bluuebunny/crossref_metadata_2025 huggingface dataset:
Exact Solution for the Torsional Vibration of an Elastic Pile in a Radially Inhomogeneous Saturated Soil
Authors: Li Xibin , Zhang Zhiqing , Sheng Jianchao
Published: January 2021

An exact solution is proposed to study the time-harmonic torsional vibration of an elastic pile embedded in a radially inhomogeneous saturated soil. The radially inhomogeneous saturated soil is composed of inner disturbed and outer semi-infinite undisturbed concentric annular regions, with the shear modulus of the inner region changing in an exponential form along the radial direction. The governing equation of each region of the saturated soil is solved through rigorous mathematical derivation and the soil torsional impedance is derived with an exact and explicit expression. Making use of the boundary and continuity conditions of the pile-soil system, the torsional complex stiffness at the pile top is obtained in an exact closed form in the frequency domain. Selected numerical results are presented to investigate the influence of the radial inhomogeneity of the surrounding soil on the vibration characteristics of the pile-soil system.
Improved Hierarchical Convolutional Features for Robust Visual Object Tracking
Authors: Sun Jinping
Published: January 2021

The target and background will change continuously in the long‐term tracking process, which brings great challenges to the accurate prediction of targets. The correlation filter algorithm based on manual features is difficult to meet the actual needs due to its limited feature representation ability. Thus, to improve the tracking performance and robustness, an improved hierarchical convolutional features model is proposed into a correlation filter framework for visual object tracking. First, the objective function is designed by lasso regression modeling, and a sparse, time‐series low‐rank filter is learned to increase the interpretability of the model. Second, the features of the last layer and the second pool layer of the convolutional neural network are extracted to realize the target position prediction from coarse to fine. In addition, using the filters learned from the first frame and the current frame to calculate the response maps, respectively, the target position is obtained by finding the maximum response value in the response map. The filter model is updated only when these two maximum responses meet the threshold condition. The proposed tracker is evaluated by simulation analysis on TC‐128/OTB2015 benchmarks including more than 100 video sequences. Extensive experiments demonstrate that the proposed tracker achieves competitive performance against state‐of‐the‐art trackers. The distance precision rate and overlap success rate of the proposed algorithm on OTB2015 are 0.829 and 0.695, respectively. The proposed algorithm effectively solves the long‐term object tracking problem in complex scenes.
EGCG Promotes Neurite Outgrowth through the Integrin β1/FAK/p38 Signaling Pathway after Subarachnoid Hemorrhage
Authors: Zhang Yuyuan , Han Mengguo , Sun Xiaoxue , Gao Guojun , Yu Guoying , Huang Liong , Chen Ying
Published: January 2021

The abnormal neurites have long been regarded as the main player contributing to the poor outcome of patients with subarachnoid hemorrhage (SAH). (-)-Eigallocatechin-3-gallate (EGCG), the major biological component of tea catechin, exhibited strong neuroprotective effects against central nervous system diseases; however, the role of EGCG-mediated neurite outgrowth after SAH has not been delineated. Here, the effect of reactive oxygen species (ROS)/integrin β1/FAK/p38 pathway on neurite outgrowth was investigated. As expected, oxyhemoglobin- (OxyHb-) induced excessive ROS level was significantly reduced by EGCG as well as antioxidant N-acetyl-l-cysteine (NAC). Consequently, the expression of integrin β1 was significantly inhibited by EGCG and NAC. Meanwhile, EGCG significantly inhibited the overexpression of phosphorylated FAK and p38 to basal level after SAH. As a result, the abnormal neurites and cell injury were rescued by EGCG, which eventually increased energy generation and neurological score after SAH. These results suggested that EGCG promoted neurite outgrowth after SAH by inhibition of ROS/integrin β1/FAK/p38 signaling pathway. Therefore, EGCG might be a new pharmacological agent that targets neurite outgrowth in SAH therapy.
Multifaceted Optimization of MSC-Based Formulation upon Sodium Iodoacetate-Induced Osteoarthritis Models by Combining Advantageous HA/PG Hydrogel and Fluorescent Tracer
Authors: Wang Ai-tong , Zhao Meng , Feng Ying , Jia Honghong , Zhang Leisheng , Yu Hao , Li Zongjin , Han Zhibo , Han Zhongchao
Published: January 2021

Owing to the boundedness of conventional remedies upon articular cartilage for self-rehabilitation and the incrementally senior citizens, the incidence of osteoarthritis (OA) is increasing worldwide. Empirical studies have revealed the advantageous and promising potentials of mesenchymal stem/stromal cells (MSCs) on the refractory OA, whereas the deficiency of systematic and detailed exploration of MSC-based therapy largely hampers the large-scale applications in regenerative medicine. Herein, we initially utilized the monosodium iodoacetate- (MIA-) induced OA rabbit models and investigated the therapeutic effect of human umbilical cord-derived UC-MSCs at serial dose gradients with the splendid hyaluronic acid and/or propylene glycol hydrogels (HA, HA/PG), respectively. Afterwards, we turned to a dual-luciferase reporter tracing system and evaluated the spatiotemporal distribution and metabolokinetics of bifluorescence expressing UC-MSCs (BF-MSCs) in OA rats. Of the aforementioned trials, we verified that the combination of HA/PG and middle-dose MSCs (

0.5
×

10

7

cells/ml) eventually manifested the optimal efficacy on OA rabbits. Furthermore, with the aid of the bioluminescence imaging (BLI) technology for dynamic in vitro and in vivo tracking, we intuitively delineated the spatiotemporal distribution and therapeutic process of BF-MSCs in OA rats, which substantially confirmed the reinforcement of HA/PG on BF-MSCs for OA treatment. Collectively, our data conformably demonstrated that the middle dose of UC-MSCs combined with HA/PG hydrogel was sufficient for optimal MSC-based formulation for blocking OA progression and promoting cartilage repair, which supplied overwhelming new references and enlightened MSC-based therapeutic strategies for cartilage defects.
Primary Myelofibrosis-Related Renal Disorders Treated with a Janus Kinase Inhibitor
Authors: Asou Mea , Asakawa Tomohiko , Araki Makoto , Ehara Takashi , Hishima Tsunekazu , Sakamaki Hisashi
Published: January 2021

Extramedullary hematopoiesis is widely known to occur in patients with primary myelofibrosis (PMF). Autopsy studies on individuals with PMF revealed that extramedullary hematopoiesis occurred in the kidneys in 35% of the cases, but there is little awareness regarding such lesions. A 63-year-old man was diagnosed with PMF based on a detailed examination of persistent high white blood cells. An examination of the patient’s medical records revealed an increased white blood cell count, deterioration of kidney function, and urinary protein excretion developed simultaneously. Thus, a kidney biopsy was performed. Advanced lymphocyte invasion was recognized in the interstitial tissue, and the tubular structure was highly disrupted. Based on these findings, he was diagnosed with interstitial nephritis. However, because of the large number of cells with nuclear atypia in the stroma, additional immunohistochemical staining was also performed, such as glycophorin A, naphthol AS-D, myeloperoxidase, and CD42b. As a result, invasion of three lineages of immature cells, erythroblasts, megakaryocytes, and granulocytes, was identified. Renal dysfunction resulting from interstitial cellular infiltration due to extramedullary hematopoiesis was therefore diagnosed. Treatment with ruxolitinib was initiated after a renal biopsy and the rate of decline in renal function was slightly reduced. Although, in myeloproliferative disorders, proliferative glomerular lesions are widely considered to be renal disorders, there is little awareness regarding interstitial lesions. Extramedullary hematopoiesis of the kidney in PMF is not uncommon, but 40% of cases are reportedly misdiagnosed as interstitial nephritis. Because extramedullary hematopoiesis can be controlled by ruxolitinib, early detection is important.
SMART Syndrome Identification and Successful Treatment
Authors: de Oliveira Franco Álvaro , Anzolin Eduardo , Schneider Medeiros Marcio , Machado Castilhos Raphael , Targa Martins Rodrigo , Moser Filho Humberto Luiz
Published: January 2021

Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a rare late complication of brain irradiation. Patients commonly present recurrent attacks of headaches, seizures, and paroxysmal focal neurological deficits including aphasia, negligence, or hemianopsia. We report a 41-year-old male patient admitted to our emergency room with a reduced level of consciousness and global aphasia. One month prior to admission, he started with frequent headache attacks of moderate intensity and paroxysmal behavioral alterations, advancing to confusion, gait instability, language impairment, and somnolence. He had a history of medulloblastoma treated with surgical resection followed by craniospinal irradiation 21 years before symptom onset. After excluding more frequent causes for the patient’s symptoms along with a suggestive image pattern, we started treatment for SMART syndrome with high-dose corticosteroid and calcium channel blocker verapamil. The patient gradually improved his level of consciousness and recovered from aphasia and gait instability without new seizures or neuropsychiatric symptoms. Follow-up brain magnetic resonance imaging showed resolution of the typical findings. This case displays a successful clinical evolution of a patient treated for SMART syndrome in which identification of previous radiation treatment, exclusion of other etiologies, and prompt treatment institution were key for effectively tackling this disease.
Multiple Keratoacanthomas after a Recent Tattoo: A Case Report
Authors: Mitri Fouad , Hartschuh Wolfgang , Toberer Ferdinand
Published: January 2021

We report on a 39-year-old man who presented with seven skin lesions on the right thigh 3 weeks after receiving a large tattoo which included red and black pigments. Initially, the lesions grew fast, later their growth stabilized. Histopathology showed well-circumscribed symmetric tumors with a central keratin-filled crater along with further trademarks of a keratoacanthoma. The patient had previously had multiple tattoos with no history of similar lesions. PCR analysis of one of the lesions revealed the presence of human papillomavirus 6. All lesions were excised with a safety margin. A 3-month follow-up revealed no further lesions.
Next-Generation Sequencing for Non-Ampullary Duodenal Carcinoma Suggesting the Existence of an Adenoma-Carcinoma Sequence
Authors: Yoshida Tsubasa , Kojima Yohei , Shimada Ryusuke , Tanabe Hidesato , Tabei Koichi , Yanagida Osamu , Nikaido Takashi , Ohtsuka Kouki , Ohnishi Hiroaki , Abe Nobutsugu , Hisamatsu Tadakazu , Takahashi Shinichi
Published: January 2021

Duodenal tumors with a sporadic adenoma-carcinoma sequence are extremely rare. For such clinically suspected cases without a specific family history, performing a comprehensive gene search is important to understand the germline mutation background. We present a 68-year-old woman without a genetic or familial history of familial adenomatous polyposis (FAP), Peutz-Jeghers syndrome, or Lynch syndrome who presented to Kosei Hospital, Japan, with exertional dyspnea induced by abdominal pain lasting 3 weeks. A duodenal tumor was suspected by contrast-enhanced computed tomography. Esophagogastroduodenoscopy showed a lesion accompanied by a white microprotuberance on the descending part of the duodenum opposite the papilla, with a giant ulcerative lesion at the center of the white lesion. Biopsy revealed a low-grade adenoma, high-grade adenoma, and adenocarcinoma. Immunohistochemical analysis of the adenoma and adenocarcinoma showed Ki-67, p53, cytokeratin 20, caudal-type homeobox 2, and carcinoembryonic antigen positivity and cytokeratin 7 negativity. The findings suggested the presence of an adenoma-adenocarcinoma sequence in duodenal carcinoma. However, in the mutational analysis using next-generation sequencing, c.4348C>T (p.Arg1450Ter) mutation in APC was detected in all normal mucosal, adenoma, and carcinoma tissues. This mutation is common in FAP patients. Even if the presence of an adenoma-adenocarcinoma sequence in duodenal carcinoma is suggested in cases without a familial FAP history, as in this case, genetic analysis may reveal FAP. Thus, performing a comprehensive genetic analysis of duodenal carcinoma patients with a possible adenoma-carcinoma sequence is necessary to explore their genetic background.
Alpha-Fetoprotein-Producing Gastric Cancer with Nonbiliary Pancreatitis
Authors: Yavuz Arda , Güleç Büşra , Girgin Rabia Burçin , Tuncer İlyas
Published: January 2021

Alpha-fetoprotein (AFP)-producing gastric cancer (AFPGC) is a rare, aggressive tumor. In the absence of metastasis in diagnosis, close observation and long-term follow-up is needed to monitor and slow its progress. We report a young patient who presented with nonbiliary pancreatitis. Upon finding Virchow’s nodule, we conducted tests and observed multiple lymph nodes and liver and pancreatic metastasis. We subsequently made a diagnosis of AFPGC. This study describes the different presentations of this rare but aggressive subtype of gastric cancer with a review of the literature.
Non-Resolving Sciatica Due to Sacroiliac Joint Osteophyte Compressing the Sciatic Nerve in a Young Patient: A Case Report and Literature Review
Authors: Aouad Dany K. , Rahi Rayane , Maalouly Joseph , Ayoubi Rami A. , Saade Jamal , Wehbe Joseph
Published: January 2021

Sciatica is a common syndrome mostly affecting adults. It has a wide range of etiologies, classified into intra- and extra-spinal, with intra-spinal being the most common, usually due to lumbar disc herniation causing nerve root compression. Sacroiliac (SI) joint pathologies are a known cause of extra-spinal sciatica syndrome, following multiple possible mechanisms. We report a case of a 33-year-old female patient who presented for non-resolving sciatica symptoms, found to have an inferior SI joint osteophyte compressing the sciatic nerve, who underwent surgical excision due to failure of conservative measures. All causes of sciatica related pain should be subjected to further investigations if not attributed clinically and radiologically to intra-spinal etiologies. SI joint imaging play an important role in the diagnosis of SI joint related sciatica, with the gold standard being an intra-articular anesthetic injection, to monitor for symptom relief in order to confirm the diagnosis, and choose the optimal treatment modality.
Patchy Alopecia in a Patient with Rheumatoid Arthritis: A Practical Application of Trichoscopy
Authors: Vafaeian Ahmad , Taghizadeh Elham , Daneshpazhooh Maryam , Mahmoudi Hamidreza
Published: January 2021

Trichoscopy is an efficient, convenient, and accurate diagnostic dermatological procedure which is widely used in the examination of patients with skin diseases. Herein, we report a 56-year-old woman with a long-term history of rheumatoid arthritis complaining of pruritic patchy alopecia on her scalp who was referred for biopsy to exclude cutaneous lupus erythematosus. Taking advantage of trichoscopy, we were able to quickly diagnose tinea capitis. Following administration of the proper treatment the disease resolved completely.
Should Newborns with Refractory Chylothorax Be Tried on Higher Dose of Octreotide?
Authors: Vass Geza , Evans Fry Ria , Roehr Charles C.
Published: January 2021

Chylothorax is a rare but life-threatening condition in newborns, often requiring a prolonged hospital stay. To date, no unified guidance exists for best management approach. Octreotide, a somatostatin analogue, has been used to treat neonatal chylothorax due to its effect on the splanchnic circulation and lipid absorption. It is administered either subcutaneously or intravenously; for the latter, a dose range between 1 and 10 µg/kg/h is most commonly used. However, the optimal dose and way of administration remain unclear. Here, we report 2 newborn cases with large volume chylothorax (>500 mL/day), one with congenital chylothorax and one following a repair of a congenital diaphragmatic hernia (post-operative form). In both cases, a significant and sustained reduction in the volume of evacuated chyle was only seen once the dose of intravenous octreotide was increased to 20 µg/kg/h. We suggest that high-dose octreotide can be considered in seemingly refractory cases of neonatal chylothorax.
Glyceryl Tristearate-Based Lipid Microparticles Loaded with the Tattoo Colorant, Acid Red 87: Colorant Retention Capacity in Excised Porcine Skin
Authors: Scalia Santo , Bertoni Serena , Dozzo Annachiara , Rimessi Alessandro , Pinton Paolo , Passerini Nadia , Albertini Beatrice
Published: January 2021

Background: With the increasing diffusion of tattooing, the photolability of tattoo inks has become a critical issue, as available data indicated that several tattoo colorants are unstable under sunlight, generating potentially toxic photodegradation products. Therefore, it is desirable to enhance the photostability of coloring agents contained in tattoo inks. Aims: Lipid microparticles (LMs) highly loaded with Acid Red 87 (C.I. 45380), a colorant used in tattoo inks, were evaluated for their effect on the colorant photoinstability. In addition, the capacity of the LMs to retain the incorporated C.I. 45380 colorant after their intradermal administration in excised porcine skin was investigated. Methods: LMs loaded with C.I. 45380 were prepared using glyceryl tristearate as the lipidic material and phosphatidylcholine as the surfactant. Non-encapsulated C.I. 45380 or the colorant-loaded LMs were irradiated with a solar simulator for photodecomposition studies or introduced in the excised porcine skin mounted in Franz diffusion cells for stability evaluation in the dermal tissue. Results and Conclusion: The colorant content of the microparticles was 17.7%, and their size ranged from 25 to 170 μm. The light-induced degradation of C.I. 45380 was significantly decreased by its incorporation in the LMs from 20.2 ± 5.8% to 1.9 ± 2.1%. Moreover, after intradermal injection of free or microencapsulated C.I. 45380 in the excised pig skin, the LMs reduced by 93.7% (from 24.6 to 1.5%) the quantity of the colorant diffused and hence lost in the Franz cell receptor fluid. Hence, the LM carrier efficiently retained the entrapped C.I. 45380 following incubation in the dermal region of the isolated porcine skin, which is in favor of a long-lasting tattoo. Based on these data, the incorporation of C.I. 45380 in the LMs could represent a potentially useful strategy to reduce the photodecomposition of the tattoo colorant and its harmful interactions with the skin tissue.
Metabolic Changes after Radioiodine Correction of Grade 1 and Grade 2 Subclinical Hyperthyroidism
Authors: Russo Lucia , Nguyen Thi Ngoc Huyen , Kyrilli Aglaia , Robin Martin , Bel Lassen Pierre , Moreno-Reyes Rodrigo , Corvilain Bernard
Published: January 2021

Objective: Endogenous subclinical hyperthyroidism (eSCH) is defined by subnormal serum thyroid-stimulating hormone (TSH) level. There is limited evidence of metabolic changes induced by eSCH. The aim of our work was to evaluate changes in BMI and lipid parameters after radioiodine treatment in patients with grade 1 (TSH: 0.1–0.39 mlU/L) and 2 (TSH <0.1 mlU/L) eSCH. Design: A retrospective study was performed on 74 patients with eSCH caused by benign autonomous nodular goiter which was treated with radioiodine. Methods: We assessed BMI, lipids parameters, and TSH after radioiodine therapy. The 12-month follow-up time point was used to compare the primary outcome variables. TSH was measured by the electrochemiluminescence method. Results: After radioiodine therapy, the absolute and relative increases in BMI at 12 months were significantly higher in the grade 2 group than in the grade 1 group (1.07 ± 0.27 kg/m2 vs. 0.26 ± 0.15 kg/m2, respectively; p = 0.023 and 4.01 ± 0.98% vs. 1.01 ± 0.56%, respectively; p = 0.026). Compared to baseline, significant increases in the levels of total cholesterol and LDL were observed after treatment in the grade 2 eSCH group (16.7 ± 4.5 mg/dL p < 0.01 and 14.3 ± 4.1 mg/dL p < 0.01, respectively) but not in the grade 1 group. In a multivariate model, a negative correlation was observed between pretreatment TSH levels and absolute BMI gain (p < 0.01). Conclusions: After correction of eSCH, increases in BMI and LDL levels were observed only in patients with grade 2 eSCH. Pretreatment serum TSH was the main independent factor associated with BMI changes after radioiodine treatment.
Co-Occurrence of Guillain-Barre Syndrome and Multiple Sclerosis: A Rare Case Report
Authors: Hassan Amr , El-Mazny Alaa , Saher Mohammed , Ibrahim Ismail Ismail , Almuqbil Mohammed
Published: January 2021

Guillain-Barre syndrome (GBS) and multiple sclerosis (MS) are autoimmune demyelinating disorders of the peripheral and central nervous systems, respectively. The co-occurrence of these 2 conditions is rare in the literature. Herein, we present a rare case of GBS and MS in a 19-year-old female who presented initially with GBS followed by MS, and we provide a literature review. Despite being rare, it should be kept in mind in the differential diagnosis of patients with atypical and usual presentation of both diseases.
Solving optimal reactive power problem by hurricane search optimization algorithm
Authors: Lenin Kanagasabai
Published: January 2021

In this paper Proposed Hurricane Search Optimization (HSO) algorithm is proposed to solve optimal reactive power problem. An upward motion of air is caused due to release of heat which creates a low-pressure zone and by the rotation of the earth that is set into spin. In this spiraling airflow when energy is high then hurricane is created. Projected Hurricane Search Optimization (HSO) algorithm design is based on the examination of the horizontal wind structure in a hurricane and how the wind parcels the progression in the neighboring atmosphere. A mixture of wind models has been developed for past few years to Backtesting and to compute hurricane exterior wind fields. Proposed Hurricane Search Optimization (HSO) algorithm has been tested in standard IEEE 30, 57bus test systems and simulation results show the projected algorithm reduced the real power loss considerably.
Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association
Authors: Levine Glenn N. , Cohen Beth E. , Commodore-Mensah Yvonne , Fleury Julie , Huffman Jeff C. , Khalid Umair , Labarthe Darwin R. , Lavretsky Helen , Michos Erin D. , Spatz Erica S. , Kubzansky Laura D. ,   On behalf of the American Heart Association Council on Clinical Cardiology; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; and Council on Lifestyle and Cardiometabolic Health
Published: January 2021

As clinicians delivering health care, we are very good at treating disease but often not as good at treating the person. The focus of our attention has been on the specific physical condition rather than the patient as a whole. Less attention has been given to psychological health and how that can contribute to physical health and disease. However, there is now an increasing appreciation of how psychological health can contribute not only in a negative way to cardiovascular disease (CVD) but also in a positive way to better cardiovascular health and reduced cardiovascular risk. This American Heart Association scientific statement was commissioned to evaluate, synthesize, and summarize for the health care community knowledge to date on the relationship between psychological health and cardiovascular health and disease and to suggest simple steps to screen for, and ultimately improve, the psychological health of patients with and at risk for CVD. Based on current study data, the following statements can be made: There are good data showing clear associations between psychological health and CVD and risk; there is increasing evidence that psychological health may be causally linked to biological processes and behaviors that contribute to and cause CVD; the preponderance of data suggest that interventions to improve psychological health can have a beneficial impact on cardiovascular health; simple screening measures can be used by health care providers for patients with or at risk for CVD to assess psychological health status; and consideration of psychological health is advisable in the evaluation and management of patients with or at risk for CVD.
Transient ACE (Angiotensin-Converting Enzyme) Inhibition Suppresses Future Fibrogenic Capacity and Heterogeneity of Cardiac Fibroblast Subpopulations
Authors: Garvin Alexandra M. , De Both Matthew D. , Talboom Joshua S. , Lindsey Merry L. , Huentelman Matthew J. , Hale Taben M.
Published: January 2021

Transient ACE (angiotensin-converting enzyme) inhibition in spontaneously hypertensive rats is known to protect against future injury-induced cardiac inflammation, fibrosis, and dysfunction; however, the mechanisms of protection have not been delineated. Here, we used single-cell RNA sequencing to test the hypothesis that transient ACE inhibitor treatment would induce a persistent shift in cardiac fibroblast subpopulations. Adult male spontaneously hypertensive rats (11 weeks old, hypertensive with cardiac hypertrophy) were treated for 2 weeks with an ACE inhibitor, enalapril (30 mg/kg per day, PO), or water (untreated spontaneously hypertensive rats) followed by a 2-week washout period (n=7/group). Cardiac fibroblasts were isolated from the left ventricle and subjected to single-cell RNA sequencing. Nine clusters of fibroblasts were identified, with 98% of cells in clusters 0 to 6. The transient treatment produced significant changes both within and across clusters. Cluster 1 depicted a highly fibrogenic gene profile, with cluster 6 serving as a gateway to cluster 1. Transient ACE inhibition depleted the gateway and expanded cluster 0, which was the least fibrogenic profile. Moreover, within cluster 1 fibroblasts, ACE inhibition reduced expression of individual fibrosis genes (eg,
COL1A1, COL3A1
, and
FN1
; all
P
<1×10
-35
). Clusters 2 to 5 reflected proliferative, moderately fibrogenic, translationally active, and less inflammatory subsets of fibroblasts, all of which exhibited attenuated fibrogenic gene expression after transient ACE inhibition. In conclusion, transient ACE inhibition shifts cardiac fibroblast subpopulations and degree of activation resulting in an overall reduced fibrogenic phenotype.
Sex-Related Differences in Clinical Features, Neuroimaging, and Long-Term Prognosis After Transient Ischemic Attack
Authors: Purroy Francisco , Vicente-Pascual Mikel , Arque Gloria , Baraldes-Rovira Mariona , Begue Robert , Gallego Yhovany , Gil M. Isabel , Gil-Villar M. Pilar , Mauri Gerard , Quilez Alejandro , Sanahuja Jordi , Vazquez-Justes Daniel
Published: January 2021

Background and Purpose:

Differences in sex in the incidence, presentation, and outcome of events after ischemic stroke have been studied in depth. In contrast, only limited data are available after transient ischemic attack (TIA). We aim to assess sex-related differences in the presentation, cause, neuroimaging features, and predictors of long-term prognosis in patients with TIA.

Methods:

We carried out a prospective cohort study of consecutive patients with TIA from January 2006 to June 2010. Nondefinitive TIA events were defined by the presence of isolated atypical symptoms. The risk of stroke recurrence (SR) and composite of major vascular events were stratified by sex after a median follow-up time of 6.5 (interquartile range, 5.0–9.6) years.

Results:

Among the 723 patients studied, 302 (41.8%) were female and 79 (10.9%) suffered a nondefinitive TIA event. Vascular territory diffusion-weighted imaging patterns (odds ratio, 1.61 [95% CI, 0.94–2.77]), and nondefinitive TIA events (odds ratio, 2.66 [95% CI, 1.55–4.59]) were associated with women, whereas active smoking (odds ratio, 0.30 [95% CI, 0.15–0.58]) and large artery atherosclerosis causes (odds ratio, 0.50 [95% CI, 0.29–0.83]) were related to men. The risk of SR was similar in both sexes (12.6% [95% CI, 8.9–16.3] for women versus 14.3% [95% CI, 11.0–17.6] for men). In contrast, the risk of major vascular events was significantly lower in women than in men (17.5% [95% CI, 13.2–21.8] versus 23.8% [95% CI, 19.7–27.9]). In both sexes, after adjusting for age, large artery atherosclerosis was associated with SR (hazard ratio, 3.22 [95% CI, 1.42–7.24] and hazard ratio, 2.00 [95% CI, 1.14–3.51]). In a Kaplan-Meier analysis, females with positive diffusion-weighted imaging (
P
=0.014) and definitive TIA (log-rank test
P
=0.022) had a significantly higher risk of SR.

Conclusions:

Despite similar risks of SR, there were sex-related differences in baseline characteristics, presenting symptoms, patterns of acute ischemic lesions, cause, and outcomes. These findings encourage further research into optimal preventive strategies that take into account these differences.
Stroke Incidence by Sex Across the Lifespan
Authors: Vyas Manav V. , Silver Frank L. , Austin Peter C. , Yu Amy Y.X. , Pequeno Priscila , Fang Jiming , Laupacis Andreas , Kapral Moira K.
Published: January 2021

Background and Purpose:

We evaluated the influence of age on the association between sex and the incidence of stroke or transient ischemic attack (TIA) using a population-based cohort from Ontario, Canada.

Methods:

We followed a cohort of adults (≥18 years) without prior stroke from January 1, 2003 (cohort start date) to March 31, 2018, to identify incident events. We calculated hazard ratios (HRs), in women compared to men, of incident stroke or TIA, adjusted for demographics and comorbidities, overall and stratified by stroke type. We calculated piecewise adjusted HRs for each decade of age to evaluate the effect of age on sex differences in stroke incidence.

Results:

We followed 9.2 million adults for a median of 15 years and observed 280,197 incident stroke or TIA events. Compared with men, women had an overall lower adjusted hazard of stroke or TIA (HR, 0.82 [95% CI, 0.82–0.83]), with similar findings across all stroke types except for subarachnoid hemorrhage (HR, 1.29 [95% CI, 1.24–1.33]). We found a U-shaped association between age and sex differences in the incidence of stroke or TIA: compared with men, the hazard of stroke was higher in women among those aged ≤30 years (HR, 1.26 [95% CI, 1.10–1.45]), lower among those between ages 40 and 80 years (eg, age 50–59, HR, 0.69 [95% CI, 0.68–0.70]), and similar among those aged ≥80 years (HR, 0.99 [95% CI, 0.98–1.01]).

Conclusions:

Overall, women have a lower hazard of stroke than men, but this association varies by age and across stroke types. Recognition of age-sex variations in stroke incidence can help guide prevention efforts to reduce stroke incidence in both men and women.
Under-Enrollment of Women in Stroke Clinical Trials
Authors: Carcel Cheryl , Reeves Mathew
Published: January 2021

The under-representation of women in clinical trials is a commonly recognized and seemingly intractable problem in many different areas of clinical medicine. Discrepancies in the enrollment of women in clinical trials raises concerns about the generalizability of trial evidence, as well as the potential for reduced access and utilization of new therapies in women. Recent studies confirm that the problem of under-enrollment of women continues to exist in stroke clinical trials, even after accounting for the sex ratio of stroke cases in the underlying population. The origins of these disparities are complex, and there remains a relative dearth of stroke studies that have examined the causes in detail. Although caution should be used when generalizing research findings from studies conducted in other medical conditions including cardiology trials, factors that contribute to lower enrollment in women include the use of specific trial eligibility criteria (eg, older age, presence of specific comorbidities), patient attitudes and beliefs (resulting in less interest and more refusals in women), and potentially implicit biases among study personnel. Beyond a general call to prioritize stroke research in this area, we also recommend the greater use of trial screening logs, the use of qualitative studies to understand patient attitudes and beliefs towards stroke research, avoiding the use of age-based exclusion criteria (eg, >80 years), and increasing the number of women who lead stroke clinical trials.
Conventional Counterforce Dilemmas: South Korea's Deterrence Strategy and Stability on the Korean Peninsula
Authors: Bowers Ian , Hiim Henrik Stålhane
Published: January 2021

In response to North Korea's nuclear weapons program, South Korea is quietly pursuing an independent conventional counterforce and countervalue strategy. This strategy is unique. Few, if any, nonnuclear states have sought to rely on advanced conventional capabilities to deter a nuclear-armed adversary. Why is South Korea pursuing a conventional counterforce and countervalue strategy, and what could its impact be on strategic stability on the Korean Peninsula? South Korea's approach should be understood as both a short- and long-term hedge against U.S. abandonment. Its deterrent effect, no matter how uncertain, acts as a short-term stopgap if the United States abandons South Korea. Over the long term, capabilities such as advanced ballistic and cruise missiles bolster South Korea's nuclear latency. At the same time, we highlight that the strategy poses numerous technological and operational difficulties and has negative implications for arms race and crisis stability. Given South Korea's approach and North Korea's response, disarmament efforts focused purely on the bilateral U.S.–North Korea relationship will not succeed. Rather, any agreement will now need to address the growing gap in the conventional balance of forces on the Korean Peninsula.
PRC Assertiveness in the South China Sea: Measuring Continuity and Change, 1970–2015
Authors: Chubb Andrew
Published: January 2021

Why has the People's Republic of China (PRC) courted international opprobrium, alarmed its neighbors, and risked military conflict in pursuit of its claims over vast areas of the South China Sea? Answering this question depends on recognizing long-term patterns of continuity and change in the PRC's policy. A new typology of “assertive” state behaviors in maritime and territorial disputes, and original time-series events data covering the period from 1970 to 2015, shows that the key policy change—China's rapid administrative buildup and introduction of regular coercive behaviors—occurred in 2007, between two and five years earlier than most analysis has supposed. This finding disconfirms three common explanations for Beijing's assertive turn in maritime Asia: the Global Financial Crisis, domestic legitimacy issues, and the ascendancy of Xi Jinping. Focused qualitative case studies of four breakpoints identified in the data indicate that PRC policy shifts in 1973, 1987, and 1992 were largely opportunistic responses to favorable geopolitical circumstances. In contrast, the policy change observed from 2007 was a lagged effect of decisions taken in the 1990s to build specific capabilities designed to realize strategic objectives that emerged in the 1970s.
1. Reading Pride and Prejudice over Fifty Years
Authors: Bartlett Nora
Published: January 2021

This chapter examines some of the techniques Jane Austen uses to enable readers to identify with, as well as feel through and alongside, her characters (particularly Pride and Prejudice’s Elizabeth Bennet). Bartlett explores the way in which one's reading changes at different stages of life; the roles of silence and listening in Austen's novels; and whether the novel is seen as presupposing, or addressing, a female reader. There is a look at characterizing Austen's narrative voice/voices; her use of dialogue and grammar; and the influence of Fanny Burney's Evelina. Finally, Bartlett discusses Austen as a "physical" novelist; Elizabeth Bennet's (and her father's) humour; and the distancing of the reader from Mrs. Bennet.
6. In Sickness and in Health: Courting and Nursing in Some Jane Austen Novels
Authors: Bartlett Nora
Published: January 2021

This chapter examines the narrative role of illness (both real and imagined) in Jane Austen's novels, including a quick run-through of the events in the novels that might be thought to call for medical intervention. Austen’s family history is discussed (including her writing history), as well as her own fatal illness and the relationship she had with her mother. Bartlett explores late eighteenth-century medical care in England, and the larger role that family played in this care. There is a detailed discussion of four of the six novels (Sense and Sensibility, Pride and Prejudice, Persuasion, Emma). The interactions of characters (including romantic interests) with the sick are explored, as well as the nursing of the ill, and the symbolic imports of “nursing” itself. Bartlett further explores Austen’s underlying interests in presenting illness in her novels: Austen is not interested in a set of symptoms, but in a situation, in the emotional and physical tenderness between people who share an experience. In turn, Bartlett illuminates Austen’s interest in illness as a device to reveal one’s real nature: in illness one cannot hide it, and perhaps the care of the sick is as revealing as illness itself? An "illness" unique to the eighteenth century is discussed—“nerves”—particularly as it applied to Pride and Prejudice. Finally, Bartlett comments on Jane Austen as a novelist; her portrayal of some illnesses being more equal than others; and similarities between these two groups: the sick and the well, on the one hand; and men and women in love, on the other.
11. Jane Austen and Grandparents
Authors: Bartlett Nora
Published: January 2021

This chapter examines the degree to which the grandparent-grandchild relationship is explored in Austen's mature novels. Regarding the experience of being a grandparent, Bartlett considers its rarity: in a time of high infant mortality, late marriage, and early death. There is a look at the Austen family history of marriage, remarriage, children, and the extensive grandparental experience described in the Memoir. Bartlett explores the experience of the grandparent and the treatment of grandchildren, in terms of their use in Austen's novels. Sense and Sensibility, Emma, and Persuasion are examined for their hard look at grandparents and grandchildren. Bartlett discusses dynastic drive; high-intensity scenes in Persuasion; and the depiction of grandparents that reflects Jane Austen’s own experience. Lastly, there is a comment on the connection between grandparenting and character in Persuasion.
13. Sanditon and Suspense
Authors: Bartlett Nora
Published: January 2021

This chapter explores Jane Austen's unfinished Sanditon and its characters, particularly Mr. Parker and Diana. Sanditon is compared to Northanger Abbey and Persuasion. Bartlett examines the closing chapter that was dropped from Persuasion; how it differs from the two chapters that replaced it; and a characteristic shared by that cancelled chapter and Sanditon. There is a discussion of Sanditon's problems and positive qualities. Bartlett discusses Sanditon and contrasts it with Austen's other villages. Next, the author examines Austen's "steady and sensible" viewpoint; her interest in wild imaginations; and invalidism in Sanditon. Bartlett discusses how nursing moves the plot in Austen’s novels; a peculiarity in Sanditon regarding nursing; and suspense (including use of delay; concealment; wit and feeling; and pace) in Austen's novels, particularly Sanditon.
GECO: gene expression clustering optimization app for non-linear data visualization of patterns
Authors: Habowski A. N. , Habowski T. J. , Waterman M. L.
Published: January 2021

Background

Due to continued advances in sequencing technology, the limitation in understanding biological systems through an “-omics” lens is no longer the generation of data, but the ability to analyze it. Importantly, much of this rich -omics data is publicly available waiting to be further investigated. Although many code-based pipelines exist, there is a lack of user-friendly and accessible applications that enable rapid analysis or visualization of data.

Results

GECO (Gene Expression Clustering Optimization; http://www.theGECOapp.com) is a minimalistic GUI app that utilizes non-linear reduction techniques to rapidly visualize expression trends in many types of biological data matrices (such as bulk RNA-seq or proteomics). The required input is a data matrix with samples and any type of expression level of genes/protein/other with a unique ID. The output is an interactive t-SNE or UMAP analysis that clusters genes (or proteins/other unique IDs) based on their expression patterns across the multiple samples enabling visualization of expression trends. Customizable settings for dimensionality reduction, data normalization, along with visualization parameters including coloring and filters, ensure adaptability to a variety of user uploaded data.

Conclusion

This local and cloud-hosted web browser app enables investigation of any -omic data matrix in a rapid and code-independent manner. With the continued growth of available -omic data, the ability to quickly evaluate a dataset, including specific genes of interest, is more important than ever. GECO is intended to supplement traditional statistical analysis methods and is particularly useful when visualizing clusters of genes with similar trajectories across many samples (ex: multiple cell types, time course, dose response). Users will be empowered to investigate -omic data with a new lens of visualization and analysis that has the potential to uncover genes of interest, cohorts of co-regulated genes programs, and previously undetected patterns of expression.
Environmental and genetic regulation of plant height in soybean
Authors: Yang Qing , Lin Gaoming , Lv Huiyong , Wang Cunhu , Yang Yongqing , Liao Hong
Published: January 2021

Background

Shoot architecture is fundamentally crucial to crop growth and productivity. As a key component of shoot architecture, plant height is known to be controlled by both genetic and environmental factors, though specific details remain scarce.

Results

In this study, 308 representative soybean lines from a core collection and 168 F9 soybean progeny were planted at distinct field sites. The results demonstrated the presence of significant genotype × environment interaction (G × E) effects on traits associated with plant height in a natural soybean population. In total, 19 loci containing 51 QTLs (quantitative trait locus) for plant height were identified across four environments, with 23, 13 and 15 being QTLs for SH (shoot height), SNN (stem node number) and AIL (average internode length), respectively. Significant LOD ranging from 2.50 to 16.46 explained 2.80–26.10% of phenotypic variation. Intriguingly, only two loci, Loc11 and Loc19–1, containing 20 QTLs, were simultaneously detected across all environments. Results from Pearson correlation analysis and PCA (principal component analysis) revealed that each of the five agro-meteorological factors and four soil properties significantly affected soybean plant height traits, and that the corresponding QTLs had additive effects. Among significant environmental factors, AD (average day-length), AMaT (average maximum temperature), pH, and AN (available nitrogen) had the largest impacts on soybean plant height. Therefore, in spite of uncontrollable agro-meteorological factors, soybean shoot architecture might be remolded through combined efforts to produce superior soybean genetic materials while also optimizing soil properties.

Conclusions

Overall, the comprehensive set of relationships outlined herein among environment factors, soybean genotypes and QTLs in effects on plant height opens new avenues to explore in work aiming to increase soybean yield through improvements in shoot architecture.
The evaluation of maximum condyle-tragus distance can predict difficult airway management without exposing upper respiratory tract; a prospective observational study
Authors: Wu Hao , Hu Dandan , Chen Xu , Zhang Xuebing , Xia Min , Chai Xiaoqing , Wang Sheng , Zhang Wei
Published: January 2021

Background

Routine preoperative methods to assess airway such as the interincisor distance (IID), Mallampati classification, and upper lip bite test (ULBT) have a certain risk of upper respiratory tract exposure and virus spread. Condyle-tragus maximal distance(C-TMD) can be used to assess the airway, and does not require the patient to expose the upper respiratory tract, but its value in predicting difficult laryngoscopy compared to other indicators (Mallampati classification, IID, and ULBT) remains unknown. The purpose of this study was to observe the value of C-TMD to predict difficult laryngoscopy and the influence on intubation time and intubation attempts, and provide a new idea for preoperative airway assessment during epidemic.

Methods

Adult patients undergoing general anesthesia and tracheal intubation were enrolled. IID, Mallampati classification, ULBT, and C-TMD of each patient were evaluated before the initiation of anesthesia. The primary outcome was intubation time. The secondary outcomes were difficult laryngoscopy defined as the Cormack-Lehane Level > grade 2 and the number of intubation attempts.

Results

Three hundred four patients were successfully enrolled and completed the study, 39 patients were identified as difficult laryngoscopy. The intubation time was shorter with the C-TMD>1 finger group 46.8 ± 7.3 s, compared with the C-TMD<1 finger group 50.8 ± 8.6 s (p<0.01). First attempt success rate was higher in the C-TMD>1 finger group 98.9% than in the C-TMD<1 finger group 87.1% (P<0.01). The correlation between the C-TMD and Cormack-Lehane Level was 0.317 (Spearman correlation coefficient,P<0.001), and the area under the ROC curve was 0.699 (P<0.01). The C-TMD < 1 finger width was the most consistent with difficult laryngoscopy (κ = 0.485;95%CI:0.286–0.612) and its OR value was 10.09 (95%CI: 4.19–24.28), sensitivity was 0.469 (95%CI: 0.325–0.617), specificity was 0.929 (95%CI: 0.877–0.964), positive predictive value was 0.676 (95%CI: 0.484–0.745), negative predictive value was 0.847 (95%CI: 0.825–0.865).

Conclusion

Compared with the IID, Mallampati classification and ULBT, C-TMD has higher value in predicting difficult laryngoscopy and does not require the exposure of upper respiratory tract.

Trial registration

The study was registered on October 21, 2019 in the Chinese Clinical Trial Registry (ChiCTR1900026775).