bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence dimension and 2-packing number in graphs
Authors: Božović Dragana , Kelenc Aleksander , Peterin Iztok , Yero Ismael G.
Published: January 2022

Let G = (V, E) be a graph. A set of vertices A is an incidence generator for G if for any two distinct edges e, f ∈ E(G) there exists a vertex from A which is an endpoint of either e or f. The smallest cardinality of an incidence generator for G is called the incidence dimension and is denoted by dimI(G). A set of vertices P ⊆ V(G) is a 2-packing of G if the distance in G between any pair of distinct vertices from P is larger than two. The largest cardinality of a 2-packing of G is the packing number of G and is denoted by ρ(G). In this article, the incidence dimension is introduced and studied. The given results show a close relationship between dimI(G) and ρ(G). We first note that the complement of any 2-packing in graph G is an incidence generator for G, and further show that either dimI(G) = |V(G)-|ρ(G) or dimI(G) = |V(G)-|ρ(G) - 1 for any graph G. In addition, we present some bounds for dimI(G) and prove that the problem of determining the incidence dimension of a graph is NP-hard.
Beziehungen reflektieren und verstehen – Übertragung und Gegenübertragung
Authors: Brünen Andreas
Published: January 2022

Wenn sich die therapeutische Beziehung zu Patient*innen schwierig gestaltet, kann der Grund dafür eine negative Übertragung sein. Andreas Brünen deckt auf, was sich hinter dem Begriff verbirgt und wie sich solche Phänomene auf unsere Arbeit auswirken.
Die Rückkehr an den Arbeitsplatz begleiten – Assessment: Work-ability Support Scale (WSS)
Authors: Häberli Michèle , Nyffeler Thomas , Vanbellingen Tim
Published: January 2022

Welche Unterstützung benötigt ein Mensch mit erworbener Hirnschädigung, um wieder seinen Beruf auszuüben? Dieser Frage geht die Work-ability Support Scale auf den Grund. Das Besondere an dem Assessment: Neben dem persönlichen Unterstützungsbedarf erfasst die WSS außerdem die Kontextfaktoren rund um den Arbeitsplatz.
Genauigkeit eines scanbaren Materials für Durchbissregistrate im teildigitalen Workflow
Authors: Pott Philipp-Cornelius , Becker Carolin , Schaumann Simone , Stiesch Meike , Eisenburger Michael
Published: January 2022

Digitale Prozessketten sind heute fester Bestandteil moderner Zahnmedizin und können bei komplexen Versorgungen mit konventionellen Abläufen zu teildigitalen Workflows kombiniert werden. Durchbissregistrate eignen sich dabei für die Modellzuordnung im Artikulator. Ziel dieser Studie war es, ein scanbares Bissnahmesilikon (Registrado Scan [RS], VOCO GmbH) und Vergleichsmaterialien (Registrado Xtra [RX] und Registrado Clear [RC], VOCO GmbH) hinsichtlich der Genauigkeit zu untersuchen. Dafür wurden bei insgesamt 40 Proband*innen Registrate durchgeführt, und mittels farbsensitivem Intraoralscan wurden intraorale angefärbte Kontakte als Referenz dokumentiert. Ober- und Unterkiefermodelle der Proband*innen wurden im Artikulator in Okklusion gebracht und digitalisiert. Die Abweichung der sich ergebenden Kontaktpunkte auf den Modellen zur intraoral erhobenen Referenz wurde in einer 3-D-Software vermessen.

Es konnte gezeigt werden, dass sich die Werte in den Gruppen RS (0,52 ± 0,56 mm), RX (0,55 ± 0,53 mm) und RC (0,58 ± 0,53 mm) nicht signifikant voneinander unterscheiden (p ≥ 0,136). Das scanbare Material kann demnach sowohl in volldigitalen, in teildigitalen und auch in konventionellen Workflows angewendet werden.
Impact of n-Doping Mechanisms on the Molecular Packing and Electron Mobilities of Molecular Semiconductors for Organic Thermoelectrics
Authors: Zeng Yan , Han Guangchao , Yi Yuanping
Published: January 2022

Electrical conductivity is one of the key parameters for organic thermoelectrics and depends on both the concentration and mobility of charge carriers. To increase the carrier concentration, molecular dopants have to be added into organic semiconductor materials, whereas the introduction of dopants can influence the molecular packing structures and hence carrier mobility of the organic semiconductors. Herein, we have theoretically investigated the impact of different n-doping mechanisms on molecular packing and electron transport properties by taking (4-(1,3-dimethyl-2,3-dihydro-1H-benzoimidazol-2-yl)phenyl)dimethylamine (N-DMBI-H) and quinoid-dicyanomethylene-dipyrrolo-[3,4-c]pyrrole-1,4-diylidene)bis(thieno[3,2-b]thiophene (Q-DCM-DPPTT) respectively as representative n-dopant and molecular semiconductor. The results show that when the doping reactions and charge transfer spontaneously occur in the solution at room temperature, the oppositely charged dopant and semiconductor molecules will be tightly bound to disrupt the semiconductor to form long-range molecular packing, leading to a substantial decrease of electron mobility in the doped film. In contrast, when the doping reactions and charge transfer are activated by heating the doped film, the molecular packing of the semiconductor is slightly affected and hence the electron mobility remains quite high. This work indicates that thermally activated n-doping is an effective way to achieve both high carrier concentration and high electron mobility in n-type organic thermoelectric materials.
A Randomized Controlled Study on the Use of Tourniquet in Primary Total Knee Arthroplasty
Authors: Zhang Chaofan , Yan Chun Hoi , Chan Ping Keung , Fu Henry , Chiu Kwong Yuen
Published: January 2022

Background The use and the optimal timing of tourniquet during primary total knee arthroplasty (TKA) is controversial. Most previous studies failed to show clinically significant differences in different strategies. The aim of this study was to determine how three strategies of tourniquet application affect the outcome in TKA patients.

Methods This was a prospective randomized controlled study. Patients who undergo TKA were randomized into one of the three groups (1:1:1 ratio): tourniquet inflated from skin incision to cement hardening, tourniquet from cement application to hardening, and tourniquet from skin incision to skin closure. The perioperative blood loss, limb swelling, and complications were recorded. The level of hemoglobin, hematocrit, C-reactive protein (CRP), interleukin (IL)-6, creatine kinase (CK), and lactate dehydrogenase (LDH) were determined. Patients' thigh and TKA wound pain, Knee Society knee score (KSKS) and Knee Society functional assessment (KSFA) scores, and rehabilitation parameters were evaluated.

Results A total of 90 patients were enrolled. The baseline characteristics were comparable. We only found significant difference in the intraoperative blood loss (skin to cement: 58.7 ± 36.1 mL, cement-only: 147.8 ± 107.9 mL, skin to skin: 16.3 ± 13.1 mL, p < 0.0001). There were no statistical differences in postoperative drainage, thigh/knee circumference, change of hemoglobin/hematocrit, CRP, IL-6, CK, and LDH on day 1 to day 4 after surgery. The thigh/TKA wound Visual Analogue Scale scores, KSKS score, KSFA score, and rehabilitation parameters were not significantly different at up to 6-month follow-up. No thromboembolic events were noted.

Conclusion Our results revealed that there was no best tourniquet strategy in TKA. Different tourniquet methods can be utilized based on surgeon preference without affecting outcomes.
Clinical Profile and Characterization of Rotavirus Strains in Under-Five Children with Diarrhea: A Hospital-Based Study from Eastern Odisha, India
Authors: Prusty J. Bikrant Kumar , Choudhury Jasashree , Akhila Goolla , Dash Mrutunjay , Mohanty Mamata Devi , Peddu Sai Praveen
Published: January 2022

Objective Diarrheal diseases are one of the most common causes of hospitalization in children under five. Rotavirus is the most common cause of acute diarrhea in younger children, and the prevalence decreases rapidly with increasing age. The objective of the study was to estimate the burden of rotavirus infection in acute gastroenteritis among under-five children admitted to a tertiary care hospital in eastern Odisha, for the clinical profile and identity of the prevalent strains.

Methods This was a prospective observational study linked to the National Rotavirus Surveillance Network (NRSN), where 720 under-five children with diarrhea were enrolled. In total, 675 stool samples of eligible candidates were sent for rotavirus isolation, and identification of strains was done by identifying VP7 (G-type) and VP4 (P-type) genes by reverse transcription polymerase chain reaction.

Results Categorical variables were presented as frequency and percentage, and continuous variables were expressed as mean ± standard deviation. Rotavirus was detected in 256 (37.92%) samples. Males outnumbered females. The most common affected age group was 7 to 12 months, followed by 13 to 18 months. G3P[8] was the most prevalent strain in this study.

Conclusion Children between the age of 7 and 18 months were most vulnerable to rotavirus infection. The most prevalent strain varies from one region to another and continuous surveillance is needed.
Evaluation of Influenza Patients Admitted in 2019–2020 Flu Season
Authors: Öztelcan Gündüz Bahar , Ataş Erman , Ünay Bülent , Halil Halit
Published: January 2022

Objective Influenza viruses are among the most common respiratory pathogens for all age groups, and may cause seasonal outbreaks. The aim of our study was to describe the clinical characteristics of influenza cases in the 2019–2020 flu season and to study the risk factors for hospital admission and complications.

Methods This was a retrospective study in 251 children (group 1: nonhospitalized; group 2: hospitalized) with influenza in the 2019–2020 flu season. Data on demographic features, influenza type, complaints, complications, and hospitalization length were collected and recorded.

Results Influenza A was detected in 199 (79.3%) patients, and influenza B was detected in 52 (20.7%); 43.4% of patients were girls and 56.6% were boys. The mean age of the patients was 3.91 ± 3.3 years (16 days to 18 years). A total of 52 (20.7%) patients were hospitalized. The age of the patients in group 2 was lower than that in group 1 (3.1 vs. 4.2 years, p = 0.03). Group 2 patients were more likely to have creatine kinase (CK) elevation, febrile seizures, and physical examination abnormalities. Group 2 patients were also more likely to have influenza A. Patients with febrile seizures, chronic diseases, abnormal physical examination findings, developed complications, and additional drug use apart from oseltamivir in the treatment were also more likely to require hospitalization.

Conclusion Infants and children with chronic diseases, history of febrile seizures, complications, and the use of drugs other than antiviral drugs should be carefully evaluated in case they need hospitalization. Increasing vaccination rates, initiation of antiviral treatment for selected patients, and close monitoring of patients in risk groups can decrease morbidity and mortality. Myalgias are a common complaint in patients with acute influenza infection. Previous studies suggest CK measurement be part of the work-up for the hospitalized patient with acute influenza infection.
The impact of annealing process on the grain morphology and performance of mesoporous n-i-p carbon-based perovskite solar cells
Authors: Ibrahim Ahmed H. , Saad Laila , Said Ahmed Ali , Soliman Moataz , Ebrahim Shaker
Published: January 2022

Organic–inorganic perovskite solar cells (PSCs) have been emerging as one of the most promising photovoltaic technologies. Surface morphology is considered as a key-parameter in energy alignment and plays a dominant role in specifying the device performance. The large grains and low roughness enhance the transport of charge carriers from perovskite layers to the transport layers, and this reflects on the delivered power conversion efficiency (PCE). Therefore, in this study, we investigated the influence of the fabrication parameters on the grain size and the morphology of perovskite layers, thereby the PCE of PSCs. These parameters included the anti-solvent nature (chlorobenzene or toluene), annealing temperature, and annealing ramp rate (slow or flash annealing). The scanning electron microscope confirmed that flash annealing results in a better morphology than slow annealing whether by employing an anti-solvent dripping or not. Furthermore, the dripping of chlorobenzene as an anti-solvent produced better morphology and large grains compared with toluene. Therefore, combining chlorobenzene with flash annealing induced the formation of large grains, full cover, and a uniform perovskite layer, which reflects on the performance of the fabricated PSCs. Finally, employing the aforementioned optimum preparation parameters to fabricate carbon-based PSCs resulted in decent PCE, current density short circuit (Jsc), open circuit voltage (Voc), and fill factor (FF) of 7%, 11.3 mA/cm2, 0.74 V, and 34%, respectively.
Growth and characterization of quaternary-alloy ferromagnetic semiconductor (In,Ga,Fe)Sb
Authors: Hotta Tomoki , Takase Kengo , Takiguchi Kosuke , Sriharsha Karumuri , Anh Le Duc , Tanaka Masaaki
Published: January 2022

We study the growth and properties of the quaternary-alloy ferromagnetic semiconductor (In0.94−x,Gax,Fe0.06)Sb (x = 5%–30%; the Fe concentration is fixed at 6%) grown by low-temperature molecular beam epitaxy. Reflection high-energy electron diffraction patterns, scanning transmission electron microscopy lattice images, and x-ray diffraction spectra indicate that the (In0.94−x,Gax,Fe0.06)Sb layers have a zinc blende crystal structure without any other second phase. The lattice constant of the (In0.94−x,Gax,Fe0.06)Sb films changes linearly with the Ga concentration x, indicating that Ga atoms substitute In atoms in the zinc-blende structure. We found that the carrier type of (In0.94−x,Gax,Fe0.06)Sb can be systematically controlled by varying x, being n-type when x ≤ 10% and p-type when x ≥ 20%. Characterization studies using magnetic circular dichroism spectroscopy indicate that the (In0.94−x,Gax,Fe0.06)Sb layers have intrinsic ferromagnetism with relatively high Curie temperatures (TC = 40–120 K). The ability to widely control the fundamental material properties (lattice constant, bandgap, carrier type, and magnetic property) of (In0.94−x,Gax,Fe0.06)Sb demonstrated in this work is essential for spintronic device applications.
Electric field modulation of spin transport
Authors: Zucchetti C. , Marchionni A. , Bollani M. , Ciccacci F. , Finazzi M. , Bottegoni F.
Published: January 2022

The finite spin lifetime in solids is often considered a major hindrance for the development of spintronic devices, which typically require cryogenic temperatures to mitigate this phenomenon. In this work, we show that this feature can instead be exploited to realize a scheme where spin transport is modulated at room temperature by a modest electric field. A field directed antiparallel (parallel) to the spin-diffusion velocity can, in fact, largely increase (decrease) the spin-transport length compared with the zero field case. We find that applying an electric field E = 24 V/cm along a 40 μm-long path in germanium results in about one order of magnitude modulation of the spin-polarized electrons entering into the detector. This work demonstrates that electric fields can be exploited for guiding spins over macroscopic distances and for realizing fast room temperature modulation of spin accumulation.
Continental-scale measurements of soil pyrogenic carbon in Europe
Authors: Pressler Yamina , Boot Claudia M. , Abiven Samuel , Lugato Emanuele , Francesca Cotrufo M.
Published: January 2022

Pyrogenic carbon (PyC), the product of incomplete biomass combustion, is a key component of soil organic carbon (SOC) because it can persist in soils for centuries to millennia. Quantifying PyC across large spatial scales remains a significant challenge in constraining the global carbon cycle. We measured PyC in topsoils across Europe using molecular marker (benzene polycarboxylic acids, BPCA) and spectroscopic techniques (Diffuse Reflectance Infrared Fourier Transform Spectroscopy, DRIFTS). We developed a calibration between BPCA and DRIFTS, but the calibration was less reliable (Y-variance explained = 0.62) than previous reports due to low soil PyC content and heterogeneity of soil matrices. Thus, we performed multiple regressions to identify drivers of PyC distribution using only the measured BPCA data. PyC content varied widely among soils, contributing 0–24% of SOC. Organic carbon was the strongest predictor of soil PyC content, but mean annual temperature, clay, and cation exchange capacity also emerged as predictors. PyC contributes a smaller proportion of SOC in European soils compared to other geographic regions. Comparing soil PyC measurements to PyC production rates in high latitude and Mediterranean regions suggests that transport, degradation, and recombustion are important mechanisms regulating soil PyC accumulation.
A scenario analysis under epistemic uncertainty in Natech accidents: imprecise probability reasoning in Bayesian Network
Authors: Wang Qiuhan , Cai Mei , Wei Guo
Published: January 2022

The increasing frequency and severity of Natech accidents warn us to investigate the occurrence mechanism of these events. Cascading disasters chain magnifies the impact of natural hazards due to its propagation through critical infrastructures and socio-economic networks. In order to manipulate imprecise probabilities of cascading events in Natech scenarios, this work proposes an improved Bayesian network (BN) combining with evidence theory to better deal with epistemic uncertainty in Natech accidents than traditional BNs. Effective inference algorithms have been developed to propagate system faulty in a socio-economic system. The conditional probability table (CPT) of BN in the traditional probability approach is modified by utilizing an OR/AND gate to obtain the belief mass propagation in the framework of evidence theory. Our improved Bayesian network methodology makes it possible to assess the impact and damage of Natech accidents under the environment of complex interdependence among accidents with insufficient data. Finally, a case study of Guangdong province, an area prone to natural disasters, is given. The modified Bayesian network is carried out to analyze this area’s Natech scenario. After diagnostic analysis and sensitivity analysis of human factors and the natural factor, we are able to locate the key nodes in the cascading disaster chain. Findings can provide useful theoretical support for urban managers of industrial cities to enhance disaster prevention and mitigation ability.
Precise Analgesic Instructions Improve Narcotic Usage: A Randomized Trial
Authors: Erz Logan , Larson Brandon , Mirhaidari Shayda , Cook Chad , Wagner Doug
Published: January 2022

Background

Given the ongoing battle with opioid abuse and overuse in the United States, new strategies are consistently being implemented to reduce opioid utilization and overprescribing.

Objectives

The purpose of this study was to determine if a more regulated explicit pain management instruction plan could reduce the number of opioids taken.

Methods

Blinded randomized prospective study comparing a total of 110 (Group A = 55, Group B = 55) women who underwent elective outpatient bilateral breast reduction surgery by 2 different plastic surgeons. Patients were randomly divided into either Group A (control) that received general pain management instructions or Group B (experimental) that received explicit pain management instructions from the surgeons and nurses. Participants were asked to record the number of times they treated their pain with each separate modality. They were also asked to record their average daily pain scale for the days that they were treating their pain.

Results

Patients in Group B took on average 1.5 oxycodone (5 mg) and patients in Group A took on average 5.7 oxycodone (5 mg) (P < 0.01). Thirty-four patients in Group B took no oxycodone. Patients in Group B also had statistically significant lower subjective pain scores.

Conclusions

Based on these results, it appears that standardizing how patients are instructed to treat their pain postoperatively may reduce the number of narcotics needed, thus reducing the number of narcotics prescribed without compromising pain control.

Level of Evidence: 2
Should we continue to use renin–angiotensin–aldosterone system blockers in patients with COVID-19?
Authors: Copur Sidar , Kanbay Asiye , Kanbay Mehmet
Published: January 2022

Patients with chronic kidney disease, chronic heart failure and hypertension have an increased risk of coronavirus disease 2019 (COVID-19)-related death. Renin–angiotensin–aldosterone system (RAS) blockers are commonly prescribed to decrease morbidity and mortality in these conditions. Following the pre-clinical demonstration of COVID-19 viral entry into cells via angiotensin-converting enzyme-2, the use of RAS blockers was questioned in infected individuals. Theodorakopoulou et al. extensively review the pathophysiology behind that hypothesis and observational or clinical trials on RAS blockers and COVID-19. Despite being a scientific hot spot of an ongoing debate, discontinuation of RAS blockers is not associated with improved clinical outcomes in COVID-19 and may have potential harmful effects, including exacerbation of the underlying disease.
Effect of intensity and duration of anthropic noises on European mink locomotor activity and fecal cortisol metabolite levels
Authors: Ortiz-Jiménez Lorena , Iglesias-Merchan Carlos , Martínez-Salazar Alba Itzel , Barja Isabel
Published: January 2022

Human activities involving noise emission can affect wild animals. European mink was exposed to road noise and human voice playbacks to analyze how sound intensity level and duration of both noises altered the time that individuals were active and if their fecal cortisol metabolite (FCM) levels varied. A Hierarchical Analysis Cluster was performed to establish 2 mink groups with respect to both noise source type: short duration/low intensity (SL) and long duration/high intensity (LH). We performed general linear mixed models to evaluate the variation in locomotor activity duration (s) and FCM (nanogram per gram) levels, respectively. The results showed both road noise and human voices decreased locomotor activity duration in SL more sharply compared with LH, and human voices were the triggers that induced the most pronounced response to both exposure conditions. FCM (ng/g) levels increased in SL compared with LH during road noise while the opposite happened during human voices. Differences based on sex and age of individuals were observed. In conclusion, noise characteristics given by the sound type determined the variations in locomotor activity duration while noise exposure level determined the variations in FCM (ng/g) levels. Attention should be paid to noisy activities (e.g., recreational activities for visitors in protected natural areas) and loud groups of people to conserve wildlife, especially noise sensitive species.
The DASH diet is associated with a lower risk of heart failure: a cohort study
Authors: Ibsen Daniel B , Levitan Emily B , Åkesson Agneta , Gigante Bruna , Wolk Alicja
Published: January 2022

Aims

Trials demonstrate that following the DASH diet lowers blood pressure, which may prevent the development of heart failure (HF). We investigated the association between long-term adherence to the DASH diet and food substitutions within the DASH diet on the risk of HF.

Methods and results

Men and women aged 45–83 years without previous HF, ischaemic heart disease or cancer at baseline in 1998 from the Cohort of Swedish Men (n = 41 118) and the Swedish Mammography Cohort (n = 35 004) were studied. The DASH diet emphasizes intake of fruit, vegetables, whole grains, nuts and legumes, and low-fat dairy and deemphasizes red and processed meat, sugar-sweetened beverages, and sodium. DASH diet scores were calculated based on diet assessed by food frequency questionnaires in late 1997 and 2009. Incidence of HF was ascertained using the Swedish Patient Register. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). During the median 22 years of follow-up (1998–2019), 12 164 participants developed HF. Those with the greatest adherence to the DASH diet had a lower risk of HF compared to those with the lowest adherence (HR 0.85, 95% CI: 0.80, 0.91 for baseline diet and HR 0.83, 95% CI: 0.78, 0.89 for long-term diet, comparing quintiles). Replacing 1 serving/day of red and processed meat with emphasized DASH diet foods was associated with an 8–12% lower risk of HF.

Conclusion

Long-term adherence to the DASH diet and relevant food substitutions within the DASH diet were associated with a lower risk of HF.
9. European Union agencies:
Authors: Rimkutė Dovilė
Published: January 2022

The institutional development of EU agencies is striking. Over the past decades, forty-six EU agencies have been established to support the European Commission and member states in their regulatory and executive tasks. Today, EU agencies are a vital part of the EU’s administrative capacity. EU agencies have received considerable scholarly attention that used a myriad of theoretical approaches—ranging from institutional, organizational, and bureaucratic reputation to interest-group theories—to explain why EU agencies have been created; how they develop over time; whether they are wielders of supranational or intergovernmental power; how they legitimize themselves and cultivate a positive bureaucratic reputation; and how they form alliances or insulate themselves from specific stakeholders. This chapter reviews the rise of EU agencies and introduces a selection of theoretical perspectives that have been used by EU agency scholars to study EU-level agencification and EU agency behaviour, regulatory processes, and outputs.
Virtual assets: compelling a new anti-money laundering and counter-terrorism financing regulatory model
Authors: Schmidt Alicia
Published: January 2022

Virtual assets present unique Anti-Money Laundering and Counter-Terrorism Financing (AML/CTF) risks that have been overlooked by global regulation in the past. This article considers virtual assets’ potential as a new way to exchange value and the need for effective AML/CTF regulation. It analyses the emerging issues that will elevate the risks and considers the current global regulatory response including the reliance on centralized intermediaries. This article recommends extending the regulatory framework to include regulation that is native to the peer-to-peer nature of virtual assets to address the risks. This article argues this new regulatory model will ultimately be more effective in achieving the goal of AML/CTF regulation than the current regulation has been in the traditional financial system. Despite the inherently global nature of virtual assets, where the domestic perspective is required this will be considered in the context of Australia, drawing upon other jurisdictions where applicable.
Prevention of Pemetrexed-Induced Rash Using Low-Dose Corticosteroids: A Phase II Study
Authors: Sakurada Takumi , Nokihara Hiroshi , Koga Tadashi , Zamami Yoshito , Goda Mitsuhiro , Yagi Kenta , Hamano Hirofumi , Aizawa Fuka , Ogino Hirokazu , Sato Seidai , Kirino Yasushi , Goto Hisatsugu , Nishioka Yasuhiko , Ishizawa Keisuke
Published: January 2022

Background

Rash eruptions are a common side-effect of pemetrexed, for which the administration of 8 mg/day of dexamethasone for 3 days from the day preceding pemetrexed administration is recommended. This study aimed to prospectively assess the effectiveness of prophylactic administration of low-dose dexamethasone for pemetrexed-induced rashes.

Methods

This single-arm, phase II study recruited patients with non-squamous non–small cell lung cancer and malignant pleural mesothelioma scheduled to receive chemotherapy including pemetrexed. Patients received 2 mg of dexamethasone daily from days 2 to 6 after chemotherapy with pemetrexed. The primary endpoint was the 3-week incidence of rash eruptions.

Results

Twenty-five patients were enrolled between September 2017 and May 2019. The incidence of rash after 3 weeks was 16.7%. Rashes erupted mainly on the upper half of the body, such as the chest and neck, and were of grades 1 and 2 in 2 patients each. No rashes of grade 3 or higher were observed, and there were no adverse events associated with additional corticosteroids.

Conclusion

Prophylactic administration of low-dose dexamethasone for 5 days from the day after pemetrexed administration resulted in a milder incidence and severity of rash. These findings may provide a standard preventative strategy for pemetrexed-induced rashes. (Trial identifier: UMIN000025666).
Regional anaesthesia in patients on antithrombotic drugs
Authors: Kietaibl Sibylle , Ferrandis Raquel , Godier Anne , Llau Juan , Lobo Clara , Macfarlane Alan JR , Schlimp Christoph J. , Vandermeulen Erik , Volk Thomas , von Heymann Christian , Wolmarans Morné , Afshari Arash
Published: January 2022

BACKGROUND

Bleeding is a potential complication after neuraxial and peripheral nerve blocks. The risk is increased in patients on antiplatelet and anticoagulant drugs. This joint guideline from the European Society of Anaesthesiology and Intensive Care and the European Society of Regional Anaesthesia aims to provide an evidence-based set of recommendations and suggestions on how to reduce the risk of antithrombotic drug-induced haematoma formation related to the practice of regional anaesthesia and analgesia.

DESIGN

A systematic literature search was performed, examining seven drug comparators and 10 types of clinical intervention with the outcome being peripheral and neuraxial haematoma. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the methodological quality of the included studies and for formulating recommendations. A Delphi process was used to prepare a clinical practice guideline.

RESULTS

Clinical studies were limited in number and quality and the certainty of evidence was assessed to be GRADE C throughout. Forty clinical practice statements were formulated. Using the Delphi-process, strong consensus (>90% agreement) was achieved in 57.5% of recommendations and consensus (75 to 90% agreement) in 42.5%.

DISCUSSION

Specific time intervals should be observed concerning the adminstration of antithrombotic drugs both prior to, and after, neuraxial procedures or those peripheral nerve blocks with higher bleeding risk (deep, noncompressible). These time intervals vary according to the type and dose of anticoagulant drugs, renal function and whether a traumatic puncture has occured. Drug measurements may be used to guide certain time intervals, whilst specific reversal for vitamin K antagonists and dabigatran may also influence these. Ultrasound guidance, drug combinations and bleeding risk scores do not modify the time intervals. In peripheral nerve blocks with low bleeding risk (superficial, compressible), these time intervals do not apply.

CONCLUSION

In patients taking antiplatelet or anticoagulant medications, practitioners must consider the bleeding risk both before and after nerve blockade and during insertion or removal of a catheter. Healthcare teams managing such patients must be aware of the risk and be competent in detecting and managing any possible haematomas.
Outcomes of patients with thromboembolic events following coronavirus disease 2019 AstraZeneca vaccination: a systematic review and meta-analysis
Authors: Matar Reem H. , Than Christian A. , Nakanishi Hayato , Daniel Rohan Suresh , Smayra Karen , Sim Bernice L. , Beran Azizullah , Danoun Omar A.
Published: January 2022

AstraZeneca coronavirus disease 2019 (COVID-19) vaccinations have recently been implicated in thromboembolism formations. Our aim was to investigate the outcomes of patients with thromboembolic events following the AstraZeneca vaccine (ChAdOx1 nCoV-19, AZD1222). A literature search was performed from December 2019 to September 2021. Eligible studies must report participants older than 18 years vaccinated with AstraZeneca and outcomes of thromboembolic events. Pooled mean or proportion were analyzed using a random-effects model. A total of 45 unique studies (number of patients = 144, 64.6% women, mean age 21–68 years) were included. The most common presenting adverse events were headache (12.1%), intracerebral hemorrhage (7.5%), and hemiparesis (7%). The most common thromboembolic adverse events were cerebral venous sinus thrombosis (38.5%) and deep vein thrombosis/pulmonary embolism (21.1%). The most common radiologic finding were intracerebral hemorrhage and cerebral venous thrombosis. Laboratory findings included thrombocytopenia (75%) and hypofibrinogenemia (41%). On admission, 64 patients tested positive for PF4-Heparin ELISA assay (80%). Seventy-four patients were hospitalized with 22 being admitted to the ICU. A total of 78 patients recovered while 39 patients died. This meta-analysis presents evidence to suggest vaccine-induced immune thrombotic thrombocytopenia (VITT) following AstraZeneca vaccine. Clinical practice must, therefore, account for the possibility of VITT and subsequent embolic events in certain individuals’ postvaccination with adenovirus-based COVID-19 vaccines. Serum anti-PF4 suggests diagnostic value for VITT and could subsequently inform treatment choices in such instances.
HDL functionality in type 1 and type 2 diabetes: new insights
Authors: Chapman M. John
Published: January 2022

Purpose of review

To critically appraise new insights into HDL structure and function in type 1 diabetes (T1DM) and type 2 diabetes (T2DM).

Recent findings

In young T1DM patients with early renal impairment and a high inflammatory score, both HDL antioxidative activity and endothelial vasodilatory function were impaired, revealing a critical link between HDL dysfunction, subclinical vascular damage, systemic inflammation and end organ damage. HDL may inhibit development of T2DM by attenuating endoplasmic reticulum (ER) stress and apoptotic loss of pancreatic β-cells, an effect due in part to ABC transporter-mediated efflux of specific oxysterols with downstream activation of the hedghehog signalling receptor, Smoothened. The apoM-sphingosine-1-phosphate complex is critical to HDL antidiabetic activity, encompassing protection against insulin resistance, promotion of insulin secretion, enhanced β-cell survival and inhibition of hepatic glucose production. Structure-function studies of HDL in hyperglycemic, dyslipidemic T2DM patients revealed both gain and loss of lipidomic and proteomic components. Such changes attenuated both the optimal protective effects of HDL on mitochondrial function and its capacity to inhibit endothelial cell apoptosis. Distinct structural components associated with individual HDL functions.

Extensive evidence indicates that both the proteome and lipidome of HDL are altered in T1DM and T2DM, with impairment of multiple functions.
Intraoperative monitoring of femoral head perfusion in adult femoral neck fractures
Authors: Donahue Jeffrey , Schrader Timothy , Bruggers Jennifer , Becher Stephen
Published: January 2022

Objectives:

To validate a novel intraoperative method of quantifying femoral head perfusion in adult patients with femoral neck fractures and to determine whether the lack of a perfusion waveform correlates with the development of osteonecrosis, nonunion, or reoperation.

Design:

Prospective cohort.

Setting:

Level 1 trauma center.

Patients/Participants:

Nineteen patients with 20 acute femoral neck fractures treated with hip-preserving surgical fixation. All patients underwent intraoperative quantification of femoral head perfusion.

Intervention:

Intraoperative quantification of femoral head perfusion pressure and waveform utilizing an intracranial pressure monitor.

Main outcome measurements:

Radiographic union, avascular necrosis, revision surgery.

Results:

Nineteen patients (8 male, 11 female, average age 56 ± 21 years) with 20 femoral neck fractures were enrolled. Eight fractures were stable (Garden 1-2/OTA B1.1–1.3) and 12 were unstable (Garden 3-4/OTAB2.1–3.3). A waveform was present in 12 of 20 cases. The average pressures were systolic 36.8 mm Hg, diastolic 30.8 mm Hg, pulse pressure 6.0 mm Hg. A perfusion waveform was significantly associated with advanced age (P = 0.02) and accompanied by trend toward stable fracture patterns. There were 4 deaths during the 1-year follow-up period (20%), and there were 5 conversions to total hip arthroplasty (25%). There was no significant association between revision surgery or death with the absence of a waveform.

Conclusions:

Our study demonstrated the feasibility of a relatively low cost, minimally invasive, technique to quantify femoral head perfusion. In our limited sample, the absence of perfusion did not correlate with our main outcomes; however, the trend toward correlation with increased fracture displacement was as expected. A larger cohort of patients will be needed to detect a significant difference between those with and without a perfusion waveform with regards to our primary outcomes. Further study is needed to delineate the role such data may play in medical decision making at the time of index surgery.

Level of Evidence:

Prognostic Level II.
Iliosacral screw corridors in Japanese subjects: a study using reconstruction CT scans
Authors: Iga Toru
Published: January 2022

Objectives:

To investigate the characteristics of iliosacral (IS) screw corridors of Japanese pelves.

Methods:

Computer tomography images of 42 adult Japanese subjects without any pelvic injury were analyzed at a workstation. Using the manual reconstruction function, the width of a simulated horizontal corridor for an IS screw on the true coronal and true axial planes in the upper (S1), second (S2), and the third (S3) sacral segments was measured. For pelves without an adequate S1 corridor, a cranially tilted corridor was sought. A corridor was defined as “adequate” if its width on both planes was 10 mm or more.

Results:

An adequate horizontal corridor was found in S1 in 17 (40.5%) subjects, in S2 in 29 (69.0%) subjects, and in S3 in no subject. An independent factor affecting the adequacy of the S1 corridor was the adequacy of the S2 corridor (OR: 0.09). Similarly, an independent factor affecting S2 adequacy was S1 adequacy (OR: 0.10). A tilted, 10 mm diameter corridor was found in all 25 subjects who did not have an adequate horizontal corridor in the S1 segment. The angle required to obtain a 10 mm diameter corridor inversely correlated with the diameter of a horizontal corridor on the true coronal plane (R = −0.713, P = .000).

Conclusions:

The characteristics of IS screw corridors in the 42 Japanese subjects were similar to those reported in previous studies conducted in the West. The importance of preoperative planning using reliable techniques, such as three-dimensional reconstruction, should be emphasized.

Level of evidence: Diagnostic Level III. See Instructions for Authors for a complete description of level of evidence.
Image Fusion Improves Interdisciplinary Communication in the Treatment of Head and Neck Cancer
Authors: Thoenissen Philipp , Bucher Andreas , Burck Iris , Sader Robert , Vogl Thomas , Ghanaati Shahram
Published: January 2022

Introduction:

The diagnosis and therapy of oral squamous cell carcinoma (Osee) in Germany is according to guidelines and relies on interdisciplinary board meetings. Standard examination techniques are computed tomography (CT) and magnet resonance imaging (MRI). These technologies are used as objective tools for serial presentation in an oncologic board meeting. The presentation of multiple series at different time points can be time consuming and might not often depict a patients case clearly for all involved disciplinaries. A conclusive image fusion could improve the communication. Thus, this study aims to introduce a novel idea of image fusion into the field of craniomaxillofacial surgery in order to ease understanding and improve therapy in complex Osee patients’ cases.

Materials and Methods:

Three key data sets of a patient with OSCC at the right tongue have been merged by image fusion of 3 MRi of head and neck with 3 CT thorax and abdomen using Syngo via (Siemens). Fused images were used as at a glance picture for presenting and discussion a patients case. Focus was on presenting a case of a primary manifestation of OSCC with the potential of a local relapse and distant metastases in an interdisciplinary oncol-ogic board meeting.

Results:

Image fusion enabled to visualize the primary tumor, local relapse as well as distant pulmonary metastasis and within the suprarenal gland, which have been occurred in a linear time line of 13 months.

Discussion:

Image fusion of different modalities that is CT and MRi, which were gathered at different time points, presents a new approach within the field of craniomaxillofacial surgery and helped to understand cancer localization and relapse at 1 glance. This new approach will enable a compact data set of patients oncological history as a more decisive tool for all involved disciplinaries.

Conclusions:

Image fusion might have the potential to become a standard approach in order to ease multiple therapists to make therapy decisions in oncologic board meetings on basis of current three-dimensional ready CT imaging and MRI.
Does International Surgical Mission Involvement During Residency Predict Involvement in Practice?
Authors: Sasson Daniel C. , Kearney Aaron M. , Gosain Arun K.
Published: January 2022

Despite efforts to incorporate global health rotations during residency, it is unclear whether this experience affects the likelihood that plastic surgeons will continue such missions during practice. The authors conducted a survey of the American Society of Plastic Surgeons and the American Council of Academic Plastic Surgeons members regarding the impact of international experiences before practice upon future involvement. 138 surveys were analyzed. Ten percent participated in missions before medical school, 13% during medical school, 53% in residency, and 61% in practice. Sixty-seven percent of surgeons in an academic practice continued to engage in international missions, versus 55% in nonacademic practices (P = 0.152). No significant difference in the number of surgeons participating in missions was found between those who had attended their first mission before starting practice instead of those starting in practice (P = 0.163). Surgeons who graduated recently were more likely to have attended a mission during residency (P = 0.015). Fifty-four percent of surgeons reported that a mentor initiated their interest in missions, and 44% reported that their involvement in missions had decreased over the last 5 years, with most citing a financial disincentive. Given that over 2/3 of plastic surgeons from all practice types participate in international missions, it would behoove residency programs to offer formal training in global health to facilitate this interest. Our study is the largest thus far attempting to quantify the downstream effects of surgical mission participation in residency and highlights the need for further inquiry into this matter.
Cardiovascular Burden Is High in Pediatric Lung Transplant Recipients
Authors: Memaran Nima , Onnen Mareike , Müller Carsten , Schwerk Nicolaus , Carlens Julia , Borchert-Mörlins Bianca , Bauer Elena , Blöte Ricarda , Sugianto Rizky I. , Zürn Katharina , Wühl Elke , Warnecke Gregor , Tudorache Igor , Hansen Gesine , Gjertson David W. , Schmidt Bernhard M. W. , Melk Anette
Published: January 2022

Background.

Cardiovascular morbidity is common in adults after lung transplantation (LTx) but has not been described for pediatric LTx recipients. Early subclinical cardiovascular damage is reflected by increases in pulse wave velocity (PWV; indicating arteriosclerosis), intima–media thickness (IMT; indicating atherosclerosis), and left ventricular mass index (LVMI; indicating left ventricular hypertrophy).

Methods.

We annually assessed 47 pediatric LTx recipients in a prospective longitudinal study (144 observations, mean 3.1 visits/patient, range of 1–4 visits, mean follow-up 2.2 y).

Results.

At inclusion, increased PWV and IMT were detected in 13% and 30%, respectively, and elevated LVMI was detected in 33%. Higher PWV was associated with male sex, longer time since LTx, higher diastolic blood pressure, and lower glomerular filtration rate. Male sex and lower hemoglobin levels were associated with higher IMT, and the presence of diabetes was associated with higher LVMI.

Conclusions.

Pediatric LTx recipients suffer from a high and sustained burden of subclinical cardiovascular damage. In light of improving long-term outcomes, cardiovascular morbidity needs to be addressed. Our analysis identified classical and nonclassical risk factors to be associated with the measures for cardiovascular damage, which could serve as targets for intervention.
Splicing QTL analysis focusing on coding sequences reveals pathogenicity of disease susceptibility loci
Authors: Yamaguchi Kensuke , Ishigaki Kazuyoshi , Suzuki Akari , Tsuchida Yumi , Tsuchiya Haruka , Sumitomo Shuji , Nagafuchi Yasuo , Miya Fuyuki , Tsunoda Tatsuhiko , Hirofumi Shoda , Fujio Keishi , Yamamoto Kazuhiko , Kochi Yuta
Published: January 2022

Splicing QTL (sQTL) are one of the major causal mechanisms in GWAS loci, but their role in disease pathogenesis is poorly understood. One reason is the huge complexity of alternative splicing events producing many unknown isoforms. Here, we proposed two novel approaches, namely integration and selection, for this complexity by focusing on protein-structure of isoforms. First, we integrated isoforms with the same coding sequence (CDS) and identified 369-601 integrated-isoform ratio QTLs (i2-rQTLs), which altered protein-structure, in six immune subsets. Second, we selected CDS incomplete isoforms annotated in GENCODE and identified 175-337 isoform-ratio QTL (i-rQTL). By comprehensive long-read capture RNA-seq among these incomplete isoforms, we revealed 29 full-length isoforms with novel CDSs associated with GWAS traits. Furthermore, we have shown that disease-causal sQTL genes can be identified by evaluating their trans-eQTL effects. Our approaches highlight the understudied role of protein-altering sQTLs and are broadly applicable to other tissues and diseases.