bluuebunny/crossref_metadata_2025 huggingface dataset:
Airway management of congenital pulmonary airway malformation resection in neonates and infants: A case cohort study
Authors: Narayanasamy Suryakumar , Adler Elena , Mahmoud Mohamed , Burkley Meghan , Lim Foong‐Yen , Subramanyam Rajeev
Published: April 2019

Background

Anesthestic management of congenital pulmonary airway malformation has not been well described in the literature. It is not clear whether one‐lung ventialtion is indicated during thoracoscopic lobectomy and if so, what is the best technique achieve it.

Aims

We describe the variables with the two commonly performed surgical techniques, thoracoscopic lobectomy and open thoracotomy, from our institutional database to assess the role of lung isolation and the preferable method of lung isolation technique for congenital pulmonary airway malformation resections.

Methods

After institutional review board approval, fetal center records were reviewed retrospectively from January 2010 to July 2016 for patients who underwent congenital pulmonary airway malformation resection. The primary goal was to describe the anesthesia induction‐airway management techniques with emphasis on one‐lung ventilation techniques.

Results

Among the 65 resections, one‐lung ventilation was performed in 30 resections (46%) and was primarily achieved by endobronchial intubation in most cases (80%). One‐lung ventilation was performed in a greater number of resections with thoracoscopic lobectomy (96%) compared to open thoracotomies.

Conclusion

From our institution cohort, one‐lung ventilation was more commonly used during thoracoscopic resections and was most commonly achieved with endobronchial intubation. Most patients were induced with inhalational anesthesia (sevoflurane), nondepolarizing neuromuscular blocker, and gentle positive pressure ventilation for intubation.
Use of genetic risks in pediatric organ transplantation listing decisions: A national survey
Authors: Graf Madeline , Char Danton , Hanson‐Kahn Andrea , Magnus David
Published: April 2019

There is a limited supply of organs for all those who need them for survival. Thus, careful decisions must be made about who is listed for transplant. Studies show that manifesting genetic disease can impact listing eligibility. What has not yet been studied is the impact genetic risks for future disease have on a patient's chance to be listed. Surveys were emailed to 163 pediatric liver, heart, and kidney transplant programs across the United States to elicit views and experiences of key clinicians regarding each program's use of genetic risks (ie, predispositions, positive predictive testing) in listing decisions. Response rate was 42%. Sixty‐four percent of programs have required genetic testing for specific indications prior to listing decisions. Sixteen percent have required it without specific indications, suggesting that genetic testing may be used to screen candidates. Six percent have chosen not to list patients with secondary findings or family histories of genetic conditions. In hypothetical scenarios, programs consider cancer predispositions and adult‐onset neurological conditions to be relative contraindications to listing (61%, 17%, and 8% depending on scenario), and some consider them absolute contraindications (5% and 3% depending on scenario). Only 3% of programs have formal policies for these scenarios, but all consult genetic specialists at least “sometimes” for results interpretation. Our study reveals that pediatric transplant programs are using future onset genetic risks in listing decisions. As genetic testing is increasingly adopted into pediatric medicine, further study is needed to prevent possible inappropriate use of genetic information from impacting listing eligibility.
Complementors as connectors: managing open innovation around digital product platforms
Authors: Hilbolling Susan , Berends Hans , Deken Fleur , Tuertscher Philipp
Published: April 2019

In the digital age, open innovation is increasingly organized around platform ecosystems. This paper investigates how firms can coordinate open innovation as a platform strategy for the development of complementary products by independent third parties. We draw on a qualitative case study of Philips Hue – a connected lighting platform for consumers with its variety of complementary products. We identify three increasingly complex ways in which independent complements connect to a focal platform. Our findings show that managing these connections requires a hybrid open innovation approach that combines arm’s length coordination, with a large number of complementors through open interfaces, and intensive bilateral collaboration, with a selected number of partners. Our findings demonstrate that complex interconnections across digital platforms and products lead to the management challenge of navigating an ‘ecology of platforms’, which warrants future research.
Precarious versus Entrepreneurial Origins of the Recently Self‐Employed: Work and Family Determinants of Canadians’ Self‐Employment Transitions
Authors: Glavin Paul , Filipovic Tomislav , van der Maas Mark
Published: April 2019

We investigate the wage work and family determinants of self‐employment entry using a panel study of Canadian workers (Canadian Work Stress and Health Study). Rather than treating the self‐employed as a homogenous group—a characterization that conflates entrepreneurial ventures with lower quality and more precarious self‐employment—we disaggregate self‐employment entrants by occupational class. Descriptive analyses show that the nonprofessional self‐employed—the most common form of self‐employment observed in the study—are considerably more likely to report low income (<$25,000) and insufficient work hours compared to wage workers and the professional self‐employed. Event history analyses based on a multinomial logistic model also reveal that poor wage‐work quality—including low income, job insecurity, and unchallenging work—increases the likelihood of a transition from wage work into nonprofessional self‐employment. In contrast, job autonomy and human capital predict an increased likelihood of a transition into professional self‐employment. Our results suggest that both classic entrepreneurial and forced motivations explain self‐employment entry when the self‐employed's occupational class is distinguished; however, findings are mixed regarding the salience of work‐family factors in predicting self‐employment entry. We discuss the value of using a “good jobs, bad jobs” perspective to disaggregate the pathways from wage work into lower versus higher quality self‐employment.
EXPOsing Men's Gender Role Attitudes as Porn Superfans
Authors: Jackson Crystal A. , Baldwin Aleta , Brents Barbara G. , Maginn Paul J.
Published: April 2019

Much contemporary debate about pornography centers on its role in portraying and perpetuating gender inequality. This article compares traditional gendered attitudes between cisgender men attending the Adult Entertainment Expo (n = 294) and a random sample of male respondents from the 2016 General Social Survey (GSS), a U.S. representative survey of general attitudes and beliefs collected every two years (n = 863). Our survey borrowed questions from theGSSto measure attitudes about gender equality across four dimensions: (1) working mothers, (2) women in politics, (3) traditional gender roles in the family, and (4) affirmative action for women in the workplace. Through bivariate analyses, we found that “porn superfans” are no more sexist or misogynistic than the general U.S. public on two of the four measures (women in politics and women in the general workplace) and held more progressive gender‐role attitudes than the general public on the other two measures. We conducted binary logistic regressions for those two measures to determine if the relationship remained significant when controlling for other factors. For one dimension, working mothers, it did (p < .001). Our results call into question some of the claims that porn consumption fosters de facto negative and hostile attitudes toward women.
Characterization of organic matter fractions in the top layer of soils under different land uses in Central‐Eastern Europe
Authors: Ukalska‐Jaruga Aleksandra , Klimkowicz‐Pawlas Agnieszka , Smreczak Bożena
Published: April 2019

The objective of this study was to investigate differences in organic matter fractions, such as dissolved organic carbon and humic substances, in soils under different land uses. Soil samples were collected from the upper layer of arable lands and grasslands. Humic substances (HS) were chemically fractionated into fulvic acids (FA), humic acids (HA) and humins (HUM), and based on the separated fractions, the humification index (HI) and the degree of HS transformation (DT) were calculated. Dissolved organic carbon (DOC) was determined by cold (CWE) and hot water (HWE) extractions. Regardless of land use, the results indicated significant differences in soil organic carbon (SOC) and HS composition, with HA and HUM as the dominant fractions. Total SOC was higher in grassland (median = 17.51 g kg−1) than arable soils (median = 9.98 g kg−1); the HI and DT indices did not differ significantly between land uses (HI = 0.3–10.3 and DT = 0.2–6.2 for grasslands, p > 0.05; HI = 0.3–3.9 and DT = 0.2–20.1 for arable lands, p > 0.05). This indicates the relatively high stability of organic carbon and efficient humification processes in both land uses. Additionally, in arable soils lower CWE‐C (0.75 g kg−1) and higher HWE‐C (2.59 g kg−1) than in grasslands (CWE‐C = 1.13 g kg−1, HWE‐C = 1.60 g kg−1) can be related to farming practice and application of soil amendments. The results showed that both labile and humified organic matter are better protected in grassland soils and are consequently less vulnerable to mineralization.
Simprovisation: A model for student‐led simulation
Authors: Babla Kunal , Lipton Joseph , Williams Sophie , Chopra Preeti , Thenabadu Sam
Published: April 2019

Background

Simulation is well established in medical education, with scenarios designed by faculty members to elicit specific learning outcomes. We describe and evaluate a learner‐led style of simulation‐based education that puts learners in control of the day. Simprovisation harnesses the principles of socially constructed learning and andragogy, encouraging learners to address their own learning requirements. Participants are divided into two groups. They are asked to consider their learning needs and are provided with resources and faculty member support to write two simulation scenarios. Faculty members remain available to guide scenario writing and offer ‘micro‐teaching’ on required topics. The groups then swap and participate in the scenarios written for them by the opposite group. Each scenario is followed by a structured debriefing, providing opportunities for participants to share their learning from the scenarios.

Simprovisation harnesses the principles of socially constructed learning and andragogy, encouraging learners to address their own learning requirements

Methods

We delivered Simprovisation to 62 participants ranging from fourth‐year medical students to junior doctors. We conducted pre‐ and post‐course questionnaire surveys and invited participants to focus groups to discuss their experiences.

Results

Our feedback questionnaire shows 100% of 58 respondents found Simprovisation useful, and 95% were able to meet at least two out of three self‐determined learning outcomes. Thematic analysis of focus group transcriptions showed that participants valued group‐based work and setting their own learning objectives. They found writing simulation scenarios to be challenging, but a valuable source of learning, and reported being more engaged compared with previous simulation study days.

Conclusions

Simprovisation is an innovative style of simulation‐based education that allows learners to effectively define and address their own learning needs.
Akapwa‐infused paradigm in teaching Catholic theology/catechesis in a multireligious classroom in the Philippines
Authors: Macaraan Willard Enrique R.
Published: April 2019

The increasing religious diversity in educational space has raised a legitimate question on how Catholic theology/catechesis must be taught in Philippine Catholic universities given the institutional mandate to educate students “into the faith of the Church through teaching of Christian doctrine in an organic and systematic way” (Wuerl,, 1). On this note, the paper makes reference to “centered pluralism” (CP), a positional posture espoused by Georgetown University in dealing with this predicament. In an attempt to (re)appropriate CP into local context, there is a need to explore the Filipino conception of self/others as enveloped within the indigenous concept ofkapwa. Hereon, the paper finds that CP is not just feasibly suitable in local context but withkapwa'smore inclusive description of the relationship of self and others, a CP‐based teaching paradigm in theology/catechesis is a promising project in the educational scene of the Philippines.
The BEST criteria improve sensitivity for detecting positive cultures in residual blood components cultured in suspected septic transfusion reactions
Authors: Shih Andrew W. , Cohn Claudia S. , Delaney Meghan , Fontaine Magali J. , Martin Isabella , Dunbar Nancy M. ,   the SCARED Study Investigators on behalf of the Biomedical Excellence for Safer Transfusion (BEST) Collaborative
Published: April 2019

BACKGROUND

Culturing residual blood components after suspected septic transfusion reactions guides management of patients and cocomponents. Current practice, accuracy of provider vital sign assessment, and performance of the AABB culture criteria are unknown. A multicenter international study was undertaken to investigate these issues and develop improved culture criteria.

STUDY DESIGN AND METHODS

Retrospective data for all transfusion reactions resulting in residual blood component culture in 2016 were collected from participating hospitals. The performance of the AABB culture criteria were assessed for detection of positive culture results. Modifications to the AABB criteria including 1) recommending culturing in the setting of isolated high fevers, 2) defining hypotension and tachycardia using objective parameters, and 3) incorporating antipyretic use were tested to determine if modifications improved performance. Modifications associated with improvement were incorporate into the BEST criteria. The AABB and the BEST criteria were then tested against a data set enriched for positive culture results to determine which criteria were superior.

RESULTS

Data were collected from 20 centers encompassing 779,143 transfusions, 3,187 reported transfusion reactions, and 1,104 cultured components. There was marked variation in reaction reporting and culturing rates (0.0%‐100.0%). Of 35 total positive component cultures, only one of 35 (2.9%) had concordant patient cultures; 12 of 34 (35.3%) did not have patient cultures performed. The BEST criteria had better sensitivity for detection of a positive culture result compared to the AABB criteria (74% vs. 41%), although specificity decreased (45% vs. 65%).

CONCLUSION

Compared to the AABB criteria, the BEST criteria have improved sensitivity for positive culture detection.
Clinicopathologic abnormalities associated with increased animal triage trauma score in cats with bite wound injuries: 43 cases (1998–2009)
Authors: Lyons Bridget M. , Ateca Laura B. , Otto Cynthia M.
Published: April 2019

Objective

To document the clinical and clinicopathologic changes in cats presenting with trauma from bite wounds, identify common abnormalities associated with bite wounds, and to determine whether the calculated animal trauma triage (ATT) score is related to any clinicopathologic abnormalities.

Design

Retrospective descriptive study.

Setting

University veterinary teaching hospital.

Animals

Forty‐three client‐owned cats that presented for bite wounds to a large, urban, veterinary hospital between 1998 and 2009.

Interventions

None.

Measurements and main results

Pertinent history, physical examination findings, results of biochemical testing, and outcome were extracted from medical records. Animal triage trauma score was calculated based on the physical examination at presentation in cats with adequate available information. Patients were classified as having either a low (<5) ATT (n = 20) or a high (≥5) ATT (n = 23) score. Male cats were overrepresented (65.1%), and a majority of cats had outdoor access (53.4%). Low venous blood pH (P = 0.047), high plasma lactate concentration (P = 0.018), and low ionized calcium concentration (P = 0.004) were associated with higher ATT scores.

Conclusions

There is a significant association between low venous blood pH, high plasma lactate concentration, and low ionized calcium concentration and higher ATT scores at presentation in cats suffering from bite wounds. Early recognition of these abnormalities may help to identify more severely injured patients.
Formality conjecture for K3 surfaces
Authors: Budur Nero , Zhang Ziyu
Published: April 2019

We give a proof of the formality conjecture of Kaledin and Lehn: on a complex projective K3 surface, the differential graded (DG) algebra$\operatorname{RHom}^{\bullet }(F,F)$is formal for any sheaf$F$polystable with respect to an ample line bundle. Our main tool is the uniqueness of the DG enhancement of the bounded derived category of coherent sheaves. We also extend the formality result to derived objects that are polystable with respect to a generic Bridgeland stability condition.
Planning the Shortest Path in Cluttered Environments: A Review and a Planar Convex Hull-Based Approach
Authors: Masoudi Nafiseh , Fadel Georges M. , Wiecek Margaret M.
Published: April 2019

Routing or path-planning is the problem of finding a collision-free and preferably shortest path in an environment usually scattered with polygonal or polyhedral obstacles. The geometric algorithms oftentimes tackle the problem by modeling the environment as a collision-free graph. Search algorithms such as Dijkstra’s can then be applied to find an optimal path on the created graph. Previously developed methods to construct the collision-free graph, without loss of generality, explore the entire workspace of the problem. For the single-source single-destination planning problems, this results in generating some unnecessary information that has little value and could increase the time complexity of the algorithm. In this paper, first a comprehensive review of the previous studies on the path-planning subject is presented. Next, an approach to address the planar problem based on the notion of convex hulls is introduced and its efficiency is tested on sample planar problems. The proposed algorithm focuses only on a portion of the workspace interacting with the straight line connecting the start and goal points. Hence, we are able to reduce the size of the roadmap while generating the exact globally optimal solution. Considering the worst case that all the obstacles in a planar workspace are intersecting, the algorithm yields a time complexity of O(n log(n/f)), with n being the total number of vertices and f being the number of obstacles. The computational complexity of the algorithm outperforms the previous attempts in reducing the size of the graph yet generates the exact solution.
Spatial Wiener filter to reduce spatial aliasing with spherical microphone arrays
Authors: Brown Stefanie , Sethu Vidhyasaharan , Taubman David
Published: April 2019

Three dimensional acoustic soundfields can be represented by a set of spherical harmonic coefficients that are extracted from pressure signals recorded by a spherical microphone array. The extraction method used and truncation order chosen introduce errors of spatial aliasing in the coefficients and truncation error in a reconstructed signal. A spatial Wiener filter (SWF) extraction method is proposed in this paper, using second order statistics of typical soundfield characteristics (signal power, estimated source locations, and internal microphone noise) and accounts for the presence of coefficients beyond the truncation order to reduce spatial aliasing in the extracted coefficients. The SWF can also distinguish between “wanted” and “unwanted” sources, reducing the contributions of unwanted sources to the extracted coefficients. The SWF is compared against the state of the art methods; regularized inverse (or generalized inverse), and orthonormal extraction methods, which are explored under a similar framework to the SWF. The authors compare these methods and show the benefit of the SWF for plane waves, with varying assumptions about the source characteristics. The SWF can also extract coefficients beyond the traditional truncation limit of a given array, unlike other methods.
Sentence recognition for native and non-native English listeners in quiet and babble: Effects of contextual cues
Authors: Zhong Ling , Liu Chang , Tao Sha
Published: April 2019

The purpose of this study was to investigate the difference between English-native (EN) listeners and Chinese-native (CN) listeners using contextual cues to perceive speech in quiet and four-talker babble in English. Three types of sentences served as speech stimuli: high (semantic and syntactic cues), low (syntactic cues), and zero predictability. Results showed that CN listeners primarily relied on semantic information when perceiving speech, whereas EN listeners used both semantic and syntactic cues more equally. Moreover, the four-talker babble enlarged the group difference similarly across the three types of sentences, indicating that non-native listeners' greater-than-native difficulty in noise depended on speech materials.
Proximity biotinylation identifies a set of conformation-specific interactions between Merlin and cell junction proteins
Authors: Hennigan Robert F. , Fletcher Jonathan S. , Guard Steven , Ratner Nancy
Published: April 2019

The tumor suppressor Merlin interacts with cell junction–associated proteins and with the proapoptotic protein ASPP2.
Understanding the Genetic Code
Authors: Saier Milton H.
Published: April 2019

The universal triple-nucleotide genetic code is often viewed as a given, randomly selected through evolution. However, as summarized in this article, many observations and deductions within structural and thermodynamic frameworks help to explain the forces that must have shaped the code during the early evolution of life on Earth.
Fitting Pieces into the Puzzle of
Pseudomonas aeruginosa
Type III Secretion System Gene Expression
Authors: Williams McMackin Emily A. , Djapgne Louise , Corley Jodi M. , Yahr Timothy L.
Published: April 2019

Type III secretion systems (T3SS) are widely distributed in Gram-negative microorganisms and critical for host-pathogen and host-symbiont interactions with plants and animals. Central features of the T3SS are a highly conserved set of secretion and translocation genes and contact dependence wherein host-pathogen interactions trigger effector protein delivery and serve as an inducing signal for T3SS gene expression.
Evaluation of a Novel
Aspergillus
Antigen Enzyme-Linked Immunosorbent Assay
Authors: Dichtl Karl , Seybold Ulrich , Ormanns Steffen , Horns Heidi , Wagener Johannes
Published: April 2019

Invasive aspergillosis (IA) is a life-threatening infection that mainly occurs in immunocompromised patients. Here, we compared the novel
Aspergillus
-specific galactomannoprotein (GP) enzyme-linked immunosorbent assay (ELISA) (Euroimmun Medizinische Labordiagnostika AG) to the established Platelia
Aspergillus
galactomannan (GM) ELISA (Bio-Rad Laboratories) for the detection of IA.
Equine Influenza Virus in Asia: Phylogeographic Pattern and Molecular Features Reveal Circulation of an Autochthonous Lineage
Authors: Miño Samuel , Mojsiejczuk Laura , Guo Wei , Zhang Haili , Qi Ting , Du Cheng , Zhang Xiang , Wang Jingfei , Campos Rodolfo , Wang Xiaojun
Published: April 2019

The complex and continuous antigenic evolution of equine influenza viruses (EIVs) remains a major hurdle for vaccine development and the design of effective immunization programs. The present study provides a comprehensive analysis showing the EIV evolutionary dynamics, including the spread and circulation within the Asian continent and its relationship to global EIV populations over a 10-year period. Moreover, we provide a better understanding of EIV molecular evolution in Asian countries and its consequences on the antigenicity. The study underscores the association between the global horse movement and the circulation of EIV in this region. Understanding EIV evolution is imperative in order to mitigate the risk of outbreaks affecting the horse industry and to help with the selection of the viral strains to be included in the formulation of future vaccines.
Roles of Type 1, 2, and 3 Innate Lymphoid Cells in Herpes Simplex Virus 1 InfectionIn VitroandIn Vivo
Authors: Hirose Satoshi , Wang Shaohui , Tormanen Kati , Wang Yizhou , Tang Jie , Akbari Omid , Ghiasi Homayon
Published: April 2019

In this study, we investigated for the first time what roles, if any, innate lymphoid cells (ILCs) play in HSV-1 infection. Analysis of isolated ILCsin vitrorevealed that all three subtypes could be infected with HSV-1 but that they were resistant to replication. The expression profiles of HSV-1-induced cytokines/chemokines and cellular and viral genes differed among the infected type 1, 2, and 3 ILCsin vitro. While ILCs play no role or a redundant role in the outcomes of latency-reactivation in infected mice, absence of type 1 and type 3, but not type 2, ILCs affects the survival of infected mice.
Development and Standardization of a High-Throughput Multiplex Immunoassay for the Simultaneous Quantification of Specific Antibodies to Five Respiratory Syncytial Virus Proteins
Authors: Schepp Rutger M. , de Haan Cornelis A. M. , Wilkins Deidre , Layman Hans , Graham Barney S. , Esser Mark T. , Berbers Guy A. M.
Published: April 2019

In view of vaccine and monoclonal development to reduce hospitalization and death due to lower respiratory tract infection caused by RSV, assessment of antibody levels against RSV is essential. This newly developed multiplex immunoassay is able to measure antibody levels against five RSV proteins simultaneously. This can provide valuable insight into the dynamics of (maternal) antibody levels and RSV infection in infants and toddlers during the first few years of life, when primary RSV infection occurs.
Periorbital necrotising fasciitis with underlying undiagnosed hepatitis C infection
Authors: Cereceda-Monteoliva Nicholas , Lewis Hannah , Al-Himdani Sarah , Stone Christopher
Published: April 2019

We report the case of a 56-year-old man, previously well, who presented with a spontaneous right-sided periorbital necrotising soft tissue infection and subsequently found to have undiagnosed hepatitis C and liver cirrhosis. The patient presented with rapid onset right eye pain, periorbital swelling and septic shock. CT scan revealed diffuse inflammatory changes to the soft tissue anterior to the right eye. The initial treatment included intravenous antibiotics, emergency debridement of necrotic tissue and admission to intensive care. Group A streptococcus was cultured from the debrided tissue. The patient developed decompensated liver failure and life-threatening haematemesis. Liver screening detected hepatitis C positive serology, the only risk factor for which was an old tattoo. The patient was effectively managed by early involvement of multiple clinical teams. We review the literature surrounding periorbital necrotising fasciitis, discuss the evidence for hepatic disorders as a potential cause and make recommendations for managing these patients.
Robust response to nivolumab in patient with renal cell carcinoma inferior vena cava tumour thrombus
Authors: Berends Joel , Gourley Eric , Kaushik Dharam
Published: April 2019

A 47-year-old previously healthy man presented with acute moderate flank pain. Evaluation revealed left renal cell carcinoma, with inferior vena cava tumour thrombus invasion. Patient had no significant history or risk factors to pre-dispose him to genitourinary cancers. Surgery was deemed to not be appropriate due to distant metastases, but patient received targeted molecular therapy and immunotherapy with striking regression of the thrombus.
Intraorbital aneurysm of the ophthalmic artery
Authors: Garala Pavitra , Virdee Jasvir , Qureshi Madyan , Gillow Timothy
Published: April 2019

Intraorbital ophthalmic artery (OA) aneurysms are rare. They can be asymptomatic or present with visual disturbances, exophthalmos and headaches. We present a case of a 57-year-old man who presented with reduced vision, diplopia and exophthalmos. A carotid artery angiogram identified a right OA aneurysm. Due to the low risk of rupture and the patient’s comorbidities including cardiac and renal impairment, a conservative approach was followed. A few weeks post presentation, the patient’s vision and optic nerve function had improved. This case reiterates the importance of considering conservative treatment for patients with intraorbital OA aneurysms.
Cutaneous malakoplakia presenting as a groin swelling and graft failure
Authors: Macdonald Ross Andrew , Moyes Colin , Clancy Marc , Douglas Peter
Published: April 2019

Malakoplakia (from the Greek malakos, ‘soft’ and plakos ‘plaque’) is a granulomatous inflammatory condition, commonly presenting as a plaque in the genitourinary system, but has been shown to affect a wide variety of structures including the skin. Presentation is varied and a high degree of clinical suspicion is needed to make a diagnosis. We report a case of cutaneous malakoplakia presenting as an inguinal swelling in a 48-year-old kidney transplant patient with temporally associated graft dysfunction. New groin swelling in an immunosuppressed patient often prompts investigation centred on a malignant cause. While this is often appropriate, less common infectious and inflammatory causes should be considered. This case highlights the importance of thorough workup and investigation, including histopathology, in immunosuppressed cohorts and acts as a reminder that less common and more complex diagnoses warrant consideration in this group.
Merkel cell carcinoma: an aggressive cutaneous carcinoma with rare metastasis to the thyroid gland
Authors: Vaiciunaite Donata , Beddell Gregory , Ivanov Nedyalko
Published: April 2019

Merkel cell carcinoma (MCC) is an aggressive and rare neuroendocrine cutaneous carcinoma with poor prognosis and with increasing morbidity and mortality in cases of distant metastasis. Given the rarity of MCC, optimal treatment is not well established. Treatment usually consists of multidisciplinary management with local excision of the primary tumour. Imaging studies are essential for accurate staging and monitoring of disease progression. The incidence of local recurrence is highest in the first 2 years and ranges from 27% to 60%. Distant metastasis is most common in the skin, liver, bone, lung/pleura, brain or distant lymph nodes. The thyroid gland is a rare site of metastasis for MCC with only two case reports published to date. Our patient had a repeat 2-[18F]-fluoro-2-deoxy-d-glucose-postiron emission tomography/CT after the discovery of recurrence of MCC. The high-intensity maximal standardised uptake value of 10.9 in the thyroid isthmus is consistent with malignancy. This case report describes an exceedingly rare thyroid metastasis secondary to MCC.
Pyoderma gangrenosum-like lesion secondary to methylenetetrahydrofolate reductase mutation: an unusual presentation of a rare disease
Authors: Turkowski Yana , Razvi Syed , Ahmed Abdul Razzaque
Published: April 2019

Pyoderma gangrenosum (PG)-like ulcerations are a rare clinical manifestation of methylenetetrahydrofolate reductase (MTHFR) mutation. We describe a patient considered to have PG who was treated with long-term high doses of systemic corticosteroids and multiple immunosuppressive agents for several years. In spite of this continuous aggressive therapy, the lesions did not improve but continued to get worse. She developed many significant and catastrophic side effects to them. When referred to our dermatology centre, on investigation, it was discovered that she has an MTHFR mutation. It seemed reasonable to presume that PG-like lesions were related to it. Treatment with a biologically active form of folate—[6S]-5-MTHF—with vitamins B6 and B12 was initiated. It was considered to be beneficial and capable of reducing hyperhomocysteinaemia and endothelial damage consequent from it. Since the institution of this treatment, the patient has begun to show very gradual but slow and incremental improvement.
Use of ventriculostomy in the treatment of septic cavernous sinus thrombosis (SCST)
Authors: Thomas Justin , Fayad Mohamad , Tong Doris , Richards Boyd F
Published: April 2019

We present a novel treatment with the use of intraventricular antibiotics delivered through a ventriculostomy in a patient who developed septic cavernous sinus thrombosis after sinus surgery. A 65-year-old woman presented with acute on chronic sinusitis. The patient underwent a diagnostic left maxillary antrostomy, ethmoidectomy, sphenoidotomy and sinusotomy. Postoperatively, the patient experienced altered mental status with episodic fever despite treatment with broad-spectrum antimicrobial therapy. MRI of the brain showed extensive meningeal enhancement with the involvement of the right trigeminal and abducens nerve along with thick enhancement along the right pons and midbrain. MR arteriogram revealed a large filling defect within the cavernous sinus. Intraventricular gentamicin was administered via external ventricular drain (ie, ventriculostomy) every 24 hours for 14 days with continued treatment of intravenous ceftriaxone and metronidazole. The patient improved with complete resolution of her cavernous sinus meningitis on repeat brain imaging at 6 months posthospitalisation.
Desmopressin treatment combined with clotting factor VIII concentrates in patients with non-severe haemophilia A: protocol for a multicentre single-armed trial, the DAVID study
Authors: Schütte Lisette M , Cnossen Marjon H , van Hest Reinier M , Driessens Mariette H E , Fijnvandraat Karin , Polinder Suzanne , Beckers Erik A M , Coppens Michiel , Eikenboom Jeroen , Laros-van Gorkom Britta A P , Meijer Karina , Nieuwenhuizen Laurens , Mauser-Bunschoten Evelien P , Leebeek Frank W G , Mathôt Ron A A , Kruip Marieke J H A
Published: April 2019

Introduction

Haemophilia A is an inherited bleeding disorder characterised by factor VIII (FVIII) deficiency. In patients with non-severe haemophilia A, surgery and bleeding are the main indications for treatment with FVIII concentrate. A recent study reported that standard dosing frequently results in FVIII levels (FVIII:C) below or above FVIII target ranges, leading to respectively a bleeding risk or excessive costs. In addition, FVIII concentrate treatment carries a risk of development of neutralising antibodies. An alternative is desmopressin, which releases endogenous FVIII and von Willebrand factor. In most patients with non-severe haemophilia A, desmopressin alone is not enough to achieve FVIII target levels during surgery or bleeding. We hypothesise that combined pharmacokinetic (PK)-guided administration of desmopressin and FVIII concentrate may improve dosing accuracy and reduces FVIII concentrate consumption.

Methods and analysis

In the DAVID study, 50 patients with non-severe haemophilia A (FVIII:C ≥0.01 IU/mL) with a bleeding episode or undergoing surgery will receive desmopressin and FVIII concentrate combination treatment. The necessary dose of FVIII concentrate to reach FVIII target levels after desmopressin administration will be calculated with a population PK model. The primary endpoint is the proportion of patients reaching FVIII target levels during the first 72 hours after start of the combination treatment. This approach was successfully tested in one pilot patient who received perioperative combination treatment.

Ethics and dissemination

The DAVID study was approved by the medical ethics committee of the Erasmus MC. Results of the study will be communicated trough publication in international scientific journals and presentation at (inter)national conferences.

Trial registration number

NTR5383; Pre-results.
Trends in occupational diseases in Finland, 1975–2013: a register study
Authors: Oksa Panu , Sauni Riitta , Talola Nina , Virtanen Simo , Nevalainen Jaakko , Saalo Anja , Uitti Jukka
Published: April 2019

Objectives

The objective was to investigate trends in the incidence of recognized and suspected cases of occupational diseases in Finland from 1975 to 2013, including variations by industry – and describe and recognize factors affecting variations in incidence.

Design

A register study.

Setting

The data consisted of recognized and suspected cases of occupational diseases recorded in the Finnish Registry of Occupational Diseases (FROD) in 1975–2013.

Participants

Altogether 240 000 cases of suspected and recognized ODs were analysed.

Primary and secondary outcome measures

From the annual workforce statistics and FROD data, we calculated the incidence of ODs and suspected ODs per 10 000 employees. For time trends by industrial sector, we used a 5-year moving average and a Poisson regression analysis.

Results

Annual average rates of ODs have varied from year to year. The total number was 25.0/10 000 employees in 1975 and 20.1/10 000 employees in 2013. Screening campaigns and legislative changes have caused temporary increases. When the financial sector was the reference (1.0), the highest incidence rates according to industrial sector were in mining and quarrying (9.87; 95% CI 8.65 to 11.30), construction (9.11; 95% CI 9.98 to 10.43), manufacturing (9.04; 95% CI 7.93 to 10.36) and agriculture (8.78; 95% CI 7.69 to 10.06). There is a distinct decreasing trend from 2005 onwards: the average annual change in incidence was, for example, −9.2% in agriculture, −10.3% in transportation and −4.7% in construction. The average annual decline was greatest in upper limb strain injuries (−11.1%).

Conclusion

This study provides a useful overview of the status of ODs in Finland over several decades. These data are a valuable resource for determining which occupations are at an increased risk and where preventive actions should be targeted. It is important to study long-term trends in the statistics of ODs to see beyond the year-to-year fluctuations.
Usefulness of the heparin-binding protein level to diagnose sepsis and septic shock according to Sepsis-3 compared with procalcitonin and C reactive protein: a prospective cohort study in China
Authors: Zhou Yixuan , Liu Zhen , Huang Jun , Li Guiling , Li Fengying , Cheng Yulan , Xie Xinyou , Zhang Jun
Published: April 2019

Objectives

Our aim was to assess the release level of heparin-binding protein (HBP) in sepsis and septic shock under theThird International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3).

Design

Prospective cohort study.

Setting

A general teaching hospital in China.

Participants

Adult infected patients with suspected sepsis and people who underwent physical examination were included. According to the health status and severity of illness, the research subjects were divided into healthy, local infection, sepsis non-shock and septic shock under Sepsis-3 definitions.

Main outcome measures

Plasma levels of HBP, procalcitonin (PCT), C reactive protein (CRP) and complete blood count were detected in all subjects. Single-factor analysis of variance was used to compare the biomarker levels of multiple groups. A receiver operating characteristic (ROC) curve was used to assess the diagnostic capacity of each marker.

Results

HBP levels were significantly higher in patients with sepsis non-shock than in those with local infections (median 49.7ng/mL vs 11.8 ng/mL, p<0.01) at enrolment. Moreover, HBP levels in patients with septic shock were significantly higher than in patients with sepsis without shock (median 153.8ng/mL vs 49.7 ng/mL, p<0.01). The area under the ROC curve (AUC) of HBP (cut-off ≥28.1 ng/mL) was 0.893 for sepsis which was higher than those of PCT (0.856) for a cut-off ≥2.05 ng/mL and of CRP (0.699) for a cut-off ≥151.9 mg/L. Moreover, AUC of HBP (cut-off ≥103.5 ng/mL) was 0.760 for septic shock which was higher than the ROC curve of sequential [sepsis-related] organ failure assessment (SOFA) Score (0.656) for a cut-off ≥5.5. However, there was no significant difference between 28-d survivors (n=56) and 28-d non-survivors (n=37) with sepsis in terms of HBP value (p=0.182).

Conclusions

A high level of HBP in plasma is associated with sepsis, which might be a useful diagnostic marker in patients with suspected sepsis.
Trends in the wear of personal flotation devices (PFDs) in the UK 2009–2017
Authors: Pitman Sebastian
Published: April 2019

Around 372 000 people drown every year globally. In countries, such as the UK, a large proportion of these deaths are due to recreational boating accidents, and a dominant factor influencing the outcome is whether the person was wearing a personal flotation device (PFD). The rate of PFD wear is low around the world, with reported rates ranging from 5% to 40%. In an effort to combat this, the UK has been running an education campaign since 2009 to try and increase PFD wear. In this contribution, 9 years of observational data show that the educational efforts have had little impact on the rate of wear over time. Activity type and age both influenced wear rates, with kayakers and children significantly more likely to wear PFDs. This study shows that education has been ineffective and there needs to be some consideration of regulatory approaches in order to reduce drowning.
Long noncoding RNA XIST regulates the EGF receptor to promote TGF-β1-induced epithelial–mesenchymal transition in pancreatic cancer
Authors: Zou Lei , Chen Feng-Rong , Xia Ren-Pin , Wang Hua-Wei , Xie Zhen-Rong , Xu Yu , Yu Jue-Hua , Wang Kun-Hua
Published: April 2019

Background: This study focuses on the lncRNA XIST (X inactive-specific transcript), an lncRNA involved in multiple human cancers, and investigates the functional significance of XIST and the molecular mechanisms underlying the epithelial–mesenchymal transition (EMT) in pancreatic cancer (PC). Methods: Clinical specimens from 25 patients as well as 5 human PC cell lines were analyzed for XIST, YAP, and microRNA(miR)-34a by quantitative real-time PCR (qRT-PCR) and immunohistochemistry. To investigate how XIST influences cell proliferation, invasiveness, and apoptosis in PC, we performed the CCK-8 assays, Transwell assays, and flow cytometry. Luciferase reporter assays, qRT-PCR, and Western blot were applied to prove that miR-34a directly binds to XIST. Results: Up-regulation of XIST and Yes associated protein (YAP) and down-regulation of miR-34a were consistently observed in the clinical specimens and PC cell lines. Silencing XIST reduced the expression of YAP and suppressed transforming growth factor (TGF)-β1-induced EMT, while over-expression of XIST increased the expression of YAP and promoted EMT. In addition, inhibition of epidermal growth factor receptor (EGFR) hampered the XIST-promoted EMT. The results from the luciferase reporter assays confirmed that miR-34a directly targets XIST and suggested that XIST regulates cell proliferation, invasiveness, and apoptosis in PC by sponging miR-34a. Conclusions: XIST promotes TGF-β1-induced EMT by regulating the miR-34a–YAP–EGFR axis in PC.
Strain-softening model evaluating geobelt–clay interaction validated by laboratory tests of sensor-enabled geobelts
Authors: Cui Xin-zhuang , Wang Yi-lin , Liu Kai-Wen , Li Jun , Zhang Lei , Su Jun-wei
Published: April 2019

The interaction between geosynthetics and soil is vital for the stability and the bearing capacity of geosynthetic-reinforced soil structures. This contact behavior between geosynthetics and granular soils has been extensively studied in the literature while there is scarcity of it related to geosynthetics and cohesive soils particularly with softening responses. This paper presents a strain-softening model of geobelt–clay interaction based on direct shear test results under two compaction degrees. A theoretical model for evaluating the pullout behavior of a geobelt is proposed by employing the strain-softening model verified by direct shear tests and a hyperbolic model capturing the stress–strain curves of a geobelt calibrated by uniaxial tensile tests. The proposed model is numerically solved and validated by pullout tests. A kind of sensor-enabled geobelt (SEGB) was adopted in all the aforementioned tests. Both test and numerical results show an overall softening trend in terms of front pull-out force versus displacement. Generally, the model proposed can give reasonably good agreement between calculations and test data during the whole pull-out range. Also, the strain distributions measured by SEGBs demonstrate the working process during the pullout tests, which makes SEGBs a potentially new choice for the strain measurements of in-soil geobelts.
Water flow in unsaturated soils subjected to multiple infiltration events
Authors: Hou Xiaokun , Vanapalli Sai K. , Li Tonglu
Published: April 2019

In this paper, water flow in a 4 m height column with an unsaturated soil that is subjected to multiple infiltration events for a 62 day period is investigated. One-dimensional (1D) numerical analysis is also undertaken to analyze the flow, extending the seepage theory for unsaturated soils. Results highlight the formation of two wetting fronts; namely, wetting front I and wetting front II that are induced by the first and subsequent infiltration events, respectively. There is a stable zone where the water content is approximately constant; it forms between the two fronts. A conceptual model of the suction profile is proposed for interpreting in situ water flow by dividing the unsaturated zone into four distinct zones; namely, active, steady, transition, and capillary fringe zones. This division is helpful for providing a rational explanation of water flow in different zones. Novel contributions from this study include a relationship between the hydraulic properties in the steady zone and the flow velocity, which is determined by an average influx rate. In addition, the rate of groundwater recharge can also be estimated using the average influx rate. Results of the present study are useful to understand and interpret the relationship between water infiltration and suction or water content profile in the unsaturated zone as well as variation of groundwater table level.
Quantitative risk assessment of rock slope instabilities that threaten a highway near Canmore, Alberta, Canada: managing risk calculation uncertainty in practice
Authors: Macciotta Renato , Gräpel Chris , Keegan Tim , Duxbury Jason , Skirrow Roger
Published: April 2019

We present a quantitative risk assessment (QRA) to guide decision-making for selection of rock fall protection strategies. The analysis corresponds to a section of highway near Canmore, Alberta, Canada; where rock falls are common. Environmental concerns, tourism, and economic activities overlap the project area, which increased the complexity of the decision-making process. QRA was adopted to improve highway user safety and minimize effects on natural, social, and economic environments. Uncertainty was associated with hazard and consequence quantification, and the study elicited plausible ranges of input variables for risk calculation. Expected and range in risk were calculated for current conditions and after mitigation. Individual risk to highway users was found to be low, following the limited exposure of any particular individual. Current total risk was calculated at 2.9 × 10−4probability of fatality and a plausible range between 2.0 × 10−5and 5.5 × 10−3. The slope protection configuration selected had a residual total risk between 9.0 × 10−4and 2.9 × 10−6, and a best estimate of 4.5 × 10−5. The risk levels were evaluated against criteria previously used in Canada and were considered an appropriate balance between project costs, public safety, environmental concerns, tourism, and economic activities after mitigation.