bluuebunny/crossref_metadata_2025 huggingface dataset:
Late permissive hypercapnia and respiratory stability among very preterm infants: a pilot randomised trial
Authors: Travers Colm P , Carlo Waldemar A , Nakhmani Arie , Laney Deborah , Chahine Rouba A , Aban Immaculada , Ambalavanan Namasivayam
Published: March 2023

Objective

Determine if targeting higher transcutaneous carbon dioxide improves respiratory stability among very preterm infants on ventilatory support.

Design

Single-centre pilot randomised clinical trial.

Setting

The University of Alabama at Birmingham.

Patients

Very preterm infants on ventilatory support after postnatal day 7.

Interventions

Infants were randomised to two different transcutaneous carbon dioxide levels targeting 5 mm Hg (0.67 kPa) changes with four sessions each lasting 24 hours for 96 hours: baseline-increase-baseline-increase or baseline-decrease-baseline-decrease.

Main outcome measures

We collected cardiorespiratory data evaluating episodes of intermittent hypoxaemia (oxygen saturations (SpO2)<85% for ≥10 s), bradycardia (<100 bpm for ≥10 s), and cerebral and abdominal hypoxaemia on near-infrared spectroscopy.

Results

We enrolled 25 infants with a gestational age of 24 w 6 d±11 d (mean±SD) and birth weight 645±142 g on postnatal day 14±3. Continuous transcutaneous carbon dioxide values (56.8±6.9 in the higher group vs 54.5±7.8 in the lower group; p=0.36) did not differ significantly between groups during the intervention days. There were no differences in intermittent hypoxaemia (126±64 vs 105±61 per 24 hours; p=0.30) or bradycardia (11±16 vs 15±23 per hour; p=0.89) episodes between groups. The proportion of time with SpO2<85%, SpO2<80%, cerebral hypoxaemia or abdominal hypoxaemia did not differ (all p>0.05). There was moderate negative correlation between mean transcutaneous carbon dioxide and bradycardia episodes (r=−0.56; p<0.001).

Conclusion

Targeting 5 mm Hg (0.67 kPa) changes in transcutaneous carbon dioxide did not improve respiratory stability among very preterm infants on ventilatory support but the intended carbon dioxide separation was difficult to achieve and maintain.

Trial registration number

NCT03333161.
Phase III, two arm, multi-centre, open label, parallel-group randomised designed clinical investigation of the use of a personalised early warning decision support system to predict and prevent acute exacerbations of chronic obstructive pulmonary disease: ‘Predict & Prevent AECOPD’ – study protocol
Authors: Kaur Dalbir , Mehta Rajnikant L , Jarrett Hugh , Jowett Sue , Gale Nicola K , Turner Alice M , Spiteri Monica , Patel Neil
Published: March 2023

Introduction

With 65 million cases globally, chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death and imposes a heavy burden on patients’ lives and healthcare resources worldwide. Around half of all patients with COPD have frequent (≥2 per year) acute exacerbations of COPD (AECOPD). Rapid readmissions are also common. Exacerbations impact significantly on COPD outcomes, causing significant lung function decline. Prompt exacerbation management optimises recovery and delays the time to the next acute episode.

Methods/analysis

The Predict & Prevent AECOPD trial is a phase III, two arm, multi-centre, open label, parallel-group individually randomised clinical trial investigating the use of a personalised early warning decision support system (COPDPredict) to predict and prevent AECOPD. We aim to recruit 384 participants and randomise each individual in a 1:1 ratio to either standard self-management plans with rescue medication (RM) (control arm) or COPDPredict with RM (intervention arm).

The trial will inform the future standard of care regarding management of exacerbations in COPD patients. The main outcome measure is to provide further validation, as compared with usual care, for the clinical effectiveness of COPDPredict to help guide and support COPD patients and their respective clinical teams in identifying exacerbations early, with an aim to reduce the total number of AECOPD-induced hospital admissions in the 12 months following each patient’s randomisation.

Ethics and dissemination

This study protocol is reported in accordance with the guidance set out in the Standard Protocol Items: Recommendations for Interventional Trials statement. Predict & Prevent AECOPD has obtained ethical approval in England (19/LO/1939). On completion of the trial and publication of results a lay findings summary will be disseminated to trial participants.

Trial registration number

NCT04136418.
Day-to-day variability of knee pain and the relationship with physical activity in people with knee osteoarthritis: an observational, feasibility study using consumer smartwatches
Authors: Vivekanantham Arani , Selby David , Lunt Mark , Sergeant Jamie C , Parkes Matthew J , O'Neill Terence W , Dixon Will
Published: March 2023

Objective

To assess the feasibility of using smartwatches in people with knee osteoarthritis (OA) to determine the day-to-day variability of pain and the relationship between daily pain and step count.

Design

Observational, feasibility study.

Setting

In July 2017, the study was advertised in newspapers, magazines and, on social media. Participants had to be living/willing to travel to Manchester. Recruitment was in September 2017 and data collection was completed in January 2018.

Participants

26 participants aged>50 years with self-diagnosed symptomatic knee OA were recruited.

Outcome measures

Participants were provided with a consumer cellular smartwatch with a bespoke app that triggered a series of daily questions including two times per day questions about level of knee pain and one time per month question from the pain subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. The smartwatch also recorded daily step counts.

Results

Of the 25 participants, 13 were men and their mean age was 65 years (standard deviation (SD) 8 years). The smartwatch app was successful in simultaneously assessing and recording data on knee pain and step count in real time. Knee pain was categorised into sustained high/low or fluctuating levels, but there was considerable day-to-day variation within these categories. Levels of knee pain in general correlated with pain assessed by KOOS. Those with sustained high/low levels of pain had a similar daily step count average (mean 3754 (SD 2524)/4307 (SD 2992)), but those with fluctuating pain had much lower step count levels (mean 2064 (SD 1716)).

Conclusions

Smartwatches can be used to assess pain and physical activity in knee OA. Larger studies may help inform a better understanding of causal links between physical activity patterns and pain. In time, this could inform development of personalised physical activity recommendations for people with knee OA.
National cross-sectional study of the sociodemographic characteristics of Aotearoa New Zealand’s regulated health workforce pre-registration students: a mirror on society?
Authors: Crampton Peter , Bagg Warwick , Bristowe Zoe , Brunton Paul , Curtis Elana , Hendry Chris , Kool Bridget , Scarf Damian , Shaw Susan , Tukuitonga Collin , Williman Jonathan , Wilson Denise
Published: March 2023

Objectives

To provide a sociodemographic profile of students enrolled in their first year of a health professional pre-registration programme offered within New Zealand (NZ) tertiary institutions.

Design

Observational, cross-sectional study. Data were sought from NZ tertiary education institutions for all eligible students accepted into the first ‘professional’ year of a health professional programme for the 5-year period 2016–2020 inclusive. Variables of interest: gender, citizenship, ethnicity, rural classification, socioeconomic deprivation, school type and school socioeconomic scores. Analyses were carried out using the R statistics software.

Setting

Aotearoa NZ.

Participants

All students (domestic and international) accepted into the first ‘professional’ year of a health professional programme leading to registration under the Health Practitioners Competence Assurance Act 2003.

Results

NZ’s health workforce pre-registration students do not reflect the diverse communities they will serve in several important dimensions. There is a systematic under-representation of students who identify as Māori and Pacific, and students who come from low socioeconomic and rural backgrounds. The enrolment rate for Māori students is about 99 per 100 000 eligible population and for some Pacific ethnic groups is lower still, compared with 152 per 100 000 for NZ European students. The unadjusted rate ratio for enrolment for both Māori students and Pacific students versus ‘NZ European and Other’ students is approximately 0.7.

Conclusions

We recommend that: (1) there should be a nationally coordinated system for collecting and reporting on the sociodemographic characteristics of the health workforce pre-registration; (2) mechanisms be developed to allow the agencies that fund tertiary education to base their funding decisions directly on the projected health workforce needs of the health system and (3) tertiary education funding decisions be based on Te Tiriti o Waitangi (the foundational constitutional agreement between the Indigenous people, Māori and the British Crown signed in 1840) and have a strong pro-equity focus.
Protocol for the Pathways Study: a realist evaluation of staff social ties and communication in the delivery of neonatal care in Kenya
Authors: Wanyama Conrad , Blacklock Claire , Jepkosgei Juliet , English Mike , Hinton Lisa , McKnight Jacob , Molyneux Sassy , Boga Mwanamvua , Musitia Peris Muoga , Wong Geoff
Published: March 2023

Introduction

The informal social ties that health workers form with their colleagues influence knowledge, skills and individual and group behaviours and norms in the workplace. However, improved understanding of these ‘software’ aspects of the workforce (eg, relationships, norms, power) have been neglected in health systems research. In Kenya, neonatal mortality has lagged despite reductions in other age groups under 5 years. A rich understanding of workforce social ties is likely to be valuable to inform behavioural change initiatives seeking to improve quality of neonatal healthcare.

This study aims to better understand the relational components among health workers in Kenyan neonatal care areas, and how such understanding might inform the design and implementation of quality improvement interventions targeting health workers’ behaviours.

Methods and analysis

We will collect data in two phases. In phase 1, we will conduct non-participant observation of hospital staff during patient care and hospital meetings, a social network questionnaire with staff, in-depth interviews, key informant interviews and focus group discussions at two large public hospitals in Kenya. Data will be collected purposively and analysed using realist evaluation, interim analyses including thematic analysis of qualitative data and quantitative analysis of social network metrics. In phase 2, a stakeholder workshop will be held to discuss and refine phase one findings.

Study findings will help refine an evolving programme theory with recommendations used to develop theory-informed interventions targeted at enhancing quality improvement efforts in Kenyan hospitals.

Ethics and dissemination

The study has been approved by Kenya Medical Research Institute (KEMRI/SERU/CGMR-C/241/4374) and Oxford Tropical Research Ethics Committee (OxTREC 519-22). Research findings will be shared with the sites, and disseminated in seminars, conferences and published in open-access scientific journals.
Phytoplankton communities as indicators of environmental change in the Canadian Rockies
Authors: Cook Jenna , Loewen Charlie J. G. , Nagao Tamika L. , Graham Mark D. , Vinebrooke Rolf D.
Published: March 2023

Remote mountain lakes in protected areas are sentinels of the ecological impacts of extreme and novel environmental changes occurring at broad regional scales. Ecosystem responses to such stressors are often first detected as shifts in community composition. We surveyed phytoplankton communities across 82 mountain lakes to test the hypothesis that taxonomic composition is indicative of more environmental changes than are aggregate properties, such as total biomass. Phosphorus was the only significant predictor of chlorophyll-inferred algal biomass, a correlative finding supported by evidence from our nutrient amendment bioassays. Interlake variances in taxonomically diagnostic algal pigments and 78 genera were indicative of changes in total phosphorus, glacial coverage, underwater light availability, and dissolved organic carbon. Lack of concordance was observed between ordinations of pigment- and genus-based data as environmental variables captured more variance in the pigment data. Our findings provide a baseline for future lake monitoring programs in the Canadian Rockies as they increasingly experience interactive effects involving climate change and landscape features, such as variation in turbid glacial meltwaters and aeolian phosphorus deposition from wildfires.
Self-Evisceration of Intestines as the Initial Presentation of Schizoaffective Disorder
Authors: Hamlin Stephanie , Sharma Dana L. , Kablinger Anita S.
Published: March 2023

Schizoaffective disorder is categorized by major mood episodes and symptoms of schizophrenia that include disorganized speech, delusions, paranoia, and hallucinations. It is associated with risk factors, including a history of abuse and cannabis use, and patients are typically diagnosed in adolescence and young adulthood. In this case report, we describe the unusual case of a 39-year-old male patient with undiagnosed schizoaffective disorder who self-eviscerated his intestines during an episode of psychosis. He received an emergent exploratory laparotomy with a partial colectomy. After medical stabilization and reorientation, the patient recalled a 10-year history of paranoia associated with significant cannabis use, despite otherwise functioning appropriately in society. During a two-week hospital course, his paranoia and hallucinations were remitted on olanzapine and valproic acid. In addition to discussing his presentation and recollection of the incident, we also discuss similar cases of self-mutilation in nonsuicidal patients and the relationship between cannabis use and schizophrenia spectrum disorders.
Dietary Antioxidant Capacity Indices are Negatively Correlated to LDL-Oxidation in Adults
Authors: Nouri Mehran , Soltani Mitra , Rajabzadeh-Dehkordi Milad , Rafieipour Nastaran , Askarpour Moein , Najafi Maryam , Faghih Shiva
Published: March 2023

Introduction. Former research studies have demonstrated controversial associations between dietary indices and oxidative stress biomarkers including oxidized low-density lipoprotein (ox-LDL) and malondialdehyde (MDA). So, in this cross-sectional study, we aimed to assess the association of dietary total antioxidant capacity (DTAC), oxidative balance score, and phytochemical index (PI) with ox-LDL/MDA in a healthy adult population of Shiraz, Iran. Methods. 236 individuals participated in this cross-sectional study. DTAC, OBS, and PI were calculated using a 168-item food frequency questionnaire (FFQ), which was previously validated in Iran. We measured ox-LDL and MDA in blood samples of the participants using commercially existing kits. Crude and adjusted models of linear regression were used to evaluate the relation of dietary indices with ox-LDL and MDA. Results. There was a significant association between ox-LDL and DTAC in both crude (β = −1.55; 95% CI: −2.53, −0.58; P-trend = 0.002) and adjusted (β = −1.65 95% CI: −2.66, −0.64; P-trend = 0.001) models. Also, a negative association was observed between ox-LDL and PI in the crude (β = −1.26 95% CI: −2.33, −0.29; P-trend = 0.01) and adjusted (β = −1.36 95% CI: −2.38, −0.34; P-trend = 0.01) models. Conclusion. Results of this study showed that DTAC and PI were inversely associated with ox-LDL as markers of lipid peroxidation. But no correlations were seen between MDA and dietary antioxidant indices.
A Real-Time Data Monitoring Framework for Predictive Maintenance Based on the Internet of Things
Authors: Uppal Mudita , Gupta Deepali , Goyal Nitin , Imoize Agbotiname Lucky , Kumar Arun , Ojo Stephen , Pani Subhendu Kumar , Kim Yongsung , Choi Jaeun
Published: March 2023

The Internet of Things (IoT) is a platform that manages daily life tasks to establish an interaction between things and humans. One of its applications, the smart office that uses the Internet to monitor electrical appliances and sensor data using an automation system, is presented in this study. Some of the limitations of the existing office automation system are an unfriendly user interface, lack of IoT technology, high cost, or restricted range of wireless transmission. Therefore, this paper presents the design and fabrication of an IoT-based office automation system with a user-friendly smartphone interface. Also, real-time data monitoring is conducted for the predictive maintenance of sensor nodes. This model uses an Arduino Mega 2560 Rev3 microcontroller connected to different appliances and sensors. The data collected from different sensors and appliances are sent to the cloud and accessible to the user on their smartphone despite their location. A sensor fault prediction model based on a machine learning algorithm is proposed in this paper, where the k-nearest neighbors model achieved better performance with 99.63% accuracy, 99.59% F1-score, and 99.67% recall. The performance of both models, i.e., k-nearest neighbors and naive Bayes, was evaluated using different performance metrics such as precision, recall, F1-score, and accuracy. It is a reliable, continuous, and stable automation system that provides safety and convenience to smart office employees and improves their work efficiency while saving resources.
ANO1 Reprograms Cholesterol Metabolism and the Tumor Microenvironment to Promote Cancer Metastasis
Authors: Deng Chun-Miao , Zhang Guo-Geng , Liu Qin-Wen , Xu Jiao-Jiao , Liu Zhi-Chao , Yang Jing , Xu Tao-Yang , Li Zhi-Gang , Zhang Fan , Li Bin
Published: March 2023

Tumor metastasis is a complex process. A better understanding of the mechanistic underpinnings of the metastatic cascade could uncover approaches to better prevent and target metastases. Here, we integrated transcriptomic profiling in primary esophageal squamous cell carcinoma (ESCC) and matched lymph node metastatic tissues and genome-wide CRISPR/Cas9 functional screening to identify the key drivers of cancer metastasis. Anoctamin 1 (ANO1) expression was found to be elevated in primary tumors and further increased in metastatic tissues. High expression of ANO1 was associated with poor patient survival, and ANO1 overexpression promoted cancer invasion and metastasis. Mechanistically, ANO1 inactivated the LXR pathway and increased intracellular cholesterol accumulation by interacting with JUN to repress the transcription of cholesterol hydroxylase, CYP27A1. In a paracrine manner, IL1β secreted from ANO1-expressing ESCC cancer cells activated NF-κB signaling in fibroblasts to stimulate production of the chemokine CCL1, which in turn enhanced invasion of ESCC cancer cells. Furthermore, molecular docking and in silico screening of 1,500,000 small molecules identified K786–4469 as a lead compound that targeted ANO1 and suppressed cancer metastasis in vitro and in vivo. Overall, these findings uncover a noncanonical function of ANO1 in regulating cholesterol metabolism and fibroblast function, revealing ANO1 as a potential prognostic biomarker and therapeutic target for metastatic ESCC.

Significance:

Metastatic cancer cells upregulate ANO1 to activate cell-intrinsic and -extrinsic mechanisms that alter cholesterol metabolism and stimulate fibroblasts, which can be targeted with ANO1 inhibitors to inhibit metastatic growth.

See related commentary by Singh and Mehla, p. 1759
Comparison of Three Transcytotic Pathways for Distribution to Brain Metastases of Breast Cancer
Authors: Khan Imran , Gril Brunilde , Paranjape Anurag N. , Robinson Christina M. , Difilippantonio Simone , Biernat Wojciech , Bieńkowski Michał , Pęksa Rafał , Duchnowska Renata , Jassem Jacek , Brastianos Priscilla K. , Metellus Philippe , Bialecki Emilie , Woodroofe Carolyn C. , Wu Haitao , Swenson Rolf E. , Steeg Patricia S.
Published: March 2023

Advances in drug treatments for brain metastases of breast cancer have improved progression-free survival but new, more efficacious strategies are needed. Most chemotherapeutic drugs infiltrate brain metastases by moving between brain capillary endothelial cells, paracellular distribution, resulting in heterogeneous distribution, lower than that of systemic metastases. Herein, we tested three well-known transcytotic pathways through brain capillary endothelial cells as potential avenues for drug access: transferrin receptor (TfR) peptide, low-density lipoprotein receptor 1 (LRP1) peptide, albumin. Each was far-red labeled, injected into two hematogenous models of brain metastases, circulated for two different times, and their uptake quantified in metastases and uninvolved (nonmetastatic) brain. Surprisingly, all three pathways demonstrated distinct distribution patterns in vivo. Two were suboptimal: TfR distributed to uninvolved brain but poorly in metastases, while LRP1 was poorly distributed. Albumin distributed to virtually all metastases in both model systems, significantly greater than in uninvolved brain (P < 0.0001). Further experiments revealed that albumin entered both macrometastases and micrometastases, the targets of treatment and prevention translational strategies. Albumin uptake into brain metastases was not correlated with the uptake of a paracellular probe (biocytin). We identified a novel mechanism of albumin endocytosis through the endothelia of brain metastases consistent with clathrin-independent endocytosis (CIE), involving the neonatal Fc receptor, galectin-3, and glycosphingolipids. Components of the CIE process were found on metastatic endothelial cells in human craniotomies. The data suggest a reconsideration of albumin as a translational mechanism for improved drug delivery to brain metastases and possibly other central nervous system (CNS) cancers.

In conclusion, drug therapy for brain metastasis needs improvement. We surveyed three transcytotic pathways as potential delivery systems in brain-tropic models and found that albumin has optimal properties. Albumin used a novel endocytic mechanism.
Studying the Brain Monoaminergic Systems and Neurotrophic Factors in Minipigs with High and Low Tolerance to the Presence of Human
Authors: Bazovkina Darya , Illarionova Nina B. , Kulikova Elizabeth A. , Bazhenova Ekaterina Yu. , Sinyakova Nadezhda A. , Khotskin Nikita V. , Nikitin Sergey , Lankin Vasily S. , Terenina Elena E. , Trapezov Oleg V. , Kulikov Aleksandr V.
Published: March 2023

Here, we present the first evidence for brain adaptation in pigs tolerant to the human presence, as a behavioral trait favoring domestication. The study was carried out on minipiglets from population bred at the Institute of Cytology and Genetics (Novosibirsk, Russia). We compared the behavior, metabolism of monoaminergic neurotransmitter systems, and functional activity of the hypothalamic-pituitary-adrenal system, as well as neurotrophic markers in the brain of minipigs differing by tolerance to human presence (HT and LT – high and low tolerance). The piglets did not differ in the levels of activity in the open field test. However, the concentration of cortisol plasma was significantly higher in minipigs with a low tolerance to the presence of humans. Moreover, LT minipigs demonstrated a decreased level of serotonin in the hypothalamus and augmented levels of serotonin and its metabolite 5-HIAA in the substantia nigra as compared to HT animals. In addition, LT minipigs showed increased content of dopamine and its metabolite DOPAC in the substantia nigra and decreased dopamine level in the striatum as well as reduced content of noradrenaline in the hippocampus. Increased mRNA levels of two markers of the serotonin system – TPH2 and HTR7 genes – in the raphe nuclei and in the prefrontal cortex, respectively, were associated in minipigs with a low tolerance to human presence. However, the expression of genes regulating a dopaminergic system (COMT, DRD1, and DRD2) in HT and LT animal groups varied depending on brain structure. In addition, a decrease in the expression of genes encoding BDNF (brain-derived neurotrophic factor) and GDNF (glial cell line-derived neurotrophic factor) was revealed in LT minipigs. The results may contribute to our understanding of the initial stage of domestication in pigs.
A educação médica através das fotopinturas: o legado histórico de conhecimento que permeia gerações em vida
Authors: Macedo Ariane Nascimento , Sena Josias Cardoso de , Mota Ritta Maria Morais Correia
Published: March 2023

A compreensão acerca das descobertas, intervenções e técnicas pioneiras dos professores catedráticos, que ao longo da história fizeram ou fazem parte da trajetória do ensino médico da Faculdade de Medicina da Bahia (FMB), da Universidade Federal da Bahia (UFBA), figura como divisor de águas para o entendimento da cronologia da medicina e como ponto de inflexão para novas perspectivas. A partir das imagens das fotopinturas dos professores catedráticos da FMB, que integram o acervo do Memorial da Medicina Brasileira (MMB), são realizadas pesquisas virtuais em publicações biográficas e acadêmicas. Com categorização por ano, disciplina exercida, cadeira ocupada, área médica de atuação e contribuições notáveis, para a produção de dossiês. A catalogação está em andamento, com o quantitativo de pinturas em cada sala do acervo contabilizado, algumas intervenções e contribuições documentadas em dossiês no site da instituição. O levantamento da estilística da moldura e pintura, autoria de cada obra e pesquisas em fonte primária, no arquivo da institucional, sobre a pessoa fotopintada estão previstas como etapa futura em decorrência da pandemia de COVID-19.
Brain abscess nocardiosis: case report
Authors: Medeiros Erika Sielfeld de , Cruvinel Heloísa Resende , Rocha Antônio José da , Lancellotti Carmen Lucia Penteado
Published: March 2023

Nocardiosis is an infection caused by Nocardia species, that are filamentous aerobic Gram-positive bacilli that belong to Actinomycetaceae family, it can cause a localized or a disseminated infection. Pulmonary disease is the most common presentation of nocardiosis in immunosuppressed patients and approximately one-third have a disseminated disease, that happens when lesions are found at two or more locations in the body. Nocardial brain abscesses are a rare central nervous system infection but has been highlighted as a differential diagnosis of brain tumors, due to the increase of the infection in deficient cell-mediated immunity patients. Even though nocardiosis represents only 2% of brain abscesses, it is an illness associated with significant mortality, present on 75% to 90% of cases. We present a case of central nervous system nocardiosis in a 59-year-old patient with a previous history of diabetes mellitus and alcoholic liver disease. The patient sought the emergency department with temporal occipital headache and mental confusion for 3 days. Imaging tests were performed that showed an oval lesion in the temporoparietooccipital region. Nocardiosis in the central nervous system was hypothesized and treatment was initiated. Despite medical support, the patient died. The lesion material was collected in which nocardiosis was diagnosed when analyzed histochemically.
Modelo de treinamento cadavérico de baixo custo em videolaparoscopia sem pneumoperitônio
Authors: Suartz Caio Vinícius , Brito Pedro Henrique , Abdalla Ricardo Zugaib , Mendes Cristiano Gomes , Mitre Anuar Ibrahim , Nahas William Carlos
Published: March 2023

A laparoscopia consiste em acesso cirúrgico realizado por meio de diminutas incisões na parede abdominal seguidas de estabelecimento de pneumoperitônio, representando um avanço na recuperação pós-operatória em relação a cirurgia aberta. Modelos de treinamento em cirurgia videolaparoscópica utilizando de modelos inanimados, animados e envolvendo uso de realidade virtual (RV) foram desenvolvidos para facilitar a curva de aprendizado. Esses modelos procuram permitir aos cirurgiões em treinamento adquirir competências básicas em laparoscopia, tais como a coordenação mão-olho, destreza na utilização das pinças e melhora da percepção de profundidade na imagem bidimensional (2D). Os elevados custos dos modelos de treinamento têm levado instituições e cirurgiões a procurarem modelos menos onerosos, tais como caixa de treinamento e simuladores de RV. No entanto, não oferecem a mesma experiência de aprendizado que o treinamento VLP em porcos ou em cadáveres. Os custos para realização do pneumoperitônio e para utilização de equipamentos do set de vídeo são elevados. Buscando reduzir esses custos e a complexidade do treinamento VLP em cadáveres, desenvolveu-se um modelo de polietileno sem a necessidade de estabelecimento de pneumoperitônio.
Análise do perfil epidemiológico das hospitalizações por veias varicosas das extremidades inferiores de 2018 a 2022: uma visão quantitativa e comparativa no Brasil
Authors: Macedo Ariane Nascimento , Lopes Cícero Fidelis
Published: March 2023

A relevância clínica, cirúrgica e socioeconômica das veias varicosas de membros inferiores, configura-se como ponto de ressonância para a investigação desse acometimento com amplo impacto para o paciente e a sociedade. O estudo visa traçar o perfil epidemiológico das internações por essa patologia venosa através de uma análise quantitativa e comparativa entre as cinco regiões brasileiras. A partir da consulta ao DATASUS, de janeiro de 2018 a maio de 2022 foram analisados CID-10, raça/cor, sexo, idade, número, caráter, valor total das internações e média de permanência. O número total de internações foi maior para o sexo feminino com 151011 hospitalizações. Na faixa etária de 50 a 59 anos, para o sexo feminino com 44070 internamentos. A raça/cor branca, no sexo feminino, possui um maior quantitativo de internamentos com 25570 hospitalizações. A região Sudeste concentra 57,14 % do número total de internamentos e detém a maior parte dos valores totais de internação. A região Nordeste apresentou elevadas médias de permanência, no caráter urgência, acima de 12; 12; 10; 8 e 6, no sexo feminino, e os valores acima de 18; 14; 14; 10 e 10, no sexo masculino, de 2018 a 2022 respectivamente.
Anxiety and hope: a study about the caregiver overload in the care of patients with stroke
Authors: Murayama Luis Henrique Vallesquino , Meirelles Havy Alexssander Abrami , Sampaio Natalie Carlos Ferreira Mello , Moreira Bruno Zanluqui , Sampaio Raul Pansardis , Cotrim Renan Macionil , Bazan Rodrigo
Published: March 2023

Stroke involves injury to the central nervous system, presenting most frequently as cerebral infarction and intracerebral hemorrhage. It’s an important cause of disability worldwide, being associated with high burden to the patients’ caregivers, who are, frequently, family members. In that matter, it is reported that the main caregivers of stroke patients have the same, or even greater incidence of mental illnesses, such as depression and anxiety. Therefore, we present this study protocol aiming to observe the association between the patient’s type of stroke along with the severity of their sequelae, and the levels of anxiety and hope of their caregivers, in a descriptive, cross-sectional study with a quali-quantitative approach. For that purpose, patients of both sexes, over 18 years of age, who have had a stroke and are being followed up at the Cerebrovascular Diseases Ambulatory will be randomly selected. Then, data will be collected from the caregiver through questionnaires: Zarit Burden Interview (ZBI), Beck Hopelessness Scale (BHS), Beck Anxiety Inventory (BAI) and a socioeconomic questionnaire. The ZBI analyzes psychological, financial, social and physical aspects of the caregiver’s universe, while the BAI and BHS are used to quantify the caregiver’s anxiety state, and bring information about the individual’s hope and life expectations. Information about the patient will be obtained from medical records. Finally, we hope to find useful information for health services about the reality in which they are inserted, in order to promote the creation of disease prevention measures, which is essential to improve the quality of healthcare provided.
Além da tela: a Itália através do cinema na sala de aula remota da Rede Andifes - ISF
Authors: Caramori Alessandra Paola , Araujo Marlon da Fonseca Misceno de , Mello Suélen Najara de
Published: March 2023

Em tempos pandêmicos e de ensino remoto, fomos chamados a unir forças para enfrentar incertezas e assim (res)surgem nas Universidades Federal de Santa Maria (UFSM) e Federal de Viçosa (UFV), fomentadas pela Embaixada Italiana e integrantes da Rede Andifes - IsF, os cursos Pomeriggio al cinema e Serata al cinema, buscando olhares plurais para o contexto de aprendizado da língua italiana. Ao revisitar temas como o fascismo, a guerra, a máfia, as eleições, as minorias e as políticas linguísticas, oportunizou-se aos alunos um espaço para reflexão sobre temas sociais não somente nos filmes, mas também em sua própria realidade. Para a realização dessas aulas on-line, ao longo de 2020 e 2021, foram escolhidas produções cinematográficas que mobilizassem diferentes reflexões; dentre essas, destacam-se as selecionadas para o Ciclo 4, em que foram abordadas questões históricas, políticas e sociais do contexto italiano ao trabalhar os filmes Parenti Serpenti (1992), Metti la nonna in freezer (2018), Rosso come il cielo (2006) e Nuovo Cinema Paradiso (1988). Como pudemos observar ao final das atividades, as discussões sobre temas sociais suscitadas a partir das temáticas abordadas em cada filme aplicavam-se tanto à realidade e contexto italiano, quanto ao brasileiro. Partindo do pressuposto de que o professor é um importante agente colaborador e formador do pensamento crítico, social e político, este artigo relata experiências de reflexão suscitadas a partir de temas sociais recortados de alguns filmes italianos e as contribuições para favorecer a criticidade no ensinoaprendizagem de línguas.
Bronchial Safety After Pulsed Field Ablation for Paroxysmal Atrial Fibrillation
Authors: Füting Anna , Reinsch Nico , Brokkaar Lenny , Hartl Stefan , Höwel Dennis , Essling Anika , Bell John , Rausch Eva , Neven Kars
Published: March 2023

Background:

Thermal left atrial ablation can cause bronchial damage. Pulsed field ablation (PFA) is a novel, nonthermal ablation modality for paroxysmal atrial fibrillation. We report on bronchial effects after pulmonary vein isolation using PFA for paroxysmal atrial fibrillation.

Methods:

A computed tomography scan showing the respiratory tract adjacent to the left atrial was obtained. Oral anticoagulation was interrupted on procedure day. Peri-procedurally, patients received heparin with an activated clotting time goal of >350 seconds. All pulmonary veins were individually isolated with a 13F steerable sheath and a pentaspline PFA catheter using either a straight-tip or J-tip guide wire. The J-tip guide wire patients were added to test the hypothesis that the straight-tip guidewire was associated with bleeding complications. One day afterward, bronchoscopy was performed. Serial hemoglobin levels were measured during 30-day follow-up.

Results:

In 2 series of 30 patients, PFA was performed, with all pulmonary veins acutely isolated. Clinical course was uneventful, no patient had chest discomfort, coughing, or hemoptysis. All patients underwent uncomplicated bronchoscopy, without thermal lesions or ulcers. In 12 out of 30 (40%) straight-tip guide wire patients, small amounts of old blood without active bleeding were seen in multiple segments. All hemoglobin levels remained clinically stable. At 30-day follow-up, all patients were asymptomatic.

Conclusions:

Pulmonary vein isolation using PFA for paroxysmal atrial fibrillation does not cause thermal lesions in the bronchial system. Use of a straight-tip, extrastiff guide wire for the over-the-wire PFA catheter can lead to asymptomatic bleeding in the bronchial system without clinical relevance at 30-day follow-up, opposite to use of a J-tip guide wire.
Pharmacology and Clinical Development of Factor XI Inhibitors
Authors: Greco Antonio , Laudani Claudio , Spagnolo Marco , Agnello Federica , Faro Denise Cristiana , Finocchiaro Simone , Legnazzi Marco , Mauro Maria Sara , Mazzone Placido Maria , Occhipinti Giovanni , Rochira Carla , Scalia Lorenzo , Capodanno Davide
Published: March 2023

Therapeutic anticoagulation is indicated for a variety of circumstances and conditions in several fields of medicine to prevent or treat venous and arterial thromboembolism. According to the different mechanisms of action, the available parenteral and oral anticoagulant drugs share the common principle of hampering or blocking key steps of the coagulation cascade, which unavoidably comes at the price of an increased propensity to bleed. Hemorrhagic complications affect patient prognosis both directly and indirectly (ie, by preventing the adoption of an effective antithrombotic strategy). Inhibition of factor XI (FXI) has emerged as a strategy with the potential to uncouple the pharmacological effect and the adverse events of anticoagulant therapy. This observation is based on the differential contribution of FXI to thrombus amplification, in which it plays a major role, and hemostasis, in which it plays an ancillary role in final clot consolidation. Several agents were developed to inhibit FXI at different stages (ie, suppressing biosynthesis, preventing zymogen activation, or impeding the biological action of the active form), including antisense oligonucleotides, monoclonal antibodies, small synthetic molecules, natural peptides, and aptamers. Phase 2 studies of different classes of FXI inhibitors in orthopedic surgery suggested that dose-dependent reductions in thrombotic complications are not paralleled by dose-dependent increases in bleeding compared with low-molecular-weight heparin. Likewise, the FXI inhibitor asundexian was associated with lower rates of bleeding compared with the activated factor X inhibitor apixaban in patients with atrial fibrillation, although no evidence of a therapeutic effect on stroke prevention is available so far. FXI inhibition could also be appealing for patients with other conditions, including end-stage renal disease, noncardioembolic stroke, or acute myocardial infarction, for which other phase 2 studies have been conducted. The balance between thromboprophylaxis and bleeding achieved by FXI inhibitors needs confirmation in large-scale phase 3 clinical trials powered for clinical end points. Several of such trials are ongoing or planned to define the role of FXI inhibitors in clinical practice and to clarify which FXI inhibitor may be most suited for each clinical indication. This article reviews the rationale, pharmacology, results of medium or small phase 2 studies, and future perspectives of drugs inhibiting FXI.
The identity of the freshwater crab Aiyunamon tumidum (Wood-Mason, 1871) (Brachyura, Potamidae), with description of a new species from China
Authors: Pan Da , Sun Hongying , Ng Peter K. L.
Published: March 2023

The identity of the freshwater crab, Aiyunamon tumidum (Wood-Mason, 1871), is clarified after the types are re-examined. The type series is mixed and includes specimens of two species. A syntype from Ponsee in Yunnan, P.R. China, is designated the lectotype of the species; those from Hotha in Yunnan are now referred to A. daiae (Zhang & Sun, in Zhang, Pan, Hao & Sun, 2020). Specimens which have previously been referred to as “A. tumidum” from other parts of Yunnan are here identified as a new species, Aiyunamon fatum sp. nov.. Aiyunamon fatum is most easily distinguished from congeners by the structure of the male first gonopod.
Benjamin Ferencz and the Treatment of Victims in International Criminal Law: Mapping Out Lex Lata and Lex Ferenda (Ferencza?) in an Emerging Field
Authors: Gordon Gregory S.
Published: March 2023

This piece examines a hitherto underexplored legal history chapter in international criminal law pioneer Benjamin Ferencz’s career, and, based on that, offers fixes for problems in current atrocity victim law. Known primarily for his Nuremberg prosecutorial exploits, Ferencz actually spent most of his career innovatively seeking reparations for Holocaust survivors and then later, with the benefit of such experience, sought to ensure coverage of victims in the International Criminal Court’s Rome Statute. After examining this history, the article maps Ferencz’s trailblazing practices onto the atrocity victim lex lata. It then considers that law’s deficits, including front-end and back-end problems (i.e., at the investigation and early release application phases), International Criminal Court retributive versus reparative mission dissonance, inadequate funding, hindrances to proactive victim participation and victim exclusion in prosecuting aggression. For each problem, Ferencz’s history offers viable solutions, such as victim-oriented investigations, bifurcated retribution/restitution processes, bilateral treaty funding, transnational victim networking, and charging illegal use of force as crimes against humanity. As a result, perhaps such proposed modifications of the framework should not be called lex ferenda, but rather ‘lex ferencza.’
Ekklēsia: Contending for Church as ‘People’
Authors: Zarns Phil
Published: March 2023

This article investigates the presumed identity of the present-day Church while seeking parity in terms and meaning with the identity of the early church. The phrase, ‘The church is not a building; the people are the church’, displays the existence of multiple perceived identities of what/who is known as the church within Western culture. New Testament Scripture best defines the church of Jesus Christ as a gathering of believers, not an inert structure. English-speaking contexts utilize church to describe both a community in relationship to God and owned real estate. Identity confusion about what/who the church is affects the perceived agency of the community of faith. This research then proposes cues to define and retain a nt scriptural identity of the church amidst contemporary cultural influence.
On the power of the complaint and the complaints of the disempowered
Authors: Tickoo Asha
Published: March 2023

The objective of this paper is to examine how Chinese learners of EFL frame their complaints on English language learning (ELL) to understand their sense of entitlement to complain. Two basic complaint-frames are identified—complaint proper (Cp), which communicates entitlement in blaming and asking for correction of what is intrinsically correctable, and lament (Lt), which conveys the lack thereof by simply ‘lamenting’ something that cannot be solved. Though Cp and Lt appear, therefore, tied to specific concern-kinds, the inherently addressable and unaddressable, respectively, their actual use depends on the perception of the complaint-concern and the relative power of the complainant. When Cp is selected, subordinate status may require diminished expression of entitlement. This is not achieved by mitigating face-threat. Rather, it is necessary to modify the complaint-framing by selecting more, rather than less, Lt-defining features. Applied to complaints on ELL, in the Chinese context, it is found that this inherently Cp-appropriate, patently addressable problem is only, and always, used with mitigation and/or ‘Lt-ization’ to convey deference and/or disentitlement. In the vast majority, students address limitations in program implementation—in authentic language use, and the opportunity for individual thought, creativity and self-determination—in complaints that suggest disaffection and disenfranchisement.
Off-Vertical Body Orientation Delays the Perceived Onset of Visual Motion
Authors: Chung William , Barnett-Cowan Michael
Published: March 2023

The integration of vestibular, visual and body cues is a fundamental process in the perception of self-motion and is commonly experienced in an upright posture. However, when the body is tilted in an off-vertical orientation these signals are no longer aligned relative to the influence of gravity. In this study, the perceived timing of visual motion was examined in the presence of sensory conflict introduced by manipulating the orientation of the body, generating a mismatch between body and vestibular cues due to gravity and creating an ambiguous vestibular signal of either head tilt or translation. In a series of temporal-order judgment tasks, participants reported the perceived onset of a visual scene simulating rotation around the yaw axis presented in virtual reality with a paired auditory tone while in an upright, supine and side-recumbent body position. The results revealed that the perceived onset of visual motion was further delayed from zero (i.e., true simultaneity between visual onset and a reference auditory tone) by approximately an additional 30 ms when viewed in a supine or side-recumbent orientation compared to an upright posture. There were also no significant differences in the timing estimates of the visual motion between all the non-upright orientations. This indicates that the perceived timing of visual motion is negatively impacted by the presence of conflict in the vestibular and body signals due to the direction of gravity and body orientation, even when the mismatch is not in the direct plane of the axis of rotation.
A semi-thin section technique-based approach to quantify the xylem secondary cell wall deposition process
Authors: Liu Tong-Yan , Ji Chengjun , Tang Zhiyao
Published: March 2023

Identification of wood formation, cell wall deposition, lignification, and the maturation process contribute to a better understanding of biomass accumulation processes. Traditional methods for studying xylem development are limited by dyeing effects and discrimination experience, are non-quantitative for the degree of cell wall deposition and lignification, or are unsuitable for broad-leaved trees. In this study, we integrated several already existing methods to improve the discriminative accuracy of the cell development stage and to quantitatively describe the cell wall deposition and lignification degree for both softwood and hardwood tree species. To do this, we collected tree microcores every 7–14 days during a growing season for two species, one conifer (Platycladus orientalis) and one broad-leaved tree (Acer truncatum), in the mountainous areas in Beijing, China. We tracked the xylem development using semi-thin section technology combined with polarization microscopy. This integrated approach allows a quantitative description of the xylem cell wall deposition and lignification process of both hardwood and softwood tree species. This approach can be applied to demonstrate the dynamic process between the cambium layer and the production of wood cells and to describe the cell wall deposition and lignification process of wood cells from generation to maturation. This approach has certain application prospects for exploring scientific issues related to wood formation and accumulation processes in forestry and ecological studies.