bluuebunny/crossref_metadata_2025 huggingface dataset:
Type Va extrahepatic bile duct duplication: a case report
Authors: Banjade Bharat Mani , Rajbhandari Ashish , Koirala Rabin , Shah Tuhin , Bhattachan Chitra Lal
Published: October 2019

Background

Extrahepatic bile duct duplication is an extremely rare congenital anomaly in which two common bile ducts exist. There are five different types of this anomaly and we present an unusual variant of duplication of an extrahepatic biliary system of type Va variety.

Case presentation

This case report describes a 63-year-old women from rural Nepal who presented with type Va of duplicated extrahepatic bile duct, with chronic calculous cholecystitis and choledocholithiasis. She was managed with cholecystectomy with hepatic ductoplasty and hepaticojejunostomy.

Conclusion

A rare case of double common bile duct (type Va) complicated by choledocholithiasis, cholangitis, and chronic cholecystitis is reported here. Rare cases are sometimes overlooked by modern diagnostic techniques. Correct diagnosis helps appropriate surgical intervention.
Measuring the impact of screening automation on meta-analyses of diagnostic test accuracy
Authors: Norman Christopher R. , Leeflang Mariska M. G. , Porcher Raphaël , Névéol Aurélie
Published: October 2019

Background

The large and increasing number of new studies published each year is making literature identification in systematic reviews ever more time-consuming and costly. Technological assistance has been suggested as an alternative to the conventional, manual study identification to mitigate the cost, but previous literature has mainly evaluated methods in terms of recall (search sensitivity) and workload reduction. There is a need to also evaluate whether screening prioritization methods leads to the same results and conclusions as exhaustive manual screening. In this study, we examined the impact of one screening prioritization method based on active learning on sensitivity and specificity estimates in systematic reviews of diagnostic test accuracy.

Methods

We simulated the screening process in 48 Cochrane reviews of diagnostic test accuracy and re-run 400 meta-analyses based on a least 3 studies. We compared screening prioritization (with technological assistance) and screening in randomized order (standard practice without technology assistance). We examined if the screening could have been stopped before identifying all relevant studies while still producing reliable summary estimates. For all meta-analyses, we also examined the relationship between the number of relevant studies and the reliability of the final estimates.

Results

The main meta-analysis in each systematic review could have been performed after screening an average of 30% of the candidate articles (range 0.07 to 100%). No systematic review would have required screening more than 2308 studies, whereas manual screening would have required screening up to 43,363 studies. Despite an average 70% recall, the estimation error would have been 1.3% on average, compared to an average 2% estimation error expected when replicating summary estimate calculations.

Conclusion

Screening prioritization coupled with stopping criteria in diagnostic test accuracy reviews can reliably detect when the screening process has identified a sufficient number of studies to perform the main meta-analysis with an accuracy within pre-specified tolerance limits. However, many of the systematic reviews did not identify a sufficient number of studies that the meta-analyses were accurate within a 2% limit even with exhaustive manual screening, i.e., using current practice.
Debate on the compositions of influenza B in northern hemisphere seasonal influenza vaccines
Authors: He Guozhong , Yang Pengfei , Yan Qingli , Xiong Chenglong
Published: October 2019

Background

Annual influenza vaccination is the most effective way to prevent influenza. Influenza vaccines have traditionally included the hemagglutinins (HA) and neuraminidases (NA) from the two A viruses (H1N1 and H3N2) and either B Yamagata or B Victoria. Mismatches between circulating isolates of influenza B and the vaccines are very common. Taking 2017/2018 winter in northern hemisphere as an example, this study was designed to find out the reasons for mismatch between the trivalent influenza vaccine (TIV) and most of the epidemic isolates at that time, and to discuss if there are some optimized programs for seasonal influenza vaccines.

Methods

HA and NA sequences of the seasonal isolates circulating from December 1, 2017 to February 28, 2018, and in the previously other 7 winters in northern hemisphere from Global Initiative on Sharing All Influenza Data (GISAID) and the influenza database of National Center for Biotechnology Information (NCBI). Phylogenetic trees and genetic distances were constructed or calculated by using MAFFT and MEGA 6.0 software.

Results

Influenza B composition in the TIV recommendation mismatched most of circulating viruses in 2017/2018 winter; the vaccine strain was from the B/Victoria lineage, while most of epidemic isolates were from the B/Yamagata lineage. The epidemic lineage of influenza B reached its peak a little late in the previous winter might be responsible for this mismatch. During 2010–2018, the mean genetic distances between epidemic isolates of influenza A (H1N1 and H3N2) and the vaccines were no higher than 0.02375 ± 0.00341 in both HA and NA. However, concerning influenza B virus, when forecasting done well, the mean genetic distances between epidemic isolates and the vaccines were no higher than 0.02368 ± 0.00272; otherwise, the distances could reach 0.13695 ± 0.00238.

Conclusion

When applying quadrivalent influenza vaccines (QIVs) for vaccination, the recommendations of compositions for influenza B could be altered and assessed once in 3 or 4 years; when economic burden was considered intensively and TIVs were utilized, the recommended compositions for influenza B could be announced in April or May, rather than in February or March as now.
Tumors diagnosed as cerebellar glioblastoma comprise distinct molecular entities
Authors: Reinhardt Annekathrin , Stichel Damian , Schrimpf Daniel , Koelsche Christian , Wefers Annika K. , Ebrahimi Azadeh , Sievers Philipp , Huang Kristin , Casalini M. Belén , Fernández-Klett Francisco , Suwala Abigail , Weller Michael , Gramatzki Dorothee , Felsberg Joerg , Reifenberger Guido , Becker Albert , Hans Volkmar H. , Prinz Marco , Staszewski Ori , Acker Till , Dohmen Hildegard , Hartmann Christian , Paulus Werner , Heß Katharina , Brokinkel Benjamin , Schittenhelm Jens , Buslei Rolf , Deckert Martina , Mawrin Christian , Hewer Ekkehard , Pohl Ute , Jaunmuktane Zane , Brandner Sebastian , Unterberg Andreas , Hänggi Daniel , Platten Michael , Pfister Stefan M. , Wick Wolfgang , Herold-Mende Christel , Korshunov Andrey , Reuss David E. , Sahm Felix , Jones David T. W. , Capper David , von Deimling Andreas
Published: October 2019

In this multi-institutional study we compiled a retrospective cohort of 86 posterior fossa tumors having received the diagnosis of cerebellar glioblastoma (cGBM). All tumors were reviewed histologically and subjected to array-based methylation analysis followed by algorithm-based classification into distinct methylation classes (MCs). The single MC containing the largest proportion of 25 tumors diagnosed as cGBM was MC anaplastic astrocytoma with piloid features representing a recently-described molecular tumor entity not yet included in the WHO Classification of Tumours of the Central Nervous System (WHO classification). Twenty-nine tumors molecularly corresponded to either of 6 methylation subclasses subsumed in the MC family GBM IDH wildtype. Further we identified 6 tumors belonging to the MC diffuse midline glioma H3 K27 M mutant and 6 tumors allotted to the MC IDH mutant glioma subclass astrocytoma. Two tumors were classified as MC pilocytic astrocytoma of the posterior fossa, one as MC CNS high grade neuroepithelial tumor with BCOR alteration and one as MC control tissue, inflammatory tumor microenvironment. The methylation profiles of 16 tumors could not clearly be assigned to one distinct MC. In comparison to supratentorial localization, the MC GBM IDH wildtype subclass midline was overrepresented, whereas the MCs GBM IDH wildtype subclass mesenchymal and subclass RTK II were underrepresented in the cerebellum. Based on the integration of molecular and histological findings all tumors received an integrated diagnosis in line with the WHO classification 2016. In conclusion, cGBM does not represent a molecularly uniform tumor entity, but rather comprises different brain tumor entities with diverse prognosis and therapeutic options. Distinction of these molecular tumor classes requires molecular analysis. More than 30% of tumors diagnosed as cGBM belong to the recently described molecular entity of anaplastic astrocytoma with piloid features.
Deep morphological analysis of muscle biopsies from type III glycogenesis (GSDIII), debranching enzyme deficiency, revealed stereotyped vacuolar myopathy and autophagy impairment
Authors: Laforêt Pascal , Inoue Michio , Goillot Evelyne , Lefeuvre Claire , Cagin Umut , Streichenberger Nathalie , Leonard-Louis Sarah , Brochier Guy , Madelaine Angeline , Labasse Clemence , Hedberg-Oldfors Carola , Krag Thomas , Jauze Louisa , Fabregue Julien , Labrune Philippe , Milisenda Jose , Nadaj-Pakleza Aleksandra , Sacconi Sabrina , Mingozzi Federico , Ronzitti Giuseppe , Petit François , Schoser Benedikt , Oldfors Anders , Vissing John , Romero Norma B. , Nishino Ichizo , Malfatti Edoardo
Published: October 2019

Glycogen storage disorder type III (GSDIII), or debranching enzyme (GDE) deficiency, is a rare metabolic disorder characterized by variable liver, cardiac, and skeletal muscle involvement. GSDIII manifests with liver symptoms in infancy and muscle involvement during early adulthood. Muscle biopsy is mainly performed in patients diagnosed in adulthood, as routine diagnosis relies on blood or liver GDE analysis, followed by AGL gene sequencing. The GSDIII mouse model recapitulate the clinical phenotype in humans, and a nearly full rescue of muscle function was observed in mice treated with the dual AAV vector expressing the GDE transgene.

In order to characterize GSDIII muscle morphological spectrum and identify novel disease markers and pathways, we performed a large international multicentric morphological study on 30 muscle biopsies from GSDIII patients. Autophagy flux studies were performed in human muscle biopsies and muscles from GSDIII mice. The human muscle biopsies revealed a typical and constant vacuolar myopathy, characterized by multiple and variably sized vacuoles filled with PAS-positive material. Using electron microscopy, we confirmed the presence of large non-membrane bound sarcoplasmic deposits of normally structured glycogen as well as smaller rounded sac structures lined by a continuous double membrane containing only glycogen, corresponding to autophagosomes. A consistent SQSTM1/p62 decrease and beclin-1 increase in human muscle biopsies suggested an enhanced autophagy. Consistent with this, an increase in the lipidated form of LC3, LC3II was found in patients compared to controls. A decrease in SQSTM1/p62 was also found in the GSDIII mouse model.

In conclusion, we characterized the morphological phenotype in GSDIII muscle and demonstrated dysfunctional autophagy in GSDIII human samples.

These findings suggest that autophagic modulation combined with gene therapy might be considered as a novel treatment for GSDIII.
Phosphorylated TDP-43 aggregates in skeletal and cardiac muscle are a marker of myogenic degeneration in amyotrophic lateral sclerosis and various conditions
Authors: Mori Fumiaki , Tada Mari , Kon Tomoya , Miki Yasuo , Tanji Kunikazu , Kurotaki Hidekachi , Tomiyama Masahiko , Ishihara Tomohiko , Onodera Osamu , Kakita Akiyoshi , Wakabayashi Koichi
Published: October 2019

Background

Amyotrophic lateral sclerosis (ALS) is characterized pathologically by the occurrence of phosphorylated TDP-43 (pTDP-43)-immunoreactive neuronal and glial inclusions in the central nervous system. Recent studies have shown that pTDP-43 aggregates also occur in the skeletal muscles in a certain proportion of ALS patients.

Aim

The aim of this study was to clarify the distribution and incidence of pTDP-43 aggregates in the skeletal and cardiac muscles of patients with ALS, and also those of patients with neuromuscular diseases (NMDs) and non-NMDs.

Material and methods

Five regions of muscle (tongue, cervical muscle, diaphragm, iliopsoas muscle and heart) were examined histologically and immunohistochemically in patients with ALS (n = 30), NMDs (n = 13) and non-NMDs (n = 7).

Results

Two types of pTDP-43 aggregates were distinguishable morphologically: dense filamentous and short linear inclusions. These inclusions were found in at least one of the five muscle regions in all 30 cases of ALS; skeletal muscles in 28 cases and myocardium in 12. pTDP-43 aggregates were also found in 9 of 13 patients with NMDs, including myositis, muscular dystrophy and mitochondrial myopathy, as well as in 3 of 7 patients with non-NMDs. In ALS, pTDP-43 aggregates were most frequent in the diaphragm (19 cases). The mean density of pTDP-43 aggregates in ALS was significantly higher than that in NMDs and non-NMDs. In contiguous sections stained with hematoxylin and eosin and anti-pTDP-43, muscle fibers with dense filamentous inclusions demonstrated single-fiber atrophy with vacuolar degeneration.

Conclusion

The present findings indicate that pTDP-43 aggregates in skeletal and cardiac muscle are a myogenic pathological marker in multiple diseases including ALS.
The influence of tantalum on human cell lineages important for healing in soft-tissue reattachment surgery: an in-vitro analysis
Authors: Gee Edward C. A. , Eleotério Renato , Bowker Laura M. , Saithna Adnan , Hunt John A.
Published: October 2019

Background

Porous tantalum is currently used in orthopaedic surgery for a variety of indications including soft tissue re-attachment. However, the clinical results have been variable and a previous laboratory study has suggested that tantalum may actually inhibit chick tendon fibroblasts. The influence of tantalum on human cell-types involved in soft tissue re-attachment has not been defined.

Methods

Human fibroblasts, human osteoblasts and human mesenchymal stem cells were plated on glass cover slips, half of which were coated with tantalum. Cell numbers were assessed at 1, 2, 7 and 14 days using Cyquant® assay. Cell adhesion and morphology were assessed using light microscopy at 7, 14 and 28 days. To reduce the effect of an expected rate of error,n = 4 was utilised for each cell type and the experiment was repeated twice.

Results

Statistically similar numbers of human osteoblasts and human mesenchymal stem cells were present at 14 days on tantalum-coated and uncoated glass cover slips, revealing no inhibitory effect on cell proliferation. More than double the number of human fibroblasts was seen on tantalum-coated cover slips at that time point (compared to controls), which was statistically significant (p < 0.0001). Morphological assessment revealed normal cell spreading and adhesion on both substrates at all time points.

Conclusions

In vitro study demonstrates that Tantalum causes a significant increase in the proliferation of human fibroblasts with no quantifiable negative effects seen on fibroblast behaviour after 28 days culture. Furthermore, tantalum does not exert any inhibitory effects on the proliferation or behaviour of human osteoblasts or human mesenchymal stem cells. Tantalum could be an appropriate biomaterial for use in situations where soft tissue requires direct reattachment to implants and may stimulate soft tissue healing.
Cranial-first approach of laparoscopic left colectomy for T4 descending colon cancer invading the Gerota’s fascia
Authors: Ogura Atsushi , Kobayashi Ryutaro , Kawai Satoru , Takagi Kenji , Kawai Kiyotaka , Maeda Takashi , Aritake Tsukasa , Nagano Natsuki , Kamiya Satoaki
Published: October 2019

Background

The safety and feasibility of laparoscopic colectomy for T4 colorectal cancer remain controversial. We believe that setting a “Goal” that will guide the surgeons in returning from the deep layer could be the key to safe en bloc resection of neighboring organs. For descending colon cancer, the cranial-first approach makes it possible to clearly visualize the pancreas and origin of the transverse mesocolon, leading to safe splenic flexure mobilization and complete mesocolic excision, which is the strongest advantage of this approach.

Case presentation

A 75-year-old woman was diagnosed with T4 descending colon cancer invading the Gerota’s fascia. We performed laparoscopic left colectomy using the cranial-first approach to set a “Goal” at the inferior border of the pancreas for safe resection of the Gerota’s fascia. The total operative time was 233 min, and the estimated blood loss was 98 ml. She was discharged after surgery without postoperative complications. Pathological findings revealed the invasion into the Gerota’s fascia, and the resection margin was negative for cancer.

Conclusions

The cranial-first approach of laparoscopic left colectomy appears to be safe and feasible and could be a promising method for selected patients with T4 descending colon cancer invading the Gerota’s fascia.
Systematic review of research on artificial intelligence applications in higher education – where are the educators?
Authors: Zawacki-Richter Olaf , Marín Victoria I. , Bond Melissa , Gouverneur Franziska
Published: October 2019

According to various international reports, Artificial Intelligence in Education (AIEd) is one of the currently emerging fields in educational technology. Whilst it has been around for about 30 years, it is still unclear for educators how to make pedagogical advantage of it on a broader scale, and how it can actually impact meaningfully on teaching and learning in higher education. This paper seeks to provide an overview of research on AI applications in higher education through a systematic review. Out of 2656 initially identified publications for the period between 2007 and 2018, 146 articles were included for final synthesis, according to explicit inclusion and exclusion criteria. The descriptive results show that most of the disciplines involved in AIEd papers come from Computer Science and STEM, and that quantitative methods were the most frequently used in empirical studies. The synthesis of results presents four areas of AIEd applications in academic support services, and institutional and administrative services: 1. profiling and prediction, 2. assessment and evaluation, 3. adaptive systems and personalisation, and 4. intelligent tutoring systems. The conclusions reflect on the almost lack of critical reflection of challenges and risks of AIEd, the weak connection to theoretical pedagogical perspectives, and the need for further exploration of ethical and educational approaches in the application of AIEd in higher education.
Wild at heart: 34-year-old male with new onset dyspnea, heart failure and history of amphetamine use; a case report
Authors: Navid Hossein , Soleimani Hamidreza , Hosseini Kaveh
Published: October 2019

Background

Spontaneous coronary artery dissection (SCAD) is a rather rare cause of acute coronary syndrome with a preponderance for young female patients. Amphetamines are now the second most widely used substance drugs in the world and they are associated with a myriad of cardiac diseases including cardiomyopathies and SCADs. There is much uncertainty regarding the best treatment strategy in such cases and decision-making remains mostly individualized and based on expert opinions.

Case presentation

A 34-year-old male with an unremarkable past medical history presented to a cardiologist with prominent dyspnea and orthopnea. He reported occasional methamphetamine use from 3 years before the presentation. An echocardiogram showed an enlarged left ventricle and severe systolic dysfunction with an ejection fraction of 10–15%. Coronary angiography revealed multiple linear dissections in both left anterior descending coronary artery (LAD) and left circumflex coronary artery (LCX). The patient’s right coronary artery (RCA) showed occlusion in the proximal segment. The patient was diagnosed with amphetamine-induced spontaneous coronary artery dissection and resultant ischemic cardiomyopathy. After thorough evaluation, medical treatment ensued.

Conclusions

Methamphetamine abusers have a 3.7 fold risk of developing some form of a cardiomyopathy in comparison to individuals without amphetamine abuse. Coronary artery dissection and increased thrombus burden are some of the mechanisms responsible for ischemic cardiomyopathy in these groups of patients.
OSSMAR: An Observational Study to Describe the Use of Sunitinib in Real-Life Practice for the Treatment of Metastatic Renal Cell Carcinoma
Authors: Ghosn Marwan , Eid Roland , Hamada Emad , Abdel Azim Hamdy , Zekri Jamal , Al-Mansour Mubarak , Jaloudi Mohammed , Nasr Fadi , Errihani Hassan , Bounedjar Adda , Mezlini Amel , Boussen Hamouda , Kattan Joseph , El Karak Fadi , Farhat Fadi ,   on behalf of the Africa Middle East Cancer Intergroup
Published: October 2019

PURPOSE

Sunitinib offers improved efficacy for patients with metastatic renal cell carcinoma (mRCC). To provide better disease management in the Middle East, we studied its use in mRCC in real-life practice in this region.

MATERIAL AND METHODS

Patients diagnosed with mRCC and started on sunitinib between 2006 and 2016 from 10 centers in Africa and the Middle East region were studied in this regional, multicenter, observational, retrospective trial to obtain routine clinical practice data on the usage patterns and outcomes of sunitinib in mRCC in real-life practice.

RESULTS

A total of 289 patients were enrolled. Median age at diagnosis was 58.7 years. The patient characteristics were as follows: 73.6% of patients were males; 85.8% had clear-cell renal cell carcinoma (RCC); 97.5% had unilateral RCC; 66.3% had metastatic disease at initial diagnosis; 56.3% received previous treatment for RCC, among which 98.7% had undergone surgery; and 15.2% and 31.4% were classified in the favorable and poor-risk groups (expanded Memorial Sloan Kettering Cancer Center criteria), respectively. On treatment initiation, the mean total sunitinib dose was 48.1 mg, and 87.6% of patients were started on a sunitinib dose of 50 mg. The mean duration of sunitinib treatment was 9.6 months. Overall response rate was 20.8%, with a median duration of 8.2 months. Median time to progression was 5.7 months. Median follow-up time was 7.8 months. By months 12 and 24, 34.3% and 11.4% of patients, respectively, were still alive. Seventy-six patients (60.9%) experienced 314 adverse events. Twenty-three patients (8.0%) experienced 28 serious adverse events. Overall, 83 patients (28.7%) discontinued their sunitinib treatment.

CONCLUSION

The results are indicative of the general treatment outcomes of patients with mRCC in the Middle East using sunitinib in routine clinical practice. Reported adverse events are similar to those described in the literature but at lower frequencies.
[Retracted] Construction of a New In(III)-Based Coordination Polymer for Selective Luminescent Detection of Cr2O72− and Anti-Bacterial Protective Effect on Staphylococcus Aureus Infection after Missed Abortion
Authors: Wang Di , Zhang Bin , Xu Lin-Fen , Huang Ling-Na
Published: October 2019

A new luminescent In(III)-based coordination polymer with the chemical formula of {[In(ipa)(H2O)](H2O)(CH3CN)2}n (1, H3ipa = 5-hydroxyisophthalate) has been successfully prepared via a solvothermal reaction of H3ipa and In(NO3)3·6H2O in CH3CN and DMF mixed solvent. The strong emission of 1 could be quenched efficiently by trace amounts of Cr2O72−, while other competing analogues show no such quenching effect, indicating complex 1 could be applied as an effective sensor for the detection of Cr2O72− in the solution. To solve the problem of bacterial infection after missed abortion, the protective effect of the compound in vivo was further explored. CFU detection was carried to evaluate the inhibitory effect of compound on bacterial numbers, and then ELISA was conducted to detect the level of IL-18 and IL-1β in the infectious tissues. The pharmacokinetic detection of the compound was also performed in SD rats. The results obtained from molecular docking and pose scoring software exhibited a possible binding mode of the compound binding to NFκB, which might provide potential regulation mechanisms for the compound.
Dynamic Non-monetary Incentives
Authors: Bird Daniel , Frug Alexander
Published: October 2019

We study a principal-agent interaction where investments and rewards arrive stochastically over time and are privately observed by the agent. Investments (costly for the agent, beneficial for the principal) can be concealed by the agent. Rewards (beneficial for the agent, costly for the principal) can be forbidden by the principal. We ask how rewards should be used and which investments incentivized. We identify the unique optimal mechanism and analyze the dynamic investment and compensation policies. When all rewards are identical, the unique optimal way to provide incentives is by a “carte blanche” to pursue all rewards arriving in a predetermined time frame. (JEL D82, M52)
Information Design
Authors: Taneva Ina
Published: October 2019

A designer commits to a signal distribution that is informative about a payoff-relevant state. Conditional upon the privately observed signals, agents take actions that affect their payoffs as well as those of the designer. We show how to derive the (designer) optimal information structure in static finite environments. We fully characterize it in a symmetric binary setting for a parameterized game. In this environment, conditionally independent private signals are never strictly optimal. (JEL C72, D78, D82, D83)
Assessing service and treatment needs of young people who use illicit and non-medical prescription drugs living in Northern Ontario, Canada
Authors: Varatharajan Thepikaa , Sabioni Pamela , Russell Cayley , Henderson Joanna , Fischer Benedikt , Miles Sarah , Rehm Jürgen
Published: October 2019

Background: The use of illicit and prescription drugs for non-medical purposes among youth and young adults living in Northern Ontario communities is a major public health concern. This problem is amplified in that there is insufficient knowledge on the types of services and treatment centers available for and utilized by young people with substance use issues in Northern Ontario. This needs assessment study aims to examine the service and treatment needs of youth and young adults who use drugs in Northern Ontario communities.

Methods/Design: A mixed-methods study design will be used to assess the service and treatment needs of youth and young adults (aged 14-25) who have used one or more illicit drug (excluding cannabis) and/or psychoactive prescription drug for non-medical purposes for at least 3 months and on at least 10 days in the last month. Participants will be recruited from approximately ten Northern, remote and rural communities across Northern Ontario using a mobile research lab. Eligible study candidates from each community will be asked to partake in a focus group and questionnaire exploring service and treatment utilization and needs. We will additionally collect basic socio-demographic information as well as examine patterns of problematic drug use. Interviews with service providers and community organizers will also be conducted in each community. 

Discussion: Findings from our study will highlight the availability, accessibility and utilization of existing services; identify the gaps and barriers in current service provision; and provide insight into the service and treatment needs of youth and young adults who use drugs in Northern Ontario communities. Assessing the needs of young people who use drugs will allow service providers, community organizers and health policymakers to improve addiction-related services and treatment centers in Northern Ontario.
A new statistical method to analyze Morris Water Maze data using Dirichlet distribution
Authors: Maugard Marianne , Doux Cyrille , Bonvento Gilles
Published: October 2019

The Morris Water Maze (MWM) is a behavioral test widely used in the field of neuroscience to evaluate spatial learning memory of rodents. However, the interpretation of results is often impaired by the common use of statistical tests based on independence and normal distributions that do not reflect basic properties of the test data, such as the constant-sum constraint. In this work, we propose to analyze MWM data with the Dirichlet distribution, which describes constant-sum data with minimal hypotheses, and we introduce a statistical test based on uniformity (equal amount of time spent in each quadrant of the maze) that evaluates memory impairments. We demonstrate that this test better represents MWM data and show its efficiency on simulated as well as in vivo data. Based on Dirichlet distribution, we also propose a new way to plot MWM data, showing mean values and inter-individual variability at the same time, on an easily interpretable chart. Finally, we conclude with a perspective on using Bayesian analysis for MWM data.
The new Italian and Albanian archaeological project in Butrint (2015-2018)
Authors: Enrico Giorgi  , Belisa Muka
Published: October 2019

As it is well known to the scholars of ancient Albania, the history of Italian research in Northern Epirus is well established and began at least at the end of 1920s, with the Italian Archaeological Missions of Luigi Maria Ugolini, who worked in Phoinike first and then moved to Butrint. Thanks to this excavation, many of the monuments still visible in the current Butrint archaeological parc were brought to light.
New research at the Sanctuary of Monte Rinaldo (FM)
Authors: Francesco Belfiori  , Stephen Kay
Published: October 2019

The remains of the sanctuary of Monte Rinaldo (FM) are located midway along the Aso river valley in an archaeological park known as ‘La Cuma’ which was excavated and partially reconstructed in the 1960s. The complex dates to the 2nd – 1st century BC and centres on a Tuscanic temple surrounded by a porticoed area flanked by a sacellum. Since 2016 the site has been the focus of a new research programme led by the University of Bologna Department of History and Culture, the British School at Rome, the Soprintendenza Archeologia Belle Arti e Paesaggio delle Marche and the Comune di Monte Rinaldo
La inserción laboral de graduados y graduadas a través de los contactos personales. Una propuesta desde la gestión del conocimiento
Authors: Fernández-Salinero De Miguel Carolina , García-Álvarez Jesús
Published: October 2019

La transformación de la economía a partir de la crisis financiera, junto con la aparición de nuevos productos y servicios, han supuesto un desafío, tanto en clave educativa como profesional, en la inserción laboral de las y los graduados universitarios, obligando a la educación superior a tomar decisiones en sintonía con esos cambios. En este contexto, el presente trabajo pretende ofrecer una visión analítica sobre el fenómeno de la inserción laboral a través del recurso de los contactos personales. Adoptando como hipótesis la derivada devaluación de la formación de las y los egresados en beneficio de lo que se ha denominado capital interpersonal, es decir, el volumen de redes y contactos de las y los egresados que les permiten acceder a un empleo, se proponen una serie de líneas estratégicas a desarrollar en el ámbito de la educación superior que giran en torno a la gestión de conocimiento. Para ello, se ha procedido con una metodología de corte cualitativo basada en la revisión sistemática de los principales estudios e informes realizados en el contexto español por universidades, observatorios de empleo, organizaciones público-privadas, agencias de evaluación de la calidad del sistema universitario y especialistas en el ámbito. Concretamente, se han analizado 56 estudios e informes realizados entre los años 2000 y 2018.  Los resultados permiten identificar dos trayectorias fundamentales en la inserción laboral de los titulados superiores, descubriéndose un incremento notable en el uso del capital social como recurso de intermediación laboral en el último período analizado (2011-2018). Por consiguiente, se observa un importante cambio en la valoración de la formación de los recién titulados por parte de los propios egresados y egresadas, las y los empleadores y la universidad, justificando la propuesta planteada en relación con la gestión del conocimiento y su contribución a la empleabilidad de las y los universitarios.
Performance of Eigenvalue-Based Spectrum Sensing With Approximate Eigenvalue Estimation Methods
Authors:   National Institute of Telecommunications (Inatel), Guimarães Dayan , Aquino Guilherme ,   National Institute of Telecommunications (Inatel), Santos Rafaela ,   National Institute of Telecommunications (Inatel), dos Reis Ana Carolina
Published: October 2019

This article presents a performance and computational complexity analysis of cooperative spectrum sensing techniques based on the eigenvalues of the received signal sample covariance matrix, under three methods for approximate eigenvalue estimation: the Cholesky iterations algorithm, the Gershgorin theorem with transformed covariance matrix, and the conventional Gershgorin theorem. Widely used eigenvalue-based test statistics are addressed: the generalized likelihood ratio test, the ratio between the maximum and the minimum eigenvalues, and the Roy’s largest root test. Simulation results show that the first two eigenvalue estimation methods can yield comparable performances, whereas the latter may operate satisfactorily only in situations of high signal-to-noise ratios. It is also demonstrated that the test statistics are not equally sensitive to eigenvalue estimation errors. The Cholesky iterations algorithm is attractive in terms of complexity and performance for all spectrum sensing techniques, while the simple Gershgoring method may be attractive for the Roy’s largest root test.
Genes in Tumor Formation
Authors: Riede Isolde
Published: October 2019

With the definition of four gene classes, all differences between tumor cells and normal cells can be explained. Proliferative mutations induce a shortcut, forcing the cell to divide. They allow replication without control, induce somatic pairing defects of chromosomes and genome instability. Intact Tumor Supressors or mutant Switch Functions can inhibit this process. Oncogene mutations optimize the growth of the cells.
Increased Risk of Osteoporotic Fracture in Postgastrectomy Gastric Cancer Survivors Compared With Matched Controls: A Nationwide Cohort Study in Korea
Authors: Shin Dong Wook , Suh Beomseok , Lim Hyunsun , Suh Yun-Suhk , Choi Yoon Jin , Jeong Su-Min , Yun Jae Moon , Song Sun Ok , Park Youngmin
Published: October 2019

OBJECTIVES:

Gastrectomy can lead to bone loss. Previous studies have suggested that there is an increased risk of fracture in gastric cancer survivors. However, these studies were performed without proper control groups. Therefore, we used Korean national health insurance data to compare the fracture risk in gastric cancer survivors who received gastrectomy to that of the general population.

METHODS:

A total of 133,179 gastric cancer survivors were included and matched to noncancer controls using 1:1 propensity score matching. Cox proportional hazards regression analysis was used to determine the relative risk of fracture between the gastric cancer survivors and matched controls. We also examined the factors associated with fracture in gastric cancer survivors.

RESULTS:

Compared with the matched controls, gastric cancer survivors had an elevated risk of osteoporotic fracture (hazard ratio [HR] 1.61, 95% confidence interval [CI] 1.53–1.70), which was most prominent in patients who underwent total gastrectomy (HR 2.18, 95% CI 1.96–2.44) and adjuvant chemotherapy (HR 2.01, 95% CI 1.81–2.23). In multivariate analysis, anemia was significantly associated with increased fracture risk (aHR 1.34, 95% CI 1.13–1.59), while decrease in weight >5% was not (aHR 1.06, 95% CI 0.89–1.25).

DISCUSSION:

Gastric cancer survivors who underwent gastrectomy had an increased osteoporotic fracture risk than did matched controls. Total gastrectomy, adjuvant chemotherapy, and anemia were associated with an even higher risk in these patients. Additional studies are needed to establish optimal strategies, such as screening for osteoporosis and preventive interventions, that will reduce fracture risk in this population.
Endoscopic Sleeve Gastroplasty in 109 Consecutive Children and Adolescents With Obesity: Two-Year Outcomes of a New Modality
Authors: Alqahtani Aayed , Elahmedi Mohamed , Alqahtani Yara A. , Al-Darwish Abdullah
Published: October 2019

OBJECTIVES:

Endoscopic sleeve gastroplasty (ESG) uses full-thickness sutures that restrict the stomach to a sleeve-like configuration. There is no published evidence on endoscopic tissue apposition techniques in pediatric patients. In this article, we report our ESG experience with the first 109 pediatric patients with obesity who underwent ESG under our care.

METHODS:

ESG was offered as a day-case procedure under a standardized protocol and clinical pathway that included surgical, medical, and endoscopic modalities for the treatment of pediatric and adult obesity. ClinicalTrials.gov Identifier: NCT03778697.

RESULTS:

The 109 patients in this study had a baseline body mass index and age of 33.0 ± 4.7 and 17.6 ± 2.2 (range: 10–21) years, respectively. Ninety-nine (90.8%) were females. The mean procedure time was 61 ± 19 minutes. The mean % total weight loss at 6, 12, 18, and 24 months was 14.4% ± 6.5%, 16.2% ± 8.3%, 15.4% ± 9.2%, and 13.7% ± 8.0%, respectively. Fourteen adolescents visited the ambulatory clinic for analgesia. One patient (aged 19.8 years) requested removal of endoscopic stitches due to abdominal pain, and another underwent Redo-ESG for insufficient weight loss. There were no blood transfusions, emergency admissions, mortality, or significant morbidity.

DISCUSSION:

In this first study to date on ESG in pediatric patients, we observed that the procedure is safe and effective in children and adolescents with obesity. Significant weight loss occurs during the first 2 years without mortality or significant morbidity, and this weight loss seems to be maintained.
Massive Pulmonary Embolism with Hemodynamic Compromise Successfully Treated with Veno-Arterial Extracorporeal Membrane Oxygenation
Authors: Akkanti Bindu , Nathan Sriram , Centeno E. Núñez , Akasapu Karunakar , Doshi Pratik , Hussain Rahat , Raissi Farshad , Nascimbene Angelo , Srinivasan Ravi , Rajapreyar Indranee , Patel Manish , Patel Jayesh , Akay Mehmet , Loyalka P. , Kar B. , Gregoric I.
Published: October 2019

Introduction: Cardiogenic shock that results from pulmonary embolus has a high mortality rate. Systemic thrombolysis is frequently used in submassive and massive pulmonary embolus and has been shown to restore circulation. However, in the event of impending or ongoing cardiac arrest, systemic thrombolysis or anticoagulation alone has not been always shown to be effective. Case reports have previously established that extracorporeal membrane oxygenation can effectively be used as an effective rescue strategy in cases of cardiac arrest as a result from massive pulmonary embolus. We report six cases of massive pulmonary embolism (PE), in which veno-arterial extracorporeal membrane oxygenation (VA ECMO) was utilized or used as a backup strategy with excellent outcomes. We highly recommend using this strategy at the bedside in a tertiary care facility where VA ECMO support is available.

Methods: This is a retrospective study of all patients that underwent VA ECMO or utilized VA ECMO at the bedside as a rescue strategy in the setting of massive PE. We abstracted relevant clinical information from patient charts for this review.

Results and analysis: Out of the 107 VA ECMO runs performed at our facility between 1 September 2013 and 31 December 2014, four patients utilized this strategy in the setting of massive PE with impending cardiac arrest; in two cases it was available to use as a backup strategy. All six patients (Table 1) had successful recovery with complete restoration of cognitive status, functional status, and without any clinical signs of right ventricular (RV) dysfunction on discharge.
Damaging Cardiac and Cancer Genetic Variants in the LVAD Population
Authors: Lowes Brian D. , Rome Eric T. , Dhar Kajari , Kittrell Jeff , Eudy James D. , Um John Y. , Moulton Alexandra , Zao J. , Redder Ronald , Moulton Michael J. , Anderson Daniel R. , Raichlin Eugenia
Published: October 2019

Abstract

Background: Next generation sequencing technology, coupled with population genetic databases, have made broad genetic evaluation relatively inexpensive and widely available. Our objective was to assess the prevalence of potentially damaging cancer and cardiac gene variants in advanced non-ischemic cardiomyopathy patients.

Methods: Explanted human heart tissue procured at LVAD placement was obtained from the University of Nebraska Medical Center Heart Tissue Bank. Genomic DNA was isolated from tissues and amplified by PCR using targeted ampliseq primer pools from an inherited disease panel. Individual libraries were amplified by emulsion PCR on Ion Sphere particles and sequencing was performed on a PGM sequencer (Ion torrent) using the Ion 316 chip. The Ion Torrent browser suite was used to map the reads and call the variants. The identified single nucleotide polymorphisms, insertions, and deletions were then annotated and characterized with ANNOVAR. Non-synonymous mutations with a population frequency of less than or equal to 1% were identified and analyzed utilizing an open source integrative genomics viewer. Amino acid substitution effects on protein function were determined by a bioinformatics algorithm. Myocardial recovery was defined as an improvement in EF to greater than 45% at three months post implant.

Results: Our sample population included 12 males and 2 females with an average age of 49 and an average EF at presentation of 17%. Damaging cardiac gene variants were present in 11/14 patients. Only 1 of the 11 patients with damaging cardiac gene variants improved their ejection fraction to greater than 45% post LVAD. Two of the 2 patients without mutations improved their ejection fraction to greater than 45%, p-value=.04. Nine of the 14 patients in this population had damaging oncogene mutations.

Conclusions: Damaging variants in cancer and cardiac genes are common in end-stage non-ischemic cardiomyopathy patients undergoing LVAD placement. Genetic variation likely contributes to disease progression and cancer risk.
What Did We Learn About VADs in 2014?
Authors: Guglin Maya
Published: October 2019

The field of mechanical circulatory support is evolving rapidly and new data are published at a rate that can be overwhelming. In this review, we summarized some of the publications from 2014 that we think are particularly important. We have also included a few selected papers from the end of 2013 and the very beginning of 2015. Some of this overlap reflects the inevitable delay between online and paper publications. Readers who wish to supplement this review or argue with the author’s statements are encouraged to do so on our Facebook page at https://www.facebook.com/TheVADJournal.
Successful Left Ventricular Assist Device Support in Patient with Bjork-Shiley Mitral Valve Replacement
Authors: Rajagopalan Navin , Booth David C.
Published: October 2019

There is limited clinical experience with left ventricular assist device therapy in patients with prosthetic mitral valves. We present a case of successful left ventricular assist device support in a patient with previous mechanical mitral valve replacement.
ST-Segment Elevation Myocardial Infarction in Patient with Left Ventricular Assist Device
Authors: Rajagopalan Navin , Wilson Ryan E.
Published: October 2019

Acute myocardial infarction is a rare event in a patient with a left ventricular assist device (LVAD). We present a case of ST-segment elevation myocardial infarction in a LVAD patient.
Bleeding and Thromboembolic Events in Patients with Heartmate II Mechanical Circulatory Support
Authors: Allana Salman S. , Chapman Carrie B. , Sweitzer Nancy K. , Johnson Maryl R. , Kohmoto Takushi , Murray Margaret , Murray David , Li Zhanhai , Rahko Peter S.
Published: October 2019

Background

Bleeding and thromboembolic events (TE) are common complications following HeartMate II (HMII) implantation. The aim of the study was to review our experience related to bleeding and TE events in patients with a HMII and identify factors associated with increased risk of these events.

Methods

We retrospectively reviewed 70 consecutive patients who received a HMII between May 2006 and December 2011. The patients were followed for 12 months or until cardiac transplantation, device explantation or death. Major bleeding was defined by INTERMACS criteria with intracranial bleeding events added.

Results

There were 48 bleeding events in 28 (40%) patients with gastrointestinal bleeding (54.2%) being most common. Patients with bleeding events had significantly higher average INR (p=0.04) and more chronic kidney disease (p=0.03), although 43.8% of bleeding events occurred at an INR <2. Twelve TE events occurred in 9 patients (12.9%), with ischemic stroke the most common (75%). TE events were associated with young age (p=0.04) and non-diabetes status (p=0.03) and were not associated with average INR. There was no association of bleeding or thromboembolism with gender, BMI, HMII speed, pulsatility index, hypothyroidism, smoking history or INTERMACS profile at the time of HMII implantation.

Conclusion

Different factors are associated with bleeding and TE events. The appropriate target INR range for HMII patients should be chosen to balance the risk between bleeding and TE events based largely on patient factors.