bluuebunny/crossref_metadata_2025 huggingface dataset:
Global Existence and Uniqueness of Periodic Waves in a Population Model with Density-Dependent Migrations and Allee Effect
Authors: Sun Xianbo , Yu Pei , Qin Bin
Published: December 2017

We report a new result on the traveling wave solutions of a biological invasion model with density-dependent migrations and Allee effect. It has been shown in the literature that such a model can exhibit one periodic wave solution by using Hopf bifurcation theory. In this paper, global bifurcation theory is applied to prove that there exists maximal one periodic solution which can be reached in a large feasible parameter regime. The basic idea used in our technique is to examine the monotonicity of the ratio of related Abelian integrals. Especially, the existence condition for the solution near a homoclinic loop is obtained.
Involutions of hyperbolic spatial graph exteriors whose fixed point sets are closed surfaces
Authors: Ikeda Toru
Published: December 2017

A [Formula: see text]-component non-splittable spatial graph [Formula: see text] in [Formula: see text] possibly admits a smooth involution on its exterior whose fixed point set is a closed surface [Formula: see text] of genus [Formula: see text]. It is known that [Formula: see text] holds if [Formula: see text] is a graph link in [Formula: see text]. In this paper, we consider [Formula: see text] to be a hyperbolic spatial graph in a closed orientable 3-manifold [Formula: see text]. We first study the case where [Formula: see text] is the 3-sphere, and provide a method for constructing [Formula: see text] and [Formula: see text] with [Formula: see text], where [Formula: see text] is the Euler characteristic of [Formula: see text] for [Formula: see text]. Next, we study the case where [Formula: see text] is a closed orientable 3-manifold in relation to Heegaard splittings and Dehn surgeries.
On unstabilized Heegaard splittings of amalgamated 3-manifolds
Authors: Du Kun
Published: December 2017

Let [Formula: see text] [Formula: see text] be a Heegaard splitting of compact orientable [Formula: see text]-manifold, and [Formula: see text] be an amalgamation along an essential surface [Formula: see text]. In this paper, we show that if there is an essential disk [Formula: see text] in [Formula: see text], such that [Formula: see text] cuts [Formula: see text] into two product [Formula: see text]-bundles, one of which is [Formula: see text], and [Formula: see text] [Formula: see text], then [Formula: see text] is unstabilized and [Formula: see text] is uncritical. We also give a sufficient condition for [Formula: see text] to be critical.
On the Hilbert polynomial of the HOMFLYPT homology
Authors: Wu Hao
Published: December 2017

We prove that the degree of the Hilbert polynomial of the HOMFLYPT homology of a closed braid [Formula: see text] is [Formula: see text], where [Formula: see text] is the number of components of [Formula: see text]. This controls the growth of the HOMFLYPT homology with respect to its polynomial grading. The Hilbert polynomial also reveals a link polynomial hidden in the HOMFLYPT polynomial.
A simplification in Vassiliev's spectral sequence
Authors: Mortier Arnaud
Published: December 2017

We establish a simple formula to compute the incidence signs in the spectral sequence used by Vassiliev to define finite-type cohomology classes in the space of long knots. We consider only the subcomplex of tree diagrams, which carries all the cohomology in low degrees and is the most difficult to compute. On the way, it is shown that by getting rid of the most complicated ingredients in the boundary maps, one obtains an isomorphic complex.
A characterization of almost alternating knots
Authors: Ito Tetsuya
Published: December 2017

We give an intrinsic (not diagrammatic) characterization of almost alternating knots by generalizing Howie and Greene’s characterization of alternating knots. We also introduce a notion of a spanning surface defect by using the Gordon–Litherland pairing of (possibly non-orientable) spanning surfaces of the knot, and show that it is an alternating distance, a quantity which measures to what extent the knot is far from alternating.
The Tait conjecture in #g(S1 × S2)
Authors: Carrega Alessio
Published: December 2017

The Tait conjecture states that alternating reduced diagrams of links in [Formula: see text] have the minimal number of crossings. It has been proved in 1987 by Thistlethwaite, Kauffman and Murasugi studying the Jones polynomial. In [A. Carrega, The Tait conjecture in [Formula: see text], J. Knot Theory Ramifications 25(11) (2016) 1650063], the author proved an analogous result for alternating links in [Formula: see text] giving a complete answer to this problem. In this paper, we extend the result to alternating links in the connected sum [Formula: see text] of [Formula: see text] copies of [Formula: see text]. In [Formula: see text] and [Formula: see text], the appropriate version of the statement is true for [Formula: see text]-homologically trivial links, and the proof also uses the Jones polynomial. Unfortunately, in the general case, the method provides just a partial result and we are not able to say if the appropriate statement is true.
Bridge spectra of cables of 2-bridge knots
Authors: Owad Nicholas J.
Published: December 2017

We compute the bridge spectra of cables of 2-bridge knots. We also give some results about bridge spectra and distance of Montesinos knots.
Groups whose proper Schur rings are commutative
Authors: Cho Eun-Kyung
Published: December 2017

A Schur ring [Formula: see text] is called Dedekind if the formal sum of every [Formula: see text]-subgroup is in the center of [Formula: see text]. In this paper, we find all finite groups [Formula: see text] such that every proper Schur ring over [Formula: see text] is Dedekind. As a corollary of our main theorem, we find all finite groups [Formula: see text] such that every proper Schur ring over [Formula: see text] is commutative.
Hochschild cohomology of some quantum complete intersections
Authors: Erdmann Karin , Hellstrøm-Finnsen Magnus
Published: December 2017

We compute the Hochschild cohomology ring of the algebras [Formula: see text] over a field [Formula: see text] where [Formula: see text] and where [Formula: see text] is a primitive [Formula: see text]th root of unity. We find the dimension of [Formula: see text] and show that it is independent of [Formula: see text]. We compute explicitly the ring structure of the even part of the Hochschild cohomology modulo homogeneous nilpotent elements.
Antibacterial Activity of Silver Nanoparticles Using Jasminum auriculatum Stem Extract
Authors: Balasubramanian S. , Jeyapaul U. , Kala S. Mary Jelastin
Published: December 2017

In the present study, bio-meditated silver nanoparticles have been synthesized using Jasminum auriculatum stem extracts. The silver nanoparticles were confirmed using UV-visible and FT-IR spectra. The size and morphology of silver nanoparticles were confirmed using XRD, SEM and EDAX techniques. The antibacterial activity of green synthesized silver nanoparticles was assessed by disc diffusion method against human pathogens. The antibacterial studies indicate that green synthesized silver nanoparticles have several pharmaceutical applications for the management of deadly human pathogens.
Unbounded Generators of Dynamical Semigroups
Authors: Siemon I. , Holevo A. S. , Werner R. F.
Published: December 2017

Dynamical semigroups have become the key structure for describing open system dynamics in all of physics. Bounded generators are known to be of a standard form, due to Gorini, Kossakowski, Sudarshan and Lindblad. This form is often used also in the unbounded case, but rather little is known about the general form of unbounded generators. In this paper we first give a precise description of the standard form in the unbounded case, emphasizing intuition, and collecting and even proving the basic results around it. We also give a cautionary example showing that the standard form must not be read too naively. Further examples are given of semigroups, which appear to be probability preserving to first order, but are not for finite times. Based on these, we construct examples of generators which are not of standard form.
An Introduction to Operational Quantum Dynamics
Authors: Milz Simon , Pollock Felix A. , Modi Kavan
Published: December 2017

This special volume celebrates the 40th anniversary of the discovery of the Gorini-Kossakowski-Sudarshan-Lindblad master equation, which is widely used in quantum physics and quantum chemistry. The present contribution aims to celebrate a related discovery — also by Sudarshan — that of Quantum Maps (which had their 55th anniversary in the same year). Nowadays, much like the master equation, quantum maps are ubiquitous in physics and chemistry. Their importance in quantum information and related fields cannot be overstated. Here, we motivate quantum maps from a tomographic perspective, and derive their well-known representations. We then dive into the murky world beyond these maps, where recent research has yielded their generalisation to non-Markovian quantum processes.
Quantum Systems Theory Viewed from Kossakowski-Lindblad Lie Semigroups — andVice Versa
Authors: Schulte-Herbrüggen Thomas , Dirr Gunther , Zeier Robert
Published: December 2017

The solutions to the celebrated Kossakowski-Lindblad equation extended by coherent controls yield Markovian quantum maps. More precisely, the set of all its solutions forms a semigroup of completely positive trace-preserving maps taking the specific form of a Lie semigroup. Non-trivial symmetries of these semigroups are shown to preclude accessibility in Markovian dissipative systems. This is the open-system analogue to closed systems, where triviality of (quadratic) symmetries of the Hamiltonian part suffices to decide that the system is fully controllable. The findings are placed into a unifying Lie frame of quantum systems and control theory alongside with illustrating examples.
Rapid processing of ferrite ceramics with promising magneto-dielectric characteristics
Authors: Xiao Zhuohao , Wang Chuanhu , Liu Lie , Yang Zhihong , Kong Ling Bing
Published: December 2017

Ferrite ceramics, Ni[Formula: see text]Zn[Formula: see text]Co[Formula: see text]Fe[Formula: see text]O4, with the addition of 4[Formula: see text]wt.% Bi2O3 as sintering aid, were fabricated by using a simple one-step processing without involving the step of calcination. X-ray diffraction (XRD) results indicated that single phase ferrite ceramics can be achieved after sintering at 1000[Formula: see text]C for 2[Formula: see text]h. The samples demonstrated relative densities in the range of 97–99%. Desired magneto-dielectric properties have been approached by adjusting the sintering temperature and sintering time duration. This technique is believed to be applicable to other ceramic materials.
An analytical model of the melt pool and single track in coaxial laser direct metal deposition (LDMD) additive manufacturing
Authors: Liu Jian , Stevens Erica , Yang Qingchen , Chmielus Markus , To Albert C.
Published: December 2017

An analytical model was developed for the melt pool and single scan track geometry as a function of process parameters. For computational efficiency, the developed model has simple mathematical forms with essential physics taken into account, without the need for complicated numerical simulation. In this research, a non-diverging Gaussian laser beam and coaxial diverging Gaussian powder stream combination is used to represent the coaxial laser direct metal deposition (LDMD) process. Analytical laser-powder interaction model is used to obtain the distribution of attenuated laser intensity and temperature of heated powders at the substrate. On the substrate, the melt pool is calculated by integrating Rosenthal's point heat source model. An iterative procedure is used to ensure the mass–energy balances and to calculate the melt pool and catchment efficiency. By assuming that the assimilated powder will reshape due to surface tension before solidification, a simple clad geometry model is established. The proposed model is used to simulate the geometry of single track depositions of Ti6Al4V, which shows a good agreement between model prediction and experimental results. This work demonstrates that the developed model has the potential to be used to narrow the parameter space for process optimization.
FPGA Implementations of Kernel Normalised Least Mean Squares Processors
Authors: Fraser Nicholas J. , Lee Junkyu , Moss Duncan J. M. , Faraone Julian , Tridgell Stephen , Jin Craig T. , Leong Philip H. W.
Published: December 2017

Kernel adaptive filters (KAFs) are online machine learning algorithms which are amenable to highly efficient streaming implementations. They require only a single pass through the data and can act as universal approximators, i.e. approximate any continuous function with arbitrary accuracy. KAFs are members of a family of kernel methods which apply an implicit non-linear mapping of input data to a high dimensional feature space, permitting learning algorithms to be expressed entirely as inner products. Such an approach avoids explicit projection into the feature space, enabling computational efficiency. In this paper, we propose the first fully pipelined implementation of the kernel normalised least mean squares algorithm for regression. Independent training tasks necessary for hyperparameter optimisation fill pipeline stages, so no stall cycles to resolve dependencies are required. Together with other optimisations to reduce resource utilisation and latency, our core achieves 161 GFLOPS on a Virtex 7 XC7VX485T FPGA for a floating point implementation and 211 GOPS for fixed point. Our PCI Express based floating-point system implementation achieves 80% of the core’s speed, this being a speedup of 10× over an optimised implementation on a desktop processor and 2.66× over a GPU.
Seamless Virtual Network for International Business Continuity in Presence of Intentional Blocks
Authors: Fujikawa Hiroshi , Yamaki Hirofumi , Tsuruta Setsuo
Published: December 2017

In developing countries, links are poor among domestic communities or internet service providers. Besides, international internet channels are suddenly blocked by such as Golden Shield (GS) in China. Offshore business communications are involved in these. To avoid such involvement, a seamless virtual network is proposed as an international business communication bridging solution. This uses Round Trip Time (RTT) based multiple thresholds for differential switch to Virtual Private Network (VPN) bypass. The characteristics are (1) using multiple threshold integrated differential calculus of RTT increase, a sign of the block is recognized as the steep staircase increase of RTT, (2) followed by the immediate automatic switch to VPN having RTT below 200ms. (3) Asymmetrically, only the absolute threshold value and continuation time are used to determine when to switch back. This method is analytically and statistically evaluated as being successful (below 3% errors), using around 200 cases of data on GS blocks. Furthermore, it has been validated by the real seamless usage in more than 20 offshore companies for three years. Besides response time in offshore applications, our method can also alleviate problems such as voice echoes and video jitters which irritate business users. These effects were validated analytically and by questionnaires to scores of business customers.
hfplayer
Authors: Haghdoost Alireza , He Weiping , Fredin Jerry , Du David H. C.
Published: December 2017

We introduce new methods to replay intensive block I/O workloads more accurately. These methods can be used to reproduce realistic workloads for benchmarking, performance validation, and tuning of a high-performance block storage device/system. In this article, we study several sources in the stock operating system that introduce uncertainty in the workload replay. Based on the remedies of these findings, we design and develop a new replay tool called
hfplayer
that replays intensive block I/O workloads in a similar unscaled environment with more accuracy. To replay a given workload trace in a scaled environment with faster storage or host server, the dependency between I/O requests becomes crucial since the timing and ordering of I/O requests is expected to change according to these dependencies. Therefore, we propose a heuristic way of speculating I/O dependencies in a block I/O trace. Using the generated dependency graph,
hfplayer
tries to propagate I/O related performance gains appropriately along the I/O dependency chains and mimics the original application behavior when it executes in a scaled environment with slower or faster storage system and servers. We evaluate
hfplayer
with a wide range of workloads using several accuracy metrics and find that it produces better accuracy when compared to other replay approaches.
Recurrent Enlarging Mesenteric Desmoid Tumor following Remote Surgical Resection
Authors: Hapgood Connie , DeLong Allison
Published: December 2017

Intra-abdominal desmoid tumors are commonly associated with genetic syndromes such as familial polyposis coli. Radiological cross imaging studies such as CT and MRI are used in the preoperative work-up of such tumors. Postoperatively, CT and MRI are useful in the assessment of recurrent desmoid tumors. MRI is more accurate in tissue characterization. Where possible, surgical resection remains the standard first-line treatment. For patients where surgery is not possible, or the resection margins are not clear, other forms of treatment are possible. These include hormonal and nonhormonal options. We present a case of a recurrent sporadic intra-abdominal (mesenteric) desmoid tumor. Such an entity is rare with few cases reported in the literature. Treatment options regarding intra-abdominal desmoid tumors will be discussed.
A Rare Finding of Falciform Ligament Thrombosis as a Sequel of Acute Pancreatitis
Authors: Lim H. Q. C. , Lee X. W. J. , Mathias N.
Published: December 2017

Falciform ligament (remnant of umbilical vein) is an anatomical structure that connects the liver to the anterior abdominal wall. This case reports a rare clinical presentation of falciform ligament thrombosis as a consequence of acute gallstone pancreatitis, in a patient with noncirrhotic liver. A 55-year-old female with a history of cholelithiasis was admitted with abdominal pain. Biochemistry profile showed hyperamylasemia and deranged liver function tests. Computerized Tomography (CT) revealed a 3 cm attenuated structure that can be traced up to the left portal vein, which represents an acute thrombosis of the falciform ligament. The patient was treated with Tinzaparin and subsequently anticoagulated. She subsequently had a laparoscopic cholecystectomy and made an uneventful recovery. We suspect that pancreatitis caused thrombophlebitis subsequently leading to recanalization and thrombosis of the umbilical vein. Falciform ligament thrombosis is a rare and poorly described complication following pancreatitis which clinicians and radiologists should be aware of.
EGCG Maintains Th1/Th2 Balance and Mitigates Ulcerative Colitis Induced by Dextran Sulfate Sodium through TLR4/MyD88/NF-κB Signaling Pathway in Rats
Authors: Bing Xue , Xuelei Liu , Wanwei Dong , Linlang Liang , Keyan Chen
Published: December 2017

Objective.To observe the protective effect of epigallocatechin gallate (EGCG) on dextran sulfate sodium- (DSS-) induced ulcerative colitis in rats and to explore the roles of TLR4/MyD88/NF-κB signaling pathway.Methods.Rat models of ulcerative colitis were established by giving DSS. EGCG (50 mg/kg/d) was given to assess disease activity index. HE staining was applied to observe histological changes. ELISA and qPCR detected the expression of inflammatory factors. Flow cytometry was used to measure the percentage of CD4+IFN-γ+and CD4+IL-4+in the spleen and colon. TLR4 antagonist E5564 was given in each group. Flow cytometry was utilized to detect CD4+IFN-γ+and CD4+IL-4+cells. Immunohistochemistry, qPCR, and western blot assay were applied to measure the expression of TLR4, MyD88, and NF-κB.Results.EGCG improved the intestinal mucosal injury in rats, inhibited production of inflammatory factors, maintained the balance of Th1/Th2, and reduced the expression of TLR4, MyD88, and NF-κB. After TLR4 antagonism, the protective effect of EGCG on intestinal mucosal injury was weakened in rats with ulcerative colitis, and the expressions of inflammatory factors were upregulated.Conclusion.EGCG can inhibit the intestinal inflammatory response by reducing the severity of ulcerative colitis and maintaining the Th1/Th2 balance through the TLR4/MyD88/NF-κB signaling pathway.
Privacy-Preserving and Scalable Service Recommendation Based on SimHash in a Distributed Cloud Environment
Authors: Xu Yanwei , Qi Lianyong , Dou Wanchun , Yu Jiguo
Published: December 2017

With the increasing volume of web services in the cloud environment, Collaborative Filtering- (CF-) based service recommendation has become one of the most effective techniques to alleviate the heavy burden on the service selection decisions of a target user. However, the service recommendation bases, that is, historical service usage data, are often distributed in different cloud platforms. Two challenges are present in such a cross-cloud service recommendation scenario. First, a cloud platform is often not willing to share its data to other cloud platforms due to privacy concerns, which decreases the feasibility of cross-cloud service recommendation severely. Second, the historical service usage data recorded in each cloud platform may update over time, which reduces the recommendation scalability significantly. In view of these two challenges, a novel privacy-preserving and scalable service recommendation approach based on SimHash, named SerRecSimHash, is proposed in this paper. Finally, through a set of experiments deployed on a real distributed service quality dataset WS-DREAM, we validate the feasibility of our proposal in terms of recommendation accuracy and efficiency while guaranteeing privacy-preservation.
Phylogeny of Ten Kenyan Plectranthus Species in the Coleus Clade Inferred from Leaf Micromorphology, Rbcl and MatK Genes
Authors: Musila Fredrick M. , Lukhoba Catherine W. , Nguta Joseph M. , Dossaji Saifuddin F.
Published: December 2017

Plectranthus species are difficult to taxonomically delimit due to lack of clear-cut morphological synapomorphies. This study is aimed at bringing insights into classification of ten Plectranthus species in the Coleus clade by using leaf micromorphology and molecular data. Stomatal counts and observation of microtome leaf sections generated leaf micromorphology data, while molecular data was obtained from sequencing MatK and Rbcl genes from each species. Phylogeny based on the MatK and Rbcl gene sequences clustered four species P. caninus, P. otostegioides, P. barbatus, and P. lanuginosus together (Clusters A and D, respectively), while P. pseudomarrubioides, P. ornatus, and P. aegyptiacus were grouped together into Clusters B and E, respectively, and P. montanus and P. amboinicus were grouped together (Cluster C). A dendrogram was generated through a cluster analysis of the leaf micromorphological characters grouped together, P. caninus, P. ornatus, P. otostegioides, P. montanus, and P. pseudomarrubioides (Cluster F). The dendrogram also grouped together P. aegyptiacus, P. amboinicus, P. edulis, P. barbatus, and P. lanuginosus (Cluster G). The present study has grouped the ten studied Plectranthus species using molecular and leaf micromorphology characters into phylogenies, which are supported by previous studies, and proved that these characters can aid in plant identification and phylogenetic studies.
Cost-Effectiveness Analysis of Total Hip Arthroplasty Performed by a Canadian Short-Stay Surgical Team in Ecuador
Authors: Schlegelmilch Michael , Rashiq Saifee , Moreau Barbara , Jarrín Patricia , Tran Bach , Chuck Anderson
Published: December 2017

Background. Few charitable overseas surgical missions produce cost-effectiveness analyses of their work. Methods. We compared the pre- and postoperative health status for 157 total hip arthroplasty (THA) patients operated on from 2007 to 2011 attended by an annual Canadian orthopedic mission to Ecuador to determine the quality-adjusted life years (QALYs) gained. The costs of each mission are known. The cost per surgery was divided by the average lifetime QALYs gained to estimate an incremental cost-effectiveness ratio (ICER) in Canadian dollars per QALY. Results. The average lifetime QALYs (95% CI) gained were 1.46 (1.4–1.5), 2.5 (2.4–2.6), and 2.9 (2.7–3.1) for unilateral, bilateral, and staged (two THAs in different years) operations, respectively. The ICERs were $4,442 for unilateral, $2,939 for bilateral, and $4392 for staged procedures. Seventy percent of the mission budget was spent on the transport and accommodation of volunteers. Conclusion. THA by a Canadian short-stay surgical team was highly cost-effective, according to criteria from the National Institute for Health and Care Excellence and the World Health Organization. We encourage other international missions to provide similar cost-effectiveness data to enable better comparison between mission types and between mission and nonmission care.
Sparse Learning of the Disease Severity Score for High-Dimensional Data
Authors: Stojkovic Ivan , Obradovic Zoran
Published: December 2017

Learning disease severity scores automatically from collected measurements may aid in the quality of both healthcare and scientific understanding. Some steps in that direction have been taken and machine learning algorithms for extracting scoring functions from data have been proposed. Given the rapid increase in both quantity and diversity of data measured and stored, the large amount of information is becoming one of the challenges for learning algorithms. In this work, we investigated the direction of the problem where the dimensionality of measured variables is large. Learning the severity score in such cases brings the issue of which of measured features are relevant. We have proposed a novel approach by combining desirable properties of existing formulations, which compares favorably to alternatives in accuracy and especially in the robustness of the learned scoring function. The proposed formulation has a nonsmooth penalty that induces sparsity. This problem is solved by addressing a dual formulation which is smooth and allows an efficient optimization. The proposed approach might be used as an effective and reliable tool for both scoring function learning and biomarker discovery, as demonstrated by identifying a stable set of genes related to influenza symptoms’ severity, which are enriched in immune-related processes.
Prevalence of Cam and Pincer Deformities in the X-Rays of Asymptomatic Individuals
Authors: Thier Steffen , Gerisch Daniel , Weiss Christel , Fickert Stefan , Brunner Alexander
Published: December 2017

Objective. The presence of radiological signs of femoroacetabular impingement (FAI) is not necessarily associated with symptoms. Hence, the prevalence of cam and pincer deformities in the overall population may be underestimated. The purpose of this study was to screen an unselected cohort of people without hip symptoms for native radiological signs of cam and pincer deformities to determine their actual prevalence.Materials and Methods. 110 asymptomatic patients had AP pelvis X-rays and cross-table hip X-rays performed. We evaluated the images for the presence of cross-over signs and measured lateral center edge (LCE) angles, alpha angles (α-angles), and femoral offset ratios.Results. Positive cross-over signs were seen in 34%; LCE angles > 40° in 13%; and femoral offset ratios < 0.18 in 43%. In 41% of the patients,α-angles were >50°. Male patients showed significantly higherα-angles, lower offset ratios, and a higher prevalence of cross-over signs. In contrast, female patients had significantly higher LCE angles.Conclusion. According to our data, radiological signs of cam and pincer deformities are common in asymptomatic people. In clinical practice, patients presenting with hip pain and radiological signs of FAI should undergo further diagnostic evaluation. However, in asymptomatic patients, no further evaluation is recommended.
Right Internal Jugular Vein Phlebectasia: A Rare Cause of Neck Swelling
Authors: Bhattacharya Deepanjan , Endrakanti Mounika , Kumar Rakesh
Published: December 2017

Internal jugular vein (IJV) phlebectasia is a rare condition presenting as a self-reducible soft tissue swelling of the neck due to fusiform dilation of the venous wall. We report the case of a 7-year-old boy who presented with painless soft mass in the side of the neck which appears during coughing and straining and reduces spontaneously. Diagnosis was confirmed by Doppler ultrasonography and magnetic resonance imaging of the neck. Conservative management and regular follow-up were considered. In this case report, we highlight this rare benign condition as an uncommon differential of neck swellings in order to avoid unnecessary diagnostic workup and interventions.
Bisphosphonate Use and Risk of Recurrence, Second Primary Breast Cancer, and Breast Cancer Mortality in a Population-Based Cohort of Breast Cancer Patients
Authors: Korde Larissa A. , Doody David R. , Hsu Li , Porter Peggy L. , Malone Kathleen E.
Published: December 2017

Background: Studies of bisphosphonate use and breast cancer recurrence have produced conflicting results. Analyses of large adjuvant trials suggest that bisphosphonates reduce recurrence risk only in postmenopausal women.

Methods: We assessed the effect of noncancer treatment–related bisphosphonate use on breast cancer outcomes in a population-based prognostic cohort of women with early-stage invasive breast cancer (n = 1,813; median follow-up = 11.8 years). Using medical record, interview, and cancer registry data, information was assembled on risk factors, cancer treatment, medication use, and outcomes. Statistical analyses used Cox proportional hazards regression models.

Results: Bisphosphonate use was associated with a significantly decreased risk of a breast cancer event [locoregional/distant recurrence or second primary breast cancer; HR ever use, 0.65; 95% confidence interval (CI), 0.47–0.90]. Reduced risks were observed in both pre/peri and postmenopausal women, in both ER-negative and ER-positive breast cancers, and for both earlier and later recurrences. Bisphosphonate use was also associated with a significantly decreased risk of breast cancer mortality (HR, 0.40; 95% CI, 0.23–0.69).

Conclusions: Bisphosphonate use was associated with a reduction in risk of breast cancer events and improved breast cancer–specific survival in women with early-stage breast cancer. We hypothesize that the benefit of bisphosphonates on breast cancer outcomes may be present primarily in women with low bone density and regardless of menopausal status.

Impact: Our findings suggest further consideration of bone density status as a modifier of bisphosphonate's potential beneficial benefits on breast cancer outcomes is warranted. Cancer Epidemiol Biomarkers Prev; 27(2); 165–73. ©2017 AACR.
ICS Use May Modify FEV1 Decline in α1-Antitrypsin Deficiency Patients with Relatively High Blood Eosinophils
Authors: Low Emma V. , Hughes Siân M. , Zaffarullah Safia , Kantas Dimitris , Stockley Robert Andrew , Turner Alice M.
Published: December 2017

Background: α1-Antitrypsin deficiency (AATD) predisposes to chronic obstructive pulmonary disease (COPD). In COPD unrelated to AATD, the role of a higher blood eosinophil count in disease and subsequent personalization of therapy has recently received much attention. We sought to investigate this concept in patients with AATD-associated COPD. Objectives: The study aims to evaluate eosinophilia status against outcomes including mortality and FEV1 decline in patients with AATD. Methods: All patients with PiSZ and PiZZ genotypes were identified from the UK AATD registry. The participants were substratified according to inhaled corticosteroid (ICS) use. Blood eosinophil counts were assessed from baseline and annually during follow-up (range 1–18 years). Eosinophilia was defined as a level >0.2 × 109/L, and classified by the frequency of such counts into “always,” “intermittent,” or “never present.” Univariate and multivariate analyses were conducted. Results: In total, 646 participants were included, 53.9% of whom demonstrated intermittent and 7.4% persistent eosinophilia. Survival did not differ according to eosinophilic group (p > 0.05). Those with persistent eosinophilia showed a slower FEV1 decline (p < 0.001). There was no clear association with exacerbation frequency. Patients on ICS at baseline were more likely to be eosinophilic (p = 0.002) and having a lower FEV1 (p < 0.001) and greater pack-year exposure (16.5 vs. 7.8 pack-years, p < 0.001). When the multivariate analyses of FEV1 decline were stratified for baseline ICS use, the association of persistent eosinophilia with slower decline persisted in those on ICS. Conclusions: Blood eosinophil levels persistently >0.2 × 109/L may be an indication for ICS use in PiZZ AATD in order to reduce FEV1 decline.
Persistent Hemichorea and Caudate Atrophy in Untreated Diabetic Striatopathy: A Case Report
Authors: Lucassen Elisabeth B. , Delfyett William T. , Stahl Mark C.
Published: December 2017

Background: Neurological complications of diabetes and hyperglycemia are relatively common but the specific manifestations can vary widely. Diabetic striatal disease or “diabetic striatopathy” is an uncommon condition usually thought to result from hyperglycemic injury to the basal ganglia, producing a hyperkinetic movement disorder, usually choreiform in nature. Symptoms are generally reversible with treatment of the hyperglycemia. Case Description: We report the case of a 57-year-old woman presenting with a unilateral choreoathetosis of the left upper extremity, persistent for 4 years. Contemporaneous imaging demonstrated severe atrophy of the right caudate nucleus, while imaging obtained at the onset of symptoms was consistent with a right diabetic striatopathy. Symptoms improved with the use of dopamine antagonists and benzodiazepines. Conclusion: Although generally considered to be fully reversible, this case demonstrates that diabetic striatopathy can result in permanent structural lesions with persistent symptoms if left untreated.
A Case Report of Compound Heterozygous CYP24A1 Mutations Leading to Nephrolithiasis Successfully Treated with Ketoconazole
Authors: Davidson Peiris Emma , Wusirika Raghav
Published: December 2017

CYP24A1 is an enzyme that inactivates vitamin D. Loss-of-function mutations in this enzyme are rare but have been linked with idiopathic infantile hypercalcemia as well as adult-onset nephrocalcinosis and nephrolithiasis. Genetic testing for this mutation should be considered in the presence of calciuria, elevated serum calcium, elevated 1,25-dihydroxyvitamin D, and suppressed parathyroid hormone. We present a case with these lab findings as well as an elevated 25-hydroxyvitamin D/24,25-dihydroxyvitamin D ratio in whom compound heterozygous CYP24A1 mutations were found. His hypercalciuria resolved and 1,25-vitamin D level improved with ketoconazole treatment. We suggest that it is clinically important to identify patients with this phenotype as testing and treatment options are available which could reduce progression to chronic kidney disease in this population.
Babesiosis Presenting as Acute Liver Failure
Authors: Nassar Yousef , Richter Seth
Published: December 2017

Babesiosis is a zoonotic, tick-borne infection caused by the protozoan Babesia. It is transmitted by the Ixodes ticks which transmit the infection to humans. Babesia microti, Babesia duncani, Babesia divergens, and Babesia venatorum are species that have been identified as being infectious to humans worldwide. The most common species causing infection to humans is B. microti which is endemic to the Northeast and Midwestern United States with most infections occurring between the months of May and October. We report a case of an elderly man with acute liver failure due to an infection with B. microti.
Antithrombotic Therapy in Atrial Fibrillation Associated with Valvular Heart Disease: Executive Summary of a Joint Consensus Document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology Working Group on Thrombosis, Endorsed by the ESC Working Group on Valvular Heart Disease, Cardiac Arrhythmia Society of Southern Africa (CASSA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE)
Authors: Lip Gregory , Collet Jean , de Caterina Raffaele , Fauchier Laurent , Lane Deirdre , Larsen Torben , Marin Francisco , Morais Joao , Narasimhan Calambur , Olshansky Brian , Pierard Luc , Potpara Tatjana , Sarrafzadegan Nizal , Sliwa Karen , Varela Gonzalo , Vilahur Gemma , Weiss Thomas , Boriani Giuseppe , Rocca Bianca
Published: December 2017

Management strategies for patients with atrial fibrillation (AF) in association with valvular heart disease (VHD) have been less informed by randomized trials, which have largely focused on ‘non-valvular AF’ patients. Thromboembolic risk also varies according to valve lesion and may also be associated with CHA2DS2-VASc score risk factor components, rather than only the valve disease being causal.

Given the need to provide expert recommendations for professionals participating in the care of patients presenting with AF and associated VHD, a task force was convened by the European Heart Rhythm Association (EHRA) and European Society of Cardiology (ESC) Working Group (WG) on Thrombosis, with representation from the ESC WG on Valvular Heart Disease, Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE) with the remit to comprehensively review the published evidence, and to produce a consensus document on the management of patients with AF and associated VHD, with up-to-date consensus statements for clinical practice for different forms of VHD, based on the principles of evidence-based medicine.

This is an executive summary of a consensus document which proposes that the term ‘valvular AF’ is outdated and given that any definition ultimately relates to the evaluated practical use of oral anticoagulation (OAC) type, we propose a functional EHRA (Evaluated Heartvalves, Rheumatic or Artificial) categorization in relation to the type of OAC use in patients with AF, as follows: (1) EHRA (Evaluated Heartvalves, Rheumatic or Artificial) type 1 VHD, which refers to AF patients with ‘VHD needing therapy with a vitamin K antagonist (VKA)’ and (2) EHRA (Evaluated Heartvalves, Rheumatic or Artificial) type 2 VHD, which refers to AF patients with ‘VHD needing therapy with a VKA or a non-VKA oral anticoagulant also taking into consideration CHA2DS2-VASc score risk factor components.
Risk Factors for the Progression from Low to High Titres in 260 Children with Severe Haemophilia A and Newly Developed Inhibitors
Authors: Mancuso Maria Elisa , Fischer Kathelijn , Santagostino Elena , Oldenburg Johannes , Platokouki Helen , Königs Cristoph , Escuriola-Ettingshausen Carmen , Rivard George , Cid Ana , Carcao Manuel , Ljung Rolf , Petrini Pia , Altisent Carmen , Kenet Gili , Liesner Raina , Kurnik Karin , Auerswald Günther , Chambost Hérvè , Mäkipernaa Anne , Molinari Angelo , Williams Mike , van den Berg H. ,   on behalf of the European Pediatric Network for Haemophilia Management (PedNet) the REMAIN (REal life MAnagement of children with INhibitors) Study Group
Published: December 2017

In children with severe haemophilia A, inhibitors to factor VIII (FVIII) usually develop during the first 50 treatment exposure days and are classified as low or high titre depending on the peak inhibitor titre being greater or less than 5 Bethesda units/mL (BU/mL). Classification of the inhibitor may change with time, as some low-titre inhibitors progress to high titre following re-exposure to FVIII concentrate. The aim of this study was to investigate potential risk factors for such a progression in children with severe haemophilia A and newly diagnosed inhibitors. This study was a follow-up study of the PedNet Registry and included 260 children with severe haemophilia A and inhibitors born between 1990 and 2009 and recruited consecutively from 31 haemophilia centres. Clinical and laboratory data were collected from the date of each child's first positive inhibitor test for at least 3 years. At the time of first positive inhibitor test, 49% (n = 127) had low-titre inhibitors, with 50% of them progressing to high titre and only 25% maintaining low titres. The FVIII gene (F8) mutation type was known in 247 patients (95%), and included 202 (82%) null mutations. The progression to high-titre inhibitors was associated with null F8 mutations (odds ratio [OR]: 2.6; 95% confidence interval [CI]: 1.0–6.5), family history of inhibitors (OR: 7.2; 95% CI: 1.8–28.4) and the use of high-dose immune tolerance induction, defined as ≥100 IU FVIII concentrate/kg/d (OR: 3.9; 95% CI: 1.5–10.0). These results suggest that high-dose immune tolerance induction should be avoided as the initial strategy in patients who develop low-titre FVIII inhibitors.
Incidence of Venous Thromboembolism in Asian Populations: A Systematic Review
Authors: Lee Lai , Gallus Alexander , Jindal Ravul , Wang Chen , Wu Chau-Chung
Published: December 2017

Introduction Despite a marked recent increase in the number of publications describing the incidence of venous thromboembolism (VTE) in Asia, and especially in mainland China, Hong Kong, Taiwan, Korea, Japan and Singapore, there remains a lack of consensus on the true risks, and trends over time, to inform appropriate clinical practice. The purpose of this systematic review was therefore to examine evidence about the incidence of symptomatic VTE in Asia.

Methods Databases were searched for studies from Asia, published between January 1995 and February 2016, on the incidence of symptomatic VTE, deep vein thrombosis (DVT) or pulmonary embolism. Review of eligible studies was conducted independently by two reviewers. Data were extracted on incidence, predispositions and recurrence of VTE.

Results One thousand nighty-five studies were identified, of which 73 were eligible for full text review and data extraction. Three population-wide estimates of VTE rates identified from Korea, Taiwan and Hong Kong reported annual incidences of 13.8, 15.9 and 19.9 per 100,000, respectively. Nine studies of Asian hospital registries or databases reported VTE rates ranging from 11 to 88 cases per 10,000 admissions. Population-based estimates of post-surgical DVT rates ranged from 0.15 to 1.35%. Age was a significant risk factor for VTE in all population groups.

Conclusion Population-wide incidence estimates in Asia were approximately 15 to 20% of the levels recorded in western countries but have increased over time. It is anticipated this synthesis of evidence on the incidence of VTE and its predisposing factors will increase awareness about VTE in Asian populations.
Levels of Circulating Intermediate Monocytes Decrease after Aortic Valve Replacement in Patients with Severe Aortic Stenosis
Authors: Hewing Bernd , Ellerbroek Rena , Au Sebastian , Stangl Verena , Dreger Henryk , Laule Michael , Grubitzsch Herko , Knebel Fabian , Baumann Gert , Ludwig Antje , Stangl Karl
Published: December 2017

Aortic valve stenosis (AS) is a chronic inflammatory disease. We have previously shown that severe AS is associated with increased levels of circulating intermediate monocytes. Haemodynamics are considered to influence levels of circulating monocyte subsets; we therefore hypothesized that aortic valve replacement may result in changes in the distribution of circulating monocyte subsets. In the present study, we evaluated levels of circulating monocyte subsets in patients with severe AS undergoing surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). Levels of classical (CD14++CD16–), intermediate (CD14++CD16+), and non-classical (CD14+CD16++) CD86-positive monocytes were determined by flow cytometry in peripheral blood of patients with severe AS before (baseline) and at 3- and 6-month follow-ups (FUP) after SAVR (n = 25 patients) or TAVR (n = 44 patients). Absolute and relative levels of circulating intermediate monocytes decreased from median 39.9/µL (interquartile range [IQR]: 31.7–53.6/µL) and 6.7% (5.6–8.1%) at baseline to 31.6/µL (24.3–42.4/µL; p < 0.001) and 5.4% (4.4–6.7%; p < 0.001) at 6-month FUP after aortic valve replacement, respectively. The decrease in levels of circulating intermediate monocytes appeared earlier (between baseline and 3-month FUP) in the TAVR group compared with the SAVR group (between 3- and 6-month FUP). In conclusion, levels of circulating intermediate monocytes decrease after SAVR or TAVR in patients with severe AS.
Dabigatran after Short Heparin Anticoagulation for Acute Intermediate-Risk Pulmonary Embolism: Rationale and Design of the Single-Arm PEITHO-2 Study
Authors: Klok Frederikus , Ageno Walter , Barco Stefano , Binder Harald , Brenner Benjamin , Duerschmied Daniel , Empen Klaus , Faggiano Pompilio , Ficker Joachim , Galiè Nazzareno , Ghuysen Alexandre , Held Matthias , Heydenreich Nadine , Huisman Menno , Jiménez David , Kozak Matija , Lang Irene , Lankeit Mareike , Münzel Thomas , Petris Antoniu , Pruszczyk Piotr , Quitzau Kurt , Schellong Sebastian , Schmidt Kai-Helge , Stefanovic Branislav , Verschuren Franck , Wolf-Puetz Anamaria , Meyer Guy , Konstantinides Stavros ,   for the PEITHO-2 Investigators
Published: December 2017

Patients with intermediate-risk pulmonary embolism (PE) may, depending on the method and cut-off values used for definition, account for up to 60% of all patients with PE and have an 8% or higher risk of short-term adverse outcome. Although four non-vitamin K-dependent direct oral anticoagulants (NOACs) have been approved for the treatment of venous thromboembolism, their safety and efficacy as well as the optimal anticoagulation regimen using these drugs have not been systematically investigated in intermediate-risk PE. Moreover, it remains unknown how many patients with intermediate-high-risk and intermediate-low-risk PE were included in most of the phase III NOAC trials. The ongoing Pulmonary Embolism International Thrombolysis 2 (PEITHO-2) study is a prospective, multicentre, multinational, single-arm trial investigating whether treatment of acute intermediate-risk PE with parenteral heparin anticoagulation over the first 72 hours, followed by the direct oral thrombin inhibitor dabigatran over 6 months, is effective and safe. The primary efficacy outcome is recurrent symptomatic venous thromboembolism or death related to PE within the first 6 months. The primary safety outcome is major bleeding as defined by the International Society on Thrombosis and Haemostasis. Secondary outcomes include all-cause mortality, the overall duration of hospital stay (index event and repeated hospitalizations) and the temporal pattern of recovery of right ventricular function over the 6-month follow-up period. By applying and evaluating a contemporary risk-tailored treatment strategy for acute PE, PEITHO-2 will implement the recommendations of current guidelines and contribute to their further evolution.