bluuebunny/crossref_metadata_2025_split huggingface dataset:
A new species of <i>Arene</i> (Vetigastropoda, Areneidae) from Canopus Bank, off NE Brazil
Authors: Cavallari Daniel Caracanhas , Simone Luiz Ricardo Lopes de 
Published: April 2018

Arene lychee sp. nov. is described from Canopus Bank, a seamount located ~190 km off Fortaleza, Ceará, NE Brazil (02°14’25”S, 38°22’50”W), based on shell morphology. The species is characterized by a large, trochiform shell; color ranging from intense reddish to white (darker on spiral cords, lighter at base) with a yellow apex; sculpture of 3‑8 wide spiral cords with large scale-like spines; cords separated by deep interspaces with similar width, and interspaces sculptured by closely-packed, thin axial growth lines.
Causal Impact of Type 2 Diabetes Mellitus on Cerebral Small Vessel Disease
Authors: Liu Junfeng , Rutten-Jacobs Loes , Liu Ming , Markus Hugh S. , Traylor Matthew 
Published: April 2018

Background and Purpose—
The relationship between type 2 diabetes mellitus (T2D) and cerebral small vessel disease (CSVD) is unclear. We aimed to examine the causal effect of T2D, fasting glucose levels, and higher insulin resistance on CSVD using Mendelian randomization.

Methods—
Five CSVD phenotypes were studied; 2 were clinical outcomes associated with CSVD (lacunar stroke: n=2191/27 297 and intracerebral hemorrhage [ICH]: n=2254/8195 [deep and lobar ICH]), whereas 3 were radiological markers of CSVD (white matter hyperintensities: n=8429; fractional anisotropy [FA]: n=8357; and mean diffusivity: n=8357). We applied 2 complementary analyses to evaluate the association of T2D with CSVD. First, we used summarized data from genome-wide association study to calculate the effects of T2D-related variants on CSVD with inverse-variance weighted and weighted median approaches. Second, we performed a genetic risk score approach to test the effects of T2D-associated variants on white matter hyperintensities, FA, and mean diffusivity using individual-level data in UK Biobank.

Results—

T2D was associated with higher risk of lacunar stroke (odds ratio [OR], 1.15; 95% confidence interval [CI], 1.04–1.28;
P
=0.007) and lower mean FA (OR, 0.78; 95% CI, 0.66–0.92;
P
=0.004) but not white matter hyperintensities volume (OR, 1.01; 95% CI, 0.97–1.04;
P
=0.626), higher mean diffusivity (OR, 1.04; 95% CI, 0.89–1.23;
P
=0.612), ICH (OR, 1.07; 95% CI, 0.95–1.20;
P
=0.269), lobar ICH (OR, 1.07; 95% CI, 0.89–1.28;
P
=0.466), or deep ICH (OR, 1.16; 95% CI, 0.99–1.36;
P
=0.074). Weighted median and penalized median weighted analysis showed similar effect estimates of T2D on lacunar stroke and FA, but with wider CIs, meaning they were not significant. The genetic score on individual-level data was significantly associated with FA (OR, 0.63; 95% CI, 0.45–0.89;
P
=0.008) after adjusting for potential confounders.

Conclusions—
Our Mendelian randomization study provides evidence to suggest that T2D may be causally associated with CSVD, in particular with lacunar stroke and FA.
Shorter Intensive Care Unit Stays?
Authors: Chang Adam , Llinas Edward J. , Chen Karen , Llinas Rafael H. , Marsh Elisabeth B. 
Published: April 2018

Background and Purpose—
Symptomatic intracranial hemorrhage (sICH) is a life-threatening complication after treatment with intravenous tPA (tissue-type plasminogen activator) for acute stroke. Currently, patients are monitored for sICH in a neurocritical care unit or intensive care unit-like setting for 24 hours post-treatment—a costly and resource intensive practice. Because the half-life of tPA is much shorter than 24 hours, it is possible that the majority of patients do not require such intensive monitoring. In this study, we evaluate the time period of the highest risk for sICH post-tPA.

Methods—
All patients receiving intravenous tPA for acute stroke between 2004 and 2017 at our institution were prospectively followed for sICH for 36 hours after treatment. The mean time from tPA administration to hemorrhage was calculated. Additional data were collected regarding: patient demographics, medical variables, and stroke characteristics. Variables significant in univariate analysis were entered into multivariable logistic regression models to determine factors associated with symptomatic hemorrhage.

Results—
Three hundred eighty-five patients were administered intravenous tPA. Twenty-one (5.5%) developed sICH. The mean time from administration to hemorrhage was 8.5 hours. Greater than 80% of sICHs occurred before 12 hours post-treatment. The only variable significantly associated with sICH was combination therapy (intravenous tPA and intra-arterial thrombectomy).

Conclusions—
sICH associated with the administration of intravenous tPA typically occurs within the first 12 hours of treatment. Longer monitoring in an intensive care unit-like setting may be unnecessary for most individuals.
A Critique of Immunity for Multilateral Development Banks in National Courts
Authors: Xu Chengjin , Gu Bin 
Published: April 2018

Abstract
Since their emergence after World War II, multilateral development banks (MDBs, or Banks) have become crucial players in promoting economic development in the developing world. The theory of immunity enables the MDBs to shield themselves from jurisdictions of national courts, and protects them in Bank operations. This paper presents a critique of the immunity claimed by MDBs, and argues that such a claim of immunity should be restrictive, rather than absolute. Meanwhile, it is important to establish adequate dispute settlement systems within the MDBs, counterbalancing their immunities from legal process. The systems offer a fair trial to private parties, and should be independent from Bank management. As for the Asian Infrastructure Investment Bank (AIIB), the young Bank’s operations can be on the ground only with its immunities respected by members, while the committed high standards are possible only with adequate internal dispute settlement systems.
Wind Energy Exploration over the Atacama Desert: A Numerical Model–Guided Observational Program
Authors: Muñoz Ricardo C. , Falvey Mark J. , Arancibia Mario , Astudillo Valentina I. , Elgueta Javier , Ibarra Marcelo , Santana Christian , Vásquez Camila 
Published: April 2018

AbstractOver the past 15 years, Chile’s energy agencies have undertaken a series of projects aimed at evaluating the wind energy potential of the northern part of the country (western South America between 18° and 32°S), including the Atacama Desert. These projects have produced an unprecedented database of wind observations and ancillary meteorological data over an especially interesting climatic region, including more than 30 sites with 20-m meteorological masts and six high towers (60–80 m) with multilevel wind and temperature measurements. Measuring periods vary between 1 and 10 years, with about half the stations having 5 or more years of data. Site selection was guided by the results of a mesoscale numerical model, so the program provides a good example of modeling–observation interaction, as well as being a demonstration of a successful collaboration between government, university, and international assistance programs. This paper describes the publically available database of meteorological measurements, provides examples of regional climatological features revealed by the observations, compares observations with model results, and describes how the information provided by the program has contributed to the development of wind energy projects in the region.
Climate Model Biases and Modification of the Climate Change Signal by Intensity-Dependent Bias Correction
Authors: Ivanov Martin Aleksandrov , Luterbacher Jürg , Kotlarski Sven 
Published: April 2018

AbstractClimate change impact research and risk assessment require accurate estimates of the climate change signal (CCS). Raw climate model data include systematic biases that affect the CCS of high-impact variables such as daily precipitation and wind speed. This paper presents a novel, general, and extensible analytical theory of the effect of these biases on the CCS of the distribution mean and quantiles. The theory reveals that misrepresented model intensities and probability of nonzero (positive) events have the potential to distort raw model CCS estimates. We test the analytical description in a challenging application of bias correction and downscaling to daily precipitation over alpine terrain, where the output of 15 regional climate models (RCMs) is reduced to local weather stations. The theoretically predicted CCS modification well approximates the modification by the bias correction method, even for the station–RCM combinations with the largest absolute modifications. These results demonstrate that the CCS modification by bias correction is a direct consequence of removing model biases. Therefore, provided that application of intensity-dependent bias correction is scientifically appropriate, the CCS modification should be a desirable effect. The analytical theory can be used as a tool to 1) detect model biases with high potential to distort the CCS and 2) efficiently generate novel, improved CCS datasets. The latter are highly relevant for the development of appropriate climate change adaptation, mitigation, and resilience strategies. Future research needs to focus on developing process-based bias corrections that depend on simulated intensities rather than preserving the raw model CCS.
Features of the Equatorial Intermediate Current Associated with Basin Resonance in the Indian Ocean
Authors: Huang Ke , Han Weiqing , Wang Dongxiao , Wang Weiqiang , Xie Qiang , Chen Ju , Chen Gengxin 
Published: April 2018

AbstractThis paper investigates the features of the Equatorial Intermediate Current (EIC) in the Indian Ocean and its relationship with basin resonance at the semiannual time scale by using in situ observations, reanalysis output, and a continuously stratified linear ocean model (LOM). The observational results show that the EIC is characterized by prominent semiannual variations with velocity reversals and westward phase propagation and that it is strongly influenced by the pronounced second baroclinic mode structure but with identifiable vertical phase propagation. Similar behavior is found in the reanalysis data and LOM results. The simulation of wind-driven equatorial wave dynamics in the LOM reveals that the observed variability of the EIC can be largely explained by the equatorial basin resonance at the semiannual period, when the second baroclinic Rossby wave reflected from the eastern boundary intensifies the directly forced equatorial Kelvin and Rossby waves in the basin interior. The sum of the first 10 modes can reproduce the main features of the EIC. Among these modes, the resonant second baroclinic mode makes the largest contribution, which dominates the vertical structure, semiannual cycle, and westward phase propagation of the EIC. The other 9 modes, however, are also important, and the superposition of the first 10 modes produces downward energy propagation in the equatorial Indian Ocean.
Carbon Monoxide, Cigarettes and Family Doctors
Authors: Invernizzi Giovanni , Bettoncelli Germano , D'Ambrosio Gaetano , Zappa Mario , Calzolari Mauro , Paredi Paolo , Mazza Roberto , Soresi Enzo , Boffi Roberto 
Published: April 2018

Aims and Background General practitioners could play a key role in preventive programs against tobacco-related diseases. However, they seldom take action in the office even with minimal advice counselling. Such behaviour might reflect the lack of academic teaching and the lack of practice with motivational and dependence questionnaires, considered basic tools to help smokers to quit successfully. The study was aimed to investigate the awareness of a sample of Italian family doctors as regards tobacco epidemiology and smoking cessation strategies. Methods A total of 428 family doctors were administered a questionnaire with a set of questions on their personal smoking habits and on personal initiatives in the office towards smokers. Another set of questions regarded their knowledge on tobacco issues, with special attention to carbon monoxide, which is widely perceived as a very dangerous poison and works as a motivational tool on smokers and adolescents. Carbon monoxide measurement was carried out on all participants to obtain objective data on smoking and to show the feasibility of the test. Results The percentage of self-reported current smokers among general practitioners was 24%, with a high prevalence of ex-smokers (46%), and 29% of never smokers. Family doctors were more keen to counsel adolescents than adults about tobacco, and they were very interested in continuing medical education on the issue. The doctors who took part in our study showed a surprising limited knowledge of all the issues associated with smoking cessation and prevention such as epidemiology, cigarette characteristics, success rate of smoking cessation programs, Fagerström's tolerance questionnaire, safety of nicotine replacement therapy and the knowledge of carbon monoxide as a product of cigarette smoke. Conclusions The scenario depicted by our survey underscores the necessity to improve the knowledge and performance of primary care physicians on tobacco-related issues in order to implement primary and secondary prevention in clinical practice.
Cytoreductive Surgery Followed by Intraperitoneal Hyperthermic Perfusion in the Treatment of Recurrent Epithelial Ovarian Cancer: A Phase II Clinical Study
Authors: Deraco Marcello , Rossi Carlo R , Pennacchioli Elisabetta , Guadagni Stefano , Somers Danielle Carlier , Santoro Nicola , Raspagliesi Francesco , Kusamura Shigeki , Vaglini Maurizio 
Published: April 2018

Aims and Background The optimal salvage therapy for recurrent ovarian carcinoma has not been clearly established. Response to second-line chemotherapy is low, with a short median survival (8.8-15 months). We investigated the effect of an aggressive approach consisting of surgery followed by intraperitoneal drug delivery and local hyperthermia. Patients and Methods In a phase II clinical study, 27 patients with advanced/recurrent ovarian carcinoma were treated with cytoreductive surgery and intraperitoneal hyperthermic perfusion. Median patient age was 53 years (range, 30-67) and mean follow-up was 17.4 months (range, 0.3-36.0). Patients had been surgically staged and heavily pretreated with cisplatin-based, taxol-based or taxol/platinum-containing regimens. Nineteen (70%) patients were cytoreduced to minimal residual disease <2.5 mm. The intraperitoneal hyperthermic perfusion was performed with the closed abdomen technique, using a preheated polysaline perfusate containing cisplatin (25 mg/m2/L) + mitomycin C (3.3 mg/m2/L) through a heart-lung pump (mean flow of 700 mL/min) for 60 min in the hyperthermic phase (42.5 °C). Results Two-year overall survival was 55%. Median times to overall progression and local progression were 16 months and 21.8 months, respectively. Variables that affected the overall survival or time to progression were as follows: residual disease (P = 0.00025), patient age (P = 0.04), and lag time between diagnosis and cytoreductive surgery + intraperitoneal hyperthermic perfusion (P = 0.04). Treatment-related morbidity, mortality and acute toxicity (grade II-III) rates were 11%, 4% and 11%, respectively. Eight (89%) of 9 patients had ascites resolution. Conclusion Our results suggest that cytoreductive surgery + intraperitoneal hyperthermic perfusion is a well-tolerated, feasible and promising alternative in the management of selected patients with recurrent ovarian cancer, but further randomized controlled studies are needed in order to confirm our findings.
Roach's Mathematical Equations in Predicting Pathological Stage in Men with Clinically Localized Prostate Cancer
Authors: Medica Mauro , Giglio Matteo , Germinale Francesco , Timossi Luca , Romagnoli Andrea , Bertolotto Franco , Carmignani Giorgio 
Published: April 2018

Aims and Background The therapeutic choice in patients with clinically localized prostate cancer depends on preoperative clinical stage. Diagnostic instruments currently available for such an evaluation – considered separately – have not shown enough efficacy. Roach has recently introduced three simple mathematical equations that – on the basis of prostate-specific antigen and the biopsy Gleason score – are aimed at calculating the definitive pathological stage. We retrospectively analyzed our radical prostatectomy data base to assess the accuracy of the equations in predicting the final stage in patients with clinically localized prostate cancer. Methods Study Design The study included 173 patients who had undergone radical retropubic prostatectomy at our Institution. Patients were divided into 25 groups, depending on preoperative PSA and the biopsy Gleason score. The risk of extracapsular neoplastic growth, seminal vesicle involvement and lymph node involvement was calculated for each group by means of Roach's equations. On the basis of definitive histological examinations, we compared the expected risk to the observed risk. Results The observed risk fell within the interval of expected risk in I6 of 17 groups (94%) regarding the evaluation of extracapsular growth, in I5 of 17 (88%) regarding the analysis of seminal vesicle involvement, and in 14 of 17 (82%) regarding the evaluation of lymph node involvement. Therefore, the observed event was in agreement with the expected event in 45 of 51 groups (88%). Conclusions The equations represent a practical and effective instrument for preoperative clinical staging in patients with localized prostate cancer. By means of these mathematical formulas, one can assess the correct prognosis and – above all – plan the best therapeutic approach.
Suicide and Suicidal Thoughts in Cancer Patients
Authors: Filiberti Antonio , Ripamonti Carla 
Published: April 2018

Backround Many factors increase vulnerability to suicide in cancer patients. Uncontrolled pain and other physical symptoms, psychological distress, and existential suffering are related to suicide in oncology. There is a strong consensus that physicians and nurses are not adequately trained to manage the potential suicide patient. This paper offers suggestions for the early recognition of cancer patients at risk of suicide, for the planning of crisis intervention and a physician-patient communication strategy. Methods A review of the literature about suicide in cancer patients was carried out by MEDLINE and PSYLIT and peer contacts. Results Through a review of the literature and their clinical experience, the authors outline a number of vulnerability factors of suicide with the intention to help health professionals to face the dilemma of suicide in cancer patients. Clinical vignettes reveal how a patient may reject his/her suicidal intention if adequate pharmacological and psychosocial supports are offered. Other case reports of patients refusing cancer therapy show that suicide is a complex phenomenon touching ethical, sociological, medical and psychiatric issues. Conclusions Our findings support the hypothesis that improved patient-physician communication, to supply adequate psychological crisis intervention, respect for patient-centered care, familiarity with the tenets of palliative medicine alongside effective education in suicidology, and the routine use of teamwork may reduce the need of suicide in cancer patients and probably the need to hasten death.
Amitriptyline in Neuropathic Cancer Pain in Patients on Morphine Therapy: A Randomized Placebo-controlled, Double-blind Crossover Study
Authors: Mercadante Sebastiano , Arcuri Edoardo , Tirelli Walter , Villari Patrizia , Casuccio Alessandra 
Published: April 2018

Aims and Background Amitriptyline is the most common analgesic adjuvant used in cancer patients with neuropathic pain, even though no specific studies have demonstrated a benefit. A randomized placebo-controlled, double-blind crossover study was designed to evidence the effects of amitriptyline in patients with neuropathic cancer pain. Methods Sixteen advanced cancer patients with neuropathic pain on systemic morphine therapy, no longer receiving oncologic treatment, presenting moderate pain (about 4 or more, but less than 7, on a numerical scale of 0-10) in the last week, and given a stable morphine dose in the last 2 days were admitted to the study. During the first week of study, patients were administered 25 mg of amitriptyline or equivalent drops of placebo at night for 3 days and 50 mg for the following 4 days. Doses for patients aged more than 65 years were 15 mg (first 3 days) and 30 mg (3 days after). After a week, a crossover took place for the second week, with the other treatment at an inverse sequence. Opioid consumption, pain intensity, symptoms and adverse effects, mood, sleep, patient's preference, quality of life before starting the study, the first week after and the second week after were recorded. Results No significant benefits in analgesia were found in the global pain intensity of the previous week of treatment, the least pain intensity or the pain evaluated just after a week of treatment, at the moment of the visit, when amitriptyline was compared with placebo. A significant difference was evidenced for the worst pain (P < 0.035). No differences in opioid doses during the period of study were found. Drowsiness, confusion and dry mouth were significantly more intense with amitriptyline than with placebo (P < 0.036, 0.003, and 0.034, respectively). There were no substantial differences between the two treatments in Spitzer's quality of life score and for each item. No differences in patients' preference for the two treatment periods were found. The analgesic effects of amitriptyline were slight and associated with adverse effects. Conclusions In light of the results obtained in the study, the extensive use of the drug for cancer pain should be questioned.
Sentinel Lymph Node Biopsy to Stage Patients with Cutaneous Melanoma at the National Cancer Institute of Naples. Results from 240 Sentinel Node Biopsies
Authors: Caracò C , Chiofalo MG , Niro J , Ascierto PA , Botti G , Lastoria S , Mozzillo N 
Published: April 2018

Aimsand background The presence of lymph node metastases in patients with cutaneous melanoma represents the basis for correct therapy planning and is the most powerful prognostic factor to evaluate overall survival at diagnosis. Methods and Study Design Since 1992, when Dr Morton published his first experience, the sentinel lymph node (SLN) biopsy technique seems to have resolved this matter by correctly staging patients. We analyzed our data from 240 SLN biopsies performed in the last five years at the National Cancer Institute of Naples, evaluating the total identification rate and the nodal recurrence rate, and compared them with the preliminary data of the MSLT (melanoma sentinel lymph node trial). Results Of all SLNs evaluated 18.5% were micrometastatic and 14% were identified by immunohistochemical staining. Forty-one patients had metastatic SLNs and nodal dissection of the positive basins revealed no other tumor-positive lymph nodes in more than 80% of them. All patients with a Breslow thickness of less than 2 mm had micrometastases only in the SLN, while with increasing thickness two, three or more positive nodes were found. Among SLN-negative patients nine (4%) developed lymph node recurrence in the previously treated basin and were therefore considered as false negative SLN biopsies. Conclusions The prognostic value of SLN biopsy needs to be confirmed by the final results of the MSLT evaluating the therapeutic use of this procedure in patients with a Breslow thickness of less than 2 mm and its possible impact on the course of the disease.