bluuebunny/crossref_metadata_2025 huggingface dataset:
Sarcoidosis following alemtuzumab treatment for multiple sclerosis
Authors: Willis Mark D , Hope-Gill Ben , Flood-Page Patrick , Joseph Fady , Needham Ed , Jones Joanne , Coles Alasdair , Robertson Neil P
Published: October 2018

Despite proven efficacy of alemtuzumab in multiple sclerosis (MS), approximately 50% of individuals will develop a new autoimmune disease following treatment. To date, these have largely been antibody mediated and organ specific (primarily affecting the thyroid gland). In a retrospective case series of 187 patients from two UK specialist centres (Cardiff and Cambridge) followed up for a median of 10 years, we report three (1.6%) cases of sarcoidosis following alemtuzumab treatment of MS. This report increases the spectrum of auto-inflammatory disease following alemtuzumab and should be considered by clinicians when using this therapeutic agent for MS.
The association between social characteristics, alcoholic beverage preferences, and binge drinking in a Serbian adult population
Authors: Pakovic Ljubica , Todorovic Jovana , Santric-Milicevic Milena , Bukumiric Dragica , Terzic-Supic Zorica
Published: October 2018

Aim:

To determine the association of sociodemographic characteristics and type of alcoholic beverage consumed during binge drinking in Serbia.

Method:

We conducted a secondary analysis of data from the 2014 national survey on Serbian lifestyles focusing on substance abuse and gambling. The sample consisted of 5385 individuals. The respondents were divided into non-binge drinkers and binge drinkers, according to the quantity of alcohol consumed during one occasion. Binge drinkers reported consuming more than 60 g of pure alcohol (7.5 units of alcohol) during one occasion at least once during the previous year.

Results:

The prevalence of binge drinking in the past year among 2676 female and 2709 male participants aged 18–64 years was 28.4%. The multivariate logistic regression model showed that binge drinkers were more likely to be male (95% CI 3.58–4.94), single (95% CI 1.01–1.53), to be former (95% CI 1.06–1.62) or current smokers (95% CI 1.57–2.19), and to consume more than one type of alcoholic beverage (95% CI 2.04–3.44). There was a negative association of binge drinking with age (95% CI 0.98–0.99), living outside Northern Serbia-Vojvodina region, and drinking only spirits (95% CI 0.39–0.93).

Conclusion:

Focusing on the positive association of sociodemographic factors and binge drinking could help policy makers create public health interventions against alcohol misuse. These interventions should be directed to males, smokers, and those who consume more than one type of alcoholic beverage.
Interrogating the promise of a whole-school approach to intercultural education: An Australian investigation
Authors: Ohi Sarah , O’Mara Joanne , Arber Ruth , Hartung Catherine , Shaw Gary , Halse Christine
Published: October 2018

Intercultural education (ICE) is a priority for schools and schooling systems worldwide. While extensive policy and academic literature exists that describes how ICE should be done in schools, relatively little has been published about the pragmatics of implementing and enacting ICE, despite evidence that principals, teachers and schools feel ill equipped to teach and engage in ICE. This article investigates how schools implementing ICE are confronted with distinctive challenges. Engaging methodological tools of social constructivism (Denzin and Lincoln, 2005) and an analytical lens supported by social cultural theories of identity and representation (Hall, 1997; Gee, 2004), we argue that the everyday experiences and practices of teachers need be explored, but also interrogated and understood otherwise (Lather, 1991). We draw on qualitative data from a large-scale study conducted in schools in Victoria, Australia. We present three vignettes that elucidate how ICE was enacted at the principal, curriculum and teacher levels. Each vignette is based upon a key challenge confronted by schools and illustrates the processes different schools used to tackle these issues and to embed ICE into the daily schooling practice.
Private companies and policy-making: Ideological repertoires and concealed geographies in the evaluation of European education policies
Authors: Souto-Otero Manuel
Published: October 2018

This article explores the relationship between education, training and the single market, focusing on the market for the production of policy evaluations in the areas of education and training, culture and youth of the European Commission. Two questions are addressed: the first question relates to the geographical distribution of the organisations that deliver policy evaluation services to the European Commission (‘Commission’) in those areas; and the second relates to the nature of the ideas for policy development put forward in the evaluations examined. Based on information gathered from 23 evaluations carried out between 2012 and 2016 (in particular, the circa 300 recommendations they included), the analysis reveals that although the Commission relied on competitive processes for the award of those evaluations, competition was somewhat restricted: there is a marked dominance of a limited number of countries as the powerhouses for the Commission’s education policy evaluation. In relation to the second question, and by contrast to other policy spaces, the analysis provided little evidence of unfettered penetration of private sector ‘ideological repertoires’, lexicons and sensitivities into the European policy evaluation space.
Characterization of carbon fiber reinforced polymer strengthened concrete and gap detection with a piezoelectric-based sensory technique
Authors: Giri Paritosh , Kharkovsky Sergey , Zhu Xinqun , Clark Simon Martin , Taheri Shima , Samali Bijan
Published: October 2018

In this article, a piezoelectric-based sensory technique is proposed for detection of the gap between surfaces of a carbon fiber reinforced polymer plate and a concrete specimen and characterization of shrinkage of early-age concrete. The proposed technique uses the propagation properties of the guided waves in the carbon fiber reinforced polymer plate excited and received by piezoelectric transducers attached to an external surface of the carbon fiber reinforced polymer–strengthened concrete specimen. Measurements are conducted with fresh and hardened early-age concrete specimens and two carbon fiber reinforced polymer plates at different gaps. A piezoelectric actuator is excited using a sine burst signal, and the generated wave is received by a sensor after propagation along the specimen. The received signal at different gap values is used to detect a gap. To quantify the gap, damage indices, including correlation coefficient, peak-to-peak amplitude of resultant signal, and root-mean-square deviation, are used. The shrinkage of concrete is detected and predicted by comparing the damage indices at different gaps with the indices at different stages of early-age concrete. The proposed technique is relatively simple method using small transducers. It is one-sided, non-destructive, and cost-effective solution for gap detection and concrete characterization.
Dream Accounts in the Hebrew Bible and Ancient Jewish Literature
Authors: Quick Laura
Published: October 2018

The study of dreams and their interpretation in the literary remains from antiquity have become increasingly popular access points to the phenomenological study of religious experience in the ancient world, as well as of the literary forms in which this experience was couched. This article considers the phenomenon of dreaming in the Hebrew Bible and ancient Jewish literature. I consider treatments of these dream accounts, noting the development in the methodological means by which this material has been approached, moving from source criticism, to tradition history, and finally to form-critical methods. Ultimately, I will argue that form criticism in particular enables scholars to discern shifts and developments across diachronic perspectives. Study of dream accounts is thus illuminating not only for the understanding of dream phenomena, but also for the development of apocalyptic and the method and means of early Jewish biblical interpretation.
Jesus as Goat of the Day of Atonement in Recent Synoptic Gospels Research
Authors: Moscicke Hans
Published: October 2018

Do the Synoptic passion narratives portray Jesus (and Barabbas) as one (or both) of the goats of the Day of Atonement? This question currently has no consensus in biblical scholarship but four contrasting positions: The evangelists portray (1) Jesus as the abused scapegoat in his maltreatment by the Roman soldiers (Mk 15.16-20 parr.); (2) Jesus as a pharmakos-like scapegoat patterned after Hellenistic motifs of redemptive suffering; (3) Barabbas as the scapegoat and Jesus as the immolated goat (Mt. 27.15-26 parr.); and (4) Jesus as neither goat, but the typological fulfillment of alternative (suffering) figures: Isaiah’s Servant, the Psalms’ Righteous Sufferer, the Son of Man, and the divine warrior. This article reviews and evaluates these four positions, suggesting avenues for future research.
Clinical outcomes of extended endovascular recanalization of 16 consecutive Buerger’s disease patients
Authors: Kacmaz Fehmi , Kaya Adnan , Keskin Muhammed , Keceoglu Serdar , Algin Ibrahim Halil , Yilmazkaya Bayram , Ilkay Erdogan
Published: October 2018

Objective

Buerger’s disease is one of the worst diseases causing peripheral artery occlusions (especially lower extremity) with increased morbidity and mortality. Endovascular treatment of the diseased arteries gains preference over bypass surgery nowadays. Here, we aimed to present the clinical outcomes of 16 consecutive Buerger’s disease patients underwent extended endovascular recanalization which is a new technique to restore direct blood flow to at least one foot artery, with the performance of angioplasty for each tibial and foot artery obstructions.

Methods

A total of 16 consecutive patients with confirmed diagnosis of Buerger’s disease that percutaneously treated in our center between February 2014 and March 2018 were included in the study. The mean age of the patients was 44.25 ± 4.28 ranging from 36 to 50 years. After physical examination and complementary diagnostic tests, performance of extended angioplasty for occluded arteries was intended to restore direct blood flow to at least one of the blow-the-knee arteries.

Results

A successful extended endovascular treatment was performed in 20 of 22 limbs, achieving a technical success of 91%. All patients were successfully discharged without any complication. Mean follow-up duration was 21.43 ± 7.08 months. Reintervention was performed in one patient and minor amputation was needed in one of the failed limbs. Limb salvage rate was 100%. A significant difference was observed based on Rutherford classification, ankle brachial index, direct blood flow to foot, presence of ulcer and rest pain when compared before and after the intervention.

Conclusion

We showed successful extended endovascular recanalization of Buerger’s disease patients with a high technical success rate and sustained clinical improvement. Extended endovascular recanalization could be a therapeutic option in Buerger’s disease patients, since they are not good candidates for surgery.
Sharing a mental number line across individuals? The role of body position and empathy in joint numerical cognition
Authors: Hartmann Matthias , Fischer Martin H , Mast Fred W
Published: October 2018

A growing body of research shows that the human brain acts differently when performing a task together with another person than when performing the same task alone. In this study, we investigated the influence of a co-actor on numerical cognition using a joint random number generation (RNG) task. We found that participants generated relatively smaller numbers when they were located to the left (vs. right) of a co-actor (Experiment 1), as if the two individuals shared a mental number line and predominantly selected numbers corresponding to their relative body position. Moreover, the mere presence of another person on the left or right side or the processing of numbers from loudspeaker on the left or right side had no influence on the magnitude of generated numbers (Experiment 2), suggesting that a bias in RNG only emerged during interpersonal interactions. Interestingly, the effect of relative body position on RNG was driven by participants with high trait empathic concern towards others, pointing towards a mediating role of feelings of sympathy for joint compatibility effects. Finally, the spatial bias emerged only after the co-actors swapped their spatial position, suggesting that joint spatial representations are constructed only after the spatial reference frame became salient. In contrast to previous studies, our findings cannot be explained by action co-representation because the consecutive production of numbers does not involve conflict at the motor response level. Our results therefore suggest that spatial reference coding, rather than motor mirroring, can determine joint compatibility effects. Our results demonstrate how physical properties of interpersonal situations, such as the relative body position, shape seemingly abstract cognition.
Reduced Stroop interference under stress: Decreased cue utilisation, not increased executive control
Authors: Booth Robert W
Published: October 2018

Since the 1960s, researchers have been reporting that stress reduces Stroop interference. This is puzzling, as stress and anxiety typically have deleterious effects on cognitive control and performance. The traditional explanation is that stress reduces “cue utilisation”: It withdraws attentional resources from less relevant stimuli (including the distracter word), meaning that the target colour is left with a stronger influence over response selection. However, it could also be that stress somehow boosts distracter inhibition, or some other aspect of executive control. To test these two accounts, 59 students completed a Stroop task featuring occasional startlingly loud sounds (high stress) or the same sounds at a lower, comfortable volume (low stress). Alongside standard Stroop interference, two measures of executive control—negative priming and conflict adaptation—were calculated from the Stroop data. Stress produced a clear reduction of Stroop interference, but it did not influence negative priming, and no conflict adaptation effects were detected at all. These findings support the cue utilisation account. Furthermore, for the first time, stress was shown to reduce Stroop interference in a task with no congruent trials, showing that the effect does not result from stress’s modulating any strategy changes participants might make in response to congruent trials.
Impact of cyber dependencies in critical infrastructures: The reliability of grid splitting in power systems
Authors: Tian Di-An , Sansavini Giovanni
Published: October 2018

The growing presence of cyber interdependencies in critical infrastructures can be exemplified by grid splitting, which is an application in power system stability and control dependent on communication services. It involves the controlled separation of a power system into islands in reaction to an imminent instability. Communication is necessary for gathering system-wide synchronized measurements for state estimation as well as for the dispatch of line switch-opening signals. However, grid splitting may become ineffective due to a degradation in communication, which is accrued by the use of non-dedicated, open communication networks. To address this issue, this article aims to quantify the reliability of grid splitting under degraded communication conditions. A simulation framework is developed that allows the integration of a transient electrical model and a stochastic communication delay model that captures the effects of congestion and traffic uncertainty. The application to the IEEE 39-Bus Test System shows that the reliability of grid splitting is reduced under the influence of degraded communication leading to increased time delays. Furthermore, the results identify a critical transition range in the grid splitting reliability for a very narrow range of external interfering traffic and network data rate. Finally, the interdependency of the electric and the communication network is quantified by the expected efficiency of the communication network subject to degraded communication following the grid splitting action. The decrease in the expected communication efficiency under degraded communication is driven by increased congestion levels and by failures of electrical and co-located communication nodes and is related to the critical transition range for reliability. The developed methodology allows identifying the communication requirements for a reliable grid splitting execution under traffic uncertainty and congestion.
Effectiveness of a continuous patient position monitoring system in improving hospital turn protocol compliance in an ICU: A multiphase multisite study in India
Authors: Renganathan BS , Nagaiyan Sridhar , Preejith SP , Gopal Shameer , Mitra Susovan , Sivaprakasam Mohanasankar
Published: October 2018

Purpose

Hospital-acquired pressure ulcers are a significant cause of morbidity and consume considerable financial resources. Turn protocols (repositioning patients at regular intervals) are utilized to reduce incidence of pressure ulcers. Adherence to turn protocols is particularly challenging for nursing teams, given the high number of interventions in intensive care unit, and lack of widely available tools to monitor patient position and generate alerts. We decided to develop and evaluate usefulness of a continuous patient position monitoring system to assist nurses in improving turn protocol compliance.

Methods

We conducted a prospective, non-randomized, multiphase, multicentre trial. In Phase I (control group), the function of the device was not revealed to nurses so as to observe their baseline adherence to turn protocol, while Phase II (intervention group) used continuous patient position monitoring system to generate alerts, when non-compliant with the turn protocol. All consecutive patients admitted to one of the two intensive care units during the study period were screened for enrolment. Patients at risk of acquiring pressure ulcers (Braden score < 18) were considered for the study (Phase I (N = 22), Phase II (N = 25)).

Results

We analysed over 1450 h of patient position data collected from 40 patients (Phase I (N = 20), Phase II (N = 20)). Turn protocol compliance was significantly higher in Phase II (80.15 ± 8.97%) compared to the Phase I (24.36 ± 12.67%); p < 0.001.

Conclusion

Using a continuous patient position monitoring system to provide alerts significantly improved compliance with hospital turn protocol. Nurses found the system to be useful in providing automated turn reminders and prioritising tasks.
Optimization of aerodynamic performance for co-axial rotors with different rotor spacings
Authors: Lei Yao , Ji Yuxia , Wang Changwei
Published: October 2018

In this article, attempts are made to study the aerodynamic performance of co-axial rotors with different rotor spacings in hover. A custom-designed experimental platform with seven rotor spacings ( z/D = 0.16, 0.19, 0.23, 0.26, 0.29, 0.33 and 0.38) is applied to measure the hover performance, i.e. co-axial thrust and power consumption, and to optimize the aerodynamic configuration of the co-axial system. The experimental errors in thrust coefficient, power coefficient and power loading calculated through ‘Kline-McClintock equation’ are less than 2%. Additionally, the streamline distribution and pressure of blade tip at different rotor spacings obtained from numerical simulations are presented to visualize the effects of aerodynamic interference between the top and bottom rotor. Results show that the aerodynamic performance of a co-axial rotor with the specific rotor configure and speed range can be indeed improved by changing the rotor spacing, and the optimal performance is obtained with a rotor spacing of 0.19. Also, the magnitude of aerodynamic interference related to the axial separation distance has demonstrated to be beneficial on the total thrust and power consumption. For the same disc loading, a decrease in rotational speed results in an increase in power loading especially for z/D = 0.19. It is also found that the bottom rotor does affect the performance of the top rotor at smaller rotor spacings, whereas the effect is significantly reduced as the rotor spacing increases.
Antenatal Microbial Colonization of Mammalian Gut
Authors: Borghi Elisa , Massa Valentina , Severgnini Marco , Fazio Grazia , Avagliano Laura , Menegola Elena , Bulfamante Gaetano Pietro , Morace Giulia , Borgo Francesca
Published: October 2018

The widely accepted dogma of intrauterine sterility and initial colonization of the newborn during birth has been blurred by recent observations of microbial presence in meconium, placenta, and amniotic fluid. Given the importance of a maternal-derived in utero infant seeding, it is crucial to exclude potential environmental or procedural contaminations and to assess fetal colonization before parturition. To this end, we analyzed sterilely collected intestinal tissues, placenta, and amniotic fluid from rodent fetuses and tissues from autoptic human fetuses. Total bacterial DNA was extracted from collected samples and analyzed by Next Generation Sequencing (NGS) techniques using hypervariable 16S ribosomal RNA (rRNA) regions (V3-V4). Colonizing microbes were visualized in situ, using labeled probes targeting 16S ribosomal DNA by fluorescent in situ hybridization. The NGS analysis showed the presence of pioneer microbes in both rat and human intestines as well as in rodent placentas and amniotic fluids. Microbial communities showed fetus- and dam-dependent clustering, confirming the high interindividual variability of commensal microbiota even in the antenatal period. Fluorescent in situ hybridization analysis confirmed the microbes’ presence in the lumen of the developing gut. These findings suggest a possible antenatal colonization of the developing mammalian gut.
Properties and characterization of acrylic latex prepared with novel emulsifiers
Authors: Chen Lijun , Shao Tantan , Zhang Xin , Wang Xiuming , Chen Dawei
Published: October 2018

The polyacrylate latex has been successfully prepared by semicontinuous seeded emulsion polymerization with methyl methacrylate (MMA), butyl acrylate (BA), and acrylic acid (AA), which were initiated with potassium persulfate and emulsified with the novel green mixed surfactants of alkyl polyglycoside (APG1214) and disodium laureth sulfosuccinate (MES). The particle size of the latex was measured by Zetatrac dynamic light scattering detector. The structure of the latex was tested by Fourier-transform infrared spectroscopy. The film of latex was tested by differential scanning calorimetry and thermogravimetric analysis. Factors, which had an influence on the properties of the latex, were studied in detail. The optimum conditions for preparing the polyacrylate latex were as follows: the amount of emulsifiers was 7.0%, the mass ratio of APG1214 to MES was 3:1, the amount of the initiator was 0.7%, the mass ratio of MMA to BA was 1:1, and the amount of AA was 2.0%. In this case, the conversion of the mixed monomers was high and the mechanical and ionic stability of the latex was good.
Effect of time of day and daily endoscopic workload on outcomes of endoscopic mucosal resection for large sessile colon polyps
Authors: Hillman Yonatan J , Hillman Bari S , Sejpal Divyesh V , Lee Calvin , Miller Larry S , Benias Petros C , Trindade Arvind J
Published: October 2018

Background

Endoscopic mucosal resection of large non‐pedunculated colon polyps is challenging.

Objective

To determine if the time of day or daily endoscopic workload play a role in outcomes of endoscopic mucosal resection for large non‐pedunculated colon polyps greater than 20 mm.

Methods

This is a retrospective study of patients who underwent endoscopic mucosal resection of large non‐pedunculated colon polyps. The time of day and endoscopic workload were compared across the following outcomes: the rate of complete resection of the polyp, the rate of referral for surgery, and the rate of residual neoplasia on follow‐up.

Results

One hundred and three endoscopic mucosal resection procedures were performed. There were no differences in the rates of complete resection (80.8% vs. 70.0%; P = 0.25), the need for surgery (27.4% vs. 33.3%; P = 0.55), and rate of residual neoplasia (24.5% vs. 50.0%; P = 0.07) when comparing the time of day. Colon polyps greater than 40 mm were less likely to be completely resected versus polyps sized 20–39 mm (56.8% vs. 91.9%; P < 0.001). In cases with no residual neoplasia on follow‐up, the mean duration for the index procedure was 45.6 minutes versus 60.7 minutes when there was residual neoplasia (P < 0.01).

Conclusion

The time of day and endoscopic workload does not affect outcomes for endoscopic mucosal resection of large non‐pedunculated colon polyps, but the size of large non‐pedunculated colon polyps and resection times do.
Structured care delivery in the management of cardiac arrhythmias
Authors: Hendriks Jeroen ML
Published: October 2018

Chronic conditions often require complex and long-lasting management which burdens healthcare systems significantly. Atrial fibrillation is a prevalent heart rhythm disorder and an example of such chronic condition. Management of atrial fibrillation focusses on four main treatment fundamentals being: (i) controlling the heart rate, (ii) controlling the heart rhythm, (iii) stroke prevention, and (iv) detecting and treating cardiovascular risk factors. The question rises whether a single healthcare professional is able to adequately address each of these fundamentals in the treatment of atrial fibrillation. To guide the answer to this question and to improve the coordination of care, the 2016 European Society of Cardiology Guidelines for the management of atrial fibrillation suggests that an integrated care approach should be considered. The approach consists of four interrelated elements: (i) patient involvement, (ii) multidisciplinary teams, (iii) use of technology tools, and (iv) providing access to all care options by delivering comprehensive care.
Expression of interleukin-17 is associated with different immune phases in patients with chronic hepatitis B
Authors: Yang Yan , Dai Jun , Yan Ming , Yue Meng , Wang Xiao hua , Min Xiang , Wang Yan yan , Zhang Wei
Published: October 2018

Serum interleukin-17 is closely related to inflammatory liver injury after hepatitis B virus (HBV) infection. The objective is to study the expression of interleukin-17 (IL-17) in different immune phases in patients with chronic hepatitis B. Whole venous blood was obtained from normal controls (n = 20) and four patient groups (n = 213): immune tolerance phase (IT, n = 57), immune clearance phase (IC, n = 59), non (low)-replicating phase (LR, n = 44), and reactivation phase (RA, n = 53). We measured IL-17, IL-6, and tumor necrosis factor alpha (TNF-α) levels in serum samples and measured IL-17, IL-6, and TNF-α messenger RNA (mRNA) levels in peripheral blood mononuclear cell (PBMC). Compared to normal controls, IL-17, IL-6, and TNF-α protein levels in serum and mRNA levels in PBMC were significantly higher in the four groups. IL-17 protein levels in serum and mRNA levels in PBMC were positively correlated with alanine aminotransferase (ALT), aspartate aminotransferase (AST), IL-6, and TNF-α. Compared to patients in the IT phase and LR phase, patients in the IC phase exhibited the highest serum IL-17 and PBMC mRNA levels. The IL-17 mRNA levels of patients in RA phase were higher than those in patients in IT phase. IL-17 plays an important part in the various immune phases of chronic hepatitis B (CHB).
Extracardiac Fontan With Direct Inferior Vena Cava to Main Pulmonary Artery Connection Without Cardiopulmonary Bypass
Authors: Talwar Sachin , Mathew Arun Basil , Bhoje Amol , Makhija Neeti , Choudhary Shiv Kumar , Airan Balram
Published: October 2018

We report the case of a six-year-old patient who underwent an extracardiac Fontan operation including bilateral bidirectional superior cavopulmonary anastomosis and direct inferior vena cava to main pulmonary artery connection that was performed without cardiopulmonary bypass.
The American Dream in Postsocialist Hungary: Melodrama, Reflexivity, and Transference in Elite Swimming
Authors: Vaczi Mariann
Published: October 2018

Hungarian-born, 3-time Olympic champion Katinka Hosszú and her American coach-husband Shane Tusup revolutionized elite swimming through a training methodology that produced one of the most spectacular comebacks in sport history and turned Hosszú into the financially most successful swimmer. In Hungary, they were considered the “American Dream” due to their Hollywoodish love story, can-do attitude, and professional success. The Hosszú–Tusup collaboration became a site of intercultural encounter that brought into relief the discrepancies between the so-called American mentality of democratic, capitalist professionalism, and the socialist-style paternalism of Hungarian sport. Through their May 2018 split, the public and the media deployed melodramatic conventions of meaning making to narrativize, and thus understand, a diverse set of issues such as marriage, adultery, feminism, gender relations, masculinity, coach–athlete relationships, postsocialist transformations, corruption, state paternalism, capitalism, and professionalism.
Anatomic and Histological Study of the Anterolateral Aspect of the Knee: A SANTI Group Investigation
Authors: Daggett Matt , Stephenson Clark , Dobson John , Whitaker Amy , Redler Andrea , Monaco Edoardo , Wright Barth , Saithna Adnan , Sonnery-Cottet Bertrand
Published: October 2018

Background:

The structure and function of the anterolateral aspect of the knee have been significantly debated, with renewed interest in this topic since the description of the anterolateral ligament (ALL).

Purpose:

To define and describe the distinct structures of the lateral knee and to correlate the macroscopic and histologic anatomic features.

Study Design:

Descriptive laboratory study.

Methods:

Twelve fresh-frozen human cadavers were used for anatomic analysis. In the left knee, a layer-by-layer dissection and macroscopic analysis were performed. In the right knee, an en bloc specimen was obtained encompassing an area from the Gerdy tubercle to the posterior fibular head and extending proximally from the anterior aspect to the posterior aspect of the lateral femoral epicondyle. The en bloc resection was then frozen, sliced at the level of the joint line, and reviewed by a musculoskeletal pathologist.

Results:

Macroscopically, the lateral knee has 4 main layers overlying the capsule of the knee: the aponeurotic layer, the superficial layer including the iliotibial band (ITB), the deep fascial layer, and the ALL. Histologically, 8 of 12 specimens demonstrated 4 consistent, distinct structures: the ITB, the ALL, the lateral collateral ligament, and the meniscus.

Conclusion:

The lateral knee has a complex orientation of layers and fibers. The ALL is a distinct structure from the ITB and is synonymous to the previously described capsulo-osseous layer of the ITB.

Clinical Relevance:

Increasingly, lateral extra-articular procedures are performed at the time of anterior cruciate ligament reconstruction. Understanding the anatomic features of the anterolateral aspect of the knee is necessary to understand the biomechanics and function of the structures present and allows surgeons to attempt to replicate those anatomic characteristics when performing extra-articular reconstruction.
Road network risk analysis considering people flow under ordinary and evacuation situations
Authors: Sasabe Masahiro , Fujii Kodai , Kasahara Shoji
Published: October 2018

Both pre-disaster approaches, e.g., mitigation and preparedness, and post-disaster approaches, e.g., response and recovery, play important roles to mitigate the damage from large-scale disasters. From the viewpoint of disaster response, there have been studies on evacuation guiding schemes and applications using evacuees’ mobile devices, e.g., smart phones. On the other hand, disaster preparedness has also been studied mainly on geographical information analysis, e.g., road blockage probability and people flow data. The road blockage probability is the probability that the corresponding road is blocked due to collapse of roadside buildings when an earthquake occurs. The people flow data express the people flow in usual time. In this paper, with the help of evacuation guiding schemes, road blockage probability, and people flow data, we propose a road network risk analysis approach that considers people flow in both ordinary and evacuation situations, which can be used to as a tool to strengthen the urban fabric for fostering better evacuees’ responses in disaster situations. First, the proposed approach derives ordinary road demand, which is the degree of road usage at a certain interval in an ordinary situation, from the people flow data. Then, it calculates evacuation road demand, i.e., the degree of road usage at a certain interval in an evacuation situation, by extending the edge betweenness centrality under the assumption that people located according to the ordinary road demand move to refuges along their evacuation paths. Finally, it detects roads with high risk of encountering blocked road segments by combining the road blockage probability and evacuation road demand. Through numerical experiments under a case study of Arako area of Nagoya city in Japan, we show the proposed approach can detect such high-risk roads. Furthermore, we show the detected roads spatially change according to the people flow in ordinary situations, evacuation behavior, and disaster occurrence time.
Gfi1aa and Gfi1b set the pace for primitive erythroblast differentiation from hemangioblasts in the zebrafish embryo
Authors: Moore Chris , Richens Joanna L. , Hough Yasmin , Ucanok Deniz , Malla Sunir , Sang Fei , Chen Yan , Elworthy Stone , Wilkinson Robert N. , Gering Martin
Published: October 2018

The transcriptional repressors Gfi1(a) and Gfi1b are epigenetic regulators with unique and overlapping roles in hematopoiesis. In different contexts, Gfi1 and Gfi1b restrict or promote cell proliferation, prevent apoptosis, influence cell fate decisions, and are essential for terminal differentiation. Here, we show in primitive red blood cells (prRBCs) that they can also set the pace for cellular differentiation. In zebrafish, prRBCs express 2 of 3 zebrafish Gfi1/1b paralogs, Gfi1aa and Gfi1b. The recently identified zebrafish gfi1aa gene trap allele qmc551 drives erythroid green fluorescent protein (GFP) instead of Gfi1aa expression, yet homozygous carriers have normal prRBCs. prRBCs display a maturation defect only after splice morpholino-mediated knockdown of Gfi1b in gfi1aaqmc551 homozygous embryos. To study the transcriptome of the Gfi1aa/1b double-depleted cells, we performed an RNA-Seq experiment on GFP-positive prRBCs sorted from 20-hour-old embryos that were heterozygous or homozygous for gfi1aaqmc551, as well as wt or morphant for gfi1b. We subsequently confirmed and extended these data in whole-mount in situ hybridization experiments on newly generated single- and double-mutant embryos. Combined, the data showed that in the absence of Gfi1aa, the synchronously developing prRBCs were delayed in activating late erythroid differentiation, as they struggled to suppress early erythroid and endothelial transcription programs. The latter highlighted the bipotent nature of the progenitors from which prRBCs arise. In the absence of Gfi1aa, Gfi1b promoted erythroid differentiation as stepwise loss of wt gfi1b copies progressively delayed Gfi1aa-depleted prRBCs even further, showing that Gfi1aa and Gfi1b together set the pace for prRBC differentiation from hemangioblasts.
Maternal blood pressure and hypertensive disorders during pregnancy and childhood respiratory morbidity: the Generation R Study
Authors: Wilmink Freke A. , den Dekker Herman T. , de Jongste Johan C. , Reiss Irwin K.M. , Jaddoe Vincent W.V. , Steegers Eric A. , Duijts Liesbeth
Published: October 2018

Pre-eclampsia is associated with an increased risk of bronchopulmonary dysplasia, wheezing and asthma in later childhood. Currently, there are no studies available investigating maternal blood pressure measurements during multiple time-points in pregnancy and respiratory outcome measures in the child.

We examined the associations of maternal blood pressure and hypertensive disorders with the risk of lower lung function, wheezing and asthma in children aged 10 years. This study among 4894 children was embedded in a population-based prospective cohort study. We used multivariate analyses, taking lifestyle and socioeconomic factors into account.

We observed consistent associations per 5 mmHg higher maternal blood pressure in early pregnancy with a lower forced expiratory volume in 1 s/forced vital capacity ratio (z-score −0.03 (95% CI −0.05– −0.01)) and per 5 mmHg higher blood pressure in late pregnancy with a higher risk for current wheezing and current asthma (OR 1.07 (95% CI 1.02–1.12) and 1.06 (95% CI 1.00–1.11), respectively). We found no associations of maternal hypertensive disorders during pregnancy with child lung function, current wheezing or current asthma.

Our results suggest that higher blood pressure in pregnant women is associated with lower lung function and increased risks of current wheezing and current asthma in children. The associations may be trimester specific.
Safety of benzodiazepines and opioids in interstitial lung disease: a national prospective study
Authors: Bajwah Sabrina , Davies Joanna M. , Tanash Hanan , Currow David C. , Oluyase Adejoke O. , Ekström Magnus
Published: October 2018

Safety concerns are a barrier to prescribing benzodiazepines (BDZs) and opioids in interstitial lung disease (ILD). We therefore examined the association of BDZs and opioids on risk of admission to hospital and death.

We conducted a population-based longitudinal cohort study of fibrotic ILD patients starting long-term oxygen therapy in Sweden between October 2005 and December 2014. Effects of BDZs and opioids on rates of admission to hospital and mortality were analysed using Fine–Gray and Cox regression while adjusting for potential confounders.

We included 1603 patients (61% females). BDZs were used by 196 (12%) patients and opioids were used by 254 (15%) patients. There was no association between BDZs and increased admission. Treatment with high-versuslow-dose BDZs was associated with increased mortality (subdistribution hazard ratio (SHR) 1.46, 95% CI 1.08–1.98versus1.13, 95% CI 0.92–1.38). Opioids showed no association with increased admission. Neither low-dose opioids (≤30 mg·day−1oral morphine equivalent) (SHR 1.18, 95% CI 0.96–1.45) nor high-dose opioids (>30 mg·day−1oral morphine equivalent) (SHR 1.11, 95% CI 0.89–1.39) showed association with increased mortality.

This first ever study to examine associations between BDZ and opioid use and harm in ILD supports the use of opioids and low-dose BDZs in severely ill patients with respiratory compromise.
Matching-adjusted indirect comparison of benralizumabversusinterleukin-5 inhibitors for the treatment of severe asthma: a systematic review
Authors: Bourdin Arnaud , Husereau Don , Molinari Nicolas , Golam Sarowar , Siddiqui Mohd Kashif , Lindner Leandro , Xu Xiao
Published: October 2018

Benralizumab is an interleukin-5 receptor α-directed cytolytic monoclonal antibody that directly depletes eosinophils. Its relative efficacyversusother IL-5-targeted treatments for patients with severe, uncontrolled asthma is not yet fully characterised.

We performed a matching-adjusted indirect comparison (MAIC) of benralizumabversusmepolizumab and reslizumab. Trials were selected through systematic review and evaluation of trial methods. Benralizumab patient-level data were weighted to match treatment-effect-modifying patient characteristics of comparator trials before indirect efficacy comparisons.

After matching adjustment, benralizumab and mepolizumab reduced exacerbationsversusplacebo by 52% and 49%, respectively (rate ratio [RR] 0.94, 95% CI 0.78–1.13; n=1524) and reduced the rate of exacerbations requiring hospitalisation/emergency department visit by 52% and 52%, respectively (RR 1.00, 95% CI 0.57–1.75; n=1524). Benralizumab and mepolizumab similarly improved pre-bronchodilator forced expiratory volume in 1 s at 32 weeks (difference 0.03 L, 95% CI −0.06–0.12; n=1443). Benralizumab and reslizumab patient populations were too dissimilar to generate a sufficient effective sample size to produce a reliable estimate for MAIC.

MAIC is a robust way to indirectly compare treatment efficacies from trials with heterogeneous patient populations. When baseline patient characteristics were matched across asthma trials, benralizumab and mepolizumab yielded similar efficacy.
Triple therapyversussingle and dual long-acting bronchodilator therapy in COPD: a systematic review and meta-analysis
Authors: Cazzola Mario , Rogliani Paola , Calzetta Luigino , Matera Maria Gabriella
Published: October 2018

We performed a meta-analysis to compare the impact of triple combination therapy with inhaled corticosteroids (ICS), long-acting β2-agonists (LABAs) and long-acting muscarinic receptor antagonists (LAMAs)versusLABA/LAMA combination therapy or single long-acting bronchodilator therapy in chronic obstructive pulmonary disease. The ICS/LABA/LAMA combination reduced the risk of exacerbation (relative risk 0.70, 95% CI 0.53–0.94) and improved trough forced expiratory volume in 1 s (mean difference in mL +37.94, 95% CI 18.83–53.89)versusLABA/LAMA combination therapy. The protective effect of triple combination therapyversusLABA/LAMA combination therapy against risk of exacerbation was greater in patients with blood eosinophil counts ≥300 cells·µL−1(relative risk 0.57, 95% CI 0.48–0.68). While ∼38 patients had to be treated for 1 year with ICS/LABA/LAMA combination therapy to prevent one exacerbation compared to LABA/LAMA combination therapy, the number needed to treat (NNT) was ∼21 when compared to single long-acting bronchodilator therapy. The person-based NNT per year of ICS/LABA/LAMA combination therapyversusLABA/LAMA combination therapy was significantly (p<0.05) lower in patients with eosinophil counts ≥300 cells·µL−1(NNT value: 8.58) than in those with counts <300 cells·µL−1(NNT value: 46.28). The risk of pneumonia did not differ between ICS/LABA/LAMA combination therapy and its comparators. The number needed to harm was ∼195. This meta-analysis suggests that patients on single long-acting bronchodilator therapy or LABA/LAMA combination therapy, who still have exacerbations and have blood eosinophil counts ≥300 cells·µL−1, could benefit from ICS/LABA/LAMA combination therapy.
Prevalence of different carbapenemase genes among carbapenem-resistant Acinetobacter baumannii blood isolates in Taiwan
Authors: Wang Teng-Ho , Leu Yi-Shing , Wang Nai-Yu , Liu Chang-Pan , Yan Tsong-Rong
Published: October 2018

Background

Although the prevalence of the carbapenem-resistant A. baumannii (CRAB) has increased in Taiwan, few studies have elucidated the prevalence of different carbapenemase genes in Taiwan. The first objective of this study was to identify the types and prevalence of different carbapenemase genes, and the second objective was to determine the carbapenem antimicrobial susceptibility of carbapenemase producing isolates.

Methods

In total, 269 CRAB blood isolates from four medical centres in Taiwan from 1/1/2009 to 31/12/2013 were analysed. Antimicrobial susceptibilities were determined using the Vitek 2 system. Carbapenemase genes were identified by polymerase chain reaction (PCR) and sequencing. Pulsed-field gel electrophoresis (PFGE) was used to identify the different pulsotypes.

Results

All 269 CRAB isolates had the blaOXA-51-like gene, while 237 (88.1%) had the blaOXA-23-like gene, and 11 (4.09%) had the blaOXA-24-like gene. Twenty-one CRAB isolates (7.81%) contained only the blaOXA-51-like gene. None of the isolates had the blaOXA-58-like gene or the metallo-β-lactamases (MBL)-encoding genes. In 28.69% of isolates with the blaOXA-23-like gene and 90.91% of isolates with the blaOXA-24-like gene, the minimum inhibitory concentrations (MICs) for imipenem were 64 mg/L or more. In 37.55% of isolates with the blaOXA-23-like gene and 100% of isolates with the blaOXA-24-like gene, meropenem MICs were 64 mg/L or more. PFGE analyses indicated that six highly similar genomes which harbored the blaOXA-24-like gene came from three different medical centres.

Conclusion

Our study determined the prevalence of CRAB, the types and prevalence of carbapenemase genes, carbapenem susceptibility among CRAB isolates, and documented that the blaOXA-24-like gene had greater resistance to carbapenem than the blaOXA-23-like gene. We also demonstrated inter-hospital transmission of the highly resistant blaOXA-24-like gene.
‘A man who revels in his own ignorance, racism and misogyny’: Identifiable referents trump indefinite grammar
Authors: Jones Katy
Published: October 2018

Typically, a noun phrase beginning with the indefinite article introduces a referent assumed to be unknown to the addressee. But in newspaper opinion journalism, this is not always the case. In ‘instead of hailing its first female president, it [the US] seems poised to hand the awesome power of its highest office toa man who revels in his own ignorance, racism and misogyny’ (The Guardian, 9/11/16), ‘a man who…’canbe understood as a new referent or type. But once seen in context, where the identity of the man is known, it becomes clear that it is signalling something different. This paper examines how this sort of reference works by challenging existing accounts of ‘late’ indefinites and the meaning relation of co-extension.It is shown that lexical cohesive ties between the expression and preceding text and context create a shared space which allows these expressions to function ‘definitely’.
Diagnostic Classification of Cystoscopic Images Using Deep Convolutional Neural Networks
Authors: Eminaga Okyaz , Eminaga Nurettin , Semjonow Axel , Breil Bernhard
Published: October 2018

Purpose

The recognition of cystoscopic findings remains challenging for young colleagues and depends on the examiner’s skills. Computer-aided diagnosis tools using feature extraction and deep learning show promise as instruments to perform diagnostic classification.

Materials and Methods

Our study considered 479 patient cases that represented 44 urologic findings. Image color was linearly normalized and was equalized by applying contrast-limited adaptive histogram equalization. Because these findings can be viewed via cystoscopy from every possible angle and side, we ultimately generated images rotated in 10-degree grades and flipped them vertically or horizontally, which resulted in 18,681 images. After image preprocessing, we developed deep convolutional neural network (CNN) models (ResNet50, VGG-19, VGG-16, InceptionV3, and Xception) and evaluated these models using F1 scores. Furthermore, we proposed two CNN concepts: 90%-previous-layer filter size and harmonic-series filter size. A training set (60%), a validation set (10%), and a test set (30%) were randomly generated from the study data set. All models were trained on the training set, validated on the validation set, and evaluated on the test set.

Results

The Xception-based model achieved the highest F1 score (99.52%), followed by models that were based on ResNet50 (99.48%) and the harmonic-series concept (99.45%). All images with cancer lesions were correctly determined by these models. When the focus was on the images misclassified by the model with the best performance, 7.86% of images that showed bladder stones with indwelling catheter and 1.43% of images that showed bladder diverticulum were falsely classified.

Conclusion

The results of this study show the potential of deep learning for the diagnostic classification of cystoscopic images. Future work will focus on integration of artificial intelligence–aided cystoscopy into clinical routines and possibly expansion to other clinical endoscopy applications.