bluuebunny/crossref_metadata_2025 huggingface dataset:
Influencing Factors of the Ultimate Tensile Bearing Capacity of the Composite Laminated Square Tube Single-bolt Joint
Authors: Zhu Xiujie , Zheng Jian , Xiong Chao , Yin Junhui , Tang Qiongjie
Published: March 2021

The three-dimensional progressive damage finite element model was established to accurately simulate the failure process and modes of the composite laminated square tube single-bolt joints. The effects of layup angle, layup ratio and bolt diameter on the ultimate bearing capacity of joints were studied using the validated numerical model, and the reinforced flange gasket was designed according to the damage characteristics of the laminated square tube wall. The results showed that the ultimate bearing capacity of the composite laminated square tube bolt connection structure was relevant to the proportion of 0 degree layers, which increased with the increase of the bolt diameter. The ultimate bearing capacity were increased by the flange gasket reinforcement about 15%.
The sparsity of character tables of high rank groups of Lie type
Authors: Larsen Michael , Miller Alexander
Published: March 2021

In the high rank limit, the fraction of non-zero character table entries of finite simple groups of Lie type goes to zero.
Broadening the Scope: A Qualitative Study of Pathologists’ Attitudes Toward Patient-Pathologist Interactions
Authors: Lapedis Cathryn J , Kroll-Wheeler Lauren , DeJonckheere Melissa , Johnston Dustin , Owens Scott R
Published: March 2021

Objectives

This study qualitatively explored and described pathologists’ attitudes toward patient interaction.

Methods

In a survey to pathologists, we asked, “How interested would you be in meeting with patients to discuss their pathology report and show them microscopic images of their tissue?” Then, we asked “Why,” followed by a free-text box. We asked pathologists to assume that their time would be adequately compensated and that patients’ treating clinicians had already told them their diagnosis. Physician age, gender, rank, and type of practice were also collected.

Results

We surveyed 197 pathologists, 86% of whom were either definitely interested or interested in meeting with patients. Interest level did not differ by age, gender, or rank but was higher in academic practices than in community practices. Thematic analysis showed that pathologists believed that meeting with patients could impact (1) patients, through cognitive and emotional pathways; (2) pathologists, through patient contact and job satisfaction; and (3) the field of pathology, through quality of care and a redefined image of the specialty.

Conclusions

Pathologists’ interest level in meeting with patients was high. Potential impacts on patients, pathologists, and the field of pathology were identified.
Comparison of Invasive and Oscillometric Blood Pressure Measurement in Obese and Nonobese Children
Authors: Fundora Michael P , Beshish Asaad G , Rao Nikita , Berry Christopher M , Figueroa Janet , McCracken Courtney , Maher Kevin O
Published: March 2021

BACKGROUND

Obesity and hypertension are public health priorities, with obesity considered to be a potential cause of hypertension. Accurate blood pressure (BP) determination is required and often obtained by automated oscillometric cuff devices. We sought to determine the correlation of oscillometric measurement in children, and if obesity was associated with worse correlation between methods than nonobese children.

METHODS

Retrospective matched case-controlled study of 100 obese (97–99th percentile) and 100 nonobese (25–70th percentile) children after cardiac surgery with simultaneous systolic, diastolic, and mean invasive and oscillometric measurements. Matching was 1:1 for age, sex, race, and Risk Adjustment for Congenital Heart Surgery-1 score. Intraclass correlation coefficients and Bland–Altman plots were used to determine agreement with 0.75 as threshold.

RESULTS

Median age was 13 years (10–15). Agreement was low for systolic (0.65 and 0.61), diastolic (0.68 and 0.61), and mean measurements (0.73 and 0.69) (obese/nonobese). Bland–Altman plots demonstrated oscillometric BP measurements underestimated systolic hypertension (oscillometric readings lower than intra-arterial). Oscillometric measurements underestimated hypotension (systolic oscillometric measurements were higher than intra-arterial). This occurred in obese and nonobese patients. Correlation of oscillometric measurements was similar for nonobese and obese patients.

CONCLUSIONS

In this first ever study of simultaneous BP measurement by oscillometric vs. intra-arterial in obese and nonobese children, correlation is below accepted norms. The correlation of oscillometric cuff measurements is not affected by habitus in children. There is less correlation between oscillometric measurements and intra-arterial measurements during hypertension or hypotension. Healthcare providers should be aware of the limitations of oscillometric measurements.
Plastome genomics in South American maize landraces: chloroplast lineages parallel the geographical structuring of nuclear gene pools
Authors: López Mariana Gabriela , Fass Mónica , Rivas Juan Gabriel , Carbonell-Caballero José , Vera Pablo , Puebla Andrea , Defacio Raquel , Dopazo Joaquín , Paniego Norma , Hopp Horacio Esteban , Lia Verónica Viviana
Published: March 2021

Background and Aims

The number of plastome sequences has increased exponentially during the last decade. However, there is still little knowledge of the levels and distribution of intraspecific variation. The aims of this study were to estimate plastome diversity within Zea mays and analyse the distribution of haplotypes in connection with the landrace groups previously delimited for South American maize based on nuclear markers.

Methods

We obtained the complete plastomes of 30 South American maize landraces and three teosintes by means of next-generation sequencing (NGS) and used them in combination with data from public repositories. After quality filtering, the curated data were employed to search for single-nucleotide polymorphisms, indels and chloroplast simple sequence repeats. Exact permutational contingency tests were performed to assess associations between plastome and nuclear variation. Network and Bayesian phylogenetic analyses were used to infer evolutionary relationships among haplotypes.

Key Results

Our analyses identified a total of 124 polymorphic plastome loci, with the intergenic regions psbE-rps18, petN-rpoB, trnL_UAG-ndhF and rpoC2-atpI exhibiting the highest marker densities. Although restricted in number, these markers allowed the discrimination of 27 haplotypes in a total of 51 Zea mays individuals. Andean and lowland South American landraces differed significantly in haplotype distribution. However, overall differentiation patterns were not informative with respect to subspecies diversification, as evidenced by the scattered distribution of maize and teosinte plastomes in both the network and Bayesian phylogenetic reconstructions.

Conclusions

Knowledge of intraspecific plastome variation provides the framework for a more comprehensive understanding of evolutionary processes at low taxonomic levels and may become increasingly important for future plant barcoding efforts. Whole-plastome sequencing provided useful variability to contribute to maize phylogeographic studies. The structuring of haplotype diversity in the maize landraces examined here clearly reflects the distinction between the Andean and South American lowland gene pools previously inferred based on nuclear markers.
NP-LFA: Non-profiled Leakage Fingerprint Attacks against Improved Rotating S-box Masking Scheme
Authors: Liu Zeyi , Zhang Weijuan , Xiang Ji , Zha Daren , Wang Lei
Published: March 2021

DPA Contest is a world-famous side-channel competition aiming at analyzing and evaluating the implementing security of some latest countermeasures. Improved Rotating S-box Masking Scheme (RSM2.0) is one of the most popular countermeasures designed during DPA Contest V4.2, which arms with both Low Entropy Masking Schemes and shuffling strategy to ensure the software security of AES-128, particularly the non-profiled security. Up to now, conducting high efficient non-profiled attacking scheme with low resource costs is still a challenge. In this paper, we first propose general and non-profiled leakage fingerprint attacks (named NP-LFA) for secret cracking and make use of it to crack RSM2.0 random masks with almost 100% accuracy. Further, we analyze the hidden vulnerabilities embedded in RSM2.0 implementation, and utilize them to bypass the shuffling defense and perform the master key recovery. Official evaluation results show that NP-LFA is capable of compromising RSM2.0 within 14 traces, each of which only costs 60 ms processing time. Such result validates the high efficiency and light-weighted characteristics of our attacking scheme, which has ranked the first in the official website till now. In addition, we discuss and put forward some possible strategies to mitigate our NP-LFA threats.
Comparing Deliveries of Sterile Codling Moth (Lepidoptera: Tortricidae) by Two Types of Unmanned Aerial Systems and from the Ground
Authors: Lo Peter L , Rogers David J , Walker James T S , Abbott Bruce H , Vandervoet Timothy F , Kokeny Anna , Horner Rachael M , Suckling D Maxwell
Published: March 2021

New Zealand apple exports must meet strict phytosanitary measures to eliminate codling moth (Cydia pomonella Linnaeus) (Lepidoptera: Tortricidae) larval infestation. This study was part of a program attempting the localized eradication of codling moth within an isolated cluster of seven orchards (391 ha). A conventional management program of insecticide sprays and pheromone mating disruption was supplemented with weekly releases of sterile moths for 1–6 yr. Our objective was to compare the recapture rate of sterile moths following their release by four methods, and the efficiency of each system. The methods were the following: a fixed-wing unmanned plane flying ~40–45 m high at 70 km/h, an unmanned hexacopter travelling 20 m high at 25 km/h, and manually from the ground via bicycles or motor vehicles. The different release methods were used in different years or weeks. Sterile male moths were recaptured in grids of pheromone traps positioned throughout each orchard. The highest recapture rate followed delivery by hexacopter, then bicycle, vehicle, and plane. There was a 17-fold difference in catches between releases by hexacopter and plane, and sixfold between vehicle and plane in the same season. Bicycle delivery had a 3.5-fold higher recapture rate than the plane in different years. The wind-borne horizontal drift of moths was investigated as a possible explanation for the disparity of recaptures between the two aircraft delivery systems. The methods in ascending order of time per hectare for delivery were the following: plane and vehicle, hexacopter, then bicycle. The advantages and disadvantages of each moth delivery method are discussed.
Operando observation of magnetism in HDD writing heads by spin-polarized scanning electron microscopy
Authors: Kohashi Teruo , Motai Kumi , Matsuyama Hideo , Maruyama Yohji
Published: March 2021

Operando observation using spin-polarized scanning electron microscopy (spin SEM) has been demonstrated by detecting changes in the magnetization in the writing head of a hard disk drive (HDD) during operation. A current-applying system developed for use in the sample stage of a spin SEM enables imaging of the magnetization changes in the writing head of an HDD while the writing head is activated. Focused ion beam (FIB) technology is used to fabricate electric contacts between the head terminals and the sample holder electrodes. Tungsten film is deposited by FIB technology on the insulator around the writing head to prevent electrostatic charge buildup in the insulators during SEM measurement. This system is well suited for studying the characteristics of writing heads in HDDs in an activated state.
Regulator-dependent temporal dynamics of a restriction-modification system's gene expression upon entering new host cells: single-cell and population studies
Authors: Negri Alessandro , Werbowy Olesia , Wons Ewa , Dersch Simon , Hinrichs Rebecca , Graumann Peter L , Mruk Iwona
Published: March 2021

Restriction-modification (R-M) systems represent a first line of defense against invasive DNAs, such as bacteriophage DNAs, and are widespread among bacteria and archaea. By acquiring a Type II R-M system via horizontal gene transfer, the new hosts generally become more resistant to phage infection, through the action of a restriction endonuclease (REase), which cleaves DNA at or near specific sequences. A modification methyltransferase (MTase) serves to protect the host genome against its cognate REase activity. The production of R-M system components upon entering a new host cell must be finely tuned to confer protective methylation before the REase acts, to avoid host genome damage. Some type II R-M systems rely on a third component, the controller (C) protein, which is a transcription factor that regulates the production of REase and/or MTase. Previous studies have suggested C protein effects on the dynamics of expression of an R-M system during its establishment in a new host cell. Here, we directly examine these effects. By fluorescently labelling REase and MTase, we demonstrate that lack of a C protein reduces the delay of REase production, to the point of being simultaneous with, or even preceding, production of the MTase. Single molecule tracking suggests that a REase and a MTase employ different strategies for their target search within host cells, with the MTase spending much more time diffusing in proximity to the nucleoid than does the REase. This difference may partially ameliorate the toxic effects of premature REase expression.
The Effect of Intergovernmental Policy Conflict on Immigrants’ Behavior: Insights from a Survey Experiment in California
Authors: Wong Tom K , Shklyan Karina , Silva Andrea
Published: March 2021

As Congress remains gridlocked on the issue of comprehensive immigration reform, immigration policy debates, particularly with respect to interior immigration enforcement, are increasingly taking place at state and local levels. Scholarship on immigration federalism has focused on federal and local governments, while states are passing laws that tighten or delimit cooperation with Immigration and Customs Enforcement (i.e., “sanctuary policies”). Simultaneously, cities are passing laws contradictory to state policy. We examine how these state and local enforcement ambiguities affect undocumented immigrants’ trust in the efficacy of sanctuary policies. Using California as a case, we embedded an experiment in a survey of undocumented immigrants and find trust in sanctuary policies decreases when cities seek to opt out of statewide sanctuary laws. Further, “opting out” has negative implications for the daily behavior of undocumented immigrants, like the chilling effects resulting from local law enforcement cooperation with federal immigration enforcement.
Dapsone Prevents Allodynia and Hyperalgesia and Decreased Oxidative Stress After Spinal Cord Injury in Rats
Authors: Mata-Bermudez Alfonso , Diaz-Ruiz Araceli , Burelo Masha , García-Martínez Betzabeth Anali , Jardon-Guadarrama Gustavo , Calderón-Estrella Francisco , Rangel-Hernández Andrea , Pérez-González Cuauhtémoc , Camilo Rios
Published: March 2021

Study Design.

Prospective longitudinal experimental study.

Objective.

We evaluate the effect of dapsone on tactile allodynia and mechanical hyperalgesia and to determine its anti-oxidant effect in a spinal cord injury (SC) model in rats.

Summary of Background Data.

Neuropathic pain (NP) as result of traumatic spinal cord injury is a deleterious medical condition with temporal or permanent time-course. Painful stimuli trigger a cascade of events that activate the N-methyl-D-aspartate (NMDA) receptor, inducing an increase in oxidative stress. Since there is no effective treatment for this condition, dapsone (4,4′diaminodiphenylsulfone) is proposed as potential treatment for NP. Its anti-oxidant, neuroprotective, and anti-inflammatory properties have been documented, however, there is no evidence regarding its use for treatment of NP induced by SCI.

Methods.

In this study, we evaluated the anti-allodynic and anti-hyperalgesic effect of dapsone as preventive or acute treatment after NP was already established. Furthermore, participation of oxidative stress was evaluated by measuring lipid peroxidation (LP) and glutathione concentration (GSH) in rats with SCI.

Results.

Acute treatment with dapsone (3.1–25 mg/kg, i.p.) decreased nociceptive behaviors in a dose-dependent manner, decreased LP, and increased GSH in the injured tissue 15 days after the injury was produced. On the other hand, preventive treatment (3 h post-injury, once daily for 3 days) with dapsone (3.1–25 mg/kg, i.p.) yielded similar results.

Conclusion.

The findings suggest that the anti-nociceptive effect of dapsone is regulated through the decrease of oxidative stress and the excitotoxicity is associated with the activation of NMDA receptors.

Level of Evidence: N/A
Comparing the Effects of Early Versus Late Exercise Intervention on Pain and Neurodynamic Mobility Following Unilateral Lumbar Microdiscectomy
Authors: LeBlanc Lorraine , Moldovan Ioana D. , Sabri Elham , Phan Philippe , Agbi Charles , Mohammed Safraz , AlKherayf Fahad
Published: March 2021

Study Design.

A pilot, two-group pretest–posttest randomized controlled, single blinded study.

Objective.

Our study aim was to compare the changes in low back pain level, fear avoidance, neurodynamic mobility, and function after early versus later exercise intervention following a unilateral lumbar microdiscectomy.

Summary of Background Data.

Exercise is commonly recommended to patients following a lumbar microdiscectomy although controversy remains as to the timing and protocols for exercise intervention.

Methods.

Forty patients were randomly allocated to early (Group 1) or later (Group 2) exercise intervention group. The low back pain and fear avoidance were evaluated using Oswestry Low Back Pain Disability Questionnaire, Numeric Pain Rating Scale, and Fear-Avoidance Beliefs Questionnaire. The neurodynamic mobility and function were recorded with Dualer Pro IQ Inclinometer, 50-foot walk test, and Patient-Specific Functional Scale. Two-sided t test for continuous variables and chi-square or Fisher exact test for categorical variables were used to compare the two groups’ demographic data. The Wilcoxon signed-rank and rank-sum tests were used to compare the changes and the differences, respectively, in low back pain, fear avoidance, neurodynamic mobility, and function between baseline (before surgery) and postoperative repeated measurements (at 1–2, 4–6, and 8–10 wks after surgery) within each study group, after exercise intervention.

Results.

Both groups showed a significant decrease in low back pain levels and fear avoidance as well as a significant improvement in neurodynamic mobility and function at 4 and 8 weeks after surgery. However, no significant difference was reported between the two groups.

Conclusion.

Our study results showed that early exercise intervention after lumbar microdiscectomy is safe and may reduce the low back pain, decrease fear avoidance, and improve neurodynamic mobility and function. A randomized controlled trial is needed to evaluate the early exercise intervention's effectiveness after lumbar microdiscectomy, and thus validate our findings.

Level of Evidence: 4
Factors Affecting Pedicle Screw Insertional Torque in Spine Deformity Surgery
Authors: Oda Kotaro , Ohba Tetsuro , Hiroshi Yokomichi , Fujita Koji , Tanaka Nobuki , Koyma Kensuke , Haro Hirotaka
Published: March 2021

Study Design.

Retrospective observational study of consecutive patients.

Objective.

We sought to: (1) clarify the key factors predominantly associated with the insertional torque of pedicle screws; (2) compare the optimal factors for pedicle screw insertion to obtain rigid screw fixation in patients with adult spinal deformity (ASD) and in those with adolescent idiopathic scoliosis (AIS); (3) determine the optimal screw/pedicle ratio (S/P) to obtain rigid pedicle screw fixation.

Summary of Background Data.

Rigid pedicle screw fixation is mandatory to perform corrections for spinal deformities properly and to allow successful fusion after surgery. The fixation depends mainly on screw position accuracy and patient bone quality. Traditionally, spinal surgeons have decided the screw size, trajectory, and tapping size based on their intuition. Insertional torque has been indicated as useful to predict screw fixation strength, and is correlated with screw pullout strength and frequency of postoperative screw loosening.

Methods.

We compared insertion torque at L1–L3 levels of 324 screws in 68 patients with ASD and 58 screws in 32 patients with AIS. We assessed the association between screw/pedicle ratio and insertion torque by constructing a spline curve.

Results.

Pedicle and screw diameter correlated positively with insertion torque in patients with either ASD or AIS. The optimal screw/pedicle ratio to obtain rigid pedicle screw fixation in patients with ASD was close to, but less than one, and, by contrast, was about 1 to 1.25 in patients with AIS.

Conclusion.

We propose the concept of an optimal S/P ratio for obtaining rigid pedicle screw fixation during spinal corrective surgery, which is different for patients with ASD and patients with AIS. The S/P ratio is useful for deciding the appropriate diameter screw for each case in preoperative planning.

Level of Evidence: 4
Using Simulation to Prepare Students for Medical Mission Trips
Authors: Woods Ashleigh , Mumbower Rachael , Mumba Mercy N.
Published: March 2021

Simulation is a valuable tool in nursing education, including during preparation for students going on medical mission trips. Faculty assessed the learning and management of expectations of undergraduate nursing students who participated in a simulation prior to an international medical mission experience. Through student focus groups postsimulation and posttrip, faculty discovered three learning themes and student recommendations for future simulation use
Simulating the Refugee Experience to Cultivate Cultural Competence and Sensitivity
Authors: Harvey Nina R. , Wynn Stephanie T.
Published: March 2021

Although the United States has offered refuge to millions of immigrants, healthcare providers still lack sufficient understanding of social and ethnic issues in this population. Sociocultural barriers inhibit service accessibility and compromise the quality and appropriateness of care for resettled refugees. To address this issue, faculty from a school of nursing pioneered a spiritually and culturally centered simulation experience to enhance prelicensure students' cultural competence and sensitivity in caring for refugees.
Combined nicotine and ethanol age-dependently alter neural and behavioral responses in male rats
Authors: Cross Sarah J. , Leslie Frances M.
Published: March 2021

Use of alcohol (EtOH) and nicotine (Nic) typically begins during adolescence. Smoking and drinking often occur together and lead to a higher consumption of alcohol. Although we have shown that Nic+EtOH is reinforcing in self-administration tests in adolescent male rats, whether Nic+EtOH affects other behaviors or neuronal activity in an age-dependent manner is unknown. To address this, adolescent and adult male rats were given intravenous injections of Nic (30 µg/kg)+EtOH (4 mg/kg) and evaluated for locomotor and anxiety-like behaviors. Regional neuronal activity, assessed by cFos mRNA expression, was measured and used to evaluate functional connectivity in limbic regions associated with anxiety and motivation. Nic+EtOH increased locomotor activity and was anxiolytic in adolescents, but not adults. The posterior ventral tegmental area (pVTA), a critical regulator of drug reward, was selectively activated by Nic+EtOH in adults, while activity in its target region, the NAc-shell, was decreased. Drug-induced alterations in functional connectivity were more extensive in adults than adolescents and may act to inhibit behavioral responses to Nic+EtOH that are seen in adolescence. Overall, our findings suggest that brief, low-dose exposure to Nic+EtOH produces marked, age-dependent changes in brain and behavior and that there may be an ongoing maturation of the pVTA during adolescence that allows increased sensitivity to Nic+EtOH’s reinforcing, hyperlocomotor, and anxiolytic effects. Furthermore, this work provides a potential mechanism for high rates of co-use of nicotine and alcohol by teenagers: this drug combination is anxiolytic and recruits functional networks that are unique from protective, inhibitory networks recruited in the mature and adult brain.
Obsessive-Compulsive Personality Disorder Co-occurring in Individuals with Obsessive-Compulsive Disorder: A Systematic Review and Meta-analysis
Authors: Pozza Andrea , Starcevic Vladan , Ferretti Fabio , Pedani Carolina , Crispino Roberta , Governi Guido , Luchi Simonetta , Gallorini Antonella , Lochner Christine , Coluccia Anna
Published: March 2021

Learning objectives

After participating in this activity, learners should be better able to:

• Assess the rates of co-occurring obsessive-compulsive personality disorder (OCPD) in patients with obsessive-compulsive disorder (OCD)

• Identify characteristics related to OCD with co-occurring OCPD

The current literature discloses discrepant findings regarding the rates of co-occurring obsessive-compulsive personality disorder (OCPD) in patients with obsessive-compulsive disorder (OCD). In addition, it is not clear which characteristics are related specifically to OCD with co-occurring OCPD. We conducted the first systematic review and meta-analysis of the studies of the prevalence of OCPD in patients with OCD. We also investigated potential moderators of the prevalence, including OCD severity, age of onset of OCD, sex, current age, methodological quality, and publication date of the studies. Electronic databases and gray literature were searched by two independent reviewers. A PRISMA systematic review with a random-effect meta-analysis was conducted. Thirty-four studies were included. A significant mean effect size of 0.25 without publication bias indicated that OCPD was present in 25% of patients with OCD, suggesting that the two conditions are distinct clinical entities. This prevalence was higher than the rates found in the literature for any other personality disorders among OCD patients. OCPD that occurs in the context of OCD was more likely to be present in males and to be characterized by a later age of onset of OCD, older age at assessment, and less severe OCD symptoms. Clinicians should consider these findings when assessing and planning treatment of OCD with co-occurring OCPD.
Validation of the PHILIPS DL8760 upper arm blood pressure monitor, in oscillometry mode, for self-measurement in a general population, according to the European Society of Hypertension International Protocol revision 2010
Authors: Chahine Mirna N. , Bou Harb Souad , Saad Abdel Rahman , Sarkis Patrick , Azaki Alaa , Harb Aya , Allouch Ali , Asmar Roland
Published: March 2021

Objective

The aim of this study was to determine the accuracy of the PHILIPS DL8760, an oscillometric blood pressure (BP) measuring device designed for self-measurement in the general population according to the European Society of Hypertension International Protocol (ESH-IP) revision 2010.

Participants and Methods

The PHILIPS DL8760 measures BP at the brachial level. The validation was performed in 33 subjects. The mean age of the participants was 55.8 ± 14 years. SBP 146.1 ± 26 mmHg (range: 103–193), DBP was 86.8 ± 17.0 mmHg (range: 47–123), and arm circumference was 28.3 ± 4.0 cm (range: 22–39).

Results

The PHILIPS DL8760 fulfilled the criteria of the ESH-IP by passing phases one and two for both SBP measurements and DBP measurements. The device overestimated SBP by 1.5 ± 5.0 mmHg and underestimated DBP by 0.7 ± 3.9 mmHg.

Conclusion

The PHILIPS DL8760 BP device, with its specially designed cuff covering a broad range of arm circumferences, fulfilled the requirements of the International Protocol Revision 2010.
Ulcerative enteritis. How the extension of ulcerative colitis to small bowel may jeopardize postcolectomy course: a case report and literature review
Authors: Gonella Federica , Massucco Paolo , Daperno Marco , Mineccia Michela , Perotti Serena , Rocca Rodolfo , Ferrero Alessandro
Published: March 2021

Intestinal involvement in ulcerative colitis is generally limited to the colon and rectum. We describe a life-threatening case of ulcerative enteritis occurring after colectomy. Other 53 similar cases are reported in the literature. The aim of this narrative review was to focus on ulcerative enteritis characteristics and diagnostic workup. A 25-year-old boy affected by ulcerative colitis underwent a total colectomy in an urgent setting for septic shock. Postoperative course was characterized by elevated ileostomy output, raised up to 10 L/day. Critical clinical conditions required resuscitation therapy. After exclusion of surgical complications, intestinal infections, and histologic specimen revision, the patient underwent endoscopic examination. Ileal biopsies revealed ileal localization of ulcerative colitis. Steroid treatment was finally effective. After literature revision, we classified all cases of ulcerative enteritis in three groups, according to intestinal involvement pattern and timing of clinical manifestation after operation. Out of 54 cases, 18 occurred within 1 month since colectomy (early ileitis), 10 later on (late ileitis) and 26 do not involve ileus (nonileitis). Clinical manifestation is generally severe in the first group and mild and chronic in the others. Differential diagnoses of ulcerative enteritis are represented by infectious, immunological, toxic, and ischemic disorders. Those conditions excluded, ulcerative enteritis can be easily detected by endoscopic biopsies and treated with immunosuppressive agents. Long term surveillance seems important since recurrences are described. In conclusion, clinicians should suspect ulcerative enteritis in all patients with previous colectomy history that develop unexplained gastrointestinal syndromes, in order to avoid therapeutic delay.
Natural History of Chronic Hepatitis B Infection Among Chinese Children and Young Adults
Authors: Mo Shirley , Au Loretta , Huang Sherry , Malik Preeti , Pan Debra H.
Published: March 2021

Objectives:

There are limited data on the natural history of chronic hepatitis B virus (HBV) infection in Asian American children. The aim of the present study was to describe a single‐center experience of chronic HBV infection in Chinese American patients in New York City.

Methods:

A retrospective chart review was conducted for patients with chronic HBV infection who had pediatric visits from 2006 to 2017. Clinical and laboratory data were collected to characterize the status of HBV infection and its disease course both cross‐sectionally and longitudinally. Available maternal charts were reviewed.

Results:

Of the total 353 patients, 72 patients (20%) were US‐born. Positive hepatitis B envelope antigen (HBeAg) was documented in 208 patients (58%). Three phases of chronic HBV infection were categorized for 329 patients: immune‐tolerant 112 (34%), HBeAg‐positive immune‐active 47 (14%), and inactive carrier 82 (25%). The remaining 88 patients (27%) did not fit into a particular category with 26 of 88 patients meeting the criteria for inactive carrier except for mildly elevated alanine aminotransferase. Age and liver enzyme levels were significantly different between HBeAg‐positive and HBeAg‐negative groups (P < 0.05). Among 179 patients followed for ≥5 years, the spontaneous seroconversion rate was 38%. In eight patients with linked maternal data, all children completed the HBV vaccine series and seven of eight received hepatitis B immunoglobulin. All mothers were HBeAg‐positive with high HBV DNA and had no anti‐viral therapy during pregnancy.

Conclusions:

Both immune‐tolerant and inactive carrier phases were common for chronic HBV infection with a spontaneous seroconversion rate of 38%. All US‐born patients were born in the era of implemented universal immune‐prophylaxis.
Indeterminate Pulmonary Nodules in Osteosarcoma Are Associated With Increased Risk of Pulmonary Metastasis
Authors: Seher Komal , Saeed Haleema , Kareem Tooba , Baqari Ali S. , Niazi Imran , Wali Rabia M.
Published: March 2021

Osteosarcoma is the most common primary malignant bone tumor in children. In addition to pulmonary metastasis, computed tomography frequently detects indeterminate pulmonary nodules (IPN). We conducted this study to determine the clinical significance of IPN in terms of progression to pulmonary metastasis and its impact on survival. It was a retrospective cohort study of pediatric nonmetastatic osteosarcoma patients treated from January 2005 to December 2018. Baseline computed tomography scans were reviewed for the presence of IPN (defined as a single nodule of <10 mm or ≥3 nodules of <5 mm). Subsequent scans were reviewed for the development of pulmonary metastasis. Of 155 patients, 31.6% (n=49) had IPN at baseline. A total of 43% (n=21) of those with IPN subsequently progressed to pulmonary metastasis compared with only 26% (n=28) of those without IPN (P<0.001) with a relative risk of 1.6 (1.03 to 2.5) in the IPN group. Patients with ≥3 IPN at baseline were at significantly greater risk of pulmonary metastasis as compared with <3 IPN (P=0.013). Overall and event-free survival in patients with and without IPN was 58% and 35%, and 72% and 46%, respectively. Our results suggest that patients with IPN may be at greater risk for progressing to pulmonary metastasis.
Successful Treatment of Gaucher Disease With Matched Sibling Hematopoietic Stem Cell Transplantation: A Case Report and Literature Review
Authors: Chavananon Shevachut , Sripornsawan Pornpun , Songthawee Natsaruth , Chotsampancharoen Thirachit
Published: March 2021

Background:

Gaucher disease (GD) is the most common lysosomal storage disease and requires long-term enzyme replacement therapy (ERT), which is costly and inconvenient for resource-limited countries such as Thailand. The authors present the case of a 1-year-old boy who was diagnosed with GD type 1 with a homozygous mutation at c.1448 T>C (L444P). He was treated with ERT and matched sibling hematopoietic stem cell transplantation (HSCT) was performed 6 months after the ERT was initiated. At a 3-year follow-up after the HSCT, he had full engraftment and the Lyso-GL1 levels were also at an acceptable level, which indicated disease remission. In conclusion, the authors suggest HSCT for long-term remission of GD in children.
Oligometastatic Bone Disease in Castration-Sensitive Prostate Cancer Patients Treated With Stereotactic Body Radiotherapy Using 68Ga-PSMA PET/CT
Authors: Onal Cem , Ozyigit Gokhan , Akgun Zuleyha , Atalar Banu , Igdem Sefik , Oymak Ezgi , Agaoglu Fulya , Selek Ugur , Guler Ozan Cem , Hurmuz Pervin , Mustafayev Teuto Zoto , Akyol Fadil
Published: March 2021

Purpose

To evaluate the outcomes of metastasis-directed treatment (MDT) using stereotactic body radiotherapy (SBRT) for bone-only oligometastasis (OM) detected with gallium prostate-specific membrane antigen (68Ga-PSMA) PET/CT in castration-sensitive prostate cancer (PC) patients.

Methods

In this multi-institutional study, clinical data of 74 PC patients with 153 bone lesions who were undergoing MDT were retrospectively evaluated. Twenty-seven patients (36.5%) had synchronous, and 47 (63.5%) had metachronous OM. All patients had PC with 5 metastases or fewer detected by 68Ga-PSMA PET/CT and treated using SBRT with a median dose of 20 Gy. The prognostic factors for PC-specific survival (PCSS) and progression-free survival (PFS) were analyzed.

Results

The median follow-up was 27.3 months. Patients with synchronous OM were older and received higher rates of androgen deprivation therapy after SBRT compared with patients with metachronous OM. The 2-year PCSS and PFS rates were 92.0% and 72.0%, respectively. A prostate-specific antigen (PSA) decline was observed in 56 patients (75.7%), and 48 (64.9%) had a PSA response defined as at least 25% decrease of PSA after MDT. The 2-year local control rate per lesion was 95.4%. In multivariate analysis, single OM and PSA response after MDT were significant predictors for better PCSS and PFS. In-field recurrence was observed in 4 patients (6.5%) with 10 lesions at a median of 13.1 months after MDT completion. No serious late toxicity was observed.

Conclusions

We demonstrated that SBRT is an efficient and well-tolerated treatment option for PC patients with 5 bone-only oligometastases or fewer detected with 68Ga-PSMA PET/CT.
18F-Fluorothymidine PET for Functional Response Assessment Following Radiation Therapy for Extramedullary Hematopoiesis
Authors: Campbell Belinda A. , Callahan Jason , Cole-Sinclair Merrole , MacManus Michael , Hofman Michael S.
Published: March 2021

As a marker of cellular proliferation, 18F-fluorothymidine (FLT) PET can detect the distribution of proliferating hematopoiesis and has an emerging role in the investigation of hematopoietic disorders. These images demonstrate the novel utility of 18F-FLT PET for imaging sites of extramedullary hematopoiesis (EMH) in a patient with Chuvash-type polycythemia and suggest a role for 18F-FLT PET in response assessment following radiotherapy. Further, the discordant response observed in the irradiated marrow and sites of EMH is a unique discovery, possibly suggesting the influence of the microenvironment favoring more rapid recovery of proliferative function within EMH sites.
Detection of Cauda Equine Syndrome With 18F-FDG PET/CT and Leptomeningeal Metastasis by 68Ga-DOTATATE in the Same Patient With Large Cell Neuroendocrine Carcinoma of Lung
Authors: Arslan Esra , Erol Özge , Beyhan Ediz , Şahin Rahime , Çermik Tevfik Fikret
Published: March 2021

Leptomeningeal metastasis is the metastatic spread of the disease to leptomeninges from solid tumors such as breast, lung cancer, and melanoma. Cauda equine syndrome is a neurological condition caused by compression of the cauda equine. The incidence of large cell neuroendocrine carcinoma in resected lung cancers appears to be 2.1% and 3.5%. The incidence of clinically diagnosed leptomeningeal metastasis in patients with solid tumors is approximately 5%. Here, we present cauda equine syndrome caused by the metastasis of large cell neuroendocrine carcinoma detected by 18F-FDG PET/CT and also 68Ga-DOTATATE PET/CT.
FDG PET/CT to Detect Incidental Findings in Patients With Hepatocellular Carcinoma—Additional Benefit for Patients Considered for Liver Transplantation?
Authors: Winkens Thomas , Rudakoff William , Rauchfuss Falk , Malessa Christina , Settmacher Utz , Freesmeyer Martin
Published: March 2021

Purpose

FDG PET/CT has been described for noninvasive grading, detection of extrahepatic spread, and recurrence in hepatocellular carcinoma (HCC). As compared with localized imaging approaches (MRI, ultrasonography), FDG PET/CT not only focuses on the liver, but covers a long field of view from the base of the skull to the thighs, visualizing pathologic findings not related to HCC. The aims of this retrospective study were to (1) describe the frequency of relevant incidental findings on FDG PET/CT in HCC patients, (2) evaluate the impact on treatment strategy in HCC patients considered for liver transplantation, and (3) to discuss the role of FDG PET/CT in patients considered for transplantation in general.

Methods

Four hundred thirty-nine FDG PET/CT examinations of 345 HCC patients were screened for incidental findings. The clinical information system was searched for examinations performed after FDG PET/CT and aimed at verification of incidental findings. Of 345 HCC patients, 81 patients were considered for liver transplantation. The impact of incidental findings was recorded separately for this subgroup.

Results

One hundred one patients with incidental findings in 439 FDG PET/CT examinations were identified. The incidental findings comprised 22 neoplasms (9 malignant) and 52 inflammations. Liver transplantation was not performed because of an incidental finding on FDG PET/CT in 9 (11.1%) of 81 patients.

Conclusions

FDG PET/CT is capable of identifying relevant incidental findings (ie, secondary malignancy, benign tumors, and inflammation) in HCC patients and HCC patients considered for liver transplantation and thus influencing HCC patient management. FDG PET/CT might also be beneficial in patients considered for transplantation of different organs.
Superb Microvascular Imaging in Assessment of Synovitis and Tenosynovitis in Juvenile Idiopathic Arthritis
Authors: Kandemirli Sedat Giray , Cicek Fatih , Erdemli Gursel Basak , Bilgin Cem , Kilic Sara Sebnem , Yazici Zeynep
Published: March 2021

The aim of this study is to evaluate the diagnostic utility of superb microvascular imaging (SMI) in assessment of synovitis/tenosynovitis in juvenile idiopathic arthritis in comparison to power Doppler ultrasound. Thirty juvenile idiopathic arthritis cases with active clinical findings and ultrasound features of effusion and/or tenosynovitis were further imaged with power Doppler and SMI. For classification of synovial inflammation, a semiquantitative scale (4 points) adopted by Outcome Measures in Rheumatology was used.

A total of 35 knee, 2 hip, 2 ankle, 2 wrist, 2 elbow joints, and 6 flexor hallucis longus/tibialis posterior tenosynovitis were assessed. In knee joint, power Doppler and SMI scales were the same for 23 (65.7%) joints, SMI upgraded scale from 0 to 2 in single joint (2.9%); 1 to 2 (14.3%) in 5 joints; and 2 to 3 (17.1%) in 6 joints. For other joints, power Doppler and SMI scales were the same for 5 (62.5%) joints. Superb microvascular imaging upgraded scale from 1 to 2 (25%) in 2 joints and 1 to 3 (12.5%) in a single joint. For flexor hallucis longus/tibialis posterior tenosynovitis, power Doppler and SMI scales were the same for two cases (33.3%). Superb microvascular imaging upgraded scale from 0 to 2 in two cases (33.3%); and 2 to 3 (33.3%) in 2 cases. There was no case of SMI scale downgraded compared with power Doppler scale.

Superb microvascular imaging is a feasible technique in the assessment of synovial inflammation and tenosynovitis in juvenile idiopathic arthritis. Superb microvascular imaging has higher sensitivity compared with power Doppler ultrasound in depiction of increased vascularity.
Imaging Findings of Mammary Myofibroblastoma
Authors: Sun Xiaoyuan , Sui Xulei , Liu Ying , Zhang Hongxia , Wang Yunqin , Tang Xiaofeng , Liang Peng
Published: March 2021

Mammary myofibroblastoma (MFB) is a rare benign stromal neoplasm; its imaging features are rarely reported and nonspecific. We retrospectively analyzed a case of pathologically proved breast MFB that revealed indistinct high-density mass in mammography and hypoechoic ill-defined breast tumor in ultrasonography. Meanwhile, hypointense appearance on T2-weighted imaging of magnetic resonance imaging and containing fat tissue might be very valuable characteristics in the differential diagnosis of breast MFB.
Predicting Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer After the Second Cycle of Chemotherapy Using Shear-Wave Elastography—A Preliminary Evaluation
Authors: Singh Tulika , Kumar Niraj , Sandhu Manavjit , Singla Veenu , Singh Gurpreet , Bal Amanjit
Published: March 2021

The primary objective of the study was to determine whether shear wave elastography can be used to predict the response of neoadjuvant chemotherapy (NACT) in women having invasive breast cancer. A prospective study involving 28 patients having invasive breast cancer and undergoing NACT followed by surgery was done after institutional review board approval. All the patients underwent 2-dimensional B-mode ultrasound and 2-dimensional shear wave elastography before the start of chemotherapy and after 2 cycles of completion of chemotherapy, and mean stiffness was recorded. The patients were segregated to responders and nonresponders based on residual cancer burden scoring. Difference in mean elasticity was compared between the 2 groups. The results showed that the mean stiffness after 2 cycles was significantly different between the responders and nonresponders and so was the change in the mean stiffness after 2 cycles of NACT. Using a cutoff value of 45.5 kPa (20.53%), change in mean elasticity after 2 cycles of NACT, sensitivity of 76.9%, and specificity of 80% with negative predictive value of 80.1 was attained. Responders show greater change in mean stiffness after 2 cycles of NACT as compared with nonresponders on shear wave elastography; thus, it can be used to predict response to NACT after 2 cycles.
A Systematic Review of Intra-abdominal Tissue Expansion for the Treatment of Exomphalos Major and a Case Report Describing a Refinement of the Technique
Authors: Alexander William , Nightingale Michael , Penington Anthony , Coombs Christopher
Published: March 2021

The management of complex exomphalos major is difficult, and traditional techniques fail to address the visceroabdominal disproportion in the most severe cases. Intra-abdominal tissue expansion is a novel technique and has been used in a small number of patients to safely increase the intra-abdominal volume and allow the reduction of viscera and subsequent closure of the abdominal domain. We review 7 published reports of this technique and add a case report describing our refinement of the technique. We propose that the use of multiple expanders placed in the intra-abdominal preperitoneal space, when expanded slowly, can allow safe reduction of viscera and immediate direct closure of the musculofascial layer of the abdomen.
Social Media and Instant Messaging
Authors: Bilal Biader Samih , Chen Philip Kuo-Ting
Published: March 2021

Background

Social media and instant messaging can improve patient education, follow-up, and outcome. The utilization of these modalities in cleft lip/palate care is not fully described. We formed an online platform consisting of a dedicated website, Facebook group and LINE group through which we provide information and counseling to our patient population. Our objective is to evaluate the impact and patient satisfaction of our online platform.

Methods

In this retrospective study, we designed a questionnaire aimed at evaluating the quality of information and patient satisfaction of the online platform. The questionnaire was distributed online to 732 cases connected to us through the LINE application.

Results

The response rate was 26%. Website information was found very necessary and sufficient by 75% and 46% of the cases, respectively. Regarding Facebook, the medical team's response was found very professional and practical by 81% and 68% of the cases, respectively. Patient-patient interaction was helpful to 96% of the cases. Regarding the LINE application, the medical team's response was found very immediate and helpful in 73% of the cases, and 91% felt that LINE saved them time from returning to the clinic on unscheduled occasions. The website, Facebook and LINE were used over 10 times per month by 17%, 32%, and 50% of the cases, respectively. A decrease in unscheduled “pop-up” visits to the clinic (from 25 to 6 per month) was registered.

Conclusions

Adapting social media and instant messaging into our cleft lip/palate care has been welcomed with high satisfaction among our patient population, increasing their knowledge, saving them time from returning to the clinic, and allowing them beneficial interaction with other families coping with similar conditions.