%. The algorithm detected 7/8 histopathologically-confirmed FCDs (86%).

Conclusions

There was a high degree of co-localisation between automated lesion detection and sEEG. We have created a framework for incorporation of deep-learning based MRI lesion detection into sEEG implantation planning. Our findings demonstrate that automated MRI analysis could be used to plan optimal electrode trajectories.