bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of adhesion properties of lignin-epoxy adhesives in structural wood applications for automotive components
Authors: Aniol A , Grosse T , Fischer F , Böhm S
Published: February 2020

The use of sustainable hybrid components is an important topic in lightweight automotive applications. Wood being a renewable material, when used in combination with other materials such as technical polymers, offers a high potential for producing hybrid components and the implementation of innovative lightweight automotive materials. The feasibility of wood-based hybrid automotive components strongly depends on the properties of the interface between wood, lignin as a renewable coupling agent, and technical polymers. This paper investigates the macromolecular reactions and the bonding area in biobased epoxy adhesives for a specific influence on the performance of structural automotive wood components. Therefore, a typical bisphenol A diglycidyl ether epoxy adhesive was modified with lignosulphonate to increase the penetration depth. The composites were characterized by thermogravimetric analysis coupled with Fourier-transform infrared spectroscopy to validate the crosslinking of the macromolecules and the thermal stability of the adhesive. In the next step, a layer-by-layer composite was built up with the biobased adhesive and 1 mm beech veneer. The bonding area was characterized by scanning electron microscopy and compression tests.
A proposed health monitoring system using fuzzy inference system
Authors: Ghosh Goldina , Roy Sandipan , Merdji Ali
Published: February 2020

Due to the busy schedule of every human being in today’s world, consciousness towards one’s health has become quite alarming. A person suffering from any chronic disease needs a gradual, regular and close monitoring to recover from the disease or to be under control. Because of heavy work pressure, anxiety, change of weather and location or due to some other causes, the effect of the diseases can turn up into an appalling state. Two vital aspects of human diseases are blood pressure (hypertension) and blood sugar imbalance. Hypertension is one of the complications of prolonged untreated diabetes. Other organs like kidney, eye and peripheral nerves are also involved. The various gradations of hypertension and diabetes are required to understand for the progression of the disease and to make plan for the treatment. So these two aspects are considered in this article. The idea is to develop a logic, which could be incorporated in a pocket friendly device in future that would generate an alarm whenever there is imbalance in blood sugar or blood pressure levels. The concept of the fuzzy inference rule and first-order logic is implemented to develop this study.
Estimating syphilis seroprevalence among patients in a sexually transmitted infections clinic in Lilongwe, Malawi
Authors: Chen Jane S , Matoga Mitch , Khan Shiraz , Jere Edward , Massa Cecilia , Ndalama Beatrice , Seña Arlene C , Lancaster Kathryn E , Hosseinipour Mina C , Cohen Myron S , Miller William C , Hoffman Irving F
Published: February 2020

The syndromic management of genital ulcer disease (GUD) misses asymptomatic syphilis cases but is widely utilized in resource-limited settings without diagnostic capabilities to ensure treatment for the most common etiologies of GUD. We used rapid serology tests for syphilis screening at a Malawian sexually transmitted infections clinic. The estimated seroprevalence was 9% and was highest among patients with genital ulcers (26%) and newly diagnosed HIV infection (19%). Rapid syphilis screening has the potential to increase syphilis detection, but accurate patient histories regarding syphilis diagnosis and prior treatment are needed.
Effect of undulating blades on highly loaded compressor cascade performance
Authors: Su Lirong , Qiang Xiaoqing , Zheng Tan , Teng Jinfang
Published: February 2020

Humpback whale’s flipper with leading-edge tubercles has been attracting aerodynamic and hydrodynamic researchers’ attentions by its stall-delayed characteristics. Inspired by this, the undulating configuration is used in a highly loaded compressor cascade as a new type of passive flow control technique. A new model of undulating compressor blade is studied in this paper. To investigate the effect of the undulating configuration on cascade performance without the impact of endwall, steady Reynolds-averaged Navier–Stokes simulations of infinite-span cascades are carried out with and without undulations at an inlet Mach number of 0.5. A parametric study is performed to conclude that, with a suitable wavelength, the undulating blade could achieve a rise in diffusion capacity, accompanied by 12.9% reduction in total pressure loss coefficient at a post-stall incidence angle of 8°, whereas it produces negligible impact in cascade performance at 0° incidence angle. Flow visualization further reveals that wavelength is a crucial parameter, determining the spanwise space for the formation of streamwise vortices. Undulating blades could produce positive effects with maximum magnitude when the counter-rotating streamwise vortices take dominant position along span with an appropriate size.
Śraddhā: Construct Definition from the Bhagavad-Gītā
Authors: Bhawuk Dharm P. S.
Published: February 2020

In this article, the construct of śraddhā which is derived from a sacred Hindu text, the Bhagavad-Gītā is explicated. The analysis of text resulted in nine themes, and many behavioural outcomes of śraddhā such as not finding faults in others. Jñāna or knowledge is seen as mediating between śraddhā and mokṣa or liberation. This relationship is moderated by tatparaḥ (or eager engagement in the spiritual practice one has chosen) and saṃyatendriyaḥ (or practicing self-restraint). Śraddhā is considered as one of the highest virtues. It is a gift of God. It always bears fruits which carry over to the next life. The highest quality of śraddhā is that of a devotee. From interpersonal perspective, śraddhā is an emotion one has for another person, a deity, God or śāstra (scriptural text or instructions in such texts that guide human behaviour). Śraddhā reflects the basic nature of people. Absence of śraddhā causes all efforts to go in vain. The nine themes that are discussed present a thick description of this indigenous construct and open avenues for future research.
Does Care Transition Matter? Exploring the Newly Published HCAHPS Measure
Authors: Hod Rafael , Maimon Oded , Zimlichman Eyal
Published: February 2020

In recent years, health care systems have undergone a consumer revolution—putting patients at the center. The study aim was to explore the association between care transition—the new measure proposed by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)—and hospital patients’ overall rating based on their experience, along with hospitals’ internal characteristics and operational attributes. Using HCAHPS and American Hospital Association published databases, the authors examined the association between hospital characteristics and measures of patient experience, focusing on the care transition measure, in 2350 US hospitals. Positive significant association was found between care transition and overall rating ( P < .0001). An interaction regression model revealed that each of the following moderators—teaching affiliation, location, and membership in a health system—significantly (all P < .05) strengthens the association between care transition and overall rating in a positive direction. These findings may help improve hospital rating, value-based payments, and patient-centered outcomes.
Supporting Successful Stepfathering: An Integration of the Professional Literature and Online Stepfather Reflections
Authors: Gold Joshua M.
Published: February 2020

Demographic data tally the prevalent numbers of stepfamilies in 21st century society, with the majority (86%) of stepfamilies involving a stepfather. However, the data also establish these families as at greater risk for dissolution than first-marrieds or remarried couples without children. Reflecting the established dynamics that promote stepfamily sustainability, this article integrates current professional knowledge with stepfathers’ web-based reflections on which clinical service providers can base their intervention strategies to facilitate positive stepfather experience and stepfamily success ( n = 77).
Investigation and performance comparison of ride comfort on the created human vehicle road integrated model adopting genetic algorithm optimized proportional integral derivative control technique
Authors: Anandan Arivazhagan , Kandavel Arunachalam
Published: February 2020

This context exhaustively investigates the ride comfort performance index on the proposed active suspension vehicle system. Ride comfort in terms of occupants (includes driver and passenger) head acceleration, sprung mass vertical and pitching accelerations is considered. For this examination, a 14-degree-of-freedom human vehicle road integrated system model was extensively developed. Then, an active suspension system composed of a hydraulic actuator and proportional-integral-derivative controller is incorporated into the developed vehicle model to enhance the ride comfort. Besides, the designed controller needs to satisfy other vehicle performance indices like vehicle stability and ride safety. Accordingly, the controller parameters were optimally tunned with the help of genetic algorithm technique, on the basis of integral time absolute error criterion. The objective function was created on the basis of minimizing the integral time absolute error of sprung mass displacement, suspension working space and tire deflection responses. The entire response of human vehicle road integrated model, with the proposed active suspension system and passive suspension system on various random road surfaces (A, B, C, D and E with respect to ISO 8608) with five constant speeds (20, 40, 60, 80 and 100 kmph), was compared via surficial presentation. Furthermore, the comfort measures such as root mean square and vibration dose value from ISO 2631-1 were adopted to evaluate the severity between the occupants via head acceleration response. The simulation results showed that the suggested active suspension system significantly improved the ride comfort with guaranteed vehicle stability and ride safety.
Complexity in regulating microRNA biogenesis in cancer
Authors: Chen Pai-Sheng , Lin Shao-Chieh , Tsai Shaw-Jenq
Published: February 2020

The discovery of microRNA (miRNA) significantly extends our knowledge on gene regulation and noncoding gene functions. MiRNAs are important post-transcriptional regulators involve in a wide range of biological functions and diseases, including cancer. MiRNAs are produced by a unique biogenesis pathway involving the two-step sequential nuclear and cytoplasmic RNase-dependent processing at post-transcriptional level. However, a specific (set) of miRNA(s) is (are) synthesized under certain circumstance or developmental/pathological stage to fine-tune the gene expression profile. In this minireview, we will discuss the mechanism of miRNA biogenesis in cancer, mainly focusing on how Drosha and Dicer, two critical molecules controlling miRNA biogenesis, are modulated and which factor contributes to the specificity of selected miRNA maturation.

Impact statement

The canonical maturation pathway of miRNAs is highly conserved, indicating the crucial roles of these mini-regulators in most cellular processes. Dysregulation of specific miRNAs or imbalance of miRNA abundance has been observed in cancers. Accumulating evidence has shown that the interplay between miRNA processing factors and regulatory proteins previously known as key players in cancer malignancy regulates the biogenesis of miRNAs, expression of target genes, and eventually the alteration of cellular phenotypes. This minireview summarizes the current findings in the modulation of miRNA biogenesis in cancer to advance the understanding of how noncoding RNA contributes to cancer development and malignancy.
Computed Tomography Angiography in the Assessment of Great Saphenous Vein as Conduit for Infrainguinal Bypass Surgery
Authors: Belvedere Shane , Gouil Quentin , Thompson Corey , Solomon Jarryd
Published: February 2020

Introduction:

The great saphenous vein (GSV) is commonly used as a conduit during infrainguinal bypass (IIB) and is usually well seen on computed tomography angiography (CTA) which is frequently performed for preoperative planning. In this study, we asked whether CTA could replace ultrasonography (US) as the primary mode of conduit assessment, by comparing GSV measurements for patients who underwent both CTA and US vein mapping prior to IIB.

Methods:

All IIB that were completed in the six-and-a-half-year period from January 1, 2012, to July 31, 2018, at the authors’ institution were examined. Great saphenous vein measurements were analyzed for patients who had undergone both CTA and US vein mapping. Correlation between the measurements was calculated with the Pearson correlation coefficient. Data were then examined using Bland-Altman plots. Then categorical analysis was used to determine the adequacy of GSV for use as a bypass conduit.

Results:

There were 302 patients who underwent IIB, with 73 legs, in 47 patients, examined with CTA and US. Computed tomography angiography and US measurements were moderately correlated ( r = 0.531) across all measurement locations. Correlation progressively reduced distally (proximal thigh r = 0.534, midthigh r = 0.536, knee r = 0.35, midcalf r = 0.185, P = .074, ankle r = 0.078, P = .485). Bland-Altman plots of the pooled location data demonstrated no systematic bias. However, the upper and lower limits of agreement were wide, between −2.02 and +2.37 mm, demonstrating a lack of agreement between CTA and US. Analysis of each location revealed similar findings. A receiver operator characteristic curve was constructed based on a minimum US GSV diameter for adequate bypass conduit of 3 mm. The CTA value that maximized the Youden index was 3.8 mm.

Conclusion:

The level of error between CTA and US measurements, demonstrated by the large limits of agreement on Bland-Altman plots, would not be clinically acceptable. However, if a larger threshold is accepted, CTA has the potential to replace preoperative US vein mapping of GSV.
Ultrasonographic Evaluation of a Patient With a Successful Digital Sympathectomy in Raynaud Phenomenon: A Case Report
Authors: Lee Jae Min , Chung Jae-Ho , Yoon Eul-Sik , Park Seung-Ha , Lee Byung-Il
Published: February 2020

Selective periarterial sympathectomy in Raynaud phenomenon (RP) has not been adequately studied as there was no reliable method to evaluate outcomes. However, dynamic Doppler ultrasonography may have clinical value in the management and follow-up of patients with RP; but few reports describe using the device to assess surgical outcomes. Here, we report a case of successful digital sympathectomy in a single digit and the postoperative evaluation using ultrasonography. A 23-year-old patient with secondary RP underwent surgery targeting both common digital artery (ulnar side) and the proper digital artery (radial side). The procedure yielded immediate pain relief and the improvement of recurrent fingertip ulceration. The 1-year postoperative assessment with dynamic Doppler ultrasonography using a hockey-stick probe was performed with a cold provocation test and revealed peak systolic velocity improvement comparable to the nontreated ulnar side but prominent fibrosis on the radial aspect. We anticipate that Doppler ultrasonography may be an effective tool for the postoperative assessment of patients who underwent digital sympathectomy for treatment of RP.
Protective Effect and Mechanism of Action of Rosmarinic Acid on Radiation-Induced Parotid Gland Injury in Rats
Authors: Zhang Tingting , Liu Chang , Ma Shanshan , Gao Yirong , Wang Rensheng
Published: February 2020

The parotid glands are damaged by oxidative stress and a series of pathophysiological changes after irradiation. Rosmarinic acid (RA) is a natural antioxidant that provides a radioprotective effect against harmful damage from ionizing radiation. The present study aims to explore the protective effects of RA on radiation-induced parotid gland injury and its underlying mechanism. Sprague-Dawley rats were irradiated with 15 Gy X-ray and treated with different concentrations of RA (30, 60, and 120 mg/kg) or amifostine (AMI, 250 mg/kg). Saliva secretion function, oxidative stress, apoptosis, the inflammatory response, and fibrosis were determined by the measurement of the salivary flow rate, enzyme-linked immunosorbent assay, transferase-mediated DUTP Nick end labeling, Western blot, quantitative real time polymerase chain reaction, and hematoxylin and eosin staining. Here, we show that RA treatment significantly attenuated reactive oxygen species by a direct hindrance effect and the indirect activation of peroxisome proliferator-activated receptor gamma coactivator 1-alpha/nicotinamide adenine dinucleotide phosphate oxidase 4 signaling. Rosmarinic acid not only reduced apoptosis by inhibiting p53/jun N-terminal kinase activation but also reduced parotid gland tissue fibrosis by downregulating inflammatory factor levels. Compared to AMI, RA has the obvious advantages of late efficacy and convenient usage. Moreover, 60 mg/kg is the minimum effective dose of RA. Therefore, RA can potentially be applied as a therapeutic radioprotective agent to treat radiation-induced parotid gland injury in the future.
Extended singular robust inverse solution of redundant serial manipulators
Authors: Sun Jingyu , Liu Yanjun , Ji Chen
Published: February 2020

We propose the use of a damping matrix β to replace the unified damping coefficient λ in the singular robust inverse method, allowing for adjustment of the manipulator’s singularity for different joints separately. In addition, the correction coefficient matrix α is employed to eliminate the Jacobian matrix approximation error, which usually exists in the iterative control solving process; the extended singular robust inverse method is thereby proposed. This article contains analyses of the singularities caused by three methods and how they result in larger values of the manipulator terminal error and joint angular velocity; additionally, the semi-empirical selection principles of β and α are given. The stability of the proposed method is investigated with the Lyapunov stability criteria, and its effectiveness is verified for spatial linear and curve trajectories with 7-axis and 10-axis redundant serial manipulators. The simulation results show that the proposed method exhibits improved optimization performance and stability, and the terminal error is stable and within the allowable range. The least singular value is larger and the joint angular velocity is the lowest, which is the expected outcome. Furthermore, the simulation results for the 10-axis manipulator also indicate the generality of the proposed method.
Cardiomyopathy
Authors: Moncrieff Gregor , Williams Howell , Bond Richard
Published: February 2020

The European Society of Cardiology (ESC) defines cardiomyopathies as structural or functional abnormalities of the ventricular myocardium not caused by coronary artery disease, valvular disease, hypertension or congenital heart disease. Presentation can range from asymptomatic patients with abnormal investigations or family history, to arrhythmia, thromboembolic disease, progressive heart failure or sudden cardiac death. Early diagnosis and referral to specialist services is important, as treatment can reduce both morbidity and mortality. Investigation and management are undertaken in secondary or tertiary care. GPs with a good working knowledge of cardiomyopathy will be alert to key features of the history, examination and electrocardiogram findings that facilitate prompt referral. Appreciation of the heritable nature of many cardiomyopathies is important in order to facilitate family screening for relatives of patients with cardiomyopathy.
Blocked ears
Authors: Wright Oliver J , Wright James W , Chambers William G
Published: February 2020

Blocked ears are a common presenting complaint in primary care, and although the cause is usually benign, a structured clinical approach and examination are essential to avoid missing more significant causes. In this article, we discuss the clinical approach, aetiology and management of the wide range of conditions that lead to the sensation of blocked ears, and provide guidance on referral to secondary care.
Using social media for smoking cessation interventions: a systematic review
Authors: Luo T , Li MS , Williams D , Phillippi S , Yu Q , Kantrow S , Kao YH , Celestin M , Lin WT , Tseng TS
Published: February 2020

Background:

Previous studies have shown that smoking tobacco significantly increases both incidence and mortality rates for many diseases. Social media has become one of the most influential platforms for various smoking cessation interventions. However, results from smoking cessation interventions have differed from study to study. Limited studies have summarised cessation outcomes from social media–based interventions. Therefore, the objective of this review is to explore the effectiveness of using social media for smoking cessation.

Methods:

We searched PubMed, MEDLINE, PsycINFO, and CINAHL for articles between June 2008 and June 2018, and also assessed the references of selected articles. We included studies that used social media as intervention platforms, provided a baseline assessment before the intervention, and provided smoking cessation outcomes after the intervention.

Results:

We identified 13 original studies that enrolled between 16 and 1698 participants; 7-day Point Prevalence Abstinence (PPA) rate was the most frequently used measure of abstinence, with a range of 7%–75%, regardless of the measurement time, study design, and analysis methods. Social media–based smoking cessation interventions were effective, because (1) smokers reported higher 7-day PPA rates after intervention compared to baseline and (2) smokers reported higher 7-day PPA rates in intervention groups than in control groups. Moreover, at each time point, approximately half of all smokers in studies reporting abstinence were found to be biochemically abstinent. There were no significant differences in the effectiveness of smoking cessation outcomes between those that used existing popular social networking platforms (e.g. Pechmann et al’s studies) and those that used individually designed interactive platforms (e.g. MyLastDip, iQuit system, Quitxt system).

Conclusions:

This review highlights the effectiveness of social media–based smoking cessation intervention studies. Due to the widespread use of social media, as well as its low cost, we suggest embedding smoking cessation interventions within existing popular social media platforms.
The Prediction Capacity 3-D Software, on a 2-D Analysis, in Planning the Positioning of the Upper Lip After Maxillary Advancement
Authors: Chihara Letícia Liana , Segantin Jéssica de Fátima , Faria Paulo Esteves Pinto , Sant’Ana Eduardo , Dias-Ribeiro Eduardo , Nogueira Renato Luiz Maia , Ferreira-Júnior Osny
Published: February 2020

Purpose:

The maxillary advancement using Le Fort I osteotomy directly affects in the positioning of the upper lip (UL) and the nasolabial angle (NLA), which plays an important role in facial expression and aesthetics, because of this, the aim of this study was to evaluate the ability of Dolphin Imaging 11.8 software in predicting changes to the UL position and NLA in patients undergoing maxillary advancement.

Materials and Methods:

It was a retrospective cohort study. Predictive and final tracings using pre- and postoperative Cone beam computed tomography (CBCT) of 24 patients undergoing maxillary advancement, regardless of mandibular movement, were compared. Whether the amount of advancement changes this predictability was also analyzed. The predictive and the 12-month postoperative data were evaluated using Dolphin Imaging 11.8 software and compared. Student t test was used to get the results.

Results:

The vertical analysis of the incisal tip and cementoenamel junction of the upper central incisor (UCI) and of the UL were statistically significant ( P = .001 for all). The horizontal measurements of the same variables ( P = .238, P = .516, P = .930, respectively) and the NLA ( P = .060) showed no statistical significance. The amount of advancement did not interfere with the variables analyzed, except for the exposure ( P = .009) and inclination of the UCI ( P = .010).

Conclusion:

It was concluded that the amount of maxillary advancement does not interfere with the UL prediction; the prediction capacity of the software was good for the horizontal measurements, but had a significant error index for vertical measurements.
The First Report of the International Cartilage Regeneration and Joint Preservation Society’s Global Registry
Authors: Biant Leela C. , Conley Caitlin W. , McNicholas Michael J.
Published: February 2020

Objective

The International Cartilage Regeneration and Joint Preservation Society’s (ICRS’s) global registry, aims to be the best source of information for patients and an unbiased resource of evidence-based medicine for scientists and clinicians working to help those unfortunate enough to suffer the pain and disability associated with articular cartilage lesions. This article constitutes the scientific summary of the reports’ main findings.

Design

The article outlines the historical precedents in the development of orthopedic registries from the earliest tumor registries, then local arthroplasty databases that led ultimately to international collaborations between national arthroplasty and soft tissue registries. The ICRS global cartilage registry was designed from the outset as a GDPR (General Data Protection Regulation) compliant, multilingual, multinational cooperative system. It is a web-based user-friendly, live in 11 languages by end 2019, which can be accessed via https://cartilage.org/society/icrs-patient-registry/ . Patients and clinicians enter data by smartphone, tablet, or computer on any knee cartilage regeneration and joint preservation treatment, including the use of focal arthroplasty. Knee Injury and Osteoarthritis Outcome Score and Kujala patient-reported outcome measures are collected preoperatively, 6 months, 12 months, and annually for ten years thereafter. EQ-5D data collection will allow cost-effectiveness analysis. Strengths, weaknesses, and future plans are discussed.

Results

Since inception the registry has 264 users across 50 countries. Major findings are presented and discussed, while the entire first ICRS global registry report is available at https://cartilage.org/society/icrs-patient-registry/registry-annual-reports/ . Conclusion. A measure of the maturity of any registry is the publication of its findings in the peer reviewed literature. With the publication of its first report, the ICRS global registry has achieved that milestone.
Current Treatment Options for Intervertebral Disc Pathologies
Authors: Eisenstein Stephen M. , Balain Birender , Roberts Sally
Published: February 2020

The complex structure of the intervertebral disc within the spine is well suited to its mechanical function. However, it is also prone to degeneration, which is associated with various clinical symptoms and conditions, ranging from disc herniation to back pain to spinal stenosis. Most patients’ conditions are managed conservatively but a small proportion progress to having surgery. This may be decompression (to remove tissue such as the disc, bone, or hypertrophic ligaments impinging on nerves) or fusion of the normally mobile intervertebral joint to immobilize it and so reduce pain. These used to involve fairly major surgical procedures, but in the past decade there has been much progress to make the surgery more refined and less invasive, for example using endoscopic approaches. Simultaneously, the research world has been studying and developing tissue engineering and cellular techniques for attempting to regenerate the intervertebral disc, whether simply the central nucleus pulposus or a complete intricate assembly to replicate the native structure of this and the surrounding annulus fibrosus, cartilage endplate, and bone. To date, none of the complex entities have been trialed, while cellular approaches are easier to utilize, have progressed to clinical trials, and may offer a better solution.
Digital collaborative platforms: A challenge for both the legislator and the social partners in the Nordic model
Authors: Westregård Annamaria
Published: February 2020

This paper focuses on the specific problems in the labour and social security legislation as it relates to crowdworkers in the digitalised new economy, analysing their place in labour market, and especially in the collective agreements which are the standard means of regulating working conditions in the Nordic model. Sweden has a binary system where a performing party is as either an employee or self-employed.

The law on working and employment conditions offers only limited protection to those on short, fixed-term contracts; instead, it is social partners that have improved crowdworkers’ conditions in some industries by using collective bargaining. However, there are no collective agreements in the digital economy, or indeed for platform entrepreneurs. The complications of the parties’ positions will be analysed, especially as platforms do not consider themselves to be employers, but rather coordinators of the self-employed.

It is not only labour law regulations that are important to prevent precariat among crowdworkers. It is also very important that the social security regulations adapt to the new labour market as the social security legislation is an important part of the Nordic model.
Sciatic neuropathy in an acromegalic cat without concurrent diabetes mellitus
Authors: Corsini Andrea , Bianchi Ezio , Volta Antonella , Bonazzi Mattia
Published: February 2020

Case summary

A 17-year-old neutered male European Shorthair cat was presented owing to an inability to jump and respiratory stridor. The owner did not report any other clinical signs. On physical examination, the main findings were plantigrade stance, broad facial features and inspiratory stridor. Neurological examination revealed posterior paraparesis, hypotonia and right hindlimb muscle atrophy. Laboratory findings were unremarkable and glycaemia was normal. Serum insulin-like growth factor 1 concentration was elevated (>1000 ng/ml). A total body CT scan showed an enlarged pituitary gland, thickening of the nasal turbinates and an L7–S1 right foraminal stenosis. Electrodiagnostic testing confirmed the presence of a neuropathy affecting both sciatic nerves. The cat was treated with gabapentin only and was still alive and euglycaemic 16 months after the diagnosis.

Relevance and novel information

This case describes for the first time sciatic neuropathy, an occasional complication of acromegaly in people, as a possible clinical presentation in acromegalic cats without concurrent diabetes mellitus.
Unequal Reward for Equal Work? Understanding Women’s Work and Wage Discrimination in India Through the Meniscus of Social Hierarchy
Authors: Singh Pushpendra , Pattanaik Falguni
Published: February 2020

The Indian society is one of the most unequal societies of the world and divided into different social hierarchies of caste, class, religion, etc. Caste is a determinant of power, economic inequality, poverty and discrimination in contemporary India. When it comes to women, they face the dual burden of discrimination, first gender based and, second, caste based. The practice of discrimination persists between Dalit/tribal and upper-class women, but still, Dalit women are trying to come out of this unequal treatment. Hence, this study investigates the magnitude of discrimination among women workers in terms of the social hierarchy and relative factors responsible for workforce discrimination. Furthermore, this study examines the extent of wage differential between Dalit/tribal and upper-class women workers. The study has used the data of the 50th Employment and Unemployment Survey to the Periodic Labour Force Survey (PLFS) from 1993–1994 to 2017–2018 by the National Sample Survey Office (NSSO). In the first part of the analysis, this study explains how and why the women workforce is decreasing, particularly as far as Dalit/tribal women are concerned. Subsequently, the relative contributions of socio-economic conditions in the women workforce have been assessed using logistic regression. However, the second part of the study examines the wage differential between general and Dalit/tribal women and the extent of wage discrimination using the Oaxaca–Blinder decomposition method. The study reveals that the women workforce has been consistently declining and the vulnerability is intense among Dalit/tribal women. Furthermore, it has been observed that the social hierarchy (caste) is a decisive factor for the remuneration (wage) in the labour market and over the period of study, the wage discrimination between Dalit and upper-caste women has significantly increased.
Building-damage detection method based on machine learning utilizing aerial photographs of the Kumamoto earthquake
Authors: Naito Shohei , Tomozawa Hiromitsu , Mori Yuji , Nagata Takeshi , Monma Naokazu , Nakamura Hiromitsu , Fujiwara Hiroyuki , Shoji Gaku
Published: February 2020

This article presents a method for detecting damaged buildings in the event of an earthquake using machine learning models and aerial photographs. We initially created training data for machine learning models using aerial photographs captured around the town of Mashiki immediately after the main shock of the 2016 Kumamoto earthquake. All buildings are classified into one of the four damage levels by visual interpretation. Subsequently, two damage discrimination models are developed: a bag-of-visual-words model and a model based on a convolutional neural network. Results are compared and validated in terms of accuracy, revealing that the latter model is preferable. Moreover, for the convolutional neural network model, the target areas are expanded and the recalls of damage classification at the four levels range approximately from 66% to 81%.
How I manage CLL with venetoclax-based treatments
Authors: Wierda William G. , Tambaro Francesco Paolo
Published: February 2020

Targeted therapies for chronic lymphocytic leukemia (CLL) include venetoclax, the oral inhibitor of B-cell lymphoma-2, and inhibitors of kinases in the B-cell receptor signaling pathway, like Bruton tyrosine kinase and phosphatidylinositol 3 kinase. Randomized clinical trials clearly demonstrated improved progression-free survival with targeted therapy over chemoimmunotherapy in first-line and treatment of relapsed/refractory CLL. Comparative trials of venetoclax-based vs other targeted therapies have not been conducted. Differentiating features and considerations with targeted therapies include goals of treatment and therapeutic approach as well as side effect and toxicity profiles. With targeted therapy options for first-line and relapsed CLL, it is ever more important to develop sound rationale and strategy for selecting first-line and treatment of relapsed disease and for long-term management of the disease, including therapeutic sequencing. Fixed-duration therapy with a treatment-free remission is a particularly appealing prospect, since it avoids continuous exposure to treatment and potential for toxicity. We discuss rationale and practical application of venetoclax in first-line and treatment of relapsed and refractory CLL. Venetoclax is highly active at achieving deep remission for most treated patients with CLL, including those with high-risk disease such as del(17p) CLL.
Oral brincidofovir decreases the incidence of HHV-6B viremia after allogeneic HCT
Authors: Hill Joshua A. , Nichols W. Garrett , Marty Francisco M. , Papanicolaou Genovefa A. , Brundage Thomas M. , Lanier Randall , Zerr Danielle M. , Boeckh Michael J.
Published: February 2020

Human herpesvirus 6B (HHV-6B) frequently reactivates after allogeneic hematopoietic cell transplantation (HCT). There are no randomized studies of antiviral treatments to prevent HHV-6B reactivation. Brincidofovir has high in vitro activity against HHV-6B and other DNA viruses, but its in vivo activity for HHV-6B has not been demonstrated. We performed a post hoc analysis of a randomized controlled trial of twice-weekly oral brincidofovir for cytomegalovirus prophylaxis after allogeneic HCT to study the effect of brincidofovir on HHV-6B reactivation. We included patients randomized within 2 weeks of HCT and who received at least 6 consecutive doses of study drug after randomization. We tested plasma for HHV-6B through week 6 post-HCT. The cohort consisted of 92 patients receiving brincidofovir and 61 receiving placebo. The cumulative incidence of HHV-6B plasma detection through day 42 post-HCT was significantly lower among patients receiving brincidofovir (14.2%) compared with placebo (32.4%; log-rank, 0.019). In an adjusted Cox model, brincidofovir exposure remained associated with a lower hazard for HHV-6B plasma detection (hazard ratio, 0.40; 95% confidence interval, 0.20-0.80). In conclusion, brincidofovir prophylaxis reduced HHV-6B reactivation after allogeneic HCT in a post hoc analysis of a randomized controlled trial. These data support the study of intravenous brincidofovir for HHV-6B prophylaxis.
Phosphorylated ERK1/2 in CD4 T cells is associated with acute GVHD in allogeneic hematopoietic stem cell transplantation
Authors: Itamura Hidekazu , Shindo Takero , Yoshioka Satoshi , Ishikawa Takayuki , Kimura Shinya
Published: February 2020

To diagnose graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is sometimes difficult. We showed previously that MEK inhibitors selectively suppress murine GVHD while retaining antiviral and antitumor immunity. Here, we asked whether the RAS/MEK/ERK pathway is activated in human allo-HSCT recipients with GVHD, and whether the phosphorylated ERK1/2 can be a biomarker of GVHD. Peripheral blood was sequentially collected from 20 allo-HSCT recipients: 1 bone marrow transplant, 7 peripheral blood stem cell transplants (PBSCT), and 12 cord blood transplants. Ten of the 20 allo-HSCT recipients developed GVHD, and phosphorylation of ERK1/2 in T and B cells was analyzed by flow cytometry. Occurrence of acute GVHD was associated with phosphorylation of ERK1/2 in CD4+ T cells at day 30 (P < .001), which was suppressed by ex vivo exposure to a MEK inhibitor trametinib at clinically achievable concentrations. In particular, ERK1/2 was phosphorylated preferentially in naive/central memory CD4+ T cells. Notably, phosphorylation of ERK1/2 fell as GVHD improved. These results suggest that phosphorylation status of ERK1/2 in peripheral blood CD4+ T cells may be a future biomarker for diagnosing human GVHD, and the potential efficacy of MEK inhibitors against human GVHD.
A 4-gene leukemic stem cell score can independently predict the prognosis of myelodysplastic syndrome patients
Authors: Wang Yu-Hung , Lin Chien-Chin , Yao Chi-Yuan , Hsu Chia-Lang , Hou Hsin-An , Tsai Cheng-Hong , Chou Wen-Chien , Tien Hwei-Fang
Published: February 2020

Myelodysplastic syndrome (MDS) comprised a heterogeneous group of diseases. The prognosis of patients varies even in the same risk groups. Searching for novel prognostic markers is warranted. Leukemic stem cells (LSCs) are responsible for chemoresistance and relapse in leukemia. Recently, expressions of 17 genes related to stemness of LSCs were found to be associated with prognosis in acute myeloid leukemia patients. However, the clinical impact of LSC genes expressions in MDS, a disorder arising from hematopoietic stem cells, remains unclear. We analyzed expression profile of the 17 stemness-related genes in primary MDS patients and identified expression of 4 genes (LAPTM4B, NGFRAP1, EMP1, and CPXM1) were significantly correlated with overall survival (OS). We constructed an LSC4 scoring system based on the weighted sums of the expression of 4 genes and explored its clinical implications in MDS patients. Higher LSC4 scores were associated with higher revised International Prognostic Scoring System (IPSS-R) scores, complex cytogenetics, and mutations in RUNX1, ASXL1, and TP53. High-score patients had significantly shorter OS and leukemia-free survival (LFS), which was also confirmed in 2 independent validation cohorts. Subgroup analysis revealed the prognostic significance of LSC4 scores for OS remained valid across IPSS-R lower- and higher-risk groups. Furthermore, higher LSC4 score was an independent adverse risk factor for OS and LFS in multivariate analysis. In summary, LSC4 score can independently predict prognosis in MDS patients irrespective of IPSS-R risks and may be used to guide the treatment of MDS patients, especially lower-risk group in whom usually only supportive treatment is given.
The Pleural Effusion And Symptom Evaluation (PLEASE) study of breathlessness in patients with a symptomatic pleural effusion
Authors: Muruganandan Sanjeevan , Azzopardi Maree , Thomas Rajesh , Fitzgerald Deirdre B. , Kuok Yi Jin , Cheah Hui Min , Read Catherine A. , Budgeon Charley A. , Eastwood Peter R. , Jenkins Susan , Singh Bhajan , Murray Kevin , Lee Y.C. Gary
Published: February 2020

Introduction

Pathophysiology changes associated with pleural effusion, its drainage and factors governing symptom response are poorly understood. Our objective was to determine: 1) the effect of pleural effusion (and its drainage) on cardiorespiratory, functional and diaphragmatic parameters; and 2) the proportion as well as characteristics of patients with breathlessness relief post-drainage.

Methods

Prospectively enrolled patients with symptomatic pleural effusions were assessed at both pre-therapeutic drainage and at 24–36 h post-therapeutic drainage.

Results

145 participants completed pre-drainage and post-drainage tests; 93% had effusions ≥25% of hemithorax. The median volume drained was 1.68 L. Breathlessness scores improved post-drainage (mean visual analogue scale (VAS) score by 28.0±24 mm; dyspnoea-12 (D12) score by 10.5±8.8; resting Borg score before 6-min walk test (6-MWT) by 0.6±1.7; all p<0.0001). The 6-min walk distance (6-MWD) increased by 29.7±73.5 m, p<0.0001. Improvements in vital signs and spirometry were modest (forced expiratory volume in 1 s (FEV1) by 0.22 L, 95% CI 0.18–0.27; forced vital capacity (FVC) by 0.30 L, 95% CI 0.24–0.37). The ipsilateral hemi-diaphragm was flattened/everted in 50% of participants pre-drainage and 48% of participants exhibited paradoxical or no diaphragmatic movement. Post-drainage, hemi-diaphragm shape and movement were normal in 94% and 73% of participants, respectively. Drainage provided meaningful breathlessness relief (VAS score improved ≥14 mm) in 73% of participants irrespective of whether the lung expanded (mean difference 0.14, 95% CI 10.02–0.29; p=0.13). Multivariate analyses found that breathlessness relief was associated with significant breathlessness pre-drainage (odds ratio (OR) 5.83 per standard deviation (sd) decrease), baseline abnormal/paralyzed/paradoxical diaphragm movement (OR 4.37), benign aetiology (OR 3.39), higher pleural pH (OR persdincrease 1.92) and higher serum albumin level (OR persdincrease 1.73).

Conclusions

Breathlessness and exercise tolerance improved in most patients with only a small mean improvement in spirometry and no change in oxygenation. Breathlessness improvement was similar in participants with and without trapped lung. Abnormal hemi-diaphragm shape and movement were independently associated with relief of breathlessness post-drainage.
Phenotype and outcome of pulmonary arterial hypertension patients carrying aTBX4mutation
Authors: Thoré Pierre , Girerd Barbara , Jaïs Xavier , Savale Laurent , Ghigna Maria-Rosa , Eyries Mélanie , Levy Marilyne , Ovaert Caroline , Servettaz Amélie , Guillaumot Anne , Dauphin Claire , Chabanne Céline , Boiffard Emmanuel , Cottin Vincent , Perros Frédéric , Simonneau Gérald , Sitbon Olivier , Soubrier Florent , Bonnet Damien , Remy-Jardin Martine , Chaouat Ari , Humbert Marc , Montani David
Published: February 2020

Introduction

TBX4mutation causes small patella syndrome (SPS) and/or pulmonary arterial hypertension (PAH). The characteristics and outcomes of PAH associated withTBX4mutations are largely unknown.

Methods

We report the clinical, functional, radiologic, histologic and haemodynamic characteristics and outcomes of heritable PAH patients carrying aTBX4mutation from the French pulmonary hypertension (PH) network.

Results

20 patients were identified in 17 families. They were characterised by a median age at diagnosis of 29 years (0–76 years) and a female to male ratio of three. Most of the patients (70%) were in New York Heart Association (NYHA) functional class III or IV with a severe haemodynamic impairment (median pulmonary vascular resistance (PVR) of 13.6 (6.2–41.8) Wood units). Skeletal signs of SPS were present in 80% of cases. Half of the patients had mild restrictive or obstructive limitation and diffusing capacity of the lung for carbon monoxide (DLCO) was decreased in all patients. High-resolution computed tomography (HRCT) showed bronchial abnormalities, peri-bronchial cysts, mosaic distribution and mediastinal lymphadenopathies. PAH therapy was associated with significant clinical improvement. At follow-up (median 76 months), two patients had died and two had undergone lung transplantation. One-year, three-year and five-year event-free survival rates were 100%, 94% and 83%, respectively. Histologic examination of explanted lungs revealed alveolar growth abnormalities, major pulmonary vascular remodelling similar to that observed in idiopathic pulmonary arterial hypertension (IPAH) and accumulation of cholesterol crystals within the lung parenchyma.

Conclusion

PAH due toTBX4mutations may occur with or without skeletal abnormalities across a broad age range from birth to late adulthood. PAH is usually severe and associated with bronchial and parenchymal abnormalities.