bluuebunny/crossref_metadata_2025 huggingface dataset:
Current status and possible extension of the global neutron monitor network
Authors: Mishev Alexander , Usoskin Ilya
Published: May 2020

The global neutron monitor network has been successfully used over several decades to study cosmic ray variations and fluxes of energetic solar particles. Nowadays, it is used also for space weather purposes, e.g. alerts and assessment of the exposure to radiation. Here, we present the current status of the global neutron monitor network. We discuss the ability of the global neutron monitor network to study solar energetic particles, specifically during large ground level enhancements. We demonstrate as an example, the derived solar proton characteristics during ground level enhancements GLE #5 and the resulting effective dose over the globe at a typical commercial jet flight altitude of 40 kft (≈12,200 m) above sea level. We present a plan for improvement of space weather services and applications of the global neutron monitor network, specifically for studies related to solar energetic particles, namely an extension of the existing network with several new monitors. We discuss the ability of the optimized global neutron monitor network to study various populations of solar energetic particles and to provide reliable space weather services.
Facies leontina bei chronischer lymphatischer Leukämie
Authors: Kuske M. , Hering M. , Sergon M. , Beissert S. , Aschoff R.
Published: May 2020

Wir berichten über die seltene Entwicklung einer Leukaemia cutis, die sich als Facies leontina bei einem Patienten mit seit 4 Jahren bekannter chronischer lymphatischer Leukämie manifestierte. In Zusammenschau der Histomorphologie und des immunhistochemischen Phänotyps zeigte sich in der Dermis ein monomorphes Infiltrat von kleinen lymphatischen Zellen mit runden chromatindichten Zellkernen sowie Koexpression von CD20, CD5 und CD23. Dazwischen eingestreut waren einzelne CD3-positive T-Zellen. Obwohl die Facies leontina am häufigsten mit der lepromatösen Lepra oder einem kutanen T-Zell-Lymphom assoziiert ist, sollte insbesondere bei älteren Menschen auch an eine zugrundeliegende Leukämie gedacht werden.
Bildgebende Diagnostik des Multiplen Myeloms
Authors: Kosmala Aleksander , Bley Thorsten , Petritsch Bernhard
Published: May 2020

Hintergrund Das Multiple Myelom ist eine maligne hämatologische Erkrankung, die sich durch die Proliferation von monoklonalen Plasmazellen vor allem im Knochenmark auszeichnet. Die Bildgebung spielt zur Diagnosestellung und Verlaufsbeurteilung eine wichtige Rolle.

Methode Dieser Übersichtsartikel informiert über das Krankheitsbild des Multiplen Myeloms samt Vorstufen und beschreibt die zur Verfügung stehenden bildgebenden Untersuchungstechniken. Diese werden samt Vor- und Nachteilen sowie möglichen prognostischen und therapeutischen Implikationen vor dem Hintergrund der aktuellen Literatur vorgestellt.

Ergebnisse und Schlussfolgerung Der konventionelle Röntgenstatus ist beim Multiplen Myelom mittlerweile vollständig von Schnittbildtechniken ersetzt worden. Die breit verfügbare Ganzkörper-Computertomografie wird routinemäßig verwendet, um Osteolysen nachzuweisen. Die Magnetresonanztomografie hat die höchste Sensitivität zur Detektion von Knochenmarkbefall und wird insbesondere bei den Vorstufen des symptomatischen Multiplen Myeloms empfohlen. Die Positronen-Emissions-Tomografie vereint morphologische und funktionelle Bildgebung. Sie kommt vor allem bei der Verlaufsbeurteilung und Evaluation von Therapieansprechen zum Einsatz.

Kernaussagen:
Checklist Focused on Patients for Making of Teaching Videos in Orthopedic Surgery
Authors: Meder Adrian , Ruesseler Miriam , Stefanescu Maria-Christina , Sakmen Dennis , Verboket Rene , Froehlich Susanne , Schulz Arndt Peter , Obertacke Udo , Houy Birgit , Sterz Jasmina
Published: May 2020

Introduction The focus of medical-didactic research is the improvement of clinical-practical training. One way to support practical skills training in a time- and resource-saving way is to provide instructional videos. Often the freely available instructional videos do not meet didactic or content requirements. Creating your own videos can therefore be a useful alternative for teachers. There are a variety of instructions on the Internet for shooting instruction videos. To date, this does not include any concrete instructions/assistance for the production of medical instructional videos. However, the presentation of medical learning content in particular can contain many hurdles. The aim of this work was to design a checklist for the creation of instructional videos, which can be used as a guide.

Methods As a first step, a systematic literature search was carried out to identify works that deal with the creation and not the use of medical instructional videos. To date, corresponding publications do not exist. In a workshop, the participants, who already gained experience in creating this type of video, exchanged ideas. These were critically discussed and analyzed. As a result, a checklist was created. In a subsequent multi-step review process, the checklist was reviewed with regard to applicability, comprehensibility, completeness and quality of the items.

Results Four phases in the creation of an instructional video could be differentiated: preliminary reflections, preparation, day of filming, post-production. The checklist is structured accordingly and should be actively processed phase by phase. The checklist is created in such a way that it can be used and edited without reading this text. Particular focus is placed on the patient and his needs.

Conclusion The checklist created provides useful help in the creation of medical instructional videos and can for the first time serve as a guide especially for orthopedic and accident surgical instructional videos.
Einfluss gutartiger Tumoren der Glandula parotis auf die Gesamtspeichelflussrate
Authors: Burghartz Marc , Sittel Christian , Fiz Ivana , Taxis Delf , Plecko Thomas , Kolkmeyer Carina Anna , Hagen Rudolf , Hackenberg Stephan
Published: May 2020

Hintergrund Der Einfluss von gutartigen Tumoren der Gl. parotis auf den Gesamtspeichelfluss oder die Zusammensetzung des Speichels ist weitestgehend unklar.

Material und Methoden 22 Patienten mit einem gutartigen Tumor der Gl. parotis und 18 Probanden einer gesunden Kontrollgruppe wurden im Hinblick auf den unstimulierten und stimulierten Gesamtspeichelfluss sowie die Speichelzusammensetzung (Natrium, Kalium, Kalzium, Amylase und pH) miteinander verglichen. Zudem wurden die Studienteilnehmer mittels visueller Analogskala (VAS) bzw. Lebensqualitätsfragebogen (QoL) zu einer möglichen Mundtrockenheit (Xerostomie) befragt.

Ergebnisse Der stimulierte Gesamtspeichelfluss in der Patientengruppe war im Vergleich zur Kontrollgruppe signifikant geringer (2,76 ± 0,96 ml/min vs. 3,85 ± 0,72 ml/min; p = 0,009). Jedoch ergab der Vergleich des unstimulierten Gesamtspeichelflusses, der Speichelzusammensetzung und der subjektiven Parameter (VAS, QoL) keinen signifikanten Unterschied zwischen der Patienten- und der Kontrollgruppe (0,73 ± 0,41 ml/min vs. 0,68 ± 0,39 ml/min; p = 1).

Schlussfolgerungen Die Ergebnisse der vorliegenden Studie könnten einen Hinweis darauf geben, dass gutartige Tumoren der Gl. parotis den stimulierten Gesamtspeichelfluss reduzieren, während sie den unstimulierten Gesamtspeichelfluss sowie die Speichelzusammensetzung unbeeinflusst lassen. Dennoch scheinen die Patienten unter keiner signifikanten Mundtrockenheit zu leiden.
The COVID-19 Pandemic and its Impact on Plastic Surgery in Europe – An ESPRAS Survey
Authors: Giunta Riccardo E. , Frank Konstantin , Costa Horacio , Demirdöver Cenk , di Benedetto Giovanni , Elander Anna , Henley Mark , Murray Dylan J. , Schaefer Dirk , Spendel Stephan , Vasar Olavi , Zic Rado
Published: May 2020

The present article provides an overview of the current and expected effects of plastic surgery in Europe. It presents the experience of departments for plastic and reconstructive surgery, as evaluated by interviews with members of the Executive Committee (ExCo) of the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS). The objective of this overview is to summmarise current information in our area of work and to make this accessible to a broad group of readers. As our knowledge is rapidly increasing during the current pandemic, it is evident that we can only provide a snapshot and this will inevitably be incomplete.
Neurocognitive Outcomes in Children with Brain Tumors
Authors: Kline Cassie N. , Mueller Sabine
Published: May 2020

Brain tumors are the most common solid tumor in childhood, and although survival outcomes continue to improve, survival is frequently offset by devastating late effects from tumor and treatment. The long-term effects of brain tumors and the therapy necessary to treat them range from sensory and neuroendocrine abnormalities to neurocognitive deficits leading to inferior quality of life. The multifactorial neurocognitive injury is one of the most broadly impacting and challenging late effects to predict and subsequently treat. Certain treatment modalities, such as intrathecal methotrexate and radiation, have been shown to be associated with poor neurocognition; however, long-term outcomes remain highly variable. There are efforts underway to investigate how to better predict, identify, and manage such neurocognitive injury in survivors of pediatric brain tumors. Herein, we focus on the current knowledge of neurocognitive outcomes and potential treatment strategies for this high-risk group.
Ultra-Early Versus Early Aneurysm Surgery After Subarachnoid Hemorrhage: A Retrospective Outcome Analysis
Authors: Carvalho Miguel Trigo , Canotilho Lage António , Pereira Ricardo , Gonçalves Jorge , Matos Ana , Henriques Carla , Barbosa Marcos
Published: May 2020

Object The timing of definitive management of ruptured intracranial aneurysms has been the subject of considerable debate, although the benefits of early surgery (until 72 hours postictus) are widely accepted. The aim of the present study is to evaluate the potential benefit of ultra-early surgery (until 24 hours) when compared with early surgery, in those patients who were treated by surgical clipping at the Neurosurgery Department of the Coimbra Hospital and University Centre.

Methods A 17-year database of consecutive ruptured and surgically treated intracranial aneurysms was analyzed. Outcome was measured by the Glasgow Outcome Scale (GOS). Baseline characteristics were analyzed by the Fisher exact test, the chi-squared and Mann-Whitney tests. Logistic regression was used to assess the impact of good grade according to the World Federation of Neurological Surgeons (WFNS) scale and ultra-early surgery in a good GOS outcome.

Results 343 patients who were submitted to surgical clipping in the first 72 hours post-ictus were included, 165 of whom have undergone ultra-early surgery. Demographics and preoperative characteristics of ultra-early and early surgery patients were similar. Good-grade patients according to the WFNS scale submitted to ultra-early surgery demonstrated an improved GOS at discharge and at 6 months. Poor-grade patients according to the WFNS scale submitted to ultra-early surgery demonstrated an improved GOS at discharge.

Conclusions Ultra-early surgery for aneurysmal subarachnoid hemorrhage patients improves outcome mainly on good-grade patients. Efforts should be made on the logistics of emergency departments to consider achieving treatment on this timeframe as a standard of care.
Spheno-Orbital Meningiomas: Optimizing Visual Outcome
Authors: Menon Sudha , O. Sandesh , Anand Debish , Menon Girish
Published: May 2020

Background Spheno-orbital meningiomas (SOMs) constitute a rare cause for orbital proptosis and visual impairment. This study aims to share our outcome experience with regard to vision and exophthalmos following the surgical management of 17 patients with SOM.

Methods Retrospective analysis of the case records of all surgically treated SOMs in the last 10 years. Exophthalmos index (EI) was calculated based on preoperative magnetic resonance imaging/computed tomography imaging. Vision was assessed using the Snellen’s chart and Goldman’s perimeter. Orbital volume was calculated using three-dimensional volume rendering assisted region-of-interest computation. Preoperative duration of symptoms and extent of surgery were the other predictors analyzed.

Results Patients’ age ranged from 17 to 72 years (mean, 50.57 y; median, 50.0 years). Women represented 13 (76.4%) of the entire study group. Proptosis (14/17; 82.4%) and visual impairment (14/17; 82.3%) were the two most common presenting complaints followed by headache (12/17; 70.1%). Gross total resection (GTR) was achieved in only 2 of the 17 patients (11.8%). Majority of the tumors were benign World Health Organization Grade I meningiomas (14/17; 84%). Mean follow-up time for the entire cohort was 56 months. Postoperatively, proptosis improved in nine (64.3%) and remained static in the rest five (35.7%) of patients. Four patients (28.6%) improved in vision following surgery. Vision remained static in eight patients (57.1%). Vision deteriorated in two (14.3%) patients who had severe preoperative visual deficits. New onset oculomotor palsy, trigeminal dysfunction, and mechanical ocular motility restriction were noticed in three (17.6%), two (11.2%), and six (35.3%) patients, respectively. The mean preoperative orbital volume was 21.68 ± 3.2 cm﻿﻿3 and the mean postoperative orbital volume was 23.72 ± 3.4 cm﻿﻿3. Orbital volume was inversely related to EI. Optic canal (OC) deroofing and extensive orbital wall decompression facilitated visual improvement and proptosis reduction. None of the variables including orbital volume proved to be statistically significant in predicting outcome.

Conclusion SOMs constitute a rare subgroup of skull base meningiomas that pose considerable surgical challenges. A surgical strategy aimed at safe maximal resection rather than aggressive GTR provides favorable outcome with less morbidity. Adequate bony decompression of the orbital walls and OC provides satisfactory improvements in proptosis and vision. Residual disease is common, but the risk of symptomatic recurrence is low especially when combined with adjuvant radiotherapy. Visual outcome is likely to be poor in patients presenting with severely compromised vision.
COVID-19-Related Severe Hypercoagulability in Patients Admitted to Intensive Care Unit for Acute Respiratory Failure
Authors: Spiezia Luca , Boscolo Annalisa , Poletto Francesco , Cerruti Lorenzo , Tiberio Ivo , Campello Elena , Navalesi Paolo , Simioni Paolo
Published: May 2020

In late December 2019 an outbreak of a novel coronavirus (SARS-CoV-2) causing severe pneumonia (COVID-19) was reported in Wuhan, Hubei Province, China. A common finding in most COVID-19 patients is high D-dimer levels which are associated with a worse prognosis. We aimed to evaluate coagulation abnormalities via traditional tests and whole blood thromboelastometry profiles in a group of 22 (mean age 67 ± 8 years, M:F 20:2) consecutive patients admitted to the Intensive Care Unit of Padova University Hospital for acute respiratory failure due to COVID-19. Cases showed significantly higher fibrinogen and D-dimer plasma levels versus healthy controls (p < 0.0001 in both comparisons). Interestingly enough, markedly hypercoagulable thromboelastometry profiles were observed in COVID-19 patients, as reflected by shorter Clot Formation Time (CFT) in INTEM (p = 0.0002) and EXTEM (p = 0.01) and higher Maximum Clot Firmness (MCF) in INTEM, EXTEM and FIBTEM (p < 0.001 in all comparisons). In conclusion, COVID-19 patients with acute respiratory failure present a severe hypercoagulability rather than consumptive coagulopathy. Fibrin formation and polymerization may predispose to thrombosis and correlate with a worse outcome.
Comparison of Clinical and Radiological Parameters with Two Different Surgical Methods for Anterior Cruciate Ligament Reconstruction
Authors: Çiloğlu Osman , Çiçek Hakan , Yılmaz Ahmet , Özalay Metin , Söker Gökhan , Leblebici Berrin
Published: May 2020

This study compared the clinical and radiological findings of nonanatomic transtibial (TT) technique with intraspongious fixation and anatomical anteromedial portal (AMP) technique with extracortical button implant in anterior cruciate ligament (ACL) reconstruction. A total of 54 patients with isolated ACL rupture were included in this prospective study. The patients who had the intraspongious fixation by nonanatomical TT technique were allocated to Group 1 (n = 27). The patients with extracortical fixation by anatomical AMP technique were placed in Group 2 (n = 27). The clinical scores of the patients were evaluated with the International Knee Documentation Committee Evaluation Form, Tegner activity score, and Lysholm II Functional Scoring. The tibial and femoral tunnels were evaluated with three-dimensional computed tomography. The kinematic examinations were performed with a Biodex System 3 Pro isokinetic dynamometer. There was no significant difference between the groups in terms of demographic data (p > 0.05). The postoperative clinical scores improved significantly in both the groups compared with the preoperative levels (p = 0.001), but there was no significant difference in the postoperative clinical scores between the groups (p > 0.05). In the extension and flexion of 60 to 180 degrees/s, the peak torque and the peak torque/body weight values of the repaired knee to intact knee ratios showed significant differences in favor of Group 2 (p = 0.001). In both the groups, no significant difference was found between the mean extent of the tunnel enlargement (p > 0.05). The mean tunnel height was significantly greater in Group 1 (45% ± 9.86 vs. 34.11% ± 10.0%) (p = 0.001). When the localization of the tunnel enlargements (proximal-middle-distal) was examined, a significant difference was found between the groups (p = 0.001). Although the AMP technique, which is a more anatomic reconstruction, had an advantage with regard to tunnel enlargement and the isokinetic muscle studies, there was no difference between the two techniques in terms of the clinical results.
Green clashes: cultural dynamics of scales in sustainability transitions in European peripheries
Authors: Häyrynen Simo , Hämeenaho Pilvi
Published: May 2020

A multi-level perspective (MLP) in studying sustainability transitions has proved its relevance in explaining the institutionalisation of sustainability ideas. However, MLP does not offer tools to grasp the dynamics of culture between knowledge regimes that occur in different loci in global-local scales. The article introduces a framework for cultural analysis by creating a crossover conceptual approach to culture in different spatial scales combining elements of MLP logic with Thomas Eriksen’s idea of the ‘clashes of scales’. Scalar dynamics related to sustainability transitions are explored through the centre–periphery patterns by reanalysing empirical data from the authors’ previous projects, which examine local responses to meet the ideas or assignments given by upscale actors. The article shows that culture is a factor that does not stick to one level of development but crosscuts through spatial scales, thus providing transitional corridors. Through various representations, culture anchors floating sustainability to a certain mentality of rule and constitutes an implicit element of the whole transition process, providing a challenge for the traditional grammar of pro-environmental diffusion. In this process, peripheral states of mind tend to mediate and integrate different ideological motivations into a local cultural reaction to sustainability transition.
Nanojoining and tailoring of current–voltage characteristics of metal-P type semiconductor nanowire heterojunction by femtosecond laser irradiation
Authors: Xiao M. , Lin L. , Xing S. , Feng J. , Hui Z. , Wang S. , Duley W. W. , Zhou Y. N.
Published: May 2020

Selective engineering of the interface between nanoscale components and the electrical properties of heterojunctions is key to the development of next-generation nanoscale circuit elements. In this paper, we show how laser processing of a metal-P type semiconductor nanoscale heterojunction between Ag and CuO nanowires can be used to control the nature of the electrical contact by reducing the Schottky barrier at the Ag–CuO interface to Ohmic contact. Elimination of the Schottky barriers occurs in response to lattice matching of Ag(111)∥CuO(111) planes at the interface induced by controlled irradiation with femtosecond (fs) laser pulses. An interdiffusion region with a mixed Ag/CuO composition is also present over a localized area of the interface between the Ag and CuO nanowires after fs laser processing, but both Ag and CuO nanowires remain crystalline away from the heterojunction. In addition, the Ag nanowire becomes totally embedded in the larger CuO nanowire after irradiation. Fabricated nanowire devices from Ag–CuO nanowire heterojunctions transition from a double-Schottky contact configuration prior to laser processing to a rectifying behavior as irradiation time increases. This study illustrates that fs laser processing can be highly effective in the engineering of electrical performance in metal–semiconductor nanoscale heterojunction devices.
Spin-wave filters based on thin Y3Fe5O12 films on Gd3Ga5O12 and Si substrates for microwave applications
Authors: Lutsev L. V. , Dubovoy V. A. , Stognij A. I. , Novitskii N. N. , Mozharov A. M. , Mukhin I. S. , Ketsko V. A.
Published: May 2020

Spin-wave bandpass filters with small sizes on the basis of thin Y3Fe5O12 [yttrium-iron garnet (YIG)] films on Gd3Ga5O12 [gadolinium-gallium garnet (GGG)] and SiO2/Si substrates have been constructed. A thin YIG film with a thickness of 0.8μm on SiO2/Si substrates has been grown by the ion-beam sputtering. It is found that the coplanar antenna structure can be successfully used to construct tunable small-sized narrowband bandpass filters based on spin waves. The filter transmission characteristic has a nonreciprocity when the direction of energy propagation changes. Spin-wave filter characteristics are analyzed using the transmission-matrix formalism.
A fundamental understanding of the unstable eigenmodes of double tearing instabilities in a shear slab geometry
Authors: Wei L. , Yu F. , Ren H. J. , Wang Z. X.
Published: May 2020

Two types of unstable eigenmodes of resistive tearing instabilities, namely, symmetric and anti-symmetric modes, in a double current sheet configuration are analyzed by means of both an eigenvalue solver and initial value simulation. It has been clearly identified that these two types of eigenmodes are different from the two independent single tearing modes even though the symmetric eigenmode in a double current sheet configuration shares the same properties of the single tearing mode near each current sheet. In the case with finite separation Δx between two current sheets, an arbitrary phase disturbance between two current sheets can lead to “phase instability,” i.e., the transition from the symmetric mode to the anti-symmetric mode. For a large Δx limit, both anti-symmetric and symmetric modes share the same properties of the single tearing mode. Thus, the superposition of two independent single tearing modes with arbitrary phases and arbitrary amplitudes at two current sheets can become the linear combination of symmetric and anti-symmetric eigenmodes. The same growth rate/eigenvalue of symmetric and anti-symmetric eigenmodes infers that an arbitrary superposition of two independent single tearing modes is still the eigenmode of the double current sheet configuration.
Temperature-induced antiferromagnetic interlayer exchange coupling in (Ga,Mn)(As,P)-based trilayer structure
Authors: Chongthanaphisut Phunvira , Lee Kyung Jae , Park Seongjin , Jang Jiyoung , Lee Sanghoon , Liu X. , Dobrowolska M. , Furdyna J. K.
Published: May 2020

We present the observation of temperature-induced transition between ferromagnetic (FM) and antiferromagnetic (AFM) interlayer exchange coupling (IEC) in trilayer structures consisting of two (Ga,Mn)(As,P) ferromagnetic layers and a GaAs:Be spacer. Hall resistance measurements were performed on trilayers prepared in as-grown and annealed states. Anomalous Hall resistance (AHR) measurements show two-step hysteresis loops, indicating that coercive fields of the two (Ga,Mn)(As,P) layers in the trilayer are different. Minor loops of AHR show characteristic shifts that correspond to FM IEC at low temperatures and AFM IEC at high temperatures in both as-grown and annealed samples. This temperature-induced transition from FM to AFM IEC occurs at a lower temperature in the annealed sample than in the as-grown sample. We attribute such an enhanced IEC transition effect in the annealed sample to the increase of carrier concentrations obtained by annealing, a characteristic feature of ferromagnetic semiconductors. The observation of AFM IEC in the (Ga,Mn)(As,P)-based trilayer suggests the possibility of realizing synthetic antiferromagnetic systems in such structures, which can be used for antiferromagnetic spintronic device applications.
Structural electronic and vibrational properties analysis of Li2CaX (X = Sn, Pb) heusler alloys: a comparative study
Authors: Gulebaglan Sinem Erden
Published: May 2020

This study was focused on structural, electronic and vibrational properties of Li2CaSn and Li2CaPb with density functional theory. All properties of these compounds were computed by implementing General Gradient Approximation and using Quantum Espresso software programme. As a result of the calculations, it was found that the lattice parameter is 6.967 Å and bulk modulus is 33.94 GPa for Li2CaSn. Also, these values are 7.062 Å and 29.574 GPa for Li2CaPb. The calculated lattice parameters are in good agreement with the available experimental data. There is no previous theoretical calculation for Li2CaSn and Li2CaPb compounds. It was calculated that Li2CaSn and Li2CaPb have a semi-metal property. The full phonon dispersion curves of Li2CaSn and Li2CaPb compounds in the Heusler type structure were examined using the linear response method. Under 0 kbar pressure, Li2CaPb was unstable while Li2CaSn was dynamically stable. Calculations showed that when 38.42 kbar pressure is applied to the Li2CaPb compound, the Li2CaPb compound becomes dynamically stable. It is believed that this study will shape future studies.
Vascularization is the next challenge for skin tissue engineering as a solution for burn management
Authors: Shahin Hady , Elmasry Moustafa , Steinvall Ingrid , Söberg Folke , El-Serafi Ahmed
Published: May 2020

Skin regeneration represents a promising line of management for patients with skin loss, including burn victims. The current approach of spraying single cells over the defective areas results in variable success rates in different centers. The modern approach is to synthesize a multilayer skin construct that is based on autologous stem cells. One of the main complications with different types of transplants is sloughing due to the absence of proper vascularization. Ensuring proper vascularization will be crucial for the integration of skin constructs with the surrounding tissues. Combination of the right cells with scaffolds of proper physico-chemical properties, vascularization can be markedly enhanced. The material effect, pore size and adsorption of certain proteins, as well as the application of appropriate growth factors, such as vascular endothelial growth factors, can have an additive effect. A selection of the most effective protocols is discussed in this review.
Functional Molecular Network Analysis Enables Prediction of Response to Vedolizumab Therapy in Anti-TNF Refractory IBD Patients
Authors: Breidert Matthias , Eftekhari Pierre , Louis François , Rotoiu Claudia , Rath Timo , Neurath Markus F , Atreya Raja
Published: May 2020

Background

We applied for the first time 2 label-free technologies, physiological intermolecular modulation spectroscopy (PIMS) and nematic protein organization technic (NPOT) in anti-tumor necrosis factor (TNF) refractory inflammatory bowel disease (IBD) patients to identify clinical responders to vedolizumab therapy and elucidate their underlying functional molecular network.

Methods

PIMS analysis was performed in peripheral blood taken prior to the first vedolizumab application in 20 IBD patients (Crohn disease n = 13; ulcerative colitis n = 7) refractory to at least 1 previous anti-TNF agent therapy. Peripheral blood taken from clinical responders and nonresponders at week 14 of vedolizumab therapy were additionally subjected to NPOT analysis. Response to therapy was assessed by respective clinical disease activity scores (partial Mayo Score and Harvey–Bradshaw Index).

Results

Clinical response to vedolizumab treatment was observed in 7 of 13 Crohn disease and 4 of 7 ulcerative colitis patients at week 14. Response to therapy was accurately predicted by PIMS blood analysis in 100% of ulcerative colitis and 77% of Crohn disease patients. Overall prediction of clinical response with PIMS blood analysis was achieved with a 89% positive predictive value and a 82% negative predictive value. NPOT analysis revealed the heightened expression of the proteins ITGB7, ITGAV, ITG3, PF4, and ASGH in the peripheral blood of vedolizumab responders compared to nonresponders.

Conclusions

PIMS analysis of the blood of anti-TNF refractory IBD patients was able to stratify responders to vedolizumab therapy with high accuracy and specificity. NPOT technology could decipher underling molecular networks in the blood of responders, enabling subsequent personalized therapeutic approaches in IBD.
Sources of Borrowing and Fiscal Multipliers
Authors: Priftis Romanos , Zimic Srec̆ko
Published: May 2020

This paper finds that debt-financed fiscal multipliers vary depending on the location of the debt buyer. In a sample of 33 countries fiscal multipliers are larger when government purchases are financed by issuing debt to foreign investors (non-residents), compared to when they are financed by issuing debt to home investors (residents). In a theoretical model, the location of the government creditor produces these differential responses through the extent that private investment is crowded out. International capital mobility of the resident private sector decreases the difference between the two types of financing both in the model and in the data.
The results of an entry-oriented strategy for acute type A aortic dissection in octogenarians: an 18-year experience
Authors: Igarashi Takashi , Sato Yoichi , Satokawa Hirono , Takase Shinya , Wakamatsu Hiroki , Seto Yuki , Iwai-Takano Masumi , Fujimiya Tsuyoshi , Shinjo Hiroharu , Yokoyama Hitoshi
Published: May 2020

OBJECTIVES

The aim of this study was to evaluate the 18-year results of emergency operations for acute type A aortic dissection, especially in octogenarians.

METHODS

We reviewed 199 patients who underwent surgical aortic repair of an acute type A aortic dissection from January 2001 to December 2018. If the primary entry existed in the ascending aorta, we limited the extent of the replacement to within the ascending aorta. We analysed the early and late outcomes and identified the predictive factors for in-hospital death and difficulty of direct discharge to home.

RESULTS

The hospital mortality was 16%. The causes of death were postoperative bleeding (n = 8, 4%), intestinal ischaemia (n = 6, 3%), respiratory failure (n = 5, 3%), systemic inflammatory response syndrome (n = 4, 2%), low output syndrome (n = 3, 2%), sudden death (n = 3, 2%), myonephrotic metabolic syndrome (n = 2, 1%) and stroke (n = 1, 1%). Multivariable analysis revealed that an estimated glomerular filtration rate <30 (P = 0.006), malperfusion (P = 0.001), rupture (P < 0.001) and cross-clamping time (P = 0.003) were independent predictive factors of in-hospital death. Age was not a significant factor for predicting in-hospital death. Ascending aorta replacement (P = 0.013), advanced age (P = 0.002) and prolonged extracorporeal circulation time (P = 0.009) were independent predictive factors of difficulty in direct discharge to home. In the late follow-up period, the 5-year survival and aortic event-free rates were 62.2% and 88.9% in octogenarians, respectively.

CONCLUSIONS

From the perspective of saving lives, the results of emergency surgery for octogenarians were acceptable. Avoiding the postoperative decline in activities of daily living in octogenarians is a consideration going forward.
Biospytial: spatial graph-based computing for ecological Big Data
Authors: Escamilla Molgora Juan M , Sedda Luigi , Atkinson Peter M
Published: May 2020

Background

The exponential accumulation of environmental and ecological data together with the adoption of open data initiatives bring opportunities and challenges for integrating and synthesising relevant knowledge that need to be addressed, given the ongoing environmental crises.

Findings

Here we present Biospytial, a modular open source knowledge engine designed to import, organise, analyse and visualise big spatial ecological datasets using the power of graph theory. The engine uses a hybrid graph-relational approach to store and access information. A graph data structure uses linkage relationships to build semantic structures represented as complex data structures stored in a graph database, while tabular and geospatial data are stored in an efficient spatial relational database system. We provide an application using information on species occurrences, their taxonomic classification and climatic datasets. We built a knowledge graph of the Tree of Life embedded in an environmental and geographical grid to perform an analysis on threatened species co-occurring with jaguars (Panthera onca).

Conclusions

The Biospytial approach reduces the complexity of joining datasets using multiple tabular relations, while its scalable design eases the problem of merging datasets from different sources. Its modular design makes it possible to distribute several instances simultaneously, allowing fast and efficient handling of big ecological datasets. The provided example demonstrates the engine's capabilities in performing basic graph manipulation, analysis and visualizations of taxonomic groups co-occurring in space. The example shows potential avenues for performing novel ecological analyses, biodiversity syntheses and species distribution models aided by a network of taxonomic and spatial relationships.
Global ocean resistome revealed: Exploring antibiotic resistance gene abundance and distribution in TARA Oceans samples
Authors: Cuadrat Rafael R C , Sorokina Maria , Andrade Bruno G , Goris Tobias , Dávila Alberto M R
Published: May 2020

Background

The rise of antibiotic resistance (AR) in clinical settings is of great concern. Therefore, the understanding of AR mechanisms, evolution, and global distribution is a priority for patient survival. Despite all efforts in the elucidation of AR mechanisms in clinical strains, little is known about its prevalence and evolution in environmental microorganisms. We used 293 metagenomic samples from the TARA Oceans project to detect and quantify environmental antibiotic resistance genes (ARGs) using machine learning tools.

Results

After manual curation of ARGs, their abundance and distribution in the global ocean are presented. Additionally, the potential of horizontal ARG transfer by plasmids and their correlation with environmental and geographical parameters is shown. A total of 99,205 environmental open reading frames (ORFs) were classified as 1 of 560 different ARGs conferring resistance to 26 antibiotic classes. We found 24,567 ORFs in putative plasmid sequences, suggesting the importance of mobile genetic elements in the dynamics of environmental ARG transmission. Moreover, 4,804 contigs with >=2 putative ARGs were found, including 2 plasmid-like contigs with 5 different ARGs, highlighting the potential presence of multi-resistant microorganisms in the natural ocean environment. Finally, we identified ARGs conferring resistance to some of the most relevant clinical antibiotics, revealing the presence of 15 ARGs similar to mobilized colistin resistance genes (mcr) with high abundance on polar biomes. Of these, 5 are assigned to Psychrobacter, a genus including opportunistic human pathogens.

Conclusions

This study uncovers the diversity and abundance of ARGs in the global ocean metagenome. Our results are available on Zenodo in MySQL database dump format, and all the code used for the analyses, including a Jupyter notebook js avaliable on Github. We also developed a dashboard web application (http://www.resistomedb.com) for data visualization.
Management of pulmonary ground-glass opacities: a position paper from a panel of experts of the Italian Society of Thoracic Surgery (SICT)
Authors: Lococo Filippo , Luzzi Luca , Cusumano Giacomo , De Filippis Antonio Fabillian , Pariscenti Gianluca , Guggino Gianluca , Rena Ottavio , Davini Federico , Grossi William , Marulli Giuseppe , Lococo Achille , Cardillo Giuseppe ,   GGO Consensus Conference Working Group
Published: May 2020

OBJECTIVES

A significant gap in our knowledge of how to manage pulmonary ground-glass opacities (GGOs) still exists. Accordingly, there is a lack of consensus among clinicians on this topic. The Italian Society of Thoracic Surgery (Società Italiana di Chirurgia Toracica, SICT) promoted a national expert meeting to provide insightful guidance for clinical practice. Our goal was to publish herein the final consensus document from this conference.

METHODS

The working panel of the PNR group (Pulmonary Nodules Recommendation Group, a branch of the SICT) together with 5 scientific supervisors (nominated by the SICT) identified a jury of expert thoracic surgeons who organized a multidisciplinary meeting to propose specific statements (n = 29); 73 participants discussed and voted on statements using a modified Delphi process (repeated iterations of anonymous voting over 2 rounds with electronic support) requiring 70% agreement to reach consensus on a statement.

RESULTS

Consensus was reached on several critical points in GGO management, in particular on the definition of GGO, radiological and radiometabolic evaluation, indications for a non-surgical biopsy, GGO management based on radiological characteristics, surgical strategies (extension of pulmonary resection and lymphadenectomy) and radiological surveillance. A list of 29 statements was finally approved.

CONCLUSIONS

The participants at this national expert meeting analysed this challenging topic and provided a list of suggestions for health institutions and physicians with practical indications for GGO management.
Correlative imaging of collagen fibers and fibroblasts using CLEM optimized for picrosirius red staining and FIB/SEM tomography
Authors: Hirashima Shingo , Ohta Keisuke , Kanazawa Tomonoshin , Togo Akinobu , Tsuneyoshi Risa , Miyazono Yoshihiro , Kusukawa Jingo , Nakamura Kei-ichiro
Published: May 2020

Conventional imaging for three-dimensional (3D) ultra-architectural analysis of collagen fibers and fibroblasts is time-consuming and requires numerous ultrathin sections to search the target area. Currently, no method allows 3D ultra-architectural analysis of predetermined areas including spatial relationships between collagen fibers and fibroblasts in vitro. Herein, we developed a new method for in vitro analysis of the 3D ultrastructure of fibroblasts and collagen fibers using CLEM optimized for picrosirius red staining and FIB/SEM tomography. Collagen fibers were observed between, rather than on top of, stacked cells. This method offers the advantage of mesoscopic and ultrastructural analysis, thus minimizing bias and ensuring accurate observation.
Microbe Profile: Bacillus subtilis: model organism for cellular development, and industrial workhorse
Authors: Errington Jeffery , Aart Lizah T van der
Published: May 2020

Bacillus subtilis

is the best studied model organism of the Gram-positive lineage. It is naturally transformable and has an extremely powerful genetic toolbox. It is fast growing and easy to cultivate. It is an important industrial organism, being proficient at secreting proteins and making small fine chemicals, as well as acting as a plant growth promoter. It has been an important model system for studying biofilms. Finally, it makes endospores, which have provided an exceptionally fruitful system for studying various central problems of cellular development, including the generation of asymmetry, cell fate determination and morphogenesis.
Spread of Covid-19 in the United States is controlled
Authors: Hu Zixin , Ge Qiyang , Li Shudi , Xu Tao , Boerwinkle Eric , Jin Li , Xiong Momiao
Published: May 2020

As of May 1, 2020, the number of cases of Covid-19 in the US passed 1,062,446, interventions to slow down the spread of Covid-19 curtailed most social activities. Meanwhile, an economic crisis and resistance to the strict intervention measures are rising. Some researchers proposed intermittent social distancing that may drive the outbreak of Covid-19 into 2022. Questions arise about whether we should maintain or relax quarantine measures. We developed novel artificial intelligence and causal inference integrated methods for real-time prediction and control of nonlinear epidemic systems. We estimated that the peak time of the Covid-19 in the US would be April 24, 2020 and its outbreak in the US will be over by the end of July and reach 1,551,901 cases. We evaluated the impact of relaxing the current interventions for reopening economy on the spread of Covid-19. We provide tools for balancing the risks of workers and reopening economy.
Hydroxychloroquine plus azithromycin: a potential interest in reducing in-hospital morbidity due to COVID-19 pneumonia (HI-ZY-COVID)?
Authors: Davido Benjamin , Lansaman Thibaud , Bessis Simon , Lawrence Christine , Alvarez Jean-Claude , Mascitti Hélène , Bouchand Frédérique , Moine Pierre , Perronne Véronique , Gal Aurélie Le , Annane Djillali , Perronne Christian , De Truchis Pierre
Published: May 2020

Introduction

Hydroxychloroquine (HCQ) with or without azithromycin is currently still debated as a potential treatment for the COVID-19 epidemic. Some studies showed discrepant results. However, timing for the treatment initiation and its setting (in-hospital or out-patient) are not consistent across studies.

Methods

Monocentric retrospective study conducted from 2th March to 17th April 2020, in adults hospitalized in a tertiary hospital for COVID-19. Patients characteristics were compared between groups depending on the therapy received (HCQ/azithromycin taken ≥ 48 hours or other treatment). Outcomes were evaluated from admission, by the need for intensive care unit (ICU) support and/or death. Univariate analyses were performed using non-parametric tests and confirmed by a multiple logistic regression using Pearson correlation test.

Results

Among 132 patients admitted for COVID-19 in the medicine ward, 45 received HCQ/azithromycin ≥ 48 hours, with a favorable outcome in 91.1% of cases (OR=6.2, p=0.002) versus others regimen (n=87). Groups were comparable at the baseline in terms of age, sex, comorbidities, extend in thoracic imaging, and severity.

Among patients that required to be transferred to ICU (n=27) (for mechanical ventilation), median delay for transfer was 2 days (IQR 1-3). We report only 1 patient that presented an adverse event (a prolonged QT interval on EKG) that required to discontinue HCQ.

Conclusion

The present study suggests a potential interest of the combination therapy using HCQ/azithromycin for the treatment of COVID-19 in in-hospital patients.
Smoking and the risk of COVID-19 infection in the UK Biobank Prospective Study
Authors: Cho Eo Rin , Jha Prabhat , Slutsky Arthur S.
Published: May 2020

Several studies suggest a lower prevalence of smoking than expected among adults with coronavirus disease (COVID-19). We conducted logistic regression analyses of the UK Biobank prospective study of 0.5 million adults followed for an average of 11 years. Compared to women, men were more likely to be tested and to test positive. In sex-stratified analyses, current smokers had higher adjusted Odds Ratios (OR) for being tested (male OR 1.60, 95%CI 1.32-1.95 and female OR 1.50,1.21-.1.86). Current smokers were more slightly more likely than never smokers to test positive for COVID-19. Further examination of smoking as a risk factor for COVID-19 is required. These must take into account reverse causality, where smokers quit to avoid disease as well as prior diseases.
An Evaluation of the MedSnap Medication Authentication System
Authors: Hymel Patrick , Wong Daisy Y. , Zheng Ning , Brossette Stephen E.
Published: May 2020

Falsified and substandard (SF) medications are a large and growing global public health threat affecting developed and developing markets. The need for scalable, easy-to-use, accurate methods to detect SF medications continues to grow. We conducted a proof-of-principle laboratory and field sample evaluation of MedSnap in Vientiane, Lao PDR. Over three days, MedSnap models were created from trusted and authentic medications and tested against samples of authentic/trusted or falsified artesunate, artemether-lumefantrine, azithromycin, and ciprofloxacin. Across 48 tests of authentic/trusted and falsified samples, MedSnap was 100% sensitive and specific. On the final day of the study, a convenience sample of ciprofloxacin and azithromycin was collected from local pharmacies and tested. Each field sample matched an authentic/trusted model. The speed and ease of data collection, reference model building, and sample testing suggest scalable use cases for the system.
Implications of Telemedicine on Educational Outcomes and Healthcare Accessibility, Case Study of a Local College in Upstate New York
Authors: Kenyon Johnathan
Published: May 2020

Importance

There is a dearth of empirical research addressing the healthcare component on the academic performance of college students. It is unknown how discrepancies in healthcare access manifest in college students.

Objective

To improve awareness of the current healthcare issues facing college students and find ways to minimize the healthcare gap.

Design, Setting, and Participants

Local college students were assessed for health status, usage of the health system, potential factors discouraging the use of health benefits, and the educational outcomes of the students.

Main Outcomes and Measures

Educational outcomes associated with differing levels of healthcare access, averages, Pearson’s r, odds ratios and 95% CIs.

Results

Nearly 1 in 4 students (26.1% [SE, 3.7%]) reported having inadequate healthcare access. Healthcare accessibility was strongly correlated with academic performance (r = .336 [95% CI, .179-.476]; P<.001). Low access students were significantly more likely to report barriers to healthcare (OR = 2.91 [95% CI, .557-5.29]; P<.001). Telemedical use corresponded with reduced absences (r = .219 [95% CI, .054-.373]; P=.01) and higher ratings on self-health assessments (OR = 1.74 [95% CI, .809-3.75]; P=.001). Use of telemedicine did not relate to reports of healthcare barriers (P>.99). Though the adoption of telemedicine among college students is staggeringly low, with fewer than 1 in 12 students (7.9% [SE 2.4%]) reporting at least some telemedical usage.

Conclusions and Relevance

Over a quarter of college students report inadequate healthcare access despite fewer than 1 in 12 students utilizing telemedicine. Further research is needed to determine the extent to how much the current healthcare norms affect college students, but fostering a pedagogical approach to telemedicine may serve to bridge the healthcare gap.

Key Points

Question

In what way does healthcare accessibility affect college students?

Findings

Many students report inadequate healthcare access, despite having health insurance. The adoption of telemedicine among college students is currently low. Students utilizing telemedicine display improvements across health and academic categories.

Meaning

Bolstering the adoption of telemedical health services may help to diminish the healthcare accessibility gap among college students.