bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heterogeneity in Conduction Underlies Obesity-Related Atrial Fibrillation Vulnerability
Authors: Schram-Serban Corina , Heida Annejet , Roos-Serote Maarten C. , Knops Paul , Kik Charles , Brundel Bianca , Bogers Ad J.J.C. , de Groot Natasja M.S. 
Published: April 2020

Background:
Obese patients are more vulnerable to development of atrial fibrillation but pathophysiology underlying this relation is only partly understood. The aim of this study is to compare the severity and extensiveness of conduction disorders between obese patients and nonobese patients measured at a high-resolution scale.

Methods:
Patients (N=212) undergoing cardiac surgery (male:161, 63±11 years) underwent epicardial mapping of the right atrium, Bachmann bundle, and left atrium during sinus rhythm. Conduction delay (CD) was defined as interelectrode conduction time of 7 to 11 ms and conduction block (CB) as conduction time ≥12 ms. Prevalence of CD/CB, continuous CDCB (cCDCB), length of CD/CB/cCDCB lines, and severity of CB were analyzed.

Results:

In obese patients, the overall incidence of CD (3.1% versus 2.6%;
P
=0.002), CB (1.8% versus 1.2%;
P
<0.001), and cCDCB (2.6% versus 1.9%;
P
<0.001) was higher and CD (
P
=0.012) and cCDCB (
P
<0.001) lines are longer. There were more conduction disorders at Bachmann bundle and this area has a higher incidence of CD (4.4% versus 3.3%,
P
=0.002), CB (3.1% versus 1.6%,
P
<0.001), cCDCB (4.6% versus 2.7%,
P
<0.001) and longer CD (
P
<0.001) or cCDCB (
P
=0.017) lines. The severity of CB is also higher, particularly in the Bachmann bundle (
P
=0.008) and pulmonary vein (
P
=0.020) areas. In addition, obese patients have a higher incidence of early de-novo postoperative atrial fibrillation (
P
=0.003). Body mass index (
P
=0.037) and the overall amount of CB (
P
=0.012) were independent predictors for incidence of early postoperative atrial fibrillation.

Conclusions:
Compared with nonobese patients, obese patients have higher incidences of conduction disorders, which are also more extensive and more severe. These differences in heterogeneity in conduction are already present during sinus rhythm and may explain the higher vulnerability to atrial fibrillation of obese patients.
Temporal Profile of Blood-Brain Barrier Breakdown in Reversible Cerebral Vasoconstriction Syndrome
Authors: Cho Soohyun , Ling Yu-Hsiang , Lee Mi Ji , Chen Shih-Pin , Fuh Jong-Ling , Lirng Jiing-Feng , Cha Jihoon , Wang Yen-Feng , Wang Shuu-Jiun , Chung Chin-Sang 
Published: April 2020

Background and Purpose—
Reversible cerebral vasoconstriction syndrome (RCVS) has a unique temporal course of vasoconstriction. Blood-brain barrier (BBB) breakdown is part of the pathophysiology of RCVS, but its temporal course is unknown. We aimed to investigate the temporal profile of BBB breakdown and relevant clinical profiles in a large sample size.

Methods—
In this prospective observatory bicenter study, patients who underwent contrast-enhanced fluid-attenuated inversion recovery magnetic resonance imaging within 2 months from onset were included. The presence and extent of BBB breakdown were evaluated using contrast-enhanced fluid-attenuated inversion recovery magnetic resonance imaging. Contrast-enhanced fluid-attenuated inversion recovery magnetic resonance imaging data were analyzed using a semiautomated segmentation technique to quantitatively measure the area of Gadolinium leakage into cerebrospinal fluid space. The univariable and multivariable linear regressions were performed to investigate the independent effect of time from onset with adjustment for other covariates.

Results—

In the 186 patients with angiogram-proven RCVS included in this analysis, BBB breakdown was observed in 52.6%, 56.8%, 30.3%, 40.0%, and 23.8% in the first, second, third, fourth, and ≥fifth week after onset. The extent of BBB breakdown peaked at first and second week, whereas the peak of vasoconstriction was observed at the third week after onset. Multivariable analysis showed the second week from onset (β, 3.35 [95% CI, 0.07–6.64];
P
=0.046) and blood pressure surge (β, 3.84 [95% CI, 1.75–5.92];
P
<0.001) were independently associated with a greater extent of BBB breakdown. A synergistic effect of time from onset and blood pressure surge was found (
P
for interaction=0.006).

Conclusions—
Frequency and extent of BBB breakdown are more prominent during the early stage in patients with RCVS, with an earlier peak than that of vasoconstriction. The temporal course of BBB breakdown may provide a pathophysiologic background of the temporal course of neurological complications of RCVS.
“I Am the One:” A Monist Looks at the Double Death and Life of Rabba bar Naḥmani
Authors: Baris Michael 
Published: April 2020

Abstract
The rabbis portray two arenas in which Torah is studied. Above the terrestrial academy of the sages, the Rabbis posit a transcendent, celestial yeshiva. This dual system seems central to the rabbinic doctrine of retribution in a sequential afterlife. In contrast to the standard dualist reading and accepted dogma, I propose a monist’s reading of these aggadic texts, which sees a single arena of human action and endeavor, with multivalent significance. My starting point is the dramatic narrative of the persecution, flight, and ultimate death of one of the leading Talmudic sages, Rabba bar Naḥmani. These esoteric stories go beyond familiar taxonomies as modes of concealment. Not cyphers to be cracked, they offer a nuanced way of thinking about the world, accessible through narrative as an adaptive mode of transmission.
European Legal Culture and WTO Dispute Settlement: Thirty Years of Socio-Legal Transplants from Brussels to Geneva
Authors: Soave Tommaso 
Published: April 2020

Abstract
This article argues that the legal culture of EC/EU institutions has made a significant contribution to the ethos, the style, and the tone of WTO dispute settlement bodies. Areas of alignment between the two regimes include the self-perceived role of adjudicators vis-à-vis their political environment and the jurisprudence on the ‘necessity’ of non-trade measures. Based on these premises, the article traces some of the social and professional pathways through which European sensibilities and perspectives have found their way from Brussels (and Luxembourg) to Geneva. In particular, it describes the convergent trajectories of the EC/EU and the GATT/WTO professional communities. The goal of the analysis is to provide a fresh outlook on the ongoing diplomatic stalemate surrounding the future of the Appellate Body and WTO dispute settlement at large.
Model Sensitivity during Extreme Positive and Negative Surges in the Río de la Plata Estuary: Highlighting the Need for an Appropriate Hindcast/Forecast System
Authors: Dinápoli Matías G. , Simionato Claudia G. , Moreira Diego 
Published: April 2020

Abstract
The large and fast-flowing Río de la Plata (RdP) estuary is affected by extreme storm surges (above ±2 m with respect to tidal datum), which have large impacts on the millions of inhabitants and for navigation. In this work the Coastal and Regional Ocean Community Model (CROCO) numerical model was modified and implemented as a set of regional one-way nested 2D applications for the hindcast/forecast of water level in the RdP. A sensitivity analysis (SA) was carried out to determine the impact on the numerical solutions of the uncertainties in the different modeling parameter forcings and to highlight the need for the construction of a modeling system that provides meaningful information to the potential users. The SA included the friction coefficients, the wind speed and direction, the atmospheric surface pressure, and the continental discharge. Water level is most sensitive to uncertainties in the wind forcing; even small changes in this input can create large errors in the water level forecast/hindcast. Forcing with different analyses’ wind products yielded differences of up to 50% in the peak water levels. Results also showed that the modeling system requires a reasonable adjustment of the bottom friction parameters; that it is important to include the atmospheric surface pressure forcing; and that, from the point of view of water level forecast, it is not necessary to couple a hydrological model in spite of the enormous runoff of this estuary. Given the strong sensitivity to errors in the wind forcing, we believe it is important to provide estimates of uncertainty together with hindcast/forecast water level for these predictions to be of greatest quality and practical applicability.
Effect of Changes in Response Options on Reported Pregnancy Intentions: A Natural Experiment in the United States
Authors: Maddow-Zimet Isaac , Kost Kathryn 
Published: April 2020

Objectives The Pregnancy Risk Assessment Monitoring System (PRAMS), conducted by the Centers for Disease Control and Prevention in collaboration with state health departments, is the largest state-level surveillance system that includes a question on the intention status of pregnancies leading to live birth. In 2012, the question was changed to include an additional response option describing uncertainty before the pregnancy about the desire for pregnancy. This analysis investigated how this additional response option affected women’s responses. Methods We used the change in the pregnancy intention question in 2012 as a natural experiment, taking advantage of relatively stable distributions of pregnancy intentions during short periods of time in states. Using PRAMS data from 2009-2014 (N = 222 781), we used a regression discontinuity-in-time design to test for differences in the proportion of women choosing each response option in the periods before and after the question change. Results During 2012-2014, 13%-15% of women chose the new response option, “I wasn’t sure what I wanted.” The addition of the new response option substantially affected distributions of pregnancy intentions, drawing responses away from all answer choices except “I wanted to be pregnant then.” Effects were not uniform across age, parity, or race/ethnicity or across states. Conclusions These effects could influence estimated levels and trends of the proportion of births that are characterized as intended, mistimed, or unwanted, as well as estimates of differences between demographic groups. These findings will help to inform new strategies for measuring pregnancy and childbearing desires among women.
Evaluating the perception of thermal environment in naturally ventilated schools in a warm and humid climate in Nigeria
Authors: Munonye Charles , Ji Yingchun 
Published: April 2020

Field study was conducted in naturally ventilated primary school buildings in a warm and humid environment in Imo State, Nigeria to determine the thermal comfort perception of young children (aged 7–12 years) and to understand the thermal conditions in the classrooms. The comfort temperature was investigated in two types of classroom buildings during the rainy and dry seasons from October 2017 to May 2018. Approximately 7050 completed valid questionnaires were collected from 330 young children repeatedly surveyed twice a day. The children answered comfort questions at the same time the indoor and outdoor thermal variables were being measured. Results indicated that the combined ‘open-space’ classrooms produced a neutral temperature of 28.8°C with comfort range, 25.2–32.3°C. The neutral temperature of the combined ‘enclosed-plan’ classrooms is 28.1°C with 25.8–30.5°C as the comfort range. The differences in the comfort perceptions may be attributed to the differences in the architectural characteristics of both categories of classroom buildings. High temperature tolerance was shown by the participating children in the study area. This article, therefore, suggests that installing air conditioning in primary schools in the warm humid environment in Nigeria may not be necessary as it could lead to unnecessary energy consumption and carbon emission. Practical application: This work is part of the main research work that pioneers research on thermal comfort in public primary school classrooms in Nigeria. The findings from this study on the acceptable indoor temperatures in naturally ventilated classrooms in the warm and humid climate in Nigeria are important information for building services engineers and architects. The young children in these classrooms can accept high indoor temperatures. The intention of this information is to discourage high energy usage in heating, ventilation and air-conditioning (HVAC) system in primary school buildings in the study area, while maintaining the acceptable thermal comfort levels.
Total Endoscopic Submandibular Sialoadenectomy Using a 3-Port Supraclavicular Approach: A New Technique
Authors: Piromchai Patorn , Suetrong Surapol 
Published: April 2020

Objectives: The objective of this pilot study was to report the feasibility and safety of a new 3-port supraclavicular approach in endoscopic submandibular sialoadenectomy. Methods: We reported the safety, surgical feasibility, and aesthetic features of the total endoscopic submandibular sialoadenectomy (submandibular gland excision) using a 3-port supraclavicular approach in our institute from December 2018 to January 2020. Results: Endoscopic submandibular sialoadenectomy using a 3-port supraclavicular approach was performed in 2 patients with intraglandular sialolithiasis. No major adverse events occurred in this study. The patient’s satisfaction score was high (more than 8; range: 0-10). Conclusions: The 3-port supraclavicular approach submandibular sialoadenectomy is a feasible method that permits a relatively good surgical scarring and minimal adverse effects.
Bioabsorbable Versus Titanium Screws in Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft: A Prospective, Randomized Controlled Trial With 13-Year Follow-up
Authors: Sundaraj Keran , Salmon Lucy J. , Heath Emma L. , Winalski Carl S. , Colak Ceylan , Vasanji Amit , Roe Justin P. , Pinczewski Leo A. 
Published: April 2020

Background: Bioabsorbable screws for anterior cruciate ligament reconstruction (ACLR) have been a popular choice, with theoretical advantages in imaging and surgery. Titanium and poly-L-lactic acid with hydroxyapatite (PLLA-HA) screws have been compared, but with less than a decade of follow-up. Purpose/Hypothesis: The purpose was to compare long-term outcomes of hamstring autograft ACLR using either PLLA-HA screws or titanium screws. We hypothesized there would be no difference at 13 years in clinical scores or tunnel widening between PLLA-HA and titanium screw types, along with high-grade resorption and ossification of PLLA-HA screws. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Forty patients undergoing ACLR were randomized to receive either a PLLA-HA screw or a titanium screw for ACL hamstring autograft fixation. Blinded evaluation was performed at 2, 5, and 13 years using the International Knee Documentation Committee score, Lysholm knee score, and KT-1000 arthrometer. Magnetic resonance imaging (MRI) was performed at 2 or 5 years and 13 years to evaluate tunnel volumes, ossification around the screw, graft integration, and cyst formation. Computed tomography (CT) of patients with PLLA-HA was performed at 13 years to evaluate tunnel volumes and intratunnel ossification. Results: No differences were seen in clinical outcomes at 2, 5, or 13 years between the 2 groups. At 13 years, tibial tunnel volumes were smaller for the PLLA-HA group (2.17 cm3) compared with the titanium group (3.33 cm3; P = .004). By 13 years, the PLLA-HA group had complete or nearly complete resorption on MRI or CT scan. Conclusion: Equivalent clinical results were found between PLLA-HA and titanium groups at 2, 5, and 13 years. Although PLLA-HA screws had complete or nearly complete resorption by 13 years, tunnel volumes remained largely unchanged, with minimal ossification.
Screw in Lisfranc Ligament
Authors: Sierra Stephen , Panchbhavi Vinod K. 
Published: April 2020

Background. Injury to the Lisfranc interosseous ligament is currently managed with a screw. However, this can potentially further disrupt the ligament. The objective of this study was to observe the proximity of the screw or disruption it can cause at the ligament attachment sites. Methods. Twenty-three feet were studied. A 40-mm, 4.0, partially threaded, cannulated screw was inserted from the base of the second metatarsal into the medial cuneiform. The relationship of the ligament attachment sites to the screw hole were measured. Results. The screw hole contacted at least 1 of the ligament attachment sites in 20 of the 23 feet. The screw hole fully penetrated it in 7 feet, partially disrupted it in 4 feet, and had less than or equal to 1 mm of contact in 9 feet. There was no contact with either of the attachment sites in 3 feet, with an average distance of 1.5 mm separating them. Conclusion. Our results show the proximity of the ligament to the screw and the disruption that can result from its insertion. This is clinically relevant as some amount ligamentous disruption is likely to occur with insertion of the “Lisfranc screw,” which may interfere with its healing process. Levels of Evidence: Level V: Expert opinion includes case reports and technique tips
Management of complications of cardiac amyloidosis: 10 questions and answers
Authors: Aimo Alberto , Rapezzi Claudio , Vergaro Giuseppe , Giannoni Alberto , Spini Valentina , Passino Claudio , Emdin Michele 
Published: April 2020

Abstract
Amyloidosis is a systemic disorder characterized by extracellular deposition of insoluble fibrils. The most common forms are amyloid light chain and amyloid transthyretin (ATTR) amyloidoses. Cardiac involvement may be found in both these forms, and is an important cause of morbidity and mortality. The clinical presentation of cardiac amyloidosis (CA) may be represented by congestive heart failure (HF), possibly progressing to end-stage HF, as well as atrial fibrillation with possible thromboembolic events, and also conduction disturbances related to amyloid infiltration of conduction fibres. Beyond therapies targeting the blood dyscrasia or the ATTR amyloidogenic cascade, a careful choice of drug therapies, need for device implantation, and possibly treatments for advanced HF is then warranted. In the present review, we try to provide a useful guide to clinicians treating patients with CA by enucleating 10 main questions and answering them based on the evidence available as well as expert opinion and our clinical experience.
Antibody development for preventing the human respiratory syncytial virus pathology
Authors: Soto Jorge A. , Gálvez Nicolás M. S. , Pacheco Gaspar A. , Bueno Susan M. , Kalergis Alexis M. 
Published: April 2020

AbstractHuman respiratory syncytial virus (hRSV) is the most important etiological agent causing hospitalizations associated with respiratory diseases in children under 5 years of age as well as the elderly, newborns and premature children are the most affected populations. This viral infection can be associated with various symptoms, such as fever, coughing, wheezing, and even pneumonia and bronchiolitis. Due to its severe symptoms, the need for mechanical ventilation is not uncommon in clinical practice. Additionally, alterations in the central nervous system -such as seizures, encephalopathy and encephalitis- have been associated with cases of hRSV-infections. Furthermore, the absence of effective vaccines or therapies against hRSV leads to elevated expenditures by the public health system and increased mortality rates for the high-risk population. Along these lines, vaccines and therapies can elicit different responses to this virus. While hRSV vaccine candidates seek to promote an active immune response associated with the achievement of immunological memory, other therapies -such as the administration of antibodies- provide a protective environment, although they do not trigger the activation of the immune system and therefore do not promote an immunological memory. An interesting approach to vaccination is the use of virus-neutralizing antibodies, which inhibit the entry of the pathogen into the host cells, therefore impairing the capacity of the virus to replicate. Currently, the most common molecule targeted for antibody design against hRSV is the F protein of this virus. However, other molecular components of the virus -such as the G or the N hRSV proteins- have also been explored as potential targets for the control of this disease. Currently, palivizumab is the only monoclonal antibody approved for human use. However, studies in humans have shown a protective effect only after the administration of at least 3 to 5 doses, due to the stability of this vaccine. Furthermore, other studies suggest that palivizumab only has an effectiveness close to 50% in high-risk infants. In this work, we will review different strategies addressed for the use of antibodies in a prophylactic or therapeutic context and their ability to prevent the symptoms caused by hRSV infection of the airways, as well as in other tissues such as the CNS.
Assessing repeatability and reproducibility of Anterior Active Rhinomanometry (AAR) in children
Authors: Cilluffo Giovanna , Zicari Anna Maria , Ferrante Giuliana , Malizia Velia , Fasola Salvatore , Duse Marzia , De Castro Giovanna , De Vittori Valentina , Schiavi Laura , Brindisi Giulia , Petrelli Paolo , La Grutta Stefania 
Published: April 2020

AbstractBackgroundRepeatability and reproducibility are essential for clinicians for several purposes. Although discouraged, use of the Coefficient of Variation (CV) for assessing repeatability and reproducibility, rather than the Intraclass Correlation Coefficient (ICC), is still widespread. The aim of the present study was to highlight how using inappropriate indices may lead to misleading results, and this is done by simulation study and using real data on Anterior Active Rhinomanometry (AAR) in both healthy children and ones with rhinitis.MethodsA simulation study was carried out to highlight how using inappropriate indices could be misleading. Then a comparison was made between CV and ICC to assess repeatability and reproducibility of AAR, for which previous studies have given underestimated results. AAR is recommended as the gold standard tool for measuring nasal resistance in clinical practice.ResultsA simulation study showed that the ICCs estimated from data generated assuming a true CV yielded results in agreement with estimated CVs; by contrast, if data were generated assuming a true ICC, CVs yielded conflicting results. For AAR, ICCs showed good repeatability, whereas CVs showed unacceptable repeatability. AUC and 95% CI for AAR showed good performance in predicting current symptoms of rhinitis in the overall study population.ConclusionsThe present study focused on the importance of the choice of appropriate indices of repeatability and reproducibility, demonstrating the repeatability of AAR in both healthy children and ones with rhinitis.Trial registrationClinicalTrials.gov(ID:NCT03286049; Registration Date: September 15, 2017; Actual Study Start Date: January 10, 2018).