bluuebunny/crossref_metadata_2025 huggingface dataset:
The continuing failure of UK climate change mitigation policy
Authors: Somerville Peter
Published: October 2020

Failure to take climate change seriously enough has resulted in the world now facing a climate emergency, with rising global temperatures, melting polar ice caps, increasingly frequent and severe storms, floods and droughts, and rising sea levels. Despite being the first country in the world to set statutory carbon emissions reduction targets (in the Climate Change Act 2008), the UK government since 2012 has fallen increasingly behind, even by its own standards. This paper details what this has meant in terms of specific policies and identifies some of the reasons for this policy failure: in particular, a negative attitude towards regulation and a return to a reliance on market forces, plus an overriding concern to continue with ‘business as usual’, in terms of support for fossil-fuel industries and ever-increasing energy demand and supply. Ironically, this has resulted in a situation where radical solutions seem even more necessary and more urgent.
Negotiating the female successor–leader role within family business succession in China
Authors: Xian Huiping , Jiang Nan , McAdam Maura
Published: October 2020

This article explores the approaches of identity construction used by Chinese daughters while negotiating the successor–leader role within family businesses. A qualitative interpretivist approach was adopted to understand daughter views on gender, family business leadership and succession, as well as the approaches adopted to negotiate the role of female successor/leader in the Chinese family business. Twenty semi-structured interviews were conducted with both actual and potential female successors. Three approaches of identity construction emerged based on the degree of conformity to traditional gender roles and Confucian family values: first, to abide by conventional gender expectations and perceive themselves as a temporary leader; second, to act as the ‘second leader’ and remain involved in decision making and third, to challenge conventional gender roles and strive to be an independent leader. This article contributes to debates on women in family business and gendered identity construction of daughters in family business in the Chinese context.
Preoperative Opioid Use Is a Risk Factor for Revision Surgery, Complications, and Increased Resource Utilization After Arthroscopic Rotator Cuff Repair
Authors: Farley Kevin X. , Wilson Jacob M. , Spencer Corey C. , Karas Spero , Xerogeanes John , Gottschalk Michael B. , Wagner Eric R.
Published: October 2020

Background:

Studies have shown preoperative opioid use to influence outcomes after various surgical procedures. Researchers have not assessed this relationship after rotator cuff repair (RCR).

Hypothesis/Purpose:

The purpose was to assess the relationship between preoperative opioid use and outcomes after arthroscopic RCR. We hypothesized that patients prescribed higher daily averages of preoperative oral morphine equivalents (OMEs) would show increased rates of 90-day complications and 3-year revision surgery.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

The MarketScan claims database was utilized to identify patients who underwent arthroscopic RCR between 2009 and 2018. We used preoperative opioid use status to divide patients into groups based on the average daily OMEs consumed in the 6 months before surgery: opioid-naïve, <1, 1-<5, 5-<10, and ≥10 OMEs per day. We retrieved 90-day complication and 3-year revision surgery rates. Opioid use groups were then compared with binomial logistic regression and generalized linear models.

Results:

We identified 214,283 patients. Of those patients, 50.7% did not receive any preoperative opioids, while 7.7%, 26.8%, 6.3%, and 8.6% received <1, 1-<5, 5-<10, and ≥10 OMEs per day over a 6-month time period, respectively. Complications increased with increasing preoperative OMEs. Multivariate analysis revealed that any patient using ≥1 OME per day had increased rates of 3-year revision surgery, reoperations, and infections. Specifically, patients averaging ≥10 OMEs per day showed a 103% (odds ratio, 2.03 [95% CI, 1.62-2.54]; P < .001) increase in the odds of revision surgery compared with opioid-naïve patients. Rates of hospital admissions and postoperative emergency department encounters were higher in all opioid use groups. Adjusted differences in 6-month preoperative and 3-month postoperative health care costs were seen in the opioid use groups compared with opioid-naïve patients, ranging from US$1307 to US$5820 ( P < .001).

Conclusion:

Preoperative opioid use was a risk factor for complications and revision surgery after arthroscopic RCR. We also observed a dose-dependent response between opioid use and postoperative complications.
The Impact of a Cognitive and Motivational Reading Intervention on the Reading Achievement and Motivation of Students At-Risk for Reading Difficulties
Authors: McBreen Miriam , Savage Robert
Published: October 2020

This research assessed the impact of combining small-group cognitive reading intervention with a motivational program targeting students’ goals, emotions, and self-efficacy beliefs on the reading performance and motivation of third-grade students at risk for reading difficulties ( n = 25, Mage = 8.99, SD = 0.38). Using a quasi-experimental pre-test/post-test efficacy trial design, effects of the intervention on phonological awareness, listening comprehension, accuracy, fluency, reading comprehension, and motivation were assessed. Results indicate that compared with students who received Cognitive-Only reading intervention, students who received the combined Cognitive plus Motivational reading intervention showed greater gains in reading comprehension and phonological awareness. Findings provide preliminary evidence that supplementing cognitive reading intervention with the proposed motivational program can improve the reading performance of students at risk for reading difficulties.
Appetite-Regulating Hormones in Human Milk: A Plausible Biological Factor for Obesity Risk Reduction?
Authors: Larson-Meyer D. Enette , Schueler Jessica , Kyle Erin , Austin Kathleen J. , Hart Ann Marie , Alexander Brenda M.
Published: October 2020

Background

Human milk contains appetite-regulating hormones that may influence infant growth and obesity risk.

Research aims

We evaluated whether leptin, peptide tyrosine-tyrosine (PYY), glucagon-like peptide-1 (GLP-1), and ghrelin concentrations in human milk (1) changed during feeding (from foremilk to hindmilk) and during the first 6 months of infancy; (2) were explained by maternal factors; and (3) were associated with infant anthropometrics and growth.

Methods

Mother–infant dyads ( N = 22) participated. Samples of foremilk and hindmilk at 1 month postpartum were collected and analyzed for leptin, PYY, GLP-1, and ghrelin via radioimmunoassay and milkfat percentage estimated via creamatocrit. Samples were also collected in mothers ( n = 15) who breastfed through 6 months. Anthropometrics were obtained on all mother–infant dyads at 1 month and all infants at 6 months and 12 months.

Results

At 1 month, milk GLP-1 and milkfat concentration increased from foremilk to hindmilk ( p ≤ .05) while leptin and PYY concentrations remained stable during feeding. Milk hormone concentrations and milkfat tended to decline overtime, with lower leptin, PYY, and ghrelin at 6 months versus 1 month ( p < .05). At 1 month, milk leptin and milkfat content were associated with maternal markers of adiposity ( r = 0.49–0.78, p < .001); whereas, milk PYY was correlated with maternal serum PYY concentration ( r = 0.672, p = .001). Average 1-month milk concentrations of GLP-1 and leptin were negatively associated with weight-for-age z-scores at 6 months ( r = −0.46, p < .05) and 12 months ( r = −0.49, p < .05), respectively.

Conclusion

The content of certain appetite-regulating hormones in human milk may be influenced by maternal factors and play a role in infant growth; much needs to be learned about their role in the obesity protection of breastfed infants.
Macronutrient Composition of Donated Human Milk in a New Zealand Population
Authors: Lamb Rachael L. , Haszard Jillian J. , Little Helen M. J. , Franks Anthea F. , Meeks Maggie G.
Published: October 2020

Background

A primary role of human donor milk banks is to provide pasteurized human milk for the sick and preterm infant populations and to support the mothers of these infants as they establish their own milk supply. The results of human milk pasteurization continue to be studied to provide information that enables optimal nutrition in this sick and preterm population.

Research aims

The aims of our study were to determine macronutrient characteristics (fat, protein, carbohydrate) and energy content of human milk donated to the Christchurch Women’s Hospital Human Milk Bank in New Zealand, and the influence of Holder pasteurization on this macronutrient composition.

Methods

This was a retrospective, pre/post pasteurization observational design to describe the macronutrient content within two groups of donors, mature preterm PDM ( n = 13; 21%) and mature term PDM ( n = 50; 79%). Sixty three samples of human milk donated to the human milk bank by 27 registered participants (mothers of preterm and term infants) were analyzed. This analysis took place July–September 2018 using a human milk analyzer before and after Holder pasteurization (62.5 °C for 30 min).

Results

Preterm milk contained on average 76 kcal/100 ml energy, 4.0 g/100 ml fat, 1.1 g/100 ml protein and 8.2 g/100 ml total carbohydrate; and mature term milk contained 68 kcal/100 ml energy, 3.5 g/100 ml fat, 0.8 g/100 ml protein and 7.9 g/100 ml total carbohydrate. Wide variation between single, donor-pooled samples was demonstrated and there was no major result of pasteurization.

Conclusion

This research adds to the evidence regarding the macronutrient content of preterm and term milk and that these values are unaffected by Holder pasteurization. The variance in individual pooled donor human milk indicates the importance of determining the nutrient composition of donated milk to inform fortification procedures.
Drag reduction of 3D bluff body using SDBD plasma actuators
Authors: Kazemi Mostafa , Ghanooni Parisa , Mani Mahmoud , Saeedi Mohammad
Published: October 2020

In the current research, a series of different combinations of plasma SDBD actuators mounted on a simplified road vehicle have been experimentally studied to find the optimum position of the actuators for controlling the flow separation and reducing the vehicle form drag. Separation point of the flow over the rear ramp, large trailing vortices of the standard model, and laminar separation bubble (LSB) of the rear ramp leading edge are among the most significant factors to be controlled. The experiments were conducted at Reynolds numbers ranging from 0.55 × 106 to 1.11 × 106 in a subsonic wind tunnel while the pressure distribution over the model and its streamwise force balance were accurately measured. Significant drag reduction due to the use of DBD actuators was observed. As such, for the range of tested Reynolds numbers, a maximum of 25.1% of drag reduction in the vehicle drag coefficient could be achieved. The optimum combinations of activation voltages (6, 9, and 12 kV) and wave frequencies (6, 10, and 14 kHz) for plasma actuators were also found. Furthermore, it was observed that SDBD actuators mounted on the rear ramp of the model had a deeper impact on the vehicle drag coefficient compared to the other actuators.
Extreme flood events and their frequency variations during the middle to late-Holocene recorded in the sediment of Lake Suigetsu, central Japan
Authors: Suzuki Yoshiaki , Tada Ryuji , Nagashima Kana , Nakagawa Takeshi , Gotanda Katsuya , Haraguchi Tsuyoshi , Schlolaut Gordon
Published: October 2020

Many studies are reconstructing flood records in the continental margins during the middle to late-Holocene. However, distinguishing the frequency and magnitude of flood events was difficult. Light gray event layers (GELs) in the sediment of Lake Suigetsu in Central Japan can solve this problem because they are recording the occurrence and magnitude of flood events during the last 80 years. Using these GELs, we aimed to reconstruct the frequency and magnitude of flood events during the last 8000 years. First, we verified whether GELs maintained the recording of flood events. We found that thin GELs (less than 40 mg/cm2 in mass) were rare, probably because of bioturbation, whereas thick GELs (larger than 40 mg/cm2 in mass) were rarely erased. We also found that GELs formed by the same amount of rainfall could have been thinner before 100 years ago. We revealed that the occurrence of extreme flood-origin event layers (EFELs: GELs thicker than 40 mg/cm2) during the last 8000 years may indicate the occurrence of extreme flood events (EFEs). Mass accumulation of EFELs may indicate the minimum estimation of rainfall on EFEs. There are several periods with higher frequency and magnitude of EFEs than those of the present level, agreeing with the periods of high flood activity in western Japan and East China. The frequency and magnitude of EFEs show different temporal variations. Northward and southward shifts in the westerly jet and monsoon fronts can partially explain such patterns.
Transplantation of Adipose-Derived Stem Cells Alleviates Striatal Degeneration in a Transgenic Mouse Model for Multiple System Atrophy
Authors: Chang Christine , Liu Jen-Wei , Chen Bo Cheng , Jiang Zhe Sheng , Tu Chi Tang , Su Che Hung , Yang Hsin Han , Liu Zong Qi , Deng Yu Chen , Chen Chih Yu , Tsai Sheng-Tzung , Lin Shinn Zong , Chiou Tzyy-Wen
Published: October 2020

Patients with multiple system atrophy (MSA), a progressive neurodegenerative disorder of adult onset, were found less than 9 years of life expectancy after onset. The disorders include bradykinesia and rigidity commonly seen in Parkinsonism disease and additional signs such as autonomic dysfunction, ataxia, or dementia. In clinical treatments, MSA poorly responds to levodopa, the drug used to remedy Parkinsonism disease. The exact cause of MSA is still unknown, and exploring a therapeutic solution to MSA remains critical. A transgenic mouse model was established to study the feasibility of human adipose-derived stem cell (ADSC) therapy in vivo. The human ADSCs were transplanted into the striatum of transgenic mice via intracerebral injection. As compared with sham control, we reported significantly enhanced rotarod performance of transgenic mice treated with ADSC at an effective dose, 2 × 105 ADSCs/mouse. Our ex vivo feasibility study supported that intracerebral transplantation of ADSC might alleviate striatal degeneration in MSA transgenic mouse model by improving the nigrostriatal pathway for dopamine, activating autophagy for α-synuclein clearance, decreasing inflammatory signal, and further cell apoptosis, improving myelination and cell survival at caudate-putamen.
Clarification of the Role of miR-9 in the Angiogenesis, Migration, and Autophagy of Endothelial Progenitor Cells Through RNA Sequence Analysis
Authors: Zhu Jian , Sun Li-Li , Li Wen-Dong , Li Xiao-Qiang
Published: October 2020

We have previously reported that miR-9 promotes the homing, proliferation, and angiogenesis of endothelial progenitor cells (EPCs) by targeting transient receptor potential melastatin 7 via the AKT autophagy pathway. In this way, miR-9 promotes thrombolysis and recanalization following deep vein thrombosis (DVT). However, the influence of miR-9 on messenger RNA (mRNA) expression profiles of EPCs remains unclear. The current study comprises a comprehensive exploration of the mechanisms underlying the miR-9-regulated angiogenesis of EPCs and highlights potential treatment strategies for DVT. We performed RNA sequence analysis, which revealed that 4068 mRNAs were differentially expressed between EPCs overexpressing miR-9 and the negative control group, of which 1894 were upregulated and 2174 were downregulated. Gene ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses indicated that these mRNAs were mainly involved in regulating cell proliferation/migration processes/pathways and the autophagy pathway, both of which represent potential EPC-based treatment strategies for DVT. Reverse transcriptase quantitative polymerase chain reaction confirmed the changes in mRNA expression related to EPC angiogenesis, migration, and autophagy. We also demonstrate that miR-9 promotes EPC migration and angiogenesis by regulating FGF5 directly or indirectly. In summary, miR-9 enhances the expression of VEGFA, FGF5, FGF12, MMP2, MMP7, MMP10, MMP11, MMP24, and ATG7, which influences EPC migration, angiogenesis, and autophagy. We provide a comprehensive evaluation of the miR-9-regulated mRNA expression in EPCs and highlight potential targets for the development of new therapeutic interventions for DVT.
Comparative study of the crystallization behavior and morphologies of carbon and glass fiber reinforced poly(ether ether ketone) composites
Authors: Wang Pan , Lin Qing , Wang Yaming , Liu Chuntai , Shen Changyu
Published: October 2020

This work aims to perform a systematic investigation on the crystallization behavior and morphologies of carbon and glass fiber reinforced PEEK. The nonisothermal and isothermal crystallization behavior was investigated by differential scanning calorimetry (DSC). The resultant morphologies were assessed by wide angle X-ray diffraction (WAXD), small angle X-ray scattering (SAXS), and polarized optical microscopy (POM) to provide details on spherulitic level, crystalline structure at unit cell, and lamellar levels. It was found that the crystallization ability of carbon fiber filled PEEK was better than that of neat PEEK, while the behavior of glass fiber filled PEEK was in an opposite trend. The incorporation of carbon fiber (or glass fiber) led to a looser packing of the unit cell or a less crystal perfection of PEEK but did not change its crystal form as well as its long period of lamellae. The isothermal crystallization kinetics was analyzed by the Avrami model, suggesting that the crystallization mechanism of carbon fiber filled PEEK was different from that of neat PEEK and its glass fiber filled composites. Nevertheless, the POM results showed that fiber-induced transcrystallization in PEEK matrix was not evidenced for either carbon or glass fiber filled PEEK. Finally, the effect of carbon and glass fiber on the crystallization of PEEK matrix was discussed to some extent.
Embracing and Expanding Feminist Theory: (Re)conceptualizing Gender and Power
Authors: Brubaker Sarah Jane
Published: October 2020

In this commentary, I promote the continued value of feminist theory for understanding gendered violence. I examine the ways that the four articles featured in this special issue engage with feminist theory’s focus on gender and power. I argue that each concept is critical to feminist analysis and needs to be conceptualized as interconnected and operating at structural, interactional/relational, and individual levels. I further investigate the extent to which the articles do, or could, account for intimate partner violence in lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) lives, arguing that this is a necessary and critical step in our continued efforts to develop stronger theories of gendered violence. I end with a discussion of some implications of these articles and their conceptual contributions for future research.
Blood loss and coagulation profile in pregnant and non-pregnant queens undergoing elective ovariohysterectomy
Authors: Fudge James Mack , Page Bernie , Mackrell Amy , Lee Inhyung , Jeffery Unity
Published: October 2020

Objectives

The aims of this study were to determine if there is increased risk of intraoperative bleeding in pregnant cats undergoing elective ovariohysterectomy (OHE), and to compare coagulation in queens in various stages of estrus and pregnancy subjected to elective OHE using a whole-blood viscoelastic assay.

Methods

Intraoperative blood loss was compared between non-pregnant and pregnant cats undergoing elective OHE. Viscoelastic evaluations of whole blood drawn pre- and postoperatively were performed using a point-of-care device measuring clot time (CT), clot formation time (CFT), alpha angle, maximum clot formation (MCF), amplitude at 10 and 20 mins (A10 and A20, respectively), and lysis index at 30 and 45 mins after MCF (LI30 and LI45, respectively).

Results

One hundred and ninety-three cats underwent OHE by a ventral midline approach. Median blood loss was greater for pregnant cats (2.0 ml, range <0.5–13 ml) than non-pregnant cats (<0.5 ml, range <0.5–15 ml; P <0.0001). Preoperatively, pregnant cats had a shorter median CFT (165 s vs 190.5 s), increased median A10 (31 from 25.5 VCM units) and A20 (38 from 35 VCM units), and a lower median LI45 (99% from 100%) than non-pregnant cats. Postoperatively, A10 and A20 increased, and LI30 and LI45 decreased in both non-pregnant and pregnant queens. In pregnant queens, mean CT also increased postoperatively.

Conclusions and relevance

Pregnant cats were relatively hypercoagulable and had an increased rate of clot lysis than non-pregnant cats. Intraoperative blood loss was increased in pregnant vs non-pregnant cats, but no clinically relevant bleeding conditions occurred.
Numerical prediction of flow noise levels on towed sonar array
Authors: Karthik K , Jeyakumar S , Sebastin J Sarathkumar
Published: October 2020

Flow noise originating in the turbulent boundary layer (TBL) often severely limits the performance of towed sonar array. Therefore, it is necessary to predict this noise for the design of an efficient towed array. This paper presents large eddy simulation methodology to establish the TBL properties and wall pressure fluctuations on a 12 m long towed array with length to diameter ratio of 1200 in the operating tow speed range of 2 to 5 knots in water. The computed flow noise levels are compared with experimental measurements available in the literature successfully. The effectiveness of scaling the flow noise spectra with the diameter and tow speed is discussed, and non-dimensional wall pressure spectra presented with respect to non-dimensional frequency. The overall sound pressure levels are also compared with experimental data that show good accuracy achieved by the proposed numerical methodology.
Numerical investigation of geometrical parameters on the hydrodynamic noise characteristics of submerged bodies and comparisons with experiments
Authors: Bulut Sertaç , Ergin Selma
Published: October 2020

The effects of the geometrical parameters on the hydroacoustic characteristics of the flow over rectangular, square and circular cylinders are investigated by numerical analyses and experiments. The numerical simulations are carried out by using a hybrid method which combines RANS with FWH equation. In order to validate the numerical results, the hydroacoustic measurements are also performed for the circular cylinders. The circular cylinders with diameters of 9.5, 19.0, 38.0 and 65.0 mm and aspect ratios of 2.5, 5.0 and 10.0 are employed for the hydroacoustic measurements and analyses. The rectangular cylinders with side ratios of 0.3, 0.6, 1.8 and 3.0, and also square cylinder with the side ratio of 1.0 are considered in hydroacoustic analyses. The Reynolds numbers are in the range of 2.25 × 104 and 1.7 × 105. The hydroacoustic characteristics of the cylinders are obtained to be completely different due to the differences in the shear layer separation, reattachment mechanism and the intensity of disturbance. The shape of the noise spectrum significantly changes with the geometrical shapes of the cylinders. The spectrum becomes narrower by an increase in the side ratio. The main peak frequency reduces when the side ratio increases. The highest value of the maximum sound pressure level, SPLmax are observed for the square cylinder and the lowest value for the rectangular cylinder with the side ratio of 0.6. The peak spectrum becomes like a line spectrum as the cylinder diameter decreases. The main peak frequency decreases when the cylinder diameter increases but it is almost constant with the aspect ratio. At the constant Reynolds number, the broadband noise level and SPLmax decrease with an increase in the cylinder diameter and decrease in the aspect ratio. A good agreement between the numerical and experimental results are obtained.
Norm-based leadership and the challenge of democratically elected authoritarians
Authors: Spector Bert A
Published: October 2020

Across the post-World War II western liberal order, antidemocratic leaders have ascended to power through the ballot box and then engaged in an assault on prodemocratic norms. Commentators have worried that counter-normative behaviors will bring into existence a “new normal,” constructing an antidemocratic regimen in which future leaders will be freed to operate beyond either long-standing or newly created democratic expectations. In this article, I explore the matter of how and when incumbent leaders establish norms for future leaders. Normative leadership is typically presented as the capacity of leaders to set norms for the social units they are heading. Less examined but vital to the understanding of how leadership is enacted is the question of how prevailing norms create opportunities and limitations on the exercise of leadership. Leaders set norms not only just for their followers but also for future leaders. With particular attention to the norm breaking of Donald Trump in the United States, I examine a pattern of norm setting, norm breaking, and norm resetting that has unfolded at the presidential level. Whatever norms Trump, or any authoritarian leaders, may break during their incumbency, the setting of new norms will rely on a network of actors: not only just future leaders but also representatives of institutions (the courts, military, press, congress, etc.) as well as voters.
Management dilemmas in pineoblastoma recurrence diagnosed during pregnancy
Authors: Garg Sonal , Maurya Dilip K , Sasidharan Gopalakrishnan M , Prem Shyama S , Ganesan Prasanth , Govindarajalou Ramkumar , Plakkal Nishad , Keepanasseril Anish
Published: October 2020

Pineoblastoma is an extremely rare intracranial neoplasm, with increased risk of craniospinal metastasis. There is only one case reported in the literature who presented during pregnancy. Described here is a woman who presented at five months of gestation with recurrence of pineoblastoma, who had previously defaulted adjuvant therapy following surgical decompression. The challenges in the diagnosis and treatment of pineoblastoma and its effects on pregnancy are also discussed.
The effects of telemedicine on the quality of life of patients with lung cancer: a systematic review and meta-analysis
Authors: Pang Lanlan , Liu Zefu , Lin Sheng , Liu Zhidong , Liu Hengyu , Mai Zihang , Liu Zhuowei , Chen Chongxiang , Zhao Qingyu
Published: October 2020

Background and aims:

Lung cancer patients suffer from deterioration in their physical and psychological function, which exerts a negative influence on their quality of life (QOL). Telemedicine has been proven to be an effective intervention for patients with several chronic diseases. The aim of this systematic review and meta-analysis was to investigate the efficacy of telemedicine in improving QOL in lung cancer patients.

Methods:

PubMed, Cochrane Library, EMBASE, Web of Science and Scopus databases were searched for randomized controlled trials that investigated the effectiveness of telemedicine in lung cancer patients. Review Manager 5.3 and Stata 15.1 were used to perform data analysis.

Results:

Our meta-analysis included eight clinical trials with a total of 635 lung cancer patients. The results showed that the telemedicine group had significantly higher QOL than the usual care group [standard mean difference (SMD) 0.96, 95% confidence interval (CI) 0.29–1.63, I2 = 91%]. In addition, the telemedicine group had lower anxiety (SMD −0.44, 95% CI −0.66 to −0.23, I2 = 3%) and depression scores (SMD −0.48, 95% CI −0.91 to −0.05, I2 = 66%) than the usual care group. However, no significant differences were found in fatigue and pain outcomes between the two groups.

Conclusion:

Telemedicine may be an effective method of improving QOL in lung cancer patients and the further development and use of telemedicine care is recommended.
Can Machine Learning Accurately Predict Postoperative Compensation for the Uninstrumented Thoracic Spine and Pelvis After Fusion From the Lower Thoracic Spine to the Sacrum?
Authors: Lee Nathan J. , Sardar Zeeshan M. , Boddapati Venkat , Mathew Justin , Cerpa Meghan , Leung Eric , Lombardi Joseph , Lenke Lawrence G. , Lehman Ronald A.
Published: October 2020

Study Design:

Consecutively collected cases.

Objective:

To determine if a machine-learning (ML) program can accurately predict the postoperative thoracic kyphosis through the uninstrumented thoracic spine and pelvic compensation in patients who undergo fusion from the lower thoracic spine (T10 or T11) to the sacrum.

Methods:

From 2015 to 2019, a consecutive series of adult (≥18 years old) patients with adult spinal deformity underwent corrective spinal fusion from the lower thoracic spine (T10 or T11) to the sacrum. Deidentified data was processed by a ML system-based platform to predict the postoperative thoracic kyphosis (TK) and pelvic tilt (PT) for each patient. To validate the ML model, the postoperative TK (T4-T12, instrumented thoracic, and uninstrumented thoracic) and the pelvic tilt were compared against the predicted values.

Results:

A total of 20 adult patients with a minimum 6-month follow-up (mean: 22.4 ± 11.3 months) were included in this study. No significant differences were observed for TK (predicted 37.6° vs postoperative 38.3°, P = .847), uninstrumented TK (predicted 33.9° vs postoperative 29.8°, P = .188), and PT (predicted 23.4° vs postoperative 22.7°, P = .754). The predicted PT and the TK of the uninstrumented thoracic spine correlated well with postoperative values (uninstrumented TK: R2 = 0.764, P < .001; PT: R2 = 0.868, P < .001). The mean error with which kyphosis through the uninstrumented thoracic spine can be measured was 4.8° ± 4.0°. The mean error for predicting PT was 2.5° ± 1.7°.

Conclusion:

ML algorithms can accurately predict the spinopelvic compensation after spinal fusion from the lower thoracic spine to the sacrum. These findings suggest that surgeons may be able to leverage this technology to reduce the risk of proximal junctional kyphosis in this population.
Tobacco Use Is Associated With Increased 90-Day Readmission Among Patients Undergoing Surgery for Degenerative Spine Disease
Authors: Connor Michelle , Briggs Robert G. , Bonney Phillip A. , Lamorie-Foote Krista , Shkirkova Kristina , Min Elliot , Ding Li , Mack William J. , Attenello Frank J. , Liu John C.
Published: October 2020

Study Design:

Retrospective database study.

Objective:

Tobacco use is associated with complications after surgical procedures, including poor wound healing, surgical site infections, and cardiovascular events. We used the Nationwide Readmissions Database (NRD) to determine if tobacco use is associated with increased 30- and 90-day readmission among patients undergoing surgery for degenerative spine disorders.

Methods:

Patients who underwent elective spine surgery were identified in the NRD from 2010 to 2014. The study population included patients with degenerative spine disorders treated with discectomy, fusion, or decompression. Descriptive and multivariate logistic regression analyses were performed to identify patient and hospital factors associated with 30- and 90-day readmission, with significance set at P value <.001.

Results:

Within 30 days, 4.8% of patients were readmitted at a median time of 9 days. The most common reasons for 30-day readmission were postoperative infection (12.5%), septicemia (3.5%), and postoperative pain (3.0%). Within 90 days, 7.3% were readmitted at a median time of 18 days. The most common reasons for 90-day readmission were postoperative infection (9.6%), septicemia (3.5%), and pneumonia (2.3%). After adjustment for patient and hospital characteristics, tobacco use was independently associated with readmission at 90 days (odds ratio 1.05, 95% confidence interval 1.03-1.07, P < .0001) but not 30 days (odds ratio 1.02, 95% confidence interval 1.00-1.05, P = .045).

Conclusions:

Tobacco use is associated with readmission within 90 days after cervical and thoracolumbar spine surgery for degenerative disease. Tobacco use is a known risk factor for adverse health events and therefore should be considered when selecting patients for spine surgery.
Association between Dental Anomalies and Orofacial Clefts: A Meta-analysis
Authors: Marzouk T. , Alves I.L. , Wong C.L. , DeLucia L. , McKinney C.M. , Pendleton C. , Howe B.J. , Marazita M.L. , Peter T.K. , Kopycka-Kedzierawski D.T. , Morrison C.S. , Malmstrom H. , Wang H. , Shope E.T.
Published: October 2020

Objectives:

To conduct a systematic review and meta-analysis to assess whether individuals with nonsyndromic orofacial clefts (OCs) display a higher frequency of dental anomalies (DAs) when compared with individuals without OCs.

Methods:

A literature search of indexed databases (PubMed, Cochrane, Web of Science, Embase, Scopus, and LILACS) was conducted without language restriction up to and including February 1, 2020. Cross-referencing was used to further identify articles. Several cleft teams across the United States and Europe were contacted to obtain unpublished data. The eligibility criteria were observational studies with original data that statistically compared individuals with OC without syndromes and those without OC on any type of DA in primary and/or permanent dentition. Random effects meta-analysis through the Mantel-Haenszel estimator was used to evaluate the association between OC and DA based on odds ratios (ORs) with 95% confidence intervals (CIs).

Results:

The literature search generated 933 records, and 75 full-text articles were reviewed. Twenty-six studies encompassing 15,213 individuals met the inclusion criteria. The meta-analysis revealed statistically significant associations between OC and agenesis (OR, 14.2; 95% CI, 9.4 to 21.3), supernumerary teeth (OR, 5.7; 95% CI, 3.3 to 9.7), developmental enamel defects (OR, 5.6; 95% CI, 3.5 to 9.0), microdontia (OR, 14.8; 95% CI, 4.0 to 54.6), peg-shaped anterior teeth (OR, 12.2; 95% CI, 3.6 to 41.2), taurodontism (OR, 1.7; 95% CI, 1.0 to 2.7), tooth malposition and/or transposition (OR, 5.6; 95% CI, 2.8 to 11.5), tooth rotation (OR, 3.2; 95% CI, 1.3 to 8.2), and tooth impaction (OR, 3.6; 95% CI, 1.1 to 12.2). The OR estimates of the reviewed studies exhibited significant heterogeneity ( P < 0.0001). No association was observed between OC and fusion and/or gemination.

Conclusion:

Within the limitations of this study, the available evidence suggests that individuals with OCs are more likely to present with a range of DAs than their unaffected peers.

Knowledge Transfer Statement:

The findings of the current review suggest that individuals with orofacial clefts (OCs) are more likely to present with a range of dental anomalies than their unaffected peers. Understanding the association between OCs and dental anomalies is essential in guiding clinicians during treatment-planning procedures and is important in raising our awareness of the possible need for future dental treatment for patients with OCs.
Sonography and Test-Feeding in the Diagnosis of Infantile Hypertrophic Pyloric Stenosis
Authors: Gilani Syed Amir , Bacha Raham , Manzoor Iqra
Published: October 2020

Objective:

To determine the use of sonography and test-feeding in the diagnosis of infantile hypertrophic pyloric stenosis (IHPS).

Methodology:

A total of 79 infants from 2 weeks up to 12 weeks presenting with clinical signs (projectile vomiting) of IHPS were included in the study while sent to sonography. The study duration was February 2014 to December 2019.

Results:

The mean age of patients was 5.18 ± 2.69 weeks ranging from 1 to 12 weeks. Male gender was predominant with 62 (78.5%) cases. Of the total 79 cases, 36 (54.6%) were suggested as positive cases of IHPS and 43 (54.4%) were as normal with sonography. Most of the cases of IHPS (23; 29.1%) were observed in firstborn babies. Mean pyloric length in normal and IHPS was 12.69 ± 0.87 and 20.78 ± 2.28 mm, respectively, and mean pyloric muscle thickness in the normal and IHPS was 2.24 ± 0.36 and 5.27 ± 0.82 mm, respectively, while mean pyloric diameter in normal and IHPS was 12.69 ±0.87 and 15.01± 2.52 mm, respectively.

Conclusion:

The reliability of sonographic findings was better than test-feeding in the diagnosis of IHPS. Male infants, in this cohort, were five times more susceptible to develop IHPS, compared with females.
Sonographic Assessment of Umbilical Cord Diameter as an Indicator of Fetal Growth and Perinatal Outcome
Authors: Udoh Benjamin E. , Erim Akwa , Anthony Ekanem
Published: October 2020

Objective:

To determine whether the assessment of umbilical cord diameter (UCD) is a viable indicator of fetal growth and perinatal outcome.

Material and Methods:

A total of 652 singleton pregnancies between 10 and 40 weeks of gestation were reviewed for this study. The UCD was measured vertically in the longitudinal section, adjacent to its insertion at the fetal abdomen. Other fetal biometrics were measured according to standard measurement protocols. The perinatal outcome of each patient case was also recorded.

Result:

The UCD ranged between 0.73 and 1.68 cm, and correlated positively with gestational age, estimated fetal weight ( r = 0.779, r = 0.639, P < .05), and other fetal biometrics. The UCD of 50 subjects was 2 standard deviations below the mean and correlated significantly ( r = 0.712, P < .05) with poor fetal outcome in the first and second trimester. Observational studies of 50 subjects, whose UCD was 2 standard deviations below the mean, resulted in 21 cases of intrauterine fetal death, 10 cases of preeclampsia, 8 cases of oligohydramnios, and 11 cases of intrauterine growth restriction.

Conclusion:

The UCD has the potential to serve as an important indicator of fetal growth, well-being, and perinatal outcome.
Immune recovery in patients with mantle cell lymphoma receiving long-term ibrutinib and venetoclax combination therapy
Authors: Davis Joanne E. , Handunnetti Sasanka M. , Ludford-Menting Mandy , Sharpe Chia , Blombery Piers , Anderson Mary Ann , Roberts Andrew W. , Seymour John F. , Tam Constantine S. , Ritchie David S. , Koldej Rachel M.
Published: October 2020

Combination venetoclax plus ibrutinib for the treatment of mantle cell lymphoma (MCL) has demonstrated efficacy in the relapsed or refractory setting; however, the long-term impact on patient immunology is unknown. In this study, changes in immune subsets of MCL patients treated with combination venetoclax and ibrutinib were assessed over a 4-year period. Multiparameter flow cytometry of peripheral blood mononuclear cells showed that ≥12 months of treatment resulted in alterations in the proportions of multiple immune subsets, most notably CD4+ and CD8+ effector and central memory T cells and natural killer cells, and normalization of T-cell cytokine production in response to T-cell receptor stimulation. Gene expression analysis identified upregulation of multiple myeloid genes (including S100 and cathepsin family members) and inflammatory pathways over 12 months. Four patients with deep responses stopped study drugs, resulting in restoration of normal immune subsets for all study parameters except myeloid gene/pathway expression, suggesting long-term combination venetoclax and ibrutinib irreversibly affects this population. Our findings demonstrate that long-term combination therapy is associated with immune recovery in MCL, which may allow responses to subsequent immunotherapies and suggests that this targeted therapy results in beneficial impacts on immunological recovery. This trial was registered at www.clinicaltrials.gov as #NCT02471391.
Lung ultrasound findings in patients with novel SARS-CoV-2
Authors: Haaksma Mark E. , Heldeweg Micah L.A. , Lopez Matta Jorge E. , Smit Jasper M. , van Trigt Jessica D. , Nooitgedacht Jip S. , Elzo Kraemer Carlos V. , van de Wiel Mark , Girbes Armand R.J. , Heunks Leo , van Westerloo David J. , Tuinman Pieter R.
Published: October 2020

Background

Over 2 million people worldwide have been infected with severe acute respiratory distress syndrome-coronavirus-2 (SARS CoV-2). Lung ultrasound has been proposed to diagnose and monitor it, despite the fact that little is known about the ultrasound appearance due to the novelty of the illness. The aim of this manuscript is to characterise the lung ultrasonographic appearance of critically ill patients with SARS-CoV-2 pneumonia, with particular emphasis on its relationship with the time course of the illness and clinical parameters.

Methods

Adult patients from the intensive care unit of two academic hospitals who tested positive for SARS-CoV-2 were included. Images were analysed using internationally recognised techniques which included assessment of the pleura, number of B-lines, pathology in the PLAPS (posterolateral alveolar and/or pleural syndrome) point, bedside lung ultrasound in emergency profiles, and the lung ultrasound score. The primary outcomes were frequencies, percentages and differences in lung ultrasound findings overall and between short (≤14 days) and long (>14 days) durations of symptoms and their correlation with clinical parameters.

Results

In this pilot observational study, 61 patients were included with 76 examinations available for analysis. 26% of patients had no anterior lung abnormalities, while the most prevalent pathological ultrasound findings were thickening of the pleura (42%), ≥3 B-lines per view (38%) and presence of PLAPS (74%). Patients with “long” duration of symptoms presented more frequently with a thickened and irregular pleura (32 (21%)versus11 (9%)), C-profile (18 (47%)versus8 (25%)) and pleural effusion (14 (19%)versus3 (5%)), compared to patients with short duration of symptoms. Lung ultrasound findings did not correlate with arterial oxygen tension/inspiratory oxygen fraction ratio, fluid balance or dynamic compliance.

Conclusion

SARS-CoV-2 results in significant, but not specific, ultrasound changes, with decreased lung sliding, thickening of the pleura and a B-profile being the most commonly observed. With time, a thickened and irregular pleura, C-profile and pleural effusion become more common findings. When screening patients, a comprehensive ultrasound protocol might be necessary.
Oscillometry and computed tomography findings in patients with idiopathic pulmonary fibrosis
Authors: Yamamoto Yuji , Miki Keisuke , Tsujino Kazuyuki , Kuge Tomoki , Okabe Fukuko , Kawasaki Takahiro , Matsuki Takanori , Kagawa Hiroyuki , Miki Mari , Kida Hiroshi
Published: October 2020

Although the utility of oscillometry for predicting disease severity in idiopathic pulmonary fibrosis (IPF) had been researched, little has been reported on the mechanism of why respiratory impedance reflects disease severity. In addition, traction bronchiectasis has been considered to reduce respiratory resistance and correlate negatively with airflow obstruction, but this hypothesis has not been validated. The present study aimed to investigate the correlations between oscillometric parameters and fibrosis-related lung abnormalities in IPF and to assess the utility of oscillometry as a surrogate marker for traction bronchiectasis and airflow obstruction.

Eighty Japanese patients with IPF underwent high-resolution computed tomography (HRCT), spirometry, and oscillometry and were retrospectively investigated. Fibrosis-related HRCT findings were scored regarding airspace consolidation, honeycombing, architectural distortion, traction bronchiectasis, and fibrosis. Correlations between the HRCT scores, spirometric parameters, and oscillometric parameters were analysed.

Respiratory reactance correlated positively with all fibrosis-related HRCT scores. Vital capacity and forced vital capacity (FVC) correlated negatively with oscillometric parameters and HRCT scores, reflecting the severity of restrictive ventilatory deficiency. Respiratory resistance was not related to any of the HRCT scores or forced expiratory volume in 1 s/FVC. However, forced expiratory volume in 1 s/FVC correlated positively with HRCT scores, which showed that airflow obstruction became milder as the disease progressed.

In conclusion, respiratory reactance reflects fibrosis and restrictive ventilatory deficiency in IPF. Moreover, respiratory resistance is independent of traction bronchiectasis and airflow obstruction in patients with IPF, which implies that respiratory resistance might reflect different properties of the airways.
Epigenome-wide association study on diffusing capacity of the lung
Authors: Terzikhan Natalie , Xu Hanfei , Edris Ahmed , Bracke Ken R. , Verhamme Fien M. , Stricker Bruno H.C. , Dupuis Josée , Lahousse Lies , O'Connor George T. , Brusselle Guy G.
Published: October 2020

Background

Epigenetics may play an important role in the pathogenesis of lung diseases. However, little is known about the epigenetic factors that influence impaired gas exchange at the lung.

Aim

To identify the epigenetic signatures of the diffusing capacity of the lung measured by carbon monoxide uptake (the diffusing capacity of the lung for carbon monoxide (DLCO)).

Methods

An epigenome-wide association study (EWAS) was performed on diffusing capacity, measured by carbon monoxide uptake (DLCO) and per alveolar volume (VA) (asDLCO/VA), using the single-breath technique in 2674 individuals from two population-based cohort studies. These were the Rotterdam Study (RS, the “discovery panel”) and the Framingham Heart Study (FHS, the “replication panel”). We assessed the clinical relevance of our findings by investigating the identified sites in whole blood and by lung tissue specific gene expression.

Results

We identified and replicated two CpG sites (cg05575921 and cg05951221) that were significantly associated withDLCO/VAand one (cg05575921) suggestively associated withDLCO. Furthermore, we found a positive association between aryl hydrocarbon receptor repressor (AHRR) gene (cg05575921) hypomethylation and gene expression of exocyst complex component 3 (EXOC3) in whole blood. We confirmed that the expression ofEXOC3in lung tissue is positively associated withDLCO/VAandDLCO.

Conclusions

We report on epigenome-wide associations with diffusing capacity in the general population. Our results suggest EXOC3 to be an excellent candidate, through which smoking-induced hypomethylation ofAHRRmight affect pulmonary gas exchange.