bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intermittent Frontogenesis in the Alboran Sea
Authors: Capó Esther , McWilliams James C. , Mason Evan , Orfila Alejandro 
Published: February 2021

AbstractWe present a phenomenological description and dynamical analysis of the Alboran fronts using a realistic simulation at submesoscale resolution. The study is focused on east Alboran fronts emerging within relatively strong flows that separate from the Spanish coast into the basin interior. Despite modest lateral shifting associated with the position of the Alboran anticyclonic gyres and variations in intensity, these fronts present a similar structure and dynamical configuration as the climatological Almeria–Oran front. The statistical analysis of our solution shows that strained-induced frontogenesis is a recurrent submesoscale mechanism associated with these fronts, and the process is assessed in terms of the advective Lagrangian frontogenetic tendencies associated with buoyancy and velocity horizontal gradients. Intermittency in their strength and patterns is indicative of high variability in the occurrence of active frontogenesis in association with the secondary (overturning) circulation across the frontal gradient. As a result, we find many episodes with strong surface fronts that do not have much associated downwelling. Frontogenesis and the associated secondary circulation are further explored during two particular frontal events, both showing strong downwelling of (1) cm s−1 extending down into the pycnocline. A frontogenetic contribution of turbulent vertical momentum mixing to the secondary circulation is identified in the easternmost region during the cold season, when the dynamics are strongly influenced by the intrusion of the salty Northern Current. The background vertical velocity fields observed during the analyzed events indicate other currents in the submesoscale range, including tidal and topographic internal waves.
A Seasonal Probabilistic Outlook for Tornadoes (SPOTter) in the Contiguous United States Based on the Leading Patterns of Large-Scale Atmospheric Anomalies
Authors: Lee Sang-Ki , Lopez Hosmay , Kim Dongmin , Wittenberg Andrew T. , Kumar Arun 
Published: February 2021

AbstractThis study presents an experimental model for Seasonal Probabilistic Outlook for Tornadoes (SPOTter) in the contiguous United States for March, April, and May and evaluates its forecast skill. This forecast model uses the leading empirical orthogonal function modes of regional variability in tornadic environmental parameters (i.e., low-level vertical wind shear and convective available potential energy), derived from the NCEP Coupled Forecast System, version 2, as the primary predictors. A multiple linear regression is applied to the predicted modes of tornadic environmental parameters to estimate U.S. tornado activity, which is presented as the probability for above-, near-, and below-normal categories. The initial forecast is carried out in late February for March–April U.S. tornado activity and then is updated in late March for April–May activity. A series of reforecast skill tests, including the jackknife cross-validation test, shows that the probabilistic reforecast is overall skillful for predicting the above- and below-normal area-averaged activity in the contiguous United States for the target months of both March–April and April–May. The forecast model also successfully reforecasts the 2011 super-tornado-outbreak season and the other three most active U.S. tornado seasons in 1982, 1991, and 2008, and thus it may be suitable for an operational use for predicting future active and inactive U.S. tornado seasons. However, additional tests show that the regional reforecast is skillful for March–April activity only in the Ohio Valley and South and for April–May activity only in the Southeast and Upper Midwest. These and other limitations of the current model, along with the future advances needed to improve the U.S. regional-scale tornado forecast, are discussed.
Microscopic Extranodal Extension in HPV‐Negative Head and Neck Cancer and the Role of Adjuvant Chemoradiation
Authors: Yan Flora , Li Hong , de Almeida John R. , Kaczmar John M. , Pipkorn Patrik , Zenga Joseph , Richardson Mary S. , Neskey David M. , Sharma Anand K. , Day Terry A. , Graboyes Evan M. 
Published: February 2021

ObjectivePathologic extranodal extension (ENE) is an important adverse feature for human papillomavirus (HPV)–negative head and neck squamous cell carcinoma (HNSCC), but the prognostic significance of microscopic ENE (ENEmi) and role of adjuvant concurrent chemoradiation (CRT) for ENEmi remain unclear. This study evaluates (1) the prognostic significance of ENEmi in HPV‐negative HNSCC and (2) whether adjuvant CRT is associated with improved overall survival (OS) for these patients.Study DesignRetrospective cohort study.SettingCommission on Cancer (CoC)–accredited facilities.MethodsThis retrospective cohort study included patients in the National Cancer Database from 2009 to 2015 with pathologic node‐positive (pN+) HPV‐negative HNSCC with either pathologic ENEmi or no ENE who had undergone margin‐negative surgery. The association of ENEmi with OS was evaluated using Cox proportional hazard analyses. Analyses were repeated in patients with ENEmi receiving adjuvant therapy to evaluate the association of adjuvant CRT with OS.ResultsWe included 5483 patients with pN+ HPV‐negative HNSCC, of whom 24% had ENEmi. On multivariable analysis, ENEmi was associated with decreased OS relative to no ENE (adjusted hazard ratio [aHR], 1.43; 95% CI, 1.28‐1.59). Among patients with ENEmi who received ≥60 Gy of adjuvant radiation therapy (RT) (n = 617), adjuvant CRT was not associated with improved OS relative to RT (aHR, 0.91; 95% CI, 0.66‐1.27).ConclusionFor patients with HPV‐negative HNSCC, pN+ with ENEmi is associated with worse OS than pN+ without ENE. However, for patients with ENEmi, concurrent CRT is not associated with improved OS relative to RT. The optimal adjuvant paradigm for ENEmi requires additional investigation.
Cochlear Implants in Neurologically Impaired Children: A Survey of Health‐Related Quality of Life
Authors: Anne Samantha , Schwartz Seth Roslow , McCoy Jennifer L. , Haberkamp Thomas , Hoffer Michael E. , Chi David H. 
Published: February 2021

ObjectivesEvaluate health‐related quality‐of‐life (HRQoL) measures in noncommunicative, neurologically impaired, developmentally delayed (NCNIDD) children compared to normally developing children (ND) who undergo cochlear implantation (CI).Study DesignCross‐sectional survey of parents of NCNIDD and ND children who underwent CI.SettingTwo tertiary care medical centers.MethodsQuestions comprising the Children With Cochlear Implants: Parental Perspectives survey were used in analysis. Average responses were calculated within 8 domains (communication, general functioning, self‐reliance, well‐being and happiness, social relationships, education, effects of implantation, and support the child). Groups were compared using Wilcoxon rank‐sum test. Impact of individual and collective socioeconomic/family covariates was assessed using analysis of variance.ResultsSurveys were returned from 17 of 42 (40%) patients with NCNIDD and 35 of 131 (27%) patients with ND. There were no statistically significant differences between groups in survey response rate, age, sex, age at implantation, current age, or duration of implant use. Overall, parents of children with ND responded more favorably in all domains vs children with NCNIDD. Parents of children with NCNIDD answered neutrally or favorably in all domains, except “support the child” and “self‐reliance” domains. Differences between groups in mean domain scores, univariably and almost universally when adjusting for socioeconomic and family variables individually and collectively, were statistically significant.ConclusionsThis study suggests that HRQoL benefits of CI are perceived in most domains by parents of children with NCNIDD, albeit less strongly than children with ND. A survey sensitive to challenges of children with NCNIDD may better capture benefits that may not be apparent in this study.
Histopathology of the Incudomalleolar Joint in Cases of “Indeterminate” Presbycusis
Authors: Roychowdhury Prithwijit , Castillo‐Bustamante Melissa , Polanik Marc , Kozin Elliott D. , Remenschneider Aaron K. 
Published: February 2021

Age‐related hearing loss (presbycusis) is a prevalent condition attributed primarily to inner ear dysfunction. Little is known about age‐related changes in the ossicular joints or their contribution to presbycusis. Herein, we performed a histopathologic analysis of the incudomalleolar joint (IMJ) in specimens from the National Temporal Bone Registry with audiometrically confirmed presbycusis but without histologically observed sensory, neural, strial, or mixed features. Seventeen “indeterminate” presbycusis (IP) ears and 13 young, normal‐hearing ears were examined. The age was 73.2 ± 9.5 years for the IP group and 32.1 ± 9.5 for the young group (P <. 05). The joint space between the 2 ossicles was 23% wider in the IP group (139 ± 26.2 µm) compared to young ears (113 ± 49.0 µm) (P =. 02). We report that IP ears have a wider IMJ than young ears. These findings have implications for understanding the etiology of presbycusis in indeterminate cases.Level of Evidence:Retrospective study.
Antidepressant use in Sweden: an intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)
Authors: Ljungman Hanna , Wemrell Maria , Khalaf Kani , Perez-Vicente Raquel , Leckie George , Merlo Juan 
Published: February 2021

Introduction: Antidepressants are among the most commonly prescribed drugs in Sweden. However, we lack detailed knowledge on the socioeconomic and demographic distribution of antidepressant use in the population. To fill this gap, we performed an intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy. Methods: Analysing all Swedish residents older than 10 years ( n=8,190,990), we measured the absolute risk of antidepressant use across 144 intersectional strata defined by combinations of age, gender, income, country of birth and psychiatric diagnosis. We calculated the strata-specific absolute risk of antidepressant use in a series of multilevel logistic regression models. By means of the variance partitioning coefficient and the area under the receiver operating characteristic curve, we quantified the discriminatory accuracy of the intersectional contexts (i.e. strata) for discerning those who use antidepressants from those who do not. Results: The absolute risk of antidepressant use ranged between 0.93% and 24.78% among those without a psychiatric diagnosis, and between 21.41% and 77.56% among those with a psychiatric diagnosis. Both the variance partitioning coefficient of 41.88% and the area under the receiver operating characteristic curve of 0.81 were considerable. Conclusions: Besides overt psychiatric diagnoses, our study shows that antidepressant use is mainly conditioned by age, which might express the embodiment of socioeconomic conditions across the individual life course. Our analysis provides a detailed and highly discriminatory mapping of the heterogeneous distribution of antidepressant use in the Swedish population, which may be useful in public health management.
The Danish National Youth Study 2019: study design and participant characteristics
Authors: Pisinger Veronica Sofie Clara , Thorsted Anne , Jezek Andrea Huber , Jørgensen Andreas , Christensen Anne Illemann , Tolstrup Janne Schurmann , Thygesen Lau Caspar 
Published: February 2021

Aim: To present the study design, study population and questionnaire content of the Danish National Youth Study 2019, and to describe the differences between participants and non-participants regarding demographic and socioeconomic characteristics. Method: The Danish National Youth Study 2019 is a nationwide web-survey among high school students in Denmark. Data was collected from January to April 2019 through a self-administered questionnaire in the classroom. The questionnaire included 120 questions on, for example, physical and mental health, health behaviour and well-being. Data collection took place at 50 general high schools, 32 preparatory high schools, 15 commercial high school and 19 technical high schools. Results: A total of 29,086 students participated (20,287 general high school students, 2,113 preparatory higher school students, 4027 commercial high school students and 2659 technical high school students) corresponding to 66% of the students in the 88 participating schools (31% of invited schools). Among students, 55% were female and the mean age was 17.8 years. Participants were more likely to be female, to be younger, to be of Danish origin, and have family disposable income in the highest quartile compared to non-participants. Conclusions: The Danish National Youth Study 2019 contributes to knowledge on high school students’ health, health behaviour and well-being that can support health planning and prioritizing, through identification of specific risk groups at both local and national level. The study also offers great opportunities for future research as it provides possibility of linkage to various Danish national registers.
Long-Term Survival of a Patient with Recurrent Dedifferentiated High-Grade Liposarcoma of the Retroperitoneum Under Adjuvant Treatment with Viscum album L. Extract: A Case Report
Authors: Reynel María , Villegas Yván , Werthmann Paul G. , Kiene Helmut , Kienle Gunver S. 
Published: February 2021

Retroperitoneal sarcomas are rare. Dedifferentiated liposarcomas (DDLs) are high-grade tumors with a high propensity for local recurrence and metastasis and are associated with reduced survival. Radical resection remains the standard treatment of sarcomas. Meanwhile, Viscum album L. extract (VAE) is used in cancer patients owing to its cytostatic and immunomodulating effects and to its ability to improve patients’ quality of life. Case Presentation: A 68-year-old male patient underwent a resection of a DDL (T2 N0 M0, FNCLCC grade 2, stage IIIA) in the retroperitoneum. Three months after this first surgery, a recurrence occurred, and was treated with neoadjuvant and adjuvant doxorubicin plus ifosfamide and surgery (resection). A second recurrence—11 months after the second surgery—was treated with surgery and radiotherapy. The patient then began to undergo VAE treatment (0.2 mg-2 mg, subcutaneously, thrice a week). After the VAE treatment was initiated, the patient reported improved quality of life. A third recurrence—12 months after the third surgery—was treated with surgery, radiotherapy, and with an increased dose of VAE (20 mg). Sixty-nine months (5.8 years) after the fourth surgery a fourth recurrence occurred. It was again treated with surgery, along with a month of intravenous VAE infusions and subsequent subcutaneous VAE (20 mg) treatment. Finally, a fifth recurrence—5 months after the fifth surgery—was treated with subcutaneous and intravenous VAE applications and eribulin. The patient died 11 months after the last recurrence; he received a total of 103 months (8.6 years) of VAE treatment and achieved 10.5 years of survival. Conclusion: The case presented herein shows a long-time survival and a prolonged recurrence-free interval in a patient with retroperitoneal DDL treated with surgery, chemotherapy, radiotherapy, and VAE injections. On the basis of the antitumoral and immunomodulating effects of VAE and on the reported prolonged survival of VAE-treated patients with other types of tumors, the adjunct VAE treatment is presumed to have contributed to the favorable outcome. Regarding the clinical relevance of VAE treatment, further investigations are needed.
Burden of pulmonary arterial hypertension in England: retrospective HES database analysis
Authors: Exposto Fernando , Hermans Ruben , Nordgren Åsa , Taylor Luke , Sikander Rehman Sanam , Ogley Robert , Davies Evan , Yesufu-Udechuku Amina , Beaudet Amélie 
Published: February 2021

Background: The clinical and economic burden of pulmonary arterial hypertension (PAH) is poorly understood outside the United States. This retrospective database study describes the characteristics of patients with PAH in England, including their healthcare resource utilisation (HCRU) and associated costs. Methods: Data from 1 April 2012 to 31 March 2018 were obtained from the National Health Service (NHS) Digital Hospital Episode Statistics database, which provides full coverage of patient events occurring in NHS England hospitals. An adult patient cohort was defined using an algorithm incorporating pulmonary hypertension (PH) diagnosis codes, PAH-associated procedures, PH specialist centre visits and PAH-specific medications. HCRU included inpatient admissions, outpatient visits and Accident and Emergency (A&E) attendances. Associated costs, calculated using national tariffs inflation-adjusted to 2017, did not include PAH-specific drugs on the High Cost Drugs list. Results: The analysis cohort included 2527 patients (68.4% female; 63.6% aged ⩾50 years). Mean annual HCRU rates ranged from 2.9 to 3.2 for admissions (21–25% of patients had ⩾5 admissions), 9.4–10.3 for outpatient visits and 0.8–0.9 for A&E attendances. Costs from 2013 to 2017 totalled £43.2M (£33.9M admissions, £8.3M outpatient visits and £0.9M A&E attendances). From 2013 to 2017, mean cost per patient decreased 13% (from £4400 to £3833) for admissions and 13% (from £1031 to £896) for outpatient visits, but increased 52% (from £81 to £123) for A&E attendances. Conclusion: PAH incurs a heavy economic burden on a per-patient basis, highlighting the need for improved treatment strategies able to reduce disease progression and hospitalisations. The reviews of this paper are available via the supplemental material section.
En bloc transurethral resection of bladder tumor: A review of the literature
Authors: Kopel Jonathan , Sharma Pranav 
Published: February 2021

Bladder cancer remains one of the most common malignancies of the genitourinary tract. Transurethral resection of the bladder tumor (TURBT) via cystoscopy with examination under anesthesia remains the primary method for determining the diagnosis and clinical stage of bladder cancer. Given the substantial cost of treatment and risk of bladder cancer recurrence after TURBT, novel approaches to transurethral resection, such as the en bloc technique, have been developed in an attempt to address these limitations. In this review, we examined the postoperative and oncological outcomes of en bloc TURBT compared to traditional resection techniques. Further prospective clinical studies, however, are still necessary to determine whether these alternative technologies or surgical techniques may improve treatment in bladder cancer patients. Level of evidence: Not applicable.
Young Male with Bilateral ICA Dissection: Beyond CADISS Trial
Authors: Bhatia Vikas , Jain Chirag , Ray Sucharita , Kumar jay 
Published: February 2021

Objective: To report a case of young male with stroke and bilateral internal carotid artery (ICA) dissection. Background: Cervical Artery Dissection in Stroke Study trial has provided some insight on management of patients with ICA dissection. However, there is a need to modify the management strategies as per specific clinical scenario. Design/Methods: Case report and literature review. Results: A 45-year-old male presented with 1 month old history of acute onset numbness of right half of the body with slurring of speech. Computed tomography angiography showed complete occlusion of left cervical ICA just beyond origin with presence of fusiform dilatation and spiral flap in right extracranial cervical ICA. The patient was started on antiplatelets and taken for endovascular procedure using 2-mesh-based carotid stents. Patient was discharged after 3 days on antiplatelet therapy. At 1-year follow-up, there were no fresh symptoms. Conclusion: This case emphasizes the role of successful endovascular management of carotid dissection in a young male. These clinical situations may not be fully represented in trials, and a case-based approach is required.
Reconstruction of the Medial Ulnar Collateral Ligament of the Elbow: The Docking Technique
Authors: Camp Christopher L. , Song Bryant M. , Wilbur Ryan R. 
Published: February 2021

Background: The medial ulnar collateral ligament (MUCL) is the primary restraint to valgus force on the elbow. Since the first description of MUCL reconstruction by Jobe et al in 1986, many technical advancements have been implemented to improve outcomes and reduce complications. The docking technique has emerged as one of the most commonly used techniques. Indications: Following repetitive stress on the elbow during the overhead throwing motion, the MUCL may become attenuated, insufficient, or rupture completely. Although nonoperative treatment with rest and therapy is often the initial treatment of choice, individuals who fail conservative measures may require MUCL reconstruction. Technique Description: The major steps of the procedure are (1) harvesting of palmaris longus autograft, (2) incision and exposure, (3) preparation of ulnar tunnel, (4) preparation of docking site on medial epicondyle, (5) graft passage, (6) graft tensioning and length determination, (7) final fixation, and (8) closure. Results: This procedure allows for reconstruction of the MUCL, restoration of valgus stability to the elbow, and return to play rates of 80% to 95%. The docking technique has advantages over previously described MUCL reconstruction techniques in that it minimizes injury to the flexor pronator mass, avoids the ulnar nerve, allows for robust graft tensioning, and reduces the amount of bone removed from the medial epicondyle. Discussion/Conclusion: The docking technique, as described in this video demonstration, is the most common MUCL reconstruction technique used today. When precise surgical steps are followed, complication rates are low and patient outcomes are favorable.
HIF2α is a direct regulator of neutrophil motility
Authors: Sormendi Sundary , Deygas Mathieu , Sinha Anupam , Bernard Mathilde , Krüger Anja , Kourtzelis Ioannis , Le Lay Gregoire , Sáez Pablo J. , Gerlach Michael , Franke Kristin , Meneses Ana , Kräter Martin , Palladini Alessandra , Guck Jochen , Coskun Ünal , Chavakis Triantafyllos , Vargas Pablo , Wielockx Ben 
Published: February 2021

Abstract
Orchestrated recruitment of neutrophils to inflamed tissue is essential during the initiation of inflammation. Inflamed areas are usually hypoxic, and adaptation to reduced oxygen pressure is typically mediated by hypoxia pathway proteins. However, it remains unclear how these factors influence the migration of neutrophils to and at the site of inflammation during their transmigration through the blood-endothelial cell barrier, as well as their motility in the interstitial space. Here, we reveal that activation of hypoxia-inducible factor 2 (HIF2α) as a result of a deficiency in HIF prolyl hydroxylase domain protein 2 (PHD2) boosts neutrophil migration specifically through highly confined microenvironments. In vivo, the increased migratory capacity of PHD2-deficient neutrophils resulted in massive tissue accumulation in models of acute local inflammation. Using systematic RNA sequencing analyses and mechanistic approaches, we identified RhoA, a cytoskeleton organizer, as the central downstream factor that mediates HIF2α-dependent neutrophil motility. Thus, we propose that the novel PHD2-HIF2α-RhoA axis is vital to the initial stages of inflammation because it promotes neutrophil movement through highly confined tissue landscapes.