bluuebunny/crossref_metadata_2025 huggingface dataset:
Recommended antimicrobial therapy for common inpatient infections: a comparative review of guidelines across 51 hospital trusts in England
Authors: Pan Daniel , Hills George , Hamilton Ashley Ryan , Nash Tamsin , Hine Thomas , Whitehorn Sarah , Barlow Gavin
Published: October 2020

Background

The number of different antimicrobial recommendations between hospital trusts for the same indication in England is unknown.

Aim

We aimed to evaluate the heterogeneity of antimicrobial recommendations for seven common inpatient infections across hospital trusts in England and evaluate changes to recommendations following introduction of national (National Institute for Healthcare and Excellence, NICE) and international (WHO) antimicrobial guidelines.

Methods

Guidelines published on the MicroGuide smartphone application were collected from December 2017 to February 2018 and re-evaluated between December 2019 and February 2020. The following indications were assessed: community-acquired pneumonia (CAP) CURB65 score ≥3, hospital-acquired pneumonia (HAP), infective exacerbation of chronic obstructive pulmonary disease (iCOPD), cellulitis, uncomplicated urinary tract infection (uUTI), intra-abdominal infection (IAI) and sepsis of unknown source (SUS). On follow-up, compliance against WHO WATCH antibiotic and NICE recommendations was evaluated.

Results

Guidelines were obtained predominantly from England. Antibiotic regimens between hospitals became increasingly diverse across indications in the following order: uUTI, cellulitis, iCOPD, CAP, HAP, IAI and SUS. A piperacillin/tazobactam-based regimen was recommended in HAP (59%), SUS (39%) and IAI (30%). After 2 years, 107 changes were made to 357 antibiotic regimen recommendations; the overall number of regimens using piperacillin–tazobactam and WHO WATCH antibiotics remained similar. Compliance of recommendations with NICE guidelines as follows: iCOPD (100% adherent), uUTI (98%), cellulitis (90%), CAP (43%) and HAP (27%).

Conclusion

The heterogeneity of antibiotic recommendations increased as the indicated infection was more severe, with broader underlying bacterial causes. Piperacillin–tazobactam remains favoured in antibiotic regimens, despite not recommended in WHO and NICE guidance.
Foliar nano-fertilization enhances fruit growth, maturity, and biochemical responses of date palm
Authors: Shareef Hussein J. , Al-Yahyai Rashid A. , Omar Alaa El-Din K. , Barus Wan Arfiani
Published: October 2020

The experiment was conducted in the Abi Al-Khaseeb orchard, Basrah, Iraq, during the 2019 season, on date palm (‘Hillawi’). The effect of foliar nano-fertilizer on the response of the growth and fruit ripening rate was positive. Adding nano-fertilizer to the annual date palm fertilization program improved growth and increased production. A comparison was done of foliar-applied NPK (traditional; 1 and 2 g·L−1), nano-fertilizer, and a combined treatment. The results revealed that the treatment of traditional foliar fertilizer and nano-fertilizer together increased the weight of fruit and bunches, water content, indoleacetic acid, and gibberellic acid relative to other treatments. Nano-fertilizers (1 g·L−1) led to an increase in fruit ripening rate, dry mass, total soluble solids, activity of the enzymes peroxidase and superoxide dismutase, and abscisic acid content. The leaflet protein expression shows that the appearance of protein bands 1 to 5 and 6 was upregulated by the control and traditional fertilizer, whereas the protein bands 6 and 7 were downregulated under nano-fertilizer. Hierarchical cluster analysis of proteins in the leaf in response to traditional fertilizer and nano-fertilizer showed two distinct clusters. The use of nano-fertilizer alone leads to the acceleration of fruit ripening, while the fruit production is increased using foliar nano-fertilizer with traditional fertilizer.
Fast-GBS v2.0: an analysis toolkit for genotyping-by-sequencing data
Authors: Torkamaneh Davoud , Laroche Jérôme , Belzile François
Published: October 2020

Genotyping-by-sequencing (GBS) is a rapid, flexible, low-cost, and robust genotyping method that simultaneously discovers variants and calls genotypes within a broad range of samples. These characteristics make GBS an excellent tool for many applications and research questions from conservation biology to functional genomics in both model and non-model species. Continued improvement of GBS relies on a more comprehensive understanding of data analysis, development of fast and efficient bioinformatics pipelines, accurate missing data imputation, and active post-release support. Here, we present the second generation of Fast-GBS (v2.0) that offers several new options (e.g., processing paired-end reads and imputation of missing data) and features (e.g., summary statistics of genotypes) to improve the GBS data analysis process. The performance assessment analysis showed that Fast-GBS v2.0 outperformed other available analytical pipelines, such as GBS-SNP-CROP and Gb-eaSy. Fast-GBS v2.0 provides an analysis platform that can be run with different types of sequencing data, modest computational resources, and allows for missing-data imputation for various species in different contexts.
VARIATIONAL PRINCIPLES FOR FRACTAL WHITHAM–BROER–KAUP EQUATIONS IN SHALLOW WATER
Authors: WANG KANG-JIA , WANG KANG-LE
Published: October 2020

In this paper, we mainly consider the Whitham–Broer–Kaup equations with unsmooth boundaries, and a new fractal derivative is adopted to construct the fractal model. The variational principles of the fractal Whitham–Broer–Kaup equations are successfully constructed by fractal Semi-inverse method, which is helpful to study the symmetry, discover the conserved quantity, and has a wide application prospect in numerical simulation. The results are discussed by the two-scale transform method. The approximate analytical solutions of the fractal Whitham–Broer–Kaup equations are obtained according to the variational iteration method and two-scale transform method.
Challenges and Opportunities in Implementing Pharmacogenetic Testing in Clinical Settings
Authors: Chang Wan-Chun , Tanoshima Reo , Ross Colin J.D. , Carleton Bruce C.
Published: October 2020

The clinical implementation of pharmacogenetic biomarkers continues to grow as new genetic variants associated with drug outcomes are discovered and validated. The number of drug labels that contain pharmacogenetic information also continues to expand. Published, peer-reviewed clinical practice guidelines have also been developed to support the implementation of pharmacogenetic tests. Incorporating pharmacogenetic information into health care benefits patients as well as clinicians by improving drug safety and reducing empiricism in drug selection. Barriers to the implementation of pharmacogenetic testing remain. This review explores current pharmacogenetic implementation initiatives with a focus on the challenges of pharmacogenetic implementation and potential opportunities to overcome these challenges.
Practicing Retrieval Facilitates Learning
Authors: McDermott Kathleen B.
Published: October 2020

How do we go about learning new information? This article reviews the importance of practicing retrieval of newly experienced information if one wants to be able to retrieve it again in the future. Specifically, practicing retrieval shortly after learning can slow the forgetting process. This benefit can be seen across various material types, and it seems prevalent in all ages and learner abilities and on all types of test. It can also be used to enhance student learning in a classroom setting. I review theoretical understanding of this phenomenon (sometimes referred to as the testing effect or as retrieval-based learning) and consider directions for future research.
A New Approach to Probe the Degradation of Fuel Cell Catalysts under Realistic Conditions: Combining Tests in a Gas Diffusion Electrode Setup with Small Angle X-ray Scattering
Authors: Schröder Johanna , Quinson Jonathan , Mathiesen Jette K. , Kirkensgaard Jacob J. K. , Alinejad Shima , Mints Vladislav A. , Jensen Kirsten M. ∅. , Arenz Matthias
Published: October 2020

A new approach for efficiently investigating the degradation of fuel cell catalysts under realistic conditions is presented combining accelerated stress tests (ASTs) in a gas diffusion electrode (GDE) setup with small angle X-ray scattering (SAXS). GDE setups were recently introduced as a novel testing tool combining the advantages of classical electrochemical cells with a three-electrode setup and membrane electrode assemblies (MEAs). SAXS characterization of the catalyst layer enables an evaluation of the particle size distribution of the catalyst and its changes upon applying an AST. The straight-forward approach not only enables stability testing of fuel cell catalysts in a comparative and reproducible manner, it also allows mechanistic insights into the degradation mechanism. Typical metal loadings for proton exchange membrane fuel cells (PEMFCs), i.e. 0.2 mgPt cm−2
geo, are applied in the GDE and the degradation of the overall (whole) catalyst layer is probed. For the first time, realistic degradation tests can be performed comparing a set of catalysts with several repeats within reasonable time. It is demonstrated that independent of the initial particle size in the pristine catalyst, for ASTs simulating load cycle conditions in a PEMFC, all catalysts degrade to a similar particle size distribution.
Flexible MIMO Radar Antenna Selection for Vehicle Positioning in IIOT Based on CNN
Authors: Xiong Yang , Wang Ke
Published: October 2020

Unmanned vehicles are widely used in industrial scenarios; their positioning information is vital for emerging the industrial internet of thing (IIOT); thus, it has aroused considerable interest. Cooperative vehicle positioning using multiple-input multiple-output (MIMO) radars is one of the most promising techniques, the core of which is to measure the direction-of-arrival (DOA) of the vehicle from various viewpoints. Owing to power limitations, the MIMO radar may be unable to utilize all the antenna elements to transmit/receive (Tx/Rx) signal. Consequently, it is necessary to deploy a full array and select an optimal Tx/Rx solution. Owing to the industrial big data (IBD), it is possible to obtain a massive labeled dataset offline, which contains all possible DOAs and the array measurement. To pursuit fast and reliable Tx/Rx selection, a convolutional neural network (CNN) framework is proposed in this paper, in which the antenna selection is formulated as a multiclass-classification problem. Herein, we assume the DOA of the vehicle has been known as a prior, and the optimization criterion is to minimize the Crame´r–Rao based on DOA estimation when we use the selected Tx/Rx subarrays. The proposed framework is flexible and energy friendly. Simulation results verify the effectiveness of the proposed framework.
The Beneficial Effect of Traditional Chinese Exercises on the Management of Obesity
Authors: Qin Yuan , Xia Weiyi , Huang Wei , Zhang Jing , Zhao Yi , Fang Min
Published: October 2020

This paper systematically reviewed the clinical update of traditional Chinese exercises in the treatment of simple obesity in recent years and discussed their specific advantages in this aspect. This review focused on several typical traditional Chinese exercises, namely, Tai Chi, Ba Duan Jin, Yi Jin Jing, Wu Qin Xi, Shaolin Neigong, and Liu Zi Jue, which all showed clinical beneficial effect on the treatment of simple obesity with their own characteristics. To optimize the clinical therapeutic effect of these traditional Chinese exercises, we need to seek the most appropriate exercise or the combo exercise based on the characteristics of different obese population, to improve the efficiency of weight loss, reduce sports injury, and consolidate the therapeutic effect. In the future, we need to further evaluate the efficacy of sitting exercise, lying exercise, and static training in the treatment of simple obesity, subdivide the treatment population, and explore the working mechanism of these traditional Chinese exercises.
Multimodal Semisupervised Deep Graph Learning for Automatic Precipitation Nowcasting
Authors: Miao Kaichao , Wang Wei , Hu Rui , Zhang Lei , Zhang Yali , Wang Xiang , Nian Fudong
Published: October 2020

Precipitation nowcasting plays a key role in land security and emergency management of natural calamities. A majority of existing deep learning-based techniques realize precipitation nowcasting by learning a deep nonlinear function from a single information source, e.g., weather radar. In this study, we propose a novel multimodal semisupervised deep graph learning framework for precipitation nowcasting. Unlike existing studies, different modalities of observation data (including both meteorological and nonmeteorological data) are modeled jointly, thereby benefiting each other. All information is converted into image structures, next, precipitation nowcasting is deemed as a computer vision task to be optimized. To handle areas with unavailable precipitation, we convert all observation information into a graph structure and introduce a semisupervised graph convolutional network with a sequence connect architecture to learn the features of all local areas. With the learned features, precipitation is predicted through a multilayer fully connected regression network. Experiments on real datasets confirm the effectiveness of the proposed method.
Investigating Potential Inhibitory Effect of Uncaria tomentosa (Cat’s Claw) against the Main Protease 3CLpro of SARS‐CoV‐2 by Molecular Modeling
Authors: Yepes-Pérez Andres F. , Herrera-Calderon Oscar , Sánchez-Aparicio José-Emilio , Tiessler-Sala Laura , Maréchal Jean-Didier , Cardona-G Wilson
Published: October 2020

COVID‐19 is a disease caused by severe acute respiratory syndrome coronavirus 2. Presently, there is no effective treatment for COVID‐19. As part of the worldwide efforts to find efficient therapies and preventions, it has been reported the crystalline structure of the SARS‐CoV‐2 main protease Mpro (also called 3CLpro) bound to a synthetic inhibitor, which represents a major druggable target. The druggability of Mpro could be used for discovering drugs to treat COVID‐19. A multilevel computational study was carried out to evaluate the potential antiviral properties of the components of the medicinal herb Uncaria tomentosa (Cat’s claw), focusing on the inhibition of Mpro. The in silico approach starts with protein‐ligand docking of 26 Cat’s claw key components, followed by ligand pathway calculations, molecular dynamics simulations, and MM‐GBSA calculation of the free energy of binding for the best docked candidates. The structural bioinformatics approaches led to identification of three bioactive compounds of Uncaria tomentosa (speciophylline, cadambine, and proanthocyanidin B2) with potential therapeutic effects by strong interaction with 3CLpro. Additionally, in silico drug‐likeness indices for these components were calculated and showed good predicted therapeutic profiles of these phytochemicals. Our findings suggest the potential effectiveness of Cat’s claw as complementary and/or alternative medicine for COVID‐19 treatment.
Real‐Time Forecast of Influenza Outbreak Using Dynamic Network Marker Based on Minimum Spanning Tree
Authors: Yang Kun , Xie Jialiu , Xie Rong , Pan Yucong , Liu Rui , Chen Pei
Published: October 2020

The influenza pandemic is a wide‐ranging threat to people’s health and property all over the world. Developing effective strategies for predicting the influenza outbreak which may prevent or at least get ready for a new influenza pandemic is now a top global public health priority. Owing to the complexity of influenza outbreaks that are usually involved with spatial and temporal characteristics of both biological and social systems, however, it is a challenging task to achieve the real‐time monitoring of influenza outbreaks. In this study, by exploring the rich dynamical information of the city network during influenza outbreaks, we developed a computational method, the minimum‐spanning‐tree‐based dynamical network marker (MST‐DNM), to identify the tipping point or critical stage prior to the influenza outbreak. With historical records of influenza outpatients between 2009 and 2018, the MST‐DNM strategy has been validated by accurate predictions of the influenza outbreaks in three Japanese cities/regions, respectively, i.e., Tokyo, Osaka, and Hokkaido. These successful applications show that the early‐warning signal was detected 4 weeks on average ahead of each influenza outbreak. The results show that our method is of considerable potential in the practice of public health surveillance.
CEO Media Exposure and Green Technological Innovation Decision: Evidence from Chinese Polluting Firms
Authors: Wang Chen , Hu Yuanlin , Zhang Jianhua , Miao Chenglin
Published: October 2020

The upper echelons theory is utilized to establish how CEO’s attributes affect firm’s technological innovation decisions. The extant literature has largely ignored the impacts of CEO media exposure. An unbalanced panel data analysis is used to examine the effects of CEO media exposure on Chinese polluting firm’s green technological innovation. It is illustrated that CEO media exposure generally enhances Chinese polluting firms’ green technological innovation decisions. In addition, we find that firms with state ownership and environmental regulations all moderate positively the relationship between CEO media exposure and green technological innovation. The research suggests that CEO media exposure appears to be a stimulus to firm’s green technological innovation decisions.
Modeling of a Tethered Testbed for a VTVL Vehicle
Authors: Sagliano Marco , Theil Stephan , Schramm Johanna , Schwarzwald Matthias
Published: October 2020

This paper proposes an algorithm for modeling a three-dimensional tethered environment for testing vertical-take off, vertical landing vehicles. The method is able to take several geometrical configurations into account and combines the classical catenary model with the elasticity theory to predict the forces acting on the lander in quasistatic conditions, i.e., in conditions of hovering, where the motion of the vehicle is reduced. Numerical results confirm that the method is potentially able to provide real-time solutions, which can be included as feedforward contributions in the design of tethered experiments.
Acute Spontaneous Perforation of Rectosigmoid Junction in a Patient with Quadriplegia following Spinal Cord Injury
Authors: Basnayake Oshan , Rathnaweera Chiran , Jayarajah Umesh , Shanthamoorthy Gishanthan , Siriwardena Heshan Dayantha , Jayathilaka Asela
Published: October 2020

Background. Patients with cervical spinal injury with quadriplegia are at an increased risk of developing serious gastrointestinal complications. We report an unusual case of spontaneous rectosigmoid perforation in a quadriplegic patient. Case Presentation. A 58-year-old man with diabetes mellitus and hypertension presented to the emergency department following a fall from 25 feet of height. He sustained a fifth cervical vertebral fracture with quadriplegia and neurogenic shock. One week later, he developed progressive abdominal distension with tachycardia, low blood pressure, and respiratory distress. His abdomen was soft but had impaired liver dullness. Imaging showed evidence of visceral perforation. He underwent an emergency laparotomy and was found to have a perforation of the antemesenteric border of the rectosigmoid junction with fecal contamination. The perforation was repaired primarily, and a temporary loop ileostomy was created. The patient received intensive care for 4 days, and thereafter, the recovery was uneventful. He was later transferred to the spinal unit for further management. The intraoperative findings, histology, and subsequent colonoscopy did not reveal any underlying cause for the perforation. Conclusions. Clinical signs and symptoms are generally absent in patients following spinal cord injury, and the diagnosis of serious gastrointestinal pathology can be difficult and challenging. We believe that ischemia at the rectosigmoid junction precipitated by multiple factors was the possible reason for the spontaneous perforation.
Interactive Verification Analysis of Multiple Sequencing Data for Identifying Potential Biomarker of Lung Adenocarcinoma
Authors: Fei Hongjun , Chen Songchang , Xu Chenming
Published: October 2020

Background. Lung adenocarcinoma (LUAD) comprises around 40% of all lung cancers, and in about 70% of patients, it has spread locally or systemically when first detected leading to a worse prognosis. Methods. We filtered out differentially expressed genes (DEGs) based on the RNA sequencing data in the Gene Expression Omnibus database and verified and deeply analyzed screened DEGs using a combined bioinformatics approach. Results. Expressions of 11,143 genes in 694 nontumor lung tissues and LUAD cases from 8 independent laboratories were analyzed; 188 mRNAs were identified as differentially expressed genes (DEGs). A PPI network constructed with 188 DEGs screened out 8 hub DEGs (CDH5, PECAM1, VWF, CLDN5, COL1A1, MMP9, SPP1, and IL6) which highly interconnected with other nodes. The expression levels of 8 hub genes in LUAD and control were assessed in the Oncomine database, and the results were consistent. The survival curves of 8 hub genes showed that their expressions are significantly related to the prognosis of lung cancer and LUAD patients except for IL6. Since the expression of IL6 is nonspecific and highly sensitive, we choose the other 7 hub genes we had verified to do the next analysis. Mutual exclusivity or cooccurrence analysis of 7 hub genes identified a tendency towards cooccurrence between CDH5, PECAM1, and VWF in LUAD. The coexpression profiles of CDH5 in LUAD were identified, and we found that PECAM1 and VWF coexpressed with CDH5. Immunohistochemistry and RT‐PCR analysis showed that higher levels of CDH5, PECAM1, and VWF were expressed in normal lung tissues but a low or undetectable level was found in LUAD tissues. Conclusions. Taken together, we speculate that CDH5, PECAM1, and VWF played an important role in LUAD.
Neighborhood-Level Redlining and Lending Bias Are Associated with Breast Cancer Mortality in a Large and Diverse Metropolitan Area
Authors: Collin Lindsay J. , Gaglioti Anne H. , Beyer Kristen M. , Zhou Yuhong , Moore Miranda A. , Nash Rebecca , Switchenko Jeffrey M. , Miller-Kleinhenz Jasmine M. , Ward Kevin C. , McCullough Lauren E.
Published: October 2020

Background:

Structural inequities have important implications for the health of marginalized groups. Neighborhood-level redlining and lending bias represent state-sponsored systems of segregation, potential drivers of adverse health outcomes. We sought to estimate the effect of redlining and lending bias on breast cancer mortality and explore differences by race.

Methods:

Using Georgia Cancer Registry data, we included 4,943 non-Hispanic White (NHW) and 3,580 non-Hispanic Black (NHB) women with a first primary invasive breast cancer diagnosis in metro-Atlanta (2010–2014). Redlining and lending bias were derived for census tracts using the Home Mortgage Disclosure Act database. We calculated hazard ratios and 95% confidence intervals (CI) for the associations of redlining, lending bias on breast cancer mortality and estimated race-stratified associations.

Results:

Overall, 20% of NHW and 80% of NHB women lived in redlined census tracts, and 60% of NHW and 26% of NHB women lived in census tracts with pronounced lending bias. Living in redlined census tracts was associated with a nearly 1.60-fold increase in breast cancer mortality (hazard ratio = 1.58; 95% CI, 1.37–1.82) while residing in areas with substantial lending bias reduced the hazard of breast cancer mortality (hazard ratio = 0.86; 95% CI, 0.75–0.99). Among NHB women living in redlined census tracts, we observed a slight increase in breast cancer mortality (hazard ratio = 1.13; 95% CI, 0.90–1.42); among NHW women the association was more pronounced (hazard ratio = 1.39; 95% CI, 1.09–1.78).

Conclusions:

These findings underscore the role of ecologic measures of structural racism on cancer outcomes.

Impact:

Place-based measures are important contributors to health outcomes, an important unexplored area that offers potential interventions to address disparities.
Electroacupuncture Might Promote the Spontaneous Resorption of Lumbar Disc Herniation: A Case Report
Authors: Li Bangwei , Hu Hantong , Gao Hong , Di Zhong , Zhang Quanai , Fang Jianqiao
Published: October 2020

Background: Although acupuncture is effective in the treatment of lumbar disc herniation (LDH), based on comprehensive literature review, reports of the resorption of large herniated discs in LDH patients treated merely by acupuncture are very rare. Case Report: A 49-year-old patient presented with distending pain in the left lower limb and numbness on the dorsum of the left foot. Physical examination revealed positive signs associated with mechanical compression by herniated lumbar discs. Magnetic resonance imaging (MRI) at symptom onset confirmed the diagnosis of LDH at L4-L5 and L5-S1. Electroacupuncture was administered on local acupoints combined with distal acupoints. His clinical symptoms gradually improved with time throughout acupuncture treatment, verified by increased Japanese Orthopaedic Association scores. The patient was discharged after a total of 20 acupuncture sessions within 1 month. Follow-up indicated that his symptoms had disappeared completely at 1.5 months after discharge and had not recurred since then. At the 10-month follow-up, MRI re-examination confirmed that the herniated discs had been resorbed significantly. Conclusion: Electroacupuncture could significantly improve clinical symptoms and might promote the spontaneous resorption of herniated discs in LDH patients. Thus, for LDH patients suitable for conservative treatment, electroacupuncture could be a favourable option recommended to patients.
Prediction of Poor Outcome in Intracerebral Hemorrhage Based on Computed Tomography Markers
Authors: Du Chaonan , Liu Boxue , Yang Mingfei , Zhang Qiang , Ma Qingfang , Ruili Ruili
Published: October 2020

Introduction: Intracerebral hemorrhage (ICH) is the most fatal type of stroke worldwide. Herein, we aim to develop a predictive model based on computed tomography (CT) markers in an ICH cohort and validate it in another cohort. Methods: This retrospective observational cohort study was conducted in 3 medical centers in China. The values of CT markers, including hypodensities, hematoma density, blend sign, black hole sign, island sign, midline shift, baseline hematoma volume, and satellite sign, in predicting poor outcome were analyzed by logistic regression analysis. A nomogram was developed based on the results of multivariate logistic regression analysis in development cohort. Area under curve (AUC) and calibration plot were used to assess the accuracy of nomogram in this development cohort and validate in another cohort. Results: A total of 1,498 patients were included in this study. Multivariate logistic regression analysis indicated that hypodensities, black hole sign, island sign, midline shift, and baseline hematoma volume were independently associated with poor outcome in development cohort. The AUC was 0.75 (95% confidence interval [CI]: 0.73–0.76) in the internal validation with development cohort and 0.74 (95% CI: 0.72–0.75) in the external validation with validation cohort. The calibration plot in development and validation cohort indicated that the nomogram was well calibrated. Conclusions: CT markers of hypodensities, black hole sign, and island sign might predict poor outcome of ICH patients within 90 days.
High Prevalence of Small Intestinal Bacterial Overgrowth among Functional Dyspepsia Patients
Authors: Tziatzios Georgios , Gkolfakis Paraskevas , Papanikolaou Ioannis S. , Mathur Ruchi , Pimentel Mark , Damoraki Georgia , Giamarellos-Bourboulis Evangelos J. , Dimitriadis George , Triantafyllou Konstantinos
Published: October 2020

Background: Small intestinal bacterial overgrowth (SIBO), characterized by either increased numbers or presence of colonic type bacteria in the small bowel has been previously described in functional dyspepsia (FD), based on breath testing. In this study, we aim to examine the prevalence of SIBO among FD patients using small bowel aspirate culture. Methods: We prospectively enrolled outpatients fulfilling Rome IV criteria for FD. Severity of symptoms was graded using the patient assessment of upper gastrointestinal symptom severity index (PAGI-SYM) questionnaire. Patients underwent upper gastrointestinal endoscopy and duodenal fluid was aspirated in sterile traps. SIBO was defined as ≥103 colony forming units/mL of duodenal aspirate and/or presence of colonic type bacteria. Patients undergoing gastroscopy due to gastroesophageal reflux symptoms – control group (CG) – and patients with irritable bowel syndrome (IBS) fulfilling Rome IV criteria were also recruited. Results: We enrolled 227 FD subjects, 30 CG, and 90 IBS patients. Among FD patients, 144 (63.4%), 64 (28.2%), and 19 (8.4%) had postprandial distress syndrome (PDS), epigastric pain syndrome (EPS), and overlapping PDS-EPS syndrome, respectively. SIBO prevalence was 20.8%, 12.5%, and 31.6% among PDS, EPS, and overlapping PDS-EPS FD subtypes, respectively. Overall, SIBO prevalence was significantly higher in FD (44/227 [19.4%]) compared to CG (1/30 [3.3%]) (p = 0.037) and similar to IBS (44/227 [19.4%] vs. 15/90 [16.7%], p = 0.63) subjects. SIBO presence was associated neither with total nor with any subscale score of the PAGI-SYM questionnaire. Conclusion: In a cohort of Greek FD patients, SIBO prevalence was similar to that of IBS subjects and higher compared to that of controls.
Comparison in the Diagnostic Yield between “Pillcam SB3” Capsule Endoscopy and “OMOM Smart Capsule 2” in Small Bowel Bleeding: A Randomized Head-to-Head Study
Authors: Blanco-Velasco Gerardo , Zamarripa-Mottú Raúl Antonio , Solórzano-Pineda Omar Michel , Mascarenhas-Saraiva Miguel , Blancas-Valencia Juan Manuel , Hernández-Mondragón Oscar Victor
Published: October 2020

Introduction: Capsule endoscopy (CE) is the first-line tool for diagnosis of small bowel bleeding. There are some studies that have compared different types of CE. OMOM CE is one of the newest in the market and has not been compared with other types of CE. The objective of this study was to compare the diagnostic yield of the Pillcam SB3 and OMOM CE in small bowel bleeding. Materials and Methods: This is a prospective, comparative, randomized, and blinded study. Patients with suspected small bowel bleeding were included. All the patients were given both types of CE in random order. Diagnostic yield and functionality between the 2 types of CE were analyzed. Results: We included 44 patients, 54.5% were female with a median age of 63.5 years. Battery time was significantly longer with SB3 (816.5 vs. 700.5 min, p < 0.001), and the download time was shorter with OMOM (33 vs. 132 min, p < 0.001). Both CEs presented 1 failure. The cause of the bleeding was identified in 39 SB3 (88.6%) and in 34 OMOM CE (77.3%) (p = 0.256). P2 lesions were observed in 32 SB3 (72.7%) and in 29 OMOM CE (65.9%) (p = 0.784). The agreement between both CEs for P2 lesions was moderate (κ = 0.628). Conclusions: Pillcam SB3 and OMOM devices are safe procedures and have a similar diagnostic yield. Significant differences were observed in the battery life and download time with both CEs.
Association Between Immune Checkpoint Inhibitors With Cardiovascular Events and Atherosclerotic Plaque
Authors: Drobni Zsofia D. , Alvi Raza M. , Taron Jana , Zafar Amna , Murphy Sean P. , Rambarat Paula K. , Mosarla Rayma C. , Lee Charlotte , Zlotoff Daniel A. , Raghu Vineet K. , Hartmann Sarah E. , Gilman Hannah K. , Gong Jingyi , Zubiri Leyre , Sullivan Ryan J. , Reynolds Kerry L. , Mayrhofer Thomas , Zhang Lili , Hoffmann Udo , Neilan Tomas G
Published: October 2020

Background:

Immune checkpoint inhibitors (ICIs) treat an expanding range of cancers. Consistent basic data suggest that these same checkpoints are critical negative regulators of atherosclerosis. Therefore, our objectives were to test whether ICIs were associated with accelerated atherosclerosis and a higher risk of atherosclerosis-related cardiovascular events.

Methods:

The study was situated in a single academic medical center. The primary analysis evaluated whether exposure to an ICI was associated with atherosclerotic cardiovascular events in 2842 patients and 2842 controls matched by age, a history of cardiovascular events, and cancer type. In a second design, a case-crossover analysis was performed with an at-risk period defined as the 2-year period after and the control period as the 2-year period before treatment. The primary outcome was a composite of atherosclerotic cardiovascular events (myocardial infarction, coronary revascularization, and ischemic stroke). Secondary outcomes included the individual components of the primary outcome. In addition, in an imaging substudy (n=40), the rate of atherosclerotic plaque progression was compared from before to after the ICI was started. All study measures and outcomes were blindly adjudicated.

Results:

In the matched cohort study, there was a 3-fold higher risk for cardiovascular events after starting an ICI (hazard ratio, 3.3 [95% CI, 2.0–5.5];
P
<0.001). There was a similar increase in each of the individual components of the primary outcome. In the case-crossover, there was also an increase in cardiovascular events from 1.37 to 6.55 per 100 person-years at 2 years (adjusted hazard ratio, 4.8 [95% CI, 3.5–6.5];
P
<0.001). In the imaging study, the rate of progression of total aortic plaque volume was >3-fold higher with ICIs (from 2.1%/y before 6.7%/y after). This association between ICI use and increased atherosclerotic plaque progression was attenuated with concomitant use of statins or corticosteroids.

Conclusions:

Cardiovascular events were higher after initiation of ICIs, potentially mediated by accelerated progression of atherosclerosis. Optimization of cardiovascular risk factors and increased awareness of cardiovascular risk before, during, and after treatment should be considered among patients on an ICI.
Association Between Left Ventricular Mechanical Deformation and Myocardial Fibrosis in Nonischemic Cardiomyopathy
Authors: Csecs Ibolya , Pashakhanloo Farhad , Paskavitz Amanda , Jang Jihye , Al‐Otaibi Talal , Neisius Ulf , Manning Warren J. , Nezafat Reza
Published: October 2020

Background

In patients with nonischemic cardiomyopathy, nonischemic fibrosis detected by late gadolinium enhancement (LGE) cardiovascular magnetic resonance is related to adverse cardiovascular outcomes. However, its relationship with left ventricular (LV) mechanical deformation parameters remains unclear. We sought to investigate the association between LV mechanics and the presence, location, and extent of fibrosis in patients with nonischemic cardiomyopathy.

Methods and Results

We retrospectively identified 239 patients with nonischemic cardiomyopathy (67% male; 55±14 years) referred for a clinical cardiovascular magnetic resonance. LGE was present in 109 patients (46%), most commonly (n=52; 22%) in the septum. LV deformation parameters did not differentiate between LGE‐positive and LGE‐negative groups. Global longitudinal, radial, and circumferential strains, twist and torsion showed no association with extent of fibrosis. Patients with septal fibrosis had a more depressed LV ejection fraction (30±12% versus 35±14%;
P
=0.032) and more impaired global circumferential strain (−7.9±3.5% versus −9.7±4.4%;
P
=0.045) and global radial strain (10.7±5.2% versus 13.3±7.7%;
P
=0.023) than patients without septal LGE. Global longitudinal strain was similar in both groups. While patients with septal‐only LGE (n=28) and free wall–only LGE (n=32) had similar fibrosis burden, the septal‐only LGE group had more impaired LV ejection fraction and global circumferential, longitudinal, and radial strains (all
P
<0.05).

Conclusions

There is no association between LV mechanical deformation parameters and presence or extent of fibrosis in patients with nonischemic cardiomyopathy. Septal LGE was associated with poor global LV function, more impaired global circumferential and radial strains, and more impaired global strain rates.
The Cardinal Importance of Names
Authors: Fletcher Matthew
Published: October 2020

Aleister Crowley’s The Book of Thoth makes four substantive changes to the traditional titles of the tarot trumps. Three of these relate to the cardinal virtues which had remained in the deck despite the almost complete esoteric revisioning of the tarot that had taken place over the preceding two centuries; the fourth is an integral part of the same topic. This article focuses on why Crowley felt impelled to make these changes as well as the significance of the new names (and associated iconography). The discussion centres around Crowley’s rejection of the cardinal virtues that underly Christian ethics in favour of the new system of morality laid out in The Book of the Law and subsequently encapsulated in Thelema. Consequently, the article first examines the development of the cardinal virtues in patristic and medieval theology and then shows how Crowley sought to overturn these values in his agenda of cultural reprogramming of which The Book of Thoth arguably constitutes the high-water mark.
Developmental speed affects ecological stoichiometry and adult fat reserves in Drosophila melanogaster
Authors: Krams Indrikis A. , Krams Ronalds , Jõers Priit , Munkevics Māris , Trakimas Giedrius , Luoto Severi , Eichler Sarah , Butler David M. , Merivee Enno , Must Anne , Rantala Markus J. , Contreras-Garduño Jorge , Krama Tatjana
Published: October 2020

The elemental composition of organisms belongs to a suite of functional traits that change during development in response to environmental conditions. However, associations between adaptive variations in developmental speed and elemental body composition are not well understood. We compared body mass, elemental body composition, food uptake and fat metabolism of Drosophila melanogaster male fruit flies in relation to their larval development speed. Slowly developing flies had higher body carbon concentration than rapidly developing and intermediate flies. Rapidly developing flies had the highest body nitrogen concentration, while slowly developing flies had higher body nitrogen levels than flies with intermediate speed of development. The carbon-to-nitrogen ratio was therefore lower in rapidly developing flies than in slow and intermediate flies. We also had a group of flies grown individually and their body mass and elemental body composition were similar to those of rapidly developing individuals grown in groups. This suggests that rapid growth is not suppressed by stress. Feeding rates were lowest in the slowly developing flies. The amount of triacylglycerides was highest in the flies with intermediate developmental speed which optimizes development under many climatic conditions. Although low food intake slows down developmental speed and the accumulation of body fat reserves in slowly developing flies, their phenotype conceivably facilitates survival under higher stochasticity of their environments. Rapidly developing flies grew with less emphasis on storage build-up. Overall, this study shoes that a combination of bet-hedging, adaptive tracking and developmental plasticity enables fruit flies to respond adaptively to environmental uncertainty.
Addressing Impact Evaluation Gaps in Belt and Road Initiative Projects in Africa: The Standard Gauge Railway Project in Kenya as a Proof of Concept
Authors: Zhu Keren , Dossani Rafiq , Bouey Jennifer
Published: October 2020

The impact of the Belt and Road Initiative (BRI) to global development will be unprecedented and significant, and developmental impact evaluation is therefore central to understanding BRI projects and making informed decisions. Compared with evaluations of individual projects and programs, evaluation of large and mega infrastructure projects under the BRI is particularly challenging and complex in integrating stakeholder objectives, accounting for social benefit and costs, and tracking long-term project impact. In this paper, we summarize the key drawbacks of existing BRI evaluation frameworks, propose a systematic evaluation framework elicitation method based on the inputs from BRI subject matter experts and verified through stakeholder participation, and apply an interim evaluation framework in understanding the Mombasa-Nairobi Standard Gauge Railway project in Kenya, as a proof of concept of a comprehensive evaluation framework. In doing so, we seek to provide a tool for BRI decision makers and stakeholders to assess these projects holistically at planning, construction and operation stages.
The Economic Implications of Belt and Road Initiative in the Development of Railway Transport Infrastructure in Africa: The Case of the Standard Gauge Railway in Kenya
Authors: Irandu Evaristus M. , Owilla Hesbon Hansen
Published: October 2020

The purpose of this paper is to examine the potential economic benefits the Standard Gauge Railway (SGR) project under Belt and Road Initiative (BRI) may bring to Kenya. This will contribute to the ongoing debate on whether Chinese investments on BRI infrastructure projects in Africa are mutually beneficial or not. The key issues discussed include the economic benefits of SGR in Kenya, the economic risks or challenges of SGR given the emergent issues of debt burden in Kenya and how China and Kenya would engage in the future to deepen Sino-Africa relations in BRI projects especially transport infrastructure. The paper relies on secondary information from available published literature on railway transport infrastructure in Africa with specific reference to SGR in Kenya. Information from key informants drawn from the Ministry of Transport and Infrastructure and the United States University based in Nairobi was used to enrich literature review. The main findings of the paper are: (1) SGR will lead to socio-economic development of the country (2) it will contribute revenue to the Government through the railway development levy levied on containerized transportation from the port of Mombasa, and (3) will boost trade and regional integration through better rail connectivity. To make BRI projects more transparent, it is recommended that there is need for more stakeholder engagement in these projects. It is also recommended that the funding mechanism should be reviewed to make borrowing more affordable.
Ecological characteristics of high quality wild ornamental plants in South China
Authors: Cong Linlin , Han Dong
Published: October 2020

Around 6.000 plant species in China have ornamental uses. This study aims to identify new ornamental plant species that are able to survive in urban environments of China and not stand out from the landscaping plants growing in the local parks, gardens, and walkways. The list of ornamental plants includes exclusively open-ground plants. The study on 29 wild plant species commonly found across Southern China involved growing plants from 9.200 seeds and measuring their survival at the first (herbals) and the fifth 5 year of age (shrubs and trees). Of all study plants, 16 showed high germination and survival rates (over 50%) and can be used in park and city landscaping, whereas other specimens demonstrated survival rates lower than 50%. For lianas, the number of species suitable for landscaping is 3. Low germination rates did not determine a rapid decline in survival during the first and fifth years. Herbals turned out to have the highest germination rates (over 50% in 6 out of 7 specimens). Among trees, species that may be planted together along sidewalks to form groves and plantations include Ilex latifolia, Delavaya toxocarpa, and Vernicia fordii. Among vines, Trachelospermum jasminoides or star jasmine can be used as a tree climber. Among shrubs and herbals, Melastoma dodecandrum and Corydalis edulis can be planted in flower beds and rock gardens. This work examines plant species not only from the decorative prospective but also in terms of suitability for growing in urban conditions.
Biomechanical Analysis of Patellar Tendon Repair With Knotless Suture Anchor Tape Versus Transosseous Suture
Authors: Massey Patrick A. , Myers Mitchell , McClary Kaylan , Brown Jimmy , Barton R. Shane , Solitro Giovanni F.
Published: October 2020

Background:

Patellar tendon ruptures have routinely been repaired with transosseous suture tunnels. The use of knotless suture anchors for repair has been suggested as an alternative.

Purpose:

To compare the load to failure and gap formation of patellar tendon repair at the inferior pole of the patella with knotless suture anchor tape versus transosseous sutures. A secondary objective was to investigate whether either technique shows an association between bone density and load to failure.

Study Design:

Controlled laboratory study.

Methods:

A total of 20 human tibias with attached patellar and quadriceps tendons were sharply incised at the bone-tendon junction at the inferior pole of the patella. A total of 10 tendons were repaired using 2 knotless suture anchors in the inferior pole of the patella and a single suture tape with 2 core sutures. The other 10 tendons were repaired using No. 2 suture passed through 3 transosseous tunnels. A distracting force was then applied through the suture in the quadriceps tendon. Gap distance through load cycling at the repair site and maximum load at repair failure were then measured. Bone density was measured using computed tomography scanning.

Results:

No difference was found in the mean load to failure of knotless patellar tendon repair versus transosseous suture repair (367.6 ± 112.2 vs 433.9 ± 99 N, respectively; P = .12). After 250 cycles, the mean repair site gap distance was 0.85 ± 0.45 mm for the knotless patellar tendon repair versus 2.94 ± 2.03 mm for the transosseous suture repair ( P = .03). A small correlation, although not statistically significant, was found between bone density and load to failure for the knotless tape repair ( R 2 = 0.228; P = .66). No correlation was found between bone density and load to failure for the transosseous repair ( R 2 = 0.086; P = .83).

Conclusion:

Suture tape repair with knotless anchors for repair of patellar tendon rupture has comparable load to failure with less gap formation than transosseous suture repair. There is a small correlation between bone density and failure load for knotless anchor repair, which may benefit from further investigation.

Clinical Relevance:

Using knotless suture anchors for patellar tendon rupture repair would allow for a smaller incision, less dissection, and likely shorter operating time.