bluuebunny/crossref_metadata_2025 huggingface dataset:
A structural equation modeling of supply chain strategies for artemisinin-based combination therapies in Uganda
Authors: Nagitta Oluka Pross , Mkansi Marcia , Nyesiga Sylvia Desire , Kajjumba George William
Published: December 2021

Introduction:

Malaria is a killer disease in the tropical environment; artemisinin-based combination therapies (ACTs) play a central role in treating malaria. Thus, the supply and presence of ACT drugs in hospitals are a key feature in the fight against malaria. Supply chain management literature has focused on the private sector, and less attention has been paid to the public sector, especially hospitals.

Aim:

This study uses an interdisciplinary lens in investigating how to boost the supply and distribution of ACTs to save lives in low-income countries, specifically in Uganda.

Methodology:

The study adopted a quantitative research design using a questionnaire as the data collection instrument. Of the 440-population size, 304 of the sample population participated in the study. The model was estimated using structural equation modeling (SEM) to establish the causal relationship among the variables.

Results:

From the SEM analysis, all the hypotheses were significant at p < 0.05. The availability of ACTs is strongly affected by strategic dimensions (0.612), followed by operation dimensions (0.257); strategic determinants significantly affect operational determinants by a magnitude of 0.599. The indirect influence of the strategic determinants via operational determinants on the availability of ACTs is not significant. Overall, the factors explained 63.9% of the observed variance in the availability of ACTs, and the ACT availability can be predicted as follows: ACT availability = 0.612 × strategic determinants + 0.256 × operation determinants. Top management commitment and organizational responsiveness are among the items that positively affect the availability of ACTs.

Conclusion:

Strategically, hospital management should invest in cheap technology and software to minimize the unavailability of medicines. Our research suggests that strategic and operational determinants should be integrated into the hospitals’ core business and implemented by the top management. The article contributes to theoretical and policy direction in the public sector medicine supply chain, specifically in public hospitals.
Amyloid cast nephropathy: A rare presentation of multiple myeloma–associated light chain amyloidosis
Authors: Reis Marina , Rodrigues Ana , Cristovão Maques Joana , Góis Mário , Sousa Helena , Nolasco Fernando
Published: December 2021

Introduction:

Monoclonal immunoglobulins can cause a variety of histologic patterns of kidney injury, depending on the physicochemical properties. Multiple myeloma manifests more often as light-chain nephropathy. On the other hand, light-chain amyloidosis leads to glomerular and vascular amyloid deposits, but a less common presentation with amyloid casts has also been described. Rarely, more than one histologic pattern can be present in the same patient.

Case report:

We report a case of a 73-year-old man, diagnosed with multiple myeloma that 8 months after achieving partial response to chemotherapy develops acute kidney injury and nephrotic syndrome. Kidney biopsy revealed features of light-chain nephropathy, amyloid cast nephropathy, and glomerular and vascular amyloid deposits. Immunofluorescence was positive for IgA (++) and lambda chains (+++) and negative for kappa chains. After the diagnosis of multiple myeloma-associated light-chain amyloidosis, chemotherapy was initiated; unfortunately, the patient died 1 month after the diagnosis.

Conclusion:

Amyloid casts, isolated or accompanied by other renal or extra-renal amyloid deposits, are another form of tubular toxicity caused by dysproteinemias and should be systematically screened in kidney biopsies.
Opioids and the Risk of Motor Vehicle Collision: A Systematic Review
Authors: Leon Silvia J. , Trachtenberg Aaron , Briscoe Derek , Ahmed Maira , Hougen Ingrid , Askin Nicole , Whitlock Reid , Ferguson Thomas , Tangri Navdeep , Rigatto Claudio , Komenda Paul
Published: December 2021

Background: Opioid analgesics are among the most commonly prescribed medications, but questions remain regarding their impact on the day-to-day functioning of patients including driving. We set out to perform a systematic review on the risk of motor vehicle collision (MVC) associated with prescription opioid exposure. Method: We searched Medline, PubMed, EMBASE, Scopus, and TRID from January 1990 to August 31, 2021 for primary studies assessing prescribed opioid use and MVCs. Results: We identified 14 observational studies that met inclusion criteria. Among those, 8 studies found an increased risk of MVC among those participants who had a concomitant opioid prescription at the time of the MVC and 3 found no significant increase of culpability of fatal MVC. The 3 studies that evaluated the presence of a dose-response relationship between the dose of opioids taken and the effects on MVC risk reported the existence of a dose-response relationship. Due to the heterogeneity of the different studies, a quantitative meta-analysis to sum evidence was deemed unfeasible. Our review supports increasing evidence on the association between motor vehicle collisions and prescribed opioids. This research would guide policies regarding driving legislation worldwide. Conclusion: Our review indicates that opioid prescriptions are likely associated with an increased risk of MVCs. Further studies are warranted to strengthen this finding, and investigate additional factors such as individual opioid medications, opioid doses and dose adjustments, and opioid tolerance for their effect on MVC risk.
Primary adenocarcinoma of renal pelvis or ureter: an uncommon histopathological entity seen in three cases
Authors: Agrawal Shashank , Singh Abhishek G. , Sabnis Ravindra B. , Desai Mahesh R.
Published: December 2021

Background

Primary adenocarcinoma of renal pelvis or ureter is rarest (< 1%) among all urothelial tumors. Regrettably, no characteristic symptoms, radiological features and treatment for this tumor are reported. We report three cases of adenocarcinoma of renal pelvis and ureter.

Case presentation

Case 1 had grossly hydronephrotic non-functional right kidney and underwent percutaneous nephrostomy followed by laparoscopic simple nephrectomy. Incidentally, histopathological examination reported adenocarcinoma of renal pelvis. Whole-body positron emission tomography-CT (PET-CT) ruled out malignancy at other sites. Patient refused adjuvant chemotherapy. Case 2 presented with previous history of right pyelolithotomy, right ureteroscopic lithotripsy and right flank pain with intermittent discharge via previous percutaneous site. On biochemical and radiological investigations, right poorly functioning pyonephrotic kidney was confirmed. Patient underwent right open nephrectomy which incidentally reported adenocarcinoma of renal pelvis. Patient is disease-free at 18 months of follow-up. Case 3 had left ureteric wall thickening on CT scan when evaluated for hematuria. Ureteroscopic-guided biopsy showed villous adenoma. Laparoscopic left nephroureterectomy with bladder cuff excision specimen showed well-differentiated adenocarcinoma in ureter with extension into periureteric fat. Patient died 32 months after surgery.

Conclusion

Primary adenocarcinoma of renal pelvis or ureter is very rare and urologists should suspect it in patients with mucinous material in nephrostomy tube. We should have a low threshold for performing radical nephrectomy with complete ureterectomy in these unusual cases to improve the prognosis.
Integrative analysis of multimodal traffic data: addressing open challenges using big data analytics in the city of Lisbon
Authors: Lemonde Carlos , Arsenio Elisabete , Henriques Rui
Published: December 2021

Worldwide cities are establishing efforts to collect urban traffic data from various modes and sources. Integrating traffic data, together with their situational context, offers more comprehensive views on the ongoing mobility changes and supports enhanced management decisions accordingly. Hence, cities are becoming sensorized and heterogeneous sources of urban data are being consolidated with the aim of monitoring multimodal traffic patterns, encompassing all major transport modes—road, railway, inland waterway—, and active transport modes such as walking and cycling. The research reported in this paper aims at bridging the existing literature gap on the integrative analysis of multimodal traffic data and its situational urban context. The reported work is anchored on the major findings and contributions from the research and innovation project Integrative Learning from Urban Data and Situational Context for City Mobility Optimization (ILU), a multi-disciplinary project on the field of artificial intelligence applied to urban mobility, joining the Lisbon city Council, public carriers, and national research institutes. The manuscript is focused on the context-aware analysis of multimodal traffic data with a focus on public transportation, offering four major contributions. First, it provides a structured view on the scientific and technical challenges and opportunities for data-centric multimodal mobility decisions. Second, rooted on existing literature and empirical evidence, we outline principles for the context-aware discovery of multimodal patterns from heterogeneous sources of urban data. Third, Lisbon is introduced as a case study to show how these principles can be enacted in practice, together with some essential findings. Finally, we instantiate some principles by conducting a spatiotemporal analysis of multimodality indices in the city against available context. Concluding, this work offers a structured view on the opportunities offered by cross-modal and context-enriched analysis of traffic data, motivating the role of Big Data to support more transparent and inclusive mobility planning decisions, promote coordination among public transport operators, and dynamically align transport supply with the emerging urban traffic dynamics.
The effect of post-fixation olecranon lengthening on range of motion of the elbow: a cadaveric study
Authors: Wong Khai Phang , Tan James Chung Hui
Published: December 2021

Background

Principles of fixation of comminuted olecranon fractures include anatomical reduction of the articular surface and restoration of ulnohumeral joint motion. However, comminution sometimes may not permit anatomical fixation of fracture fragments, resulting in inadvertent olecranon lengthening after plate fixation. The aim of our study is to investigate the relationship between olecranon lengthening following plate fixation and loss of elbow extension.

Materials and methods

Transverse olecranon osteotomies were performed on 8 cadaveric elbows. The osteotomy sites were then fixed with olecranon plates. Lengthening of the osteotomy sites were simulated by placement of 2mm, 4mm, 6mm and 8mm blocks. Lateral view photographs of the elbows were taken after each degree of lengthening. These photographs were then printed and measurements of elbow extension were performed with a goniometer with average values taken. The measurements were tabulated and statistical analysis performed to determine the relationship between degree of elbow extension loss and amount of olecranon lengthening.

Results

Average values of each degree of lengthening (at 2mm, 4mm, 6mm and 8mm) were taken and compared with the baseline measurement (at 0mm). Cluster analysis showed that for every increment in osteotomy length of 2mm, there is a corresponding increase of 0.79° of elbow extension loss (p<0.01, 95% confidence level 0.55°-1.03°).

Conclusion

Lengthening of olecranon by increments of 2mm correlates positively with loss of elbow extension. This shows that inadvertent intra-operative olecranon lengthening post-fixation may result in limited range of motion. However, it is reassuring to know that the small degree of extension loss may not translate to functional limitation.
Upregulated expression of transforming growth factor-β receptor I/II in an endemic Osteoarthropathy in China
Authors: Zhang Ying , Mu Yudong , He Ying , Li Zhengzheng , Mi Ge , Liu Yinan , Zhang Meng , Wang Hui , Feng Yiping , Fang Qian , Ma Tianyou , Deng Xianghua , Chen Jinghong
Published: December 2021

Background

Kashin–Beck disease (KBD) is a chronic, deforming, endemic osteochondropathy that begins in patients as young as 2–3 years of age. The pathogenesis of KBD remains unclear, although selenium (Se) deficiency and T-2 toxin food contamination are both linked to the disease. In the present study, we evaluated transforming growth factor-β receptor (TGF-βR I and II) levels in clinical samples of KBD and in pre-clinical disease models.

Methods

Human specimens were obtained from the hand phalanges of eight donors with KBD and eight control donors. Animal models of the disease were established using Sprague–Dawley rats, which were fed an Se-deficient diet for 4 weeks and later administered the T-2 toxin. Cartilage cellularity and morphology were examined by hematoxylin and eosin staining. Expression and localization of TGF-βRI and II were evaluated using immunohistochemical staining and western blotting.

Results

In the KBD samples, chondral necrosis was detected based on cartilage cell disappearance and alkalinity loss in the matrix ground substance. In the necrotic areas, TGF-βRI and II staining were strong. Positive percentages of TGF-βRI and II staining were higher in the cartilage samples of KBD donors than in those of control donors. TGF-βRI and II staining was also increased in cartilage samples from rats administered T-2 toxin or fed on Se-deficient plus T-2 toxin diets.

Conclusion

TGF-βRI and II may be involved in the pathophysiology of KBD. This study provides new insights into the pathways that contribute to KBD development.
Clinical feature-related single-base substitution sequence signatures identified with an unsupervised machine learning approach
Authors: Ji Hongchen , Li Junjie , Zhang Qiong , Yang Jingyue , Duan Juanli , Wang Xiaowen , Ma Ben , Zhang Zhuochao , Pan Wei , Zhang Hongmei
Published: December 2021

Background

Mutation processes leave different signatures in genes. For single-base substitutions, previous studies have suggested that mutation signatures are not only reflected in mutation bases but also in neighboring bases. However, because of the lack of a method to identify features of long sequences next to mutation bases, the understanding of how flanking sequences influence mutation signatures is limited.

Methods

We constructed a long short-term memory-self organizing map (LSTM-SOM) unsupervised neural network. By extracting mutated sequence features via LSTM and clustering similar features with the SOM, single-base substitutions in The Cancer Genome Atlas database were clustered according to both their mutation site and flanking sequences. The relationship between mutation sequence signatures and clinical features was then analyzed. Finally, we clustered patients into different classes according to the composition of the mutation sequence signatures by the K-means method and then studied the differences in clinical features and survival between classes.

Results

Ten classes of mutant sequence signatures (mutation blots, MBs) were obtained from 2,141,527 single-base substitutions via LSTM-SOM machine learning approach. Different features in mutation bases and flanking sequences were revealed among MBs. MBs reflect both the site and pathological features of cancers. MBs were related to clinical features, including age, sex, and cancer stage. The class of an MB in a given gene was associated with survival. Finally, patients were clustered into 7 classes according to the MB composition. Significant differences in survival and clinical features were observed among different patient classes.

Conclusions

We provided a method for analyzing the characteristics of mutant sequences. Result of this study showed that flanking sequences, together with mutation bases, shape the signatures of SBSs. MBs were shown related to clinical features and survival of cancer patients. Composition of MBs is a feasible predictive factor of clinical prognosis. Further study of the mechanism of MBs related to cancer characteristics is suggested.
Role of Secretoglobin+ (club cell) NFκB/RelA-TGFβ signaling in aero-allergen-induced epithelial plasticity and subepithelial myofibroblast transdifferentiation
Authors: Skibba Melissa E. , Xu Xiaofang , Weiss Kurt , Huisken Jan , Brasier Allan R.
Published: December 2021

Repetitive aeroallergen exposure is linked to sensitization and airway remodeling through incompletely understood mechanisms. In this study, we examine the dynamic mucosal response to cat dander extract (CDE), a ubiquitous aero-allergen linked to remodeling, sensitization and asthma. We find that daily exposure of CDE in naïve C57BL/6 mice activates innate neutrophilic inflammation followed by transition to a lymphocytic response associated with waves of mucosal transforming growth factor (TGF) isoform expression. In parallel, enhanced bronchiolar Smad3 expression and accumulation of phospho-SMAD3 was observed, indicating paracrine activation of canonical TGFβR signaling. CDE exposure similarly triggered epithelial cell plasticity, associated with expression of mesenchymal regulatory factors (Snai1 and Zeb1), reduction of epithelial markers (Cdh1) and activation of the NFκB/RelA transcriptional activator. To determine whether NFκB functionally mediates CDE-induced growth factor response, mice were stimulated with CDE in the absence or presence of a selective IKK inhibitor. IKK inhibition substantially reduced the level of CDE-induced TGFβ1 expression, pSMAD3 accumulation, Snai1 and Zeb1 expression. Activation of epithelial plasticity was demonstrated by flow cytometry in whole lung homogenates, where CDE induces accumulation of SMA+Epcam+ population. Club cells are important sources of cytokine and growth factor production. To determine whether Club cell innate signaling through NFκB/RelA mediated CDE induced TGFβ signaling, we depleted RelA in Secretoglobin (Scgb1a1)-expressing bronchiolar cells. Immunofluorescence-optical clearing light sheet microscopy showed a punctate distribution of Scgb1a1 progenitors throughout the small airway. We found that RelA depletion in Secretoglobin+ cells results in inhibition of the mucosal TGFβ response, blockade of EMT and reduced subepithelial myofibroblast expansion. We conclude that the Secretoglobin—derived bronchiolar cell is central to coordinating the innate response required for mucosal TGFβ1 response, EMT and myofibroblast expansion. These data have important mechanistic implications for how aero-allergens trigger mucosal injury response and remodeling in the small airway.
FPR2 participates in epithelial ovarian cancer (EOC) progression through RhoA-mediated M2 macrophage polarization
Authors: Xie Xiaohui , He Juan , Wang Qiong , Liu Yaqiong , Chen Weiwei , Shi Kun
Published: December 2021

Background

In our previous study, we found that formyl peptide receptor 2 (FPR2) promoted the invasion and metastasis of epithelial ovarian cancer (EOC) and could be a prognostic marker for EOC. In this study, we aimed to study the possible mechanism of FPR2 in promoting EOC progression.

Methods

EOC cell lines with ectopic FPR2 expression and knockdown as well as their control cell lines were established, and the expression change of RhoA in each cell line was evaluated by real time quantitative polymerase chain reaction (RT-qPCR) and Western blot. Wound healing and Transwell assays were performed to detect the migratory ability of EOCs affected by FPR2 and RhoA. The supernatant of each EOC cell line was used to coculture with macrophages, and then we tested M1 and M2 macrophage biomarkers in the supernatants by flow cytometry. The THP-1 cell line was also induced to differentiate into M1 and M2 macrophages, and FPR2 and RhoA expression in each macrophage cell line was detected by RT-qPCR and Western blot. A tumour xenograft model was established with SKOV3 and SKOV3−shFPR2 cell lines, and tumour volumes and weights were recorded.

Results

RhoA expression was significantly increased in EOCs along with the overexpression of FPR2, which showed a positive correlation by Pearson correlation analysis. Ectopic FPR2 expression contributes to the migratory ability of EOCs, and a RhoA inhibitor (C3 transferase) impairs EOC migration. Furthermore, FPR2 stimulated the secretion of Th2 cytokines by EOCs, which induced macrophages to differentiate to the M2 phenotype, while a RhoA inhibitor stimulated the secretion of Th1 cytokines and induced macrophages to differentiate to the M1 phenotype. Moreover, compared with M1 macrophages and THP-1 cells, FPR2 and RhoA expression was significantly upregulated in M2 macrophages.

Conclusion

FPR2 stimulated M2 macrophage polarization and promoted invasion and metastasis of ovarian cancer cells through RhoA.
Gene cascade analysis in human granulosa tumor cells (KGN) following exposure to high levels of free fatty acids and insulin
Authors: Tremblay Patricia G. , Fortin Chloé , Sirard Marc-André
Published: December 2021

Maternal metabolic disorders such as obesity and diabetes are detrimental factors that compromise fertility and the success rates of medically assisted procreation procedures. During metabolic stress, adipose tissue is more likely to release free fatty acids (FFA) in the serum resulting in an increase of FFA levels not only in blood, but also in follicular fluid (FF). In humans, high concentrations of palmitic acid and stearic acid reduced granulosa cell survival and were associated with poor cumulus-oocyte complex (COC) morphology. Obesity and high levels of circulating FFA were also causatively linked to hampered insulin sensitivity in cells and compensatory hyperinsulinemia. To provide a global picture of the principal upstream signaling pathways and genomic mechanisms involved in this metabolic context, human granulosa-like tumor cells (KGN) were treated with a combination of palmitic acid, oleic acid, and stearic acid at the higher physiological concentrations found in the follicular fluid of women with a higher body mass index (BMI) (≥ 30.0 kg/m2). We also tested a high concentration of insulin alone and in combination with high concentrations of fatty acids. Transcription analysis by RNA-seq with a cut off for fold change of 1.5 and p-value 0.05 resulted in thousands of differentially expressed genes for each treatment. Using analysis software such as Ingenuity Pathway Analysis (IPA), we were able to establish that high concentrations of FFA affected the expression of genes mainly related to glucose and insulin homoeostasis, fatty acid metabolism, as well as steroidogenesis and granulosa cell differentiation processes. The combination of insulin and high concentrations of FFA affected signaling pathways related to apoptosis, inflammation, and oxidative stress. Taken together, our results provided new information on the mechanisms that might be involved in human granulosa cells exposed to high concentrations of FFA and insulin in the contexts of metabolism disorders.
Synthesis of novel indole-isoxazole hybrids and evaluation of their cytotoxic activities on hepatocellular carcinoma cell lines
Authors: Hawash Mohammed , Kahraman Deniz Cansen , Ergun Sezen Guntekin , Cetin-Atalay Rengul , Baytas Sultan Nacak
Published: December 2021

Background

Liver cancer is predicted to be the sixth most diagnosed cancer globally and fourth leading cause of cancer deaths. In this study, a series of indole-3-isoxazole-5-carboxamide derivatives were designed, synthesized, and evaluated for their anticancer activities. The chemical structures of these of final compounds and intermediates were characterized by using IR, HRMS, 1H-NMR and 13C-NMR spectroscopy and element analysis.

Results

The cytotoxic activity was performed against Huh7, MCF7 and HCT116 cancer cell lines using sulforhodamine B assay. Some compounds showed potent anticancer activities and three of them were chosen for further evaluation on liver cancer cell lines based on SRB assay and real-time cell growth tracking analysis. Compounds were shown to cause arrest in the G0/G1 phase in Huh7 cells and caused a significant decrease in CDK4 levels. A good correlation was obtained between the theoretical predictions of bioavailability using Molinspiration calculation, Lipinski’s rule of five, and experimental verification. These investigations reveal that indole-isoxazole hybrid system have the potential for the development of novel anticancer agents.

Conclusions

This study has provided data that will form the basis of further studies that aim to optimize both the design and synthesis of novel compounds that have higher anticancer activities.
Ecological surveillance of bat coronaviruses in Sarawak, Malaysian Borneo
Authors: Tan Cheng-Siang , Noni Vaenessa , Sathiya Seelan Jaya Seelan , Denel Azroie , Anwarali Khan Faisal Ali
Published: December 2021

Objective

Coronaviruses (CoVs) are natural commensals of bats. Two subgenera, namely Sarbecoviruses and Merbecoviruses have a high zoonotic potential and have been associated with three separate spillover events in the past 2 decades, making surveillance of bat-CoVs crucial for the prevention of the next epidemic. The study was aimed to elucidate the presence of coronavirus in fresh bat guano sampled from Wind Cave Nature Reserve (WCNR) in Sarawak, Malaysian Borneo. Samples collected were placed into viral transport medium, transported on ice within the collection day, and preserved at − 80 °C. Nucleic acid was extracted using the column method and screened using consensus PCR primers targeting the RNA-dependent RNA polymerase (RdRp) gene. Amplicons were sequenced bidirectionally using the Sanger method. Phylogenetic tree with maximum-likelihood bootstrap and Bayesian posterior probability were constructed.

Results

CoV-RNA was detected in ten specimens (47.6%, n  = 21). Six alphacoronavirus and four betacoronaviruses were identified. The bat-CoVs can be phylogenetically grouped into four novel clades which are closely related to Decacovirus-1 and Decacovirus-2, Sarbecovirus, and an unclassified CoV. CoVs lineages unique to the Island of Borneo were discovered in Sarawak, Malaysia, with one of them closely related to Sarbecovirus. All of them are distant from currently known human coronaviruses.
Improving research quality: the view from the UK Reproducibility Network institutional leads for research improvement
Authors: Stewart Andrew J. , Farran Emily K. , Grange James A. , Macleod Malcolm , Munafò Marcus , Newton Phil , Shanks David R. ,   the UKRN Institutional Leads
Published: December 2021

The adoption and incentivisation of open and transparent research practices is critical in addressing issues around research reproducibility and research integrity. These practices will require training and funding. Individuals need to be incentivised to adopt open and transparent research practices (e.g., added as desirable criteria in hiring, probation, and promotion decisions, recognition that funded research should be conducted openly and transparently, the importance of publishers mandating the publication of research workflows and appropriately curated data associated with each research output). Similarly, institutions need to be incentivised to encourage the adoption of open and transparent practices by researchers. Research quality should be prioritised over research quantity. As research transparency will look different for different disciplines, there can be no one-size-fits-all approach. An outward looking and joined up UK research strategy is needed that places openness and transparency at the heart of research activity. This should involve key stakeholders (institutions, research organisations, funders, publishers, and Government) and crucially should be focused on action. Failure to do this will have negative consequences not just for UK research, but also for our ability to innovate and subsequently commercialise UK-led discovery.
Economic impact of spectral body imaging in diagnosis of patients suspected for occult cancer
Authors: Andersen Michael Brun , Ebbesen Dyveke , Thygesen Jesper , Kruis Matthijs , Gu Qing , Dharaiya Ekta , Rasmussen Finn
Published: December 2021

Background

Based on prior studies spectral CT has shown a higher sensitivity for malignant lesions than conventional CT at the cost of lower specificity. For the radiologists, it also offers a higher degree of certainty in the diagnosis of benign lesions. The objective of this study was to evaluate the economic impact of spectral CT in patients suspected of occult cancer in a medical center in Denmark.

Methods

This study was a secondary analysis using de-identified data from a prospective study of patients receiving a contrast-enhanced spectral CT scan. Based on suggested follow-up examinations on both spectral CT and contrast-enhanced CT, costs from a payer’s perspective were determined using unit costs obtained from national databases.

Results

The dataset contained 400 patients. Overall, 203 follow-up procedures were eliminated based on spectral data reading. The largest reduction in suggested follow-up procedures was found for the kidney (83%), followed by the liver (66%), adrenal glands (60%), and pancreas (42%). The total estimated costs for suggested follow-up procedures based on spectral data reading were €155,219, 25.2% (€52,384) less than that of conventional CT reading.

Conclusion

Our results provide support for spectral body imaging as an advanced imaging modality for suspected occult cancer. A substantial number of follow-up diagnostic procedures could be eliminated based on spectral data reading, which would result in significant cost savings.
Portomesenteric venous thrombosis in a prophylactically anticoagulated obese patient after laparoscopic sleeve gastrectomy: a case report
Authors: Alsannaa Feras , Albaqami Faisal , Shalhoub Mishary
Published: December 2021

Background

Obesity is associated with an increased risk of morbidity and mortality, so weight reduction is important. Bariatric surgery is a well-tolerated approach for reducing body weight, with laparoscopic sleeve gastrectomy commonly performed. An uncommon and potentially fatal sequela of laparoscopic sleeve gastrectomy is portomesenteric vein thrombosis, which may result in severe bowel ischemia.

Case report

A 32-year-old Middle Eastern obese man (body mass index 33) presented to the emergency department with severe, generalized abdominal pain 2 weeks after laparoscopic sleeve gastrectomy. Computed tomography of the abdomen and pelvis revealed extensive acute on chronic portosplenic and superior mesenteric vein thrombosis with associated small bowel ischemia. Laparoscopic exploration was converted to midline laparotomy and an extensive ischemic small bowel resection.

Conclusion

Laparoscopic sleeve gastrectomy carries a risk of both morbidity and mortality. Venous thromboembolism is a well-known risk of bariatric surgery, but portomesenteric vein thrombosis is also a rare but sometimes serious complication. A high index of suspicion for portomesenteric vein thrombosis to prompt early detection is essential in patients who have undergone laparoscopic sleeve gastrectomy to minimize complications and optimize outcomes. Uncertainty still remains around the optimal dose and duration of anticoagulation after laparoscopic sleeve gastrectomy.
A historical vertebrate collection from the Middle Miocene of the Peruvian Amazon
Authors: Carrillo-Briceño Jorge D. , Aguilera Orangel A. , Benites-Palomino Aldo , Hsiou Annie S. , Birindelli José L. O. , Adnet Sylvain , Cadena Edwin-Alberto , Scheyer Torsten M.
Published: December 2021

The Miocene aquatic and terrestrial fossil record from western Amazonia constitute a clear evidence of the palaeoenvironmental diversity that prevailed in the area, prior to the establishment of the Amazon River drainage. During the Miocene, the region was characterized by a freshwater megawetland basin, influenced by episodic shallow-marine incursions. A fossil vertebrate collection from the middle Miocene strata of the Pebas Formation is here studied and described. This historical collection was recovered in 1912 along the banks of the Itaya River (Iquitos, Peru), during a scientific expedition led by two scientists of the University of Zurich, Hans Bluntschli and Bernhard Peyer. Our findings include a total of 34 taxa, including stingrays, bony fishes, turtles, snakes, crocodylians, and lizards. Fishes are the most abundant group in the assemblage (~ 23 taxa), including the first fossil record of the freshwater serrasalmids Serrasalmus, and Mylossoma, and the hemiodontid Hemiodus for the Pebas system, with the latter representing the first fossil be discovered for the entire Hemiodontidae. The presence of a representative of Colubroidea in the middle Miocene of Iquitos supports the hypothesis of arrival and dispersal of these snakes into South America earlier than previously expected. This fossil assemblage sheds light on the palaeoenvironments, and the geographical/temporal range of several aquatic/terrestrial lineages inhabiting the Amazonian region.
Novel insights into early life stages of finned octopods (Octopoda: Cirrata)
Authors: Ziegler Alexander , Miller Abigail , Nagelmann Nina
Published: December 2021

The finned or dumbo octopods (Octopoda: Cirrata) constitute a cephalopod (Mollusca: Cephalopoda) taxon almost exclusively comprising organisms that inhabit the deep-sea. This renders studying the general biology of adult cirrate specimens a difficult task, but even more so when it comes to gathering knowledge on their early life stages. During his comprehensive research exploits on cephalopod development, the late Sigurd von Boletzky (1942–2020) also sought to shed light on specific adaptations that eggs and embryos of these enigmatic deep-sea octopods might show. Based on his seminal work, the present article sets out to provide additional data on a broad range of early cirrate life stages, including egg capsules without any obvious embryonic stage as well as those containing embryos. These previously unreported specimens obtained from museum collections were analyzed using conventional morphological as well as modern three-dimensional imaging techniques. The present overview includes specimens from four of the five oceans, i.e., the Atlantic, Pacific, Indian, and Southern Ocean. Based on information on cirrate ovum, chorion, and egg capsule size as well as shape gathered from the literature, an attempt is made here for the first time to identify von Boletzky's as well as the specimens introduced here down to at least genus level. The combined data provide novel insights into early life stages of finned octopods, aiming to continue von Boletzky's legacy with regard to developmental research on a still largely enigmatic taxon of extant deep-sea cephalopods.
Instantaneous cross-correlation function type of WD based LFM signals analysis via output SNR inequality modeling
Authors: Qiang Sheng-Zhou , Jiang Xian , Han Pu-Yu , Shi Xi-Ya , Wu An-Yang , Sun Yun , Chen Yun-Jie , Zhang Zhi-Chao
Published: December 2021

Linear canonical transform (LCT) is a powerful tool for improving the detection accuracy of the conventional Wigner distribution (WD). However, the LCT free parameters embedded increase computational complexity. Recently, the instantaneous cross-correlation function type of WD (ICFWD), a specific WD relevant to the LCT, has shown to be an outcome of the tradeoff between detection accuracy and computational complexity. In this paper, the ICFWD is applied to detect noisy single component and bi-component linear frequency-modulated (LFM) signals through the output signal-to-noise ratio (SNR) inequality modeling and solving with respect to the ICFWD and WD. The expectation-based output SNR inequality model between the ICFWD and WD on a pure deterministic signal added with a zero-mean random noise is proposed. The solutions of the inequality model in regard to single component and bi-component LFM signals corrupted with additive zero-mean stationary noise are obtained respectively. The detection accuracy of ICFWD with that of the closed-form ICFWD (CICFWD), the affine characteristic Wigner distribution (ACWD), the kernel function Wigner distribution (KFWD), the convolution representation Wigner distribution (CRWD) and the classical WD is compared. It also compares the computing speed of ICFWD with that of CICFWD, ACWD, KFWD and CRWD.
On compositions of special cases of Lipschitz continuous operators
Authors: Giselsson Pontus , Moursi Walaa M.
Published: December 2021

Many iterative optimization algorithms involve compositions of special cases of Lipschitz continuous operators, namely firmly nonexpansive, averaged, and nonexpansive operators. The structure and properties of the compositions are of particular importance in the proofs of convergence of such algorithms. In this paper, we systematically study the compositions of further special cases of Lipschitz continuous operators. Applications of our results include compositions of scaled conically nonexpansive mappings, as well as the Douglas–Rachford and forward–backward operators, when applied to solve certain structured monotone inclusion and optimization problems. Several examples illustrate and tighten our conclusions.
A social perspective on resilience: social support and dyadic coping in teacher training
Authors: Kärner Tobias , Weiß Julia Katharina , Heinrichs Karin
Published: December 2021

Stress in teaching and teacher training is a well-known issue and stress management during teacher training may not only be affected by individual coping efforts, but also determined by private and work-related networks the individual is integrated in. In that regard, our article aims firstly to identify sources of social support in the German teacher training system and secondly to analyze interdependencies in dyadic coping interactions based on the Actor-Partner Interdependence Model. On the basis of questionnaire data from 307 German trainees and qualified teachers from vocational and general schools, we found that mentors, partners, fellow trainees, colleagues at school, parents, and good friends were named as the most supportive reference persons during teacher training. In a follow-up survey, data from 49 sources of support were obtained, which could be assigned to the corresponding (trainee) teachers (in the sense of support recipients). These dyads thus form the basis for the analysis of dyadic coping interdependencies. The results of the moderator analyses show, among other things, that support recipients who prefer the coping strategy palliative emotion regulation tend to react rather sensitively to contrary coping strategies of the source of support with regard to their stress symptoms. Social interactions in this respect can represent both protective as well as risk factors. Therefore, a system of complex social interdependencies must be considered when analyzing relational resilience among prospective teachers.
Ultrafiltration in Japanese critically ill patients with acute kidney injury on renal replacement therapy
Authors: Kitamura Koichi , Hayashi Koichi , Fujitani Shigeki , Murugan Raghavan , Suzuki Toshihiko
Published: December 2021

A recent worldwide survey indicates an international diversity in net ultrafiltration (UFNET) practices for the treatment of fluid overload in critically ill patients with acute kidney injury (AKI) requiring renal replacement therapy (RRT). The sub-analysis of the survey has demonstrated that maximum doses of furosemide used before determination of diuretic resistance are lower in Japan than those prescribed worldwide and UFNET is lower but is initiated earlier. In contrast, the interval during which practitioners evaluate fluid balance is longer. The characterization of RRT in critically ill patients in Japan should unveil more appropriate approaches to the successful treatment of AKI.
Prolonged enhancement of cytotoxic T lymphocytes in the post-recovery state of severe COVID-19
Authors: Mitsuyama Yumi , Yamakawa Kazuma , Kayano Katsuhide , Maruyama Miho , Wada Takeshi , Fujimi Satoshi
Published: December 2021

We evaluated the peripheral blood immune responses of lymphocytes in severe Coronavirus disease 2019 (COVID-19) patients in different stages of recovery using single-cell mass cytometry. The patients with prolonged hospitalization did not show recovery of B lymphocyte counts and CD4-positive T lymphocyte counts but did show abundant CD8-positive T lymphocytes. CD4 and CD8 T cells expressing high levels of T-bet and Granzyme B were more abundant in post-recovery patients. This study showed that cytotoxic Th1 and CD8 T cells are recruited to the peripheral blood long after recovery from COVID-19.
LiDAR DNN based self-attitude estimation with learning landscape regularities
Authors: Ozaki Ryota , Sugiura Naoya , Kuroda Yoji
Published: December 2021

This paper presents an EKF (extended Kalman filter) based self-attitude estimation method with a LiDAR DNN (deep neural network) learning landscape regularities. The proposed DNN infers the gravity direction from LiDAR data. The point cloud obtained with the LiDAR is transformed to a depth image to be input to the network. It is pre-trained with large synthetic datasets. They are collected in a flight simulator because various gravity vectors can be easily obtained, although this study focuses not only on UAVs. Fine-tuning with datasets collected with real sensors is done after the pre-training. Data augmentation is processed during the training in order to provide higher general versatility. The proposed method integrates angular rates from a gyroscope and the DNN outputs in an EKF. Static validations are performed to show the DNN can infer the gravity direction. Dynamic validations are performed to show the DNN can be used in real-time estimation. Some conventional methods are implemented for comparison.
Current state and future prospects of pure mycelium materials
Authors: Vandelook Simon , Elsacker Elise , Van Wylick Aurélie , De Laet Lars , Peeters Eveline
Published: December 2021

In the context of the ongoing transition from a linear to a circular economy, ecologically friendly renewable solutions are put in place. Filamentous fungi can be grown on various organic feedstocks and functionalized into a range of diverse material types which are biobased and thus more sustainable in terms of their production, use and recycling. Pure mycelium materials, consisting only of mycelial biomass, can adopt versatile properties and appear promising as a substitute for current petrochemically produced polymeric materials or, in the case of myco-leather, as a substitute for animal-based leather. In recent years, a handful of private companies have been innovating to bring products based on pure mycelium materials to the market while scientific interest in these promising biomaterials is now starting to gain momentum. In this primer, we introduce pure mycelium materials, frame different production methods, review existing and potential future applications, thereby offering a vision on future advances for this emerging fungi-based technology.
Distal gastric tube resection with preservation of the right gastroepiploic artery for gastric tube cancer: a case report
Authors: Tajima Kohei , Shimada Hideo , Nishi Takayuki , Kamei Yutaro , Koyanagi Kazuo , Makuuchi Hiroyasu
Published: December 2021

Background

The incidence of gastric tube cancer is increasing because of improved survival rates in patients with esophageal cancer treated by esophagectomy. Total resection of the gastric tube is expected to be highly curative, but it is associated with a higher risk of severe postoperative complications. Herein we report a case of early gastric tube cancer that was successfully treated by distal gastric tube resection with preservation of the right gastroepiploic artery (RGEA).

Case presentation

An 82-year-old man was diagnosed as having gastric tube cancer, B-12-O, Type 0-IIc, T1b, N0, M0, cStage IA (Japanese Classification of Gastric Carcinoma). Upper gastrointestinal endoscopy showed a Type 0-IIc lesion measuring 30 mm in length in the lower part of the gastric tube, and histopathological examination of biopsy specimens revealed the features of poorly differentiated adenocarcinoma. The primary lesion could not be identified by computed tomography, and there was no obvious lymph node metastasis or distant metastasis. Considering that total resection of the gastric tube would have been highly invasive and that the gastric tube cancer was at a relatively early stage, we performed distal gastric tube resection with preservation of the RGEA. The postoperative course was uneventful, and the patient was discharged on postoperative day 12. There has been no recurrence during the 17 months of follow-up.

Conclusion

We successfully treated a patient with gastric tube cancer by distal gastric tube resection with preservation of the RGEA. This treatment strategy may be acceptable for patients with early gastric tube cancer without lymph node metastasis, considering the balance between the surgical invasiveness and curability of the tumor.
Hypothyroidism and hypopituitarism as immune-related adverse events due to lenvatinib plus pembrolizumab therapy in the immediate postoperative period after laparoscopic hepatectomy for liver metastases from gastric cancer: a case report
Authors: Sasaki Kimimasa , Kobayashi Shin , Kudo Masashi , Sugimoto Motokazu , Takahashi Shinichiro , Nakamura Yoshiaki , Kawazoe Akihito , Shitara Kohei , Kinoshita Takahiro , Gotohda Naoto
Published: December 2021

Background

Immune checkpoint inhibitors (ICIs) are emerging agents used for the treatment of various malignant tumors. As ICIs are generally used for unresectable malignant tumors, there have been only a few reports of patients who underwent surgery after receiving these drugs. Therefore, it remains unclear how immune-related adverse events (irAEs) affect the postoperative course. Here, we report a patient with advanced gastric cancer who underwent laparoscopic hepatectomy for liver metastases after an objective response with lenvatinib plus pembrolizumab and developed hypothyroidism and hypopituitarism as irAEs in the immediate postoperative period.

Case presentation

A 73-year-old man had undergone total gastrectomy for pT4aN2M0 gastric cancer followed by adjuvant chemotherapy with S-1 and docetaxel, and developed liver metastases in segments 6 and 7. He was enrolled in phase 2 clinical trial of lenvatinib plus pembrolizumab. He continuously achieved a partial response with the study treatment, and the liver metastases were decreased in size on imaging. The tumors were judged to be resectable and the patient underwent laparoscopic partial hepatectomy for segments 6 and 7. From the 1st postoperative day, the patient continuously presented with fever and general fatigue, and his fasting blood glucose level remained slightly lower than that before the surgery. On the 4th postoperative day, laboratory examination revealed hypothyroidism and hypopituitarism, which were suspected to be irAE caused by lenvatinib plus pembrolizumab after surgery. He received hydrocortisone first, followed by levothyroxine after adrenal insufficiency was recovered. Subsequently, his fever, general fatigue, and any abnormality regarding fasting blood glucose level resolved, and he was discharged on the 12th postoperative day. After discharge, his laboratory data for thyroid and pituitary function remained stable while receiving hydrocortisone and levothyroxine without recurrence of gastric cancer.

Conclusion

We present a case of laparoscopic hepatectomy after receiving lenvatinib plus pembrolizumab and developed hypothyroidism and hypopituitarism after surgery. Regarding surgery after ICI therapy, it is important to recognize that irAEs might occur in the postoperative period.