bluuebunny/crossref_metadata_2025 huggingface dataset:
Gait alterations in patient with intermittent claudication: Effect of unilateral vs bilateral ischemia
Authors: Guilleron Céline , Beaune Bruno , Durand Sylvain , Pouliquen Camille , Henni Samir , Abraham Pierre
Published: March 2021

Background

We seek to evaluate whether ischemia extent (unilateral or bilateral) impacts spatiotemporal and neuromuscular gait parameters differently in patients with peripheral arterial disease and presenting intermittent claudication (PAD‐IC).

Methods

Two groups of PAD‐IC patients: unilateral (Unilat‐IC; n = 15), bilateral (Bilat‐IC; n = 15) and a group of control subjects with similar risk factors (n = 15) were evaluated during a constant load treadmill walking test. Spatiotemporal parameters and neuromuscular activation in tibialis anterior and gastrocnemius medialis were recorded. Patients were instructed to describe their pain during walking test, and three phases were analysed: pain‐free, onset of pain and maximum pain in PAD‐IC patients.

Findings

Single leg stance in the asymptomatic leg of Unilat‐IC increases and becomes higher than the symptomatic leg and the Bilat‐IC legs at maximum pain. Step time is higher and cadence is lower in PAC‐IC than in controls. Tibialis anterior activation peak in Unilat‐IC continuously decreases between phases and becomes lower than in Bilat‐IC during maximum pain. Tibialis anterior activation time is higher in Bilat‐IC and in the asymptomatic leg than in the symptomatic of Unilat‐IC during all the phases. Gastrocnemius medialis activation peak in Bilat‐IC decreases with pain. Gastrocnemius medialis activation time in the symptomatic leg of Unilat‐IC presents a significant decrease between pain‐free and maximum pain phases.

Interpretation

Ischemia impacts gait in PAD‐IC patients differently according to its extent between legs compared to controls. Imbalance between legs in Unilat‐IC induces compensatory mechanism and an asymmetrical pattern. Bilat‐IC should not be simply considered as a ‘double’ Unilat‐IC when evaluating gait.
Factors associated with degraded trabecular bone score in heart transplant recipients
Authors: Rakusa Matej , Poglajen Gregor , Vrtovec Bojan , Goricar Katja , Janez Andrej , Jensterle Mojca
Published: March 2021

Trabecular bone score (TBS) is a textural index that provides indirect evaluation of trabecular microarchitecture. It improves fracture risk assessment in several high‐risk populations. We aimed to evaluate the role of TBS assessment in heart transplant recipients (HTR). In a cross‐sectional study with 87 HTR (69 males and 18 females), we assessed TBS and evaluated potential associations between TBS and factors related to increased fracture risk. We also evaluated the correlations between the presence of vertebral fractures (VF) and degraded TBS. We confirmed degraded TBS in the majority of HTR. 27.6% of HTR had partially degraded, 27.6% had degraded TBS. HTR with degraded TBS were older, had higher body mass index, lower bone mineral density (BMD), and T‐score. As opposed to stable BMD over different time points, TBS significantly differed among different post‐transplant time periods. TBS did not correlate with current methylprednisolone or past zoledronic acid treatment, presence of hypogonadism or diabetes. TBS did not have additional value over BMD in predicting the presence of VF. Most fractures occurred in patients with osteopenia and in patients with partly degraded TBS. Studies with longitudinal designs and larger sample sizes are warranted to further assess the potential role of TBS in HRT.
Museum Security and Purloin: The Manhyia Palace Museum in perspective
Authors: Manu Emmanuel Boadi , Arthur Nana Ama Pokuaa
Published: March 2021

Security in the museum is integral to the preservation of cultural heritage. Security, however, includes both the protection of collections, visitors and staff. The author undertakes a case study of the security issues at the Manhyia Palace Museum in Ghana. The study determined that lack of adequate security has led to the loss of essential collections through pilferage. The paper examines how these collections were stolen, through content analysis and a series of open‐ended systematic qualitative interviews with core staff. The author then recommends appropriate measures to prevent further loss. The findings from this case study also leads to the author to consider the state of security fractures in this case study as typical of many museums in countries with similar economic and political challenges By presenting these theories about museum theft, the author offers a set of remedies to close the loop holes for the most common forms of loss. Furthermore, the author provides a foundation for future research into the topic.
Farmers' heterogeneous perceptions of marginal land for biofuel crops in US Midwestern states considering biophysical and socioeconomic factors
Authors: Yang Pan , Cai Ximing , Khanna Madhu
Published: March 2021

Planting bioenergy crops on marginal land is critical for avoiding competition with food crop production. While many studies have estimated marginal land availability using various methods, only a few studies have considered the role of socioeconomic factors in affecting perceptions about the availability of marginal land. This study analyzes land‐use survey data to examine the determinants of farmers' perceptions of marginal land availability on their farms. We find that farmers' perceptions are affected by a combination of unfavorable biophysical (e.g., soil water capacity, temperature variability, and slope) and socioeconomic factors, of which farm size appears to be significant. Interestingly, we identify different determinants of perceptions among farmers that claim to have marginal land and those that do not; the former are determined mainly by unfavorable biophysical factors, while the latter are mainly explained by small farm size. We further apply a prediction model that is trained by a machine learning algorithm to Midwestern states, and derive maps of marginal land likelihood and associated dominant influencing factors. The results suggest that marginal land is primarily under pastureland and grassland cover and in the Dakotas and Nebraska; there is also some marginal land under crop production in the Corn Belt. Our findings contribute to improving understanding of the complex determinants of heterogeneous perceptions of marginal land and can inform the design of more targeted policies for bioenergy crop adoption.
Writing embodied generosity
Authors: Jääskeläinen Pauliina , Helin Jenny
Published: March 2021

This writing‐story showcases the possibilities of shaking off limiting conventions and finding one's own way to academic writing. Pauliina had conducted fieldwork on “embodied facilitations,” through methods from dance and movement therapy, in three organizations. She then analyzed her material through thematic coding. This procedure, based on the logic of reduction, removed the diversity of embodied movements that were essential to her and the research participants. In searching for an alternative, we read Cixous' work on “generosity” where she emphasized how the “strangeness” of the other and of ourselves is not something to stay away from, but rather to embrace, during writing. This text, written as an interplay between us, illustrates how the generous stance opened a different approach to writing embodiment in research. We call it “writing embodied generosity”; an art‐inspired writing‐in‐movement through reading, drawing, and listening that overflows and surprises us as we write in embodied multiplicity.
Etiology is a predictor of recurrence after catheter ablation of ventricular arrhythmias in pediatric patients
Authors: Gulletta Simone , Vergara Pasquale , Vitulano Gennaro , Foppoli Luca , D'Angelo Giuseppe , Cireddu Manuela , Bisceglia Caterina , Paglino Gabriele , Sala Simone , Capogrosso Cristina , Pannone Luigi , Falasconi Giulio , Trevisi Nicola , Agricola Eustachio , Della Bella Paolo
Published: March 2021

Background

Ventricular arrhythmias (VAs) are rare in pediatric patients, especially in absence of structural heart disease (SHD). Few data are available regarding the invasive VAs treatment with catheter ablation (CA) in pediatric patients and predictors of outcomes have not been fully investigated.

Objective

To describe the clinical presentation, procedural characteristics, and outcomes in pediatric patients undergoing CA for VAs.

Methods

Eighty‐one consecutive pediatric patients (58 male [72%], 15.5 ± 2.2 years) treated by CA for ventricular tachycardia (VT) or premature ventricular beats (PVBs) were retrospectively evaluated. Study endpoints were VAs recurrence and mortality for any cause.

Results

Ninety‐five procedures were performed in 81 patients, 52 (55%) PVBs and 43 (45%) VT ablations. During a follow‐up of 35.0 months (interquartile range = 13.0–71.0), 14 patients (14.7%) had a VA recurrence: 11 (33.3%) patients treated with CA for VT and 3 (6.2%) patients treated for PVBs (p < .001). One patient (1%) died 26 months after the procedure during an electrical storm. Patients with SHD had higher VAs recurrence rate, as compared with idiopathic VAs (pairwise log‐rank p < .001). Patients treated with CA for VT had higher VA recurrence rate, as compared with PVB patients (pairwise log‐rank p = .002). At Cox multivariate analysis only SHD was an independent predictor of VAs recurrence (hazard ratio = 5.56, 95% confidence interval = 2.68–11.54, p < .001).

Conclusion

CA of VAs is effective and safe in a pediatric population. CA of idiopathic and fascicular VAs are associated with lower recurrence rate, than VAs in the setting of SHD.
Ventricular activation pattern assessment during right ventricular pacing: Ultra‐high‐frequency ECG study
Authors: Curila Karol , Jurak Pavel , Halamek Josef , Prinzen Frits , Waldauf Petr , Karch Jakub , Stros Petr , Plesinger Filip , Mizner Jan , Susankova Marketa , Prochazkova Radka , Sussenbek Ondrej , Viscor Ivo , Vondra Vlastimil , Smisek Radovan , Leinveber Pavel , Osmancik Pavel
Published: March 2021

Background

Right ventricular (RV) pacing causes delayed activation of remote ventricular segments. We used the ultra‐high‐frequency ECG (UHF‐ECG) to describe ventricular depolarization when pacing different RV locations.

Methods

In 51 patients, temporary pacing was performed at the RV septum (mSp); further subclassified as right ventricular inflow tract (RVIT) and right ventricular outflow tract (RVOT) for septal inflow and outflow positions (below or above the plane of His bundle in right anterior oblique), apex, anterior lateral wall, and at the basal RV septum with nonselective His bundle or RBB capture (nsHBorRBBp). The timings of UHF‐ECG electrical activations were quantified as left ventricular lateral wall delay (LVLWd; V8 activation delay) and RV lateral wall delay (RVLWd; V1 activation delay).

Results

The LVLWd was shortest for nsHBorRBBp (11 ms [95% confidence interval = 5–17]), followed by the RVIT (19 ms [11–26]) and the RVOT (33 ms [27–40]; p < .01 between all of them), although the QRSd for the latter two were the same (153 ms (148–158) vs. 153 ms (148–158); p = .99). RV apical capture not only had a longer LVLWd (34 ms (26–43) compared to mSp (27 ms (20–34), p < .05), but its RVLWd (17 ms (9–25) was also the longest compared to other RV pacing sites (mean values for nsHBorRBBp, mSp, anterior and lateral wall captures being below 6 ms), p < .001 compared to each of them.

Conclusion

RVIT pacing produces better ventricular synchrony compared to other RV pacing locations with myocardial capture. However, UHF‐ECG ventricular dysynchrony seen during RVIT pacing is increased compared to concomitant capture of basal septal myocytes and His bundle or proximal right bundle branch.
Prognostic information, goals of care, and code status decision‐making among older patients
Authors: van Dyck Laura I. , Fried Terri R.
Published: March 2021

See related editorial byPerry et al. in this issue.
Association between motor proficiency and oral health in people with intellectual disabilities
Authors: Baumgarten A. , Hilgert J. B. , Rech R. S. , Cunha‐Cruz J. , Goulart B. N. G.
Published: March 2021

Background

People with intellectual disabilities (IDs) may be at increased risk of developing periodontal diseases and dental caries due to poor oral hygiene. Our aim was to investigate motor proficiency factors associated with presence of visible plaque and gingival bleeding in people with IDs. We were particularly interested in the level of dependence, manual coordination and fine manual control of people with ID, as well as the level of exhaustion of the primary caregiver.

Methods

In this cross‐sectional study, 299 people with ID were evaluated for oral hygiene using the simplified Visible Plaque Index and for gum inflammation using the Gingival Bleeding Index. The Bruininks‐Oseretsky Motor Proficiency Test assessed motor proficiency through fine manual control (fine motor integration and fine motor precision) and manual coordination (manual dexterity and upper limb coordination). The level of dependence was assessed by the Katz dependency index, and the caregiver was tested for exhaustion using the fatigue severity scale. Prevalence ratios [and 95% confidence intervals (CI)] were calculated using crude and adjusted Poisson regression with robust variance.

Results

The exhaustion of the caregiver was associated positively to visible plaque [prevalence ratio (PR) = 1.36; 95% CI 1.06–1.65]. For gingival bleeding, people with IDs that had better fine motor integration (PR = 0.49; 95% CI 0.33–0.75) and precision (PR = 0.50; 95% CI 0.26–0.94), as well as manual dexterity (PR = 0.62, 95% CI 0.49–0.77), presented better results.

Conclusion

Poor oral hygiene and gum inflammation were associated with motor proficiency of people with IDs and caregivers' exhaustion. Interventions to improve the oral health of people with IDs should take into account such conditions.
Facial malformations, including cleft lip and palate, in wild primates in Paraguay
Authors: Smith Rebecca L. , Blood Rachel , Smith Paul
Published: March 2021

Nine individual Alouatta caraya and Sapajus cay displaying facial malformations were observed across three sites in Paraguay. Six had cleft lip (with or without cleft palate), and three had malformations of the lower lip. This is the first record of cleft lip and/or palate in the genus Alouatta.
Trait evolution rates shape continental patterns of species richness in North America's most diverse angiosperm genus (Carex, Cyperaceae)
Authors: Pender Jocelyn E. , Hipp Andrew L. , Hahn Marlene , Starr Julian R.
Published: March 2021

Ecological opportunity has been associated with increases in diversification rates across the tree of life. Under an ecological diversification model, the emergence of novel environments is hypothesized to promote morpho‐ and ecospace evolution. Whether this model holds at the clade level within the most species‐rich angiosperm genus found in North America (Carex, Cyperaceae) is yet to be tested. Recent works demonstrate a temporal coupling of climate cooling and widespread colonization ofCarexin North America, implicating ecological diversification. In addition, research has consistently found asymmetric patterns of lineage‐level diversification in the genus. Why does variation in clade sizes exist in the genus? Is ecological diversification involved? In this study, we tested whether rates of morphological and ecological trait evolution are correlated with clade‐level species richness inCarexof North America north of Mexico. We constructed a phylogeny of 477 species—an almost complete regional sample. We estimated rates of evolution of morphological traits, habitat, and climatic niche and assessed whether differences in rates of evolution correlate with species richness differences in replicate non‐nested sister clades. Our work demonstrates significant positive correlations between climatic niche rates, habitat and reproductive morphological evolution, and species richness. This coupling of trait and niche evolution and species richness in a diverse, continental clade sample strongly suggests that the ability of clades to explore niche and functional space has shaped disparities in richness and functional diversity across the North American flora region. Our findings highlight the importance of the evolutionary history of trait and niche evolution in shaping continental and regional floras.
Research routes on improved sleep bruxism metrics: Toward a standardised approach
Authors: Lavigne Gilles , Kato Takafumi , Herrero Babiloni Alberto , Huynh Nelly , Dal Fabbro Cibele , Svensson Peter , Aarab Ghizlane , Ahlberg Jari , Baba Kazuyoshi , Carra Maria Clotilde , Cunha Thays Crosara A. , Gonçalves Daniela A. G. , Manfredini Daniele , Stuginski‐Barbosa Juliana , Wieckiewicz Mieszko , Lobbezoo Frank
Published: March 2021

A recent report from the European Sleep Research Society’s task force “Beyond AHI” discussed an issue that has been a long‐term subject of debate – what are the best metrics for obstructive sleep apnoea (OSA) diagnosis and treatment outcome assessments? In a similar way, sleep bruxism (SB) metrics have also been a recurrent issue for >30 years and there is still uncertainty in dentistry regarding their optimisation and clinical relevance. SB can occur alone or with comorbidities such as OSA, gastroesophageal reflux disorder, insomnia, headache, orofacial pain, periodic limb movement, rapid eye movement behaviour disorder, and sleep epilepsy. Classically, the diagnosis of SB is based on the patient’s dental and medical history and clinical manifestations; electromyography is used in research and for complex cases. The emergence of new technologies, such as sensors and artificial intelligence, has opened new opportunities. The main objective of the present review is to stimulate the creation of a collaborative taskforce on SB metrics. Several examples are available in sleep medicine. The development of more homogenised metrics could improve the accuracy and refinement of SB assessment, while moving forward toward a personalised approach. It is time to develop SB metrics that are relevant to clinical outcomes and benefit patients who suffer from one or more possible negative consequences of SB.
Proteomic analysis reveals how pairing of a Mycorrhizal fungus with plant growth‐promoting bacteria modulates growth and defense in wheat
Authors: Vannini Candida , Domingo Guido , Fiorilli Valentina , Seco Daniel Garçia , Novero Mara , Marsoni Milena , Wisniewski‐Dye Florence , Bracale Marcella , Moulin Lionel , Bonfante Paola
Published: March 2021

Plants rely on their microbiota for improving the nutritional status and environmental stress tolerance. Previous studies mainly focused on bipartite interactions (a plant challenged by a single microbe), while plant responses to multiple microbes have received limited attention. Here, we investigated local and systemic changes induced in wheat by two plant growth‐promoting bacteria (PGPB), Azospirillum brasilense and Paraburkholderia graminis, either alone or together with an arbuscular mycorrhizal fungus (AMF). We conducted phenotypic, proteomic, and biochemical analyses to investigate bipartite (wheat–PGPB) and tripartite (wheat–PGPB–AMF) interactions, also upon a leaf pathogen infection. Results revealed that only AMF and A. brasilense promoted plant growth by activating photosynthesis and N assimilation which led to increased glucose and amino acid content. The bioprotective effect of the PGPB–AMF interactions on infected wheat plants depended on the PGPB‐AMF combinations, which caused specific phenotypic and proteomic responses (elicitation of defense related proteins, immune response and jasmonic acid biosynthesis). In the whole, wheat responses strongly depended on the inoculum composition (single vs. multiple microbes) and the investigated organs (roots vs. leaf). Our findings showed that AMF is the best‐performing microbe, suggesting its presence as the crucial one for synthetic microbial community development.
Poplar acetylome profiling reveals lysine acetylation dynamics in seasonal bud dormancy release
Authors: Liao Xiaoli , Li Yue , Hu Zhenzhu , Lin Ying , Zheng Bo , Ding Jihua
Published: March 2021

For perennials in boreal and temperate ecosystems, bud dormancy is crucial for survival in harsh winter. Dormancy is released by prolonged exposure to low temperatures and is followed by reactive growth in the spring. Lysine acetylation (Kac) is one of the major post‐translational modifications (PTMs) that are involved in plant response to environmental signals. However, little information is available on the effects of Kac modification on bud dormancy release. Here, we report the dynamics of lysine acetylome in hybrid poplar (Populus tremula × Populus alba) dormant buds. A total of 7,594 acetyl‐sites from 3,281 acetyl‐proteins were identified, representing a large dataset of lysine acetylome in plants. Of them, 229 proteins were differentially acetylated during bud dormancy release and were mainly involved in the primary metabolic pathways. Site‐directed mutagenesis enzymatic assays showed that Kac strongly modified the activities of two key enzymes of primary metabolism, pyruvate dehydrogenase (PDH) and isocitrate dehydrogenase (IDH). We thus propose that Kac of enzymes could be an important strategy for reconfiguration of metabolic processes during bud dormancy release. In all, our results reveal the importance of Kac in bud dormancy release and provide a new perspective to understand the molecular mechanisms of seasonal growth of trees.
The economic burden of tuberculosis in Sistan: a high‐risk region in Iran
Authors: Setoodehzadeh Fatemeh , Barfar Eshagh , Ansari Hossein , Sari Ali Akbari , Azizi Najmeh
Published: March 2021

Introduction

To estimate the economic burden of tuberculosis treatment in Sistan, the region with the highest number of tuberculosis cases in Iran.

Methods

All patients with smear‐positive pulmonary tuberculosis who had contracted tuberculosis in 2018 and successfully completed their treatment were interviewed.

Results

Ninety patients with a mean age of 57 ± 18 years were interviewed. Most of them were women (58%), housewives (57%) and resided in rural areas (84%). The mean cost of treatment for tuberculosis was estimated as 6800 USD per patient. Direct costs were 87% of the total cost. Twenty‐two patients lost an average income of 530 USD (8514590 rials) during treatment. The results showed the significant correlation of direct and indirect costs with sex, age, place of residence and education (P < 0.05).

Conclusion

It appears essential to improve social protection and implement interventions to promote knowledge in rural areas.
Assessment of the Loss Map of a Centrifugal Compressor's External Volute
Authors: Ceyrowsky Thomas , Hildebrandt Andre , Heinrich Martin , Schwarze Rüdiger
Published: March 2021

A volute's loss coefficient is highly sensitive to Mach number, circumferential velocity, and flowrate at volute inlet. In case of a backswept impeller, these parameters are coupled to each other. Therefore, in order to investigate the effects of flowrate and flow angle separately, one would have to vary the diffuser width together with the flowrate, keeping the flow angle constant. This corresponds to coupling the volute with aerodynamically similar impellers, designed for higher and lower flowrates. Since this is elaborate, there is no adequate study available in open literature, assessing a volute's global loss map. In this work, a new numerical approach for the prediction of a volute's representative loss map is presented: The volute is calculated by means of steady computational fluid dynamics (CFD) as a standalone component. The inlet boundary conditions are carefully selected by means of one-dimensional calculations (1D) and applied together with different diffuser widths. This allows for the separate investigation of the impacts of flow angle, flowrate, and Mach number. Validation against full-stage CFD confirms the applicability of the standalone model. The results exhibit that minimum losses do not necessarily occur at the theoretical matching point but when the volute is either smaller or bigger, depending on the inlet flow angle. Investigations of the loss mechanisms at different operating conditions provide useful guidelines for volute design. Finally, the validity of these study's findings for volutes with different geometrical features is examined by comparison with experimental data as well as with full-stage CFD.
Investigation of Film Cooling Using Time-Resolved Stereo Particle Image Velocimetry
Authors: Stichling Katharina , Elfner Maximilian , Bauer Hans-Jörg
Published: March 2021

In the present study, an existing test rig at the Institute of Thermal Turbomachinery (ITS), Karlsruhe Institute of Technology (KIT), designed for generic film cooling studies is adopted to accommodate time-resolved stereoscopic particle image velocimetry (SPIV) measurements. Through a similarity analysis, the test rig geometry is scaled by a factor of about 20. Operating conditions of hot gas and cooling air inlet and exit can be imposed that are compliant with realistic engine conditions including density ratio (DR). The cooling air is supplied by a parallel-to-hot gas coolant flow-configuration with a coolant Reynolds number of 30, 000. Time-resolved and time-averaged stereo article image velocimetry data for a film cooling flow at high DR and a range of blowing ratios are presented in this study. The investigated film cooling hole constitutes a 10 deg–10 deg–10 deg laidback fan-shaped hole with a wide spacing of P/D = 8 to insure the absence of jet interaction. The inclination angle amounts to 35 deg. The time-resolved data indicate transient behavior of the film cooling jet.
Plasma-jet sterilization enhanced by ion wind
Authors: Zhu Hongcheng , Jiang Linxiu , Xie Shouru , Jiang Yongrong , Li Hua
Published: March 2021

This work demonstrates that a needle-ring discharge device combined with an ion-wind generator can realize a plasma-jet system of self-inlet gas, replacing huge, unportable carrier-gas systems. First, a needle-ring atmospheric-pressure plasma-jet device is designed and manufactured. The effects of a dielectric tube and the discharge voltage on the jet characteristics are analyzed. The results show that a needle-ring discharge device with a dielectric tube can produce a long, stable plasma jet under a high DC applied voltage. Second, such a device and a 10-stage ion-wind device are combined into an integrated device, and the discharge characteristics are studied. The results show that an ion wind with a speed of 2.62 m/s can be generated when a DC voltage of −13 kV is applied to the ion-wind device. The plasma jet produced by the integrated device is longer and brighter when the ion wind is included. Finally, the ion wind is found to enhance the sterilization effect of the jet and greatly increase the sterilization range.
On Oscillation Properties of Self-Adjoint Boundary Value Problems of Fourth Order
Authors: Vladimirov A. A. , Shkalikov A. A.
Published: March 2021

The connection between the number of internal zeros of nontrivial solutions to fourth-order self-adjoint boundary value problems and the inertia index of these problems is studied. We specify the types of problems for which such a connection can be established. In addition, we specify the types of problems for which a connection between the inertia index and the number of internal zeros of the derivatives of nontrivial solutions can be established. Examples demonstrating the effectiveness of the proposed new approach to an oscillatory problem are considered.
Functional benefits of a chorioretinal anastomosis at 2 years in eyes with a central retinal vein occlusion treated with ranibizumab compared with ranibizumab monotherapy
Authors: McAllister Ian L , Smithies Lynne A , Chen Fred K , Mackey David A , Sanfilippo Paul G
Published: March 2021

Objective

To evaluate the functional benefits (best corrected visual acuity (BCVA), central subfield thickness, injection loads, central venous pressure (CVP)) of a laser-induced chorioretinal anastomosis (L-CRA) in patients with central retinal vein occlusion (CRVO) treated with ranibizumab compared with ranibizumab monotherapy.

Methods and Analysis

This is a post-hoc analysis of the 2-year randomised ranibizumab plus L-CRA for CRVO trial. Twenty-four patients (82.5%) developed a functioning or successful L-CRA; outcome effects were monitored in the monthly as-needed ranibizumab phase from months 7 to 24 and compared with the ranibizumab monotherapy group (n=29).

Results

From months 7 to 24, the mean (95% CI) injection load for the functioning L-CRA group was 2.18 (1.57 to 2.78) compared with 7.07 (6.08 to 8.06) for the control group (p<0.0001). The mean BCVA was averaged across all timepoints between the control and functioning L-CRA groups (average difference=11.46 (3.16 to 19.75) letters, p=0.01). At 2 years, there was an 82.5% reduction in the odds of high CVP (greater or equal to central retinal artery diastolic pressure) for those with a successful L-CRA compared with controls (p<0.0001).

Conclusion

For patients with CRVO, adding L-CRA as a causal-based treatment to conventional therapy reduced CVP and injection loads and offered improved BCVA.

Trial registration numberACTRN12612000004864.
Practical tips for introducing high-fidelity simulation to undergraduates at a large scale: learning from our experience
Authors: Walsh Sinead M , Costello Maria , Murphy Ella , Lowery Aoife , Reid McDermott Bronwyn , Byrne Dara
Published: March 2021

The letter provides practical tips for developing, implementing and scaling an effective simulation‑based education programme at a large scale for undergraduate medical students. Using time-lapsed scenarios and the pause-discuss method of debrief are some of the useful tips that are discussed further in the letter.
Lactobacillus rhamnosus GG induces cGAS/STING- dependent type I interferon and improves response to immune checkpoint blockade
Authors: Si Wei , Liang Hua , Bugno Jason , Xu Qi , Ding Xingchen , Yang Kaiting , Fu Yanbin , Weichselbaum Ralph R , Zhao Xin , Wang Liangliang
Published: March 2021

Objective

Our goals were to evaluate the antitumour efficacy of Lactobacillus rhamnosus GG (LGG) in combination with immune checkpoint blockade (ICB) immunotherapies on tumour growth and to investigate the underlying mechanisms.

Design

We used murine models of colorectal cancer and melanoma to evaluate whether oral administration of LGG improves the efficacy of ICB therapies. We performed the whole genome shotgun metagenome sequencing of intestinal contents and RNA sequencing of dendritic cells (DCs). In a series of in vitro and in vivo experiments, we further defined the immunological and molecular mechanisms of LGG-mediated antitumour immunity.

Results

We demonstrate that oral administration of live LGG augmented the antitumour activity of anti-programmed cell death 1 (PD-1) immunotherapy by increasing tumour-infiltrating DCs and T cells. Moreover, the combination treatment shifted the gut microbial community towards enrichment in Lactobacillus murinus and Bacteroides uniformis, that are known to increase DC activation and CD8+tumour recruitment. Mechanistically, treatment with live LGG alone or in combination with anti-PD-1 antibody triggered type I interferon (IFN) production in DCs, enhancing the cross-priming of antitumour CD8+ T cells. In DCs, cyclic GMP-AMP synthase (cGAS)/stimulator of IFN genes (STING) was required for IFN-β induction in response to LGG, as evidenced by the significant decrease in IFN-β levels in cGAS or STING-deficient DCs. LGG induces IFN-β production via the cGAS/STING/TANK binding kinase 1/interferon regulatory factor 7 axis in DCs.

Conclusion

Our findings have offered valuable insight into the molecular mechanisms of live LGG-mediated antitumour immunity and establish an empirical basis for developing oral administration of live LGG as a combination agent with ICB for cancer therapies.
Non-alcoholic fatty liver disease and increased risk of incident extrahepatic cancers: a meta-analysis of observational cohort studies
Authors: Mantovani Alessandro , Petracca Graziana , Beatrice Giorgia , Csermely Alessandro , Tilg Herbert , Byrne Christopher D , Targher Giovanni
Published: March 2021

Objective

We performed a meta-analysis of observational studies to quantify the magnitude of the association between non-alcoholic fatty liver disease (NAFLD) and risk of extrahepatic cancers.

Design

We systematically searched PubMed, Scopus and Web of Science databases from the inception date to 30 December 2020 using predefined keywords to identify observational cohort studies conducted in individuals, in which NAFLD was diagnosed by imaging techniques or International Classification of Diseases codes. No studies with biopsy-proven NAFLD were available for the analysis. Meta-analysis was performed using random-effects modelling.

Results

We included 10 cohort studies with 182 202 middle-aged individuals (24.8% with NAFLD) and 8485 incident cases of extrahepatic cancers at different sites over a median follow-up of 5.8 years. NAFLD was significantly associated with a nearly 1.5-fold to twofold increased risk of developing GI cancers (oesophagus, stomach, pancreas or colorectal cancers). Furthermore, NAFLD was associated with an approximately 1.2-fold to 1.5-fold increased risk of developing lung, breast, gynaecological or urinary system cancers. All risks were independent of age, sex, smoking, obesity, diabetes or other potential confounders. The overall heterogeneity for most of the primary pooled analyses was relatively low. Sensitivity analyses did not alter these findings. Funnel plots did not reveal any significant publication bias.

Conclusion

This large meta-analysis suggests that NAFLD is associated with a moderately increased long-term risk of developing extrahepatic cancers over a median of nearly 6 years (especially GI cancers, breast cancer and gynaecological cancers). Further research is required to decipher the complex link between NAFLD and cancer development.
Expression of programmed death-ligand 1 protein in pulmonary squamous cell carcinoma correlates with tumour necrosis but not with tumour differentiation
Authors: Tancoš Vladimír , Farkašová Anna , Kviatkovská Zuzana , Grendár Marián , Líšková Alena , Huťka Zdenko , Plank Lukáš
Published: March 2021

Aims

Pulmonary squamous cell carcinoma (SqCC) represents the second most common non-small cell lung carcinoma type. The mechanisms which regulate programmed death ligand 1 (PD-L1) expression in this form of lung cancer are not fully elucidated yet.

Methods

We immunohistochemically determined the level of PD-L1 expression using the Tumour Proportion Score system in surgical resections of 133 patients with pulmonary SqCC. The results from PD-L1 immunohistochemistry were analysed in relation to tumour differentiation and the presence of necrotic areas comprising at least 20% of the tumour mass.

Results

No significant differences in terms of PD-L1 expression were found between SqCC subtypes as defined by the current WHO classification: better differentiated, keratinising tumours (12/24, 50.0 %) compared with less differentiated, non-keratinising and basaloid forms (62/109, 56.9 %) were PD-L1 positive in a comparable proportion of cases (p=0.1903). Contrary to that, SqCCs with the presence of necrosis (51/61, 83.6 %) had significantly more PD-L1-positive cases (p<0.001) compared with SqCCs without necrotic areas (23/72, 32.0 %)

Conclusions

We demonstrated that PD-L1 expression in pulmonary SqCCs does not correlate with the traditionally defined degree of differentiation of these tumours. On the other hand, we found a significant association between the positive result of PD-L1 immunohistochemistry and tumour necrosis. Further investigation regarding the role of hypoxic pathways as presumable inducers of PD-L1 expression in pulmonary SqCCs might contribute to the understanding of this phenomenon.
Value of repeated imaging in patients with a stroke who are transferred for endovascular treatment
Authors: van Meenen Laura C C , Arrarte Terreros Nerea , Groot Adrien E , Kappelhof Manon , Beenen Ludo F M , Marquering Henk A , Emmer Bart J , Roos Yvo B W E M , Majoie Charles B L M , Coutinho Jonathan M
Published: March 2021

Background

Patients with a stroke who are transferred to a comprehensive stroke center for endovascular treatment (EVT) often undergo repeated neuroimaging prior to EVT.

Objective

To evaluate the yield of repeating imaging and its effect on treatment times.

Methods

We included adult patients with a large vessel occlusion (LVO) stroke who were referred to our hospital for EVT by primary stroke centers (2016–2019). We excluded patients who underwent repeated imaging because primary imaging was unavailable, incomplete, or of insufficient quality. Outcomes included treatment times and repeated imaging findings.

Results

Of 677 transferred LVO stroke, 551 were included. Imaging was repeated in 165/551 patients (30%), mostly because of clinical improvement (86/165 (52%)) or deterioration (40/165 (24%)). Patients who underwent repeated imaging had higher door-to-groin-times than patients without repeated imaging (median 43 vs 27 min, adjusted time difference: 20 min, 95% CI 15 to 25). Among patients who underwent repeated imaging because of clinical improvement, the LVO had resolved in 50/86 (58%). In patients with clinical deterioration, repeated imaging led to refrainment from EVT in 3/40 (8%). No symptomatic intracranial hemorrhages (sICH) were identified. Ultimately, 75/165 (45%) of patients with repeated imaging underwent EVT compared with 326/386 (84%) of patients without repeated imaging (p<0.01).

Conclusions

Neuroimaging was repeated in 30% of patients with an LVO stroke and resulted in a median treatment delay of 20 minutes. In patients with clinical deterioration, no sICH were detected and repeated imaging rarely changed the indication for EVT. However, in more than half of patients with clinical improvement, the LVO had resolved, resulting in refrainment from EVT.
Combined risk modelling approach to identify the optimal carotid revascularisation approach
Authors: Burke James Francis , Morgenstern Lewis B , Osborne Nicholas H , Hayward Rodney A
Published: March 2021

Background

Carotid endarterectomy (CEA) results in fewer perioperative strokes, but more myocardial infarctions (MI) than carotid artery stenting (CAS). We explored a combined modelling approach that stratifies patients by baseline stroke and MI.

Methods

Baseline registry-based risk models for perioperative stroke and MI were identified via literature search. We then selected treatment risk models in the Carotid Revascularisation Stenting versus Endarterectomy (CREST) trial by serially adding covariates (baseline risk, treatment (CEA vs CAS), treatment-risk interaction and age-treatment interaction terms). Treatment risk models were externally validated using data from the Society for Vascular Surgery (SVS) Vascular Quality Initiative (VQI) CEA and carotid stenting registries and treatment models were recalibrated to the SVS-VQI population. Predicted net benefit was estimated by summing the predicted stroke and MI risk differences with CEA versus CAS.

Results

Perioperative treatment models had moderate predictiveness (c-statistic 0.69 for stroke and 0.68 for MI) and reasonable calibration across the risk spectrum for both stroke and MI within CREST. On external validation in SVS-VQI, predictiveness was substantially reduced (c-statistic 0.61 for stroke and 0.54 for MI) and models substantially overpredicted risk.

Most patients (86.7%) were predicted to have net benefit from CEA in CREST (97.0% of symptomatic patients vs 75% of asymptomatic patients).

Discussion

A combined modelling approach that separates risk elements has potential to inform optimal treatment. However, our current approach is not ready for clinical application. These data support guidelines that suggest that CEA should be the preferred revascularisation modality in most patients with symptomatic carotid stenosis.
VOLATILITIES AND RETURN CO-MOVEMENTS AMONG STOCK MARKETS IN MAINLAND CHINA, HONG KONG, AND THE UNITED STATES
Authors: HOU WEIJIE , CUI BAISHENG , SONG YUPING , CHEN YING
Published: March 2021

Along with the international trade and economic ties, international stock markets are performing increasingly closely. This paper investigates the volatilities and the return co-movements among three stock markets in mainland China, Hong Kong, and the United States, from January 1, 2007, to July 5, 2019. We use the MIDAS framework to separately characterize short-term and long-term features. The results reveal that different market volatilities have different sensitivities to the same events. After the second half of 2016, the volatility of China’s stock market gradually dropped below that of the other two markets. As for market co-movements, the return correlation between China and Hong Kong rose sharply after 2007. Although the co-movements for return rates among these three stock markets possess mutual dynamic synchronization features, deviations exist occasionally due to the emotional transfer of funds in the international market when a significant economic or financial event occurs. The analysis suggests that countries should stabilize the financial investment environment and guard against hot money activities.
The 3D graph approach for breakdown voltage calculation in BaTiO3 ceramics
Authors: Mitic Vojislav V. , Randjelovic Branislav , Ilic Ivana , Ribar Srdjan , Chun An-Lu , Stajcic Aleksandar , Vlahovic Branislav
Published: March 2021

After pioneering attempts for the introduction of graph theory in the field of ceramics and microstructures, where 1D and 2D graphs were used, in this paper we applied 3D graphs for the breakdown voltage calculation in BaTiO3 sample with some predefined constraints. We have described the relations between grains in the sample and established a mathematical approach for the calculation of breakdown voltage using experimental results. As a result, we introduced mapping between the property of sample and grain structure, then between the grain structure and mathematical graph, using various crystal structures. The main idea was to apply 3D graph theory for the distribution of electronic parameters between the neighboring grains. With this study, we successfully confirmed the possibilities for applications of graphs as a tool for the determination of properties even at the intergranular level.
Multi-functional gallium arsenide photonic crystal polarization splitter with a gold core
Authors: Liu Chao , An Sinuo , Lv Jingwei , Yang Lin , Wang Famei , Liu Qiang , Li Xianli , Su Weiquan , Sun Tao , Chu Paul K.
Published: March 2021

A multi-functional dual-core photonic crystal fiber (PCF) polarization beam splitter with a central oval hole filled with gold is designed and described. The first layer on the circular holes around the core is filled with the nematic liquid crystal (NLC) to enhance birefringence. The full-vector finite element method is employed to study the characteristics of the polarization beam splitter and derive the optimal parameters. When the fiber length is 14.55 [Formula: see text]m, the polarized light in the [Formula: see text]- and [Formula: see text]-directions can be separated at a wavelength of 1.31 [Formula: see text]m and the bandwidths are 257 and 238 nm, respectively, for extinction ratios bigger than 10 dB. When the fiber length is 10.86 [Formula: see text]m, the polarized light in the [Formula: see text]- and [Formula: see text]-directions can be separated at a wavelength of 1.55 [Formula: see text]m and the bandwidths are 239 and 174 nm, respectively for extinction ratios larger than 10 dB. The multifunctional polarization beam splitter with an ultra-short fiber length and broad bandwidth improves the sensing performance in comparison with single-function devices and our results provide insights into the design of beam splitters with multiple functions.
Signal representations via SIP p-frames and SIP Bessel multipliers in separable Banach spaces
Authors: Zheng Xianwei , Zou Cuiming , Yang Shouzhi
Published: March 2021

Digital signals are often modeled as functions in Banach spaces, such as the ubiquitous [Formula: see text] spaces. The frame theory in Banach spaces induces flexible representations of signals due to the robustness and redundancy of frames. Nevertheless, the lack of inner product in general Banach spaces limits the direct representations of signals in Banach spaces under a given basis or frame. In this paper, we introduce the concept of semi-inner product (SIP) [Formula: see text]-Bessel multipliers to extend the flexibility of signal representations in separable Banach spaces, where [Formula: see text]. These multipliers are defined as composition of analysis operator of an SIP-I Bessel sequence, a multiplication with a fixed sequence and synthesis operator of an SIP-II Bessel sequence. The basic properties of the SIP [Formula: see text]-Bessel multipliers are investigated. Moreover, as special cases, characterizations of [Formula: see text]-Riesz bases related to signal representations are given, and the multipliers for [Formula: see text]-Riesz bases are discussed. We show that SIP [Formula: see text]-Bessel multipliers for [Formula: see text]-Riesz bases are invertible. Finally, the continuity of SIP [Formula: see text]-Bessel multipliers with respect to their parameters is investigated. The results theoretically show that the SIP [Formula: see text]-Bessel multipliers offer a larger range of freedom than frames on signal representations in Banach spaces.
Blockchain-Based Power Energy Trading Management
Authors: Wang Hao , Ma Shenglan , Guo Chaonian , Wu Yulei , Dai Hong-Ning , Wu Di
Published: March 2021

Distributed peer-to-peer power energy markets are emerging quickly. Due to central governance and lack of effective information aggregation mechanisms, energy trading cannot be efficiently scheduled and tracked. We devise a new distributed energy transaction system over the energy Industrial Internet of Things based on predictive analytics, blockchain, and smart contract technologies. We propose a solution for scheduling distributed energy sources based on the Minimum Cut Maximum Flow theory. Blockchain is used to record transactions and reach consensus. Payment clearing for the actual power consumption is executed via smart contracts. Experimental results on real data show that our solution is practical and achieves a lower total cost for power energy consumption.
Automatic Vulnerability Detection in Embedded Devices and Firmware
Authors: Qasem Abdullah , Shirani Paria , Debbabi Mourad , Wang Lingyu , Lebel Bernard , Agba Basile L.
Published: March 2021

In the era of the internet of things (IoT), software-enabled inter-connected devices are of paramount importance. The embedded systems are very frequently used in both security and privacy-sensitive applications. However, the underlying software (a.k.a. firmware) very often suffers from a wide range of security vulnerabilities, mainly due to their outdated systems or reusing existing vulnerable libraries; which is evident by the surprising rise in the number of attacks against embedded systems. Therefore, to protect those embedded systems, detecting the presence of vulnerabilities in the large pool of embedded devices and their firmware plays a vital role. To this end, there exist several approaches to identify and trigger potential vulnerabilities within deployed embedded systems firmware. In this survey, we provide a comprehensive review of the state-of-the-art proposals, which detect vulnerabilities in embedded systems and firmware images by employing various analysis techniques, including static analysis, dynamic analysis, symbolic execution, and hybrid approaches. Furthermore, we perform both quantitative and qualitative comparisons among the surveyed approaches. Moreover, we devise taxonomies based on the applications of those approaches, the features used in the literature, and the type of the analysis. Finally, we identify the unresolved challenges and discuss possible future directions in this field of research.