bluuebunny/crossref_metadata_2025 huggingface dataset:
Pattern-of-failure and salvage treatment analysis after chemoradiotherapy for inoperable stage III non-small cell lung cancer
Authors: Taugner Julian , Eze Chukwuka , Käsmann Lukas , Roengvoraphoj Olarn , Gennen Kathrin , Karin Monika , Petrukhnov Oleg , Tufman Amanda , Belka Claus , Manapov Farkhad
Published: June 2020

Background

Loco-regional and distant failure are common in inoperable stage III non small-cell lung cancer (NSCLC) after chemoradiotherapy (CRT). However, there is limited real-world data on failure pattern, patient prognosis and salvage options.

Methods

We analysed 99 consecutive patients with inoperable stage III NSCLC treated with CRT between 2011 and 2016. Follow up CT scans from date of the first-site failure were matched with the delivered radiation treatment plans. Intra-thoracic loco-regional relapse was defined as in-field (IFR) vs. out-of-field recurrence (OFR) [in- vs. outside 50Gy isodose line in the involved lung], respectively. Extracranial distant (DMs) and brain metastases (BMs) as first site of recurrence were also evaluated. Using the Kaplan-Meier method, impact of salvage surgery (sS), radiotherapy (sRT), chemotherapy (sCT) and immunotherapy (sIO) on patient survival was assessed.

Results

Median follow-up was 60.0 months. Median PFS from the end of CRT for the entire cohort was 7.5 (95% CI: 6.0–9.0 months) months. Twenty-six (26%) and 25 (25%) patients developed IFR and OFR. Median time to diagnosis of IFR and OFR was 7.2 and 6.2 months. In the entire cohort, onset of IFR and OFR did not influence patient outcome. However, in 73 (74%) patients who survived longer than 12 months after initial diagnosis, IFR was a significant negative prognostic factor with a median survival of 19.3 vs 40.0 months (p < 0.001). No patients with IFR underwent sS and/or sRT. 18 (70%) and 5 (19%) patients with IFR underwent sCT and sIO. Three (12%) patients with OFR underwent sS and are still alive with 3-year survival rate of 100%. 5 (20%) patients with OFR underwent sRT with a median survival of 71.2 vs 19.1 months (p = 0.014). Four (16%) patients with OFR received sIO with a numerical survival benefit (64.6 vs. 26.4 months, p = 0.222).

DMs and BMs were detected in 27 (27%) and 16 (16%) patients after median time of 5.8 and 5.13 months. Both had no impact on patient outcome in the entire cohort. However, patients with more than three BMs showed significantly poor OS (9.3 vs 26.0 months; p = 0.012).

Conclusions

After completion of CRT, IFR was a negative prognostic factor in those patients, who survived longer than 12 months after initial diagnosis. Patients with OFR benefit significantly from salvage local treatment. Patients with more than three BMs as first site of failure had a significantly inferior outcome.
Modified algorithm for managing postoperative osteomyelitis following fracture fixation with Cierny-Mader type
Authors: Tan Yanbin , Li Hang , Pan Zhijun , Zheng Qiang
Published: June 2020

Background

No standardized protocol has been suggested in the treatment of postoperative osteomyelitis following fracture fixation. Our team evaluates the clinical efficacy of the modified algorithm for managing postoperative osteomyelitis following fracture fixation with Cierny–Mader type.

Methods

Ninety-five wounds were reviewed from March 2009 to February 2016 in our hospital. Sixty-one wounds were treated by the modified algorithm as follows: stable hardware + bone not healed Cierny–Mader 1 type = remove hardware, temporary stabilize; stable hardware + bone not healed Cierny–Mader 2 type = retain hardware ; stable hardware + bone not healed Cierny–Mader for type 3 and type 4 = remove hardware, temporary stabilize/Ilizarov technique; unstable hardware + bone not healed = remove hardware, temporary stabilize/Ilizarov technique; and stable hardware + bone healed = remove hardware. Thirty-four wounds were treated by the conventional algorithm. Autodermoplasty, flap transfer, myocutaneous flap, and other methods including antibiotic irrigation and drug delivery system were used in wound repair.

Results

The patients treated with modified algorithm had a significantly reduced recurrence (P < 0.01) and increased results of negative bacterial cultures (P < 0.01); however, a decrease in the number of retained hardware cases was observed (P < 0.05). For those treated with tissue reconstruction, there was no significance (P > 0.05) compared with the conventional group.

Conclusions

The modified algorithm for the postoperative osteomyelitis following fracture fixation according to the stability of the hardware and Cierny–Mader type represents a good clinical efficacy in the management of postoperative osteomyelitis. This procedure is simple and shows promising results; more clinical evidence is needed to confirm the existing findings and optimize the treatment of postoperative osteomyelitis following fracture fixation.
Racial differences in CD8+ T cell infiltration in breast tumors from Black and White women
Authors: Abdou Yara , Attwood Kristopher , Cheng Ting-Yuan David , Yao Song , Bandera Elisa V. , Zirpoli Gary R. , Ondracek Rochelle Payne , Stein Leighton , Bshara Wiam , Khoury Thaer , Ambrosone Christine B. , Omilian Angela R.
Published: June 2020

Background

African American/Black women with breast cancer have poorer survival than White women, and this disparity persists even after adjusting for non-biological factors. Differences in tumor immune biology have been reported between Black and White women, and the tumor immune milieu could potentially drive racial differences in breast cancer etiology and outcome.

Methods

We examined the association of CD8+ cytotoxic T cells with clinical-pathological variables in the Women’s Circle of Health Study (WCHS) population of predominantly Black breast cancer patients. We evaluated 688 invasive breast tumor samples (550 Black, 138 White) using immunohistochemical staining of tissue microarray slides. CD8+ T cells were scored for each patient tumor sample with digital image analysis.

Results

Black women had a significantly higher percentage of high-grade, estrogen receptor (ER)-negative, and triple-negative tumors than White women and significantly higher CD8+ T cell density (median 87.6/mm2 vs. 53.1/mm2; p < 0.001). Within the overall population and in the population of Black women only, CD8+ T cell density was significantly higher in younger patients and patients with high-grade and ER/PR-negative tumors. No significant associations were observed between CD8+ T cell density and overall survival or breast cancer-specific survival in the overall population, or when Black patients were analyzed as a separate group. However, when stratified by subtype, Black women with triple-negative breast cancer and high CD8+ T cell density showed a trend towards better overall survival in comparison with patients with low CD8+ T cell density (HR = 0.51; 95% CI 0.25–1.04).

Conclusions

Our data raise the possibility that distinct mechanisms of immune cell action may occur in different racial groups.
Implementing self-management: a mixed methods study of women’s experiences of a postpartum hypertension intervention (SNAP-HT)
Authors: Cairns Alexandra E. , Tucker Katherine L. , Crawford Carole , McManus Richard J. , Powell John
Published: June 2020

Background

Self-management strategies are effective in a number of medical conditions; however, implementation studies have demonstrated adoption into clinical practice can be problematic. The process of implementation was explored during a pilot randomised controlled trial evaluating postpartum blood pressure self-management in women with medicated hypertensive disorders of pregnancy.

Methods

A mixed methods study using semi-structured interviews with a qualitative and a scored (quantitative) component were undertaken as part of a pilot randomised controlled trial (SNAP-HT) in postnatal women with medicated gestational hypertension or pre-eclampsia. Women were randomised to usual care or blood pressure self-management. Self-management entailed daily home blood pressure monitoring and automated medication reduction via telemonitoring. Women from both groups optionally consented to participate in audio-recorded interviews at 4 weeks and 6 months postpartum. Interview questions were developed to explore the proposed benefits of self-management and the constructs of normalisation process theory. Participants provided a score (Likert scale 1–5) for each question and were encouraged to expand upon these answers through further discussion. The interviews were transcribed and analysed using the framework approach.

Results

Sixty-eight women, 34 from each randomised group, completed at least one audio-recorded interview. Several overarching themes emerged from analysis of 126 interview transcripts: control; convenience; confidence, communication and knowledge; concern; constraints; and components of the intervention. In the scored component of the analysis, both groups reported feeling more in control of their condition postpartum compared to during pregnancy, more so in those self-managing at both 4 weeks and 6 months: adjusted differences 0.6 (95% confidence interval [CI] 0.2 to 1.1) and 0.7 (95% CI 0.3 to 1.2) respectively.

Conclusions

Interviews and quantitative data showed that self-management enhanced women’s sense of control and improved their blood pressure-related anxiety. Prior to taking part, a few women anticipated that home monitoring might increase anxiety, but stated that it had the opposite effect. Self-management was perceived as more flexible and reactive and as enabling more targeted down-titration of medication. These data provide considerable support for blood pressure self-management postpartum and reinforce the effectiveness of the intervention used in this study.

Trial registration

ClinicalTrials.gov: NCT02333240. Prospectively registered on 7 January 2015.
Correction to: Upadacitinib improves patient-reported outcomes in patients with rheumatoid arthritis and inadequate response to conventional synthetic disease-modifying antirheumatic drugs: results from SELECT-NEXT
Authors: Strand Vibeke , Pope Janet , Tundia Namita , Friedman Alan , Camp Heidi S. , Pangan Aileen , Ganguli Arijit , Fuldeore Mahesh , Goldschmidt Debbie , Schiff Michael
Published: June 2020

An amendment to this paper has been published and can be accessed via the original article.
BTB/POZ zinc finger protein ZBTB16 inhibits breast cancer proliferation and metastasis through upregulating ZBTB28 and antagonizing BCL6/ZBTB27
Authors: He Jin , Wu Mingjun , Xiong Lei , Gong Yijia , Yu Renjie , Peng Weiyan , Li Lili , Li Li , Tian Shaorong , Wang Yan , Tao Qian , Xiang Tingxiu
Published: June 2020

Background

Breast cancer remains in urgent need of reliable diagnostic and prognostic markers. Zinc finger and BTB/POZ domain-containing family proteins (ZBTBs) are important transcription factors functioning as oncogenes or tumor suppressors. The role and regulation of ZBTB16 in breast cancer remain to be established.

Methods

Reverse-transcription PCR and methylation-specific PCR were applied to detect expression and methylation ofZBTB16in breast cancer cell lines and tissues. The effects of ZBTB16 in breast cancer cells were examined via cell viability, CCK8, Transwell, colony formation, and flow cytometric assays. Xenografts and immunohistochemistry analyses were conducted to determine the effects of ZBTB16 on tumorigenesis in vivo. The specific mechanisms of ZBTB16 were further investigated using Western blot, qRT-PCR, luciferase assay, and co-IP.

Results

ZBTB16was frequently downregulated in breast cancer cell lines in correlation with its promoter CpG methylation status. Restoration of ZBTB16 expression led to induction of G2/M phase arrest and apoptosis, inhibition of migration and invasion, reversal of EMT, and suppression of cell proliferation, both in vitro and in vivo. Furthermore, ectopically expressed ZBTB16 formed heterodimers with ZBTB28 or BCL6/ZBTB27 and exerted tumor suppressor effects through upregulation of ZBTB28 and antagonistic activity on BCL6.

Conclusions

Low expression ofZBTB16is associated with its promoter hypermethylation and restoration of ZBTB16 inhibits tumorigenesis. ZBTB16 functions as a tumor suppressor through upregulating ZBTB28 and antagonizing BCL6. Our findings also support the possibility of ZBTB16 being a prognostic biomarker for breast cancer.
A cost-effectiveness analysis model of Preventicus atrial fibrillation screening from the point of view of statutory health insurance in Germany
Authors: Birkemeyer Ralf , Müller Alfred , Wahler Steffen , von der Schulenburg Johann-Matthias
Published: June 2020

Background

With atrial fibrillation (AF) the risk of stroke is 4.2-fold increased to a comparable population without AF. This risk decreases by up to 70% if AF is detected early enough and effective stroke preventive measures are taken as recommended by international guidelines. Long-term studies found large number of subjects with undiagnosed AF. Preventicus Heartbeats” is a hands-on screening tool for use on smartphone to diagnose AF with high sensitivity and specificity. The aim of this study is to research the cost-effectiveness of systematic screening for AF with this smartphone application.

Method

Employing a Markov model we analysed the cost-effectiveness of the “Preventicus Heartbeats” screening for Germany, i.e. from the perspective of German statutory sick funds.

Results

For a cohort of 10,000 insured 75-year-old the use of the diagnostic app could avoid 60 strokes in the remaining lifetime thereof 32 strokes in the next four years. Former models have applied similar cohorts. The same cohort showed an increase in quality-adjusted life years (QALY) in the remaining lifetime of 165 QALYs in the scenario with screening versus.

without screening and a decrease in discounted lifetime costs (including risk compensation effects) of €129 per participant (€148 for male, €114 for female participants).

Conclusions

The modelling demonstrates the health benefits and economic effects of an implementation of a systematic screening on AF with “Preventicus Heartbeats”, given the perspective of the German payer, the statutory health care system.
Existence of infinitely many solutions for a p-Kirchhoff problem in RN
Authors: Xiu Zonghu , Zhao Jing , Chen Jianyi
Published: June 2020

We consider the existence of multiple solutions of the following singular nonlocal elliptic problem: $$\begin{aligned} \textstyle\begin{cases} -M(\int _{\mathbb{R} ^{N}}{ \vert x \vert ^{-ap} \vert \nabla u \vert ^{p}})\operatorname{div}( \vert x \vert ^{-ap} \vert \nabla u \vert ^{p-2}\nabla u)= h(x) \vert u \vert ^{r-2}u+H(x) \vert u \vert ^{q-2}u, \\ u(x)\rightarrow 0 \quad \text{as } \vert x \vert \rightarrow \infty , \end{cases}\displaystyle \end{aligned}$$ {−M(∫RN|x|−ap|∇u|p)div(|x|−ap|∇u|p−2∇u)=h(x)|u|r−2u+H(x)|u|q−2u,u(x)→0as |x|→∞, where $x\in \mathbb{R} ^{N}$x∈RN, and $M(t)=\alpha +\beta t$M(t)=α+βt. By the variational method we prove that the problem has infinitely many solutions when some conditions are fulfilled.
p-Adic integral on $\mathbb{Z}_{p}$ associated with degenerate Bernoulli polynomials of the second kind
Authors: Jang Lee-Chae , Kim Dae San , Kim Taekyun , Lee Hyunseok
Published: June 2020

In this paper, by means of p-adic Volkenborn integrals we introduce and study two different degenerate versions of Bernoulli polynomials of the second kind, namely partially and fully degenerate Bernoulli polynomials of the second kind, and also their higher-order versions. We derive several explicit expressions of those polynomials and various identities involving them.
Nonlocal boundary value problems for Hilfer-type pantograph fractional differential equations and inclusions
Authors: Wongcharoen Athasit , Ntouyas Sotiris K. , Tariboon Jessada
Published: June 2020

In this paper, we study boundary value problems, involving the Hilfer fractional derivative, for pantograph fractional differential equations and inclusions supplemented by nonlocal integral boundary conditions. Existence and uniqueness results are obtained by using well-known fixed point theorems for single and multi-valued functions. Examples illustrating our results are also presented.
Transitional fracture of the distal radius: a rare injury in adolescent athletes. Case series and literature review
Authors: Rauer Thomas , Pape Hans-Christoph , Gamble Jamison G. , Vitale Nicolo’ , Halvachizadeh Sascha , Allemann Florin
Published: June 2020

Background

Transitional fractures are fractures in adolescents where partial closure of the epiphyseal growth plate has occurred. These fractures are most commonly reported in the distal tibia. With respect to the distal radius, only a few case reports describing transitional fractures exist. Furthermore, relatively little is known about epiphyseal closure of the distal radius. A case series of four transitional fractures of the distal radius is presented by comparing non-operative and operative treatment options. At present, this is the largest case series in the literature dealing with this rare injury.

Case presentation

We present three cases of four transitional fractures of the distal radius including 1–year follow-up. Patient age ranged from 16 to 18 years including a gender ratio of two males to one female. Clinical and radiographic assessments took place 6 and 12 weeks and 1 year after trauma/surgery. Three transitional fractures were treated with open reduction and internal volar plate fixation followed by functional rehabilitation. One transitional fracture was treated non-operatively. All cases showed an excellent functional outcome.

Conclusions

The primary treatment goal in transitional fractures is anatomic reduction of the articular surface. Non-operative treatment of transitional fractures of the distal radius is the most commonly reported treatment option. Additionally, different fixation options have been described, including the use of Kirschner wires (K-wires) and lag screws. The presented cases demonstrate that volar plate fixation followed by functional rehabilitation is a valuable treatment option in significantly displaced transitional fractures of the distal radius. Furthermore, we discuss the pathogenesis as well as the different treatment options by critical reviewing the literature.
Misdiagnosis of a multi-organ involvement hematogenous disseminated tuberculosis as metastasis: a case report and literature review
Authors: Hang Tian-Xing , Fang Gang , Huang Yan , Hu Chun-Mei , Chen Wei
Published: June 2020

Background

Tuberculosis (TB) is a great mimicker and diagnostic chameleon, and prone to be diagnosed as malignancy. Even though many reports have described the differences between pulmonary TB and lung cancer, the atypical systemic hematogenous disseminated TB (HDTB) is very rare and more confusing in clinical practice.

Case presentation

A 73-year-old man, HIV-negative, was hospitalized to the local county hospital because of chest pain, low-grade fever, asthenia, anorexia and weight loss for the pasting two months. The CT findings of the two lungs showed multiple round or round-like nodules of different sizes, with clear boundaries and partial fusion. The level of serum CA19–9 was significantly higher than normal, and progressively increased. There were multiple enlarged lymph nodes in the neck, mediastinum, abdominal cavity and pelvic cavity. The symptoms were diagnosed as hematogenous spread of gastrointestinal tumor in the local county hospital. However, when transferred to our provincial hospital, through comprehensive dynamic analysis, this patient was diagnosed as atypical systemic HDTB, no cancer at all. Through routine anti-TB therapy for one year, the patient was recovered very well at the follow-up of half year after withdrawal.

Conclusions

In the past, most TB misdiagnosis cases involved in single organ and were finally confirmed through invasive examination. This case enriched clinical experiences in the diagnosis of atypical HDTB. We encouraged clinicians to establish a dynamic thinking for diagnosis and treatment and emphasized the value of biopsy and 18F-FDG-PET in distinguishing TB and cancer.
Transmission characteristics of heterozygous cases of Creutzfeldt-Jakob disease with variable abnormal prion protein allotypes
Authors: Ward Anne , Hollister Jason R. , McNally Kristin , Ritchie Diane L. , Zanusso Gianluigi , Priola Suzette A.
Published: June 2020

In the human prion disease Creutzfeldt-Jakob disease (CJD), different CJD neuropathological subtypes are defined by the presence in normal prion protein (PrPC) of a methionine or valine at residue 129, by the molecular mass of the infectious prion protein PrPSc, by the pattern of PrPSc deposition, and by the distribution of spongiform change in the brain. Heterozygous cases of CJD potentially add another layer of complexity to defining CJD subtypes since PrPSc can have either a methionine (PrPSc-M129) or valine (PrPSc-V129) at residue 129. We have recently demonstrated that the relative amount of PrPSc-M129 versus PrPSc-V129, i.e. the PrPSc allotype ratio, varies between heterozygous CJD cases. In order to determine if differences in PrPSc allotype correlated with different disease phenotypes, we have inoculated 10 cases of heterozygous CJD (7 sporadic and 3 iatrogenic) into two transgenic mouse lines overexpressing PrPC with a methionine at codon 129. In one case, brain-region specific differences in PrPSc allotype appeared to correlate with differences in prion disease transmission and phenotype. In the other 9 cases inoculated, the presence of PrPSc-V129 was associated with plaque formation but differences in PrPSc allotype did not consistently correlate with disease incubation time or neuropathology. Thus, while the PrPSc allotype ratio may contribute to diverse prion phenotypes within a single brain, it does not appear to be a primary determinative factor of disease phenotype.
Weathering mechanism of red discolorations on Limestone object: a case study from Lingyan Temple, Jinan, Shandong Province, China
Authors: Zha Jianrui , Wei Shuya , Wang Chuanchang , Li Zhimin , Cai Youzhen , Ma Qinglin
Published: June 2020

Red discolorations are an effloresce phenomenon detect on the surface of stone objects and considered as damage factor in both esthetic and conservation points of view. It is very difficult to remove and seldom report about their weathering mechanism. Recently, numerous of red discolorations have affected the limestone objects of Lingyan Temple in Shandong province, one of the most important building materials in China. In order to set up the appropriate conservation remedy, it is essential to identify the origin, characteristics, composition, and the formation process of red discolorations. Several analytical and investigation techniques, such as X-ray fluorescence spectroscopy (XRF), X-ray diffraction (XRD), Micro-Raman spectroscopy (Raman), Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM) equipped with energy dispersive spectrometer (EDS) were used to better understand the red discolorations. The results demonstrated that the discolorations on limestone surface have been caused by carbonic acid weathering process. The red discolorations consisted mainly of kutnohorite (Ca(Fe,Mg,Mn)CO3) and iron oxides. They showed tabular, lamellar, and granular morphologies, which originated from the in situ carbonic acid weathering of kutnohorite. After rainfall, the Ca, Mg, Mn ions with relatively high solubility were primarily leached from carbonatite phases. It was resulting in the sedimentation of red iron oxides through a chemical reaction and physical adhesion. Based on those analyses, a chelating agent (ethylenediamine tetraacetic acid disodium salt) was chosen to remove theses red discolorations on the stone object.
Innovative Thermobalancing therapy and Dr Allen’s Device for the first time employ body energy to treat chronic prostatic diseases effectively
Authors: Allen S.
Published: June 2020

Benign prostatic hyperplasia (BPH) and chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS) are common chronic diseases. None of the available treatments are effective in the management of these diseases. The purpose of this study was to assess the efficacy of Thermobalancing therapy (TT) with therapeutic Dr Allen's Device (DATD) for the treatment of BPH and CP/CPPS. Retrospective analysis of 2 clinical studies employing 6-month TT for the treatment of BPH (n = 124) and CP/CPPS (n = 45) was conducted. The efficacy of the TT with DATD was assessed using validated and widely accepted parameters. Results were compared with corresponding control groups comprising of subjects who did not receive any treatment. In BPH treatment group, urinary symptoms decreased (14.3 to 4.7) and QoL improved (3.9 to 1.39). In CP/CPPS treatment group, pain score decreased (10.3 to 3.5) and QoL improved (8.1 to 2.9). The results in the 2 treatment groups were statistically significantly better than the results obtained for the corresponding control groups (P < 0.001). Innovative TT with DATD provides an effective treatment that uniquely employs body energy for the management of BPH and CP/CPPS.
Factorial validity and measurement invariance across gender groups of the German version of the Interpersonal Reactivity Index
Authors: Grevenstein Dennis
Published: June 2020

The Interpersonal Reactivity Index (IRI) is the most widely used measure of empathy, but its factorial validity has been questioned. The present research investigates the factorial validity of the German adaptation of the IRI, the “Saarbrücker Persönlichkeitsfragebogen SPF-IRI”. Confirmatory Factor Analyses (CFA) and Exploratory Structural Equation Modeling (ESEM) were used to test the theoretically predicted four-factor model. Across two subsamples ESEM outperformed CFA. Substantial cross-loadings were evident in ESEM. Measurement invariance (MI) across gender groups was tested using ESEM in the combined sample. Strict MI (invariant factor loadings, intercepts, residuals) could be established, and variances and covariances were also equal. Differences for latent means were evident. Women scored higher on fantasy, empathic concern, and personal distress. No significant differences were found for perspective taking. Mean differences were due to real differences on latent variables and not a result of measurement bias. Results support the factorial validity of the German SPF-IRI. The heterogeneity of empathy and the unclear differentiation between cognitive and emotional aspects might be a source for the unclear differentiation of scales.
Value of susceptibility-weighted MR imaging (SWI) in the detection of developmental venous anomaly
Authors: Abdelgawad Mohamed Saied , Aly Rasha Abdelhafiz
Published: June 2020

Background

Developmental venous anomaly (DVA) is probably the most common anomaly of the intracranial vasculature. DVAs consist of multiple, radially oriented dilated medullary veins that converge into a transcerebral vein. Susceptibility-weighted imaging (SWI) is a high spatial resolution 3D gradient-echo MRI sequence with phase post-processing that accentuates the paramagnetic properties of blood products such as deoxyhemoglobin, intracellular methemoglobin, and hemosiderin. Its high sensitivity to hemorrhagic particles by means of susceptibility dephasing effects within the veins allow for the accurate detection, grading, and monitoring of brain venous anomalies. In this review, we evaluated the prevalence of the brain DVAs identified by SWI in many patients who had undergone magnetic resonance imaging (MRI) with contrast administration. All images were independently reviewed by two radiologists who were blinded to other MR imaging finding. It is hoped that as SWI becomes more widely available, it will provide additional diagnostic and prognostic information that will improve the care and outcome of patients with DVAs.

Results

A total of 29 DVAs were observed with its prevalence 2.8%. The DVA caputs had mostly deep localization in about 44.8% of our DVA cases. SWI proved excellent demonstration of DVAs with the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were significantly higher than the other non-contrast MR sequences. On SWI, DVA is delineated as a signal void lesion with the normal cerebral veins.

Conclusion

Susceptibility-weighted imaging (SWI) is valuable in the diagnosis of DVA and should be included in routine MR assessment of the brain.
Efficacy of perforator CTA of deep inferior epigastric artery perforator flap in preoperative planning of breast reconstruction: comparative study with CDUS
Authors: Soliman Hazem Hamed , Abozeid Mohamed F. , Moustafa Maged Abdelrahman
Published: June 2020

Background

The aim of the study is to compare the efficacy of perforator computed tomographic angiography (P-CTA) and color Doppler ultrasonography (CDUS) in preoperative planning of breast reconstruction with deep inferior epigastric artery perforator (DIEAP) flaps. From October 2018 to August 2019, 42 patients performed breast reconstruction with DIEAP flap procedures. All cases performed CDUS and multidetector perforator CT angiography (P-CTA) within 1 week prior to reconstructive surgery. The CDUS and P-CTA images were interpreted by two experienced vascular radiologists with 8- and 10-year experience, respectively, and compared with the surgical results.

Results

There were statistically significant differences (P = 0.0025) between CDUS and P-CTA in the detection of the number of perforators with P-CTA being more accurate than CDUS. There were significant differences between the P-CTA and surgical findings in measuring the caliber of dominant perforators (P = 0.002). CDUS was more accurate than P-CTA in this parameter showing sensitivity and specificity of 94 and 96%, respectively. There were significant differences between CDUS and surgical findings in the detection of the course of the intramuscular segment of the perforator (P = 0.0028). P-CTA was more accurate than CDUS in this parameter showing sensitivity and specificity of 96 and 97%, respectively.

Conclusion

The pre-operative mapping of perforators by CDUS and P-CTA proved to be effective and complementary to each other in the localization and vascular mapping of deep inferior epigastric artery perforators, thus greatly helping vascular surgeons in performing this surgical procedure.
Evaluation of axonal loss in ulnar sensory nerve fibers recorded from ring and little fingers secondary to idiopathic carpal tunnel syndrome in Egyptian patients
Authors: El-Hady Aliaa Omar , El Molla Soad Said Ahmed , Ibrahim Rehab Ali
Published: June 2020

Background

The association between carpal tunnel syndrome (CTS) and ulnar nerve entrapment is unclear, and the extra-median paresthesia in the ulnar nerve territory innervation in CTS is unexplained. Our purpose is to evaluate the neurophysiologic changes in ulnar nerve sensory fibers secondary to idiopathic CTS in comparison to normal subjects, and their relation to the severity of CTS.

Results

The difference between CTS and control hands regarding all parameters of ulnar motor nerve conduction studies (MNCS) was not statistically significant (p > 0.05). There was a statistically significant difference in all parameters of median sensory conduction study (SCS) and MNCS between CTS and control hands (p < 0.0001) except for conduction velocity and in all parameters of median and ulnar SCS recording digit 4 (D4) (p < 0.05). The mean value of abnormalities of ulnar SCS recording D4 and digit 5 (D5) was significantly higher in moderate and severe CTS hands (p < 0.05). There were significant negative correlations between median motor and sensory latency and ulnar sensory amplitude recording D4 and D5.

Conclusion

Ulnar sensory nerve abnormalities exist among CTS patients, which were more in moderate and severe grades. The drop in amplitude of ulnar nerve sensory response argues in favor of the possible impact of CTS on the ulnar nerve and did not indicate axonal deterioration of the ulnar nerve.
Bone Evaluation by High-Resolution Peripheral Quantitative Computed Tomography in Patients With Adrenal Incidentaloma
Authors: Moraes Aline Barbosa , de Paula Marcela Pessoa , de Paula Paranhos-Neto Francisco , Cavalari Emanuela Mello Ribeiro , de Morais Felipe Fernandes Cordeiro , Curi Daniel Silva Carvalho , Lima Luis Felipe Cardoso , de Mendonça Laura Maria Carvalho , Farias Maria Lucia Fleiuss , Madeira Miguel , Vieira Neto Leonardo
Published: June 2020

Context

Data regarding high-resolution peripheral quantitative computed tomography (HR-pQCT) in patients with adrenal incidentaloma (AI) are unknown.

Purpose

To evaluate the areal bone mineral density (aBMD), microstructure, and fractures in patients with nonfunctioning AI (NFAI) and autonomous cortisol secretion (ACS).

Methods

We evaluated 45 patients with NFAI (1 mg dexamethasone suppression test [DST] ≤1.8 µg/dL) and 30 patients with ACS (1 mg DST 1.9-5.0 µg/dL). aBMD was measured using dual-energy X-ray absorptiometry; vertebral fracture by spine X-ray; and bone geometry, volumetric bone mineral density (vBMD), and microstructure by HR-pQCT.

Results

Patients with ACS showed lower aBMD values at the spine, femoral neck, and radius 33% than those with NFAI. Osteoporosis was frequent in both groups: NFAI (64.9%) and ACS (75%). Parameters at the distal radius by HR-pQCT were decreased in patients with ACS compared to those with NFAI: trabecular vBMD (Tb.vBMD, P = 0.03), inner zone of the trabecular region (Inn.Tb.vBMD, P = 0.01), the bone volume/tissue volume ratio (BV/TV, P = 0.03) and trabecular thickness (P = 0.04). As consequence, a higher ratio of the outer zone of the trabecular region/inner zone vBMD (Meta/Inn.vBMD, P = 0.003) was observed. A correlation between the cortisol levels after 1 mg DST and Meta/Inn.vBMD ratio was found (r = 0.29; P = 0.01). The fracture frequency was 73.7% in patients with ACS vs 55.6% in patients with NFAI (P = 0.24).

Conclusion

Our findings point to an association between trabecular bone microarchitectural derangement at the distal radius and ACS. Our data suggest that AI have a negative impact on bone when assessed by HR-pQCT, probably associated to subclinical hypercortisolism.
A Role for GLP-1 in Treating Hyperphagia and Obesity
Authors: Grill Harvey J
Published: June 2020

Obesity is a chronic recurring disease whose prevalence has almost tripled over the past 40 years. In individuals with obesity, there is significant increased risk of morbidity and mortality, along with decreased quality of life. Increased obesity prevalence results, at least partly, from the increased global food supply that provides ubiquitous access to tasty, energy-dense foods. These hedonic foods and the nonfood cues that through association become reward predictive cues activate brain appetitive control circuits that drive hyperphagia and weight gain by enhancing food-seeking, motivation, and reward. Behavioral therapy (diet and lifestyle modifications) is the recommended initial treatment for obesity, yet it often fails to achieve meaningful weight loss. Furthermore, those who lose weight regain it over time through biological regulation. The need to effectively treat the pathophysiology of obesity thus centers on biologically based approaches such as bariatric surgery and more recently developed drug therapies. This review highlights neurobiological aspects relevant to obesity causation and treatment by emphasizing the common aspects of the feeding-inhibitory effects of multiple signals. We focus on glucagon like peptide-1 receptor (GLP-1R) signaling as a promising obesity treatment target by discussing the activation of intestinal- and brain-derived GLP-1 and GLP-1R expressing central nervous system circuits resulting from normal eating, bariatric surgery, and GLP-1R agonist drug therapy. Given the increased availability of energy-dense foods and frequent encounters with cues that drive hyperphagia, this review also describes how bariatric surgery and GLP-1R agonist therapies influence food reward and the motivational drive to overeat.
Tolvaptan Versus Fluid Restriction in the Treatment of Hyponatremia Resulting from SIADH Following Pituitary Surgery
Authors: Kleindienst Andrea , Georgiev Simeon , Schlaffer Sven Martin , Buchfelder Michael
Published: June 2020

Context

The relevance of hyponatremia has been acknowledged by guidelines from the United States (2013) and Europe (2014). However, treatment recommendations differ due to limited evidence.

Objective

In hyponatremia following pituitary surgery—caused by the syndrome of inappropriate antidiuretic hormone (SIADH) secretion—we compared fluid restriction with the pharmacological increase of water excretion by blocking the vasopressin 2 receptors with tolvaptan at a low and a moderate dose.

Design

Prospective observational study.

Setting

Neurosurgical Department of a University hospital with more than 200 surgical pituitary procedures per year.

Patients

Patients undergoing pituitary surgery and developing serum sodium below 136 mmol/L. The diagnosis of SIADH was established by euvolemia (daily measurement of body weight and fluid balance), inappropriately concentrated urine (specific gravity), and exclusion of adrenocorticotropic and thyroid-stimulating hormone deficiency.

Intervention

Patients were treated with fluid restriction (n = 40) or tolvaptan at 3.75 (n = 38) or 7.5 mg (n = 48).

Main Outcome Measures

Treatment efficacy was assessed by the duration of hyponatremia, sodium nadir, and length of hospitalization. Safety was established by a sodium increment below 10 mmol/L per day and exclusion of side effects.

Results

Treatment with 7.5 mg of tolvaptan resulted in a significant attenuation of hyponatremia and in a significant overcorrection of serum sodium in 30% of patients. The duration of hospitalization did not differ between treatment groups.

Conclusions

Tolvaptan at a moderate dose is more effective than fluid restriction in the treatment of SIADH. Overcorrection of serum sodium may be a side effect of tolvaptan even at low doses.
Moving and Moved
Authors: Ramsden-Karelse Ruth
Published: June 2020

In 1998, the recently established Gay and Lesbian Archives of South Africa acquired about 600 photographs depicting a group of individuals assigned male at birth, who presented and expressed themselves according to conventions of femininity. The girls, as they called themselves, were classified as “Coloured” under apartheid and lived in District Six, Cape Town, when it was declared “Whites Only” in 1966, after which approximately 60,000 residents were forcibly removed as the area was almost completely bulldozed. This collection of photographs has become somewhat embedded in descriptions of the district as home to a way of life or culture, variously described as “gay” or “queer,” generally accepted if not celebrated by its wider community. Drawing on audio recordings featuring their collector, Kewpie, and remaining attentive to the differing and at times contradictory ways Kewpie presents herself, the girls, and District Six more broadly, this article proposes an alternative reading of the Kewpie Photographic Collection, as it is now known. Privileging the creative as opposed to the documentary function of photography and oral testimony, Ramsden-Karelse proposes that Kewpie uses both to make and remake the world around her, as part of what the author understands to be a larger collaborative project.
Measuring development assistance for health systems strengthening and health security: an analysis using the Creditor Reporting System database
Authors: Kraus Jessica , Yamey Gavin , Schäferhoff Marco , Petitjean Hugo , Hale Jessica , Karakulah Kenan , Kardish Chris , Pineda Estuardo , Sanders Francesca , Beyeler Naomi , Fewer Sara , Nugent Rachel , Jamison Dean T. , Oppenheim Ben , Gill Indermit
Published: June 2020

Background: Health systems strengthening (HSS) and health security are two pillars of universal health coverage (UHC). Investments in these areas are essential for meeting the Sustainable Development Goals and are of heightened relevance given the emergence of the 2019 novel coronavirus disease (COVID-19). This study aims to generate information on development assistance for health (DAH) for these areas, including how to track it and how funding levels align with country needs.

Methods: We developed a framework to analyze the amount of DAH disbursed in 2015 for the six building blocks of the health system (‘system-wide HSS’) plus health security (emergency preparedness, risk management, and response) at both the global (transnational) and country level. We reviewed 2,427 of 32,801 DAH activities in the Creditor Reporting System (CRS) database (80% of the total value of disbursements in 2015) and additional public information sources. Additional aid activities were identified through a keyword search.

Results: In 2015, we estimated that US$3.1 billion (13.4%) of the US$22.9 billion of DAH captured in the CRS database was for system-wide HSS and health security: US$2.5 billion (10.9%) for system-wide HSS, mostly for infrastructure, and US$0.6 billion (2.5%) for system-wide health security. US$567.1 million (2.4%) was invested in supporting these activities at the global level. If responses to individual health emergencies are included, 7.5% of total DAH (US$1.7B) was for health security. We found a correlation between DAH for HSS and maternal mortality rates, and we interpret this as evidence that HSS aid generally flowed to countries with greater need.

Conclusions: Achieving UHC by 2030 will require greater investments in system-wide HSS and proactive health emergency preparedness. It may be appropriate for donors to more prominently consider country needs and global functions when investing in health security and HSS.
High-Performance Prototyping of Decomposition Methods in GAMS
Authors: Lohmann Timo , Bussieck Michael R. , Westermann Lutz , Rebennack Steffen
Published: June 2020

Prototyping algorithms in algebraic modeling languages has a long tradition. Despite the convenient prototyping platform that modeling languages offer, they are typically seen as rather inefficient with regard to repeatedly solving mathematical programming problems, a concept on which many algorithms are based. The most prominent examples of such algorithms are decomposition methods, such as the Benders decomposition, column generation, and the Dantzig–Wolfe decomposition. In this work, we discuss the underlying reasons for repeated solve deficiency with regard to speed in detail and provide an insider’s look into the algebraic modeling language GAMS. Further, we present recently added features in GAMS that mitigate some of the efficiency drawbacks inherent to the way modeling languages represent model data and ultimately solve a model. In particular, we demonstrate the grid-enabled gather-update-solve-scatter facility and the GAMS object-oriented application programming interface on a large-scale case study that involves a Benders decomposition–type algorithm for a power-expansion planning problem.
Tail Risk and Robust Portfolio Decisions
Authors: Jin Xing , Luo Dan , Zeng Xudong
Published: June 2020

This paper formulates a portfolio choice problem in a multiasset incomplete market characterized by ambiguous jumps and arbitrary tail assumptions. We derive the optimal portfolio in closed form through a decomposition approach. We show that, due to fear of tail incidents, an investor diminishes portfolio diversification, and even more so under heavy-tailed jumps that intensify misspecification concerns. We then implement our model in international equity markets to quantify the impact of tail risk on portfolio selection, through comparisons between a normal and a slowly decaying jump size distribution. We find that, without jump ambiguity, constant relative risk aversion (CRRA) investors increase their jump exposures merely slightly and suffer negligible wealth losses from underestimating tail risk, given that the first two moments of the jump size distributions are preserved regardless of the tail properties. In stark contrast, sizable portfolio rebalancing and subsequent wealth losses are encountered in the presence of jump ambiguity.

This paper was accepted by David Simchi-Levi, finance.
Better to Bend than to Break: Sharing Supply Risk Using the Supply-Flexibility Contract
Authors: Farahani Mehdi H. , Dawande Milind , Gurnani Haresh , Janakiraman Ganesh
Published: June 2020

Problem definition : We analyze a contract in which a supplier who is exposed to disruption risk offers a supply-flexibility contract comprising of a wholesale price and a minimum-delivery fraction (“flexibility” fraction) to a buyer facing random demand. The supplier is allowed to deviate below the order quantity by at most the flexibility fraction. The supplier’s regular production is subject to random disruption, but she has access to a reliable expedited supply source at a higher marginal cost. Academic/practical relevance : Despite the prevalence of supply-flexibility contracts in practice, to the best of our knowledge, there is no previous academic literature examining the optimal design of supply-flexibility contracts. As such, the level of flexibility in practice is usually set on an ad-hoc basis, with buyers typically reluctant to share risk with suppliers. Our analysis of supply-flexibility contracts informs practice in two ways: First, using analytically supported arguments, it educates managers on the effects of their decisions on the economic outcomes. Second, it shows that the supply-flexibility contract benefits both the supplier and the buyer, regardless of which player chooses how supply risk is allocated in the supply chain. Methodology : Non-cooperative game theory, non-convex optimization. Results : We derive the supplier-led optimal contract and show that supply chain efficiency improves relative to the price-only contract. More interestingly, even though the buyer lets the supplier decide how the two share supply risk, profits of both the players increase by the introduction of flexibility into the contract. Further, supply flexibility may be even more valuable for the buyer compared with the supplier. Interestingly, the flexibility fraction is not monotone in supplier reliability and a more reliable supplier may even prefer to transfer more risk to the buyer. The robustness of these findings is established on two extensions: one where we study a buyer-led contract (i.e., the buyer chooses the flexibility fraction) and the other where the expedited supply option is available to both the supplier and the buyer. Managerial implications : The supply-flexibility contract is mutually beneficial for both players and yet retains all the advantages of the price-only contract—it is easy to implement, it requires minimal operational and administrative burden, and there is evidence of the use of such contracts in practice. While our focus is not on supply chain coordination, we note that the combination of two mechanisms—the supply-flexibility contract derived in this paper to share supply risk and a buyback contract to share demand risk—yields a coordinating contract.