bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of guideline adherence and parameter control on the clinical outcomes in patients with diabetic nephropathy
Authors: Lu Jingru , Zhao Wei , Chen Tingyu , Xu Zhuoyang , Sun Xingzhi , Xie Honglang , An Yu , Zeng Caihong , Hu Gang , Xie Guotong , Liu Zhihong
Published: July 2020

Introduction

We assessed the association between guideline adherence and outcomes of clinical parameter control and end-stage kidney disease (ESKD), and further studied the effect of parameter control on ESKD for Chinese patients with diabetic nephropathy (DN).

Research design and methods

In this retrospective study, 1128 patients with DN (15,374 patient-visit samples) diagnosed by renal biopsy were enrolled. Samples were classified as adherence and nonadherence based on whether prescribed drugs conformed to medication regimen and drug contraindication recommended by guidelines, including American Diabetes Association (ADA) and Chinese guidelines. Guideline adherence rate was calculated on all samples for antihyperglycemic, antihypertensive and lipid-lowering treatments. Clinical parameter control was compared after 3–6 months’ therapy between two groups by generalized estimating equation models. Time-dependent Cox models were applied to evaluate the influence of guideline adherence on ESKD. Latent class mixed model was used to identify distinct trajectories for parameters and their ESKD risks were compared using Cox proportional-hazards models.

Results

Guideline adherence rate of antihyperglycemic therapy was the highest, with 72.87% and 68.15% of samples meeting ADA and Chinese guidelines, respectively. Adherence was more likely to have good glycated hemoglobin A1c (HbA1c) control (ADA: OR 1.46, 95% CI 1.12 to 1.88; Chinese guideline: OR 1.42, 95% CI 1.09 to 1.85) and good blood pressure control (ADA: OR 1.35, 95% CI 1.03 to 1.78; Chinese guideline: OR 1.39, 95% CI 1.08 to 1.79) compared with nonadherence. The improvement of patient’s adherence showed the potential to reduce ESKD risk. For proteinuria, low-density lipoprotein cholesterol (LDL-C), systolic blood pressure and uric acid, patients in higher-value trajectory group had higher ESKD risk. Proteinuria and LDL-C trajectories were most closely related to ESKD risk, while the risk was not significantly different in HbA1c trajectories.

Conclusions

Guideline adherence and good control of proteinuria and LDL-C in clinical practice are important and in need for improving clinical outcomes in patients with DN.
Atrial fibrillation and the prothrombotic state: revisiting Virchow’s triad in 2020
Authors: Ding Wern Yew , Gupta Dhiraj , Lip Gregory Y H
Published: July 2020

Atrial fibrillation (AF) is characterised by an increased risk of pathological thrombus formation due to a disruption of physiological haemostatic mechanisms that are better understood by reference to Virchow’s triad of ‘abnormal blood constituents’, ‘vessel wall abnormalities’ and ‘abnormal blood flow’. First, there is increased activation of the coagulation cascade, platelet reactivity and impaired fibrinolysis as a result of AF per se, and these processes are amplified with pre-existing comorbidities. Several prothrombotic biomarkers including platelet factor 4, von Willebrand factor, fibrinogen, β-thromboglobulin and D-dimer have been implicated in this process. Second, structural changes such as atrial fibrosis and endothelial dysfunction are linked to the development of AF which promote further atrial remodelling, thereby providing a suitable platform for clot formation and subsequent embolisation. Third, these factors are compounded by the presence of reduced blood flow secondary to dilatation of cardiac chambers and loss of atrial systole which have been confirmed using various imaging techniques. Overall, an improved understanding of the various factors involved in thrombus formation will allow better clinical risk stratification and targeted therapies in AF.
Therapeutic implications of the anergic/postactivated status of B cells in systemic lupus erythematosus
Authors: Dörner Thomas , Szelinski Franziska , Lino Andreia C , Lipsky Peter E
Published: July 2020

Systemic lupus erythematosus (SLE) is characterised by numerous abnormalities in B lineage cells, including increased CD27++ plasmablasts/plasma cells, atypical CD27-IgD- B cells with increased CD95, spleen tyrosine kinase (Syk)++, CXCR5- and CXCR5+ subsets and anergic CD11c+Tbet+ age-associated B cells. Most findings, together with preclinical lupus models, support the concept of B cell hyperactivity in SLE. However, it remains largely unknown whether these specific B cell subsets have pathogenic consequences and whether they provide relevant therapeutic targets. Recent findings indicate a global distortion of B cell functional capability, in which the entire repertoire of naïve and memory B cells in SLE exhibits an anergic or postactivated (APA) functional phenotype. The APA status of SLE B cells has some similarities to the functional derangement of lupus T cells. APA B cells are characterised by reduced global cytokine production, diminished B cell receptor (BCR) signalling with decreased Syk and Bruton’s tyrosine kinase phosphorylation related to repeated in vivo BCR stimulation as well as hyporesponsiveness to toll-like receptor 9 engagement, but intact CD40 signalling. This APA status was related to constitutive co-localisation of CD22 linked to phosphatase SHP-1 and increased overall protein phosphatase activities. Notably, CD40 co-stimulation could revert this APA status and restore BCR signalling, downregulate protein tyrosine phosphatase transcription and promote B cell proliferation and differentiation. The APA status and their potential rescue by bystander help conveyed through CD40 stimulation not only provides insights into possible mechanisms of escape of autoreactive clones from negative selection but also into novel ways to target B cells therapeutically.
Gastrodin Pretreatment Protects Liver Against Ischemia-Reperfusion Injury via Activation of the Nrf2/HO-1 Pathway
Authors: Yuan Bo , Huang Hanfei , Qu Siming , Zhang Hongbin , Lin Jie , Jin Li , Yang Shikun , Zeng Zhong
Published: July 2020

Hepatic ischemia-reperfusion (IR) injury remains the major cause of liver damage post-liver surgery or transplantation. Diminishing oxidative stress and inflammatory responses is a powerful channel to reduce the rate of morbidity and mortality. Gastrodin (GSTD), a bioactive compound extracted from the traditional Chinese herbal agent with a long history of clinical application in nervous system diseases, is suggested to possess anti-oxidative effects on liver diseases, such as nonalcoholic fatty liver disease. However, the therapeutic potential of GSTD in liver IR injury remains unclear. In this paper, we performed surgery to set up the 70% hepatic IR injury models in mice after a three-day pretreatment of GSTD. We found the administration of GSTD reduced liver damage, which correlated with lower histological Suzuki’s score, lower serum alanine transaminase (AST) and alanine transaminase (ALT) levels, less oxidative stress, and cell apoptosis in a dose-responsive manner, as compared to the parallel control. Meanwhile, we observed a great induction of heme oxygenase-1 (HO-1) and an activation of the p38 mitogen-activated protein kinases/nuclear factor erythroid 2-related factor 2 (p38MAPK/Nrf2) pathway in response to the GSTD pretreatment, while the protective effects upon GSTD diminished in mice with HO-1 heterozygous mutation. In addition, GSTD inhibited IR induced toll-like receptor (TLR) 4, but not TLR2 in a HO-1 dependent manner, leading to a down-regulation of cytokines, such as interleukin (IL)-6 and TNF-[Formula: see text]. Collectively, our findings revealed GSTD attenuated liver IR injury via activation of the HO-1 pathway, providing a novel therapeutic strategy to minimize the IR induced oxidative stress in the process of liver transplantation.
Tricetin Suppresses Migration and Presenilin-1 Expression of Nasopharyngeal Carcinoma through Akt/GSK-3β Pathway
Authors: Ho Hsin-Yu , Lin Frank Cheau-Feng , Chen Pei-Ni , Chen Mu-Kuan , Hsin Chung-Han , Yang Shun-Fa , Lin Chiao-Wen
Published: July 2020

Lymph node migration results in poor prognoses for nasopharyngeal carcinoma (NPC) patients. Tricetin, a flavonoid derivative, regulates tumorigenesis activity through its antiproliferative and antimetastatic properties. However, the molecular mechanism of tricetin affecting the migration and invasion of NPC cells remains poorly understood. In this paper, we examined the antimetastatic properties of tricetin in human NPC cells. Our results demonstrated that tricetin at noncytotoxic concentrations (0–80 3M) noticeably reduced the migration and invasion of NPC cells (HONE-1, NPC-39, and NPC-BM). Moreover, tricetin suppressed the indicative protease, presenilin-1 (PS-1), as indicated by protease array. PS-1 was transcriptionally inhibited via the Akt signaling pathway but not mitogen-activated protein kinase pathways, such as the JNK, p38, and ERK1/2 pathways. In addition to upregulating GSK-3[Formula: see text] phosphorylation through Akt suppression, tricetin may downregulate the activity of PS-1. Overall, our study provides new insight into the role of tricetin-induced molecular regulation in the suppression of NPC metastasis and suggests that tricetin has prospective therapeutic applications for patients with NPC.
Prognostic and Clinicopathological Significance of PD-L1 in Patients with Cholangiocarcinoma: A Meta-Analysis
Authors: Xie Qinfen , Wang Lidong , Zheng Shusen
Published: July 2020

Background. In recent years, there is growing literature on the prognostic significance of programmed death-ligand 1 (PD-L1) in cholangiocarcinoma (CCA); however, data have been conflicting. Therefore, the objective of this study was to assess the correlation between PD-L1 and prognosis in CCA through meta-analysis.Methods. Published studies were retrieved from the Web of Science, PubMed, Embase, and Cochrane Library up to April 17, 2020. The relationships between PD-L1 expression and survival outcomes were assessed using hazard ratios (HRs) and 95% confidence intervals (CIs).Results. Eighteen studies consisting of 2012 patients were included. Overexpression of PD-L1 was significantly associated with worse overall survival (OS) (HR=1.58,95%CI=1.30−1.92,p<0.001) but not with poor disease-free survival (DFS) (HR=1.03,95%CI=0.68−1.55,p=0.895) in CCA. Moreover, PD-L1 was associated with low differentiation (OR=1.43,95%CI=1.09−1.87,p=0.010) and higher pN stage (OR=1.45,95%CI=1.10−1.92,p=0.009) but not with sex, TNM stage, vascular invasion, perineural invasion, age, or tumor size.Conclusion. High PD-L1 expression was associated with worse OS, poor differentiation, and higher pN stage in patients with CCA. PD-L1 could be a potential prognostic marker in CCA.
Pseudodynamic Testing of Buildings Retrofitted with External Steel Reinforced Concrete Frames to Increase Lateral Strength for Earthquake Damage Prevention
Authors: Jung Ju-Seong , Lee Kang-Seok
Published: July 2020

In this study, a new technique for seismic retrofitting via the attachment of an “external steel reinforced concrete frame” (ESRCF) system was developed to strengthen medium-to-low-rise reinforced concrete (RC) buildings. Two methods (bolting and welding) were developed to connect existing RC frames and external strengthening elements; these methods are technically and practically suited to various construction conditions. The retrofitting method developed in this study can be used to perform seismic strengthening construction, while residents continue to live within the building. The method is categorized as a “strength design approach” implemented via retrofitting, allowing the lateral ultimate load capacity of RC buildings, whose failure mode is shear, to be increased easily. Test specimens were designed based on an existing RC building in Korea lacking seismic data and then strengthened using the ESRCF system. Pseudodynamic and cyclic loading tests were conducted to verify the effects of seismic retrofitting. In total, four RC frame specimens were prepared: one nonstrengthened control specimen for the cyclic loading test, one nonstrengthened control specimen, one specimen strengthened with a welded ESRCF system, and one specimen strengthened with a bolted ESRCF system for the pseudodynamic test. The earthquake response behavior with use of the proposed method, in terms of the maximum response strength, response displacement, and degree of earthquake damage, is compared with a control RC frame. The test results indicated that both the bolting and welding methods used for connecting the existing RC frame to the ESRCF effectively increased the lateral ultimate strength, resulting in reduced response displacement of building structures under large-scale earthquake conditions.
The Occurrence of Richter’s Syndrome during Treatment with Obinutuzumab and Chlorambucil
Authors: Ng Teng Fong , Carnley Benedict , Green Celia , Spagnolo Dominic , Leahy Michael F.
Published: July 2020

Chronic lymphocytic leukaemia is a slow-growing leukaemia of developing B-lymphocytes, which may transform to an aggressive lymphoma known as Richter’s syndrome. While Richter’s syndrome can present in untreated or relapsed-refractory cases, it may occur upon the commencement of less intensity treatment regimens. We present a case of Richter’s syndrome following treatment with chlorambucil and obinutuzumab and review of available literature on the topic.
A Case of Lower-Pole Moiety Ureteral Stenosis Close to Ureteropelvic Junction in an Incomplete Duplicated Collecting System Managed by Retrograde Balloon Dilatation that Needed a 2nd Ureteral Stent to the Upper-Pole
Authors: Saito Seiichi
Published: July 2020

A 71-year-old woman presented at our institution with the chief complaints of left back pain and fatigue. Radiographic examination revealed left ureteral stenosis close to ureteropelvic junction of the lower-pole with a left incomplete duplicated collecting system. Transurethral retrograde balloon dilatation under general anesthesia was performed, and a ureteral stent was inserted to the lower-pole; however, there was urinary leakage from the upper-pole at the dilated ureteral stenosis lesion, and therefore, another ureteral stent was inserted to the upper-pole just after the first stent insertion. Both stents were removed at 6 weeks and subsequent intravenous pyelography confirmed resolution of the obstruction. The patient has remained asymptomatic during 2 years of follow-up.
Relationship between IL10 and PD‐L1 in Liver Hepatocellular Carcinoma Tissue and Cell Lines
Authors: Qian Qian , Wu Changping , Chen Jianping , Wang Weibing
Published: July 2020

Background. Despite the large‐scale clinical application of programmed death‐ligand 1 (PD‐L1) monoclonal antibody, reduction in its clinical response rate has become a gradual problem. As such, use of PD‐L1 monoclonal antibody in combination with other anticarcinoma drugs has been the main strategy in improving its efficacy. Interleukin 10 (IL10) is a recognized inflammatory and immunosuppressive factor. Previous studies have suggested that there is a link between PD‐L1 and IL10. Objective. This study was aimed at clarifying the relationship between PD‐L1 and IL10 in liver hepatocellular carcinoma (LIHC) and whether IL10 enhances the efficacy of PD‐L1 inhibitor. Methods. Expression levels of PD‐L1 and IL10 in carcinoma and adjacent tissues were tested by immunochemistry, Western blotting, and RT‐PCR. Survival duration and follow‐up data of each patient were recorded. LIHC cell lines Bel7405 and MHCC 97‐H were used for in vitro experiments. Exogenous IL10 and anti‐IL10 were added to cell supernatant. Expression level of PD‐L1 in the LIHC cell lines was determined using Western blotting and ELISA. CCK8 and transwell assays were adopted to examine the effect of PD‐L1 combined with IL10 on proliferation, invasion, and metastasis of LIHC cells. Results. The survival period of patients with low expression of IL10 was longer than that of patients with high expression (P = 0.01). Overexpression of PD‐L1 increased the IL10 and Met levels in LIHC tissues and cell lines. IL10 downregulated the expression level of PD‐L1 and enhanced the efficacy of crizotinib via the Met signaling pathway in the LIHC cells. Conclusions. A combination of IL10 and PD‐L1 inhibitor holds great promise as an effective treatment for LIHC.
Cognitive Reserve Moderates the Predictive Role of Memory Complaints for Subsequent Decline in Executive Functioning
Authors: Ihle Andreas , Gouveia Élvio R. , Gouveia Bruna R. , Kliegel Matthias
Published: July 2020

Aims: We investigated whether the longitudinal relation between memory complaints and subsequent decline in executive functioning over 6 years differed by leisure activity engagement as major contributor to cognitive reserve in old age. Methods: We analyzed longitudinal data from 897 older adults (M = 74.33 years) tested on the Trail Making Test (TMT) in two waves 6 years apart. Participants reported information on memory complaints and leisure activity engagement. Results: There was a significant interaction of memory complaints with leisure activity engagement on latent change in executive functioning. Specifically, only for individuals with less (but not those with greater) leisure activity engagement, memory complaints significantly predicted a steeper subsequent decline in executive functioning across 6 years (i.e., increases in TMT completion time). Conclusion: The role of memory complaints as an early predictor of decline in executive functioning seems to vary by individuals’ cognitive reserve.
The Role of Gut Microbiome in Autoimmune Uveitis
Authors: Fu Xiangyu , Chen Yongjiang , Chen Danian
Published: July 2020

The gut microbiome has important physiological functions and plays an indispensable role in the human body. Currently, there are an increasing number of studies revealing the close correlation between dysbiosis of the gut microbiome and a variety of autoimmune diseases, including autoimmune uveitis. This brief review summarizes recent literature regarding the relationship between dysbiosis and the occurrence and development of autoimmune uveitis. Dysbiosis participates in the pathogenesis of autoimmune uveitis largely by 4 mechanisms: antigenic mimicry, disturbance of intestinal immune homeostasis, destruction of the intestinal barrier, and reduction of beneficial anti-inflammatory metabolites. Further elucidation of these mechanisms will facilitate the treatment of the gut-microbiome-relevant autoimmune diseases by potential therapeutic strategies, such as antibiotics, probiotics, diet modifications, and fecal microbial transplantation.
O Apelo à ordem nos telejornais policiais
Authors: Ribeiro Fábio
Published: July 2020

Este trabalho é fruto de uma investigação sobre o fenômeno telejornalismo policial, caracterizando-o e situando-o inicialmente num universo de constrições tanto internas ao campo como exteriores a ele. Entende-se que esses elementos estruturais em grande medida explicam forma e conteúdo do que é transmitido pelos programas desse subgênero midiático e servirá como preâmbulo analítico para a explicitação dos elementos principais contidos nos discursos veiculados ali. Através da análise empírica de determinadas edições nacionais dos programas Brasil Urgente (Band) e Cidade Alerta (Record), teremos referência para mostrar em que sentido pode-se afirmar que os discursos emanados dos telejornais policiais, frutos das condições de produção aqui analisadas, são de caráter moralista e punitivista.
Apresentação
Authors: Truzzi Oswaldo , Taniguti Gustavo
Published: July 2020

Apresentação ao dossiê "Migrações Internacionais na agenda sociológica contemporânea"
O uso do socioleto literário em três traduções de Great Expectations
Authors: Pamboukian Mateus Roman
Published: July 2020

A partir de uma discussão sumária sobre os conceitos de socioleto literário e eye dialect (baseada em Lane-Mercier, Brett e Pym), este trabalho aborda o uso do socioleto literário no romance Great Expectations (1861) de Charles Dickens e compara soluções encontradas por três diferentes tradutores do romance, a saber: Armando de Morais, Charles Bernard-Derosne e Paulo Henriques Britto. Concluímos que apenas o tradutor Paulo Henriques Britto levou em consideração a questão do socioleto literário.
“Music is Sweet When Your Praises Are Sung”
Authors: Mboya T. Michael
Published: July 2020

This paper interrogates the asymmetry that is inscribed in the patron–client paradigm often used to describe the relationship between artists and consumers of art who, also, promote it in Kenya. It does this by latching onto and inspecting a practice where members of the audience gave cash to musicians while making song requests in the “live band” music performances of Ja-Mnazi Afrika at The Noble Hotel in Eldoret town. The practice is shown to be an exchange of gifts on the basis of which a transactional relationship characterized by mutual dependence and reciprocity between musicians and members of their audience was established and maintained. A consideration of the power relations between musicians and members of their audience as read from the exchange of gifts leads to the argument that patronage was part of the “live band” music performances of Ja-Mnazi Afrika in Eldoret town and was a source of the social meaning of the performance. By participating in it, musicians and members of their audience embodied and enacted power—and thereby constructed a sense of the value of their lives.
Could Local Residents Living Close to Wind Turbines Be Compensated for Damage to Their Health and Loss of Value of Their Homes?
Authors: Tigelaar L.B.A.
Published: July 2020

Sustainability leads to the construction of more wind turbines on land. This installation is governed by rules of public law. Local residents living in the vicinity of wind turbines fear for their health and for the loss of value of their homes. This contribution examines whether and to what extent Dutch liability law offers the possibility to local residents to receive compensation for this damage. The Principles of European Tort Law are also addressed.
Changing climate change: The carbon budget and the modifying-work of the IPCC
Authors: Lahn Bård
Published: July 2020

Over the last 10 years, the concept of a global ‘carbon budget’ of allowable CO2 emissions has become ubiquitous in climate science and policy. Since it was brought to prominence by the Fifth Assessment Report of the IPCC, the carbon budget has changed how climate change is enacted as an issue of public concern, from determining the optimal rate of future emissions to establishing a fixed limit for how much emissions should be allowed before they must be stopped altogether. Exploring the emergence of the carbon budget concept, this article shows how the assessment process of the IPCC has offered scientific experts the means to modify how the climate issue is problematized, and discusses the implications of this ‘modifying-work’ for the politics of climate change. It finds that the ‘modified climate issue’ must be seen as an outcome of the ordinary work within established scientific and political institutions, and the agency these institutions afford scientists to enact the issue differently. On this basis, it argues that the case of the carbon budget holds important insights not only for the relationship between climate science and policy, but also for the pragmatist literature on ‘issue formation’ in STS.
Ultrasound- Versus CT-Guided Subpleural Lung and Pleural Biopsy: An Analysis of Wait Times, Procedure Time, Safety, and Diagnostic Adequacy
Authors: Mychajlowycz Mirek , Alabousi Abdullah , Mironov Oleg
Published: July 2020

Purpose:

To compare the wait times, safety, and diagnostic adequacy of computed tomography (CT)–guided percutaneous lung biopsies with ultrasound (US) guidance for subpleural lung and pleural lesions.

Methods:

Consecutive CT- and US-guided biopsies performed at our institution between January 2018 and January 2019 were retrospectively reviewed. Biopsy wait times, lesion size, degree of pleural contact, procedure duration, number of needle passes, complications, and pathologic diagnosis were recorded and compared.

Results:

A total of 158 biopsies of subpleural or pleural-based lesions were reviewed. Forty-three cases utilized US guidance, while 115 cases used CT, 41 with conventional CT (CCT), and 74 with cone-beam CT guidance (CBCT). Overall, the mean lesion maximum axial diameter and length of pleural contact for US-guided biopsies was greater than for CT (4.8 ± 2.6 cm vs 3.2 ± 1.9 cm and 4.0 ± 2.5 cm vs 2.6 ± 1.7 cm, respectively, P < .001). Wait times for US-guided biopsies were significantly shorter than CCT by 10.9 days on average while being equivalent to CBCT. Procedure time was shorter for lesions localized with US than CT (29.5 ± 16.4 minutes vs 37.6 ± 19.5 minutes, P = .007) despite CT using less needle passes per lesion (3.5 ± 1.1 vs 3.1 ± 0.8, P = .034). Sample adequacy was equivalent for both modalities (88% for US and 92% for CT). The frequency of pneumothoraces was similar between US (12%) and CT (15%).

Conclusion:

Ultrasound and CT guidance have similar safety and diagnostic adequacy for subpleural lung and pleural biopsies. Ultrasound guidance has shorter wait and procedure times.
The pragmatics of Indian political apologies: Sorry, but not sorry
Authors: Shukla Sangeeta , Shukla Rajita
Published: July 2020

While there is a considerable body of research on the pragmatics of apology across the globe, the Indian apology discourse has received hardly any attention from scholars. Political apologies particularly, have been neglected as an important area of research in India. The act of tendering public political apologies, which was almost absent from the Indian repertoire, is an emerging trend in India. This article aims to identify the salient characteristics of Indian political apologies by contextual analysis of the apology texts and is a first of its kind as far as known to the authors. Indian political leaders use evasion and manipulation in apology utterances to avoid an explicit apology. The graver the transgression, the greater the hesitation to offer an explicit apology. We suggest that the categorization of political apologies should take into consideration the stature of the political apologizer also and not just the magnitude of the offence, as this can have a significant impact on the apology behaviour.
Ultrasonography-guided antegrade common femoral artery approach: Factors associated with access time
Authors: Hwang Jin Ho , Park Sang Woo , Kwon Yong Wonn , Min Jeeyoung , Chee Hyun Keun , Shin Je Kyoun
Published: July 2020

Introduction:

The aim of this study was to evaluate the feasibility and safety of ultrasonography-guided antegrade common femoral artery puncture and subsequent superficial femoral artery access without the aid of fluoroscopy. Factors that could affect access time were also assessed.

Methods:

A total of 294 cases from 218 consecutive patients (163 men, 55 women; mean age: 66.9 ± 12.7 years) who underwent lower extremity endovascular procedures were retrospectively evaluated. The time between the injection of local anesthetic and the insertion of the microsheath into the superficial femoral artery was measured. The common femoral artery diameter, cutis thickness, distance between arterial puncture site and common femoral artery bifurcation, degree of common femoral artery calcification, body mass index, and history of previous access were investigated to assess their relationship with access time. Furthermore, all cases were assessed with ultrasonography for access-site complications before discharge.

Results:

Technical success was achieved in 293 of 294 procedures (99.7%). The mean time for superficial femoral artery access was 1.9 ± 0.8 min (range, 0.7–3.7 min). Additional fluoroscopic guidance was needed in one case. There were moderately positive correlations of body mass index ( r = 0.75; p < 0.001) and cutis thickness ( r = 0.58; p < 0.001) with access time. The other variables failed to reveal significant correlations with access time. Five groin hematomas occurred after percutaneous transluminal angioplasty. Complications such as pseudoaneurysm, arteriovenous fistula, or retroperitoneal hematoma were not observed.

Conclusion:

Antegrade common femoral artery puncture with subsequent superficial femoral artery access conducted solely under ultrasonography guidance was feasible and safe. In addition, the antegrade access time showed positive correlations with body mass index and cutis thickness.
Axillary vein thrombosis in COVID positive patient with midline and continuous positive airway pressure Helmet
Authors: Vailati Davide , Fusco Tiziana , Canelli Antonio , Chiariello Carmela , Zerla Pietro
Published: July 2020

We describe the case of a coronavirus disease patient with midline who, during ventilation with continuous positive airway pressure helmet with underarm fastening straps, presented thrombosis of the axillary vein in the armpit. The tip of the midline ended in the armpit. The thrombosis has been resolved with anticoagulant therapy with low molecular weight heparin of 100 IU/kg bid without giving pulmonary embolism. In an emergency context like this, the need to resort to ventilation strategies even in departments generally not accustomed to the use of these devices and to the management of this type of patients, the need to use and adapt the available material (e.g. being unable to renounce to use underarm fastening straps) obliges us to consider the use of alternative strategies also in the field of vascular access. After this case, we began to consider techniques that allow us to prevent the catheter from ending in the armpit, with benefit. It is essential to continue to observe this patient.
Dancing in Quarantine: The Spatial Refiguration of Society and the Interaction Orders
Authors: Löw Martina , Knoblauch Hubert
Published: July 2020

Brief position statements on the theme of quarantine
‘Lean on me': Sifarish, mediation & the digitisation of state bureaucracies in India
Authors: Chambers Thomas
Published: July 2020

Through an ethnographic focus on Muslim neighbourhoods in a North Indian city, this article traces the effects of increasing digitisation of Public Distribution Systems (PDS) and ID provision in India by examining the implications for relations between the state, low-level political actors and local populaces. The article explores the practice of sifarish (leaning on someone to get something done) which, it is argued, cannot be seen within simplistic rubrics of ‘corruption’ but instead comprises a socially embedded ethical continuum. With one of the stated aims of digitisation being the displacing of informal mediation, the ethnographic material illuminates the efforts of low-level political actors to navigate emerging digital infrastructures. Digitisation, however, does not end mediation and carries with it ideological, political and economic interests. This, the article argues, enables state/people spaces of mediation to be commodified and marketized and further cements processes of marginalisation experienced by India’s Muslim minority.
Images of School Times: Organizing Rhythms, Revealing Pedagogies
Authors: Marini Guillermo , Rodríguez Merchán Juan David
Published: July 2020

Among the different dimensions of visual experience that schools organize, model and reproduce, time is one of the least researched. Through the analysis of four images from four different elementary schools in Santiago, Chile, this visual essay explores ways in which the visual culture of schools refers to time, both as an organizational variable and as an interpersonal condition that, in turn, can be associated with different pedagogical practices.
Fostering ethical biomedical and health research in India during the COVID-19 pandemic
Authors: Kumar Nandini K , Muthuswamy Vasantha
Published: July 2020

The COVID-19 pandemic has brought unprecedented, major challenges to the ethical conduct of research including challenges for the rapid and robust ethical review of biomedical research. The Indian Council of Medical Research’s “National Guidelines for Ethics Committees Reviewing Biomedical and Health Research during COVID-19 Pandemic” aim to assist ethics committees in this time of crisis, whilst simultaneously protecting researchers and research participants. Whilst ethics committees are encouraged to approve studies rapidly, the Indian guidelines also make clear that no shortcuts will be taken. Informed consent must be obtained innovatively, but cannot be dispensed with. Vulnerable people should only be involved in clinical research that is relevant to their health needs. Approaching communities for research also requires new, trust-building methods, given that healthcare workers and researchers have been assaulted during their COVID-19 research. Importantly, the media must carry their share of responsibility and avoid spreading fake news. From an Indian perspective, the question of whether we are sitting on a volcano that might erupt at any time causing more damage than we ever expected is currently unclear. Only global collaborative efforts will help to tide over in the present crisis.
Gastrointestinal perforation in a critically ill patient with COVID-19 pneumonia
Authors: Kangas-Dick Aaron , Prien Christopher , Rojas Kristin , Pu Qinghua , Hamshow Mohammad , Wan Elias , Chawla Kabu , Wiesel Ory
Published: July 2020

Gastrointestinal complications in critically ill patients during the COVID-19 pandemic pose a diagnostic and treatment dilemma. We present a case of a 74-year-old male who was brought to our emergency department with worsening shortness of breath, fever, and dry cough and was found to have COVID-19 pneumonia. Early in his hospital course, he was admitted to the intensive care unit, and was found to have significant abdominal distension with large amounts of simple fluid on bedside ultrasound. Bedside paracentesis returned succus and enteric feeds, and a methylene blue test confirmed a likely gastrointestinal perforation. The patients’ family refused surgical intervention and the patient underwent bedside drainage. This case represents several critical dilemmas clinicians faced during the recent surge of the COVID-19 pandemic.
Lessons From Zika and Other Virus Induced Skull Deformity
Authors: Masoumy Mohamad , Masoumy Emily P. , Baban Babak , Yu Jack C.
Published: July 2020

Objective: Viral infections during pregnancy can cause disturbance in normal craniofacial morphogenesis. While some pathogens such as cytomegalovirus and herpes simplex are familiar to us, others remain obscure. This review examines the arbovirus-induced cranial deformities and combines biomechanics with growth dynamics to gain a deeper appreciation of this complex morphogenetic process. Materials and Methods: Using Wolfram Alpha, we analyzed the impact of cell population changes. The growth dynamics of the brain, and thus the size of the calvarium, followed 2 potential logistic curves: compensated and uncompensated. To understand the potential mechanism of cell loss, we performed literature review on maternal immune activation and viral tropism for neurons and glial cells. Results: With arboviral infections such as Zika, uncompensated loss of cells during the critical phases of fetal brain development reduces the intracranial mass and therefore decreases the tensile stress across the cranial sutures. The deflationary effect produces microcephaly by subduction and reduced osteogenesis seen clinically in these infants. Conclusion: Many viral infections cause intense maternal immune activation, some have neurotropism and can result in cell loss within the developing cranium. Unable to overcome this loss, the cranium assumes a new, abnormal shape and volume. Secondary calvarial deformities is due to, and should not cause, changes in brain development.
Examining the Safety and Efficacy of Supplemental Regional Anesthesia After Iliac Crest Harvest During Cleft Alveolar Bone Grafting
Authors: Lesko Robert , Susarla Srinivas M. , Lough Denver , Kumar Anand R.
Published: July 2020

Background: The optimal prevention and treatment of pain associated of iliac crest bone graft donor sites for the treatment of cleft alveolus defects has not been well characterized. The aim of this study is to assess the efficacy of minimal access bone graft techniques with or without regional anesthesia in iliac crest bone harvest and compare to outcomes to traditional open harvest techniques. Methods: A retrospective review of 46 patients undergoing iliac crest bone harvest using traditional open iliac crest bone graft (ICBG) alone (Group 1, n = 20), minimal access ICBG (Group 2, n = 20), or minimal access ICBG with paravertebral anesthetic block (Group 3, n = 5) was performed. Post operative pain scores, narcotic consumption, and hospital stay were analyzed. Results: The average time to first narcotic was 247 minutes in Group 1, 193 in Group 2, and 1162 minutes in Group 3 ( P < .0002). Total narcotic use was 0.117 mg/kg in Group 1, 0.131 mg/kg in Group 2, and 0.072 mg/kg in Group 3. The average pain score (VAS) was 2.96 in Group 1, 1.83 in Group 2, and 1.08 in Group 3 ( P < .01). The average length of stay was 1.45 for Group 1, 1.36 for Group 2, and 1.0 for Group 3. Bone graft extrusion occurred in 6 patients (27.3%) in Group 1 and none in Group 2 or 3. There were no wound infections, bleeding requiring reoperation, or mortalities. Conclusion: The addition of regional anesthesia to minimal access alveolar bone graft harvest significantly reduces time to first narcotic use. Although not significant, a strong trend was found with regional anesthesia to lower the pain score (VAS) and total narcotic use. Regional anesthesia did not significantly reduce the length of hospital stay compared to either group. Minimal access techniques with supplemental regional anesthesia significantly lowered the pain score and time to first narcotic and trended to decreased length of hospitalization and total narcotic use compared to traditional open techniques.
Allogeneic stem cell transplantation for high-risk acute leukemia and maintenance therapy: no time to waste
Authors: Scott Bart L.
Published: July 2020

This article has a companion Counterpoint by Soiffer.
Platelet autoantibodies in the bone marrow of patients with immune thrombocytopenia
Authors: Shrestha Sabrina , Nazy Ishac , Smith James W. , Kelton John G. , Arnold Donald M.
Published: July 2020

Autoantibodies cause platelet destruction in patients with immune thrombocytopenia (ITP); yet only 50% to 60% of patients have detectable platelet autoantibodies in peripheral blood. We hypothesized that in some ITP patients, platelet autoantibodies are sequestered in the bone marrow where pathological immune reactions target megakaryocytes or newly formed platelets. In this study, we modified the platelet glycoprotein-specific assay to test bone marrow aspiration samples for free platelet autoantibodies or antibodies bound to bone marrow cells in aspirate fluid from patients with ITP (n = 18), patients with nonimmune thrombocytopenia (n = 3), and healthy donors (n = 6). We found that 10 (56%) of 18 patients with ITP had autoantibodies in the bone marrow, including 5 (50%) of 10 with autoantibodies in bone marrow only, and 5 (50%) of 10 with autoantibodies in bone marrow and peripheral blood. In comparison, 6 (33%) of 18 ITP patients had autoantibodies in peripheral blood, most of whom (5 [83%] of 6) also had autoantibodies in bone marrow. Bone marrow autoantibodies were not detected in patients with nonimmune thrombocytopenia or healthy donors; however, peripheral blood autoantibodies were detectable in 1 (33%) of 3 patients with nonimmune thrombocytopenia. The sensitivity of platelet autoantibodies for the diagnosis of ITP increased from 60% (peripheral blood testing) to 72% (peripheral blood and bone marrow testing). Immune reactions limited to the bone marrow may be characteristic of certain subsets of ITP patients.
Low VWF: insights into pathogenesis, diagnosis, and clinical management
Authors: O’Donnell James S.
Published: July 2020

von Willebrand disease (VWD) constitutes the most common inherited human bleeding disorder. Partial quantitative von Willebrand factor (VWF) deficiency is responsible for the majority of VWD cases. International guidelines recommend that patients with mild to moderate reductions in plasma VWF antigen (VWF:Ag) levels (typically in the range of 30-50 IU/dL) should be diagnosed with low VWF. Over the past decade, a series of large cohort studies have provided significant insights into the biological mechanisms involved in type 1 VWD (plasma VWF:Ag levels <30 IU/dL). In striking contrast, however, the pathogenesis underpinning low VWF has remained poorly understood. Consequently, low VWF patients continue to present significant clinical challenges with respect to genetic counseling, diagnosis, and management. For example, there is limited information regarding the relationship between plasma VWF:Ag levels and bleeding phenotype in subjects with low VWF. In addition, it is not clear whether patients with low VWF need treatment. For those patients with low VWF in whom treatment is deemed necessary, the optimal choice of therapy remains unknown. However, a number of recent studies have provided important novel insights into these clinical conundrums and the molecular mechanisms responsible for the reduced levels observed in low VWF patients. These emerging clinical and scientific findings are considered in this review, with particular focus on pathogenesis, diagnosis, and clinical management of low VWF.
Electrochemical assessment of pigments-binding medium interactions in oil paint deterioration: a case study on indigo and Prussian blue
Authors: Doménech-Carbó Antonio , Doménech-Carbó María Teresa , Osete-Cortina Laura , Donnici Margherita , Guasch-Ferré Núria , Gasol-Fargas Rosa M. , Iglesias-Campos Manuel Ángel
Published: July 2020

The degradation of laboratory oil paint film specimens containing indigo and Prussian blue pigments and pictorial samples from the Sant Francesc de Paula painting exhibited in the Tomàs Balvey Arxiu Museum (Cardedeu (Catalonia), Spain) has been studied by voltammetry of immobilized particles. This technique, combined with light microscopy, scanning electron microscopy-energy dispersive X-ray analysis, nanoindentation-atomic force microscopy, attenuated total reflectance-Fourier-transform infrared spectroscopy and gas chromatography–mass spectroscopy techniques permits the proposal of a dual scheme for the degradation of the pigments when naturally aged and submitted to accelerated UVA aging. Under conditions of moderate temperature, humidity and natural illumination, and low gradients of these parameters, Prussian blue acts as a radical scavenger moderating the production of reactive oxygen species produced in the oil binding medium by the action of ultraviolet radiation, resulting in the formation, in the solid state, of the solid-solution, {KFeIII[FeII(CN)6]}
x
{FeIII[FeIII(CN)6]}1–x
, known as Berlin green, which then promotes the formation of indigo adducts with radicals. In several localized areas of the Sant Francesc de Paula paint showing strong degradation, Prussian blue acts as a promoter of the indigo oxidation to isatin, thus resulting in a considerable chromatic shift.
Reconstruction of monsoon evolution in southernmost Sumatra over the past 35 kyr and its response to northern hemisphere climate changes
Authors: Liu Shengfa , Zhang Hui , Shi Xuefa , Chen Min-Te , Cao Peng , Li Ziye , Troa Rainer Arief , Zuraida Rina , Triarso Eko , Marfasran Hendrizan
Published: July 2020

Reconstruction of monsoon evolution in the tropical Indian Ocean and evaluation of its influence on large-scale ocean circulation and sea-air interaction processes can help us understand climate driving mechanisms. Herein, we used a gravity core SO184-10043 to present the marine sedimentary record from the southernmost Sumatra, spanning the past 35 kyr. The age model is well constrained by 12 accelerator mass spectrometry (AMS) radiocarbon dates determined in mixed planktic foraminifera. We also measured sediment grain size and major and trace elements to reconstruct the variations in hydrodynamic conditions and chemical weathering intensity. These data were then used to reveal the evolution of the northwest (Indonesian) monsoon system over the past 35 kyr. The results showed that both monsoon current and chemical weathering coincided with summer insolation in the Northern Hemisphere and responded to glacial-interglacial climate changes in the northern Atlantic. Higher grain-size values of sensitive components, increased chemical index of alteration (CIA), and Ba/Sr ratios, together with lower CaO/MgO ratios, reflect a stronger monsoon current and chemical weathering during the late marine isotope stage 3 and Holocene. Higher intensity of chemical weathering might be attributed to a stronger northwest monsoon carrying warm and moist air from the Asian continent to Indonesian waters. Lower values of sensitive components, CIA, and Ba/Sr, along with higher CaO/MgO values, reveal a weaker monsoon current and lower intensity of chemical weathering during the last glaciation-deglaciation phase, which was controlled by a weaker monsoon system. At a millennial timescale, cold events occurred during the following intervals: 30–26 ka BP, Heinrich Stadial 1 (HS1; 18–15 ka BP), Last Glacial Maximum (LGM; 23–18 ka BP), Younger Dryas (YD; 11–10 ka BP), and 8.2 ka BP. The same cold events were identified from core SO184-10043, indicating a perfect match with climatic cooling in the Northern Hemisphere. We also observed periodicities of ~ 7.9 ka, 3.0–3.1 ka, 2.2–2.3 ka, and ~ 1.0 ka in our core records. These periodicities are coincident with solar-induced climate changes and support the hypothesis that monsoon evolution in the tropical Indian Ocean during the late Pleistocene coincided with the climate change in the Northern Hemisphere.