bluuebunny/crossref_metadata_2025 huggingface dataset:
Modeling of MHD hybrid nanofluid flow through permeable enclosure
Authors: Shafee Ahmad , Allahyari Majid , Ramzan M. , Zaib Aurang , Babazadeh Houman
Published: June 2020

Imposing the magnetic field and dispersion of nanopowders have been discussed in this paper to provide the opportunity for control the fluid movement. The second law components were analyzed and Bejan number was calculated. Outcomes illustrated that augmenting permeability allows improving the nanopowder movement and thinner boundary layer provides denser isotherm which results in greater Nu and lower Be. Growth of Ra characteristics leads to stronger buoyancy forces which boost the convection transportation and stronger circulation results in greater Nu. In addition, the share of [Formula: see text] reduces with reduction of boundary layer thickness, so, Be has reverse relation with both permeability and Ra. An increment of Ha results in thicker boundary layer and isotherms become parallel and the convection weakens. So, Nu declines with growth of Ha and an opposite trend was calculated for Be. Reduction impact of Da on Be is negligible when Ra has the lowest value.
Proper relativistic position operators in 1+1 and 2+1 dimensions
Authors: Choi Taeseung
Published: June 2020

We have revisited the Dirac theory in [Formula: see text] and [Formula: see text] dimensions by using the covariant representation of the parity-extended Poincaré group in their native dimensions. The parity operator plays a crucial role in deriving wave equations in both theories. We studied two position operators, a canonical one and a covariant one that becomes the particle position operator projected onto the particle subspace. In [Formula: see text] dimensions the particle position operator, not the canonical position operator, provides the conserved Lorentz generator. The mass moment defined by the canonical position operator needs an additional unphysical spin-like operator to become the conserved Lorentz generator in [Formula: see text] dimensions. In [Formula: see text] dimensions, the sum of the orbital angular momentum given by the canonical position operator and the spin angular momentum becomes a constant of motion. However, orbital and spin angular momentum do not conserve separately. On the other hand the orbital angular momentum given by the particle position operator and its corresponding spin angular momentum become a constant of motion separately.
Logical Encoding of Argumentation Frameworks with Higher-order Attacks and Evidential Supports
Authors: Cayrol Claudette , Lagasquie-Schiex Marie-Christine
Published: June 2020

We propose a logical encoding of argumentation frameworks with higher-order interactions (i.e. attacks/supports whose targets are arguments or other attacks/supports) with an evidential meaning for supports. Our purpose is to separate the logical expression of the meaning of an attack or an evidential support (simple or higher-order) from the logical expression of acceptability semantics. We consider semantics which specify the conditions under which the arguments (resp. the attacks/supports) are considered as accepted, directly on the extended framework, without translating the original framework into a Dung’s argumentation framework. We characterize the output of a given framework in logical terms (namely as particular models of a logical theory). Our proposal applies to the particular case of Dung’s frameworks, enabling to recover standard extensions.
Evaluating the Effects of Modern Storage Devices on the Efficiency of Parallel Machine Learning Algorithms
Authors: Akritidis Leonidas , Fevgas Athanasios , Tsompanopoulou Panagiota , Bozanis Panayiotis
Published: June 2020

Big Data analytics is presently one of the most emerging areas of research for both organizations and enterprises. The requirement for deployment of efficient machine learning algorithms over huge amounts of data led to the development of parallelization frameworks and of specialized libraries (like Mahout and MLlib) which implement the most important among these algorithms. Moreover, the recent advances in storage technology resulted in the introduction of high-performing devices, broadly known as Solid State Drives (SSDs). Compared to the traditional Hard Drives (HDDs), SSDs offer considerably higher performance and lower power consumption. Motivated by these appealing features and the growing necessity for efficient large-scale data processing, we compared the performance of several machine learning algorithms on MapReduce clusters whose nodes are equipped with HDDs, SSDs, and devices which implement the latest 3D XPoint technology. In particular, we evaluate several dataset preprocessing methods like vectorization and dimensionality reduction, two supervised classifiers, Naive Bayes and Linear Regression, and the popular k-Means clustering algorithm. We use an experimental cluster equipped with the three aforementioned storage devices under different configurations, and two large datasets, Wikipedia and HIGGS. The experiments showed that the benefits which derive from the usage of SSDs depend on the cluster setup and the nature of the applied algorithms.
THE ROLE OF LEADERSHIP BEHAVIOUR OF PROJECT MANAGER IN MANAGING THE FUZZY FRONT END IN THE DEVELOPMENT OF RADICAL AND INCREMENTAL INNOVATION
Authors: HOONSOPON DANUPOL , PURIWAT WILERT
Published: June 2020

Existing theories of organisational behaviour have addressed the relationship between the role of leadership behaviour of project manager and outcomes of subordinates in developing new products (e.g., improving innovation speed and new product performance). However, only a small number of researchers have investigated the impact of leadership behaviour on the fuzzy front end. Specifically, the role of leadership behaviour in reducing uncertainty in the fuzzy front end for each innovation type has been largely overlooked. Apart from employing the path-goal theory and using survey research, this research collects data from the food & beverage, pharmaceutical, and biotechnology industries in Thailand ([Formula: see text]) and analyses the data with structural equation modeling. Our results can contribute how the leadership behaviour of project manager impacts on development of each type of product innovation. The findings reveal that the directive path-goal behaviour of project managers helps to reduce uncertainty in the fuzzy front end during incremental innovation development. In contrast, achievement-oriented behaviour of project managers helps to reduce uncertainty in the fuzzy front end during radical innovation development. Additionally, reducing uncertainty in the fuzzy front end can enhance the new product performance of these two types of innovation.
miR-135a Alleviates Silica-Induced Pulmonary Fibrosis by Targeting NF-κB/Inflammatory Signaling Pathway
Authors: Xie Bin , Lu Can , Chen Chen , Zhou Jianhua , Deng Zhenghao
Published: June 2020

Silica exposure triggers inflammatory response and pulmonary fibrosis that is a severe occupational or environmental lung disease with no effective therapies. The complicated biological and molecular mechanisms underlying silica-induced lung damages have not yet been fully understood. miR-135a inhibits inflammation, apoptosis, and cancer cell proliferation. But the roles of miRNA135a involved in the silica-induced lung damages remain largely unexplored. We investigated the roles and mechanisms of miR-135a underlying silica-induced pulmonary fibrosis. The present study showed silica exposure caused the decrease in miR-135a level but the increase in inflammatory mediators. Transduction of lentivirus expressing miR-135a reduced the level of inflammatory mediators in lung tissues from silica-treated mice and improved pulmonary fibrosis which was consistent with the downregulated α-SMA but enhanced E-cadherin. Moreover, miR-135a overexpression inhibited p-p65 level in lung tissues. Overexpression of miR-135a inhibitor strengthened TLR4 protein level and NF-κB activation in BEAS-2B cells. Injection of PDTC, an inhibitor of NF-κB, further reinforced miR-135a-mediated amelioration of inflammation and pulmonary fibrosis induced by silica. The collective data indicate miR-135a restrains NF-κB activation probably through targeting TLR4 to alleviate silica-induced inflammatory response and pulmonary fibrosis.
Experiment and Application of Coalcrete on Roadway Stability: A Comparative Analysis
Authors: Li Guichen , Sun Yuantian , Zhang Junfei , Zhang Qianjin , Sun Changlun , Zhang Suhui , Bi Ruiyang
Published: June 2020

Improving roadway stability in deep underground mines is quite challenging, as the conventional support structures easily fail. Roadway collapse and large deformation occur just several months after tunnel excavation. In this study, a relatively new prereinforcement technique, the jet grouting (JG), is introduced to improve roadway stability. A field test was performed for evaluating the practicability and applicability of JG in soft coal mass. A series of laboratory tests were conducted to assess the properties of coalcrete (coal‐grout after JG treatment). A two‐dimensional numerical model was established for validating the input parameters. Based on the verified model, three JG support cases for roadway were modeled and compared with a conventional support case, namely, the currently used support in this mine “rock bolts + U‐shaped steel set + shotcrete.” The results show that the proposed prereinforced JG support structures can considerably control the deformation and failure zone of the roadway and improve the bearing capacity of coal mass. The mechanism of maintaining roadway stability using JG techniques is further revealed. Some suggestions are further presented to improve the stability of the jet‐grouted roadway.
Ma Xing Shi Gan Decoction Protects against PM2.5‐Induced Lung Injury through Suppression of Epithelial‐to‐Mesenchymal Transition (EMT) and Epithelial Barrier Disruption
Authors: Wang Ye-fang , Fei Yu-xiang , Zhao Bo , Yin Qi-yang , Zhu Jian-ping , Ren Guang-hui , Wang Bo-wen , Fang Wei-rong , Li Yun-man
Published: June 2020

This research was designed to explore the effect of Ma Xing Shi Gan decoction (MXD) in alleviating particulate matter less than 2.5 μm in diameter (PM2.5) induced lung injury from the perspective of epithelial barrier protection and inhibition of epithelial‐to‐mesenchymal transition (EMT). Rats were exposed to PM2.5 to establish a lung injury model in vivo, and a PM2.5‐stimulated primary cultured type II alveolar epithelial cell model was introduced in vitro. Our results indicated that MXD alleviated the weight loss and pathologic changes and improved the epithelial barrier dysfunction. MXD also significantly inhibited the TGF‐β/Smad3 pathway, increased the level of ZO‐1 and claudin‐5, and reversed the EMT process. Notably, the protection of MXD was abolished by TGF‐β in vitro. Our results indicated that MXD has a protection against PM2.5‐induced lung injury. The proposed mechanism is reversing PM2.5‐induced EMT through inhibiting TGF‐β/Smad3 pathway and then upregulating the expression of tight‐junction proteins.
Intestinal Perforation due to Neutropenic Enterocolitis in a Patient Treated with Bevacizumab for Ovarian Cancer
Authors: Sasaki Akinori , Harano Kenichi , Kogawa Takahiro , Matsubara Nobuaki , Naito Yoichi , Hosono Ako , Mukai Hirofumi , Yoshino Takayuki , Mukohara Toru
Published: June 2020

Intestinal perforation is a rare adverse event of antineoplastic therapy. However, once it occurs, it is potentially fatal. This report describes a case of intestinal perforation caused by bevacizumab in a patient with ovarian cancer who concurrently developed neutropenic enterocolitis. A 66-year-old woman diagnosed with metastatic ovarian cancer received combination chemotherapy with carboplatin, gemcitabine, and bevacizumab. On day 14, she developed grade 4 pancytopenia and febrile neutropenia, which resulted in neutropenic enterocolitis and intestinal perforation. Emergency surgery was performed, and an intestinal perforation found in the ascending colon was closed. Postoperatively, she developed an intra-abdominal abscess requiring peritoneal drainage. She was discharged from the hospital on recovery.
Auricular Acupressure in Patients with Hypertension and Insomnia: A Systematic Review and Meta‐Analysis
Authors: Zhao Zhi-Hui , Zhou Yi , Li Wei-Hong , Tang Zhao-Hui , Xia Ting-Wei , Han-Li
Published: June 2020

Objective. The efficacy of auricular acupressure in patients with hypertension and insomnia is controversial. This systematic review aims to explore the effectiveness of auricular acupressure in reducing blood pressure and improving sleep in this population. Methods. We conducted an extensive database search in Cochrane Central Register of Controlled Trials, PubMed, Ovid LWW, Web of Science, Chinese Biomedical Literature Database, China Knowledge Resource Integrated Database, Wanfang Data, and China Science and Technology Journal Database on randomized controlled trials published from inception to November 2019 that compared auricular acupressure with a control or comparison group on blood pressure control and sleep improvement. Two reviewers independently conducted data screening and extraction. Study quality was evaluated using the Cochrane Handbook for Systematic Reviews of Interventions. Meta‐analyses were performed on blood pressure, Pittsburgh Sleep Quality Index (PSQI), the efficacy rate of diagnostic and therapeutic criteria for traditional Chinese medicine syndromes (DTCTCMS), and the efficacy rate of guidelines for traditional Chinese medicine (new drug) clinical research (GTCMCR) by Revman 5.3.0. Results. A total of 18 randomized controlled trials with 1685 patients were identified. Compared with a control or comparison group, pooled meta‐analyses showed that auricular acupressure significantly improved systolic blood pressure (MD = −15.05, 95% CI (−18.49, −11.61), P < 0.00001), diastolic blood pressure (MD = −8.41, 95% CI (−11.33, −5.48), P < 0.00001), PSQI (MD = −2.37, 95% CI (−4.64, −0.10), P = 0.04), the efficacy rate of DTCTCMS (RR = 1.63, 95% CI (1.16, 2.28), P = 0.004), and the efficacy rate of GTCMCR (RR = 1.25, 95% CI (1.12, 1.38)). Conclusions. The results demonstrated a favorable effect of auricular acupressure to reduce blood pressure and improve sleep in patients with hypertension and insomnia. Further studies to better understand the acupoints and intervention times of auricular acupressure are warranted.
Peripheral Cytotoxic T Cell Lymphoma of the Appendix Presenting as Acute Appendicitis
Authors: Rahmani Negin , Daneshbod Yahya , Mirfazaelian Hadi , Vahidi Elnaz , Shirian Sadegh
Published: June 2020

Introduction. Lymphoma of the appendix is a rare cause of acute appendicitis; however, acute appendicitis is a common first manifestation of appendiceal lymphomas. Cytotoxic peripheral T cell lymphoma (PTCL) is a type of aggressive non-Hodgkin lymphoma that portends a generally poor outcome. Cytotoxic PTCL of the appendix is extremely rare with few cases reported in the literature. Case Presentation. This is the report of a 23-year-old man who had experienced lower abdominal pain for three months before presenting to the emergency department with severe right lower abdominal pain, nausea, vomiting, and anorexia since the day prior to admission. The patient was diagnosed with acute appendicitis, and the pathology report confirmed cytotoxic PTCL of the appendix. Conclusion. Patients with appendiceal PTCL commonly present with signs and symptoms of acute appendicitis due to luminal obstruction by the tumor. Therefore, appendiceal tumors such as PTCL should be considered in the differential diagnosis of patients presenting as acute appendicitis. In addition, since there is no standard chemotherapy regimen for cytotoxic PTCL, this and other case reports hopefully help in providing the clinical evidence needed for establishing appropriate treatment guidelines.
Parameter Identification of ARX Models Based on Modified Momentum Gradient Descent Algorithm
Authors: Tu Quan , Rong Yingjiao , Chen Jing
Published: June 2020

The parameter estimation problem of the ARX model is studied in this paper. First, some traditional identification algorithms are briefly introduced, and then a new parameter estimation algorithm—the modified momentum gradient descent algorithm—is developed. Two gradient directions with their corresponding step sizes are derived in each iteration. Compared with the traditional parameter identification algorithms, the modified momentum gradient descent algorithm has a faster convergence rate. A simulation example shows that the proposed algorithm is effective.
Sobre vulnerabilidad y teletrabajo durante la pandemia
Authors: Perticará Marcela , Tejada Mauricio
Published: June 2020

La pandemia del COVID-19 que estamos atravesando representa un evento de proporciones no vistas desde probablemente la gripe española de 1918 y tendrá grandes consecuencias negativas de corto y largo plazo, comparables o incluso más dramáticas de las que tuvo la gran depresión de 1929. Con el objetivo de controlar la pandemia, mediante la reducción de la tasa efectiva de reproducción del virus, la recomendación ha sido en todo momento el distanciamiento social. Continuar leyendo...
Charcot, Janet, and French Models of Psychopathology
Authors: Walusinski Olivier , Bogousslavsky Julien
Published: June 2020

Jean-Martin Charcot (1825–1893), thanks to his insight as a clinician can be said to be one of the precursors of scientific psychology. Charcot’s 30 years of activity at La Salpêtrière hospital display an intellectual trajectory that decisively changed the idea of human psychology by favouring the emergence of two concepts: the subconscious and the unconscious. It was his collaboration with Pierre Janet (1859–1947), a philosopher turned physician, that led to this evolution, relying on the search for hysteria’s aetiology, using hypnosis as a method of exploration. Focusing on clinical psychology that was experimental and observational, Janet built a theory of psychic automatism, “the involuntary exercise of memory and intelligence” leading to “independence of the faculties, freed from personal power.” From all that came the idea of the subconscious, a functioning as a passive mental mechanism, resulting from a more or less temporary dissociation of previously associated mental content.
Insult detection using a partitional CNN-LSTM model
Authors: Ben Ismail Mohamed Maher
Published: June 2020

Recently, deep learning has been coupled with notice- able advances in Natural Language Processing related research. In this work, we propose a general framework to detect verbal offense in social networks comments. We introduce a partitional CNN-LSTM architecture in order to automatically recognize ver- bal offense patterns in social network comments. Specifically, we use a partitional CNN along with a LSTM model to map the social network comments into two predefined classes. In particular, rather than considering a whole document/comments as input    as performed using typical CNN, we partition the comments into parts in order to capture and weight the locally relevant information in each partition.  The resulting local information is then sequentially exploited across partitions using LSTM for verbal offense detection. The combination of the partitional CNN and LSTM yields the integration of the local within comments information and the long distance correlation across comments. The proposed approach was assessed using real dataset, and the obtained results proved that our solution outperforms existing relevant solutions.
Na rede das apropriações: produção artística de resistência à iconomania
Authors: Ferreira José Bento Machado
Published: June 2020

Obras de arte contemporânea promovem anacronismos e constituem imagens críticas. Artistas Basel Abbas e Ruanne Abou-Rahme produzem trabalhos que se encaixam nas ideias de autores como Marie-José Mondzain, Georges Didi-Huberman e Hans Belting, que se ocupam das implicações antropológicas, políticas e estéticas da questão das imagens na cultura contemporânea.
Imagens: passagens e projeções
Authors: Aranha Carmen Sylvia Guimarães
Published: June 2020

Apresentam-se aqui diálogos revelados em Memorial do desenho, pesquisa curatorial realizada no MAC USP. Discute-se o desenho como elemento fundamental na construção da compreensão da imagem contemporânea. A partir da fenomenologia do olhar de Merleau-Ponty, destacam-se aspectos motivadores para a compreensão de relações estéticas das proposições curatorial e museográfica da mostra.
Experimentar e produzir a imagem no contemporâneo
Authors: Carvalho Maria Alice Andrade de , Troncarelli Ruth Cuiá , Pereira Vinícius Juliani , Santos Aline Silva
Published: June 2020

Este ensaio expõe duas experimentações feitas pelo grupo de estudos Devaneios Experimentais e Poéticas Imaginativas, formado por pesquisadores da FAUUSP. Elas resultaram de um processo teórico em que imagens materializam conceitos de textos debatidos pelo grupo. Portanto, trata-se de refletir sobre práticas de pesquisa científica e sua metodologia, que envolvam elementos não-textuais.
Da Luz à São Bento
Authors: Costa Luciano Bernardino da
Published: June 2020

Neste ensaio, texto e fotografias se articulam procurando problematizar a relação perceptiva e sensível que se instaura nas metrópoles contemporâneas. Nos fluxos humanos diários diferentes intercâmbios se estabelecem entre imagens, memória e esquecimento. A própria experimentação fotográfica torna-se, de modo ambíguo, uma tentativa de aproximação destes fenômenos e um modo circunstancial de registro.
As coisas como elas são
Authors: Vieira Luiz Arthur Leitão
Published: June 2020

Este artigo examina novas formas de representação fotográfica no início do século XXI. A partir do texto de Walter Benjamin, em que diferencia as obras com “valor de culto” e “valor de exposição", analisa diferenças entre a fotografia de base química (dita analógica) e a fotografia digital. Com isso, atém-se à proposta de representação da realidade contemporânea no trabalho de Andreas Gursky.
American Heart Association COVID-19 CVD Registry Powered by Get With The Guidelines
Authors: Alger Heather M. , Rutan Christine , Williams Joseph H. , Walchok Jason G. , Bolles Michele , Hall Jennifer L. , Bradley Steven M. , Elkind Mitchell S. V. , Rodriguez Fatima , Wang Tracy Y. , Morrow David A. , Das Sandeep R. , de Lemos James A.
Published: June 2020

Background:

In response to the public health emergency created by the coronavirus disease 2019 (COVID-19) pandemic, American Heart Association volunteers and staff aimed to rapidly develop and launch a resource for the medical and research community to expedite scientific advancement through shared learning, quality improvement, and research. In <4 weeks after it was first announced on April 3, 2020, AHA’s COVID-19 CVD Registry powered by Get With The Guidelines received its first clinical records.

Methods and Results:

Participating hospitals are enrolling consecutive hospitalized patients with active COVID-19 disease, regardless of CVD status. This hospital quality improvement program will allow participating hospitals and health systems to evaluate patient-level data including mortality rates, intensive care unit bed days, and ventilator days from individual review of electronic medical records of sequential adult patients with active COVID-19 infection. Participating sites can leverage these data for onsite, rapid quality improvement, and benchmarking versus other institutions. After 9 weeks, >130 sites have enrolled in the program and >4000 records have been abstracted in the national dataset. Additionally, the aggregate dataset will be a valuable data resource for the medical research community.

Conclusions:

The AHA COVID-19 CVD Registry will support greater understanding of the impact of COVID-19 on cardiovascular disease and will inform best practices for evaluation and management of patients with COVID-19.
Somatic Gain of KRAS Function in the Endothelium Is Sufficient to Cause Vascular Malformations That Require MEK but Not PI3K Signaling
Authors: Fish Jason E. , Flores Suarez Carlos Perfecto , Boudreau Emilie , Herman Alexander M. , Gutierrez Manuel Cantu , Gustafson Dakota , DiStefano Peter V. , Cui Meng , Chen Zhiqi , De Ruiz Karen Berman , Schexnayder Taylor S. , Ward Christopher S. , Radovanovic Ivan , Wythe Joshua D.
Published: June 2020

Rationale:

We previously identified somatic activating mutations in the
KRAS
(
Kirsten rat sarcoma viral oncogene homologue
) gene in the endothelium of the majority of human sporadic brain arteriovenous malformations; a disorder characterized by direct connections between arteries and veins. However, whether this genetic abnormality alone is sufficient for lesion formation, as well as how active KRAS signaling contributes to arteriovenous malformations, remains unknown.

Objective:

To establish the first in vivo models of somatic KRAS gain of function in the endothelium in both mice and zebrafish to directly observe the phenotypic consequences of constitutive KRAS activity at a cellular level in vivo, and to test potential therapeutic interventions for arteriovenous malformations.

Methods and Results:

Using both postnatal and adult mice, as well as embryonic zebrafish, we demonstrate that endothelial-specific gain of function mutations in
Kras
(G12D or G12V) are sufficient to induce brain arteriovenous malformations. Active KRAS signaling leads to altered endothelial cell morphogenesis and increased cell size, ectopic sprouting, expanded vessel lumen diameter, and direct connections between arteries and veins. Furthermore, we show that these lesions are not associated with altered endothelial growth dynamics or a lack of proper arteriovenous identity but instead seem to feature exuberant angiogenic signaling. Finally, we demonstrate that KRAS-dependent arteriovenous malformations in zebrafish are refractory to inhibition of the downstream effector PI3K but instead require active MEK (mitogen-activated protein kinase kinase 1) signaling.

Conclusions:

We demonstrate that active KRAS expression in the endothelium is sufficient for brain arteriovenous malformations, even in the setting of uninjured adult vasculature. Furthermore, the finding that KRAS-dependent lesions are reversible in zebrafish suggests that MEK inhibition may represent a promising therapeutic treatment for arteriovenous malformation patients.

Graphical Abstract:

A graphical abstract is available for this article.
Pathological Role of Receptor for Advanced Glycation End Products in Calcified Aortic Valve Stenosis
Authors: Saku Kosuke , Tahara Nobuhiro , Takaseya Tohru , Otsuka Hiroyuki , Takagi Kazuyoshi , Shojima Takahiro , Shintani Yusuke , Zaima Yasuyuki , Kikusaki Satoshi , Fukuda Tomofumi , Oryoji Atsunobu , Nishino Yuri , Matsui Takanori , Kakuma Tatsuyuki , Akiba Jun , Fukumoto Yoshihiro , Yamagishi Sho‐ichi , Tanaka Hiroyuki
Published: June 2020

Background

Aortic stenosis (
AS
) is highly prevalent in patients with atherosclerotic cardiovascular disease. Advanced glycation end products (
AGE
s) and the receptor for
AGE
s (
RAGE
) play a pivotal role for vascular calcification in atherosclerosis. We hypothesize that the AGEs–
RAGE
axis could also be involved in the pathophysiological mechanism of calcified
AS
.

Methods and Results

A total of 54 patients with calcified
AS
who underwent aortic valve replacement were prospectively enrolled from 2014 to 2016 (mean age 75.3±7.7 years). Aortic valve specimens were obtained from 47 patients and 16 deceased control subjects without aortic valve disease (mean age 63.2±14.5 years). The valvular expression of
RAGE
was evaluated by immunohistochemistry. Serum levels of
AGE
s and soluble
RAGE
were measured in 50 patients with calcified
AS
and 70 age‐matched and sex‐matched control subjects without heart disease. The valvular
RAGE
expression in patients with calcified
AS
was higher than controls (
P
=0.004) and was significantly associated with a decreased ankle‐brachial pressure index (
P
=0.007) and an increased intima‐media thickness (
P
=0.026).
RAGE
and α–smooth muscle actin were coexpressed and were partially costained with osteocalcin and alkaline phosphatase. The serum levels of
AGE
s and soluble RAGE were significantly higher in the patients with calcified
AS
than in the controls (
P
=0.013 and
P
<0.001, respectively). Soluble RAGE (inversely) and use of aspirin were independently correlated with changes in left ventricular systolic function after aortic valve replacement (
P
=0.012 and
P
=0.002, respectively).

Conclusions

Our present study suggests that
RAGE
may play a role in the pathogenesis of calcified
AS
, which is a prognostic marker in patients with
AS
after aortic valve replacement.
Efficacy of Clopidogrel for Prevention of Stroke Based on
CYP2C19
Allele Status in the POINT Trial
Authors: Meschia James F. , Walton Ronald L. , Farrugia Luca P. , Ross Owen A. , Elm Jordan J. , Farrant Mary , Meurer William J. , Lindblad Anne S. , Barsan William , Ching Marilou , Gentile Nina , Ross Michael , Nahab Fadi , Easton J. Donald , Kim Anthony S. , Zurita Karla G. , Cucchiara Brett , Johnston S. Claiborne
Published: June 2020

Background and Purpose:

Clopidogrel is an antiplatelet drug that is metabolized to its active form by the CYP2C19 enzyme. The CHANCE trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events) found a significant interaction between loss-of-function allele status for the
CYP2C19
gene and the effect of dual antiplatelet therapy with aspirin and clopidogrel on the rate of early recurrent stroke following acute transient ischemic attack/minor stroke. The POINT (Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke Trial), similar in design to CHANCE but performed largely in North America and Europe, demonstrated a reduction in early recurrent stroke with dual antiplatelet therapy compared with aspirin alone. This substudy was done to evaluate a potential interaction between loss-of-function
CYP2C19
alleles and outcome by treatment group in POINT.

Methods:

Of the 269 sites in 10 countries that enrolled patients in POINT, 134 sites participated in this substudy. DNA samples were genotyped for
CYP2C19
*2, *3, and *17 alleles and classified as being carriers or noncarriers of loss-of-function alleles. Major ischemia consisted of ischemic stroke, myocardial infarction, or ischemic vascular death.

Results:

Nine hundred thirty-two patients provided analyzable DNA. The rates of major ischemia were 6.7% for the aspirin group versus 2.3% for the dual antiplatelet therapy group (hazard ratio, 0.33 [95% CI, 0.09–1.21];
P
=0.09) among carriers of loss-of-function allele. The rates of major ischemia were 5.6% for the aspirin group versus 3.7% for the dual antiplatelet therapy group (hazard ratio, 0.65 [95% CI, 0.32–1.34];
P
=0.25) among noncarriers. There was no significant interaction by genotype for major ischemia (
P
=0.36) or stroke (
P
=0.33).

Conclusions:

This substudy of POINT found no significant interaction with
CYP2C19
loss-of-function carrier status and outcome by treatment group. Failure to confirm the findings from the CHANCE trial may be because the loss-of-function alleles tested are not clinically important in this context or because the 2 trials had differences in racial/ethnic composition. Additionally, differences between the 2 trials might be due to chance as our statistical power was limited to 50%.

Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT00991029.
Feature-Based Diversity Optimization for Problem Instance Classification
Authors: Gao Wanru , Nallaperuma Samadhi , Neumann Frank
Published: June 2020

Understanding the behaviour of heuristic search methods is a challenge. This even holds for simple local search methods such as 2-OPT for the Travelling Salesperson Problem (TSP). In this article, we present a general framework that is able to construct a diverse set of instances which are hard or easy for a given search heuristic. Such a diverse set is obtained by using an evolutionary algorithm for constructing hard or easy instances which are diverse with respect to different features of the underlying problem. Examining the constructed instance sets, we show that many combinations of two or three features give a good classification of the TSP instances in terms of whether they are hard to be solved by 2-OPT.
Achieving Highly Scalable Evolutionary Real-Valued Optimization by Exploiting Partial Evaluations
Authors: Bouter Anton , Alderliesten Tanja , Bosman Peter A.N.
Published: June 2020

It is known that to achieve efficient scalability of an Evolutionary Algorithm (EA), dependencies (also known as linkage) must be properly taken into account during variation. In a Gray-Box Optimization (GBO) setting, exploiting prior knowledge regarding these dependencies can greatly benefit optimization. We specifically consider the setting where partial evaluations are possible, meaning that the partial modification of a solution can be efficiently evaluated. Such problems are potentially very difficult, for example, non-separable, multimodal, and multiobjective. The Gene-pool Optimal Mixing Evolutionary Algorithm (GOMEA) can effectively exploit partial evaluations, leading to a substantial improvement in performance and scalability. GOMEA was recently shown to be extendable to real-valued optimization through a combination with the real-valued estimation of distribution algorithm AMaLGaM. In this article, we definitively introduce the Real-Valued GOMEA (RV-GOMEA), and introduce a new variant, constructed by combining GOMEA with what is arguably the best-known real-valued EA, the Covariance Matrix Adaptation Evolution Strategies (CMA-ES). Both variants of GOMEA are compared to L-BFGS and the Limited Memory CMA-ES (LM-CMA-ES). We show that both variants of RV-GOMEA achieve excellent performance and scalability in a GBO setting, which can be orders of magnitude better than that of EAs unable to efficiently exploit the GBO setting.
Association of Scapular Fractures and Blunt Thoracic Aortic Injury: Fact or Fiction?
Authors: Brown Carlos V.R. , Velmahos George , Wang Dennis , Kennedy Susan , Demetriades Demetrios , Rhee Peter
Published: June 2020

It is classically taught that scapular fractures (SF) are commonly associated with blunt thoracic aortic injury (BTAI). The purpose of this study was to determine the association between SF and BTAI. A 10-year retrospective review of blunt trauma admissions from two level I trauma centers located in different geographic regions, Washington Hospital Center (WHC) and Los Angeles County Medical Center and the University of Southern California (LAC/USC), was performed. Patients with SF and BTAI were identified, and records were reviewed to determine associated injuries. We identified 35,541 blunt trauma admissions (WHC: 12,971, LAC/USC: 22,570). SF and BTAI occurred in 1.1 per cent and 0.6 per cent of patients, respectively. Most of the patients with SF had associated injuries (99%). Only four patients with SF had BTAI (4/392; 1.0%). The most common injuries associated with SF were rib (43%), lower extremity (36%), and upper extremity (33%) fractures. SF is uncommon after blunt trauma. Patients with SF almost always have significant associated injuries. Although SF indicates a high amount of energy transmitted to the upper thorax, these patients rarely have BTAI. SF should not be used as an indicator of possible BTAI.
Gastrointestinal Neurofibromatosis: An Unusual Cause of Gastric Outlet Obstruction
Authors: Bakker Jennifer R. , Haber Marian M. , Garcia Fernando U.
Published: June 2020

Neurofibromatosis type-1 (NF-1), also known as von Recklinghausen disease, is a common autosomal dominant condition occurring in approximately 1/3000 births. NF-1 is known to be associated with gastrointestinal neoplasms in 2–25 per cent of patients. We report the first case of gastric outlet obstruction with perforation caused by neurofibroma in a patient with NF-1. The literature is reviewed, examining 61 previously reported cases of noncarcinoid gastrointestinal (GI) neoplasms in patients with NF-1 for symptoms, location, and types of neoplasms. Neoplasms were located most often in the small intestine (72%). Neurofibromas, found in 52 per cent of patients, were the most frequently diagnosed benign neoplasms followed by leiomyomas (13%), ganglioneurofibromas (9.8%), and gastrointestinal stomal tumor (GIST) (6.5%). Adenocarcinoma was present in 23 per cent of patients. Patients with NF-1 and GI symptoms are at risk for gastrointestinal neoplasms from which symptomatic patients are likely to experience significant morbidity.
Effect of Race on Long-Term Survival of Breast Cancer Patients: Transinstitutional Analysis from an Inner City Hospital and University Medical Center
Authors: Grau Ana M. , Ata Ashar , Foster La'Keitha , Ahmed Nasar U. , Gorman Darcie Reasoner , Shyr Yu , Stain Steven C. , Pearson A. Scott
Published: June 2020

Black women have the highest mortality for breast cancer. Our hypothesis is that racial disparities in breast cancer survival persist after controlling for stage of disease and treatment at both a city hospital as well as at a university hospital. Data from tumor registries of breast cancer patients at a city hospital and a university center were analyzed for overall and disease-specific survival, controlling for stage and treatment. Black patients presented with more advanced stages and had significantly worse survival compared with whites. After controlling for stage of disease and treatment, a difference in survival persisted for stage II patients, with blacks doing worse than whites at both institutions. Although there were socioeconomic differences, race was an independent prognostic factor, with black patients having the worse prognosis. The lower survival of black women with breast cancer is only partially explained by their advanced stage at diagnosis. Black women with potentially curable stage II cancer had a lower survival that is not explained by the variables measured.
Admission Preoperative Glucose is Predictive of Morbidity and Mortality in Trauma Patients who Require Immediate Operative Intervention
Authors: Bochicchio Grant V. , Salzano Laura , Joshi Manjari , Bochicchio Kelly , Scalea Thomasm
Published: June 2020

Although there have been reports in the surgical literature regarding the negative effects of preoperative hyperglycemia on outcome, the impact of elevated preoperative serum glucose levels in trauma patients is unknown. Our objectives were to determine whether preoperative hyperglycemia was associated with a greater morbidity and mortality in trauma patients who underwent surgical intervention upon admission. Prospective data was collected on 252 consecutive nondiabetic trauma patients admitted for ≥3 days who went directly to the OR from the resuscitation area. Patients were stratified by preoperative serum glucose level (<200 vs. ≥200 mg/dL) age, gender, Injury Severity Score (ISS), and other preexisting risk factors. Outcome was measured by incidence of infection, hospital (HLOS) and ICU (ILOS) length of stay, and mortality. Multiple linear regression models were used to evaluate serum glucose in relation to other preoperative risk factors. Blunt trauma accounted for the majority (86%) of the injuries. Orthopedic procedures were the most common (36%) followed by neurosurgical (22%), abdominal (22%), and thoracic (6%). Patients with elevated serum glucose had a significantly greater incidence of infection, HLOS, ILOS, and mortality matched per age and ISS. Elevated serum glucose on admission is an accurate predictor of postoperative infection, HLOS, ILOS, and mortality. A randomized prospective trial evaluating the impact of preoperative glucose control is warranted.
How I Do It: Safe Subclavian Vein Cannulation
Authors: Thompson Errington C. , Calver Lewis E.
Published: June 2020

Physicians and other advanced medical personnel commonly perform subclavian vein cannulation. Success depends on adequate knowledge of the anatomy. With this knowledge subclavian vein cannulation can be performed with low complication rates. The manuscript reviews the anatomy and the literature of subclavian vein cannulation.
A Burn Mass Casualty Event Due to Boiler Room Explosion on a Cruise Ship: Preparedness and Outcomes
Authors: Tekin Akin , Namias Nicholas , O'Keeffe Terence , Pizano Louis , Lynn Mauricio , Prater-Varas Robin , Quintana Olga Delia , Borges Leda , Ishii Mary , Lee Seong , Lopez Peter , Lessner-Eisenberg Sharon , Alvarez Angel , Ellison Tom , Sapnas Katherine , Lefton Jennifer , Ward Charles Gillon
Published: June 2020

The purpose of this study was to review our experience with a mass casualty incident resulting from a boiler room steam explosion aboard a cruise ship. Experience with major, moderate, and minor burns, steam inhalation, mass casualty response systems, and psychological sequelae will be discussed. Fifteen cruise ship employees were brought to the burn center after a boiler room explosion on a cruise ship. Eleven were triaged to the trauma resuscitation area and four to the surgical emergency room. Seven patients were intubated for respiratory distress or airway protection. Six patients had >80 per cent burns with steam inhalation, and all of these died. One of the 6 patients had 99 per cent burns with steam inhalation and died after withdrawal of support within the first several hours. All patients with major burns required escharotomy on arrival to trauma resuscitation. One patient died in the operating room, despite decompression by laparotomy for abdominal compartment syndrome and pericardiotomy via thoracotomy for cardiac tamponade. Four patients required crystalloid, 20,000 mls/m2–27,000 ml/m2 body surface area (BSA) in the first 48 hours to maintain blood pressure and urine output. Three of these four patients subsequently developed abdominal compartment syndrome and died in the first few days. The fourth patient of this group died after 26 days due to sepsis. Five patients had 13–20 per cent burns and four patients had less than 10 per cent burns. Two of the patients with 20 per cent burns developed edema of the vocal cords with mild hoarseness. They improved and recovered without intubation. The facility was prepared for the mass casualty event, having just completed a mass casualty drill several days earlier. Twenty-six beds were made available in 50 minutes for anticipated casualties. Fifteen physicians reported immediately to the trauma resuscitation area to assist in initial stabilization. The event occurred at shift change; thus, adequate support personnel were instantaneously to hand. Our mass casualty preparation proved useful in managing this event. Most of the patients who survived showed signs of post-traumatic stress syndrome, which was diagnosed and treated by the burn center psychology team. Despite our efforts at treating large burns (>80%) with steam inhalation, mortality was 100 per cent. Fluid requirements far exceeded those predicted by the Parkland (Baxter) formula. Abdominal compartment syndrome proved to be a significant complication of this fluid resuscitation. A coordinated effort by the facility and preparation for mass casualty events are needed to respond to such events.
Surgical Complications and Causes of Death in Trauma Patients that Require Temporary Abdominal Closure
Authors: Montalvo JosÉ A. , Acosta JosÉ A. , RodrÍguez Pablo , Alejandro Kathia , SÁrraga AndrÉs
Published: June 2020

Temporary abdominal closure (TAC) has increasingly been employed in the management of severely injured patients to avoid abdominal compartment syndrome (ACS) and as part of damage control surgery (DCS). Although the use of TAC has received great interest, few data exist describing the morbidity and mortality associated with its use in trauma victims. The main goal of this study is to describe the incidence of surgical complications following the use of TAC as well as to define the mortality associated with this procedure. A retrospective review of patients admitted to a state-designated level 1 trauma center from April 2000 to February 2003 was performed. Inclusion criteria were age >18 years, traumatic injury, and need for exploratory laparotomy and use of TAC. A total of 120 patients were included in the study. The overall mortality of trauma patients requiring TAC was 59.2 per cent. The most common causes of death were acute inflammatory process (50.7%), followed by hypovolemic shock (43.7%). The incidence of surgical complications was 26.6 per cent. Intra-abdominal abscesses were the most frequent surgical complication (10%). After multiple logistic regression analysis, increasing age and a numerically greater initial base deficit were found to be independent predictors of mortality in trauma patients that require TAC.
Chilaiditi's Syndrome: What Should Every Surgeon Know?
Authors: Saber Alan A. , Boros Michael J.
Published: June 2020

Demetrius Chilaiditi first described an incidental radiological finding1 of hepatodiaphragmatic interposition of bowel in 1910. The condition could be mistaken for pneumoperitoneum. This radiographic entity, known as Chilaiditi's sign, is found in asymptomatic patients and must be distinguished from Chilaiditi's syndrome, which produces symptomatology associated with the bowel interposition. A review of the literature yielded 27 published cases of Chilaiditi's syndrome. These cases were compiled to evaluate various aspects of this rare but important entity.
How I Do It: Novel Technique for Placement of Hemodialysis Catheters Using a Combined Open Procedure with the Seldinger Micropuncture Technique
Authors: Maa J. , Gosnell J.E. , Chuter T.A.M.
Published: June 2020

Percutaneous placement of large-diameter dialysis catheters via the Seldinger technique can be technically challenging in patients with coagulopathy, difficult anatomy, or several previous central line insertions. We describe a method for achieving safer access by combining an open approach to delineate the venous anatomy of the chest wall, with a micropuncture device and smaller diameter guidewire to gain intravascular access to the cephalic vein or its major tributaries. Serial dilation of otherwise unusable vessels can then permit successful and safer hemodialysis catheter insertion in these difficult cases.