bluuebunny/crossref_metadata_2025 huggingface dataset:
Neuropsychological characteristics of adults with attention‐deficit/hyperactivity disorder without intellectual disability
Authors: Hida Masami , Hayashi Wakaho , Okajima Yuka , Takashio Osamu , Iwanami Akira
Published: August 2020

Aims

While several studies have reported various cognitive impairments in children with attention‐deficit/hyperactivity disorder, the neuropsychological profiles of adults with this disorder are understudied. Here, the intelligence and memory functions of adults with attention‐deficit/hyperactivity disorder without intellectual disability were evaluated.

Methods

The Wechsler Adult Intelligence Scale—Third Edition and Wechsler Memory Scale—Revised were administered to 30 adults with attention‐deficit/hyperactivity disorder whose full‐scale intelligence quotients were >85. Diagnoses were based on the Diagnostic and Statistical Manual of Mental Disorders‐IV criteria. Conners' Adult ADHD Rating Scales—Self‐Report—screening version and the Autism Spectrum Quotient were also evaluated.

Results

In the Wechsler Adult Intelligence Scale—Third Edition, the verbal intelligence quotient was significantly higher than the performance intelligence quotient and the verbal comprehension score was the highest among the secondary indices. In the Wechsler Memory Scale—Revised, the visual memory score was the highest measure. Although the verbal intelligence quotient had no correlation with any Wechsler Memory Scale—Revised measures, the performance intelligence quotient was significantly correlated with the visual memory and attention scores of the Wechsler Memory Scale—Revised. Conners' Adult ADHD Rating Scales hyperactive‐impulsive score was significantly correlated with the verbal intelligence quotient, whereas the inattention score was not correlated with any measures of the Wechsler Adult Intelligence Scale—Third Edition or Wechsler Memory Scale—Revised.

Conclusions

The results suggest that while adults with normal‐intelligence attention‐deficit/hyperactivity disorder have comparatively high verbal comprehension and social knowledge, their ability of information processing and visual‐motor coordination are relatively weak.
On the nature of thiamine triphosphate in Arabidopsis
Authors: Hofmann Manuel , Loubéry Sylvain , Fitzpatrick Teresa B.
Published: August 2020

Vitamin B1 is a family of molecules, the most renowned member of which is diphosphorylated thiamine (TDP)—a coenzyme vital for the activity of key enzymes of energy metabolism. Triphosphorylated thiamine derivatives also exist within this family, specifically thiamine triphosphate (TTP) and adenosine thiamine triphosphate (ATTP). They have been investigated primarily in mammalian cells and are thought to act as metabolic messengers but have not received much attention in plants. In this study, we set out to examine for the presence of these triphosphorylated thiamine derivatives in Arabidopsis. We could find TTP in Arabidopsis under standard growth conditions, but we could not detect ATTP. Interestingly, TTP is found primarily in shoot tissue. Drivers of TTP synthesis are light intensity, the proton motive force, as well as TDP content. In plants, TTP accumulates in the organellar powerhouses, the plastids, and mitochondria. Furthermore, in contrast to other B1 vitamers, there are strong oscillations in tissue levels of TTP levels over diel periods peaking early during the light period. The elevation of TTP levels during the day appears to be coupled to a photosynthesis‐driven process. We propose that TTP may signify TDP sufficiency, particularly in the organellar powerhouses, and discuss our findings in relation to its role.
How the Reading for Understanding Initiative’s Research Complicates the Simple View of Reading Invoked in the Science of Reading
Authors: Cervetti Gina N. , Pearson P. David , Palincsar Annemarie S. , Afflerbach Peter , Kendeou Panayiota , Biancarosa Gina , Higgs Jennifer , Fitzgerald Miranda S. , Berman Amy I.
Published: August 2020

Advocates of the science of reading have invoked the simple view of reading (SVR) to justify an approach that foregrounds decoding in early reading instruction. The SVR, which describes comprehension as the product of decoding and listening comprehension, also served as the primary theoretical model underlying the Reading for Understanding (RfU) initiative. Research funded under the RfU initiative included direct examinations of the validity of the SVR and the nature of its underlying components and extended the SVR in studies of middle school and high school readers. In this article, the authors use research conducted under the RfU initiative to examine the validity and utility of the SVR, in general, and the appropriateness of its application in the “science of reading” debate. RfU research has provided not only evidence in support of the overall SVR model but also important cautions relevant to the “science of reading” debate. In particular, RfU has provided evidence regarding the significance of the listening comprehension component of the SVR, often overlooked by advocates of the science of reading. This research has documented the importance of early oral language skills, which support both decoding and listening comprehension in young readers and plays a critical role in students’ success as readers as they move through school. In addition, RfU research has identified a complicated constellation of skills and knowledge that impact reading comprehension as students advance in school.
Blast polytrauma with hemodynamic shock, hypothermia, hypoventilation and systemic inflammatory response: description of a new porcine model
Authors: Dahlquist Albin , Elander Degerstedt Louise , von Oelreich Erik , Brännström Andreas , Gustavsson Jenny , P. Arborelius Ulf , Günther Mattias
Published: August 2020

Purpose

In the past decade blast injuries have become more prevalent. Blast trauma may cause extensive injuries requiring improved early resuscitation and prevention of haemorrhage. Randomized prospective trials are logistically and ethically challenging, and large animal models are important for further research efforts. Few severe blast trauma models have been described, which is why we aimed to establish a comprehensive polytrauma model in accordance with the criteria of the Berlin definition of polytrauma and with a survival time of > 2 h. Multiple blast injuries to the groin and abdomen were combined with hypoperfusion, respiratory and metabolic acidosis, hypoventilation, hypothermia and inflammatory response. The model was compared to lung contusion and haemorrhage.

Methods

16 landrace swine (mean weight 60.5 kg) were randomized to “control” (n = 5), “chest trauma/hem” by lung contusion and class II haemorrhage (n = 5), and “blast polytrauma” caused by multiple blast injuries to the groin and abdomen, class II haemorrhage, lipopolysaccharide (LPS) infusion and hypothermia 32 °C (n = 6).

Results

The blast polytrauma group had an Injury Severity Score of 57 which resulted in haemodynamic shock, hypothermia, respiratory and metabolic acidosis and inflammatory response. The chest trauma/hem group had an Injury Severity Score of 9 and less profound physiologic effects. Physiologic parameters presented a dose–response relationship corresponding to the trauma levels.

Conclusion

A comprehensive blast polytrauma model fulfilling the Berlin polytrauma criteria, with a high trauma load and a survival time of > 2 h was established. A severe, but consistent, injury profile was accomplished enabling the addition of experimental interventions in future studies, particularly of immediate resuscitation efforts including whole blood administration, trauma packing and haemostasis.
Treatment of medial-sided injuries in patients with early bicruciate ligament reconstruction for knee dislocation
Authors: Jokela Mikko A. , Mäkinen Tatu J. , Koivikko Mika P. , Lindahl Joonas M. , Halinen Jyrki , Lindahl Jan
Published: August 2020

Purpose

In knee dislocation with bicruciate ligament and medial side injury (KDIIIM), treatment method of medial side injuries is controversial. The purpose of this study was to evaluate the outcomes of non-operative treatment of proximal and midsubstance and operative treatment of distal avulsion medial collateral ligament (MCL) ruptures in patients with early bicruciate reconstruction.

Methods

One-hundred and forty-seven patients with a knee dislocation and bicruciate ligament injury (KDII-KDV) were identified. Sixty-two patients had KDIIIM injury. Of these, 24 patients were excluded and 13 were lost to follow-up. With a minimum of 2 years of follow-up, IKDC2000 (subjective and objective), Lysholm and Tegner scores and stress radiographs were recorded.

Results

Twenty-five patients were available for follow-up: 18 had a proximal or midsubstance grade-III MCL rupture (proximal MCL group) and 7 had a distal MCL avulsion (distal MCL group). In the proximal MCL and distal MCL groups, respectively, median IKDC2000 subjective scores were 80 (range 57–99) and 62 (range 39–87), and median Lysholm scores were 88 (range 57–99) and 75 (range 40–100). The median medial opening (side-to-side difference) was 2.4 mm (range 0.1–9.2) in the proximal MCL group and 2.5 mm (range 0.2–4.8) in the distal MCL group.

Conclusion

We found acceptable recorded outcomes in patients who underwent non-operative treatment of proximal and midsubstance grade-III MCL rupture and operative treatment of distal MCL avulsion with early bicruciate ligament reconstruction.

Level of evidence

Level IV
Microvascular decompression for trigeminal neuralgia in the elderly: efficacy and safety
Authors: Greve Tobias , Tonn Joerg-Christian , Mehrkens Jan-Hinnerk
Published: August 2020

Objective

The safety and efficacy of surgical microvascular decompression (MVD) in elderly patients with trigeminal neuralgia (TN) is controversially discussed in the literature. A widespread reluctance to expose this cohort to major intracranial surgery persists. Our aim was to compare the efficacy and safety between older and younger patients with TN.

Methods

In this cross-sectional study, 139 MVD procedures (103 patients < 70 and 36 patients ≥ 70) were included. Surgical fitness was assessed by the American Society of Anesthesiology (ASA) grade. The pain-free interval was evaluated using Kaplan–Meier analysis only in patients with a recent follow-up visit. Independent risk factors for recurrence in patients with a minimum 12-month follow-up were determined.

Results

Patients ≥ 70 showed a significantly higher number of comorbidities. Pain intensity, affection of trigeminal branches and symptom duration was similar between groups. No significant difference in treatment associated complications and permanent neurological deficits was shown. There was no treatment-related mortality. A tendency towards a lower recurrence rate in patients < 70 did not reach statistical significance (17.6% vs. 28.6%, P = 0.274). Pain-free interval was not different between both cohorts (78.7 vs. 73.5 months, P = 0.391).

Conclusion

Despite a higher prevalence of comorbidities in elderly patients, complication rates and neurological deficits after MVD were comparable to younger patients. Rates of immediate and long-term pain relief compared favorably to previous studies and were similar between elderly and younger patients. These data endorse MVD as a safe and effective first-line surgical procedure for elderly patients with TN and neurovascular conflict on MRI.
Electron Nuclear Double Resonance of the Chlorophyll Triplet State in the Water-Soluble Chlorophyll Protein from Brassica oleracea: Investigation of the Effect of the Binding Site on the Hyperfine Couplings
Authors: Agostini Alessandro , Palm Daniel M. , Paulsen Harald , Di Valentin Marilena , Carbonera Donatella
Published: August 2020

An investigation of the photoexcited triplet state of chlorophyll (Chl) a in the water-soluble chlorophyll protein (WSCP) of Brassica oleracea has been carried out by means of electron-nuclear double resonance (ENDOR), achieving a complete assignment of the observed hyperfine couplings corresponding to methine protons and methyl groups of Chl a triplet state. The triplet-state properties, and in particular the hyperfine couplings, were found to be similar to those previously reported for Chl a in the WSCP of Lepidium virginicum. Therefore, the porphyrin ring deformation observed in Brassica oleracea WSCP seems to only slightly affect the spin density of 3Chl a. This may be relevant when considering the robustness of triplet–triplet energy transfer mechanisms, relying on wavefunction overlap, in systems, such as the photosynthetic light-harvesting complexes, in which Chl triplet states with distorted geometries are involved.
Biological invasions in World Heritage Sites: current status and a proposed monitoring and reporting framework
Authors: Shackleton Ross T. , Bertzky Bastian , Wood Louisa E. , Bunbury Nancy , Jäger Heinke , van Merm Remco , Sevilla Christian , Smith Kevin , Wilson John R. U. , Witt Arne B. R. , Richardson David M.
Published: August 2020

UNESCO World Heritage Sites (WHS) are areas of outstanding universal value and conservation importance. They are, however, threatened by a variety of global change drivers, including biological invasions. We assessed the current status of biological invasions and their management in 241 natural and mixed WHS globally by reviewing documents collated by UNESCO and IUCN. We found that reports on the status of biological invasions in WHS were often irregular or inconsistent. Therefore, while some reports were very informative, they were hard to compare because no systematic method of reporting was followed. Our review revealed that almost 300 different invasive alien species (IAS) were considered as a threat to just over half of all WHS. Information on IAS management undertaken in WHS was available for fewer than half of the sites that listed IAS as a threat. There is clearly a need for an improved monitoring and reporting system for biological invasions in WHS and likely the same for other protected areas globally. To address this issue, we developed a new framework to guide monitoring and reporting of IAS in protected areas building on globally accepted standards for IAS assessments, and tested it on seven WHS. The framework requires the collation of information and reporting on pathways, alien species presence, impacts, and management, the estimation of future threats and management needs, assessments of knowledge and gaps, and, using all of this information allows for an overall threat score to be assigned to the protected area. This new framework should help to improve monitoring of IAS in protected areas moving forward.
Breast cancer mortality and overdiagnosis after implementation of population-based screening in Denmark
Authors: Lynge Elsebeth , Beau Anna-Belle , von Euler-Chelpin My , Napolitano George , Njor Sisse , Olsen Anne Helene , Schwartz Walter , Vejborg Ilse
Published: August 2020

Introduction

Service breast cancer screening is difficult to evaluate because there is no unscreened control group. Due to a natural experiment, where 20% of women were offered screening in two regions up to 17 years before other women, Denmark is in a unique position. We utilized this opportunity to assess outcome of service screening.

Materials and methods

Screening was offered in Copenhagen from 1991 and Funen from 1993 to women aged 50–69 years. We used difference-in-differences methodology with a study group offered screening; a historical control group; a regional control group; and a regional–historical control group, comparing breast cancer mortality and incidence, including ductal carcinoma in situ, between study and historical control group adjusted for changes in other regions, and calculating ratios of rate ratios (RRR) with 95% confidence intervals (CI). Data came from Central Population Register; mammography screening databases; Cause of Death Register; and Danish Cancer Register.

Results

For breast cancer mortality, the study group accumulated 1,551,465 person-years and 911 deaths. Long-term breast cancer mortality in Copenhagen was 20% below expected in absence of screening; RRR 0.80 (95% CI 0.71–0.90), and in Funen 22% below; RRR 0.78 (95% CI 0.68–0.89). Combined, cumulative breast cancer incidence in women followed 8+ years post-screening was 2.3% above expected in absence of screening; RRR 1.023 (95% CI 0.97–1.08).

Discussion

Benefit-to-harm ratio of the two Danish screening programs was 2.6 saved breast cancer deaths per overdiagnosed case. Screening can affect only breast cancers diagnosed in screening age. Due to high breast cancer incidence after age 70, only one-third of breast cancer deaths after age 50 could potentially be affected by screening. Increasing upper age limit could be considered, but might affect benefit-to-harm ratio negatively.
The value of climate-resilient seeds for smallholder adaptation in sub-Saharan Africa
Authors: Cacho Oscar J. , Moss Jonathan , Thornton Philip K. , Herrero Mario , Henderson Ben , Bodirsky Benjamin L. , Humpenöder Florian , Popp Alexander , Lipper Leslie
Published: August 2020

Climate change is threatening food security in many tropical countries, where a large proportion of food is produced by vulnerable smallholder farmers. Interventions are available to offset many of the negative impacts of climate change on agriculture, and they can be tailored to local conditions often through relative modest investments. However, little quantitative information is available to guide investment or policy choices at a time when countries and development agencies are under pressure to implement policies that can help achieve Sustainable Development Goals while coping with climate change. Among smallholder adaptation options, developing seeds resilient to current and future climate shocks expected locally is one of the most important actions available now. In this paper, we used national and local data to estimate the costs of climate change to smallholder farmers in Malawi and Tanzania. We found that the benefits from adopting resilient seeds ranged between 984 million and 2.1 billion USD during 2020–2050. Our analysis demonstrates the benefits of establishing and maintaining a flexible national seed sector with participation by communities in the breeding, delivery, and adoption cycle.
Divisia monetary aggregates for a heterogeneous euro area
Authors: Brill Maximilian C. , Nautz Dieter , Sieckmann Lea
Published: August 2020

Since the run-up to the great recession, there has been a significant degree of heterogeneity across euro area countries both in terms of interest rates and in the composition of monetary assets. In order to account for the heterogeneity of monetary assets within and across member countries, we propose a Divisia monetary aggregate for the euro area. In line with earlier evidence obtained for the United States, our results from a panel probit analysis show that the divergence between the Divisia and the simple sum aggregate has a significant predictive content for recessions in euro area countries.
Review on the petroleum market in China: history, challenges and prospects
Authors: Chen Si-Yuan , Zhang Qi , Mclellan Benjamin , Zhang Tian-Tian
Published: August 2020

The petroleum industry plays an essential role in driving China’s economic development. In the past few decades, several reforms in the petroleum industry have been implemented; however, there are still some issues that have not been resolved. Moreover, with the new-normal economy, the transition to green energy and international trade disputes, the petroleum market is also facing emerging challenges. Therefore, the purpose of the present study is to review the historical development of China’s petroleum market, identify the current challenges and propose corresponding countermeasures for future prospects. As a conclusion, five main challenges are highlighted totally, namely lack of marketization, excess oil refining capacity, high external dependency, environment pollution and unstable international trading relationship. To address these challenges, it is encouraged to deepen petroleum market reform, accelerate the elimination of inefficient refining capacity, diversify oil supply sources, as well as improve domestic petroleum enterprises’ ability to resist price risks.
Metrics to analyze and improve diets through food Systems in low and Middle Income Countries
Authors: Melesse Mequanint B. , van den Berg Marrit , Béné Christophe , de Brauw Alan , Brouwer Inge D.
Published: August 2020

Taking a food systems approach is a promising strategy for improving diets. Implementing such an approach would require the use of a comprehensive set of metrics to characterize food systems, set meaningful goals, track food system performance, and evaluate the impacts of food system interventions. Food system metrics are also useful to structure debates and communicate to policy makers and the general public. This paper provides an updated analytical framework of food systems and uses this to identify systematically relevant metrics and indicators based on data availability in low and middle income countries. We conclude that public data are relatively well available for food system drivers and outcomes, but not for all of the food system activities. With only minor additional investments, existing surveys could be extended to cover a large part of the required additional data. For some indicators, however, targeted data collection efforts are needed. As the list of indicators partly overlaps with the indicators for the Sustainable Development Goals (SGDs), part of the collected data could serve not only to describe and monitor food systems, but also to track progress towards attaining the SDGs.
Correction to: Pharmacokinetic and Pharmacodynamic Studies of Elacestrant, A Novel Oral Selective Estrogen Receptor Degrader, in Healthy Post-Menopausal Women
Authors: Conlan Maureen G. , de Vries Erik F. J. , Glaudemans AWJM , Wang Yamei , Troy Steven
Published: August 2020

Authors would like to correct the errors in table 2.
Čech–Delaunay gradient flow and homology inference for self-maps
Authors: Bauer U. , Edelsbrunner H. , Jabłoński G. , Mrozek M.
Published: August 2020

We call a continuous self-map that reveals itself through a discrete set of point-value pairs a sampled dynamical system. Capturing the available information with chain maps on Delaunay complexes, we use persistent homology to quantify the evidence of recurrent behavior. We establish a sampling theorem to recover the eigenspaces of the endomorphism on homology induced by the self-map. Using a combinatorial gradient flow arising from the discrete Morse theory for Čech and Delaunay complexes, we construct a chain map to transform the problem from the natural but expensive Čech complexes to the computationally efficient Delaunay triangulations. The fast chain map algorithm has applications beyond dynamical systems.
Antidementia effects, metabolic profiles and pharmacokinetics of GJ-4, a crocin-rich botanical candidate fromGardeniae fructus
Authors: Pang Qianqian , Zhang Weiyang , Li Chenyang , Li Haibo , Zhang Yu , Li Lin , Zang Caixia , Yao Xinsheng , Zhang Dan , Yu Yang
Published: August 2020

Antidementia effect, metabolic profiles and pharmacokinetics of GJ-4, a crocin-rich botanical candidate fromGardeniae Fructus.
A porous material excited by near-infrared light for photo/chemodynamic and photothermal dual-mode combination therapy
Authors: Sun Mingdi , Yang Dan , Sun Qianqian , Jia Tao , Kuang Ye , Gai Shili , He Fei , Zhang Fangmei , Yang Piaoping
Published: August 2020

Photodynamic therapy (PDT) and photothermal therapy (PTT) are well-developed light therapy methods for cancer; however, both have a few areas that need improvement.
Water-stable lanthanide-based metal–organic gel for the detection of organic amines and white-light emission
Authors: Gu Dongxu , Yang Weiting , Lin Duoyu , Qin Xudong , Yang Yonghang , Wang Fuxiang , Pan Qinhe , Su Zhongmin
Published: August 2020

A lanthanide metal–organic gel was prepared as a fluorescent probe for detecting organic amines and serving as a white-light emitting material based on the different luminescence characteristics of its lanthanide ions and organic ligands.
Life-Threatening Hemoptysis
Authors: Deshwal Himanshu , Sinha Ankur , Mehta Atul C.
Published: August 2020

Life-threatening hemoptysis (LTH) is any amount of hemoptysis that causes significant hemodynamic decompensation or respiratory distress which may lead to death if left untreated. While the amount of hemoptysis that qualifies as massive hemoptysis has continued to be debated, any amount between 100 to 1,000 mL/day is considered significant. Up to 15% cases of hemoptysis are LTH and need urgent life-saving intervention. Understanding of pulmonary vascular anatomy is of paramount importance to manage LTH. The goal of treatment lies in airway protection, appropriate oxygenation, and prevention of exsanguination. Once the airway is stabilized, a quick diagnosis and control of bleeding site is targeted. This chapter highlights current practices and approach to LTH including medical management, bronchoscopic approach, and advanced therapies such as bronchial artery embolization and surgical resection. We review situations, such as bronchiectasis, vascular malformation, diffuse alveolar hemorrhage, and tracheostomy bleed and specific approach to management of these conditions in a systematic and evidence-based manner.
Implication of Image-Defined Risk Factors for the Extent of Surgical Resection and Clinical Outcome in Patients with Pelvic Neuroblastoma
Authors: Froeba-Pohl Alexandra , von Schweinitz Dietrich , Muehling Jakob , Paolini Marco , Hubertus Jochen
Published: August 2020

Introduction Pelvic neuroblastoma (NB) is a rare entity and occurs in 2 to 5% of all NBs. Surgery in the pelvic area is—even for the experienced oncological surgeon—technically challenging, as injuries of bladder and/or rectal innervation may carry lifelong consequences for the patient. Several studies have proven the impact of image-defined risk factors (IDRFs) for outcome, complications and extent of resection in NB; however, the specific role of IDRF in pelvic NB has not been investigated yet.

Materials and Methods Patient charts were retrospectively evaluated for International Staging System stage, IDRF status, MYCN amplification, and outcome parameters.

Results Between 2003 and 2019, 277 NBs were surgically resected in the department of pediatric surgery of Dr. von Hauner Children's Hospital. Out of these, 11 patients (3.9%) had pelvic NB. Evaluation of the preoperative imaging showed two patients without IDRF (stage L1) and eight patients in stage L2. One patient had stage M according to distant metastasis. Patients without IDRF underwent complete macroscopical resections, whereas complete tumor removal was not possible without mutilation in patients with IDRF. At time point of diagnosis, only patients with IDRF had functional neurological problems. Three patients developed perioperative complications; all of them had at least one IDRF. Three patients developed local recurrence during the course of the disease, all of them had at least one IDRF.

Conclusion Our results indicate on a preliminary level the importance of IDRF as a prognostic tool for surgical removal of pelvic NB.
Single versus Multiple Vessel Endovascular Tibial Artery Revascularization for Critical Limb Ischemia: A Review of the Literature
Authors: Anand Gautam M. , Conway Allan M. , Giangola Gary
Published: August 2020

Vascular interventionalists have long debated on whether one or multiple patent tibial arteries (run-off) are necessary to treat critical limb ischemia, including ischemic rest pain and tissue loss. This review article seeks to clarify data surrounding this topic by including literature from retrospective studies, prospective studies, meta-analyses, and randomized controlled trials. Our conclusion is that revascularizing a single tibial artery to the foot is adequate for wound healing.
Oral Administration of Fucosylated Chondroitin Sulfate Oligomers in Gastro-Resistant Microcapsules Exhibits a Safe Antithrombotic Activity
Authors: Yan Lufeng , Zhu Mengshan , Wang Danli , Tao Wenyang , Liu Donghong , Zhang Fuming , Linhardt Robert J. , Ye Xingqian , Chen Shiguo
Published: August 2020

Fucosylated chondroitin sulfate (FCS) polysaccharide isolated from sea cucumber has potent anticoagulant activity. Based on its resistance to the enzymes present in vertebrates, it may serve as an anticoagulant and shows antithrombotic effects when delivered through gastro-resistant (GR) tablets. However, due to the multiple plasma targets of FCS polysaccharide in the coagulation pathway, bleeding can occur after its oral administration. In the current study, we used FCS oligomers, in particular a mixture of oligosaccharides having 6 to 18 saccharide units, as the active ingredient in GR microcapsules for oral anticoagulation. In a Caco-2 model, the FCS oligomers showed higher absorption than native FCS polysaccharides. Oral administration of FCS oligomer-GR microcapsules provided a dose-dependent, prolonged anticoagulant effect with a selective inhibition of the intrinsic coagulation pathway when compared with subcutaneous administration of FCS oligomers or oral administration of unformulated FCS oligomers or native FCS-GR microspheres. Continued oral administration of FCS oligomer-GR microcapsules did not result in the accumulation of oligosaccharides in the plasma. Venous thrombosis animal models demonstrated that FCS oligomers delivered via GR microcapsules produced a potent antithrombotic effect dependent on their anticoagulant properties in the plasma, while oral administration of unformulated FCS oligomers at the same dose exhibited a weaker antithrombotic effect than the formulated version. Oral administration of FCS oligomer-GR microcapsules resulted in no bleeding, while oral administration of native FCS-GR microcapsules resulted in bleeding (p < 0.05). Our present results suggest that a FCS oligomer-GR microcapsule formulation represents an effective and safe oral anticoagulant for potential clinical applications.
Inflammatory Conditions in Acute Coronary Syndrome Patients Treated with Percutaneous Coronary Intervention of Saphenous Vein Graft
Authors: Cankurt Tayyar , Celik İbrahim E. , Ozturk Selcuk , Maden Orhan
Published: August 2020

The study aimed to evaluate the inflammatory blood parameters in acute coronary syndrome (ACS) patients with a history of coronary artery bypass graft (CABG) and treated with percutaneous coronary intervention (PCI) of saphenous vein graft (SVG). A total of 347 patients who underwent urgent SVG PCI with the diagnosis of ACS were included in the study. After the application of exclusion criteria, 79 patients were allocated into two groups, namely, successful PCI (n = 59) and unsuccessful PCI (n = 20), and included in the statistical analysis. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) levels were significantly higher in patients with unsuccessful SVG PCI. In the logistic regression analysis, PLR, C-reactive protein, and diabetes mellitus emerged as independent factors associated with unsuccessful SVG PCI. The area under the curve for PLR was 0.70 (95% confidence interval: 0.55–0.85, p = 0.006). The cut-off value of PLR (128.99) was associated with 70.0% sensitivity and 69.5% specificity. Elevated inflammatory status is associated with unsuccessful PCI of SVG in ACS patients. Increased PLR levels on admission is an independent predictor of this situation. This cheap and simple marker can help us to predict unsuccessful SVG PCI in ACS patients.
Treatment of Common Calcaneal Tendon Rupture Using a Central Gastrocnemius Turnover Aponeurotic Flap Technique in a Dog
Authors: Minei Sergio , Cinti Filippo , Pompei Brunella , Abrescia Paolo
Published: August 2020

A 9-year-old, intact male, German wirehaired pointer was referred for suspected Achilles tendon rupture 3 weeks after an injury. A three-loop pulley suture pattern combined with a locking loop suture reduced the gap between the tendon ends to 7 mm and a central gastrocnemius turnover aponeurotic flap was used to cover the remaining gap. A type II free-form methyl methacrylate transarticular external skeletal fixator was used to keep the tarsocrural joint in extension until 45 days postoperatively. Short- and long-term clinical and ultrasonographic evaluations showed gradual improvement in weight-bearing and progressive tendon healing. At 6 months after surgery, the dog had normal limb function and had returned to the previous activity level. To the authors' knowledge, this tendon repair technique has been described in humans and in one cat but has not yet been reported in dogs.
Force Distribution in the Canine Proximal Radio-Ulnar Joint on Extension of the Carpal Joint: A Cadaveric Study
Authors: Martin Stephen A. , Kirby Barbara M. , Kelly Gabrielle , Gilchrist Michael D. , Milgram Joshua
Published: August 2020

Objective The aim of this study was to measure the load on the lateral and medial aspects of the proximal radio-ulnar joint during extension of the carpus.

Study Design This was an ex vivo biomechanical study.

Sample Population Twenty-two cadaveric Greyhound thoracic limbs were used.

Methods Twenty-two paired thoracic limbs were used. The olecranon was attached to a custom jig with the foot resting on a stationary anvil. Load sensors were inserted into the proximal radio-ulnar joint, between the radial head and the lateral coronoid process, and between the radial head and the medial coronoid process. Specimens were tested under compression with measurements taken at 0, 4, 9 and 13.5 mm of axial displacement. Data collected at each point included forces on the specimen and medial and lateral coronoid processes as well as the angle of carpal joint extension.

Results A linear mixed effects model relating load on the specimen and carpal joint extension angle had an R-squared value of 0.66, and load at the level of the medial coronoid process and angle of carpal extension had an R-squared value of 0.61. There was a significant difference in the loads measured on the lateral and medial coronoid processes at all angles (p < 0.0001).

Conclusion Extension of the carpus results in asymmetric loading of the proximal radio-ulnar joint.

Clinical Significance The findings of this study show that loading of the medial coronoid process may be more complex than originally thought and supports the future investigation of novel management and therapeutic options for affected patients.
Anatomy, Exposure, and Preparation of Recipient Vessels in Microsurgical Head and Neck Reconstruction
Authors: Xu Hope , Jazayeri Leila , Matros Evan , Henderson Peter W.
Published: August 2020

Successful microvascular reconstruction of head and neck defects requires the ability to safely identify, isolate, and utilize recipient vessels. To date, however, a comprehensive review of the anatomy and techniques relevant to the available anatomic regions has not been undertaken. This review covers the relevant clinical anatomy of the anterior triangle, posterior triangle, submandibular region, intraoral region, preauricular region, chest, and arm, taking particular care to highlight the structures that are crucial to identify while performing each dissection. Finally, a step-by-step technique for safely dissecting the recipient vessels at each site is provided.
Lessons Learnt from Recent Trials in Ischemic Heart Disease
Authors: Mandrola John M. , Kaul Sanjay , Foy Andrew
Published: August 2020

Four recently published randomized controlled trials have informed the care of patients with stable ischemic heart disease. The purpose of this clinical focus article is to offer a summary and critical appraisal of the recent evidence. We aim to aid clinicians in the translation of the trial evidence to patient care.
Direct Oral Anticoagulant Concentrations in Obese and High Body Weight Patients: A Cohort Study
Authors: Martin Anne Céline , Thomas William , Mahir Zahra , Crowley Maeve P. , Dowling Terry , Breen Karen , Collings Victoria , Moore Gary W. , MacDonald Stephen , Hunt Beverley J. , Cohen Alexander T.
Published: August 2020

Background Direct oral anticoagulants (DOACs) are prescribed for atrial fibrillation (AF) and venous thromboembolism (VTE) and both occur more frequently in obese patients. Outcomes from DOAC trials included few individuals ≥ 120 kg leading to uncertainty whether high body weight (BW) reduces DOAC concentrations.

Objectives This article investigates the relationship between factor Xa (FXa) inhibitor concentrations, BW, and renal function, and compares them in high BW patients with unselected populations.

Methods Consecutive patients in two United Kingdom centers, weighing ≥ 120 kg receiving 5 mg twice daily apixaban or 20 mg once daily rivaroxaban for AF or VTE were prospectively included. Peak or trough concentrations were measured using specific chromogenic assays, expressed in mean or median (5th–95th percentiles). On-therapy range was the interval from the 5th percentile trough concentration to the 95th percentile peak concentration.

Results One hundred patients were included; age range: 23 to 78 years, 31% were women, 58% had AF, creatinine clearance range: 67 to 474 mL/min. Median BW was 139 kg, and 84% had body mass index (BMI) ≥ 40 kg/m2. DOAC peak and trough concentrations varied from 44 to 727 and 14 to 299 ng/mL, respectively. There was no linear relationship between FXa inhibitor concentrations at peak or trough and BW or BMI, and creatinine clearance. Apixaban troughs in AF and rivaroxaban peaks in VTE were lower than in unselected populations. However, only two trough concentrations were below the expected range, and 109/116 were within the on-therapy range.

Conclusion These data indicated that obese or high BW patients generally achieve therapeutic FXa inhibitor concentrations. However, further investigations assessing clinical outcomes are required.
Staging Severity of COVID-19 according to Hemostatic Abnormalities (CAHA Score)
Authors: Marchandot Benjamin , Trimaille Antonin , Curtiaud Anaïs , Carmona Adrien , Matsushita Kensuke , Sato Chisato , Leonard-Lorant Ian , Sattler Laurent , Grunebaum Lelia , Ohana Mickaël , Ohlmann Patrick , Jesel Laurence , Morel Olivier
Published: August 2020

This is the first study to show a stepwise increase in venous thrombotic events according to COVID-19 coagulopathy (COVID-19-associated hemostatic abnormalities [CAHA]) staging and lung injuries assessed by chest computed tomography. Excess mortality and/or transfer to intensive care unit according to CAHA staging.
Prenatal Tobacco Exposure and Childhood Neurodevelopment among Infants Born Prematurely
Authors: Robbins Lindsay S. , Blanchard Christina T. , Sinkey Rachel G. , Harris Stacy L. , Tita Alan T. , Harper Lorie M.
Published: August 2020

Objective Nicotine is an established neuroteratogen, and prenatal tobacco exposure alters the structure of the developing nervous system. An association between prenatal tobacco exposure and impaired neurologic function is less well established. We examine the association between prenatal tobacco exposure and childhood neurodevelopment among infants born preterm.

Study Design Secondary analysis of a multicenter randomized controlled trial assessing the benefits of magnesium sulfate for the prevention of cerebral palsy in preterm infants. Women were included if they delivered a singleton and nonanomalous infant before 37 weeks. Exposure was any self-reported prenatal tobacco use. Primary outcome was the original trial composite outcome of moderate or severe cerebral palsy at 2 years of age, or stillbirth, or infant death by 1 year of age. Secondary outcomes included components of the composite and mild cerebral palsy at 2 years, Bayley Scales of Infant Development II motor and mental scores, death before two years, and use of auditory aids or corrective lenses. Multivariable logistic regression models were performed to estimate adjusted odds ratios (aOR) with 95% confidence intervals.

Results Of 1,826 women included, 503 (27.5%) used tobacco. Tobacco users were more likely to be older, unmarried, and white; have a prior preterm birth; have received no prenatal care; and to use illicit drugs or alcohol. Gestational age at delivery, betamethasone exposure, and magnesium exposure were not different between groups. There were no differences in the composite primary outcome or in rates of cerebral palsy by tobacco use. Moderate developmental delay was more common among tobacco exposed in bivariate but not adjusted analysis (20.5 vs. 15.9%, p = 0.035). In adjusted analysis, tobacco exposure was associated with increased use of corrective lenses (5.0 vs. 2.9%, aOR: 2.28, 95% confidence interval: 1.28–4.07).

Conclusion Prenatal tobacco exposure is not associated with neurodevelopmental impairment in infants born preterm. However, tobacco exposure may be associated with impaired vision.

Key Points
Evaluation of the Emergency Severity Index (Version 4) in Postpartum Women after Cesarean Delivery
Authors: Kawakita Tetsuya , Thomas Alexandra , Landy Helain J.
Published: August 2020

Objective The Emergency Severity Index (ESI) version 4 is a 5-level triage system (1 being the highest acuity and 5 being the lowest acuity) used in the emergency department (ED). Our goal of the study was to compare rates of readmission according to ESI in postpartum women.

Study Design This was a secondary analysis of a retrospective cohort study of all women who presented to the ED within 6 weeks after cesarean delivery. The acuity level was assigned by triage nurses at the time of triage presentation. Our primary outcome was postpartum readmission. To examine if the addition of blood pressure to vital sign abnormalities would improve the prediction for readmission, we created a modified ESI. We identified women who had an ESI of level 3 and reassigned to a modified ESI of level 2 if blood pressure was in the severe range. Receiver operating characteristic curves with area under the curve (AUC) were created and compared between ESI and modified ESI.

Results Of 439 women, ESI distribution was 0.2% ESI 1, 23.7% ESI 2, 56.0% ESI 3, 19.4% ESI 4, and 0.7% ESI 5. Readmission rates by ESI level were 100% ESI 1, 47% ESI 2, 18% ESI 3, 2% ESI 4, and 0% ESI 5 (p < 0.001). Of 246 women who were assigned an ESI of 3, total 25 had severe range blood pressures and were reassigned to a modified ESI of 2. Of these 25 women, 14 were readmitted. The AUC of the modified ESI was statistically higher than that of the standard ESI (AUC: 0.77 and 95% confidence interval: 0.72–0.82 vs. AUC: 0.73 and 95% confidence interval: 0.68–0.78; p < 0.01).

Conclusion The ESI was a useful tool to identify women who required postpartum readmission. Incorporation of severe range blood pressure as a parameter of acuity improved the prediction of readmission.

Key Points
A Cadaveric Anatomical and Histological Study of Recipient Intercostal Nerve Selection for Sensory Reinnervation in Autologous Breast Reconstruction
Authors: Mohan Anita T. , Suchyta Marissa , Vyas Krishna S. , Lachman Nirusha , Mardini Samir , Saint-Cyr Michael
Published: August 2020

Background Autologous breast reconstruction (ABR) has grown in popularity due to improved aesthetic and long-term patient reported outcomes, but data regarding sensory reinnervation of autologous flaps remain limited. Traditionally, the lateral cutaneous branch of the fourth intercostal nerve has been used for flap neurotization, but the use of the anterior cutaneous branch of the intercostal nerves (ACB) offer a more optimal location to the microsurgical field when using internal mammary vessels for the microanastomosis. This study aimed to evaluate the optimum ACB recipient site level for sensory nerve coaptation in ABR.

Methods Twelve hemi-chests were dissected from six fresh cadaveric females. Costal cartilages were removed and the anterior cutaneous intercostal nerve (ACB) and the lateral (subcutaneous) division of the anterior cutaneous branch (LACB) of the intercostal nerve were exposed. Anatomical measurements were recorded, and nerve samples were evaluated histologically with carbonic anhydrase staining to differentiate sensory fascicles. Assessment of fascicular diameter, axonal counts, and fascicular area were compared.

Results A total of 75 nerve specimens were assessed. The ACB was identified at all levels (100%) and the subcutaneous LACB was noted consistently in the second to fourth rib space (96% cadavers), with a median length of 43, 37.5, and 37 mm, respectively. Across all rib spaces, the fascicular and axonal counts were comparable between the LACB and ACB. Nerves in the second intercostal space had a significantly larger mean fascicular area mean (112,816 ± 157,120 µm2) compared with that in the fourth (mean 26,474 ± 38,626 µm2), p = 0.03. Axonal count of sensory fascicles was the highest in the second intercostal nerves (p < 0.05).

Conclusion This study provides anatomical and histological basis to determine the optimum recipient site choice for sensory coaptation in microsurgical breast reconstruction. This would aid in operative decision-making regarding the ideal recipient anterior cutaneous intercostal nerve branches for recipient site coaptation in ABR.
Impact of Intraoperative Hypothermia on Microsurgical Free Flap Reconstructions
Authors: Moellhoff Nicholas , Broer Peter Niclas , Heidekrueger Paul I. , Ninkovic Milomir , Ehrl Denis
Published: August 2020

Background Patients requiring microsurgical defect reconstruction are highly susceptible to intraoperative hypothermia, given oftentimes long operative times and exposure of large skin surface areas. While the impact of hypothermia has been extensively studied across various surgical fields, its role in the setting of microsurgical free flap reconstruction remains elusive. This study evaluates the effects of hypothermia on outcomes of free flap reconstructions.

Methods Within 7 years, 602 patients underwent 668 microvascular free flap reconstructions. The cases were divided into two groups regarding the minimal core body temperature during free flap surgery: hypothermia (HT; < 36.0°C) versus normothermia (NT; ≥36.0°C). The data were retrospectively screened for patients' demographics, perioperative details, flap survival, surgical complications, and outcomes.

Results Our data revealed no significant difference with regard to the rate of major and minor surgical complications, or the rate of revision surgery between both groups (p > 0.05). However, patients in the HT group showed significantly higher rates of total flap loss (6.6% [HT] vs. 3.0% [NT], p < 0.05) and arterial thrombosis (4.6% [HT] vs. 1.9% [NT], p < 0.05). This translated into a significantly longer hospitalization of patients with reduced core body temperature (HT: mean 16.8 days vs. NT: mean 15.1 days; p < 0.05).

Conclusion Hypothermia increases the risk for arterial thrombosis and total flap loss. While free flap transfer is feasible also in hypothermic patients, surgeons' awareness of core body temperature should increase. Taken together, we suggest that the mean intraoperative minimum temperature should range between 36 and 36.5°C during free flap surgery as a pragmatic guideline.