bluuebunny/crossref_metadata_2025 huggingface dataset:
Selective Chemonucleolysis With Condoliase in Cynomolgus Monkeys
Authors: Muramatsu Dai , Yamaguchi Hiroaki , Minamisawa Yuka , Nii Aisuke
Published: July 2020

Selective chemonucleolytic effects of condoliase, a glycosaminoglycan degrading enzyme, was investigated histopathologically in cynomolgus monkeys. Condoliase was administered once into the lumber intervertebral disc (IVD), and as a comparative control, chymopapain, a proteolytic enzyme, was administered in a similar manner. Histopathological changes of the IVD and the adjacent vertebral body (VB) were examined at 1 to 26 weeks after administration. Major changes induced by condoliase in the IVD were degenerative and necrotic changes in the nucleus pulposus, annulus fibrosus, cartilaginous endplate (CEP), and epiphyseal growth plate (EGP); focal disappearance of the EGP; and neovascularization and ossification of the CEP. Decreased/necrosis of bone marrow cells with new bone formation was observed in the VB. Cellular regeneration in the IVD was observed as a recovery changes on and after week 4. The changes in the IVD and VB subsided at week 26. Chymopapain induced qualitatively similar but more widely extended changes. The degrees of the changes in the IVD and VB were more severe than those of condoliase, and the changes were exacerbated even at week 26. These results indicated that histopathological changes caused by condoliase were less severe and more selective than those by chymopapain.
Evaluation of 10 Urinary Biomarkers for Renal Safety With 5 Nephrotoxicants in Nonhuman Primates
Authors: Vlasakova Katerina , Troth Sean P. , Sistare Frank D. , Glaab Warren E.
Published: July 2020

To date, there has been very little published data evaluating the performance of novel urinary kidney biomarkers in nonhuman primates (NHPs). To assess the biomarker performance and characterize the corresponding histomorphologic patterns of tubular renal injury in the NHP, several studies were conducted using mechanistically diverse nephrotoxicants including cefpirome, cisplatin, naproxen, cyclosporine, and a combination of gentamicin with everninomicin. An evaluation of 10 urinary biomarkers (albumin, clusterin, cystatin C, kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, liver-type fatty acid-binding protein, N-acetyl-β-D-glucosaminidase, osteopontin, retinol binding protein 4 and total protein) was performed on urine collected from these studies. Each of these 5 treatments resulted in kidney proximal tubule injury of various severities. Histomorphologic features observed following treatment were generally consistent with analogous drug-induced changes in humans described in the literature. Most of the analyzed biomarkers were able to detect the injury earlier and with greater sensitivity than blood urea nitrogen and serum creatinine. Across all studies, KIM-1 and clusterin showed the highest overall performance. Differences in the patterns of biomarker responsiveness were noted among certain studies that may be informing tubular injury severity and recovery potential, underlying histopathologic processes, and prognosis. These findings demonstrate the utility of urinary kidney translational safety biomarkers in NHPs and provide additional supporting evidence for translating these biomarkers for use in clinical trial settings to further ensure patient safety.
Implications of Change to USMLE Step 1 Scoring for Otolaryngology Residency Programs
Authors: Kalyoussef Evelyne , Dhanda Aatin K. , Paskhover Boris
Published: July 2020

Otolaryngology is a competitive specialty, with 398 US seniors applying to an offered 328 positions in 2019. Recent changes to US Medical Licensing Exam (USMLE) Step 1 scoring raise many questions for both medical student applicants and program directors. Otolaryngologists are known to be collegial and thoughtful physicians. Focusing on other nonstandardized testing scores may help the specialty “reboot” and refocus on recruiting the best people, not just applicants with a high Step 1 score and Alpha Omega Alpha (AOA) status.
National Database Research in Head and Neck Reconstructive Surgery: A Call for Increased Transparency and Reproducibility
Authors: Bur Andrés M. , Villwock Mark R. , Nallani Rohit , Gomez Ernest D. , Varvares Mark A. , Villwock Jennifer A. , Cannady Steven B. , Wax Mark K.
Published: July 2020

Objective

To reproduce a published study comparing outcomes of patients who underwent microvascular reconstruction by plastic surgeons and otolaryngologists and to examine how case selection and methodology using the National Surgical Quality Improvement Program (NSQIP) data set can affect results and conclusions.

Study Design

Cross‐sectional analysis of US national database.

Setting

American College of Surgeons National Surgical Quality Improvement Program (NSQIP) from 2005 to 2017.

Subjects and Methods

A recently published study that used the NSQIP database to compare outcomes after head and neck free tissue transfer between plastic surgeons and otolaryngologists was reproduced. Different approaches to case selection and statistical analysis were evaluated and their effects on statistical significance and study conclusions were compared.

Results

When all cases of free tissue transfer, captured in NSQIP between 2005 and 2017, were compared between plastic surgery and otolaryngology, plastic surgery patients appeared to have lower rates of complications and length of stay. However, a more in‐depth analysis demonstrated that these results were confounded by older and sicker otolaryngology patients. A second analysis of the same NSQIP data, limited to only head and neck oncologic reconstructions, demonstrated that otolaryngology patients had fewer complications on univariate and multivariable analysis.

Conclusion

We demonstrated how case selection and analysis can significantly affect results. It is incumbent upon researchers who use NSQIP and other publicly available data sets to fully detail their methodology to allow other researchers to reproduce and evaluate their work and for the journal editorial process to carefully evaluate the methodology and conclusions of their contributing authors.
Diagnostic approach to lower limb edema
Authors: Gasparis Antonios P , Kim Pamela S , Dean Steven M , Khilnani Neil M , Labropoulos Nicos
Published: July 2020

Patients with lower limb edema are frequently referred to vascular specialists for evaluation. Multiple etiologies must be considered and often more than one cause may be present. Notably, the role of lymphatic system regardless of the underlying pathology has been underestimated. A thorough history and physical examination and a carefully considered laboratory and imaging evaluation are critical in differentiating causes. In this opinion article, we propose a diagnostic algorithm that incorporates a systematic approach to the patient with leg swelling and provides an efficient pathway for the differential diagnosis for this problem.
Bioimpedance spectroscopy and volumetry in the immediate/short-term monitoring of intensive complex decongestive treatment of lymphedema
Authors: Cavezzi Attilio , Urso Simone U , Paccasassi Stefania , Mosti Giovanni , Campana Fausto , Colucci Roberto
Published: July 2020

Aims

To assess (a) immediate/short-term outcomes of intensive complex decongestive treatment of lower limb lymphedema, by means of bioimpedance spectroscopy and tape measurement-based volumetry, and (b) correlation between these two methods.

Patients and methods

Cohort study on patients affected by unilateral primary or secondary lymphedema, stage II or III. Patients underwent complex decongestive treatment (manual and electro-sound lymphatic drainage, compression bandage, exercises, low-carb nutrition, and dietary supplements) for six days. Before (D0), three and six days after complex decongestive treatment (D3 and D6), volumetry and bioimpedance spectroscopy data of the total limb and lower leg were collected. Statistical analysis was applied to pre–post treatment outcomes and to the volumetry/bioimpedance spectroscopy correlation.

Results

Forty-one patients (15 males and 26 females, mean age: 50.7 years) were included. A progressive improvement of volumetry and bioimpedance spectroscopy figures was recorded. Total limb and leg volumetry (mean value in cc) was, respectively, 11,072.9 and 3150.8 at D0, 10,493 (−5.2%, p = 0.001) and 2980.2 (−5.4%, p < 0.001) at D6. Total limb lymphatic index at D0 and D6 was 18.9 and 14.8 (−21.5%, p < 0.001). Total limb resistance at D0, D3, and D6 was 200.4, 225.7, and 237.5 (+18.5%, p < 0.001), respectively; leg resistance at D0 and D6 was 117.5 and 150 (+27.7%, p < 0.001), respectively. Total limb reactance at D0, D3, and D6 was 12.2, 15, and 16.6 (+35.5%, p < 0.001), respectively. Leg reactance at D0 and D6 was 7.7 and 11.5 (+ 49.6%, p < 0001), respectively. Correlation volumetry/bioimpedance spectroscopy data were (a) total limb volumetry/resistance rho = −0.449, p < 0.01; volumetry/reactance rho=−0.466, p < 0.01; volumetry/lymphatic index rho = 0.581, p < 0.01; (b) leg volumetry/resistance rho=−0.579, p < 0.01; volumetry/reactance rho=−0.469, p < 0.01; volumetry/lymphatic index rho = 0.466, p < 0.05.

Conclusions

Complex decongestive treatment on lymphedematous limbs was effective at short term; both volumetry and bioimpedance spectroscopy showed a statistically significant improvement. Resistance and reactance increase, with lymphatic index decrease, correlated with volumetry decrease. Bioimpedance spectroscopy proved to help to assess fluid decrease and the tissue-related parameters variations.
Improve Bystander Cardiopulmonary Resuscitation in the Chinese Community
Authors: Guo Ningning , Hampton Michelle DeCoux
Published: July 2020

Though many community cardiopulmonary resuscitation (CPR) training classes are available throughout the United States, disparities exist in training and receipt of bystander CPR for Chinese immigrants with limited English proficiency. To increase the number of persons prepared to respond to a cardiac emergency, a Chinese language CPR training program was offered in the community in collaboration with the Stanford Department of Community Partnership. Program leaders imported the American Heart Association approved Chinese version of Heartsaver® for Adult CPR and AED from the China Mainland to make the training accessible to Chinese immigrants with LEP. In 2018, two CPR training events were conducted with 47 participants. All participants successfully demonstrated bystander (hands-only) CPR skills with 91% of participants reporting confidence and 97% willingness to perform CPR. As the first known CPR class offered in the Chinese language in the San Francisco Bay Area using official AHA products, this project provides valuable information regarding community interest and feasibility for expanding this educational program.
“Imagine All the People”: Imagined Interactions in Virtual Reality When Public Speaking
Authors: LeFebvre Leah E. , LeFebvre Luke , Allen Mike
Published: July 2020

This study explores the relationship between public speaking anxiety (PSA) and Imaginary Interactions (IIs). Participants ( N = 17) were recruited from the multi-section departmental introductory public speaking course. Virtual reality (VR) as a potential form of II treatment for PSA blurs the reality between imagined and actual interactions. This study utilized a sequential explanatory approach to examine inferential and descriptive findings. The inferential investigation employed a four-stage design requiring participants to complete pre-test PSA and post-test assessments before and after VR simulations, exploring II functions and attributions. The follow-up descriptive analysis expanded and generated new understanding for the complexities of II through participants’ experiences using directed content analysis. Utilizing VR as an extension of IIs highlighted the rehearsal function, and variations in attributions for discrepancy and specificity between VR realism and artificial simulated perceptions. The implications suggest that VR provides students in public speaking environments a treatment mechanism that minimizes the cognitive strain to imagine the scene and setting of the situation, while simultaneously providing assistance in PSA reduction.
Free space of rigid objects: caging, path non-existence, and narrow passage detection
Authors: Varava Anastasiia , Carvalho J. Frederico , Kragic Danica , Pokorny Florian T.
Published: July 2020

In this work, we propose algorithms to explicitly construct a conservative estimate of the configuration spaces of rigid objects in two and three dimensions. Our approach is able to detect compact path components and narrow passages in configuration space which are important for applications in robotic manipulation and path planning. Moreover, as we demonstrate, they are also applicable to identification of molecular cages in chemistry. Our algorithms are based on a decomposition of the resulting three- and six-dimensional configuration spaces into slices corresponding to a finite sample of fixed orientations in configuration space. We utilize dual diagrams of unions of balls and uniform grids of orientations to approximate the configuration space. Furthermore, we carry out experiments to evaluate the computational efficiency on a set of objects with different geometric features thus demonstrating that our approach is applicable to different object shapes. We investigate the performance of our algorithm by computing increasingly fine-grained approximations of the object’s configuration space. A multithreaded implementation of our approach is shown to result in significant speed improvements.
Low-Dimensional Model for Bike-Sharing Demand Forecasting that Explicitly Accounts for Weather Data
Authors: Cantelmo Guido , Kucharski Rafał , Antoniou Constantinos
Published: July 2020

With the increasing availability of big, transport-related datasets, detailed data-driven mobility analysis is becoming possible. Trips with their origins, destinations, and travel times are now collected in publicly available databases, allowing for detailed demand forecasting with methods exploiting big and accurate data. In this paper, we predict the demand pattern of New York City bikes with a low-dimensional approach utilizing three-level data clustering. We use historical demand data along with temperature and precipitation to first aggregate and then decompose data to obtain meaningful clusters. The core of this approach lies in the proposed clustering technique, which reduces the dimension of the problem and, differently from other machine learning techniques, requires limited assumptions on the model or its parameters. The proposed method allows, for the given temperature and precipitation method, to obtain expected vector of movement (mean number and direction of trips) for each zone. In this paper, we synthesize more than 17 million trips into daily and zonal vectors of movement, which combined with weather data allow forecasting of the trip demand. The method allows us to predict the demand with over 75% accuracy, as shown in series of experiments in which various settings and parameterizations are validated against 25% holdout data.
Categorizing Merging and Diverging Strategies of Truck Drivers at Motorway Ramps and Weaving Sections using a Trajectory Dataset
Authors: Sharma Salil , Snelder Maaike , Tavasszy Lóránt , van Lint Hans
Published: July 2020

Lane-changing models are essential components for microscopic simulation. Although the literature recognizes that different classes of vehicles have different ways of performing lane-change maneuvers, lane change behavior of truck drivers is an overlooked research area. We propose that truck drivers are heterogeneous in their lane change behavior too and that inter-driver differences within truck drivers exist. We explore lane changing behavior of truck drivers using a trajectory data set collected around motorway bottlenecks in the Netherlands which include on-ramp, off-ramp, and weaving sections. Finite mixture models are used to categorize truck drivers with respect to their merging and diverging maneuvers. Indicator variables include spatial, temporal, kinematic, and gap acceptance characteristics of lane-changing maneuvers. The results suggest that truck drivers can be categorized into two and three categories with respect to their merging and diverging behaviors, respectively. The majority of truck drivers show a tendency to merge or diverge at the earliest possible opportunity; this type of behavior leads to most of the lane change activity at the beginning of motorway bottlenecks, thus contributing to the raised level of turbulence. By incorporating heterogeneity within the lane-changing component, the accuracy and realism of existing microscopic simulation packages can be improved for traffic and safety-related assessments.
Teaching Guided Imagery and Relaxation Techniques in Undergraduate Nursing Education
Authors: Windle Stephanie , Berger Samantha , Kim Jung Eun E.
Published: July 2020

Guided imagery and relaxation techniques have many documented benefits yet are not traditionally taught in undergraduate nursing education. These techniques can also be used by clinicians and students to manage their own stress. The impact of teaching guided imagery in an experiential skills lab on undergraduate nursing students was examined in this mixed-methods research study. Goals were to evaluate whether students learning these skills would be more likely to use them in clinical practice, to examine whether learning these skills would provide personal benefits, and to compare personal instruction with video instruction. Students completed questionnaires evaluating the experience in terms of satisfaction, personal benefit, and intent to use. Students provided comments and answered open-ended questions regarding personal and professional benefits and ability to apply knowledge and skills. Results were positive, with students reporting satisfaction with the format, personal benefit from the course, and increased likelihood that they will use the techniques with clients in the future. The lowest scores were on confidence in using the technique with clients. A statistically significant finding is that students preferred personal instruction in the areas of satisfaction with the content, satisfaction with the format, and the value of experience in advance of using these skills with patients ( p < .05).
Consciousness reduced: The role of the ‘idiot’ in early evolutionary psychology
Authors: Jarrett Simon
Published: July 2020

A conception of the idiotic mind was used to substantiate late 19th-century theories of mental evolution. A new school of animal/comparative psychologists attempted from the 1870s to demonstrate that evolution was a mental as well as a physical process. This intellectual enterprise necessitated the closure, or narrowing, of the ‘consciousness gap’ between human and animal species. A concept of a quasi-non-conscious human mind, set against conscious intention and ability in higher animals, provided an explanatory framework for the human–animal continuum and the evolution of consciousness. The article addresses a significant lacuna in the historiographies of intellectual disability, animal science, and evolutionary psychology, where the application of a conception of human idiocy to advance theories of consciousness evolution has not hitherto been explored. These ideas retain contemporary resonance in ethology and cognitive psychology, and in the theory of ‘speciesism’, outlined by Peter Singer in Animal Liberation (1975), which claims that equal consideration of interests is not arbitrarily restricted to members of the human species, and advocates euthanasia of intellectually disabled human infants. Speciesism remains at the core of animal rights activism today. The article also explores the influence of the idea of the semi-evolved idiot mind in late-Victorian anthropology and neuroscience. These ideas operated in a separate intellectual sphere to eugenic thought. They were (and remain) deeply influential, and were at the heart of the idea of the moral idiot or imbecile, targeted in the 1913 Mental Deficiency Act, as well as in 20th-century animal and human consciousness theory.
Parameter matching and optimization for power system of range-extended electric vehicle based on requirements
Authors: Liu Hanwu , Lei Yulong , Fu Yao , Li Xingzhong
Published: July 2020

For the research on crucial technologies of range-extended electric vehicle, the first problem to be solved is parameter matching and efficiency optimization for range-extended electric vehicle power and transmission system. Parameter matching and optimization of range-extended electric vehicle power and transmission system are multi-objective optimization problem. Evaluation and analysis of multi-objective optimization problem should be mutually independent and balanced. With the aim of guaranteeing vehicle’s comprehensive performance, a parameter matching and optimization method for range-extended electric vehicle power and transmission system is proposed in this paper. First, the house of quality model of range-extended electric vehicle is established to determine weight coefficient of vehicle performance indicator based on market requirements instead of experience. Based on co-simulation control model which is established in Matlab-Simulink and AVL-Cruise, 40 groups of orthogonal tests are performed, and the sensitivity of characteristic parameters is analyzed to explore the coupling law among vehicle performance indicators, so as to clarify the entry point for parameter matching and optimization. The simulation results show that the characteristic parameters not only have a significant influence but also have a coupling effect on the vehicle performance indicators. The analysis of variance shows that there is a limitation in optimal level combination of various factors only by range. Then, particle swarm optimization algorithm is selected to optimize the parameters of range-extended electric vehicle power and transmission system based on sensitivity analysis results obtained above. The study reveals that it is more efficient and reasonable to match the range-extended electric vehicle power and transmission system with a smaller battery capacity and a “medium-sized” auxiliary power unit which can achieve adequate dynamic performance, lower purchase cost, longer driving range and less energy consumption. Finally, a comparative simulation between the range-based analysis and particle swarm optimization-based analysis is conducted, the simulation results indicate that the optimized design parameters solution can significantly improve the technical indicators of the vehicle.
Influence of resistance spot welding process parameters on dissimilar austenitic and duplex stainless steel welded joints
Authors: Krishnan Vignesh , Ayyasamy Elayaperumal , Paramasivam Velmurugan
Published: July 2020

This paper examines the impact of welding parameters on tensile shear fracture load, nugget geometry and microstructure of resistance spot welds (RSW) of austenitic stainless steel AISI 316 L and duplex stainless steel 2205 under lap shear loading condition. The macroscopic examination resulted that many of the nugget lengths were nearer to and higher than the AWS recommended value 4√t and failed at higher tensile shear load. Nugget height for DSS 2205 side was higher in comparison with AISI 316 L due to higher thermal conductivity of duplex stainless steel. Three welding parameters mainly welding current of 9 kA, heating cycle of 9 and electrode tip diameter of 6 mm were discovered as most effectual parameters on the tensile shear load and microstructure of weldments. Heterogeneous hardness was observed in the fusion zone due to the transition of equiaxed to columnar grains takes place in the both sides of nugget edge. DSS HAZ nearby BM observed higher hardness and ASS HAZ nearby BM reported lower hardness. WMZ Microstructure confirmed that thickness of austenite layers increased with heat input. Also, an unmixed zone in the microstructure identified as HAZ which contains delta ferrite. Scanning Electron Microscope (SEM) images in the nugget zone for different welding parameters confirmed that Intra-Granular Austenite (IGA) highly developed at higher welding current. SEM fractrograph for the tensile sheared specimens at higher and lower heat input confirmed the ductile type fracture even failed at Inter-Facial (IF) mode. Nugget area and nugget hardness were positively correlated with Tensile Shear Fracture Load (TSFL).
Evaluation of spinal posture during gait with inertial measurement units
Authors: Digo Elisa , Pierro Giuseppina , Pastorelli Stefano , Gastaldi Laura
Published: July 2020

The increasing number of postural disorders emphasizes the central role of the vertebral spine during gait. Indeed, clinicians need an accurate and non-invasive method to evaluate the effectiveness of a rehabilitation program on spinal kinematics. Accordingly, the aim of this work was the use of inertial sensors for the assessment of angles among vertebral segments during gait. The spine was partitioned into five segments and correspondingly five inertial measurement units were positioned. Articulations between two adjacent spine segments were modeled with spherical joints, and the tilt–twist method was adopted to evaluate flexion–extension, lateral bending and axial rotation. In total, 18 young healthy subjects (9 males and 9 females) walked barefoot in three different conditions. The spinal posture during gait was efficiently evaluated considering the patterns of planar angles of each spine segment. Some statistically significant differences highlighted the influence of gender, speed and imposed cadence. The proposed methodology proved the usability of inertial sensors for the assessment of spinal posture and it is expected to efficiently point out trunk compensatory pattern during gait in a clinical context.
MiR-663a, regulated by lncRNA GAS5, contributes to osteosarcoma development through targeting MYL9
Authors: Zhao S , Xiong W , Xu K
Published: July 2020

Osteosarcoma is characterized by high malignancy and high metastasis rate, resulting in high mortality and disability. MiR-663a has been reported in a variety of tumors to promote tumorigenesis. However, miR-663a has not been reported in the pathogenesis of osteosarcoma. Bioinformatics analysis and experiments including real-time quantitative polymerase chain reaction (RT-qPCR), luciferase reporter, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, Western blot, RNA immunoprecipitation, and flow cytometry assay were applied to explore the function and mechanism of miR-663a in MG63, U2OS, Saos-2, SF-86, and hFOB1.19 cells. In this study, we found that miR-663a is highly expressed in osteosarcoma. At the same time, we discovered that miR-663a facilitates cell proliferation and migration, whereas suppresses cell apoptosis in osteosarcoma. Through a series of biological experiments, it was found that miR-663a regulates the cellular process in osteosarcoma by modulating the expression of MYL9. In addition, we also found that long noncoding RNA (lncRNA) GAS5 serves as a molecular sponge for miR-663a and regulates the progression of osteosarcoma via the ceRNA mechanism. We uncover that miR-663a promotes osteosarcoma development through targeting MYL9, which was regulated by lncRNA GAS5.
Upregulated miR-101 inhibits acute kidney injury–chronic kidney disease transition by regulating epithelial–mesenchymal transition
Authors: Zhao J-Y , Wang X-L , Yang Y-C , Zhang B , Wu Y-B
Published: July 2020

Acute kidney injury (AKI) is an independent risk factor for chronic kidney disease (CKD). However, the role and mechanism of microRNA (miRNA, miR) in AKI-CKD transition are elusive. In this study, a murine model of renal ischemia/reperfusion was established to investigate the repairing effect and mechanism of miR-101a-3p on renal injury. The pathological damage of renal tissue was observed by hematoxylin and eosin and Masson staining. The levels of miR-101, profibrotic cytokines, and epithelial–mesenchymal transition (EMT) markers were analyzed using Western blotting, real-time polymerase chain reaction, and/or immunofluorescence. MiR-101 overexpression caused the downregulation of α-smooth muscle actin, collagen-1, and vimentin, as well as upregulation of E-cadherin, thereby alleviating the degree of renal tissue damage. MiR-101 overexpression mitigated hypoxic HK-2 cell damage. Collagen, type X, alpha 1 and transforming growth factor β receptor 1 levels were downregulated in hypoxic cells transfected with miR-101 mimic. Our study indicates that miR-101 is an anti-EMT miRNA, which provides a novel therapeutic strategy for AKI-CKD transition.
In situ polymerization of functionalized multiwalled-carbon nanotubes/epoxy resin composite fibers using a non-solvent technique
Authors: Karkhanehchin Mohammad Ebrahim , Maghrebi Morteza , Baniadam Majid , Dashti Ali , Mokhtarifar Maryam
Published: July 2020

The aim of this study was to produce carbon nanotubes (CNTs)/polymer composite fibers by wet spinning without any solvent. The functionalized multiwalled-carbon nanotubes (F-MWNTs)/epoxy resin was synthesized by in situ polymerization method. Epoxy resin, F-MWNTs, and curing agent were mixed and injected by a syringe pump. The effects of operating parameters including the percentage of CNTs and the extrusion velocity of the syringe pump on the dispersion and alignment of F-MWNTs in the cross-section of F-MWNTs/polymer composite fibers were investigated. The composite fibers were characterized by tensile strength analysis, scanning electron microscopy (SEM), and electrical conductivity analysis. The experimental results showed that a decrease (30 ml/h to 15 ml/h) in extrusion velocity increased the electrical conductivity of composite fibers by more than 3%. This behavior was attributed to the higher alignment of F-MWNTs and improved conducting pathways along the composite fiber axis, as observed by SEM. In addition, by reducing extrusion velocity (30 ml/h to 15 ml/h), the tensile strength of composite fibers was enhanced just over twofold due to the better arrangement of CNTs which can be attributed to the further retention time of composite fibers and the pressure of the walled-needle. Moreover, the higher the processing time of spinning, the lower electrical conductivity of the fibers is which might be due to the higher coagulation of fibers.
Association Between the Prothrombin Time–International Normalized Ratio and Concomitant Use of Antibiotics in Warfarin Users: Focus on Type of Antibiotic and Susceptibility of Bacteroides fragilis to Antibiotics
Authors: Yagi Tatsuya , Naito Takafumi , Kato Ayami , Hirao Kensho , Kawakami Junichi
Published: July 2020

Background:

The difference in type of antibiotics and susceptibility of Bacteroides fragilis to antibiotics may influence warfarin anticoagulation. However, these influences have not been clarified in clinical settings.

Objectives:

This study aimed to investigate association the between the prothrombin time–international normalized ratio (PT-INR) and concomitant use of antibiotics in a real-world population of warfarin users.

Methods:

This was a single-center cohort study using data from health records and included patients who received β-lactams (BLs)/fluoroquinolones (FQs) during ongoing warfarin treatment (2011-2015) at Hamamatsu University Hospital in Japan. Antibiotics were categorized into those to which B fragilis is susceptible (BLsus, FQsus) and those to which it is not (BLnon, FQnon) and into those given orally (BLpo, FQpo) or intravenously (BLiv, FQiv). Outcomes were excessive PT-INR and changes in PT-INR, defined as the ratio (INR ratio) and difference (ΔINR) of maximum PT-INR and baseline PT-INR. Excessive PT-INR was graded as INR ratio of >1.5 or >2.5.

Results:

A total of 1185 warfarin users were included. The proportion of INR ratio >2.5 in FQiv was higher than in BLiv (95% CI: 1.59-46.5). The proportions with an INR ratio of >1.5 in BLsus and FQsus were higher than in BLnon (1.72-14.1) and FQnon (1.05-9.36), respectively. ΔINR values in FQpo, FQiv, and FQsus were higher than those in BLpo, BLiv, and FQnon, respectively.

Conclusions and Relevance:

Concomitant use of FQs, or of antibiotics to which B fragilis is susceptible is associated with higher risk of excessive anticoagulation. These findings would contribute to safe and proper antibiotic treatment in warfarin users.
Nonconsensual Dose Reduction Mandates are Not Justified Clinically or Ethically: An Analysis
Authors: Kertesz Stefan G. , Manhapra Ajay , Gordon Adam J.
Published: July 2020

This manuscript describes the institutional and clinical considerations that apply to the question of whether to mandate opioid dose reduction in patients who have received opioids long-term. It describes how a calamitous rise in addiction and overdose involving opioids has both led to a clinical recalibration by healthcare providers, and to strong incentives favoring forcible opioid reduction by policy making agencies. Neither the 2016 Guideline issued by the Centers for Disease Control and Prevention nor clinical evidence can justify or promote such policies as safe or effective.
Regulating Marijuana Use in the United States: Moving Past the Gateway Hypothesis of Drug Use
Authors: Arnold Jason F. , Sade Robert M.
Published: July 2020

Many studies have shown that marijuana can negatively affect the cognitive development of adolescents. For some individuals, marijuana use may also initiate opioid use, dose escalation, and opioid use disorder. States that legalize marijuana should help adolescents through regulation of advertising and availability of marijuana-infused edibles. Such policies may assist in protecting neurodevelopment of the adolescent and young adult brain. The federal government should also remove its prohibition of marijuana sales and use, leaving their regulation to state law-makers.
High Incidence of Antiphospholipid Antibodies in Newly Diagnosed Patients With Lymphoma and a Proposed aPL Predictive Score
Authors: Kungwankiattichai Smith , Nakkinkun Yupa , Owattanapanich Weerapat , Ruchutrakool Theera
Published: July 2020

Given that the presence of antiphospholipid (aPL) antibodies has been proposed to be associated with thrombosis in newly diagnosed patients with lymphoma, we conducted a prospective cohort study on these patients. In all, 154 patients were enrolled. More than half were advanced-stage diffuse large B-cell lymphoma. Approximately one-third (35.7%) of the patients had the presence of aPLs, with single-, double-, and triple-aPL positivities of 29.9%, 5.2%, and 0.6%, respectively. Of the 154 patients, 8 (5.19%) developed symptomatic thrombosis during follow-up. There were no significant differences in the incidences of thrombosis for the aPL-positive and aPL-negative groups (5.5% vs 5.1%; P = 1.000). In a multivariate analysis, patients with male sex and lymphoma stage IV were significant risk factors for aPL positivity, with odds ratio [OR] = 2.22 (95% CI: 1.11-4.45), P = .025, and OR: 2.34 (95% CI: 1.17-4.67), P = .016, respectively. An aPL predictive score of ≥−1 was predictive of aPL positivity, with a sensitivity of 83.6% and specificity of 34.3%.
Sources of Geographic Variation in Health Care Spending Among Individuals With Employer Sponsored Insurance
Authors: Johnson William C. , Biniek Jean Fuglesten
Published: July 2020

We use health care claims data from the Health Care Cost Institute to estimate the share of geographic variation in health care spending attributable to person-specific (demand) and place-specific (supply) factors. We exploit patient migration across 112 metropolitan areas between 2012 and 2016. Using an event study approach, we find that moving to an area with 10% higher (lower) spending leads to a 4.2% increase (decrease) in individual medical spending. Our estimate implies that 42% of variation in health care spending among the commercially insured is attributable to place-specific factors. We show that variation in both price and utilization jointly determine the place-specific impact on individual spending. All else equal, we find that moving to an area with 10% higher (lower) prices, on average leads to a 5% increase (decrease) in spending, while moving to an area with 10% higher (lower) utilization leads to a 3.6% increase (decrease).
Comparison of two different intravenous serotonin antagonists used for chemotherapy-induced nausea and vomiting prophylaxis in patients treated with moderately emetogenic risk regimens: A retrospective analysis from a large academic medical center
Authors: Gamble Melissa , Carroll Elisabeth , Wright Garth C , Glode Ashley E
Published: July 2020

Introduction

Chemotherapy-induced nausea and vomiting (CINV) can be a serious and debilitating adverse effect that is highly feared by cancer patients. For patients receiving moderately emetogenic chemotherapy regimens at our institution in the ambulatory infusion center, palonosetron was selected as the preferred serotonin (5-HT3) antagonist for CINV prophylaxis per the 2016 NCCN Guidelines, when a neurokinin1 antagonist was not included in the prophylactic regimen. The purpose of this study was to evaluate the efficacy of dexamethasone and palonosetron versus granisetron for the prevention of CINV in patients receiving moderately emetogenic chemotherapy regimens.

Methods

This study is an Institutional Review Board-approved, single-center retrospective review of electronic health records including patients who received moderately emetogenic chemotherapy regimens with CINV prophylaxis with dexamethasone and either palonosetron or granisetron.

Results

A total of 268 eligible patients were included in the study. Eighty-eight patients received palonosetron and 180 patients received granisetron as their 5-HT3 receptor antagonist between October 31, 2014 and October 31, 2016. There were no statistically significant differences between the two antiemetic groups for the primary outcome of presence of any change in day 1 intravenous prophylactic antiemetics. Nine (10.23%) palonosetron patients and 15 (8.33%) granisetron patients required a change in their day 1 intravenous prophylactic antiemetics ( P = 0.610).

Conclusions

Despite palonosetron’s better efficacy, longer half-life, and higher binding affinity, the results of this retrospective review demonstrates that the choice of serotonin antagonist, palonosetron or granisetron, did not result in a change in day 1 intravenous prophylactic antiemetics or antiemetic outpatient medications for patients undergoing moderately emetogenic chemotherapy regimens.
Wound complications after total hip arthroplasty: a prospective, randomised controlled trial comparing staples with sutures
Authors: Mallee Wouter H , Wijsbek Anne E , Schafroth Matthias U , Wolkenfelt Julius , Baas Dominique C , Vervest Ton M J S
Published: July 2020

Objective:

Does the use of staples or sutures for wound closure have a lower surgical site infection rate in patients receiving primary total hip arthroplasty (THA)?

Design:

Prospective, randomised controlled multicentre trial.

Methods:

535 patients undergoing THA were included and randomised into 2 groups: 268 wounds were closed with staples, and 267 with sutures. Primary outcome was surgical site infection (SSI). Secondary outcomes were prosthetic joint infection (PJI), other wound complications (dehiscence, necrosis and prolonged drainage) and duration of admittance. Follow-up occurred at 2, 6, and 12 weeks, and at 1 year.

Results:

There were no significant demographic differences between the 2 groups. SSI occurred more frequently when wounds were closed with staples (4% compared to 1% with sutures; OR 2.8; CI, 0.885–0.952; p = 0.057). SSI was treated with oral antibiotics. The staples group showed significantly more wound complications (17% compared to 5%; OR 3.943, CI 2.073–7.498; p = 0.000). Wound discharge was significantly prolonged in the staples group ( n = 40, compared to n = 12 in the sutures group; OR 3.728; CI, 1.909–7.281; p = 0.000). There was no significant difference in PJI ( p = 0.364).

Conclusions:

In this large RCT comparing staples with sutures after THA, the use of staples is associated with a nearly 3 times greater risk of SSI (OR 2.8; p = 0.057). Staples significantly prolong wound discharge. The use of sutures for wound closure after THA is advised. Trial registration: Staples Or Sutures trial (S.O.S. trial) http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3946 , NTR3946.
Alternative vascular device for high-flow computed tomography angiography: ultrasound-guided long peripheral catheter (4 Fr × 10 cm)
Authors: Watts-Pajaro Fredy , Uribe-Buritica Francisco L
Published: July 2020

Introduction:

Radiological studies that require contrast media are common and useful in the emergency department. Alternatives have been proposed for the administration of contrast agent in patients with difficulty in the insertion of vascular access. Since 2017, our institution has used a 4-Fr × 10-cm-long peripheral catheter (Leadercath; Vygon) for venous insertion. Its ultrasound-guided insertion is carried out by emergency physicians. So far, there are no reports in the literature about the use of this long peripheral catheter for computed tomography angiography.

Objective:

To describe the experience with the said device, to point out the complications associated with it, and to evaluate it as an alternative way to gain vascular access for patients with limited venous access.

Methods:

An observational, analytical, and retrospective study was conducted. The study included patients who received an ultrasound-guided 4-Fr × 10-cm-long peripheral catheter (Leadercath; Vygon). Transparent, radiopaque, polyethylene, 18-gauge Leadercath from Vygon, sold as peripheral arterial catheter and sometimes used “off-label” as venous catheter with a flow capacity of up to 24 mL/min, was used. The flow capacity for gravity flow is 24 mL/s; with pump-driven flow, we achieved a flow infusion of 5–6 mL/s. Univariate analyses were performed. Normality was determined through the Shapiro–Wilk test.

Results:

In total, 172 patients met the inclusion criteria. Of them, 115 (67%) were female and the average age was 59 years. The main indication for performing the computed tomography angiography was the suspicion of pulmonary embolism (38.6%). The most frequent type of computed tomography angiography study was pulmonary tomography (88 patients, 51.5%). The contrast medium infusion rate was 6 mL/s in 51.5% (n = 88) of cases, 4.5 mL/s in 36.3%, and 5 mL/s in 12.3%. One adverse event occurred.

Conclusion:

An 18-gauge-long peripheral catheter (4 Fr × 10 cm, Leadercath; Vygon) following specific protocols appears to be safe for conducting high-flow computed tomography studies in patients with limited venous access.
Improvement in Compliance With Smoke-Free Environment Regulations at Hotels and Restaurants in Vietnam After an Administrative Intervention
Authors: Giang Kim Bao , Diep Pham Bich , Van Minh Hoang , Huong Nguyen Thi Diem , Lam Nguyen Tuan , Nga Pham Quynh , Takeuchi Momoe , Park Kidong
Published: July 2020

Introduction:

Vietnam is among the countries with the highest smoking prevalence among male adults, as well as high prevalence of secondhand smoke exposure at indoor places. In many countries, including Vietnam, exposure to tobacco smoking is greatest in restaurants/bars and hotels. This study aims to analyze the compliance of hotels and restaurants to smoke-free environment regulations before and after an intervention.

Methods:

Direct observations were done at the receptions, conference rooms, designated smoking areas, restaurants, and lobbies of 140 hotels and the dining rooms, kitchens, and toilets of 160 restaurants before and after an intervention. The intervention was a training course conducted by police officers followed by 3 monthly supervision visits by police officers. Compliance with smoke-free enviornment regulations was observed and assessed to generate a compliance score for each location and overall. Tobit regression was used to examine the relationship between compliance scores and the intervention and other variables such as hotel and restaurant characteristics.

Results:

Before the intervention, the highest compliance rates were found for “no tobacco advertisement” and “no cigarette selling” regulations (95%-100%) in almost all sites in hotels and restaurants. The lowest compliance rates were found for “having nonsmoking signs.” The rate of compliance with all regulations was only 5% for hotels and 0.06% of restaurants. Improvement after intervention was clearly observed, in the rate of compliance with all regulations by more hotels (15.7%) and overall compliance scores of hotels and restaurants.

Conclusions:

The intervention with participation of the police officers proved to be effective in improving compliance with smoke-free regulations. It is recommended to continue this intervention in the same areas as well as to expand the intervention to other areas.
Neuroimaging Insights Into Early Stages of HIV-Progressive Multifocal Leukoencephalopathy: A Case Report
Authors: Gonzalez Caldito Natalia , Loeb J Scott , Okuda Darin T
Published: July 2020

This report aims to enhance the understanding of early longitudinal neuroimaging features of progressive multifocal leukoencephalopathy (PML) in human immunodeficiency virus (HIV). Neuroimaging has become crucial in the diagnosis and early recognition of PML. Recognition of magnetic resonance imaging (MRI) features in the early stages of PML is paramount to avoid misdiagnosis and facilitate the delivery of treatments aimed at reducing disease progression. A 49-year-old white man with HIV presented with 4-month progressive left-sided weakness. Neurological examination revealed mild cognitive impairment, left-sided hemiparesis, and somatosense impairment to all modalities. Brain MRI revealed a punctate pattern with innumerable T2-FLAIR (fluid attenuated inversion recovery) hyperintensities in the cortex, brainstem, cerebellum, subcortical, and periventricular areas. Susceptibility-weighted imaging (SWI) revealed hypointensities involving subcortical U-fibers and cortical architecture. A comprehensive diagnostic evaluation was inconclusive. John Cunningham virus (JCV) PCR in cerebrospinal fluid (CSF) was indeterminate. He was started on antiretroviral therapy. Repeat brain MRI performed 1.5 months later, in the setting of further neurological decline, demonstrated progression of the T2-hyperintensities into a large confluent white matter lesion in the right frontoparietal lobe. Despite an indeterminate JCV PCR, the appearance and characteristic progression of the lesions in successive imaging in the setting of severe immunosuppression, with extensive negative infectious workup, was indicative of PML. This clinical experience illustrates unique neuroimaging features of HIV-PML in early stages and its progression over time. It especially highlights the relevance of the SWI sequence in the diagnosis and features observed with disease evolution. Short-term imaging follow-up may assist with the recognition of MRI features consistent with the biology of the infection.