bluuebunny/crossref_metadata_2025 huggingface dataset:
The diagnosis and management of intestinal obstruction after pediatric liver transplantation
Authors: Sun Chao , Song Zhuolun , Dong Chong , Zheng Weiping , Wang Kai , Qin Hong , Yang Yang , Han Chao , Zhang Fubo , Xu Min , Cao Shunqi , Cao Yu , Gao Wei , Shen Zhongyang
Published: August 2021

Background

The aim of this study was to analyze the risk factors, causes, and management of intestinal obstruction after pediatric liver transplantation.

Methods

Retrospective analysis was performed on pediatric liver transplantation recipients from January 1st 2013 to December 31st 2019 at Organ Transplant Center, Tianjin First Central Hospital. The cases of intestinal obstruction were analyzed.

Results

A total of 1034 pediatric liver transplantations were performed during the study period, 66 intestinal obstructions were diagnosed in 61 recipients. Three recipients suffered intestinal obstructions twice, and one recipient suffered three times. Forty of the 66 cases were treated with non‐surgical treatment, including fasting, gastrointestinal decompression, purgation, enema, and parenteral nutrition. Surgical intervention was performed in 26 cases. Diaphragmatic hernia, intestinal inflammatory stenosis, PTLD, and intestine perforation are essential causes of intestinal obstruction in pediatric liver transplant recipients. Diaphragmatic hernia was independent risk factors for intestinal obstruction. The 1‐, 2‐ and 3‐year survival rate of the recipients with or without intestinal obstruction were 98.4%, 96.5%, 96.5% and 95.3%, 94.4%, 94.0%, respectively, without significant difference.

Conclusions

Most cases of intestinal obstruction after liver transplantation in children can be remitted by non‐surgical treatment, but there are still some cases need to be treated by surgery. Both measures are related to ideal outcomes, intestinal obstruction does not increase the mortality rate in pediatric liver transplantation.
Outdoor cultivation of a novel isolate of the microalgae Scenedesmus sp. and the evaluation of its potential as a novel protein crop
Authors: Olsen Malene Fog Lihme , Pedersen Jakob Skov , Thomsen Sune Tjalfe , Martens Helle Jakobe , Petersen Annette , Jensen Poul Erik
Published: August 2021

A Danish strain of the green microalgae Scenedesmus sp. was isolated, identified and characterized with respect to productivity under outdoor cultivation conditions at northern latitudes. The algae were cultivated outdoors in Denmark in closed tubular photobioreactors using only sunlight, simple inorganic nutrients and under ambient temperatures. The biomass composition was evaluated in terms of protein content and quality. The average volumetric and areal biomass productivity obtained for the Scenedesmus sp. isolate during outdoor cultivation was 0.083 g dry matter L−1 and 6.40 g dm m−2 day−1, respectively. Thus, productivities are comparable to data reported in the literature under similar conditions. A strain‐specific nitrogen to protein conversion factor of 5.5 was determined for the Scenedesmus sp. strain enabling more accurate protein estimations from simple nitrogen determination methods like Kjeldahl analysis in the future. The protein content was determined to be 52.4% of dried biomass for this Scenedesmus strain. The sum of essential amino acids was 42% which is high compared to other microalgae. The results are compared and discussed in comparison to other microalgae and soybean as a common plant protein source.
Build it and they will come, but not all of them in fragmented Atlantic Forest landscapes
Authors: Suganuma Marcio S. , Durigan Giselda
Published: August 2021

Ecological restoration interventions, in most cases, aim to restore habitat structure and plant community composition, thus re‐establishing ecosystem functioning as similar as possible to that of the pre‐existing natural ecosystem. However, given the difficulty of cultivating many species, that goal seems unattainable, unless “if you build it, they will come.” Here we addressed the Field of Dreams hypothesis in the context of trees and shrubs of the seasonal tropical forest in southeastern Brazil. We aimed to verify if the species from the regional pool have been able to colonize the restoration forests and if functional patterns exist behind successful and unsuccessful colonization. We categorized each species by dispersal syndrome, seed traits, growth rate, shade tolerance, and rarity in the communities. Most, but not all, species from the regional pool are colonizing forest patches undergoing restoration. Successful colonizers are mostly zoochorous, dispersed by birds or bats, shade tolerant, of moderate or fast growth. By partially confirming the Field of Dreams hypothesis, our study implies that it is not necessary to reintroduce a large proportion of the regional pool in tropical forest restoration projects, given that many species will later spontaneously arrive, even in fragmented landscapes. However, the existence of a particular functional profile (slow‐growing species, dispersed by gravity or large mammals) that will rarely colonize the restoration forests should not be disregarded. Even though these are a minority, such species will likely be confined to the remaining natural fragments if they are not included in the restoration projects.
Antilocality at the Phase Edge
Authors: Zyman Erik
Published: August 2021

Much work has argued that syntactic movement is subject to antilocality constraints that prevent it from being too short. If so, a crucial question is precisely what those constraints are. This article investigates the interaction between antilocality and phases, and it argues that antilocality manifests in a particular way at phase edges. The article defends a generalization dubbed Phasal Antilocality: for a phase YP, movement from within a constituent at the edge of YP must cross an XP dominating YP. It is shown that Phasal Antilocality, together with other ingredients, explains the intricate generalizations about when PP extraction is and is not possible from subjects. The analysis also correctly predicts that violations resulting from illicit PP extractions from subjects should be ameliorated under a wide range of circumstances. Finally, the article considers a possible deduction of Phasal Antilocality effects from Last Resort, the need for Merge to immediately satisfy a previously unsatisfiable feature.
Assessing the impacts of anthropogenic drainage structures on hydrologic connectivity using high‐resolution digital elevation models
Authors: Bhadra Sourav , Li Ruopu , Wu Di , Wang Guangxing , Rekabdar Banafsheh
Published: August 2021

Delineating accurate flowlines using digital elevation models is a critical step for overland flow modeling. However, extracting surface flowlines from high‐resolution digital elevation models (HRDEMs) can be biased, partly due to the absence of information on the locations of anthropogenic drainage structures (ADS) such as bridges and culverts. Without the ADS, the roads may act as “digital dams” that prevent accurate delineation of flowlines. However, it is unclear what variables for terrain‐based hydrologic modeling can be used to mitigate the effect of “digital dams.” This study assessed the impacts of ADS locations, spatial resolution, depression processing methods, and flow direction algorithms on hydrologic connectivity in an agrarian landscape of Nebraska. The assessment was conducted based on the offset distances between modeled drainage crossings and actual ADS on the road. Results suggested that: (a) stream burning in combination with the D8 or D‐Infinity flow direction algorithm is the best option for modeling surface flowlines from HRDEMs in an agrarian landscape; (b) increasing the HRDEM resolution was found significant for facilitating accurate drainage crossing near ADS locations; and (c) D8 and D‐Infinity flow direction algorithms resulted in similar patterns of drainage crossing at ADS locations. This research is expected to result in improved parameter settings for HRDEMs‐based hydrologic modeling.
Apoptosis induction by extracorporeal photopheresis is enhanced by increasing the 8‐methoxypsoralen concentration and by replacing plasma with saline
Authors: Hähnel Viola , Brosig Andreas‐Michael , Ehrenschwender Martin , Burkhardt Ralph , Offner Robert , Ahrens Norbert
Published: August 2021

Background

Extracorporeal photopheresis (ECP), an apheresis‐based therapy for various immunological diseases, works mainly by inducing apoptosis in lymphocytes. Several factors influence the efficacy of ECP with the photosensitizer 8‐methoxypsoralen (8‐MOP) and ultraviolet light A (UVA). This study aimed to optimize treatment by varying the 8‐MOP starting concentration and the cell suspension medium.

Materials and Methods

All patients (n = 13) included in this study received photopheresis as medically indicated. Cells collected with a Spectra Optia apheresis system were suspended in plasma or physiological saline (NaCl) and incubated with 200 ng/ml versus 340 ng/ml photosensitizer before UVA irradiation (Macogenic G2 or UVA PIT system). Lymphocyte apoptosis and caspase activity were analyzed by flow cytometry and fluorimetry, and residual 8‐methoxypsoralen concentrations by liquid chromatography–mass spectrometry.

Results

Raising the 8‐MOP starting concentration significantly increased lymphocyte apoptosis, with values of 22% versus 35% (plasma) and 28%–46% (NaCl) at 24 h post‐ECP and 37% versus 86% (plasma) and 74% versus 97% (NaCl) at 48 h for 200 ng/ml versus 340 ng/ml. Pre‐transfusion residual 8‐MOP levels were 168 ng/ml (plasma) and 162 ng/ml (NaCl) versus 290 ng/ml (plasma) and 266 ng/ml (NaCl) for the lower versus higher dose, respectively.

Discussion

Hence, 8‐MOP concentration influences the efficacy of photopheresis as lymphocyte apoptosis rates were significantly higher with the higher starting concentration and with NaCl versus plasma. This indicates that increased 8‐MOP starting doses and saline as additional suspension medium could help in improving ECP's efficacy.
Paradigmas en contabilidad que impiden la incorporación de aspectos diferentes del económico
Authors: Rivera Quiguanás Valeria , Henao Pulgarín Jhonatan Javier
Published: August 2021

Este artículo presenta los resultados de un estudio que tiene como finalidad comprender desde la teoría contable por qué la contabilidad es instrumentalizada desde una corriente eminentemente económica. Se realiza una evaluación de los enfoques paradigmáticos que enmarcan y limitan la contabilidad al ámbito económico y se define la verdadera orientación de la contabilidad en función de la manera en que contribuye al desarrollo sostenible. Este estudio se lleva a cabo en cuatro aspectos: enfoque del paradigma estudiado (económico, social, ambiental, multidimensional), sustento utilizado como defensa del paradigma, nivel de actualización del paradigma con relación a su vigencia y al desarrollo de la contabilidad en la cotidianidad, y efectos del paradigma en el saber contable. De los 21 paradigmas revisados 17 corresponden a un enfoque exclusivamente económico, 21 paradigmas proclaman realidades economicistas desde la base del sustento y han permanecido sin actualización, y 15 paradigmas producen efectos limitantes de la orientación contable. Se concluye que existe incapacidad de incorporar aspectos diferentes al económico cuando el contexto requiere una orientación de tipo tridimensional para la contabilidad.
An Internal State Variable Elastoviscoplasticity-Damage Model for Irradiated Metals
Authors: Cho H. E. , Zbib H. M. , Horstemeyer M. F.
Published: August 2021

This study presents an irradiation-dependent internal state variable (ISV) elastoviscoplasticity-damage constitutive model that accounts for nuclear irradiation hardening and embrittlement of the irradiated polycrystalline materials. The irradiation effects were added to the coupled plasticity-damage kinetics with consideration of the structure–property relationships. The present irradiation-dependent elastoviscoplasticity-damage model was compared with the lab deformation experimental data of irradiated oxygen-free high conductivity (OFHC) copper, modified 9Cr-1Mo steel, and Ti-5Al-2.5Sn. The results show excellent agreement over the entire stress–strain curves at various irradiation doses. Because the ISV model, before the irradiation plasticity-damage addition, had been used on over 80 different metal alloys, it is anticipated that this nuclear irradiation supplement will also allow for application to many more irradiated metal alloys.
Friction and Wear Behavior of a Physical Vapor Deposition Coating Studied Using a Micro-Scratch Technique
Authors: Khlifi Kaouther , Dhiflaoui Hafedh , Ben Aissa Chokri , Barhoumi Najoua , Ben Cheikh Larbi Ahmed
Published: August 2021

CrSiN coating was deposited by physical vapor deposition (PVD) magnetron sputtering on XC100 steel substrate. Microstructural and morphological properties were studied using scanning electron microscopy (SEM)/energy dispersive spectroscopy (EDS), X-ray diffraction (XRD), and atomic force microscopy (AFM). Nanoindentation and scratching experiments were conducted to study the mechanical and adhesion behavior. Multi-pass scratch tests were conducted under different sliding conditions. Results showed that CrSiN coating has a dense and compact nanocomposite microstructure consisting of CrN nanocrystallites and SiN amorphous matrix. The CrSiN thin film exhibit hardness and Young's modulus of 30.52 ± 1.85 GPa and 338.32 ± 13.5 GPa, respectively. The H/E, H3/E2, and 1/HE2 ratios were also calculated (H/E ≈ 0.09, H3/E2 ≈ 0.024, and 1/HE2 ≈ 2.86 × 10−07) and used to predict and assess the elastic/plastic and wear resistance. Critical loads LC1, LC2, and LC3 obtained with scratch test, were, respectively, 11.5 ± 0.12, 16.6 ± 0.23, and 20 ± 0.35 N. Multi-pass scratch were analyzed and the friction coefficient (COF), the damage mechanism, and wear volume were determined. The use of an energetic approach allowed to determine the energetic wear coefficient. CrSiN coating revealed a low friction coefficient (around 0.1) and a low energetic wear coefficient (6.3 × 10−7 mm3/N.m). In addition, it was found that multi-pass scratch method has the potential to extract relevant information about wear behavior.
Fibrometabolism—An emerging therapeutic frontier in pulmonary fibrosis
Authors: Selvarajah Brintha , Azuelos Ilan , Anastasiou Dimitrios , Chambers Rachel C.
Published: August 2021

Metabolic reprogramming of myofibroblasts promotes fibrosis and could be targeted to treat fibrotic diseases.
The good side of CXCL10 in cancer
Authors: Ferrarelli Leslie K.
Published: August 2021

CXCL10 signaling prevents, rather than promotes, progression of premalignant pancreatic neoplasia.
SAR11 Cells Rely on Enzyme Multifunctionality To Metabolize a Range of Polyamine Compounds
Authors: Noell Stephen E. , Barrell Gregory E. , Suffridge Christopher , Morré Jeff , Gable Kevin P. , Graff Jason R. , VerWey Brian J. , Hellweger Ferdi L. , Giovannoni Stephen J.
Published: August 2021

Genome streamlining in SAR11 bacterioplankton has resulted in a small repertoire of genes, yet paradoxically, they consume a substantial fraction of primary production in the oceans. Enzyme multifunctionality, referring to enzymes that are adapted to have broader substrate and catalytic range than canonically defined, is hypothesized to be an adaptation that increases the range of organic compounds metabolized by cells in environments where selection favors genome minimization.
Homeoviscous Adaptation of the Acinetobacter baumannii Outer Membrane: Alteration of Lipooligosaccharide Structure during Cold Stress
Authors: Herrera Carmen M. , Voss Bradley J. , Trent M. Stephen
Published: August 2021

To maintain cellular fitness, the composition of biological membranes must change in response to shifts in temperature or other stresses. This process, known as homeoviscous adaptation, allows for maintenance of optimal fluidity and membrane permeability.
Stabilizing Genetically Unstable Simple Sequence Repeats in the Campylobacter jejuni Genome by Multiplex Genome Editing: a Reliable Approach for Delineating Multiple Phase-Variable Genes
Authors: Yamamoto Shouji , Iyoda Sunao , Ohnishi Makoto
Published: August 2021

Campylobacter jejuni
is the leading bacterial cause of foodborne gastroenteritis in developed countries and occasionally progresses to the autoimmune disease Guillain-Barré syndrome. A relatively large number of hypermutable simple sequence repeat (SSR) tracts in the
C. jejuni
genome markedly decreases its phenotypic stability through reversible changes in the ON or OFF expression states of the genes in which they reside, a phenomenon called phase variation.
Organelle Dynamics in Apicomplexan Parasites
Authors: Verhoef Julie M. J. , Meissner Markus , Kooij Taco W. A.
Published: August 2021

Apicomplexan parasites, such as
Toxoplasma gondii
and
Plasmodium falciparum
, are the cause of many important human and veterinarian diseases. While
T. gondii
tachyzoites replicate through endodyogeny, during which two daughter cells are formed within the parental cell,
P. falciparum
replicates through schizogony, where up to 32 parasites are formed in a single infected red blood cell and even thousands of daughter cells during mosquito- or liver-stage development.
Homeobox Transcription Factors Are Required for Fungal Development and the Suppression of Host Defense Mechanisms in the
Colletotrichum scovillei
-Pepper Pathosystem
Authors: Fu Teng , Han Joon-Hee , Shin Jong-Hwan , Song Hyeunjeong , Ko Jaeho , Lee Yong-Hwan , Kim Ki-Tae , Kim Kyoung Su
Published: August 2021

The ascomycete phytopathogenic fungus,
Colletotrichum scovillei
, causes serious yield loss on peppers. However, little is known about molecular mechanisms involved in the development of anthracnose caused by this fungus.
Multilevel Genome Typing Describes Short- and Long-Term Vibrio cholerae Molecular Epidemiology
Authors: Cheney Liam , Payne Michael , Kaur Sandeep , Lan Ruiting
Published: August 2021

In 2017, the World Health Organization launched the “Ending Cholera” initiative to reduce cholera-related deaths by 90% by 2030. This strategy emphasized the importance of the speed and accessibility of newer technologies to contain outbreaks.
Contribution of N
ε
-lysine Acetylation towards Regulation of Bacterial Pathogenesis
Authors: Luu Jackson , Carabetta Valerie J.
Published: August 2021

N
ε
-lysine acetylation is an important, dynamic regulatory posttranslational modification (PTM) that is common in bacteria. Protein acetylomes have been characterized for more than 30 different species, and it is known that acetylation plays important regulatory roles in many essential biological processes.
Proteome Dynamics during Antibiotic Persistence and Resuscitation
Authors: Semanjski Maja , Gratani Fabio Lino , Englert Till , Nashier Payal , Beke Viktor , Nalpas Nicolas , Germain Elsa , George Shilpa , Wolz Christiane , Gerdes Kenn , Macek Boris
Published: August 2021

While bactericidal antibiotics typically require actively growing cells to exploit their function, persister cells are slowly replicating which makes them tolerant to the lethal action of antimicrobials. Here, we used an established
in vitro
model of bacterial persistence based on overexpression of the paradigm toxin-antitoxin (TA) system
hipA
/
hipB
to devise a generic method for temporal analysis of protein synthesis during toxin-induced persistence and antitoxin-mediated resuscitation.
The Future of (Soil) Microbiome Studies: Current Limitations, Integration, and Perspectives
Authors: Geisen Stefan
Published: August 2021

Microbes dominate the planet’s biodiversity in terms of species number and by driving essential Earth system functions such as the carbon cycle. Soils contain most of this microbial biodiversity.
Enhanced Biosynthesis of Fatty Acids Is Associated with the Acquisition of Ciprofloxacin Resistance in Edwardsiella tarda
Authors: Su Yu-bin , Kuang Su-fang , Ye Jin-zhou , Tao Jian-jun , Li Hui , Peng Xuan-xian , Peng Bo
Published: August 2021

Edwardsiella tarda
is the causative agent of edwardsiellosis, which imposes huge challenges on clinics and aquaculture. Due to the overuse of antibiotics, the emergence and spread of antibiotic-resistant
E. tarda
threaten human health and animal farming.
Horizontal Gene Transfer Is the Main Driver of Antimicrobial Resistance in Broiler Chicks Infected with Salmonella enterica Serovar Heidelberg
Authors: Oladeinde Adelumola , Abdo Zaid , Press Maximilian O. , Cook Kimberly , Cox Nelson A. , Zwirzitz Benjamin , Woyda Reed , Lakin Steven M. , Thomas Jesse C. , Looft Torey , Cosby Douglas E. , Hinton Arthur , Guard Jean , Line Eric , Rothrock Michael J. , Berrang Mark E. , Herrington Kyler , Zock Gregory , Plumblee Lawrence Jodie , Cudnik Denice , House Sandra , Ingram Kimberly , Lariscy Leah , Wagner Martin , Aggrey Samuel E. , Chai Lilong , Ritz Casey
Published: August 2021

The reported increase in antibiotic-resistant bacteria in humans has resulted in a major shift away from antibiotic use in food animal production. This shift has been driven by the assumption that removing antibiotics will select for antibiotic susceptible bacterial taxa, which in turn will allow the currently available antibiotic arsenal to be more effective.
Towards the Characterization and Engineering of Bacteriophages in the Gut Microbiome
Authors: Hsu Bryan B.
Published: August 2021

The gut microbiome and its importance to human health are a rapidly evolving area of study. Bacteria often take center stage.
Comprehensive Wet-Bench and Bioinformatics Workflow for Complex Microbiota Using Oxford Nanopore Technologies
Authors: Ammer-Herrmenau Christoph , Pfisterer Nina , van den Berg Tim , Gavrilova Ivana , Amanzada Ahmad , Singh Shiv K. , Khalil Alaa , Alili Rohia , Belda Eugeni , Clement Karine , Abd El Wahed Ahmed , Gady ElSagad Eltayeb , Haubrock Martin , Beißbarth Tim , Ellenrieder Volker , Neesse Albrecht
Published: August 2021

Advanced microbiome analysis relies on sequencing of short DNA fragments from microorganisms like bacteria, fungi, and viruses. More recently, long fragment DNA sequencing of 3rd generation sequencing has gained increasing importance and can be rapidly conducted within a few hours due to its potential real-time sequencing.
Emergence of Caenorhabditis elegans as a Model Organism for Dissecting the Gut–Brain Axis
Authors: Ortiz de Ora Lizett , Bess Elizabeth N.
Published: August 2021

Accumulating evidence links the gut microbiome to neuronal functions in the brain. Given the increasing prevalence of brain disorders, there is a critical need to understand how gut microbes impact neuronal functions so that targeted therapeutic interventions can be developed.
Evolving Interactions and Emergent Functions in Microbial Consortia
Authors: Rodríguez-Verdugo Alejandra
Published: August 2021

Microbial communities are constantly challenged with environmental stressors, such as antimicrobials, pollutants, and global warming. How do they respond to these changes? Answering this question is crucial given that microbial communities perform essential functions for life on Earth.
The Tempo and Mode of Adaptation in a Complex Natural Population: the Microbiome
Authors: Garud Nandita
Published: August 2021

Adaptation is a fundamental process by which populations evolve to grow more fit in their environments. Recent studies are starting to show us that commensal microbes can evolve on short timescales of days and months, suggesting that ecological changes are not the only means by which microbes in complex natural populations respond to selection pressures.
Transcriptional Profiling Reveals the Importance of RcrR in the Regulation of Multiple Sugar Transportation and Biofilm Formation in Streptococcus mutans
Authors: Gong Tao , He Xiaoya , Chen Jiamin , Tang Boyu , Zheng Ting , Jing Meiling , Lin Yongwang , Pan Yangyang , Ma Qizhao , Li Yuqing , Zhou Xuedong
Published: August 2021

The human oral cavity is a constantly changing environment. Tooth decay is a commonly prevalent chronic disease mainly caused by the cariogenic bacterium
Streptococcus mutans
.
S. mutans
is an oral pathogen that metabolizes various carbohydrates into extracellular polysaccharides (EPSs), biofilm, and tooth-destroying lactic acid.
A Combinatorial Approach of High-Throughput Genomics and Mass Proteomics for Understanding the Regulation and Expression of Secondary Metabolite Production in Actinobacteria
Authors: Gupta Vipin , Singhvi Nirjara
Published: August 2021

Secondary metabolites produced by
Actinobacteria
are an important source of antibiotics, drugs, and antimicrobial peptides. However, the large genome size of actinobacteria with high gene coding density makes it difficult to understand the complex regulation of biosynthesis of such critically and economically important products.
Supplemental Material: Fluid inclusion evidence for the magmatic-hydrothermal evolution of closely linked porphyry Au, porphyry Mo, and barren systems, East Qinling, China
Authors: Tang Li , al. et
Published: August 2021

Table S1: List of studied samples from the Qiyugou Au deposit, Leimengou Mo deposit, and Huashan barren pluton; Table S2: Petrography and microthermometry data of fluid inclusion assemblages; Table S3. Average elemental concentrations (µg/g) of fluid inclusion assemblages.
Effect of P2O5 Impurities and Fluoride Ions on The Rheological Properties of Porous Glasses and Bismuth-Containing Composites Based on Them
Authors: Antropova T. V. , Stolyar S. V. , Anfimova I. N. , Girsova M. A.
Published: August 2021

The results of a study of the rheological properties (shrinkage on heating, viscosity) of porous glasses (PGs) obtained as a result of through acid leaching of two-phase sodium borosilicate glass doped with small additives of P2O5 and fluoride ions, as well as bismuth-containing PGs and quartzoid glasses based on them, depending on the temperature of the heat treatment of the PG and in comparison with the characteristics of the samples obtained from sodium borosilicate glass without additives, are presented. It is found that doping glass with the indicated impurities leads to a decrease in the thermal resistance of the obtained PGs and bismuth-containing PGs. The introduction of bismuth nitrate into PG in the case of the low-temperature treatment (at 120°C) lowers the temperature for the same viscosity values of quartzoid glasses by 15–20°C, in contrast to samples without additives, as well as from higher-temperature treatment (at 650°C) PGs with additives.
Multiple systemic paradoxical embolisation of a lower limb deep vein thrombosis due to interatrial septal puncture: a rare complication of left atrial appendage occlusion
Authors: Millar Kevin Patrick , Gallen Rory , Ullah Ihsan , Arnous Samer
Published: August 2021

A 75-year-old woman with a history of intracranial haemorrhage, atrial fibrillation and coronary artery bypass graft underwent elective left atrial appendage occlusion (LAAO) for stroke prevention. The procedure was successful, however on the third postoperative day, she presented with a lymph leak at the right femoral venous access site. She was admitted for conservative management of the lymph leak with immobility and intravenous fluids. Her inpatient stay was complicated by a right lower limb deep vein thrombosis (DVT), left middle cerebral artery territory ischaemic stroke, pulmonary emboli (PEs) and a splenic infarction. The mechanism of the systemic emboli was that of paradoxical emboli from the DVT passing through an interatrial septal defect created as part of the LAAO procedure, a previously unreported complication of LAAO. She was managed with 6 months of low-dose oral anticoagulation for treatment of DVT and PE and has made a full neurological recovery.
Rare case of traumatic bilateral testicular dislocation
Authors: Naik Mude Naveen , Shaikh Oseen Hajilal , Vijayakumar Chellappa , Kumbhar Uday Shamrao
Published: August 2021

Bilateral traumatic testicular dislocation is an uncommon condition and usually occurs after a direct impact on the scrotum. Herein, we report this as a rare case of a 21-year-old man presenting with bilateral traumatic dislocation of testes into the inguinal canal following a motorcycle accident. Imaging studies ruled out any other associated injuries. The patient underwent bilateral orchidopexy without any further complications.
Trousseau’s syndrome associated with an ovarian borderline tumour
Authors: Betsuyaku Tsubasa , Nishizawa Toshinori , Higuchi Naofumi , Misaka Satoki
Published: August 2021

A 71-year-old woman was admitted to our hospital because of sudden onset of weakness on the left side of her body. Her medical history was unremarkable, and on physical examination, hemiparesis and hyperreflexia on the left side were found. MRI of the brain showed multiple areas of restricted diffusion in both parietal lobes and in the cerebellum, consistent with embolic shower. Magnetic resonance angiography showed no abnormal findings. A contrast-enhanced CT scan revealed multiple pulmonary emboli. Abdominal MRI showed a 135 mm left ovarian tumour composed of a solid and a cystic component with liquid level formation. After a total hysterectomy and bilateral adnexectomy, the histopathology confirmed a seromucinous borderline tumour. Therefore, the patient was diagnosed with Trousseau’s syndrome associated with an ovarian seromucinous borderline tumour. To our knowledge, this is the first report mentioning a borderline ovarian tumour detected as Trousseau’s syndrome.
Economic evaluation of covered stents for transjugular intrahepatic portosystemic stent shunt in patients with variceal bleeding and refractory ascites secondary to cirrhosis
Authors: Mattock Richard , Tripathi Dhiraj , O'Neill Frank , Craig Joyce , Tanner Jennifer , Patch David , Aithal Guruprasad
Published: August 2021

Objectives

Transjugular intrahepatic portosystemic stent shunt (TIPSS) is clinically effective in variceal bleeding and refractory ascites; however, the cost-effectiveness of TIPSS has yet to be evaluated in the UK. This study aimed to establish the cost-effectiveness of (i) pre-emptive TIPSS versus endoscopic band ligation (EBL) in populations with variceal bleeding and (ii) TIPSS versus large volume paracentesis (LVP) in refractory ascites.

Methods

A cost-utility analysis was conducted with the perspective including healthcare costs and quality-adjusted life years (QALYs). A Markov model was constructed with a 2-year time horizon, health states for mortality and survival and probabilities for the development of variceal bleeding, ascites and hepatic encephalopathy. A survival analysis was conducted to extrapolate 12-month to 24-month mortality for the refractory ascites indication. Uncertainty was analysed in deterministic and probabilistic sensitivity analyses.

Results

TIPSS was cost-effective (dominant) and cost saving for both indications. For variceal bleeding, pre-emptive TIPSS resulted in 0.209 additional QALYs, and saved £600 per patient compared with EBL. TIPSS had a very high probability of being cost-effective (95%) but was not cost saving in scenario analyses driven by rates of variceal rebleeding. For refractory ascites, TIPSS resulted in 0.526 additional QALYs and saved £17 983 per patient and had a 100% probability of being cost-effective and cost saving when compared with LVP.

Conclusions

TIPSS is a cost-effective intervention for variceal bleeding and refractory ascites. TIPSS is highly cost-saving for refractory ascites. Robust randomised trial data are required to confirm whether pre-emptive TIPSS is cost saving for variceal bleeding.
Intimate partner violence (IPV) in male and female orthopaedic trauma patients: a multicentre, cross-sectional prevalence study
Authors: Downie Samantha , Kanya Iuliana , Madden Kim , Bhandari Mohit , Jariwala Arpit C
Published: August 2021

Objectives

Identify the proportion of patients attending fracture clinics who had suffered intimate partner violence (IPV) within the past year.

Design

Powered cross-sectional study using validated participant self-reported questionnaires.

Setting and participants

Adult trauma patients (no gender/age exclusions) attending one of three Scottish adult fracture clinics over 16-month period (from October 2016 to January 2018).

Primary outcome measure

Number of participants answering ‘yes’ to the Woman Abuse Screening Tool question: ‘In your current relationship over the past twelve months, has your partner ever abused you physically/emotionally/sexually?’

Results

Of 336 respondents, 46% (156/336 known) were women with 65% aged over 40 (212/328 known). The overall prevalence of IPV within the preceding 12 months was 12% 39/336) for both male and female patients. The lifetime prevalence of IPV among respondents was 20% (68/336). 38% of patients who had experienced IPV within the past 12 months had been physically abused (11/29). None of the patients were being seen for an injury caused by abuse. Two-thirds of respondents thought that staff should ask routinely about IPV (55%, 217/336), but only 5% had previously been asked about abuse (18/336).

Conclusions

This is the first study worldwide investigating the prevalence of IPV in fracture clinics for both male and female patients. 12-month prevalence of IPV in fracture clinic patients is significant and not affected by gender in this study. Patients appear willing to disclose abuse within this setting and are supportive of staff asking about abuse. This presents an opportunity to identify those at risk within this vulnerable population.
Comparison of ultrasound-guided anterior quadratus lumborum block at the lateral supra-arcuate ligament with posterior quadratus lumborum block for perioperative analgesia in laparoscopic nephrectomy: a protocol for a randomised, prospective, parallel group, non-inferior trial
Authors: Huang Xiao , Sun Yuan , Shi Rong , Ma Danxu , Wu Anshi , Wang Yun , Yang Yinan
Published: August 2021

Objective

Anterior quadratus lumborum block at the lateral supra-arcuate ligament (QLBA) is a new method for postoperative pain relief in patients undergoing abdominal surgery. Perioperative QLBA is effective, but it has not been compared with posterior quadratus lumborum block (QLB2). The present study aims to evaluate the postoperative pain of patients undergoing laparoscopic nephrectomy surgery with QLBA versus QLB2.

Methods/design

This study is a randomised, prospective, parallel group, non-inferior trial. All patients undergoing laparoscopic nephrectomy surgery will be randomised 1:1 to the QLBA group or the QLB2 group with general anaesthesia. The objective of the trial is to evaluate the postoperative pain of patients undergoing laparoscopic nephrectomy surgery with QLBA (n=50) versus QLB2 (n=50). The primary outcome for this trial is the Visual Analogue Scale scores at rest and activity (dynamic pain scores are assessed with a cough or a trial to sit up in bed) 2 hours after surgery between patients who receive QLBA versus QLB2. The secondary objectives will be to compare (1) pain at rest and activity 0.5 hour, 2 hours, 24 hours, 48 hours after surgery; (2) the time spent on block operation; (3) the blocked dermatomal coverage 5 min and 15 min after block operation; (4) intraoperative opioid consumption; (5) types and doses of the rescue analgesic after surgery; (6) nausea and vomiting score within 24 hours after surgery; (7) time from the end of surgery to the first onset significant pain; (8) patient satisfaction score.

Discussion

Clinical experience has supported that QLB is a very effective postoperative analgesic method, and we will answer the following questions in this trial: Will both approaches have the same analgesic effect and duration? Will the QLBA have a non-inferior postoperative analgesic effect compared with QLB2 or the QLBA be able to prolong the duration of analgesia after surgery? The results of this study could have actual clinical applications that could help to reduce postoperative pain and shorten hospital stays.

Ethics and dissemination

The study design was approved by the ethical committee of Beijing Chao-Yang Hospital, Beijing, China (2020-ke-321). The trial results will be published in peer-reviewed journals and at conferences.

Trial registration number

ChiCTR2000035354.
How many infants may have died in low-income and middle-income countries in 2020 due to the economic contraction accompanying the COVID-19 pandemic? Mortality projections based on forecasted declines in economic growth
Authors: Shapira Gil , de Walque Damien , Friedman Jed
Published: August 2021

Objectives

While COVID-19 has a relatively small direct impact on infant mortality, the pandemic is expected to indirectly increase mortality of this vulnerable group in low-income and middle-income countries through its effects on the economy and health system performance. Previous studies projected indirect mortality by modelling how hypothesised disruptions in health services will affect health outcomes. We provide alternative projections, relying on modelling the relationship between aggregate income shocks and mortality.

Design

We construct a sample of 5.2 million births by pooling retrospective birth histories reported by women in Demographic and Health Surveys conducted in 83 low-income and middle-income countries between 1985 and 2018. We employ regression models with country-specific fixed-effects and flexible time trends to estimate the impact of gross domestic product per capita on infant mortality rate. We then use growth projections by the International Monetary Fund to predict the effect of the economic downturn in 2020 on infant mortality.

Results

We estimate 267 208 (95% CI 112 000 to 422 415) excess infant deaths in 128 countries, corresponding to a 6.8% (95% CI 2.8% to 10.7%) increase in the total number of infant deaths expected in 2020.

Conclusions

The findings underscore the vulnerability of infants to the negative income shocks such as those imposed by the COVID-19 pandemic. While efforts towards prevention and treatment of COVID-19 remain paramount, the global community should also strengthen social safety nets and assure continuity of essential health services.
Risk events during intrahospital transport of patients from the emergency department: a prospective observational study
Authors: Neal-Williams Tom , Walker Kimberly , Lines Travis , Ugoni Antony , Taylor David McDonald
Published: August 2021

Background

We aimed to determine the incidence, nature of and predisposing factors for risk events (REs) that occur during the intrahospital transport of patients from the ED.

Methods

We undertook a prospective, observational study of intrahospital patient transports from a single ED between 30 January and 20 March 2020. An investigator attended each transport and recorded any RE on a specifically designed data collection document. An RE was any mishap, even if not foreseen, that had the potential to cause the patient harm. A patient equipment number was assigned based on the number of pieces of equipment required during the transport. Poisson regression generated incidence rate ratios (IRRs) and determined risk factors for REs.

Results

Of 738 transports, 289 (39.1%, 95% CI 35.6% to 42.8%) had at least one RE. The total of 521 REs comprised 125 patient-related, 279 device-related and 117 line/catheter-related REs. The most common included trolley collisions (n=142), intravenous fluid line catching/tangling (n=93), agitation/aggression events (n=31) and cardiac monitoring issues (n=31). Thirty-four (6.5%) REs resulted in an undesirable patient outcome, most commonly distress and pain. Predisposing factors for REs included an equipment number ≥3 (IRR 5.68, 95% CI 3.95 to 8.17), transport to a general ward (IRR 2.68, 95% CI 2.12 to 3.39), hypertension (IRR 1.93, 95% CI 1.07 to 3.50), an abnormal temperature and a GCS<14.

Conclusions

REs are common in transport of patients from the ED and can result in undesirable patient outcomes. Adequate pre-transfer preparation, especially securing equipment and lines, would result in a reduced risk.
Early toxicity and clinical outcomes after chimeric antigen receptor T-cell (CAR-T) therapy for lymphoma
Authors: Brammer Jonathan E , Braunstein Zachary , Katapadi Aashish , Porter Kyle , Biersmith Michael , Guha Avirup , Vasu Sumithira , Yildiz Vedat O , Smith Sakima A , Buck Benjamin , Haddad Devin , Gumina Richard , William Basem M , Penza Sam , Saad Ayman , Denlinger Nathan , Vallakati Ajay , Baliga Ragavendra , Benza Raymond , Binkley Philip , Wei Lai , Mocarski Mason , Devine Steven M , Jaglowski Samantha , Addison Daniel
Published: August 2021

Background

Chimeric antigen receptor T-cell (CAR-T) infusion is associated with early toxicity. Yet, whether early toxicity development holds ramifications for long-term outcomes is unknown.

Methods

From a large cohort of consecutive adult patients treated with CAR-T therapies for relapsed or refractory lymphomas from 2016 to 2019, we assessed progression-free survival (PFS), by toxicity development (cytokine release syndrome (CRS), neurotoxicity, or cardiotoxicity]. We also assessed the relationship of toxicity development to objective disease response, and overall survival (OS). Multivariable regression was utilized to evaluate relationships between standard clinical and laboratory measures and disease outcomes. Differences in outcomes, by toxicity status, were also assessed via 30-day landmark analysis. Furthermore, we assessed the effects of early anti-CRS toxicity therapy use (at ≤grade 2 toxicity) on maximum toxicity grade observed, and long-term disease outcomes (PFS and OS).

Results

Overall, from 102 CAR-T-treated patients, 90 were identified as treated with single-agent therapy, of which 88.9% developed toxicity (80 CRS, 41 neurotoxicity, and 17 cardiotoxicity), including 28.9% with high-grade (≥3) events. The most common manifestations were hypotension at 96.6% and fever at 94.8%. Among patients with cardiac events, there was a non-significant trend toward a higher prevalence of concurrent or preceding high-grade (≥3) CRS. 50.0% required tocilizumab or corticosteroids. The median time to toxicity was 3 days; high grade CRS development was associated with cardiac and neurotoxicity. In multivariable regression, accounting for disease severity and traditional predictors of disease response, moderate (maximum grade 2) CRS development was associated with higher complete response at 1 year (HR: 2.34; p=0.07), and longer PFS (HR: 0.41; p=0.02, in landmark analysis), and OS (HR: 0.43; p=0.03). Among those with CRS, relative blood pressure (HR: 2.25; p=0.004), respectively, also associated with improved PFS. There was no difference in disease outcomes, or maximum toxicity grade (CRS, neurotoxicity, or cardiotoxicity) observed, based on the presence or absence of the use of early CRS-directed therapies.

Conclusions

Among adult lymphoma patients, moderate toxicity manifest as grade 2 CRS after CAR-T infusion may associate with favorable clinical outcomes. Further studies are needed to confirm these findings.
Development of a lupus nephritis suboptimal response prediction tool using renal histopathological and clinical laboratory variables at the time of diagnosis
Authors: Helget Lindsay N , Dillon David J , Wolf Bethany , Parks Laura P , Self Sally E , Bruner Evelyn T , Oates Evan E , Oates Jim C
Published: August 2021

Objective

Lupus nephritis (LN) is an immune complex-mediated glomerular and tubulointerstitial disease in patients with SLE. Prediction of outcomes at the onset of LN diagnosis can guide decisions regarding intensity of monitoring and therapy for treatment success. Currently, no machine learning model of outcomes exists. Several outcomes modelling works have used univariate or linear modelling but were limited by the disease heterogeneity. We hypothesised that a combination of renal pathology results and routine clinical laboratory data could be used to develop and to cross-validate a clinically meaningful machine learning early decision support tool that predicts LN outcomes at approximately 1 year.

Methods

To address this hypothesis, patients with LN from a prospective longitudinal registry at the Medical University of South Carolina enrolled between 2003 and 2017 were identified if they had renal biopsies with International Society of Nephrology/Renal Pathology Society pathological classification. Clinical laboratory values at the time of diagnosis and outcome variables at approximately 1 year were recorded. Machine learning models were developed and cross-validated to predict suboptimal response.

Results

Five machine learning models predicted suboptimal response status in 10 times cross-validation with receiver operating characteristics area under the curve values >0.78. The most predictive variables were interstitial inflammation, interstitial fibrosis, activity score and chronicity score from renal pathology and urine protein-to-creatinine ratio, white blood cell count and haemoglobin from the clinical laboratories. A web-based tool was created for clinicians to enter these baseline clinical laboratory and histopathology variables to produce a probability score of suboptimal response.

Conclusion

Given the heterogeneity of disease presentation in LN, it is important that risk prediction models incorporate several data elements. This report provides for the first time a clinical proof-of-concept tool that uses the five most predictive models and simplifies understanding of them through a web-based application.
Petrogenesis and mode of emplacement of a Neoarchean tonalite–trondhjemite–diorite suite: the Eau Jaune Complex, Abitibi greenstone belt
Authors: Kieffer Marie A. , Mathieu Lucie , Bedeaux Pierre , Gaboury Damien , Hamilton Michael A.
Published: August 2021

Magmatism during the maturation phase of Archean greenstone belts produced voluminous tonalite–trondhjemite–granodiorite (TTG) suites, as well as a lesser amount of tonalite–trondhjemite–diorite (TTD) suites. Such TTD suites have recently been recognized in the Archean Abitibi greenstone belt, on the southern flank of the Superior Craton, Canada, but their source(s), differentiation processes, and depths of emplacement remain poorly constrained. The Neoarchean Eau Jaune Complex lies in the northeastern corner of the Abitibi greenstone belt and represents one of the most voluminous tonalite-dominated and diorite-bearing intrusive suites of the Chibougamau region. This TTD suite comprises six intrusive phases with distinct petrology and chemistry. All units were emplaced as laccolith-like intrusions injected along discontinuities within the volcanic succession at ca. 2724 Ma (U–Pb zircon dating), during the synvolcanic interval (i.e., construction and maturation phase), at a depth of approximately 7–8 km. The most heavy rare-earth element (HREE)-depleted phases (granodiorite, tonalite, and trondhjemite) correspond to magmas that fractionated amphibole and were likely produced by partial melting of a garnet- and titanate-bearing amphibolite, akin to TTG magmas. The least HREE-depleted phases are dioritic in composition and correspond to mantle-derived magmas that may have interacted with TTG melts. This indicates interaction between coeval mantle-derived and crustal melts during the maturation phase of the Abitibi greenstone belt. Models formulated to address the geodynamic evolution of greenstone belts must account for the coeval production of basalt-derived (TTG suites) and mantle-derived (tholeiitic magmatism) melts occasionally interacting to form TTD suites.
A biased MC for muon production for beam-dump experiments
Authors: Ghinescu Stefan , Döbrich Babette , Minucci Elisa , Spadaro Tommaso
Published: August 2021

The search for feebly-interacting new-physics particles in the MeV-GeV mass range often involves high-intensity beams dumped into thick heavy targets. The challenge of evaluating the expected backgrounds for these searches from first principles is limited by the CPU time needed to generate the shower induced by the primary beam. We present a Monte Carlo biasing method allowing a three orders of magnitude increase in the efficiency for the simulation of the muon production in a 400 GeV/c proton beam-dump setup. At the same time, this biasing method is maintaining nearly every feature of a simulation from first principles.