bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of the Atmospheric Moisture Budget in Defining the Precipitation Seasonality of the Great Lakes Region
Authors: Minallah Samar , Steiner Allison L. 
Published: November 2020

AbstractPrecipitation in the Great Lakes region has a distinct seasonal cycle that peaks in early summer, followed by a decline in August and a secondary peak in September. This seasonality is often not captured by models, which necessitates understanding of the driving mechanisms to ascertain the model biases. This study analyzes the atmospheric moisture budget using reanalysis datasets to assess the role of regional evapotranspiration and moisture influx from remote origins in defining the precipitation seasonality, and to understand how the Great Lakes modulate spatial patterns and magnitudes of these components. Specifically, the land–water thermal contrast yields large seasonal variations in the evaporative fluxes and creates distinctive localized spatial patterns of moisture flux divergence. We find considerable month-to-month variations in both evapotranspiration and the net moisture transport through the boundaries, where they play a cooperative (contrasting) role in amplifying (dampening) the moisture content available for precipitation and total precipitable water. Our seasonal analysis suggests that the misrepresentation of the budget quantities in models, for example, in simulation of moisture transport processes and parameterization schemes, can result in an anomalous precipitation behavior and, in some cases, violation of the atmospheric moisture mass balance, resulting in large residual magnitudes. We also identify conspicuous differences in the representation of moisture budget components in the various reanalyses, which can alter their representation of the regional hydroclimates.
Variability of Multisite Decadal Running Means Arising from Year-To-Year Fluctuations
Authors: Zheng Xiaogu , Frederiksen Carsten S. 
Published: November 2020

AbstractDecadal mean variables are frequently used to characterize decadal climate variabilities. Decadal means are often calculated using yearly data, which can represent variability at time scales from annual to centennial. Residuals from interannual fluctuations may contribute to the variability in decadal time series. Such variability is more difficult to be predicted at the long range. Removing it from the decadal variability means that the remaining variability is more likely to arise from slowly varying multidecadal or longer time scale external forcing and internal climate dynamics, which are more likely to be predicted. Here, a new approach is proposed to understand the uncertainty, potential predictability, and drivers of decadal mean variables. The covariance matrix of multivariate decadal running means is decomposed into unpredictable fast decadal variability and the potentially predictable slow decadal variability. EOF analysis is then applied to the decomposed matrices to find the dominant modes, which may be related to the drivers of the two types of variabilities in the multivariate decadal means. The methodology has been applied to 140-yr datasets of North Pacific sea surface temperature and the Northern Hemisphere 1000-hPa geopotential height. For sea surface temperature, the Pacific decadal oscillation is the major driver of the fast decadal variability, while the radiative forcing and the Atlantic multidecadal oscillation are major drivers of the slow decadal variability. For the 1000-hPa geopotential height, fast decadal variability is associated with the northern annular mode, the east Atlantic mode, and the Pacific decadal oscillation. Slow decadal variability is associated with the northern annular mode and the Atlantic multidecadal oscillation.
Microstructure Mixing Observations and Finescale Parameterizations in the Beaufort Sea
Authors: Fine Elizabeth C. , Alford Matthew H. , MacKinnon Jennifer A. , Mickett John B. 
Published: November 2020

AbstractIn the Beaufort Sea in September of 2015, concurrent mooring and microstructure observations were used to assess dissipation rates in the vicinity of 72°35′N, 145°1′W. Microstructure measurements from a free-falling profiler survey showed very low [(10−10) W kg−1] turbulent kinetic energy dissipation rates ε. A finescale parameterization based on both shear and strain measurements was applied to estimate the ratio of shear to strain Rω and ε at the mooring location, and a strain-based parameterization was applied to the microstructure survey (which occurred approximately 100 km away from the mooring site) for direct comparison with microstructure results. The finescale parameterization worked well, with discrepancies ranging from a factor of 1–2.5 depending on depth. The largest discrepancies occurred at depths with high shear. Mean Rω was 17, and Rω showed high variability with values ranging from 3 to 50 over 8 days. Observed ε was slightly elevated (factor of 2–3 compared with a later survey of 11 profiles taken over 3 h) from 25 to 125 m following a wind event which occurred at the beginning of the mooring deployment, reaching a maximum of ε= 6 × 10−10 W kg−1 at 30-m depth. Velocity signals associated with near-inertial waves (NIWs) were observed at depths greater than 200 m, where the Atlantic Water mass represents a reservoir of oceanic heat. However, no evidence of elevated ε or heat fluxes was observed in association with NIWs at these depths in either the microstructure survey or the finescale parameterization estimates.
Age-Based Probability of Ten-Year Overall Survival (OS) of Acute Myeloid Leukemia (AML): A National Cancer Database (NCDB) Analysis
Authors: Bhatt Vijaya R. , Shostrom Valerie K , Khanal Nabin , Chaulagain Chakra P , He Fiona , Gundabolu Krishna 
Published: November 2020

Background: Clinical trial data suggest excellent short-term outcomes for younger patients and a subset of fit older patients. Translating findings of clinical trials into the real-world practice has challenges, and longer-term data are often not available. Hence, we utilized NCDB to determine age-based probability of ten-year OS of unselected cohorts of adults with AML.
Methods: NCDB captures about 70% of all new diagnosis of cancer. We utilized NCDB to analyze ten-year OS of 15,646 patients aged ≥18 years, who were diagnosed with AML during the years 2004-2007. Univariate and multiple logistic regression models were used to determine factors associated with ten-year OS. Kaplan Meier curves were generated for OS analysis.
Results: Ten-year OS was 12.7% for patients aged 18-59 years treated with chemotherapy without hematopoietic cell transplant (HCT) (Table 1, Fig. 1). Older age, male, Charlson-Deyo comorbidity score &gt;0, insurance other than private, subtypes other than core-binding factor AML were associated with lower ten-year OS. Ten-year OS was 24.3% for patients aged 18-59 years treated with chemotherapy and HCT (Fig 2). Older age, male, and insurance other than private were associated with lower ten-year OS. Ten-year OS was 16.1% and 2.2% for patients older than 60 years and treated with and without HCT, respectively; multivariate analysis was not performed for older patients because of low sample size (HCT group) or low survival (non-HCT group). Detailed analysis will be presented.
Conclusions: Long-term OS of adults with AML is low with less than a quarter of patients being alive at ten years. Ten-year OS is particularly poor for older patients who are treated with chemotherapy alone. Whereas recent advances and approval of eight new drugs will likely improve short-term OS at 2-3 years, innovative strategies are necessary to improve long-term OS and cure. Further study to identify the cause of death will be insightful.

Disclosures
Bhatt: Takeda: Consultancy; Partnership for health analytic research: Consultancy; Jazz: Research Funding; National Marrow Donor Program: Research Funding; Oncoceutics: Other; Abbvie: Consultancy, Research Funding; Incyte: Consultancy, Research Funding; Pfizer: Research Funding; Tolero: Research Funding; Rigel: Consultancy; Agios: Consultancy; Omeros: Consultancy. Chaulagain:Sanofi Genzyme: Honoraria. Gundabolu:BioMarin: Consultancy; Bristol Myers Squibb pharmaceuticals: Consultancy.
Comparative Efficacy of First-Line Regimens in Relapsed/Refractory Mantle Cell Lymphoma (MCL): A Proportional Meta-Analysis
Authors: Haddad Philip A , Hammoud Dalia , Gallagher Kevin M. 
Published: November 2020

Introduction:
Mantle cell lymphoma (MCL) is an incurable B-cell malignancy that disproportionately affects the elderly. After first-line therapy failure, relapsed/refractory MCL assumes a more aggressive and universally fatal course. Currently, several classes of chemo/biologic therapies are approved in the second line. However, these agents and their combinations have not been compared head-to-head. We conducted this proportional meta-analysis to evaluate their relative impact on selected clinical outcomes.
Methods:
A review of the medical literature was conducted using online databases. Inclusion criteria consisted of English language; diagnosis of relapsed/refractory MCL; trials that explored the efficacy of first-line approved antineoplastic agents and their combinations that comprised: BTK-inhibitors (Ibrutininb (IB), Acalabrutinib, Zanubrutinib), Bortezomib (Velcade, VEL), Venetoclax (VEN), Lenalidomide (LEN), and Bendamustine+Rituximab (B-R); and studies reporting types of responses and duration of response. Proportional meta-analysis was conducted using random-effects model. The respective 95% confidence intervals were calculated, and funnel plots were constructed.
Results:
Thirteen studies comprising a total of 1,264 participants were included. The pooled overall response rates, ORR (95%CI), of the regimens were: 74% (66,81) BTK-inhibitors, 39% (25,53) VEL, 34% (24,46) LEN, 85% (78,92) B-R, 75% (58,92) VEN-IB, and 88% (79,97) IB-R. The pooled complete responses, CR (95%CI), of the regimens were: 33% (20,47) BTK-inhibitors, 9% (5,13) VEL, 6% (4,9) LEN, 45% (36,54) B-R, 42% (22,63) VEN-IB, and 44% (30,58) IB-R. There were no significant differences in ORR and CR between BTK-inhibitors, B-R, VEN-IB, and IB-R. ORR of VEL and LEN also did not significantly differ. However, ORR and CR of the former group were significantly higher than those of the latter. The pooled partial responses, PR (95%CI), of the regimens were: 41% (32,50) BTK-inhibitors, 28% (20,38) VEL, 28% (15,43) LEN, 41% (35,47) B-R, 34% (15,53) VEN-IB, and 44% (30,58) IB-R. There were no significant differences between PR of the regimens. The weighted duration of responses in months, DOR (95%CI), of the regimens were: 20 BTK-inhibitors, 9 VEL, 16 LEN, and 20 B-R.
Conclusions:
This proportional meta-analysis is the first to compare the current regimens in first-line relapsed/refractory MCL. It indicates that BTK-inhibitors monotherapy, IB combinations with R or VEN, and B-R provide equivalent ORR and CR rates that are significantly better than VEL and LEN with notably longer duration of response. It also raises questions about whether there is an additional ORR and CR benefits when adding VEN or R to IB in this clinical setting.

Disclosures
No relevant conflicts of interest to declare.
Periprocedural Interruption of Edoxaban in Real World Setting: Results from the Emit AF/VTE Study
Authors: Santamaria Amparo , Colonna Paolo , von Heymann Christian , Saxena Manish , Vanassche Thomas , Jin James , Wilkins Robert , Chen Cathy , Unverdorben Martin 
Published: November 2020

Background: The optimal interruption schedule for NOACs in patients undergoing invasive procedures has not been determined. This analysis describes periprocedural interruption of edoxaban in real world EMIT AF/VTE study.
Methods: EMIT AF/VTE was a prospective, non-interventional study conducted in 7 European countries that collected detailed information on periprocedural management of edoxaban from 5 days before to 30 days after procedure in patients with AF or VTE.
Results: Among 1155 patients, pre-procedural interruption occurred in 781 (68%) patients (median 2 days, IQR 1.0-2.0) and post-procedural interruption in 308 (27%) patients (median 3 days, IQR 1.0-8.0); 279 (24.2%) patients had both pre- and post-procedural interruption. Edoxaban interruption in some patients differed from 2018 EHRA Recommendations for NOAC use in AF. Of 294 patients receiving minor risk procedures, for whom no interruption is recommended, 173 (58.8%) had preprocedural interruption (median 1 day). Of 581 patients with low bleeding risk procedures, for whom ≥24h preprocedural interruption is recommended, 188 (32.4%) had no interruption. Of 280 patients receiving high bleeding risk procedures, for whom ≥48h interruption is recommended, 46 (16.4%) had no interruption. Clinical events are shown in Table.
Conclusion: Edoxaban interruption schedules in routine practice were not always consistent with EHRA guidelines; nevertheless, rates of clinically significant bleeding or acute thromboembolic events or coronary syndromes were low in the EMIT study.
Table

Disclosures
Colonna: Boehringer Ingelheim: Honoraria; Daiichi Sankyo: Honoraria; BayerAG: Honoraria; Italian Cardiology Association: Other: Non-financial support; European Society of Cardiology: Other: Non-financial support; Pfizer/BMS: Honoraria. von Heymann:Daiichi Sankyo: Honoraria, Research Funding; Boehringer Ingelheim: Honoraria; Bayer AG: Honoraria; Pfizer GmBH: Honoraria; CSL Behring: Honoraria; NovoNordisk Pharma: Honoraria; EACTA and EACTS: Other; DGGG: Other; Mitsubishi Pharma: Honoraria; Ferring GmbH: Honoraria; Biotest GmbH: Honoraria; Leo Pharma GmBH: Honoraria; German Society of Anaesthesiology and Intensive Care Medicine: Other. Saxena:Daiichi Sankyo: Honoraria, Research Funding. Vanassche:Boehringer Ingelheim: Honoraria; 367 Leo Pharma: Honoraria; Bayer: Honoraria; Daiichi Sankyo: Honoraria, Research Funding. Jin:Daiichi Sankyo: Current Employment. Wilkins:Daiichi Sankyo: Honoraria. Chen:Daiichi Sankyo: Current Employment. Unverdorben:Daiichi Sankyo: Current Employment.
Immunoglobulin Sub-Typing and Quantification in Coombs Positive Hemolysis
Authors: Chetty Thirosha , Bouwer Nikki , Wan Yuen On , Mahlangu Johnny 
Published: November 2020

Key words:immunoglobulin, coombs test, hemolysis, HIV, quantification
Introduction
A positive direct antiglobulin test (DAT, Coombs test) is valuable in identifying the etiology of autoimmune hemolysis and in guiding an immunomodulatory therapeutic intervention strategy. However, in HIV positive individuals with background polyclonal gammopathy, a false positive DAT is common. In this setting, immunoglobulin quantification and subtyping may be of value in characterizing the autoimmune hemolysis. There is paucity of published literature evaluating the diagnostic usefulness of IgG subtyping and quantification in HIV positive individuals who are investigated for possible autoimmune haemolysis (AIHA). The recently introduced gel card used for AIHA diagnosis can subtype and quantify the IgG antibody titre. This study evaluated the usefulness of IgG quantification and subtyping in the diagnostic workup of autoimmune hemolysis in patients who were DAT positive with and without HIV infection.
Methods:
This retrospective, cross sectional study was reviewed and approved by the institutional Ethics Committee. The study population included HIV positive and HIV negative patients who were investigated for autoimmune hemolysis in a quaternary care hospital as part of their diagnostic workup. Those with a positive DAT had their IgG subtyped and quantified using the ID -Card DAT IgG1/IgG3 and IgG-dilution cards (Bio-Rad©, Cressier, Switzerland).
Results:
From December 2019 to March 2020, 90 patients admitted in our hospital were investigated for AIHA. Forty four (49%) were found to be DAT positive. Of those who were DAT positive, 26 (59%) had biochemical evidence of haemolysis (raised LDH, raised unconjugated bilirubin). Of the total DAT positive population, 16 (36%) were HIV positive. Concurrent HIV and haemolysis was present in 8 patients. Four of the 8 had antibody titre≤1:30. Most patients had IgG 1 subtype. None of the HIV positive patients without features of haemolysis had IgG1 or IgG3 subtypes present and 2 of the 8 had antibody titres≤1:30.
Conclusion:
IgG quantification and subtyping was found to be of limited value in the diagnostic characterization of AIHA in HIV positive patients with false positive DAT.

Disclosures
Mahlangu: CSL Behring, Catalyst Biosciences, Freeline Therapeutics, Novo Nordisk, F. Hoffmann-La Roche Ltd, Sanofi, Spark and Takeda:Consultancy;CSL Behring, Catalyst Biosciences, Novo Nordisk, F. Hoffmann-La Roche Ltd, Sanofi, Spark and Takeda:Speakers Bureau;South Africa Medical Research Council, Wits Health Consortium, Colleges of Medicine of South Africa:Membership on an entity's Board of Directors or advisory committees;BioMarin, CSL Behring, Freeline Therapeutics, Novo Nordisk, Novartis, Pfizer, Sanofi, F. Hoffmann-La Roche Ltd, uniQure:Research Funding.
Follicular Lymphoma Masquerading As a Neuroendocrine Tumor
Authors: Dhami Dana Victoria , Dhami Sabina , Kapur Dinesh , Coletti David , Sreedevi Kurella , Dhami Mandeep 
Published: November 2020

A 73 y/o Caucasian female presented with abdominal pain for 2 years, gradually worsening in the recent past. The pain was more severe at night, especially while sleeping on her abdomen. An A/P CT scan showed a mid-abdominal mesenteric mass measuring 8 x 4 cm, which was new since prior examinations. The new mass was accompanied by prominent retro-peritoneal lymph nodes, the largest along the left paraaortic region measuring 1.9 x 1.6 cm. She reported good appetite and denied fever, chills, night sweats or unexplained weight loss. She admitted to a 6-month history of diarrhea consisting of 2-3 loose stools daily. Her clinical presentation was felt to be concerning for Carcinoid tumor.
A GA-68 dotatate PET/CT showed uptake within the known mesenteric mass, most likely representing carcinoid tumor. Minimal uptake observed in retroperitoneal lymph nodes felt to represent early metastatic disease.
The patient underwent laparotomy, small bowel resection and retroperitoneal lymph node resection.
Pertinent laboratory studies -
Chromogranin level, pre op - 625 (ref 25 - 140)
Chromogranin level post op - 54
Pathology showed grade 2, follicular lymphoma. The neoplastic cells predominantly composed of small, irregular cleaved centrocytes mixed with a minor population of centroblasts (less than 15 per high-power field). Neoplastic follicles were diffusely positive for CD20, PAX5, CD10, BCL6, and BCL2. Ki67 showed 10-20% proliferation index. Cyclin D1 was negative. Flow cytometry identified monoclonal B-cell population positive for CD10, CD19 (dim), and CD20, which expressed dim monotypic lambda light chain. CD5 negative.
Discussion: There is evidence that lymphoma cells express somatostatin receptors (SSTR). Octreotide scan (111In-pentetreotide - binds to SSTR2 and SSTR5) uptake has been described in lymphomas with variable degree of avidity. Gallium Dotatate scan (68Ga-Dotatate - binds selectively to SSTR2) uptake has been previously described in a patient with large cell lymphoma. Here we describe a case of follicular lymphoma presenting with symptoms suggestive of carcinoid that showed uptake on Gallium Dotatae scan. This finding therefore warrants recognition by clinicians for potential of lymphoma presenting with positive Gallium Dotatate scan.
Ruuska et al* have shown that 62% of various PET positive lymphomas (DLBCL, follicular and Hodgkin's) were also 68Ga-DOTONAC PET/CT positive and there was concordance between SSTR2 positivity by IHC and 68Ga-DOTONAC PET/CT. If this finding is confirmed in further studies, perhaps this may lead to a possible therapeutic application for 177Lu-DOTA-TATE in management of some refractory lymphomas.
*Tina Ruuska et al, Acta Oncologica, 2018, vol 57, no. 2. 283-289
Figure

Disclosures
No relevant conflicts of interest to declare.
B7-H6 Is Associated with Poor Prognosis and a Potential Therapeutic Target of T-Lymphoblastic Lymphoma
Authors: Yuan Lei , Sun Lu , Zhao Yu , Jing Hongmei , Ke Xiaoyan 
Published: November 2020

Background:B7-H6 is a novel co-stimulatory protein that is exclusively expressed on a variety of cancer cells and associated with poor prognosis. T cell lymphoblastic lymphoma (T-LBL) is a highly aggressive hematological malignancy whose treatment requires reliable prognostic biomarkers and therapeutic targets. The rare nature and delayed progression of T-LBL has limited its clinical management.
Methods:B7-H6 expression was analyzed by immunohistochemistry (IHC) in 65 T-LBL samples, and its association with clinicopathological characteristics and prognosis was analyzed. Jurkat cell with B7-H6 depletion was constructed to investigate the impact of B7-H6 on cell proliferation, migration, and invasion ability. RNA sequencing was used to explore aberrantly expressing genes.
Results:In this study, we used immunohistochemistry to show the expression of B7-H6 in 61.5% (40/65) of the cohort, including 38.5% (25/65) patients with membrane/cytoplasmic expression of B7-H6. Although B7-H6 expression varied across samples and did not correlate with patient survival, it was significantly associated with B symptoms, higher ECOG score (3-4), elevated serum lactate dehydrogenase, and reduced complete remission at interim evaluation. B7-H6 underwent translocation into the nucleus of T-LBL cells and had a specific nuclear localization sequence in the C-terminus. Depleting Jurkat cells of B7-H6 impaired cell proliferation, migration, and invasion. RNAseq showed the differential expression of RAG-1 that could be involved in the tumorigenesis of T-LBL.
Conclusions:B7-H6 may serve as a novel prognostic biomarker and therapeutic target of T-LBL.

Disclosures
Ke: Peking University Third Hospital:Current Employment.