bluuebunny/crossref_metadata_2025 huggingface dataset:
Measurement and modelling of nonlinear ultrasound fields using Fabry-Perot sensors and k-wave
Authors: Martin Elly , Cox Ben , Treeby Bradley
Published: December 2020

Measurement and modelling of nonlinear ultrasound fields underpins many aspects of clinical ultrasound therapies from transducer design, to treatment planning and computational dosimetry, and quality assurance during the manufacture and use of devices. Measurement of high amplitude nonlinear ultrasound fields presents a significant challenge due to the extreme pressures, temperature rises, and mechanical effects that are generated. Additionally, understanding the properties of suitable sensors and their effect on the measurement is critical to ensure that accurate measurements are obtained. Modelling the propagation of ultrasound under these conditions is similarly challenging, as simulations can become large and computationally expensive when highly nonlinear fields are simulated over clinically relevant domains, and experimental validation becomes more difficult. Here we discuss our approach to overcoming these challenges to perform accurate measurement and modelling of high intensity therapeutic ultrasound fields using the open-source k-Wave toolbox, and devices based on Fabry-Perot interferometers developed for measurement of high acoustic pressures.
Analytical solution based on spatial distortion for a time-harmonicdipole source in a transverse isotropic viscoelastic solid
Authors: Royston Thomas
Published: December 2020

Elastography refers to mapping mechanical properties in a material by measuring wave motion in it using noninvasive optical, acoustic or magnetic resonance imaging methods. Elasticity and viscosity can depend on location and direction. A material with aligned fibers may have different elastic and viscosity values along the fibers versus across them. Reconstruction refers to converting wave measurements into a mechanical property map. To make reconstruction analytically tractable, isotropy and homogeneity are often assumed. But, isotropic homogeneity is often not the case of interest, when there are pathological conditions or hidden anomalies non-uniformly distributed in fibrous or layered structures. A strategy of spatial distortion to make an anisotropic problem become isotropic has been previously validated in two-dimensional transverse isotropic (TI) viscoelastic cases. Here, the approach is extended to the three-dimensional problem by considering a time-harmonic point force (dipole) in a TI viscoelastic material. The resulting wave field, exactly solvable using a Radon transform with numerical integration, is approximated via spatial distortion of the closed form analytical solution to the isotropic case. Different distortions are used depending on whether or not the polarization of the wave motion is orthogonal to the axis of isotropy resulting in differing levels of accuracy.
Pathways for Long-Term Physical Activity Participation for Military Veterans With a Physical Disability
Authors: Shirazipour Celina H. , Latimer-Cheung Amy E.
Published: December 2020

A gap in knowledge exists regarding how to maintain physical activity (PA) for individuals with acquired disabilities following initial introductory experiences. The current study aimed to contribute to filling this gap by exploring the PA pathways of military veterans with a physical disability, particularly those who maintain long-term PA, from impairment to the present. Veterans with a physical disability (N = 18) participated in interviews exploring their PA history and experiences. A reflexive thematic analysis was conducted to generate common pathways in PA participation, as well as to examine which elements of participation supported PA maintenance. Three long-term pathways were identified—two parasport pathways and one recreational PA pathway. Four elements of participation (i.e., mastery, challenge, belongingness, meaning) supported to maintain PA at key junctures. This knowledge provides further understanding of how to promote long-term PA for individuals with acquired disabilities and can support advancements in theory, as well as program development.
Additional Functional Performance Gains After 24-Week Unstable Strength Training With Cognitive Training in Community-Dwelling Healthy Older Adults: A Randomized Trial
Authors: de Oliveira Valéria Mayaly Alves , Pirauá André Luiz Torres , Cavalcante Bruno Remígio , Beltrão Natália Barros , de Farias Wevans Monthier , Pitangui Ana Carolina Rodarti , de Araújo Rodrigo Cappato
Published: December 2020

The authors investigated the effects of unstable strength training (UST) without or with cognitive training (C+UST) on functional performance in community-dwelling older adults. A total of 50 participants were randomly assigned (1:1) to either 24 weeks of thrice-weekly UST (n = 25) or C+UST (n = 25). All participants performed moderate-intensity strength exercises using unstable surfaces, and C+UST participants simultaneously received cognitive training in addition to UST. Primary outcomes included measures of functional performance: single- and dual-task timed up and go tests. Secondary outcomes included dynamic balance, mobility, handgrip strength, flexibility, quality of life, and concern about falling. The authors observed similar improvements on functional performance through the interventions. The C+UST group experienced additional gains at completion (single-task timed up and go: −0.90 s, 95% confidence interval [–2.38, –0.03]; dual-task timed up and go: –4.80 s, 95% confidence interval [–8.65, –0.95]) compared with the UST group. Moreover, significant differences were observed in mobility (sitting-rising test: −1.34, 95% confidence interval [−2.00, −0.20]) at 24 weeks. Both exercise modes improved single-task functional performance, while adding cognitive-training-optimized dual-task functional performance gains.
Black scientists matter
Authors: Makgoba Malegapuru William
Published: December 2020

The recent murder of George Floyd by police in the United States, the Black Lives Matter protests around the world, and racial inequalities everywhere that have been exposed by the coronavirus disease 2019 (COVID-19) pandemic—such as the disproportionately high vulnerability and mortality in African-American, Afro-Caribbean, and Afro-Latin communities—are a wake-up call for humankind to recalibrate, restructure, and reimagine its beliefs and behaviors. It's important to recognize that beneath overt racism are subtle forms of structural and institutionalized racism that have existed for a very long time, unabated, across communities—in homes, hospitals, churches, schools, governments, and so many other institutions—throughout the Western world. Now, societies are being provoked to ponder fundamental questions about racism. What about the scientific world? Do Black scientists matter?
Recognizing the work of women
Rebels, Scholars, Explorers: Women in Vertebrate Paleontology
Annalisa Berta and Susan Turner
Johns Hopkins University Press, 2020. 344 pp.
Authors: Miller-Camp Jess
Published: December 2020

Despite several stumbles, a new volume about women in paleontology will likely prove valuable to future scholars
Public health during the pandemic in India
Authors: John Jacob , Kang Gagandeep
Published: December 2020

Data from two Indian states give detail about variation in transmission and disease outcomes
Gradually, then suddenly
Authors: Thorp H. Holden
Published: December 2020

Racism, climate denial, and coronavirus disease 2019 (COVID-19) are major crises standing in the way of a prosperous future for the United States, and resolution of all three could be enabled by science that is persistently ignored. In Ernest Hemingway's novel
The Sun Also Rises
, a character named Mike is asked how he went bankrupt. “Two ways,” he answers. “Gradually, then suddenly.” The resistance of U.S. policy to science has followed a similar path: It gradually built up over 40 years, beginning with the election of Ronald Reagan, but suddenly reached a tipping point in the chaos of 2020. Will the path to resolution also be gradual and then sudden, and if so, at what cost?
Shotgun Sequencing Revealed the Microbiota of Zea mays Rhizosphere of a Former Grassland and an Intensively Cultivated Agricultural Land
Authors: Babalola Olubukola Oluranti , Chukwuneme Chinenyenwa Fortune , Ayangbenro Ayansina Segun
Published: December 2020

Land use is a major factor contributing to the differences in soil microbial assemblages. Despite the importance of microbial communities on crop health and productivity, a knowledge gap exists on the effects of land use change on microbial functions in the rhizosphere.
Draft Genome Sequence of the Antimony-Oxidizing
Pseudomonas
sp. Strain SbOxS1, Isolated from Stibnite Mine Tailing Soil
Authors: Hamamura Natsuko , Nakajima Nobuyoshi , Yamamura Shigeki
Published: December 2020

Pseudomonas
sp. strain SbOxS1 was isolated from stibnite mine tailing soil for its ability to oxidize antimonite. We present a draft genome sequence of strain SbOxS1, which contains 6,484 predicted protein-coding sequences. This genome information extends our understanding of the physiological versatility of antimony-transforming microorganisms.
Healthcare trajectories and costs in the last year of life: a retrospective primary care and hospital analysis
Authors: Luta Xhyljeta , Diernberger Katharina , Bowden Joanna , Droney Joanne , Howdon Daniel , Schmidlin Kurt , Rodwin Victor , Hall Peter , Marti Joachim
Published: December 2020

Objectives

To analyse healthcare utilisation and costs in the last year of life in England, and to study variation by cause of death, region of patient residence and socioeconomic status.

Methods

This is a retrospective cohort study. Individuals aged 60 years and over (N=108 510) who died in England between 2010 and 2017 were included in the study.

Results

Healthcare utilisation and costs in the last year of life increased with proximity to death, particularly in the last month of life. The mean total costs were higher among males (£8089) compared with females (£6898) and declined with age at death (£9164 at age 60–69 to £5228 at age 90+) with inpatient care accounting for over 60% of total costs. Costs decline with age at death (0.92, 95% CI 0.88 to 0.95, p<0.0001 for age group 90+ compared with to the reference category age group 60–69) and were lower among females (0.91, 95% CI 0.90 to 0.92, p<0.0001 compared with males). Costs were higher (1.09, 95% CI 1.01 to 1.14, p<0.0001) in London compared with other regions.

Conclusions

Healthcare utilisation and costs in the last year of life increase with proximity to death, particularly in the last month of life. Finer geographical data and information on healthcare supply would allow further investigating whether people receiving more planned care by primary care and or specialist palliative care towards the end of life require less acute care.
Xsec: the cross-section evaluation code
Authors: Buckley Andy , Kvellestad Anders , Raklev Are , Scott Pat , Sparre Jon Vegard , Van den Abeele Jeriek , Vazquez-Holm Ingrid A.
Published: December 2020

The evaluation of higher-order cross-sections is an important component in the search for new physics, both at hadron colliders and elsewhere. For most new physics processes of interest, total cross-sections are known at next-to-leading order (NLO) in the strong coupling $$\alpha _s$$

α
s

, and often beyond, via either higher-order terms at fixed powers of $$\alpha _s$$

α
s

, or multi-emission resummation. However, the computation time for such higher-order cross-sections is prohibitively expensive, and precludes efficient evaluation in parameter-space scans beyond two dimensions. Here we describe the software tool , which allows for fast evaluation of cross-sections based on the use of machine-learning regression, using distributed Gaussian processes trained on a pre-generated sample of parameter points. This first version of the code provides all NLO Minimal Supersymmetric Standard Model strong-production cross-sections at the LHC, for individual flavour final states, evaluated in a fraction of a second. Moreover, it calculates regression errors, as well as estimates of errors from higher-order contributions, from uncertainties in the parton distribution functions, and from the value of $$\alpha _s$$

α
s

. While we focus on a specific phenomenological model of supersymmetry, the method readily generalises to any process where it is possible to generate a sufficient training sample.
A New Intelligent Learning Diagnosis Method Constructed Based on Concept Map
Authors: Hu Yun , Li Hui , Zhou Zuojian , Li Haining
Published: December 2020

With the rapid development of Internet technology, online learning and online education are becoming more and more popular. Intelligent learning diagnosis has become an effective means to guarantee the quality of online learning, and has become a research hotspot in the direction of education informatization. Concept map is an intuitive visual tool that can discover the concepts poorly mastered by students, and provide useful clues for identifying learning disabilities of students. This paper proposed a learning diagnosis method constructed based on the concept map. First, it groups learners, then uses direct hashing and pruning (DHP) to generate association rules between the different concepts, and finally uses the DHP algorithm to produce and construct the concept map automatically to discover the concepts poorly mastered by students, and realize the automatic diagnosis of learning problems. Case studies that have been done in college mathematics classes in some universities of Lianyungang have fully verified the effectiveness of our method.
DIFFUSION ON FRACTAL OBJECTS MODELING AND ITS PHYSICS-INFORMED NEURAL NETWORK SOLUTION
Authors: ZHAO DAZHI , YU GUOZHU , LI WEIBIN
Published: December 2020

Fractional operators are the main tools to describe diffusion problems on fractal objects. This paper first shows the equivalence between conformable fractional derivative and fractal derivative, and then investigates various models for the diffusion on fractal objects by the conformable fractional derivative and its generalized form. The recommended models are solved by the mesh-free physics-informed neural network method with high computational effectiveness and universality.
DNA Circuits-Based Signal Amplification for Ultrasensitive Nucleic Acids Detection
Authors: Zhang Zhikun , Zhao Wenmeng , Hu Cuixia , Cao Yapeng , Yun Jimmy , Liu Runjing , Yuan Longfei , Liu Yumin
Published: December 2020

Nucleic acids detection has significant meanings in disease diagnosis, monitoring of environment and so on. However, only trace concentration of nucleic acids exists in specimen. Ultrasensitive nucleic acids detection is required based on the strategies of signal amplification. Currently, DNA nanotechnologies are employed to amplify the detecting signal, mainly including DNA hybridization-based sensors and DNA circuits-based sensors. DNA circuits-based sensors have higher sensitive than that of DNA hybridization-based sensors, which attract the attention of researchers. With this view, we present an overview of DNA circuits-based amplification strategies for nucleic acids detection with fluorescent sensors and electrochemical sensors, respectively. It mainly contains duplex specific nuclease (DSN)-based DNA circuits and strand displace reaction (SDR)-based DNA circuits, which enable nucleic acids to trigger DNA circuits without consumption. The strategies can multiply the increase of the signal of nucleic acids with simple operation. Meanwhile, this review discusses the current challenges and future outlook of DNA circuits in sensors. We envision that our review provides implications to promote the development of DNA circuits-based biosensors for nucleic acids detection.
Transport Characteristics of Gallium Nitride Nanowire Field-Effect Transistor (GaN-NWFET) for High Temperature Electronics
Authors: Yildirim Mustafa A. , Teker Kasif
Published: December 2020

This paper presents a systematic investigation of high-temperature transport characteristics of a single nanowire Gallium Nitride nanowire field-effect transistor (GaN-NWFET) ranging from room temperature to as high as [Formula: see text]C for the first time. The GaN-NWFET demonstrated a very good on/off current ratio ([Formula: see text] of [Formula: see text] for the p-side and [Formula: see text] for the n-side at room temperature and considerably well at high temperatures. In fact, the device exhibited an on/off current ratio of [Formula: see text] and a transconductance value of [Formula: see text]S for the p-side at [Formula: see text]C indicating a good gating effect even at high temperatures. Additionally, the device exhibited very high mobilities with the hole mobility of [Formula: see text][Formula: see text]cm2/V. s and electron mobility of [Formula: see text] cm2/V. s at room temperature. Furthermore, the device showed very high transconductance values of [Formula: see text]S and [Formula: see text]S at the temperatures of [Formula: see text]C and [Formula: see text]C, respectively. As a consequence, the GaN-NWFET devices could find much use not only in high-power, but also in low-power transistor applications beyond the ambient temperature [Formula: see text]C) of silicon and silicon-on-insulator technologies for electronic and photonic circuits.
Trailblazing the Artificial Intelligence for Cybersecurity Discipline
Authors: Samtani Sagar , Kantarcioglu Murat , Chen Hsinchun
Published: December 2020

Cybersecurity has rapidly emerged as a grand societal challenge of the 21st century. Innovative solutions to proactively tackle emerging cybersecurity challenges are essential to ensuring a safe and secure society. Artificial Intelligence (AI) has rapidly emerged as a viable approach for sifting through terabytes of heterogeneous cybersecurity data to execute fundamental cybersecurity tasks, such as asset prioritization, control allocation, vulnerability management, and threat detection, with unprecedented efficiency and effectiveness. Despite its initial promise, AI and cybersecurity have been traditionally siloed disciplines that relied on disparate knowledge and methodologies. Consequently, the AI for Cybersecurity discipline is in its nascency. In this article, we aim to provide an important step to progress the AI for Cybersecurity discipline. We first provide an overview of prevailing cybersecurity data, summarize extant AI for Cybersecurity application areas, and identify key limitations in the prevailing landscape. Based on these key issues, we offer a multi-disciplinary AI for Cybersecurity roadmap that centers on major themes such as cybersecurity applications and data, advanced AI methodologies for cybersecurity, and AI-enabled decision making. To help scholars and practitioners make significant headway in tackling these grand AI for Cybersecurity issues, we summarize promising funding mechanisms from the National Science Foundation (NSF) that can support long-term, systematic research programs. We conclude this article with an introduction of the articles included in this special issue.
Pandemic check-in
Authors: Conrad Philip
Published: December 2020

We reached out to last year's travel grant recipients to see how they are faring during the pandemic. Philip Conrad (U. South Carolina) wrote it with this update.
Machine learning for evaluating and improving theories
Authors: Fudenberg Drew , Liang Annie
Published: December 2020

We summarize our recent work that uses machine learning techniques as a complement to theoretical modeling, rather than a substitute for it. The key concepts are those of the completeness and restrictiveness of a model. A theory's completeness is how much it improves predictions over a naive baseline, relative to how much improvement is possible. When a theory is relatively incomplete, machine learning algorithms can help reveal regularities that the theory doesn't capture, and thus lead to the construction of theories that make more accurate predictions. Restrictiveness measures a theory's ability to match arbitrary hypothetical data: A very unrestrictive theory will be complete on almost any data, so the fact that it is complete on the actual data is not very instructive. We algorithmically quantify restrictiveness by measuring how well the theory approximates randomly generated behaviors. Finally, we propose "algorithmic experimental design" as a method to help select which experiments to run.
Ethical algorithm design
Authors: Kearns Michael , Roth Aaron
Published: December 2020

In this letter, we summarize the research agenda that we survey in our recent book
The Ethical Algorithm
, which is intended for a general, nontechnical audience. At a high level, this research agenda proposes
formalizing
the ethical and social values that we want our algorithms to maintain --- values including privacy, fairness, and explainability --- and then to embed these social values directly into our algorithms as part of their design. This broad research area is most mature in the area of privacy, specifically
differential privacy
. It is off to a good start in emerging areas like algorithmic fairness, and seems promising for more nebulous goals like explainability, if only we can find the right definitions. Most work in this area to date analyzes algorithms as isolated components, but game-theoretic and economic analysis will become increasingly important as we try and study the effects of algorithmic interventions in larger sociotechnical systems.
Spatio-temporal pricing for ridesharing platforms
Authors: Ma Hongyao , Fang Fei , Parkes David C.
Published: December 2020

Ridesharing platforms match drivers and riders to trips, using dynamic prices to balance supply and demand. A challenge is to set prices that are appropriately smooth in space and time, so that drivers will choose to accept their dispatched trips, rather than drive to another area or wait for higher prices or a better trip. We work in a complete information, discrete time, multi-period, multi-location model, and introduce the
Spatio-Temporal Pricing (STP) mechanism.
The mechanism is incentive-aligned, in that it is a subgame-perfect equilibrium for drivers to always accept their trip dispatches. The mechanism is also welfare-optimal, envy-free, individually rational, budget balanced and core-selecting in equilibrium from any history onward. The proof of incentive alignment makes use of the
M
♯
concavity of minimum cost flow objectives. We also give an impossibility result, that there can be no dominant-strategy mechanism with the same economic properties. Simulation results suggest that the STP mechanism can achieve significantly higher social welfare than a myopic pricing mechanism.
Protective and anti-inflammatory effects of acetylcholine in the heart
Authors: Rocha-Resende Cibele , da Silva Aristóbolo Mendes , Prado Marco A. M. , Guatimosim Silvia
Published: December 2020

The innate and adaptive immune systems play an important role in the development of cardiac diseases. Therefore, it has become critical to identify molecules that can modulate inflammation in the injured heart. In this regard, activation of the cholinergic system in animal models of heart disease has been shown to exert protective actions that include immunomodulation of cardiac inflammation. In this mini-review, we briefly present our current understanding on the cardiac cellular sources of acetylcholine (ACh) (neuronal vs. nonneuronal), followed by a discussion on its contribution to the regulation of inflammatory cells. Although the mechanism behind ACh-mediated protection still remains to be fully elucidated, the beneficial immunomodulatory role of the cholinergic signaling emerges as a potential key regulator of cardiac inflammation.
V1a and V1b vasopressin receptors within the paraventricular nucleus contribute to hypertension in male rats exposed to chronic mild unpredictable stress
Authors: Komnenov Dragana , Quaal Harrison , Rossi Noreen F.
Published: December 2020

Depression is an independent nontraditional risk factor for cardiovascular disease and mortality. The chronic unpredictable mild stress (CMS) rat model is a validated model of depression. Within the paraventricular nucleus (PVN), vasopressin (VP) via V1aR and V1bR have been implicated in stress and neurocardiovascular dysregulation. We hypothesized that in conscious, unrestrained CMS rats versus control, unstressed rats, PVN VP results in elevated arterial pressure (MAP), heart rate, and renal sympathetic nerve activity (RSNA) via activation of V1aR and/or V1bR. Male rats underwent 4 wk of CMS or control conditions. They were then equipped with hemodynamic telemetry transmitters, PVN cannula, and left renal nerve electrode. V1aR or V1bR antagonism dose-dependently inhibited MAP after VP injection. V1aR or V1bR blockers at their ED50 doses did not alter baseline parameters in either control or CMS rats but attenuated the pressor response to VP microinjected into PVN by ∼50%. Combined V1aR and V1bR inhibition completely blocked the pressor response to PVN VP in control but not CMS rats. CMS rats required combined maximally inhibitory doses to block either endogenous VP within the PVN or responses to microinjected VP. Compared with unstressed control rats, CMS rats had higher plasma VP levels and greater abundance of V1aR and V1bR transcripts within PVN. Thus, the CMS rat model of depression results in higher resting MAP, heart rate, and RSNA, which can be mitigated by inhibiting vasopressinergic mechanisms involving both V1aR and V1bR within the PVN. Circulating VP may also play a role in the pressor response.
The detailed organization of the human cerebellum estimated by intrinsic functional connectivity within the individual
Authors: Xue Aihuiping , Kong Ru , Yang Qing , Eldaief Mark C. , Angeli Peter A. , DiNicola Lauren M. , Braga Rodrigo M. , Buckner Randy L. , Yeo B. T. Thomas
Published: December 2020

Stable, within-individual maps of cerebellar organization reveal orderly macroscale representations of the cerebral cortex with local juxtaposed zones representing distinct networks. In addition, individuals reveal idiosyncratic organizational features.
Neutropenic Enterocolitis Disclosing an Underlying Cyclic Neutropenia
Authors: Lahlimi Fatima Ezzahra , Khalil Khawla , Lahiaouni Soumia , Tazi Illias
Published: December 2020

Neutropenic enterocolitis is a syndrome characterized by fever and abdominal pain in a neutropenic patient. It is often reported in children treated for leukemia and rarely reported in patients with other diseases. Herein, we report the case of a 9-year-old patient with a medical history of recurrent fever and mouth ulcers since the age of 4, who presented with neutropenic enterocolitis complicated with intestinal perforation which all leaded to disclose cyclic neutropenia. The patient was successfully treated by aggressive supportive care combined with surgical intervention. Neutropenic enterocolitis with possible complications should be considered and promptly managed in every neutropenic patient and may reveal a rare cause of neutropenia as cyclic neutropenia.
IgA Vasculitis Nephritis: A Case Series and Comparison of Treatment Guidelines
Authors: Al Harash Abdalhamid , Saeli Stephanie , Lucke Michael , Arora Swati
Published: December 2020

Immunoglobulin A (IgA) vasculitis nephritis (IgAVN) and IgA nephropathy (IgAN) share many pathological parallels and are viewed as related diseases by many groups. Current treatment guidelines remain vague, controversial, and without consensus, especially regarding the role of immunosuppressive medications. We present five cases of IgAVN encountered at our tertiary care center between 2016 and 2020, which were treated with different immunosuppression regimens. Infection was the leading cause of death in this series. These cases provide evidence that IgAVN should be distinguished from IgAN on a spectrum of IgA-associated glomerulonephritis. The outcomes presented herein suggest that the morbidity and systematic involvement IgAVN is greater than previously believed and that these substantial risks should be reflected in contemporary treatment guidelines.
Don’t Judge a Tumor by Its Biopsy!
Authors: Demant Mia , Saltvig Iselin , Trøstrup Hannah , Schmidt Volker J. , Hesselfeldt Jørgen
Published: December 2020

Trichoblastomas (TBs) are extremely rare, benign hair germ tumors that can mimic basal cell carcinoma (BCC). They usually arise on the head or neck and have a potential for malignant transformation, albeit it is rare. We report a case of giant TB on the forehead of a 75-year-old otherwise healthy woman. Since the age of 20 she reported a bulge on her forehead, in which a superficial-looking wound had now developed. Initially a dermatologist biopsied the tumor suspecting a BCC, which the histological analyses confirmed. The patient was then referred to the Department of Plastic Surgery for complete excision of the carcinoma, including the large frontal bulge. Surprisingly, the concluding pathology report changed the diagnosis from a BCC to a TB. Current management of most skin lesions relies on the histopathological subtype of a single punch biopsy. Many benign and malignant dermatological entities may mimic BCC, and therefore misdiagnosis can lead to either unnecessary excision or delayed treatment of metastatic disease. Mimics may include various types of nonneoplastic processes, benign adnexal tumors, including TB, or cutaneous carcinomas with basaloid features. A single punch biopsy is not always adequate in making the correct diagnosis. Although it is considered the gold standard, the clinical assessment is just as important. Due to its potential for malignant transformation, it is recommended to excise TB with negative margins.
Dual Myelomeningoceles in Twins: Case Report, Review, and Insights for Etiology
Authors: Kobets Andrew , Lee Ryan P. , Oriko David , Jackson Eric , Robinson Shenandoah , Cohen Alan , Groves Mari L.
Published: December 2020

Introduction: Despite folate supplementation, neural tube defects (NTDs) still occur in 0.5–1.0/1,000 pregnancies, with 30–50% not preventable with folate. Twinning has increased due to artificial fertilization and in itself predisposes to NTDs at a rate of 1.6/1,000. The contributions of genetic and environmental factors to myelomeningocele development remain poorly understood. Expression patterns of congenital pathologies in twins can sometimes provide etiological insight. Concordance of NTDs in twins is 0.03/1,000, with dual myelomeningocele reported in only 23 pairs, only one of which survived. We present the 24th pair, the 1st to maintain lower extremity motor function. We review all prior cases and discuss implications of twin concordance on the interplay of genetic and environmental influences. Case Report and Review: A new case of female monozygotic twins born to a well-nourished 24-year-old female is reported with details of perioperative care. Prenatal ultrasound showed L3-S4 and L5-S4 myelomeningoceles, Chiari II malformations, and ventriculomegaly. Copy number microarray was unrevealing. Each underwent uncomplicated repair on day of life 1, and ventriculoperitoneal shunt placement on days of life 10 and 16. Both had movement in the legs upon 6-week follow-up. All prior reported cases of concordant twin myelomeningoceles were abstracted and analyzed, revealing persistence of occurrence despite folate supplementation and a majority occurring in dizygotic pairs. The literature is also reviewed to summarize current knowledge of myelomeningocele pathophysiology as it relates to genetic and environmental influences. Discussion: Meticulous surgical and perioperative care allowed for early positive outcomes in each twin. However, etiopathogenesis remains elusive. In general, only of a minority of cases have underlying genetic lesions or clear environmental triggers. Concordance in monozygotic twins argues for a strong genetic influence; yet, literature review reveals a higher rate of concordant dizygotic twins. This, along with the observation of differing resultant phenotypes in monozygotic twins as seen in this case, prompts further investigation into nonfolate environmental influences. While efforts in genetic investigation should continue, the role of teratogens and exposures should not be minimized in research efforts, public health, and family counseling. Clinical genetic testing remains of limited utility in the majority of patients until more is known.
The Use of HbA1c, Glycated Albumin and Continuous Glucose Monitoring to Assess Glucose Control in the Chronic Kidney Disease Population Including Dialysis
Authors: Bomholt Tobias , Adrian Therese , Nørgaard Kirsten , Ranjan Ajenthen G. , Almdal Thomas , Larsson Anders , Vadstrup Mette , Rix Marianne , Feldt-Rasmussen Bo , Hornum Mads
Published: December 2020

Background: Glycated haemoglobin A1c (HbA1c) has limitations as a glycemic marker for patients with diabetes and CKD and for those receiving dialysis. Glycated albumin is an alternative glycemic marker, and some studies have found that glycated albumin more accurately reflects glycemic control than HbA1c in these groups. However, several factors are known to influence the value of glycated albumin including proteinuria. Continuous glucose monitoring (CGM) is another alternative to HbA1c. CGM allows one to assess mean glucose, glucose variability, and the time spent in hypo-, normo-, and hyperglycemia. Currently, several different CGM models are approved for use in patients receiving dialysis; CKD (not on dialysis) is not a contraindication in any of these models. Some devices are for blind recording, while others provide real-time data to patients. Small studies suggest that CGM could improve glycemic control in hemodialysis patients, but this has not been studied for individual CKD stages. Summary: Glycated albumin and CGM avoid the pitfalls of HbA1c in CKD and dialysis populations. However, the value of glycated albumin may be affected by several factors. CGM provides a precise estimation of the mean glucose. Here, we discuss the strengths and limitations for using HbA1c, glycated albumin, or CGM in CKD and dialysis population. Key Messages: Glycated albumin is an alternative glycemic marker but is affected by proteinuria. CGM provides a precise estimation of mean glucose and glucose variability. It remains unclear if CGM improves glycemic control in the CKD and dialysis populations.
The Choice of Population and Outcomes in Neonatal Trials on Hyperbilirubinemia: Are They Relevant? An Analysis of Cochrane Neonatal Reviews
Authors: Lai Nai Ming , Lee Shaun Wen Huey , Wai Sheng Xuan , Teh Zhi Wei , Chan Min Yao , Lim Yin Sear , Ovelman Colleen , Soll Roger
Published: December 2020

Background: Neonates with jaundice are usually managed according to their serum bilirubin despite an unclear overall correlation between bilirubin levels and patient-important outcomes (PIOs) such as kernicterus spectrum disorder (KSD). Objectives: We examined data from Cochrane Neonatal reviews to assess whether conditions that constituted KSD were included as key outcomes and how commonly they occurred in the population studied. Methods: We identified Cochrane reviews, published till November 2017 that evaluated interventions for neonatal jaundice (NNJ). We extracted the following information at the review and study levels: included population, outcomes assessed (in particular, whether PIOs such as KSD were listed as the primary outcomes), as well as their cumulative incidence in the reviews. Results: Out of 311 reviews, 11 evaluated interventions for NNJ with 78 randomized controlled trials (RCTs) included. Among the reviews, a total number of 148 outcomes were predefined and 30 (20.3%) were PIOs related to KSD, with 11 (36.7%) listed as primary outcomes. Among the 78 included RCTs (total participants = 8,232), 38 (48.7%) enrolled predominantly high-risk and 40 (51.3%) enrolled predominantly low-risk population. A total number of 431 outcomes were reported, and 40 (9.2%) were PIOs related to KSD (of which 37 were from studies with high-risk infants), with 13 (32.5%) listed as primary outcome. Cumulatively, no infant developed KSD across all studies. Conclusions: There is suboptimal representation of PIOs such as KSD in neonatal trials and Cochrane reviews on NNJ. Over half of the trials included populations with very low risk of KSD, which does not represent judicious use of resources. Amidst our continued search for a more reliable surrogate marker for NNJ, studies should evaluate the whole spectrum KSD alongside serum bilirubin in high-risk populations with sufficiently significant event rates, as this will make the trial methodologically feasible, with findings that will impact the population concerned.
Presence of Trichodynia Symptoms in Hair Diseases and Related Factors
Authors: Askin Ozge , Gok Ayse Mine , Serdaroglu Server
Published: December 2020

Background: Trichodynia can be described as a feeling of discomfort in the scalp. Studies on trichodynia also have different data. Aim: The aim of this study was to investigate the frequency and associated factors of trichodynia. Methods: A questionnaire was applied to 249 patients who were admitted to the Hair Diseases Unit of Istanbul University, Cerrahpaşa Hospital. We recorded the age, sex, hair loss duration, diagnosis, and whether or not patients had trichodynia symptoms. Results: Out of a total of 249 patients, 89 patients (35.7%) had trichodynia. We found that the mean age of patients with trichodynia was higher than the mean age of those without trichodynia. Trichodynia was more common in women than in men. In addition, it was more common in the cicatricial alopecia group than the other disease groups. Discussion: The frequency of trichodynia was significantly higher in women in comparison to that in men. Symptoms of trichodynia were significantly more common in patients with cicatricial alopecia in comparison to that in the other 4 diagnostic categories. There was no significant difference between the 4 diagnostic categories in terms of trichodynia severity.
Role of Body Weight in the Onset and the Progression of Idiopathic Premature Pubarche
Authors: Cavarzere Paolo , Mauro Margherita , Gaudino Rossella , Micciolo Rocco , Piacentini Giorgio , Antoniazzi Franco
Published: December 2020

Background: The term premature pubarche (PP) refers to the appearance of pubic hair before age 8 in girls and before age 9 in boys. Although idiopathic PP (often associated with premature adrenarche) is considered an extreme variation from the norm, it may be an initial sign of persistent hyperandrogenism. Factors contributing to PP onset and progression have not been identified to date. Aims: The objectives of this study are to describe a group of Italian children with PP, to identify potential factors for its onset, and to define its clinical and biochemical progression. Methods: We retrospectively enrolled all infants born between 2001 and 2014 with PP. Children with advanced bone age (BA) underwent functional tests to determine the cause of PP. Hormonal analysis and BA determination were performed annually during a 4-year follow-up period. Results: A total of 334 children with PP were identified: idiopathic PP (92.5%, associated with premature adrenarche in some cases); related to precocious puberty (6.6%); late-onset 21-hydroxylase deficiency (0.9%). Low birth weight was associated with premature adrenal activation. Body mass index (BMI) was the only factor that influenced the progression of BA during follow-up. Conclusions: Low birth weight is a predisposing factor for premature adrenal activation. The increase in BMI in patients with idiopathic PP during the 4-years of follow-up was responsible for BA acceleration. We recommend prevention of excessive weight gain in children with PP and strict adherence to follow-up in order to prevent serious metabolic consequences.
Clinicopathological Analysis of Acute/Active Antibody-Mediated Rejection in Renal Allografts According to the Banff 2013 Classification
Authors: Arai Taichi , Oguchi Hideyo , Shinoda Kazunobu , Sakurabayashi Kei , Mikami Tetuo , Itabashi Yoshihiro , Sakai Ken
Published: December 2020

Aim: This study evaluated the clinicopathological findings of acute/active antibody-mediated rejection (AABMR) according to the Banff 2013 classification. Methods: We analyzed 345 biopsies of 269 kidney transplant recipients. Pathological AABMR (PAABMR) was defined as histological evidence of acute tissue injury and endothelial injury by light microscopy regardless of donor-specific antibodies (DSAs). Results: Among the 345 biopsies, 29 (8.4%) were diagnosed as PAABMR. The mean g score was 1.17 ± 0.60, the mean ptc score was 1.97 ± 1.32, and DSA positivity was found in 69% of PAABMR. The mean duration after transplantation was 22.9 ± 26.7 months. Among 3 groups (DSA-high, mean fluorescence intensity (MFI) ≥ 5,000; DSA-low, MFI < 5,000 to ≥1,000; below cutoff), ABO incompatibility in DSA-high was significantly lower and second transplantation in DSA-high was significantly higher. We found 83% of PAABMR by the protocol biopsy (subclinical AABMR [SAABMR]). The short-term clinical and light microscopical changes in 8 cases of SAABMR did not show worsening during follow-up period (9–24 months). However, ultrastructural finding, including glomerular endothelial swelling, subendothelial electron-lucent widening, and early glomerular basement duplication, were found by electron microscopy (EM) in the first biopsies, and half of the SAABMR cases developed de novo circular peritubular capillary multilayering in the follow-up biopsies. Conclusion: PAABMR was mainly found by the protocol biopsy. The short-term follow-up of SAABMR patients did not show worsening clinically and light microscopically, but ultrastructural examination by EM was useful to detect early lesions of endothelial injury and progression of glomerular and peritubular capillary basement membrane alterations.
Prostatakarzinom: Die optimale Sequenz für die zweite und nachfolgende Therapielinien beim mCRPC ist noch nicht gefunden
Authors: Gschwend Jürgen E.
Published: December 2020

Die von Ronald de Wit 2019 im NEJM publizierte Arbeit [1] beschäftigt sich mit der Wirksamkeit und Sicherheit einer Cabazitaxel-Chemotherapie versus einer Androgenrezeptor-gerichteten Therapie (ART) mit Abirateron oder Enzalutamid bei Patienten mit einem kastrationsresistenten, metastasierten Prostatakarzinom (mCRPC). Es wurden 255 Patienten nach Vortherapie mit Docetaxel und einem ART 1:1 randomisiert und erhielten entweder eine Chemotherapie mit Cabazitaxel 25mg/m² intravenös in Kombination mit Prednison einmal täglich und G-CSF-Unterstützung oder einen weiteren ART (1000mg Abirateron/Prednison oder 160mg Enzalutamid täglich). Der primäre Endpunkte der Studie war das radiologische progressionsfreie Überleben (rPFS), sekundäre Endpunkte waren das Gesamtüberleben, das Therapieansprechen und die Sicherheit. Nach einer medianen Nachbeobachtung von 9,2 Monaten lag die radiologische Progressionsrate bei 73.6% unter Cabazitaxel und bei 80.2% unter ART. Dieser Unterschied war mit einer Hazard Ratio (HR) von 0,54 (95%CI 0,40–0,73) signifikant (p < 0.001) zugunsten von Cabazitaxel verbessert. Das mediane rPFS war für Cabazitaxel mit 8,0 versus 3,7 Monaten ebenfalls signifikant verbessert. Auch der sekundäre Endpunkt des Gesamtüberlebens war mit 13,6 versus 11,0 Monaten und einer HR von 0,64 (95%CI 0,46 – 0,89) signifikant besser (p = 0,008). Demgegenüber lag die Rate an Nebenwirkungen Grad ≥3 bei 56,3% für Cabazitaxel versus 52,4% für eine ART und war damit nicht unterschiedlich.
Implementation of Targeted Temperature Management After Out‐of‐Hospital Cardiac Arrest: Observations From the Los Angeles County Regional System
Authors: Hermel Melody , Bosson Nichole , Fang Andrea , French William J. , Niemann James T. , Sung Gene , Thomas Joseph L. , Shavelle David M.
Published: December 2020

Background

Despite the benefits of targeted temperature management (TTM) for out‐of‐hospital cardiac arrest), implementation within the United States remains low. The objective of this study was to evaluate the prevalence and factors associated with TTM use in a large, urban‐suburban regional system of care.

Methods and Results

This was a retrospective analysis from the Los Angeles County regional cardiac system of care serving a population of >10 million residents. All adult patients aged ≥18 years with non‐traumatic out‐of‐hospital cardiac arrest transported to a cardiac arrest center from April 2011 to August 2017 were included. Patients awake and alert in the emergency department and patients who died in the emergency department before consideration for TTM were excluded. The primary outcome measure was prevalence of TTM use. The secondary analysis were annual trends in TTM use over the study period and factors associated with TTM use. The study population included 8072 patients; 4154 patients (51.5%) received TTM and 3767 patients (46.7%) did not receive TTM. Median age was 67 years, 4780 patients (59.2%) were men, 4645 patients (57.5%) were non‐White, and the most common arrest location was personal residence in 4841 patients (60.0%). In the adjusted analysis, younger age, male sex, an initial shockable rhythm, witnessed arrest, and receiving coronary angiography were associated with receiving TTM.

Conclusions

Within this regional system of care, use of TTM was higher than previously reported in the literature at just over 50%. Use of integrated systems of care may be a novel method to increase TTM use within the United States.
Role of Computed Tomography Perfusion in Identification of Acute Lacunar Stroke Syndromes
Authors: Garcia-Esperon Carlos , Visser Milanka , Churilov Leonid , Miteff Ferdinand , Bivard Andrew , Lillicrap Thomas , Levi Christopher R. , Spratt Neil J. , Parsons Mark W.
Published: December 2020

Background and Purpose:

Lacunar syndromes correlate with a lacunar stroke on imaging in 50% to 60% of cases. Computed tomography perfusion (CTP) is becoming the preferred imaging modality for acute stroke triage. We aimed to estimate the sensitivity, specificity, and predictive values for noncontrast computed tomography and CTP in lacunar syndromes, and for cortical, subcortical, and posterior fossa regions.

Methods:

A retrospective analysis of confirmed ischemic stroke patients who underwent acute CTP and follow-up magnetic resonance imaging between 2010 and 2018 was performed. Brain noncontrast computed tomography and CTP were assessed independently by 2 stroke neurologists. Receiver operating characteristic curve analysis was performed to estimate sensitivity, specificity, and area under the curve (AUC) for the detection of strokes in patients with lacunar syndromes using different CTP maps.

Results:

We found 106 clinical lacunar syndromes, but on diffusion-weighted imaging, these consisted of 59 lacunar, 33 cortical, and 14 posterior fossa strokes. The discrimination of ischemia identification was very poor using noncontrast computed tomography in all 3 regions, but good for cortical (AUC, 0.82) and poor for subcortical and posterior regions (AUCs, 0.55 and 0.66) using automated core-penumbra maps. The addition of delay time and mean transient time maps substantially increased subcortical (AUC, 0.80) and slightly posterior stroke detection (AUC, 0.69).

Conclusions:

Analysis of mean transient time and delay time maps in combination with core-penumbra maps improves detection of subcortical and posterior strokes.