bluuebunny/crossref_metadata_2025 huggingface dataset:
Using machine learning to identify diabetes patients with canagliflozin prescriptions at high‐risk of lower extremity amputation using real‐world data
Authors: Yang Lanting , Gabriel Nico , Hernandez Inmaculada , Winterstein Almut G. , Guo Jingchuan
Published: February 2021

Aims

Canagliflozin, a sodium‐glucose cotransporter 2 inhibitor indicated for lowering glucose, has been increasingly used in diabetes patients because of its beneficial effects on cardiovascular and renal outcomes. However, clinical trials have documented an increased risk of lower extremity amputations (LEA) associated with canagliflozin. We applied machine learning methods to predict LEA among diabetes patients treated with canagliflozin.

Methods

Using claims data from a 5% random sample of Medicare beneficiaries, we identified 13 904 diabetes individuals initiating canagliflozin between April 2013 and December 2016. The samples were randomly and equally split into training and testing sets. We identified 41 predictor candidates using information from the year prior to canagliflozin initiation, and applied four machine learning approaches (elastic net, least absolute shrinkage and selection operator [LASSO], gradient boosting machine and random forests) to predict LEA risk after canagliflozin initiation.

Results

The incidence rate of LEA was 0.57% over a median 1.5 years follow‐up. LASSO produced the best prediction, yielding a C‐statistic of 0.81 (95% CI: 0.76, 0.86). Among individuals categorized in the top 5% of the risk score, the actual incidence rate of LEA was 3.74%. Among the 16 factors selected by LASSO, history of LEA [adjusted odds ratio (aOR): 33.6 (13.8, 81.9)] and loop diuretic use [aOR: 3.6 (1.8,7.3)] had the strongest associations with LEA incidence.

Conclusions

Our machine learning model efficiently predicted the risk of LEA among diabetes patients undergoing canagliflozin treatment. The risk score may support optimized treatment decisions and thus improve health outcomes of diabetes patients.
Thermal ablation‐insulation performance, microstructural, and mechanical properties of carbon aerogel based lightweight heat shielding composites
Authors: Seraji Mohammad Mehdi , Arefazar Ahmad
Published: February 2021

In this study, carbon aerogel based lightweight composite ablators (CALCAs) with different densities and microstructures were prepared using the vacuum impregnation method. The mechanical strength and morphology of CALCAs were investigated. Ablation‐insulation performance of the samples was also evaluated by an oxyacetylene flame test with a constant heating rate of 2.5 MW/m2. Moreover, the structural evolution during the ablation was studied and the ablation mechanism of CALCAs was proposed. The porous insulators showed good compressive strength (3.2–9 MPa) and low thermal conductivity (lower than 0.35 W/mK). Besides the tunable density, the low recession rate (as low as 0.117 mm/s), and good ablation‐insulation performance (175°C at 25 mm and 125 at 35 mm in‐depth), these lightweight porous heat shielding composites are promising candidates to use as the thermal protection systems for aerospace applications.
Training the next generation of operators: AFPM immersive learning
Authors: Forest Daniel D.
Published: February 2021

Demographics of the petroleum refining and petrochemical industries have shown an aging workforce nearing retirement and being replaced by a younger generation of workers who learn and were taught differently. To address the challenge of building competency in the young workforce, the Immersive Learning Committee was created by the American Fuel & Petrochemical Manufacturers (AFPM), a trade association representing nearly all U.S. refining and petrochemical manufacturing capacity. AFPM members produce the fuels that drive the U.S. economy and the chemical building blocks integral to millions of products that make modern life possible. This paper will show how the work of both AFPM and its members is helping bridge the knowledge gap between generations of employees and addressing competency training challenges by developing a digital library of tools—including virtual reality and augmented reality simulations, as well as three‐dimensional assets, and other resources—for broad industry use. The work also assists member companies with their own development of training tools tailored to their unique facilities, processes or company practices. The pilot project, a fired heater training simulation using virtual reality, will be discussed in the paper, as well as a set of leading metrics currently being developed that will help industry understand the effectiveness of the tools.
A Synergistic Precursor Regulation Strategy for Scalable Fabrication of Perovskite Solar Cells
Authors: Wang Shubo , Xu Yibo , Gu Leilei , Chen Yiqi , Fan Jiahao , Qian Binhui , Li Ruiyi , Yuan Ningyi , Ding Jianning
Published: February 2021

The nucleation and crystallization processes within solution‐processed deposition is key for obtaining perovskite films with high quality. Herein, the synergistic effect of Cs+, ligand solvent (tetramethylene sulfoxide, TMSO), and methylammonium ions (MA+) on nucleation and crystallization procedures of preparing perovskites films is studied. The results reveal that producing α‐phase nuclei in the intermediate‐phase film (a perovskite film formed by removing the solvent before annealing) is the key factor for obtaining α‐phase‐pure perovskites, wherein Cs+ is necessary for reducing the formation energy of the α‐phase. In addition, the nonvolatile ligand (TMSO) is used to inhibit rapid nucleation, because it can form a stable intermediate phase. Furthermore, the introduction of the volatile MA+ cations compound (MACl) combined with Cs+ contributed to the direct formation of α‐phase nuclei in the intermediate‐phase film, and ion exchange (between FA+ and MA+) occurs during the subsequent annealing process, which leads to the formation of large‐grain perovskite film with good crystallinity. Maximum power conversion efficiencies of 22.08% and 16.88% are obtained via this strategy for a perovskite solar cell on a small area (active area: 0.09 cm2) and a perovskite solar module (aperture area: 12.92 cm2), respectively.
Medicinal plants: Treasure for antiviral drug discovery
Authors: Ali Sofi Imtiyaz , Sheikh Wajid Mohammad , Rather Muzafar Ahmad , Venkatesalu Venugopalan , Muzamil Bashir Showkeen , Nabi Showkat Ul
Published: February 2021

The pandemic of viral diseases like novel coronavirus (2019‐nCoV) prompted the scientific world to examine antiviral bioactive compounds rather than nucleic acid analogous, protease inhibitors, or other toxic synthetic molecules. The emerging viral infections significantly associated with 2019‐nCoV have challenged humanity's survival. Further, there is a constant emergence of new resistant viral strains that demand novel antiviral agents with fewer side effects and cell toxicity. Despite significant progress made in immunization and regenerative medicine, numerous viruses still lack prophylactic vaccines and specific antiviral treatments that are so often influenced by the generation of viral escape mutants. Of importance, medicinal herbs offer a wide variety of therapeutic antiviral chemotypes that can inhibit viral replication by preventing viral adsorption, adhering to cell receptors, inhibiting virus penetration in the host cell, and competing for pathways of activation of intracellular signals. The present review will comprehensively summarize the promising antiviral activities of medicinal plants and their bioactive molecules. Furthermore, it will elucidate their mechanism of action and possible implications in the treatment/prevention of viral diseases even when their mechanism of action is not fully understood, which could serve as the base for the future development of novel or complementary antiviral treatments.
Synthesis of Chiral CF3‐Contaning Pinane‐Type Hydroxythiols
Authors: Ilchenko Nikita O. , Sudarikov Denis V. , Slepukhin Pavel A. , Rubtsova Svetlana A. , Kutchin Alexandr V.
Published: February 2021

For the first time, the isomeric trifluoromethylated thioacetates have been synthesized in 37–52 % yields by nucleophilic addition of the Ruppert‐Prakash reagent (TMSCF3) to the corresponding thioacetates based on (1R)‐(−)‐myrtenal and (1S)‐(−)‐verbenone. Thioacetates have been transformed into the corresponding pinane thiols in 73–90 % yields. The structure and configuration of the resulting compounds have been determined.
Naphthalimide Assemblies for Simultaneous Detection of Ferrous Ion and H2O2 to Prevent Fenton Reaction
Authors: Kaur Amrit , Kaur Mandeep , Bhalla Vandana , Singh Manroop , Bhanwer A.J.S. , Kumar Manoj
Published: February 2021

The supramolecular assemblies of naphthalimide derivative having morpholine and dihydropyridine units referred as Naph‐MDHP exhibit strong affinity for Fe2+ ions and H2O2 to generate ‘more ordered’ highly fluorescent architectures in aqueous medium. In the presence of supramolecular assemblies of Naph‐MDHP, the oxidation of Fe2+ ions and Fenton reaction is prevented, despite the co‐existence of Fe2+ ions and H2O2 as indicated by slow photocatalytic degradation of dye Methylene blue monitored by UV‐vis spectroscopic studies. The work presented in this manuscript reveals the real time application of naphthalimide assemblies to protect dopamine and DNA against iron‐H2O2 induced oxidative stress.
Greenwaylactams A, B and C, the First Group of Sesquiterpene Alkaloids with an Eight‐Membered Lactam Ring from Greenwayodendron oliveri
Authors: Kemgni Mireille F. , Chenda Laurice Bracine N. , Tchamgoue Joseph , Kenfack Patrice T. , Ngandjui Yvan Anderson T. , Wouamba Steven C. N. , Tiani Gesquière Laure M. , Green Ivan R. , Kouam Simeon F.
Published: February 2021

Three new sesquiterpene alkaloids of the polyveoline type containing eight‐membered lactam rings named greenwaylactam A (1), B (2) and C (3) were isolated from the leaves of a Cameroonian medicinal plant Greenwayodendron oliveri (Engl.) Verdc along with three known compounds diacetylpolyveoline (4), N‐acetyl‐8α‐polyveolinone (5) and methyl pheophorbide‐A (6). These comprise the first members of a new class of ξ‐lactam sesquiterpenes. Compounds were isolated by means of successive column chromatographies and their structures were elucidated by extensive NMR spectroscopic analyses and HRESIMS. The configuration of 1 was deduced from its single‐crystal X‐ray diffraction. The crude extract and some isolated compounds were assessed for their antibacterial activity against four enteric bacterial strains Escherichia coli, Salmonelles typhi, Shigella dysenterie and Klebseilla pneumonie using the micro‐dilution method. Compounds 1, 2, 5 and 6 were the most active with MIC values varying between 31.25–250 μg/mL.
Fusing RGB and Thermal Imagery with Channel State Information for Abnormal Activity Detection Using Multimodal Bidirectional LSTM
Authors: Bakalos Nikolaos , Voulodimos Athanasios , Doulamis Nikolaos , Doulamis Anastasios , Papasotiriou Kassiani , Bimpas Matthaios
Published: February 2021

In this paper, we present a multimodal deep model for detection of abnormal activity, based on bidirectional Long Short-Term Memory neural networks (LSTM). The proposed model exploits three different input modalities: RGB imagery, thermographic imagery and Channel State Information from Wi-Fi signal reflectance to estimate human intrusion and suspicious activity. The fused multimodal information is used as input in a Bidirectional LSTM, which has the benefit of being able to capture temporal interdependencies in both past and future time instances, a significant aspect in the discussed unusual activity detection scenario. We also present a Bayesian optimization framework that fine-tunes the Bidirectional LSTM parameters in an optimal manner. The proposed framework is evaluated on real-world data from a critical water infrastructure protection and monitoring scenario and the results indicate a superior performance compared to other unimodal and multimodal approaches and classification models.
Aspects of Hyperscaling Violating geometries at finite cutoff
Authors: Khoeini-Moghaddam Salomeh , Omidi Farzad , Paul Chandrima
Published: February 2021

Abstract

Recently, it was proposed that a $$ T\overline{T} $$
T

T
¯

deformed CFT is dual to a gravity theory in an asymptotically AdS spacetime at finite radial cutoff. Motivated by this proposal, we explore some aspects of Hyperscaling Violating geometries at finite cutoff and zero temperature. We study holographic entanglement entropy, mutual information (HMI) and entanglement wedge cross section (EWCS) for entangling regions in the shape of strips. It is observed that the HMI shows interesting features in comparison to the very small cutoff case: it is a decreasing function of the cutoff. It is finite when the distance between the two entangling regions goes to zero. The location of its phase transition also depends on the cutoff, and decreases by increasing the cutoff. On the other hand, the EWCS is a decreasing function of the cutoff. It does not show a discontinuous phase transition when the HMI undergoes a first-order phase transition. However, its concavity changes. Moreover, it is finite when the distance between the two strips goes to zero. Furthermore, it satisfies the bound EW ≥ $$ \frac{I}{2} $$

I
2

for all values of the cutoff.
The Cat’s Cradle: deforming the higher rank E1 and $$ {\tilde{E}}_1 $$ theories
Authors: Bergman Oren , Rodríguez-Gómez Diego
Published: February 2021

Abstract

We use 5-brane webs to study the two-dimensional space of supersymmetric mass deformations of higher rank generalizations of the 5d E1 and $$ {\tilde{E}}_1 $$

E
˜

1

theories. Some of the resulting IR phases are described by IR free supersymmetric gauge theories, while others correspond to interacting fixed points. The number of different phases appears to grow with the rank. The space of deformations is qualitatively different for the even and odd rank cases, but that of the even (odd) rank E1 theory is similar to that of the odd (even) rank $$ {\tilde{E}}_1 $$

E
˜

1

theory. One result of our analysis predicts that the supersymmetric SU(N) theory with CS level k = $$ \frac{N}{2} $$

N
2

+ 4 and a single massless antisymmetric hypermultiplet exhibits an enhanced global symmetry at the UV fixed point, given by SU(2) × SU(2) if N is even, and SU(2) × U(1) if N is odd.
Numerical twist-even SU(1,1)-singlet solutions in open string field theory around the identity-based solution
Authors: Kishimoto Isao , Takahashi Tomohiko
Published: February 2021

Abstract

Using the level truncation method, we construct numerical solutions, which are twist even and SU(1) singlet, in the theory around the Takahashi-Tanimoto identity-based solution (TT solution) with a real parameter a in the framework of bosonic open string field theory. We find solutions corresponding to “double brane” and “ghost brane” solutions which were constructed by Kudrna and Schnabl in the conventional theory around the perturbative vacuum. Our solutions show somewhat similar a-dependence to tachyon vacuum and single brane solutions, which we found in the earlier works. In this sense, we might be able to expect that they are consistent with the conventional interpretation of a-dependence of the TT solution. We observe that numerical complex solutions at low levels become real ones at higher levels for some region of the parameter a. However, these real solutions do not so improve interpretation for double brane.
Entanglement entropy inequalities in BCFT by holography
Authors: Chou Chia-Jui , Lin Bo-Han , Wang Bin , Yang Yi
Published: February 2021

Abstract

We study entanglement entropy inequalities in boundary conformal field theory (BCFT) by holographic correspondence. By carefully classifying all the configurations for different phases, we prove the strong subadditiviy and the monogamy of mutual information for holographic entanglement entropy in BCFT at both zero and finite temperatures.
2-Group Symmetries of 6D Little String Theories and T-Duality
Authors: Del Zotto Michele , Ohmori Kantaro
Published: February 2021

We determine the 2-group structure constants for all the six-dimensional little string theories (LSTs) geometrically engineered in F-theory without frozen singularities. We use this result as a consistency check for T-duality: the 2-groups of a pair of T-dual LSTs have to match. When the T-duality involves a discrete symmetry twist, the 2-group used in the matching is modified. We demonstrate the matching of the 2-groups in several examples.
Phase-field gradient theory
Authors: Espath Luis , Calo Victor
Published: February 2021

We propose a phase-field theory for enriched continua. To generalize classical phase-field models, we derive the phase-field gradient theory based on balances of microforces, microtorques, and mass. We focus on materials where second gradients of the phase field describe long-range interactions. By considering a nontrivial interaction inside the body, described by a boundary-edge microtraction, we characterize the existence of a hypermicrotraction field, a central aspect of this theory. On surfaces, we define the surface microtraction and the surface-couple microtraction emerging from internal surface interactions. We explicitly account for the lack of smoothness along a curve on surfaces enclosing arbitrary parts of the domain. In these rough areas, internal-edge microtractions appear. We begin our theory by characterizing these tractions. Next, in balancing microforces and microtorques, we arrive at the field equations. Subject to thermodynamic constraints, we develop a general set of constitutive relations for a phase-field model where its free-energy density depends on second gradients of the phase field. A priori, the balance equations are general and independent of constitutive equations, where the thermodynamics constrain the constitutive relations through the free-energy imbalance. To exemplify the usefulness of our theory, we generalize two commonly used phase-field equations. We propose a ‘generalized Swift–Hohenberg equation’—a second-grade phase-field equation—and its conserved version, the ‘generalized phase-field crystal equation’—a conserved second-grade phase-field equation. Furthermore, we derive the configurational fields arising in this theory. We conclude with the presentation of a comprehensive, thermodynamically consistent set of boundary conditions.
The challenges, approaches, and used techniques of CPS for manufacturing in Industry 4.0: a literature review
Authors: Dafflon Baudouin , Moalla Nejib , Ouzrout Yacine
Published: February 2021

This work aims to review literature related to the latest cyber-physical systems (CPS) for manufacturing in the revolutionary Industry 4.0 for a comprehensive understanding of the challenges, approaches, and used techniques in this domain. Different published studies on CPS for manufacturing in Industry 4.0 paradigms through 2010 to 2019 were searched and summarized. We, then, analyzed the studies at a different granularity level inspecting the title, abstract, and full text to include in the prospective study list. Out of 626 primarily extracted relevant articles, we scrutinized 78 articles as the prospective studies on CPS for manufacturing in Industry 4.0. First, we analyzed the articles’ context to identify the major components along with their associated fine-grained constituents of Industry 4.0. Then, we reviewed different studies through a number of synthesized matrices to narrate the challenges, approaches, and used techniques as the key-enablers of the CPS for manufacturing in Industry 4.0. Although the key technologies of Industry 4.0 are the CPS, Internet of Things (IoT), and Internet of Services (IoS), the human component (HC), cyber component (CC), physical component (PC), and their HC-CC, CC-PC, and HC-PC interfaces need to be standardized to achieve the success of Industry 4.0.
Sharp Error Term in Local Limit Theorems and Mixing for Lorentz Gases with Infinite Horizon
Authors: Pène Françoise , Terhesiu Dalia
Published: February 2021

We obtain sharp error rates in the local limit theorem for the Sinai billiard map (one and two dimensional) with infinite horizon. This result allows us to further obtain higher order terms and thus, sharp mixing rates in the speed of mixing of dynamically Hölder observables for the planar and tubular infinite horizon Lorentz gases in the map (discrete time) case. We also obtain an asymptotic estimate for the tail probability of the first return time to the initial cell. In the process, we study families of transfer operators for infinite horizon Sinai billiards perturbed with the free flight function and obtain higher order expansions for the associated families of eigenvalues and eigenprojectors.
Manufacture of all-wood sawdust-based particle board using ionic liquid-facilitated fusion process
Authors: Orelma Hannes , Tanaka Atsushi , Vuoriluoto Maija , Khakalo Alexey , Korpela Antti
Published: February 2021

Traditional particle board can generate harmful indoor air emissions due to the volatile resin-based compounds present. This study investigated the preparation of sawdust particle board using the novel ionic liquid based fusion approach with [EMIM]OAc. The dissolution parameters were investigated using the thermal optical microscopy technique. The particle board sheets were prepared by hot pressing sawdust in the presence of ionic liquid (IL) ([EMIM]OAc) and subsequently purifying the fusion sawdust matrix from the IL with methanol. The fusion process of the sawdust particles was analysed with SEM and mechanical testing. The raw materials and the produced materials were investigated with elemental analysis, FTIR, and 13C-SS-NMR. IL fusion of the sawdust required a temperature above 150 °C, similar to the glass transition temperature (tg) of lignin. At lower temperatures, strong particle fusion was not obtained. It was observed that the sawdust/IL weight ratio was an important parameter of the fusion process, and a 1:3 weight ratio resulted in the strongest particle boards with a tensile strength of up to 10 MPa, similar to commercial particle boards. The particle fusion process was also studied with a twin-screw extruder. The extrusion enhanced the fusion of the sawdust particles by increasing dissolution of the sawdust particles, which was subsequently seen in elevated tensile strength (20 MPa). The study provides a practical view of how sawdust-based particle board can be manufactured using ionic liquid-based fusion.
Thoracic migration of silicone gel after breast implant rupture: a case report and literature review
Authors: Fanelli Benedetta , Marcasciano Marco , Lovero Stefano , Codolini Luca , Casella Donato , Onesti Maria Giuseppina , Ribuffo Diego , Scuderi Nicolo
Published: February 2021

Nowadays silicone is a widespread material for medical devices. In particular, it is commonly used for implants manufacturing, for that patients undergoing breast augmentation or breast reconstruction after mastectomy. However, the use of silicone implants is not free from risks. Ruptures of silicone breast implants are uncommon, in general post-traumatic or iatrogenic, and usually related to implant’s wall weakness of unknown origin but probably due to biochemical reactions that cause wall rupture. As a consequence of a rupture, silicone gel from damaged implants may have a continuity migration to the chest wall, axillae, and upper extremities, resulting in granulomatous inflammation or siliconoma, or a lymphatic migration to axillary lymph nodes. In this regard, silicone thoracic migration is extremely rare, and nowadays a leakage is unlikely to happen with more modern cohesive silicone gel implants. Nevertheless, procedures such as thoracic surgery and thoracotomies may be responsible for accidental breast implant rupture, capsular discontinuity, and eventually intrathoracic silicone migration, especially when dealing with older generations of breast implants. We report a rare case of a 75-year-old woman presenting with pleural silicone effusion, 18 years after a right breast reconstruction for breast cancer, followed by right upper lobe resection for a lung carcinoma. A combination of muscular flap and DTI pre-pectoral breast reconstruction with biological membrane (ADM) has been used for treatment. Literature was reviewed for cases of breast implants free silicone localization in the chest cavity, focusing on previous surgeries, anamnestic relevances, and surgical management.

Level of Evidence: Level V, risk/prognostic study.
Constructive Neutral Evolution 20 Years Later
Authors: Muñoz-Gómez Sergio A. , Bilolikar Gaurav , Wideman Jeremy G. , Geiler-Samerotte Kerry
Published: February 2021

Evolution has led to a great diversity that ranges from elegant simplicity to ornate complexity. Many complex features are often assumed to be more functional or adaptive than their simpler alternatives. However, in 1999, Arlin Stolzfus published a paper in the Journal of Molecular Evolution that outlined a framework in which complexity can arise through a series of non-adaptive steps. He called this framework Constructive Neutral Evolution (CNE). Despite its two-decade-old roots, many evolutionary biologists still appear to be unaware of this explanatory framework for the origins of complexity. In this perspective piece, we explain the theory of CNE and how it changes the order of events in narratives that describe the evolution of complexity. We also provide an extensive list of cellular features that may have become more complex through CNE. We end by discussing strategies to determine whether complexity arose through neutral or adaptive processes.
Membrane fusion studied by colloidal probes
Authors: Witt Hannes , Savić Filip , Verbeek Sarah , Dietz Jörn , Tarantola Gesa , Oelkers Marieelen , Geil Burkhard , Janshoff Andreas
Published: February 2021

Membrane-coated colloidal probes combine the benefits of solid-supported membranes with a more complex three-dimensional geometry. This combination makes them a powerful model system that enables the visualization of dynamic biological processes with high throughput and minimal reliance on fluorescent labels. Here, we want to review recent applications of colloidal probes for the study of membrane fusion. After discussing the advantages and disadvantages of some classical vesicle-based fusion assays, we introduce an assay using optical detection of fusion between membrane-coated glass microspheres in a quasi two-dimensional assembly. Then, we discuss free energy considerations of membrane fusion between supported bilayers, and show how colloidal probes can be combined with atomic force microscopy or optical tweezers to access the fusion process with even greater detail.
Intravital microscopy of tumor vessel morphology and function using a standard fluorescence microscope
Authors: Gaustad Jon-Vidar , Simonsen Trude G. , Hansem Lise Mari K. , Rofstad Einar K.
Published: February 2021

Purpose

The purpose of the study was to demonstrate the performance and possible applications of an intravital microscopy assay using a standard fluorescence microscope.

Methods

Melanoma and pancreatic ductal adenocarcinoma xenografts were initiated in dorsal window chambers and subjected to repeated intravital microscopy. The entire tumor vasculature as well as the normal tissue surrounding the tumor was imaged simultaneously with high spatial and temporal resolution. Vascular morphology images were recorded by using transillumination, and vascular masks were produced to quantify vessel density, vessel diameter, vessel segment length, and vessel tortuosity. First-pass imaging movies were recorded after an intervenous injection of a fluorescent marker and were used to investigate vascular function. Lymphatics were visualized by intradermal injections of a fluorescent marker.

Results

The intravital microscopy assay was used to study tumor growth and vascularization, tumor vessel morphology and function, tumor-associated lymphatics, and vascular effects of acute cyclic hypoxia and antiangiogenic treatment. The assay was sensitive to tumor-line differences in vascular morphology and function and detected tumor-induced lymphatic dilation. Acute cyclic hypoxia induced angiogenesis and increased the density of small diameter vessels and blood supply times, whereas antiangiogenic treatment selectively removed small-diameter vessels, reduced blood supply times, and induced hypoxia. Moreover, the window chamber was compatible with magnetic resonance imaging (MRI), and parametric images derived by dynamic contrast-enhanced MRI were shown to reflect vascular morphology and function.

Conclusions

The presented assay represents a useful and affordable alternative to intravital microscopy assays using confocal and multi-photon microscopes.
Changes in Serum Lactate Level Predict Postoperative Intra‐Abdominal Infection After Pancreatic Resection
Authors: Li Yatong , Chen Lixin , Xing Cheng , Ding Cheng , Zhang Hanyu , Wang Shunda , Long Yun , Guo Junchao , Liao Quan , Zhang Taiping , Zhao Yupei , Dai Menghua
Published: February 2021

Objective

Postoperative intra‐abdominal infection is one of the most serious complications after pancreatic resection. In this article, we investigated the relationship between serum lactate level and postoperative infection, to suggest a new predictor of potential infection risk after pancreatectomy.

Methods

A retrospective analysis of 156 patients who underwent pancreatic surgery and admitted in the intensive care unit for recovery after surgery between August 2017 and August 2019 was performed.

Results

The basic characteristics, preoperative information, pathological diagnoses, surgical methods, and intraoperative situations of patients in the postoperative intra‐abdominal infection group (n = 52) and non‐infection group (n = 104) showed no significant differences. With the same postoperative treatments and results of fluid balance, blood pressure maintenance, and laboratory tests, postoperative serum lactate level increased much higher in the infection group than non‐infection group (P < 0.001), while the base excess level declined much lower (P = 0.002). Patients in the infection group needed more time to elute lactate (P < 0.001), and stayed longer in the intensive care unit after surgery (P = 0.007). The overall postoperative complications were certainly more in the infection group (P < 0.001), resulting in a longer hospitalization time (P < 0.001).

Conclusions

When patients recovered smoothly from anesthesia with a stable hemodynamics situation and normal results of laboratory tests, abnormally high serum lactate level could be a predictor of postoperative intra‐abdominal infection after pancreatic resection.
Choosing the best algorithm among five thyroid nodule ultrasound scores: from performance to cytology sparing—a single-center retrospective study in a large cohort
Authors: Sparano Clotilde , Verdiani Valentina , Pupilli Cinzia , Perigli Giuliano , Badii Benedetta , Vezzosi Vania , Mannucci Edoardo , Maggi Mario , Petrone Luisa
Published: February 2021

Objective

Incidental diagnosis of thyroid nodules, and therefore of thyroid cancer, has definitely increased in recent years, but the mortality rate for thyroid malignancies remains very low. Within this landscape of overdiagnosis, several nodule ultrasound scores (NUS) have been proposed to reduce unnecessary diagnostic procedures. Our aim was to verify the suitability of five main NUS.

Methods

This single-center, retrospective, observational study analyzed a total number of 6474 valid cytologies. A full clinical and US description of the thyroid gland and nodules was performed. We retrospectively applied five available NUS: KTIRADS, ATA, AACE/ACE-AME, EUTIRADS, and ACRTIRADS. Thereafter, we calculated the sensitivity, specificity, PPV, and NPV, along with the number of possible fine-needle aspiration (FNA) sparing, according to each NUS algorithm and to clustering risk classes within three macro-groups (low, intermediate, and high risk).

Results

In a real-life setting of thyroid nodule management, available NUS scoring systems show good accuracy at ROC analysis (AUC up to 0.647) and higher NPV (up to 96%). The ability in FNA sparing ranges from 10 to 38% and reaches 44.2% of potential FNA economization in the low-risk macro-group. Considering our cohort, ACRTIRADS and AACE/ACE-AME scores provide the best compromise in terms of accuracy and spared cytology.

Conclusions

Despite several limitations, available NUS do appear to assist physicians in clinical practice. In the context of a common disease, such as thyroid nodules, higher accuracy and NPV are desirable NUS features. Further improvements in NUS sensitivity and specificity are attainable future goals to optimize nodule management.

Key Points

• Thyroid nodule ultrasound scores do assist clinicians in real practice.

• Ultrasound scores reduce unnecessary diagnostic procedures, containing indolent thyroid microcarcinoma overdiagnosis.

• The variable malignancy risk of the “indeterminate” category negatively influences score’s performance in real-life management of thyroid lesions.
The importance of including uric acid in the definition of metabolic syndrome when assessing the mortality risk
Authors: Pugliese Nicola Riccardo , Mengozzi Alessandro , Virdis Agostino , Casiglia Edoardo , Tikhonoff Valerie , Cicero Arrigo F. G. , Ungar Andrea , Rivasi Giulia , Salvetti Massimo , Barbagallo Carlo M. , Bombelli Michele , Dell’Oro Raffaella , Bruno Berardino , Lippa Luciano , D’Elia Lanfranco , Verdecchia Paolo , Mallamaci Francesca , Cirillo Massimo , Rattazzi Marcello , Cirillo Pietro , Gesualdo Loreto , Mazza Alberto , Giannattasio Cristina , Maloberti Alessandro , Volpe Massimo , Tocci Giuliano , Georgiopoulos Georgios , Iaccarino Guido , Nazzaro Pietro , Parati Gianfranco , Palatini Paolo , Galletti Ferruccio , Ferri Claudio , Desideri Giovambattista , Viazzi Francesca , Pontremoli Roberto , Muiesan Maria Lorenza , Grassi Guido , Masi Stefano , Borghi Claudio ,   The Working Group on Uric Acid and Cardiovascular Risk of the Italian Society of Hypertension
Published: February 2021

Introduction

Serum uric acid (SUA) has been depicted as a contributory causal factor in metabolic syndrome (MS), which in turn, portends unfavourable prognosis.

Aim

We assessed the prognostic role of SUA in patients with and without MS.

Methods

We used data from the multicentre Uric Acid Right for Heart Health study and considered cardiovascular mortality (CVM) as death due to fatal myocardial infarction, stroke, sudden cardiac death, or heart failure.

Results

A total of 9589 subjects (median age 58.5 years, 45% males) were included in the analysis, and 5100 (53%) patients had a final diagnosis of MS. After a median follow-up of 142 months, we observed 558 events. Using a previously validated cardiovascular SUA cut-off to predict CVM (> 5.1 mg/dL in women and 5.6 mg/dL in men), elevated SUA levels were significantly associated to a worse outcome in patients with and without MS (all p < 0.0001) and provided a significant net reclassification improvement of 7.1% over the diagnosis of MS for CVM (p = 0.004). Cox regression analyses identified an independent association between SUA and CVM (Hazard Ratio: 1.79 [95% CI, 1.15–2.79]; p < 0.0001) after the adjustment for MS, its single components and renal function. Three specific combinations of the MS components were associated with higher CVM when increasing SUA levels were reported, and systemic hypertension was the only individual component ever-present (all p < 0.0001).

Conclusion

Increasing SUA levels are associated with a higher CVM risk irrespective of the presence of MS: a cardiovascular SUA threshold may improve risk stratification.

Graphic abstract
LUCL reconstruction of the elbow: clinical midterm results based on the underlying pathogenesis
Authors: Geyer Stephanie , Heine Caroline , Winkler Philipp W. , Lutz Patricia M. , Lenich Andreas , Scheiderer Bastian , Imhoff Andreas B. , Siebenlist Sebastian
Published: February 2021

Purpose

Traumatic and atraumatic insufficiency of the lateral ulnar collateral ligament (LUCL) can cause posterolateral rotatory instability (PLRI) of the elbow. The influence of the underlying pathogenesis on functional outcomes remains unknown so far. The objective of this study was to determine the impact of the initial pathogenesis of PLRI on clinical outcomes after LUCL reconstruction using an ipsilateral triceps tendon autograft.

Methods

Thirty-six patients were reviewed in this retrospective study. Depending on the pathogenesis patients were assigned to either group EPI (atraumatic, secondary LUCL insufficiency due to chronic epicondylopathia) or group TRAUMA (traumatic LUCL lesion). Range-of-motion (ROM) and posterolateral joint stability were evaluated preoperatively and at follow-up survey. For clinical assessment, the Mayo elbow performance (MEPS) score was used. Patient-reported outcomes (PROs) consisting of visual analogue scale (VAS) for pain, disability of arm, shoulder and hand (DASH) score, patient-rated elbow evaluation (PREE) score and subjective elbow evaluation (SEV) as well as complications were analyzed.

Results

Thirty-one patients (group EPI, n = 17; group TRAUMA, n = 14), 13 men and 18 women with a mean age of 42.9 ± 11.0 were available for follow-up evaluation (57.7 ± 17.5 months). In 93.5%, posterolateral elbow stability was restored (n = 2 with re-instability, both group TRAUMA). No differences were seen between groups in relation to ROM. Even though group EPI (98.9 ± 3.7 points) showed better results than group TRAUMA (91.1 ± 12.6 points) (p = 0.034) according to MEPS, no differences were found for evaluated PROs (group A: VAS 1 ± 1.8, PREE 9.3 ± 15.7, DASH 7.7 ± 11.9, SEV 92.9 ± 8.3 vs. group B: VAS 1.9 ± 3.2, PREE 22.4 ± 26.1, DASH 16.0 ± 19.4, SEV 87.9 ± 15.4. 12.9% of patients required revision surgery.

Conclusion

LUCL reconstruction using a triceps tendon autograft for the treatment of PLRI provides good to excellent clinical outcomes regardless of the underlying pathogenesis (traumatic vs. atraumatic). However, in the present case series, posterolateral re-instability tends to be higher for traumatic PLRI and patient-reported outcomes showed inferior results.

Level of evidence

Therapeutic study, LEVEL III.
Three-dimensional exoscope-assisted laser stapedotomy: a preliminary experience
Authors: Milanesi Umberto , Pasquariello Benedetta , Saibene Alberto Maria , Felisati Giovanni , Atac Murat , Corbetta Davide
Published: February 2021

Purpose

Stapes surgery, despite the introduction of lasers and endoscopes, still represents a challenging procedure. Recently introduced 3-dimensional exoscopes have known advantages in otological surgery. This study aims to evaluate exoscopes role in stapes surgery, both from a surgical perspective and on the educational profile.

Methods

Seven consecutive otosclerosis patients underwent single-sided endaural laser stapedotomy with a 4K 3-dimensional exoscope. The surgical setting allowed all operating room personnel 3-dimensional vision. Pre- and postoperative pure tone audiometry and air-bone gaps, and information on the postoperative course and complications were systematically collected. An informal ergonomic evaluation was carried out by the operating room personnel and an informal didactic evaluation was provided by the trainees. A comparable group of microscope-assisted stapedotomy patients undergoing the same procedures and evaluations was chosen as a control group.

Results

Outcomes were solid in all patients, median air-bone gap decreased from 26.5 to 10 dB at the 3-month evaluation (p = 0.01, Wilcoxon’s test). No vertigo, tinnitus, or facial palsy was reported. The median operating time was 40 min. The compact design and configuration of the exoscope allowed more practical management of the operating theater. All personnel had the chance for a better understanding of the procedure and trainees felt more confident when asked to identify surgical landmarks and procedure steps. Audiological outcomes, operative times, and complication rates were not different between study and control groups.

Conclusion

Though further validation and systematic comparison with microscope- and endoscope-assisted stapedotomy are required, the exoscope proved a safe, practical, and educational tool.
Deficient visuomotor hand coordination in normal pressure hydrocephalus
Authors: Köster Hannah , Müller-Schmitz Katharina , Kolman Aschwin G. J. , Seitz Rüdiger J.
Published: February 2021

Objective

To investigate if visuomotor coordination of hand movements is impaired in patients with normal pressure hydrocephalus (NPH) identified by dedicated testing procedures.

Methods

Forty-seven patients admitted for diagnostic workup for suspected NPH were studied prospectively with MRI, testing of cognitive and motor functions, lumbar puncture, and visuomotor coordination of hand movements using the PABLOR-device before and after a spinal tap of 40–50 ml CSF. Statistical analyses were carried out with repeated measures ANOVA and non-parametric correlation analyses.

Results

Fourteen patients were found to suffer from ideopathic NPH. They were severely impaired in visuomotor control of intermittent arm movements in comparison to patients who were found not to be affected by NPH (n = 18). In the patients with NPH the deficient arm control was improved after the spinal tap in proportion to the improvement of gait. There was no improvement of cognitive and motor functions in the patients not affected by NPH, while the patients with possible NPH (n = 15) showed intermediate deficit and improvement patterns.

Interpretation: Our data underline the importance of a multiparametric assessment of NPH and provide evidence for a motor control deficit in idiopathic NPH involving leg and arm movements. It is suggested that this motor control deficit resulted from an affection of the output tracts from the supplementary motor area in the periventricular vicinity.
The pulmonary pathology of COVID-19
Authors: Bösmüller Hans , Matter Matthias , Fend Falko , Tzankov Alexandar
Published: February 2021

The lung is the main affected organ in severe coronavirus disease 2019 (COVID-19) caused by the novel coronavirus SARS-CoV-2, and lung damage is the leading cause of death in the vast majority of patients. Mainly based on results obtained by autopsies, the seminal features of fatal COVID-19 have been described by many groups worldwide. Early changes encompass edema, epithelial damage, and capillaritis/endothelialitis, frequently combined with microthrombosis. Subsequently, patients with manifest respiratory insufficiency exhibit exudative diffuse alveolar damage (DAD) with hyaline membrane formation and pneumocyte type 2 hyperplasia, variably complicated by superinfection, which may progress to organizing/fibrotic stage DAD. These features, however, are not specific for COVID-19 and can be found in other disorders including viral infections. Clinically, the early disease stage of severe COVID-19 is characterized by high viral load, lymphopenia, massive secretion of pro-inflammatory cytokines and hypercoagulability, documented by elevated D-dimers and an increased frequency of thrombotic and thromboembolic events, whereas virus loads and cytokine levels tend to decrease in late disease stages, when tissue repair including angiogenesis prevails. The present review describes the spectrum of lung pathology based on the current literature and the authors’ personal experience derived from clinical autopsies, and tries to summarize our current understanding and open questions of the pathophysiology of severe pulmonary COVID-19.
Mineralogical and geochemical investigation of megaspherulites from Argentina, Germany, and the USA
Authors: Breitkreuz Christoph , Götze Jens , Weißmantel Alexandra
Published: February 2021

Textures and whole-rock chemistry, as well as mineral composition, were analyzed in megaspherulites (high-temperature crystallization domains [HTCDs]) that formed in different geographical and geotectonic contexts and during different geological periods (Silver Cliff, CO, USA—Paleogene; El Quevar, Argentina—Miocene; Meissen Volcanic Complex, Germany—Late Carboniferous). All of these megaspherulites have formed exclusively in rhyolitic lava, and their mineral composition is dominated by K-feldspar (sanidine) and SiO2phases (quartz, cristobalite, tridymite). All megaspherulites represent composite HTCDs, comprising three zones: inner domain (ID), outer domain (OD), and a marginal domain (MD). Early evolution of megaspherulites is characterized by either central cavities and sector- to full-sphere spherulites or dendritic quartz-sanidine domains. The latter consist of bundles of fibrils each radiating from a single point reflecting relatively high growth rates. A common feature of OD and MD of all three megaspherulite occurrences is autocyclic banding. It mainly comprises fibrous (≤ 100 μm length), radially oriented sanidine and quartz, which formed at a temperature close to glass transition temperature (Tg). The termination of megaspherulite growth is marked by centimeter-sized sector-sphere spherulites on the surface. Megaspherulite formation requires limited nucleation, which is probably related to the low phenocryst content of the hosting lava. Latent heat from overlying crystallizing lithoidal rhyolite maintained low undercooling conditions keeping nucleation density low and facilitating high diffusion and growth rates. Late megaspherulite growth and its termination under low diffusion conditions is controlled by cooling close toTg. Calculations based on literature data suggest that the megaspherulite growth presumably lasted less than 60 years, perhaps 30 to 40 years.
Versatility and clinical effectiveness of a synthetic sealing hemostatic patch as alternative to parenchyma suturing in laparoscopic partial nephrectomy
Authors: Erne Eva , Kruck Stephan , Todenhoefer Tilman , Aufderklamm Stefan , Amend Bastian , Bedke Jens , Stenzl Arnulf , Rausch Steffen
Published: February 2021

Background

Improvements in laparoscopic partial nephrectomy (LPN) in order to minimize perioperative warm ischemia time (WIT), complications, and consequently patient outcome are desirable. Veriset™ is a ready-to-use hemostatic patch of absorbable oxidized cellulose and hydrogel components that has earlier been implemented in vascular and hepatic surgery. We report our experience using this device in LPN.

Methods

Patients with a solitary malignant renal mass suspicious for renal cancer underwent LPN with either the use of Veriset™ hemostatic patch (n = 40) or conventional suture technique (n = 40). Patient characteristics, operation time and WIT, postoperative course and complications were recorded retrospectively. Tumor complexity was calculated according to the R.E.N.A.L. score. Outcome was determined according to the “trifecta” criteria (negative surgical margin, WIT < 25 min, no complications within 30 days).

Results

No significant differences with regard to clinical parameters and median R.E.N.A.L. score (6) were observed between both groups. Operation time (mean 127.1 min vs. 162. 8 min; p = 0.001) and WIT were both lower in the Veriset™ group (14.6 min vs. 20.6 min; p = 0.01). No differences in surgical margins (p = 0.602) and overall complication rates at 30 (p = 0.599) and 90 days (p = 0.611) postoperatively were noticed. The surgical outcome according to “trifecta” was achieved in 65% of patients using Veriset™ and in 57.5% of patients by suture closure, respectively.

Conclusion

The hemostatic Veriset™ patch can successfully be implemented in LPN. Handling and application appear favorable, thereby reducing operation time and WIT. The present results suggest that the device may represent an alternative to parenchyma suturing in LPN.