bluuebunny/crossref_metadata_2025 huggingface dataset:
The Morphology of Somatosensory Evoked Potentials During Middle Cerebral Artery Aneurysm Clipping (MoSAC): A Pilot Study
Authors: Tecchio Franca , Cecconi Federico , Colamartino Elisabetta , Padalino Matteo , Valci Luca , Reinert Michael
Published: September 2019

Somatosensory evoked potential (SEP) monitoring is a standard tool during clipping of aneurysms of the middle cerebral artery (MCA), and the parameter used to detect a state of cortical ischemia is amplitude. We think that the sensitivity of SEP can however be improved by using other parameters. Our study moves in this direction via SEP morphology. In this pilot preliminary study, involving a small sample without postoperative neurological deficit, we aimed at investigating the value of SEP morphology (in the 15- to 35-ms time frame), in comparison with SEP amplitude (N20 peak-to-peak), as a measure of sensitivity to blood flow reduction. The changes in the SEP morphology of 16 patients undergoing clipping of an unruptured MCA aneurysm was studied. We applied the Morph-Fréchet index for each recorded SEP (at 30-second intervals), quantifying the pattern shape change with regard to the average SEP recorded after dura opening (baseline). We also compared 3 measurements of the SEP morphology, without and with GARCH-derived filter. Filtered Morph-Fréchet never exceeded the individual’s “normality” range in baseline but did so in 81% of the risk phase on average across the 16 subjects, which is more than that for amplitude (36%, P = .002). This pilot study indicates that a measurement derived from the networking nature of the brain was sensitive to blood flow reduction. The SEP morphology approach promises to improve SEP monitoring sensitivity during clipping of unruptured MCA aneurysms. New and Noteworthy. The higher sensitivity to blood flow reduction of SEP morphology than amplitude promises to improve the effectiveness of intraoperative monitoring during MCA aneurysm clipping procedures.
Long-term Reoperation Rate for Cubital Tunnel Syndrome: Subcutaneous Transposition Versus In Situ Decompression
Authors: Hutchinson Douglas T. , Sullivan Ryan , Sinclair Micah K.
Published: September 2019

Background: The purpose of this study was to compare the long-term revision rate of in situ ulnar nerve decompression with anterior subcutaneous transposition surgery for idiopathic cubital tunnel syndrome. Methods: This retrospective, multicenter, cohort study compared patients who underwent ulnar nerve surgery with a minimum 5 years of follow-up. The primary outcome studied was the need for revision cubital tunnel surgery. In total, there were 132 cases corresponding to 119 patients. The cohorts were matched for age and comorbidity. Results: The long-term reoperation rate for in situ decompression was 25% compared with 12% for anterior subcutaneous transposition. Seventy-eight percent of revisions of in situ decompression were performed within the first 3 years. Younger age and female sex were identified as independent predictors of need for revision. Conclusions: In the long-term follow-up, in situ decompression is seen to have a statistically significant higher reoperation rate compared with subcutaneous transposition.
A driver model–based direct yaw moment controller for in-wheel motor electric vehicles
Authors: Wang Qiguang , Zhuang Ye , Wei Jiannan , Guo Konghui
Published: September 2019

In this article, a driver model–based direct yaw moment controller, selected as the upper controller, is developed, of which the control target is determined through a reference driver model in accordance with the driver’s intention. The sliding surface is chosen by the difference between the desired yaw rate and the real output yaw rate. Then, the desired yaw moment is calculated by the sliding mode control. In the lower controller, a novel control torque distribution strategy is designed based on the analysis of the tire characteristics. In addition, an admissible control set of the control torques is calculated in real time through an embedded tire model “UniTire.” Finally, a driver-in-the-loop experiment, via the driving simulator, is conducted to verify the proposed direct yaw moment controller.
Model parameter estimation and residual life span prediction of pneumatic diaphragm pump based on hidden Markov model in intelligent spraying
Authors: Yan Liangwen , Chen Jiale , Yu Peng , Yu Yue , Cao Kele , Huang Shan
Published: September 2019

Pneumatic diaphragm pump is an important part in intelligent spraying. When pneumatic diaphragm pump does not work normally, the entire intelligent spraying product line will be malfunctioned. To maintain and manage pneumatic diaphragm pump effectively, the grade analysis of the health status of pneumatic diaphragm pump is generally used according to its working state. Due to the effects of condition monitoring and random faults, some observable health predictions are often inaccurate. There are very few papers dealing with the health monitoring of pneumatic diaphragm pump and their estimation of residual life span. In this article, a method with vector autoregressive model and continuous-time hidden Markov model was proposed to analyze and evaluate the life span of pneumatic diaphragm pump based on the estimation error of the health condition and the cumulative deterioration of pneumatic diaphragm pump. It is modeled through a continuous-time Markov chain with three states, which includes unobservable healthy state 0, unobservable warning state 1, and observable fault state 2. The expectation–maximization algorithm is used to estimate the model parameters of the fitted hidden Markov. Through the posterior probability of pneumatic diaphragm pump in warning state 1, the derived conditional reliability function and mean residual life span formula can be calculated to evaluate the residual life span of pneumatic diaphragm pump. The results showed that the method can effectively predict the residual life span of pneumatic diaphragm pump, illustrate the effectiveness of the model, and improve the accuracy of the health status rating.
Evaluation of irrational dose assignment definitions using the continual reassessment method
Authors: Wages Nolan A. , Bagley Evan
Published: September 2019

Background:

This article studies the notion of irrational dose assignment in Phase I clinical trials. This property was recently defined by Zhou and colleagues as a dose assignment that fails to de-escalate the dose when two out of three, three out of six, or four out of six patients have experienced a dose-limiting toxicity event at the current dose level. The authors claimed that a drawback of the well-known continual reassessment method is that it can result in irrational dose assignments. The aim of this article is to examine this definition of irrationality more closely within the conduct of the continual reassessment method.

Methods:

Over a broad range of assumed dose-limiting toxicity probability scenarios for six study dose levels and a variety of target dose-limiting toxicity rates, we simulated 2000 trials of n = 36 patients. For each scenario, we counted the number of irrational dose assignments that were made by the continual reassessment method, according to the definitions of Zhou and colleagues. For each of the irrational decisions made, we classified the dose assignment as an underdose assignment, a target dose assignment, or an overdose assignment based on the true dose-limiting toxicity probability at that dose.

Results:

Across eight dose-toxicity scenarios, there were a total of 181,581 dose assignments made in the simulation study. Of these assignments, 8165 (4.5%) decisions were made when two out of three, three out of six, or four out of six patients had experienced a dose-limiting toxicity at the current dose. Of these 8165 decisions, 1505 (18.4%) recommended staying at the current dose level and would therefore be classified as irrational by Zhou and colleagues. Among the irrational decisions, 41.2% were misclassified, meaning they were made either at the true target dose (17.9%) or at a true underdose (23.3%). The remaining 58.8% were made at a true overdose and therefore truly irrational. Overall, irrational dose assignments comprised <1% of the total dose assignments made during the simulation study. Similar findings are reported in simulations across 100 randomly generated dose-toxicity scenarios from a recently proposed family of curves.

Conclusion:

Zhou and colleagues argue that the behavior of the continual reassessment method is disturbing due to its ability to make irrational dose assignments. These definitions are based on rules that mimic the popular 3 + 3 design, which should not be the benchmark used to construct guidelines for trial conduct of modern Phase I methods. Our study illustrates that these dose assignments occur very seldom in the continual reassessment method and that even when they do occur, they can often be considered sensible when accounting for all accumulated data in the study.
Learning how to deliver bad and challenging news: Exploring the experience of trainee sonographers – A qualitative study
Authors: Tomlin Liz , Parsons Molly , Kumar Prashanth V , Arezina Jane , Harrison Reema , Johnson Judith
Published: September 2019

Background

Previous studies suggest there is a need to improve the delivery of bad and challenging news in obstetric ultrasound settings. However, no research has explored the experiences of trainee sonographers when learning how to deliver challenging news. Understanding this could identify gaps in current provision and inform future training interventions.

Aims

To explore the experiences of trainee sonographers when learning how to deliver challenging news.

Methods

Semi-structured interviews were conducted with trainee sonographers ( n = 7) from four training centres to explore their experiences and preferences for news delivery training.

Results

Learning how to deliver difficult news was a journey where trainees developed their confidence over time. Most learning occurred in clinical settings, but classroom teaching complemented this. Trainees appreciated the opportunity to observe clinical practice and to hear from patient representatives. However, quality of teaching varied between centres and trainees reported uncertainty regarding the specific language and behaviours they should use. They described building their own personal protocol for news delivery through the course of their training.

Discussion

An ultrasound-specific news delivery protocol which details the words and behaviours sonographers can employ could help reduce uncertainty in trainees. Trainees may also benefit from receiving structured feedback on their news delivery performance.
Na2CO3-promoted thioesterification via N–C bond cleavage of amides to construct thioester derivatives
Authors: Tao Jiasi , Yu Weijie , Luo Jin , Wang Tao , Ge Wanling , Zhang Ziwei , Yang Bingjie , Xiong Fei
Published: September 2019

A mild, efficient, and transition-metal-free catalytic strategy is developed to construct thioesters via selective N–C bond cleavage of Boc2-activated primary amides. This strategy is successfully carried out with stoichiometric Na2CO3 as the base and provides the corresponding products in moderate to excellent yields.
A New Eremophilanolide Sesquiterpene From Ligularia macrophylla and Diversity of the Species
Authors: Lu Chuanqi , Dai Wei , Zhou Wei , Zhang Lin , Wang Qi
Published: September 2019

A new eremophilanolide sesquiterpene, 1α,6β,10β-trihydroxyeremophila-7(11),8-dien-12,8-olide (macrophyllalarin A, 1), and along with 5 known eremophilanolide sesquiterpenes, 6α,10β-dihydroxyeremophila-7(11)-en-12,8-olide (2), 8β-hydroxyeremophila-7(11)-en-12,8α(15,6α)-diolide (3), 6α,15β-epoxy-8β-hydroxyeremophila-7(11)-en-8α,12-olide (4), 6β,10α-dihydroxy-1-oxo-eremophila-7(11),8-dien-8,12-olide (5), and 1β,10-epoxy-6β,8β-dihydroxyeremophila-7(11)-en-8α,12-olide (6), were isolated from the roots and rhizomes of Ligularia macrophylla. The structure of the new compound was identified by comprehensive spectral analysis.
Revisiting Neighborhood Context and Racial Disparities in Drug Arrests Under the Opioid Epidemic
Authors: Donnelly Ellen A. , Wagner Jascha , Anderson Tammy L. , O’Connell Daniel
Published: September 2019

As opioid addiction has risen in recent years, racial disparities in drug arrests may be changing in their size and sources. Neighborhood conditions, like economic disadvantage and racial composition, are powerful determinants of racial differences in arrests. Overdoses and police responses to these incidents may, however, alter the neighborhood context of drug arrests, especially those tied to heroin, synthetic narcotics, and related opium derivatives offenses. This study revisits the environmental correlates of arrest disparities by conducting a neighborhood-level analysis of Black–White differences in drug possession and selling arrests by substance type across the State of Delaware. Spatial model estimates suggest economic disadvantage and racial diversity in neighborhoods substantially increase Black arrest rates. Conversely, White arrest rates grow with more calls for service for overdose incidents, racial homogeneity, and to a lesser extent, economic disadvantage within a community. Disparities in arrest also vary by substance type, as heroin arrests for Whites are most correlated with higher overdose service calls relative to White arrests for marijuana, cocaine, and other substances or Black arrests for any substance. Results underscore the need to reexamine neighborhood conditions and arrest disparities due to emerging shifts in drug use and drug law enforcement.
“Playing Mother”: Channeled Careers and the Construction of Gender in Academia
Authors: Ashencaen Crabtree Sara , Shiel Chris
Published: September 2019

Gender discrimination in the academy globally is widely recognized in terms of faculty ranking and career progression rates. U.K. national data notes the lower research recognition of women scholars as well as gendered pay gaps. This article reports on a qualitative study of women academics across discipline groups at a British post-1992 corporate university. Focus group discussion findings suggest that gendered career pathways are implicated in hindering the career progression of women academics. Participants perceive themselves to be regularly channeled into feminized teaching and administrative roles considered to be less advantageous routes to progression than elite and masculinized research routes. This together with the affective intensity of academic tasks that perform as emotional labour in relation to pastoral care are critically examined as examples of both essential and essentialized roles, where key “mothering” duties and “housekeeping” academic roles are allocated primarily to women academics. However, although regarded as vital, gendered roles and tasks are insufficiently recognized and rewarded by the bureaucratic processes that exploit them for institutional ends.
Choice, Voice, and Coproduction in Intermediate Care: Exploring Geriatric Patients’ and Their Relatives’ Perspectives on Patient Participation
Authors: Kvæl Linda Aimée Hartford , Debesay Jonas , Bye Asta , Langaas Anne , Bergland Astrid
Published: September 2019

Geriatric patients in intermediate care (IC) often do not feel involved in their rehabilitation process. We conducted interviews with 15 patients and 12 relatives to explore their experiences and preferences regarding patient participation in IC and identify types of patient participation and their potential empowering or disempowering effect. The analysis disclosed a lack of patient choice in a predetermined IC pathway. Being deserving of help meant being sick enough and was associated with the compliant patient who fits the system. Some main additional features were the need of a rehabilitation perspective and patient engagement to enable coproduction as well as the important contribution of relatives as advocates and allies. Finally, the results show the patients’ vulnerable voice in the meeting with the experts’ views. The study will add important knowledge on how staff can contribute to the tailoring of good interventions in IC and improve the understanding of underlying structures.
Future Hopes and Fears of Portuguese Emerging Adults in Macroeconomic Hard Times: The Role of Economic Strain and Family Functioning
Authors: Fonseca Gabriela , da Silva José Tomás , Paixão Maria Paula , Crespo Carla , Relvas Ana Paula
Published: September 2019

Thinking about the future is paramount in emerging adulthood. The present study examines the role of economic strain during macroeconomic hard times and family functioning on emerging adults’ domain-specific future hopes and fears and their links with psychological well-being. Participating were 418 Portuguese emerging adults aged 18–30, mean ( M) = 22.4; standard deviation ( SD) = 2.8. Results from path analysis showed that greater economic strain was associated with a higher number of financial resources–related hopes and fears, positive levels of family functioning were associated with a higher number of work/career-related hopes and fears, and a higher number of property-related hopes were associated with a greater psychological well-being. Multigroup analyses indicated that these associations were moderated by living arrangements but not by participants’ sex, age, occupational status, and socioeconomic status. In sum, this study shed light on emerging adults’ lives during times of financial instability in Portugal.
Evaluation of Microleakage of Orthodontic Bands Cemented With CPP-ACP-Modified Glass Ionomer Cement
Authors: Heravi Farzin , Bagheri Hossein , Rangrazi Abdolrasoul
Published: September 2019

Aims and Objectives:

In recent years, researchers have focused on finding methods of eliminating caries and white spot lesions under orthodontic bands without requiring patient cooperation. One of the effective and preventive strategies is the addition of antibacterial and remineralizing agents to the band cement. However, modifying the cement should not lead to microleakage and weakening of its mechanical properties. This in vitro study represents a continuation of our previous work of investigating the retentive strength of orthodontic bands cemented with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)-modified glass ionomer cement (GIC).

Material and Methods:

60 extracted human premolars were randomly divided into two groups (n = 30). In group 1, stainless steel bands were cemented with GIC. In group 2, a novel dental caries-preventive material, CPP-ACP, was incorporated into the GIC for cementing. The microleakage of each group was measured by the fluid filtration method.

Results:

Results showed no statistically significant difference in microleakage of either group (GIC and CPP-ACP-modified GIC).

Conclusion:

We concluded that 1.56% w/w CPP-ACP can be incorporated with GIC for cementing orthodontic bands without promoting microleakage.
Using a National Register as a Sampling Frame from the Perspective of an Early Career Researcher
Authors: Callanan A.
Published: September 2019

Background:

Selection of a sampling frame is a key component of conducting survey-based research. This article discusses the use of a national register, the Dental Register, as a sampling frame from the perspective of an early career researcher.

Methods:

While conducting a survey-based study of a nationally representative sample of general dentists in Ireland, I documented the difficulties I encountered while using a national register. As a research assistant and novice researcher, I recorded the advantages and disadvantages I discovered over the course of the project and its impact on the study.

Conclusion:

While using a national register has advantages such as a readily available sample of the target population, there are also inherent disadvantages depending on the manner in which records are recorded.

Knowledge Transfer Statement:

This article can be used as an informative guide to researchers in selecting a sampling frame, with particular emphasis on the use of a national register in selecting a nationally representative sample of dentists.
Leadership Agility for Organizational Agility
Authors: Joiner Bill
Published: September 2019

Organizational agility has become an imperative for companies around the globe, who want to be competitive and add value in today’s business environment of hyper change and complexity. Yet, executives and academics alike agree that the current level of agility in the vast majority of companies is not nearly what it needs to be. To develop a level of organizational agility suited to turbulent environmental conditions, executives need to place an emphasis on three areas: strategic agility, operational agility (including culture as well as structures and systems), and leadership agility. This article highlights the central role that leadership agility plays in creating agile organizations, and it presents a framework for understanding and developing leadership agility.
From Administrative to Political Evaluation: Estimating Water, Sanitation, and Hygiene Indicators for Parliamentary Constituencies in India
Authors: Chatterjee Pritha , Kim Rockli , Swaminathan Akshay , Kumar Rakesh , Subramanian S.V.
Published: September 2019

With the launch of the Swachh Bharat Mission (SBM), India accelerated access to improved sanitation in a ‘mass movement’ emphasising people’s participation and political leadership. However, SBM continues to be implemented at the administrative unit of districts, disassociated from the political and electoral units of Parliamentary Constituencies (PC). We provide estimates of India’s 543 PCs by their performance on three important Water Sanitation and Hygiene (WASH) indicators: unsafe disposal of child stool, unimproved drinking water supply, and unimproved sanitary facilities. We used multilevel modelling to generate precision-weighted estimates of each indicator at PC-level, based on recently developed methodologies linking cluster GPS data from the National Family Health Survey (NFHS), 2016 to potential PCs. We found very high heterogeneity across PCs ranging from 0.95 per cent–95.85 per cent for unsafe stool disposal, 0.35 per cent–64.17 per cent for unimproved drinking water source, and 0.19 per cent–90.69 per cent for unimproved sanitation facility. Unsafe child stool disposal and unimproved sanitary facility were strongly correlated ( r = 0.85, Pearson and r = 0.83, Spearman). Monitoring of SBM data at the PC level will allow parliamentarians to effectively improve WASH conditions in their constituencies, while accounting for critical between-PC variability that may be obfuscated in an approach focussed on state or district means.
Biomechanical Comparison of the Influences of 2 Proximal Metatarsal Osteotomies on First Ray Articular Contact Characteristics
Authors: Reddy Sudheer C. , Li Jihui , Cuttica Daniel J. , Thiess Mark
Published: September 2019

Background:

An understudied area of proximal first metatarsal osteotomies is the effect on articular contact properties following the surgeries. Potential long-term risks include altered joint mechanics and possible arthritic progression. A biomechanical comparison of articular characteristics of the proximal opening wedge and Ludloff osteotomies was performed in this study. It was hypothesized that the proximal opening wedge osteotomy (POWO) would lead to greater alterations in articular contact properties along the first ray.

Methods:

Seven paired fresh-frozen below-knee cadaveric limbs with hallux valgus were selected. Specimens in each pair were tested in the intact state and then randomized to receive either a Ludloff or POWO. A 4-mm opening wedge osteotomy was used in all cases. Loading of the flexor hallucis longus was to 100 N using an instrumented tensioner. A 28-N load was added at the distal phalanx to simulate the ground reaction force. First metatarsophalangeal (MTP) and tarsometatarsal (TMT) articular properties were recorded simultaneously using 2 pressure sensors. For each state, a pressure map was generated and contact area, peak pressure, and center of pressure were calculated. Wilcoxon signed-rank test was used to assess statistical significance.

Results:

Average peak pressure was noted to be elevated at the MTP (4.6 vs 6.9 mPa, P = .04) and TMT (3.3 mPa vs 5.1 mPa, P = .30) joints when comparing the Ludloff and the POWO, respectively. Contact area was also noted to be lower in the POWO relative to the Ludloff for the MTP (86.6 vs 69.1 mm2, P = .30) but not the TMT joints (89.1 vs 88.5 mm2, P = .97). There was a slight plantar-lateral and dorsomedial shift in pressure at the MTP and TMT articulations, respectively, of the POWO relative to the Ludloff. A trend toward decreased contact force within the TMT joint was noted following opening wedge osteotomy relative to the intact state (103.8 vs 113.9 N, P = .31), while forces were elevated at the MTP joint (104.3 vs 96.0 N, P = .63), although not statistically significant. Smaller increases in TMT and MTP joint forces were noted following the Ludloff when compared to the intact state (95.6 vs 93.3 N at TMT and 109.2 vs 103.2 N at MTP).

Conclusion:

POWO can potentially change articular contact characteristics along the TMT and MTP articulations of the first ray. This could possibly lead to altered loading patterns and possible long-term damage vs other osteotomies.

Clinical Relevance:

While it is unlikely that the changes observed with the sizes of the osteotomy commonly used would lead to long-term significant clinical consequences, further study with larger group sizes would be beneficial.
Team Communication on Tasks Performed in Blood Pressure Clinics in Community Pharmacies
Authors: Hsu Shih-Ying H. , Hwang Monica J. , Mount Jeanine K.
Published: September 2019

Background: To successfully deliver pharmacy services, pharmacists and technicians need to work as a team and have effective communication. Objectives: To measure the amount of communication between community pharmacists and their technicians during monthly blood pressure (BP) clinics. Methods: Cross-sectional survey method was used to assess the amount of communication pharmacists and technicians had on each task. Study participants were pharmacist-technician pairs (teams) from 10 intervention community pharmacies in the Team Education and Adherence Monitoring (TEAM) trial. Each team provided services designed to improve BP among hypertensive African American patients. Thirteen specific tasks were identified as essential in providing monthly BP clinics, and they were being performed by either the pharmacist or technician. At the end of the trial, each pharmacist and technician were asked to report his/her perception of discussion levels that occurred for each task. The level of team communication was summarized for each task (task-specific) and for each team (team-specific). Results: For task-specific communication, 3 teams had communication regarding pharmacist tasks and 5 teams engaged in communication for technician tasks. More communication was reported for newly developed technician tasks in the BP clinic. For team-specific communication, 2 teams reported no communication on any task, and another 2 teams reported having communication on all the tasks. Overall, pharmacy teams showed different levels of communication in this study. Conclusion: The amounts of communication between pharmacists and technicians were found to vary for different tasks and teams. This suggests that the nature of tasks and the unique dynamics existing in each pharmacy team could influence pharmacist-technician communication.
Lightly Embalmed Cadavers in Sonography Education: A Novel Approach to Improving Students’ Perceived Competence in Renal Biopsy Procedures
Authors: Wampler Kathryn , Bartenhagen Lisa , Sayles Harlan , Michael Kimberly
Published: September 2019

Objective:

To determine if a simulation lab using lightly embalmed cadavers would improve diagnostic medical sonography (DMS) students’ perceived competence in ultrasound-guided native renal biopsy examinations.

Methods:

Subjects included DMS students (n = 49) enrolled in academic years 2012 to 2018. Each DMS student performed a native renal biopsy with a nephrology fellow. Skills practiced included machine setup, inferior renal pole localization, biopsy guide preparation, needle visualization, and communication skills. Pre- and postlab surveys assessed DMS students’ perceived competence.

Results:

Prelab, 12% (n = 6) of students felt competent to assist in the procedure. Postlab, 61% (n = 35) of students felt competent, a statistically significant ( P < .001) change. All students viewed the lab as a valuable experience. Hands-on experience (53%), student/physician collaboration (33%), and low-stress environment (13%) were reported themes. Additional resources (50%) and scheduling (22%) were areas for improvement.

Conclusion:

A renal biopsy simulation lab using lightly embalmed cadavers is an effective method to improve DMS students’ perceived competence in this procedure.
Skin colonization by circulating neoplastic clones in cutaneous T-cell lymphoma
Authors: Iyer Aishwarya , Hennessey Dylan , O’Keefe Sandra , Patterson Jordan , Wang Weiwei , Wong Gane Ka-Shu , Gniadecki Robert
Published: September 2019

Iyer and colleagues used deep sequencing of T-cell receptor genes to demonstrate clonal heterogeneity of mycosis fungoides, with repeated seeding of disparate clones from the blood.
MBEC Versus MBIC: the Lack of Differentiation between Biofilm Reducing and Inhibitory Effects as a Current Problem in Biofilm Methodology
Authors: Thieme Lara , Hartung Anita , Tramm Kristina , Klinger-Strobel Mareike , Jandt Klaus D. , Makarewicz Oliwia , Pletz Mathias W.
Published: September 2019

Background

Biofilms are communities of aggregated, matrix-embedded microbial cells showing a high tolerance to an in principle adequate antibiotic therapy, often resulting in treatment failure. A major challenge in the management of biofilm-associated infections is the development of adequate, standardized biofilm susceptibility testing assays that are clinically meaningful, i.e. that their results correlate with treatment outcome. Different biofilm susceptibility endpoint parameters like the minimal biofilm eradication concentration (MBEC) or the minimal biofilm inhibitory concentration (MBIC) have been suggested as a guide for treatment of biofilm-associated infections, however with inconsistent perception and use among biofilm researchers, leading to confusion and contradictions among different anti-biofilm component studies and clinical trials.

Findings

Evaluation of anti-biofilm effects is mostly based on the untreated reference growth control biofilm measured at the same endpoint as the treated biofilm, neglecting the possible change of the untreated reference biofilm from the time point of pre-antimicrobial exposure to the measured endpoint. In this commentary, we point out the importance of individual quantification of mature, established biofilms before antimicrobial treatment for each biofilm model in order to draw conclusions on the measured biofilm effect size, i.e. biofilm reducing (MBEC) or biofilm inhibitory (MBIC) effects.

Conclusion

The assessment of pre-treatment biofilms contributes to a standardized use of biofilm susceptibility endpoint parameters, which is urgently needed to improve the clinical validity of future anti-biofilm assays.
Microbial community structure and the relationship with soil carbon and nitrogen in an original Korean pine forest of Changbai Mountain, China
Authors: Liu Minghui , Sui Xin , Hu Yanbo , Feng Fujuan
Published: September 2019

Background

The broad-leaved Korean pine mixed forest is an important and typical component of a global temperate forest. Soil microbes are the main driver of biogeochemical cycling in this forest ecosystem and have complex interactions with carbon (C) and nitrogen (N) components in the soil.

Results

We investigated the vertical soil microbial community structure in a primary Korean pine-broadleaved mixed forest in Changbai Mountain (from 699 to 1177 m) and analyzed the relationship between the microbial community and both C and N components in the soil. The results showed that the total phospholipid fatty acid (PLFA) of soil microbes and Gram-negative bacteria (G-), Gram-positive bacteria (G+), fungi (F), arbuscular mycorrhizal fungi (AMF), and Actinomycetes varied significantly (p < 0.05) at different sites (elevations). The ratio of fungal PLFAs to bacterial PLFAs (F/B) was higher at site H1, and H2. The relationship between microbial community composition and geographic distance did not show a distance-decay pattern. The coefficients of variation for bacteria were maximum among different sites (elevations). Total soil organic carbon (TOC), total nitrogen (TN), soil water content (W), and the ratio of breast-height basal area of coniferous trees to that of broad-leaved tree species (RBA) were the main contributors to the variation observed in each subgroup of microbial PLFAs. The structure equation model showed that TOC had a significant direct effect on bacterial biomass and an indirect effect upon bacterial and fungal biomass via soil readily oxidized organic carbon (ROC). No significant relationship was observed between soil N fraction and the biomass of fungi and bacteria.

Conclusion

The total PLFAs (tPLFA) and PLFAs of soil microbes, including G-, G+, F, AMF, and Actinomycetes, were significantly affected by elevation. Bacteria were more sensitive to changes in elevation than other microbes. Environmental heterogeneity was the main factor affecting the geographical distribution pattern of microbial community structure. TOC, TN, W and RBA were the main driving factors for the change in soil microbial biomass. C fraction was the main factor affecting the biomass of fungi and bacteria and ROC was one of the main sources of the microbial-derived C pool.
Peripheral arterial disease and systematic detection of circulating tumor cells: rationale and design of the DETECTOR prospective cohort study
Authors: Yannoutsos Alexandra , Fontaine Manon , Galloula Alexandre , Damotte Diane , Chatellier Gilles , Paterlini-Bréchot Patrizia , Meyer Guy , Pastre Jean , Duchatelle Véronique , Marini Valéria , Schwering Karl-Léo , Lazareth Isabelle , Ghaffari Parinaz , Stansal Audrey , Sanson Hélène , Labrousse Cécile , Beaussier Hélène , Nasr Nesrine Ben , Zins Marc , Salmeron Sergio , Messas Emmanuel , Lajonchère Jean-Patrick , Emmerich Joseph , Priollet Pascal , Trédaniel Jean
Published: September 2019

Background

Smoking is a strong risk factor for cancer and atherosclerosis. Cancer mortality, especially from lung cancer, overtakes cardiovascular (CV) death rate in patients with peripheral arterial disease (PAD). Only a few patients with lung cancer after PAD management may benefit from surgical excision. Circulating tumor cells (CTC) associated with low-dose chest CT (LDCT) may improve early cancer detection. This study focuses on a screening strategy that can address not only lung cancer but all tobacco-related cancers in this high-risk population.

Methods

DETECTOR Project is a prospective cohort study in two French University hospitals. Participants are smokers or former smokers (≥30 pack-years, quitted ≤15 years), aged ≥55 to 80 years, with atherosclerotic PAD or abdominal aortic aneurysm. After the first screening round combining LDCT and CTC search on a blood sample, two other screening rounds will be performed at one-year interval. Incidental lung nodule volume, volume doubling time and presence of CTC will be taken into consideration for adapted diagnostic management. In case of negative LDCT and presence of CTC, a contrast enhanced whole-body PET/CT will be performed for extra-pulmonary malignancy screening. Psychological impact of this screening strategy will be evaluated in population study using a qualitative methodology. Assuming 10% prevalence of smoking-associated cancer in the studied population, a total of at least 300 participants will be enrolled.

Discussion

Epidemiological data underline an increase incidence in cancer and related death in the follow-up of patients with PAD, compared with the general population, particularly for tobacco-related cancers. The clinical benefit of a special workup for neoplasms in patients with PAD and a history of cigarette smoking has never been investigated. By considering CTCs detection in this very high-risk selected PAD population for tobacco-induced cancer, we expect to detect earlier pulmonary and extra-pulmonary malignancies, at a potentially curable stage.

Trial registration

The study was registered in the French National Agency for Medicines and Health Products Safety (No N° EUDRACT_ID RCB: 2016-A00657–44) and was approved by the ethics Committee for Persons Protection (IRB number 1072 and n° initial agreement 2016-08-02; ClinicalTrials.gov identifier NCT02849041).
Measuring the palpable pulsatility length as a physical examination test in defining the severity of inflow stenosis for hemodialysis fistulas
Authors: Chen Matt Chiung-Yu , Weng Mei-Jui , Wu Misoso Yi-Wen , Liu Yi-Chun , Chi Wen-Che
Published: September 2019

Background

Pulsatility is an important property of hemodialysis arteriovenous fistulas (AVF) and can be perceived by the fingers as a gradual decrease in strength downstream from the anastomosis along the main trunk of the fistula. The distance from the point at which the pulse becomes imperceptible to the anastomosis is termed the palpable pulsatility length (PPL); we considered this length may play a role in assessing the severity of inflow stenosis for hemodialysis fistulas.

Methods

This study was performed by retrospective analysis of routinely collected data. Physical examinations and fistula measurements were performed in a selected population of 76 hemodialysis patients with mature fistulas during half a year. Fistula measurements included the PPL before and after treatment and the distance between the anastomosis and the arterial cannulation site (aPump length). The aPump index (API) was calculated by dividing the PPL by the aPump length. Angiograms were reviewed to determine the location and severity of stenosis. PPL and API were used to detect the critical inflow stenosis, which indicates severe inflow stenosis of an AVF.

Results

Receiver operating characteristic analysis showed that the area under the curve was 0.895 for API and 0.878 for PPL. A cutoff value of API < 1.29 and PPL < 11.0 cm were selected to detect the critical inflow stenosis. The sensitivity was 96.0% versus 80.0% and specificity was 84.31% versus 84.31% for API and PPL, respectively.

Conclusions

PPL and API are useful tools in defining the severity of pure inflow stenosis for mature AVFs in the hands of trained examiners with high sensitivity and specificity.
A transplantable tumor model allowing investigation of NY-BR-1-specific T cell responses in HLA-DRB1*0401 transgenic mice
Authors: Das Krishna , Eisel David , Vormehr Mathias , Müller-Decker Karin , Hommertgen Adriane , Jäger Dirk , Zörnig Inka , Feuerer Markus , Kopp-Schneider Annette , Osen Wolfram , Eichmüller Stefan B.
Published: September 2019

Background

NY-BR-1 has been described as a breast cancer associated differentiation antigen with intrinsic immunogenicity giving rise to endogenous T and B cell responses. The current study presents the first murine tumor model allowing functional investigation of NY-BR-1-specific immune responses in vivo.

Methods

A NY-BR-1 expressing tumor model was established in DR4tg mice based on heterotopic transplantation of stable transfectant clones derived from the murine H2 compatible breast cancer cell line EO771. Composition and phenotype of tumor infiltrating immune cells were analyzed by qPCR and FACS. MHC I binding affinity of candidate CTL epitopes predicted in silico was determined by FACS using the mutant cell line RMA-S. Frequencies of NY-BR-1 specific CTLs among splenocytes of immunized mice were quantified by FACS with an epitope loaded Db-dextramer. Functional CTL activity was determined by IFNγ catch or IFNγ ELISpot assays and statistical analysis was done applying the Mann Whitney test. Tumor protection experiments were performed by immunization of DR4tg mice with replication deficient recombinant adenovirus followed by s.c. challenge with NY-BR-1 expressing breast cancer cells.

Results

Our results show spontaneous accumulation of CD8+T cells and F4/80+myeloid cells preferentially in NY-BR-1 expressing tumors. Upon NY-BR-1-specific immunization experiments combined with in silico prediction and in vitro binding assays, the first NY-BR-1-specific H2-Db-restricted T cell epitope could be identified. Consequently, flow cytometric analysis with fluorochrome conjugated multimers showed enhanced frequencies of CD8+T cells specific for the newly identified epitope in spleens of immunized mice. Moreover, immunization with Ad.NY-BR-1 resulted in partial protection against outgrowth of NY-BR-1 expressing tumors and promoted intratumoral accumulation of macrophages.

Conclusion

This study introduces the first H2-Db-resctricted CD8+T cell epitope-specific for the human breast cancer associated tumor antigen NY-BR-1. Our novel, partially humanized tumor model enables investigation of the interplay between HLA-DR4-restricted T cell responses and CTLs within their joint attack of NY-BR-1 expressing tumors.
Early prediction of spontaneous Patent Ductus Arteriosus (PDA) closure and PDA-associated outcomes: a prospective cohort investigation
Authors: Slaughter Jonathan L. , Cua Clifford L. , Notestine Jennifer L. , Rivera Brian K. , Marzec Laura , Hade Erinn M. , Maitre Nathalie L. , Klebanoff Mark A. , Ilgenfritz Megan , Le Vi T. , Lewandowski Dennis J. , Backes Carl H.
Published: September 2019

Background

Patent ductus arteriosus (PDA), the most commonly diagnosed cardiovascular condition in preterm infants, is associated with increased mortality and harmful long-term outcomes (chronic lung disease, neurodevelopmental delay). Although pharmacologic and/or interventional treatments to close PDA likely benefit some infants, widespread routine treatment of all preterm infants with PDA may not improve outcomes. Most PDAs close spontaneously by 44-weeks postmenstrual age; treatment is increasingly controversial, varying markedly between institutions and providers. Because treatment detriments may outweigh benefits, especially in infants destined for early, spontaneous PDA closure, the relevant unanswered clinical question is not whether to treat all preterm infants with PDA, but whom to treat (and when). Clinicians cannot currently predict in the first month which infants are at highest risk for persistent PDA, nor which combination of clinical risk factors, echocardiographic measurements, and biomarkers best predict PDA-associated harm.

Methods

Prospective cohort of untreated infants with PDA (n=450) will be used to predict spontaneous ductal closure timing. Clinical measures, serum (brain natriuretic peptide, N-terminal pro-brain natriuretic peptide) and urine (neutrophil gelatinase-associated lipocalin, heart-type fatty acid-binding protein) biomarkers, and echocardiographic variables collected during each of first 4 postnatal weeks will be analyzed to identify those associated with long-term impairment. Myocardial deformation imaging and tissue Doppler imaging, innovative echocardiographic techniques, will facilitate quantitative evaluation of myocardial performance. Aim1 will estimate probability of spontaneous PDA closure and predict timing of ductal closure using echocardiographic, biomarker, and clinical predictors. Aim2 will specify which echocardiographic predictors and biomarkers are associated with mortality and respiratory illness severity at 36-weeks postmenstrual age. Aim3 will identify which echocardiographic predictors and biomarkers are associated with 22 to 26-month neurodevelopmental delay. Models will be validated in a separate cohort of infants (n=225) enrolled subsequent to primary study cohort.

Discussion

The current study will make significant contributions to scientific knowledge and effective PDA management. Study results will reduce unnecessary and harmful overtreatment of infants with a high probability of early spontaneous PDA closure and facilitate development of outcomes-focused trials to examine effectiveness of PDA closure in “high-risk” infants most likely to receive benefit.

Trial registration

ClinicalTrials.govNCT03782610. Registered 20 December 2018.
Surgical configurations of the pectoralis major flap for reconstruction of sternoclavicular defects: a systematic review and new classification of described techniques
Authors: Opoku-Agyeman Jude , Matera David , Simone Jamee
Published: September 2019

Objectives

The pectoralis major flap has been considered the workhorse flap for chest and sternoclavicular defect reconstruction. There have been many configurations of the pectoralis major flap reported in the literature for use in reconstruction sternoclavicular defects either involving bone, soft tissue elements, or both. This study reviews the different configurations of the pectoralis major flap for sternoclavicular defect reconstruction and provides the first ever classification for these techniques. We also provide an algorithm for the selection of these flap variants for sternoclavicular defect reconstruction.

Methods

EMBASE, Cochrane library, Ovid medicine and PubMed databases were searched from its inception to August of 2019. We included all studies describing surgical management of sternoclavicular defects. The studies were reviewed, and the different configurations of the pectoralis major flap used for sternoclavicular defect reconstruction were cataloged. We then proposed a new classification system for these procedures.

Results

The study included 6 articles published in the English language that provided a descriptive procedure for the use of pectoralis major flap in the reconstruction of sternoclavicular defects. The procedures were classified into three broad categories. In Type 1, the whole pectoris muscle is used. In Type 2, the pectoralis muscle is split and either advanced medially (type 2a) or rotated (type 2b) to fill the defect. In type 3, the clavicular portion of the pectoralis is islandized on a pedicle, either the thoracoacromial artery (type 3a) or the deltoid branch of the thoracoacromial artery (type 3b).

Conclusion

There are multiple configurations of the pectoralis flap reported in the English language literature for the reconstruction of sternoclavicular defects. Our classification system, the Opoku Classification will help surgeons select the appropriate configuration of the pectoralis major flap for sternoclavicular joint defect reconstruction based on size of defect, the status of the vascular anatomy, and acceptability of upper extremity disability. It will also help facilitate communication when describing the different configurations of the pectoralis major flap for reconstruction of sternoclavicular joint defects.