bluuebunny/crossref_metadata_2025 huggingface dataset:
VIBRATION-ASSISTED TURNING SIMULATION WITH TEXTURED TOOLS: A NUMERICAL INVESTIGATION
Authors: ROY RIMA SINGHA , MAITY KALIPADA
Published: July 2023

In this study, through numerical simulation, an effort has been made to acknowledge the efficiency of machining Titanium grade 23 under vibration assistance with textured cutting tools. Dry turning experiments with commercially available carbide inserts without texturing were carried out without vibration assistance. Cutting forces ([Formula: see text][Formula: see text], [Formula: see text][Formula: see text], [Formula: see text][Formula: see text]) were observed during experimentation, which were further validated using DEFORM 3D. The forces were validated using DEFORM 3D. Closer to the cutting edge, dimple type 1, dimple type 2, horizontal, and vertical patterns were made on cutting inserts using SOLIDWORKS software. A numerical model based on experimentation was developed employing DEFORM 3D software for conventional and vibration-assisted turning. Cutting forces ([Formula: see text][Formula: see text], [Formula: see text][Formula: see text], [Formula: see text][Formula: see text]), cutting temperature, tool wear, and the mechanism of chip formation were also explored through FEM investigation. Micro-textured inserts were found to be enhancing machinability. Machining with vibration assistance also improved machinability. The study found that textured tools improved machinability in conventional and vibration-assisted machining modes. The effect of textured tools on machinability improved with vibration-assisted machining. The numerical analysis revealed that dimple type 1 and vertical grooved tool improved the machinability of Titanium grade 23.
MICROSTRUCTURAL ANALYSIS AND MECHANICAL PROPERTIES OF THREE-LAYERED STACK OF FSAM AA7075-CU ALLOYS
Authors: NALLUSAMY M. , SURIYAPRAKASH M. , KIRAN K. , JAYACHITRA M.
Published: July 2023

Friction Stir Additive Manufacturing (FSAM) is a novel solid-state technique which is performed on the basis of Friction Stir Welding (FSW) process. Compared with conventional fusion welding, FSW overcomes welding defects when it is used for joining dissimilar metals. In this study, Friction Stir Additive Manufactured AA7075-Cu alloy is performed on the principle of FSW by which the materials are not melted during the process. The FSW process is performed on the three-layered stack of alloy combinations of AA7075-Cu alloys. The input process parameters, such as axial load, welding feed and rotational speed at different levels, are considered. The effect of mechanical properties, such as microhardness, Ultimate Tensile Strength (UTS) and % elongation, is observed. The microstructure on the welded nugget zone is obtained using Scanning Electron Microscope (SEM). The microhardness of FSAM AA7075-Cu alloys is significantly increased when compared to the microhardness of AA7075 and Cu alloys. The crystalline structure on the welded nugget zone is observed on the microstructure of FSAM AA7075-Cu alloys from SEM microstructures of parent zone as well as welded zone.
Extended High Convergence Compositions for Solving Nonlinear Equations in Banach Space
Authors: Behl Ramandeep , Argyros Ioannis K.
Published: July 2023

The local as well as the semi-local convergence analysis is provided for two compositions for solving Banach space valued operator nonlinear equations. These compositions are defined on the real line. They were shown to be efficient and of convergence order six. But, the convergence in the local convergence case utilized assumptions reaching the seventh derivative not on the composition. Moreover, no computable error estimates on the distances or uniqueness of the solution regions were provided, limiting the applicability of these compositions. The new convergence analysis is using conditions only on the operators on these compositions. Moreover, computable error estimates and uniqueness results are developed based on [Formula: see text]-continuity and in the more general setting of Banach space valued operators. Numerical applications are presented to validate the theoretical aspects.
Risk Factors, Presentation, and Outcome in Acute Stroke according to Social Position Indicators in Patients Hospitalised in a Referral Centre in Bogotá 2011–2019
Authors: Pantoja-Ruiz Camila , Porto Felipe , Parra-Artunduaga Mauren , Omaña-Alvarez Laura , Coral Juliana , Rosselli Diego
Published: July 2023

Introduction: Treatment of stroke is time-dependent and it challenges patients’ social and demographic context for timely consultation and effective access to reperfusion therapies. Objective: The objective of this study was to relate indicators of social position to cardiovascular risk factors, time of arrival, access to reperfusion therapy, and mortality in the setting of acute stroke. Methods: A retrospective analysis of patients with a diagnosis of ischaemic stroke in a referral hospital in Bogotá was performed. A simple random sample with a 5% margin of error and 95% confidence interval was selected. Patients were characterised according to educational level, place of origin, marital status, occupation, duration of symptoms before consultation, cardiovascular risk factors, access to reperfusion therapy, and mortality during hospitalisation. Results: 558 patients were included with a slight predominance of women. Diagnosis of diabetes was more common in women and smoking in men (n = 68, 28.4% vs. n = 51, 15.9%; p = 0.0004). Rural origin was associated with higher prevalence of hypertension, diabetes, and dyslipidaemia (hypertension n = 45, 73.8% vs. n = 282, 57.4%; p = 0.007; diabetes n = 20, 33.3% vs. 109, 19.5%; p = 0.02; dyslipidaemia n = 19, 32.7% vs. n = 93, 18.9%; p = 0.02). Mortality was higher in rural patients (n = 8, 14.2% vs. n = 30, 6.1%; p = 0.03). Lower schooling was associated with higher frequency of hypertension and dyslipidaemia (hypertension n = 152, 76.0% vs. n = 94, 46.3%; p ≤ 0.0001; dyslipidaemia n = 56, 28% vs. n = 35, 17.0%; p = 0.009) as well as with late consultation (n = 30, 15% vs. n = 59, 28.7%; p = 0.0011) and lower probability of accessing reperfusion therapy (n = 12, 6% vs. n = 45, 22%; p ≤ 0.0001). Formal employment was associated with a visit to the emergency department in less than 3 h (n = 50, 25.2% vs. n = 58, 18%, p = 0.04 and a higher probability of accessing reperfusion therapy (n = 35, 17.6% vs. n = 33, 10.2%; p = 0.01). Finally, living in a household with a stratum higher than 3 was associated with a consultation before 3 h (n = 77, 25.5% vs. n = 39, 15.6%; p = 0.004) and a higher probability of reperfusion therapy (n = 57, 18.9% vs. n = 13, 5.2%; p ≤ 0.0001). Conclusion: Indicators of socio-economic status are related to mortality, consultation time, and access to reperfusion therapy. Mortality and reperfusion therapy are inequitably distributed and, therefore, more attention needs to be directed to the cause of these disparities in order to reduce the access gap in the context of acute stroke in Bogotá.
Development and Validation of a Prediction Model for 30-Day Mortality and Functional Outcome in Patients with Primary Brainstem Hemorrhage
Authors: Cai Chengwei , Yan Chuangnan , Chen Shuxin , Yang Wenpeng , Huang Yiping , Ma Junqiang , Xu Hongwu
Published: July 2023

Introduction: Primary brainstem hemorrhage (PBSH) is the most fatal subtype of intracerebral hemorrhage and is associated with poor prognosis. We aimed to develop a prediction model for predicting 30-day mortality and functional outcome in patients with PBSH. Methods: We reviewed records of 642 consecutive patients with first-time PBSH from three hospitals between 2016 and 2021. Multivariate logistic regression was used to establish a nomogram in a training cohort. Cutoff points of the variables were determined by receiver operating characteristic curve analysis, and certain points were assigned to these predictors to produce the PBSH score. The nomogram and PBSH score were compared with other scoring systems for PBSH. Results: Five independent predictors, comprised of temperature, pupillary light reflex, platelet-to-lymphocyte ratio, Glasgow Coma Scale (GCS) score on admission, and hematoma volume, were incorporated to construct the nomogram. The PBSH score consisted of 4 independent factors with individual points assigned as follows: temperature, ≥38°C (=1 point), <38°C (=0 points); pupillary light reflex, absence (=1 point), presence (=0 points); GCS score 3–4 (=2 points), 5–11 (=1 point), and 12–15 (=0 points); PBSH volume >10 mL (=2 points), 5–10 mL (=1 point), and <5 mL (=0 points). Results showed that the nomogram was discriminative in predicting both 30-day mortality (area under the ROC curve [AUC] of 0.924 in the training cohort, and 0.931 in the validation cohort) and 30-day functional outcome (AUC of 0.887). The PBSH score was discriminative in predicting both 30-day mortality (AUC of 0.923 in the training cohort and 0.923 in the validation cohort) and 30-day functional outcome (AUC of 0.887). The prediction performances of the nomogram and the PBSH score were superior to the intracranial hemorrhage (ICH) score, primary pontine hemorrhage (PPH) score, and new PPH score. Conclusions: We developed and validated two prediction models for 30-day mortality and functional outcome in patients with PBSH. The nomogram and PBSH score could predict 30-day mortality and functional outcome in PBSH patients.
Zugangsbarrieren zur Psychotherapie für Menschen mit Psychosen aus Psychotherapeut_innenperspektive: Eine explorative Studie
Authors: Kullmann Fine , Teismann Tobias , Krause Karen , Friedrich Sören , Margraf Jürgen , Schneider Silvia , Rus-Calafell Mar
Published: July 2023

Hintergrund: In aktuellen deutschsprachigen Leitlinien zur Behandlung von Menschen mit Schizophrenie wird für kognitive Verhaltenstherapie (KVT) die höchste Evidenzstufe angegeben. Jedoch weist vergangene Forschung darauf hin, dass nur ein geringer Teil eine entsprechende Behandlung erhält. Methode: Um Zugangsbarrieren für Menschen mit psychotischen Störungen vonseiten der Psychotherapeut_innen zu identifizieren, wurden in der vorliegenden Studie 215 Psychotherapeut_innen in einer Online-Umfrage unter anderem nach ihren Einschätzungen zur Indikation und Schwierigkeiten in der Bewilligung einer Psychotherapie, ihrer Ausbildung hinsichtlich psychotischer Störungen so­wie Vorschlägen zur Verbesserung der Zugänglichkeit von Psychotherapie für Menschen mit Psychose befragt. Ergebnisse: Als größtes Hindernis wurde unzureichende Ausbildung hinsichtlich der Behandlung von psychotischen Störungen berichtet. Jedoch wird die Bewilligung einer Psychotherapie von einigen Befragten als erschwert eingeschätzt. Diskussion: Die zentralen Verbesserungen, einschließlich aktueller symptomspezifischer KVT-basierter Ansätze zu Wahn oder Halluzinationen, werden als Perspektive zur gezielten Weiterbildung diskutiert.
Blood Biomarkers in the Fetally Growth Restricted and Small for Gestational Age Neonate: Associations with Brain Injury
Authors: Musco Hannah , Beecher Kate , Chand Kirat K. , Colditz Paul B. , Wixey Julie A.
Published: July 2023

Fetal growth restriction (FGR) and small for gestational age (SGA) infants have increased risk of mortality and morbidity. Although both FGR and SGA infants have low birthweights for gestational age, a diagnosis of FGR also requires assessments of umbilical artery Doppler, physiological determinants, neonatal features of malnutrition, and in utero growth retardation. Both FGR and SGA are associated with adverse neurodevelopmental outcomes ranging from learning and behavioral difficulties to cerebral palsy. Up to 50% of FGR, newborns are not diagnosed until around the time of birth, yet this diagnosis lacks further indication of the risk of brain injury or adverse neurodevelopmental outcomes. Blood biomarkers may be a promising tool. Defining blood biomarkers indicating an infant’s risk of brain injury would provide the opportunity for early detection and therefore earlier support. The aim of this review was to summarize the current literature to assist in guiding the future direction for the early detection of adverse brain outcomes in FGR and SGA neonates. The studies investigated potential diagnostic blood biomarkers from cord and neonatal blood or serum from FGR and SGA human neonates. Results were often conflicting with heterogeneity common in the biomarkers examined, timepoints, gestational age, and definitions of FGR and SGA used. Due to these variations, it was difficult to draw strong conclusions from the results. The search for blood biomarkers of brain injury in FGR and SGA neonates should continue as early detection and intervention is critical to improve outcomes for these neonates.
Evaluating Rural Ethiopian Youths’ Willingness and Competency to Promote Literacy Regarding G × E Influences on Podoconiosis
Authors: Ayode Desta , Engdawork Kibur , Moore Renee , Tadele Getnet , Davey Gail , McBride Colleen M.
Published: July 2023

Introduction: Engaging youth as peer educators has yet to be considered to promote literacy concerning conjoint genetic and environmental (G × E) influences on health conditions. Whether youth living in low- and middle-income countries (LMICs) could and would be willing to serve as lay educators of G × E education is unclear. Methods: A cross-sectional survey of youth living in Southern Ethiopia was conducted from August to September 2017. Trained data collectors administered the survey on 377 randomly selected youth who ranged in age from 15 to 24; 52% were female and 95% reported having some formal education. Self-reported willingness and a constructed competency score were assessed. Bivariate analyses tested for factors associated with willingness and competency to serve as lay G × E literacy builders. Results: Competency and willingness were significantly greater (p < 0.05) for youth who were male, had some formal education, and had civic or leadership experience. Differences in median willingness were significant for youth who scored as more competent versus those who scored as less competent (p < 0.001). There were no characteristics that moderated the association of competency with willingness. Conclusion: Youth peer educator programs hold promise for disseminating improved G Χ E literacy and reducing stigma associated with deterministic misunderstandings. Thoughtful recruitment and training strategies will be needed to ensure that the broadest representation of youth in LMIC contexts has the opportunity to serve in this role, particularly girls and those without formal education.
Complete Response to Immunotherapy in a Patient with MUTYH-Associated Polyposis and Gastric Cancer: A Case Report
Authors: Mathias-Machado Maria Cecilia , Peixoto Renata D. , Ashton-Prolla Patricia , Medeiros da Silva Leonard , Dienstmann Rodrigo
Published: July 2023

MUTYH-associated polyposis syndrome is an uncommon, autosomal recessive colorectal polyposis syndrome caused by biallelic inactivation of MUTYH. Most patients present with multiple colorectal polyps. However, other primary tumor sites have been described as less frequent. In this report, we describe the case of a young patient with a germline biallelic pathogenic MUTYH mutation with three different primary tumors. We focused on a metastatic gastric adenocarcinoma that presented with complete bowel obstruction secondary to extensive peritoneal carcinomatosis and achieved complete response upon treatment with immunotherapy. The patient’s tumor presented with a high tumor mutational burden and a 100% combined positive score, which certainly contributed to the complete response to immunotherapy. To date, no studies have described the association of MUTYH-related tumors with high PD-L1 expression, but we hypothesized that it may be linked to the increased antigenicity of these cancers.
Soluble CD14 and Osteoprotegerin Associate with Ankle-Brachial Index as a Measure of Arterial Stiffness in Patients with Mild-to-Moderate Chronic Kidney Disease in a Five-Year Prospective Study
Authors: Sendic Senka , Mansouri Ladan , Hong Mun-Gwan , Schwenk Jochen M , Eriksson Maria J , Hylander Britta , Lundahl Joachim , Jacobson Stefan H
Published: July 2023

Introduction: Vascular lesions and arterial stiffness appear at early stages of chronic kidney disease (CKD) and follow an accelerated course with disease progression, contributing to high cardiovascular mortality. There are limited prospective data on mechanisms contributing to progression of arterial stiffness in mild-to-moderate CKD (stages 2–3). Methods: We applied an affinity proteomics approach to identify candidates of circulating biomarkers with potential impact on vascular lesions in CKD and selected soluble cluster of differentiation 14 (sCD14), angiogenin (ANG), and osteoprotegerin (OPG) for further analysis. We studied their association with ankle-brachial index (ABI) and carotid intima-media thickness, as measures of arteriosclerosis and atherosclerosis, respectively, in 48 patients with CKD stages 2–3, who were prospectively followed and intensively treated for 5 years, and 44 healthy controls. Results: Concentrations of sCD14 (p < 0.001), ANG (p < 0.001), and OPG (p < 0.05) were higher in patients with CKD 2–3 at baseline, and sCD14 (p < 0.001) and ANG (p < 0.001) remained elevated in CKD patients at follow-up. There were positive correlations between ABI and sCD14 levels (r = 0.36, p = 0.01) and between ABI and OPG (r = 0.31, p = 0.03) at 5 years. The changes in sCD14 during follow-up correlated to changes in ABI from baseline to 5 years (r = 0.41, p = 0.004). Conclusion: Elevated levels of circulating sCD14 and OPG in patients with CKD 2–3 were significantly associated with ABI, a measure of arterial stiffness. An increase in sCD14 over time in CKD 2–3 patients was associated with a corresponding increase in ABI. Further studies are needed to examine if early intensive multifactorial medication to align with international treatment targets may influence cardiovascular outcomes.
Long-Term Proton Pump Inhibitor Therapy Increases the Risk of Infection in Patients with Incident Hemodialysis
Authors: Saka Yosuke , Naruse Tomohiko , Chikamatsu Taiki , Mitani Kotaro , Hayashi Mako , Matsumoto Jun , Yosizawa Yuka , Mimura Tetsushi , Takahashi Hiroshi , Watanabe Yuzo
Published: July 2023

Background: Infection is one of the most common causes of death in patients with chronic kidney disease (CKD). Proton pump inhibitors (PPIs) are not only widely used in patients with CKD but also represent a known risk factor for infection in the general population. Here, we investigated associations between PPIs and infection events in patients with incident hemodialysis. Methods: We analyzed data from 485 consecutive patients with CKD who started hemodialysis at our hospital between January 2013 and December 2019. We analyzed associations between infection events and long-term (≥6 months) PPI use before and after propensity score-matched analysis. Results: Of the 485 patients, PPIs were administered to 177 patients (36.5%). During 24 months of follow-up, infection events occurred in 53 patients (29.9%) with PPIs and 40 patients (13.0%) without PPIs (p < 0.001). Patients with PPIs had a significantly higher cumulative incidence rate of infection events than those without PPIs (hazard ratio [HR] 2.13, 95% confidence interval [CI]: 1.36–3.32; p < 0.001). Even after propensity score-matched analysis (132 patients matched in each), the rate of infection events was higher for patients with PPIs (28.8% vs. 12.1%, HR 2.88, 95% CI: 1.61–5.16; p < 0.001). Similar results were obtained for severe infection events in both unmatched (14.1% vs. 4.5%, HR 2.97, 95% CI: 1.47–6.00; p = 0.002) and propensity score-matched analyses (14.4% vs. 3.8%, HR 4.54, 95% CI: 1.85–11.13; p < 0.001). Conclusions: In patients with incident hemodialysis, long-term PPI use increases the risk of infection. Clinicians should be wary of unnecessarily prolonging PPI therapy.
What Is Wrong with the Blood Pressure Target Recommendation of KDIGO 2021 for Hypertension in Chronic Kidney Disease?
Authors: Jamale Tukaram , Kulkarni Manjunath , Keskar Vaibhav
Published: July 2023

Context: Eighty-five percent of patients with chronic kidney disease (CKD) have hypertension, and blood pressure (BP) control is the cornerstone in the management of CKD. Although it is widely accepted that BP should be optimized, BP targets in CKD are not known. Subject of Review: Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guideline for the management of BP in CKD (Kidney Int. 2021 Mar 1;99(3S):S1–87) recommends targeting BP to less than 120 mm Hg systolic for patients with CKD. Second Opinion: KDIGO BP target differs from all other hypertension guidelines. This is also a major change from the previous recommendation which was <140 systolic to all patients with CKD and <130 systolic for those with proteinuria. Targeting systolic BP to less than 120 mm Hg is hard to substantiate based on available data and is based primarily on subgroup analysis of a randomized control trial. Intensive BP lowering as suggested by the guidelines may lead to polypharmacy, added cost burden, and risk of serious harms.
Acute Myeloid Leukemia with NPM1 Mutation and Disseminated Leukemia Cutis: Achievement of Molecular Complete Remission by Venetoclax/Azacitidine Combination in a Very Old Patient
Authors: Niscola Pasquale , Mazzone Carla , Fratoni Stefano , Ardu Nicolina Rita , Cesini Laura , Giovannini Marco , Ottone Tiziana , Anemona Lucia , Voso Maria Teresa , de Fabritiis Paolo
Published: July 2023

We describe a case of acute myeloid leukemia with NPM1 mutation and disseminated leukemia cutis in a very old patient, who achieved a long-lasting response to the azacitidine/venetoclax combination with molecular complete remission, given the potential value of this rarely observed clinical outcome.
Preoperative Magnetic Resonance Imaging Cannot Predict the Presence of a Rare Myoid Gonadal Stromal Testicular Tumor: A Case Report
Authors: Madendere Serdar , Kılıç Mert , Yıldırım Hakan , Ekemen Süheyla , Yıldız Demir Kürşat , Balbay Mevlana Derya
Published: July 2023

Testicular myoid gonadal stromal tumors (MGSTs) are rare neoplasms. While past research has detailed the pathological characteristics of these tumors, the radiological differences between MGST and other types of testicular tumors have not been elucidated. Our study aimed to reveal the possible distinctive features of MGST using magnetic resonance imaging (MRI). We report a 24-year-old patient presenting with a left scrotal mass. During the patient’s preoperative MRI, we observed a testicular tumor measuring 2.5 cm that was consistent with the findings of a seminoma. The serum tumor markers were within the normal range. The T1-weighted MRI revealed a solid mass that was isointense-slightly hyperintense compared to the testicular parenchyma, while the mass appeared homogeneously hypointense on the T2-weighted imaging. The patient was planned to undergo left inguinal orchiectomy with the final pathological diagnosis of MGST. The MGST cannot be distinguished from other testicular tumors with certainty based on any MRI findings. The main tool for diagnosis should be based on the histomorphological characteristics and the immunohistochemical profile of the mass.
Data Preprocessing and Augmentation Improved Visual Field Prediction of Recurrent Neural Network with Multi-Central Datasets
Authors: Park Jeong Rye , Kim Sangil , Kim Taehyeong , Jin Sang Wook , Kim Jung Lim , Shin Jonghoon , Lee Seung Uk , Jang Geunsoo , Hu Yuanmeng , Lee Ji Woong
Published: July 2023

Introduction: The purpose of this study was to determine whether data preprocessing and augmentation could improve visual field (VF) prediction of recurrent neural network (RNN) with multi-central datasets. Methods: This retrospective study collected data from five glaucoma services between June 2004 and January 2021. From an initial dataset of 331,691 VFs, we considered reliable VF tests with fixed intervals. Since the VF monitoring interval is very variable, we applied data augmentation using multiple sets of data for patients with more than eight VFs. We obtained 5,430 VFs from 463 patients and 13,747 VFs from 1,076 patients by setting the fixed test interval to 365 ± 60 days (D = 365) and 180 ± 60 days (D = 180), respectively. Five consecutive VFs were provided to the constructed RNN as input and the 6th VF was compared with the output of the RNN. The performance of the periodic RNN (D = 365) was compared to that of an aperiodic RNN. The performance of the RNN with 6 long- and short-term memory (LSTM) cells (D = 180) was compared with that of the RNN with 5-LSTM cells. To compare the prediction performance, the root mean square error (RMSE) and mean absolute error (MAE) of the total deviation value (TDV) were calculated as accuracy metrics. Results: The performance of the periodic model (D = 365) improved significantly over aperiodic model. Overall prediction error (MAE) was 2.56 ± 0.46 dB versus 3.26 ± 0.41 dB (periodic vs. aperiodic) (p < 0.001). A higher perimetric frequency was better for predicting future VF. The overall prediction error (RMSE) was 3.15 ± 2.29 dB versus 3.42 ± 2.25 dB (D = 180 vs. D = 365). Increasing the number of input VFs improved the performance of VF prediction in D = 180 periodic model (3.15 ± 2.29 dB vs. 3.18 ± 2.34 dB, p < 0.001). The 6-LSTM in the D = 180 periodic model was more robust to worsening of VF reliability and disease severity. The prediction accuracy worsened as the false-negative rate increased and the mean deviation decreased. Conclusion: Data preprocessing with augmentation improved the VF prediction of the RNN model using multi-center datasets. The periodic RNN model predicted the future VF significantly better than the aperiodic RNN model.
How Can Oncoplastic Breast Surgery Contribute to the Management of Locally Advanced Breast Cancer in Sub-Saharan Africa?
Authors: Ali Omar Abdul Hameed , Elhaj Ahmed
Published: July 2023

Background: Because of resource constrains in sub-Saharan African countries, breast-conserving surgery (BCS) has no role in patients with locally advanced breast cancer (LABC) following neoadjuvant chemotherapy (NACT), and mastectomy remains the standard surgical treatment for these patients. Objectives: The first objective of the study was to assess the safety of oncoplastic BCS in patients with LABC who showed good clinical response to NACT in a breast center with enhanced level of resources in Sudan. The second objective was to assess the cosmetic outcome. Patients and Methods: Two hundred and fifty patients with LABC were treated with NACT at Khartoum Breast Care Center during the period 2013–2019. Out of this, 52 patients were surgically treated with oncoplastic breast-conserving surgery. Kaplan-Meier curve was used to calculate the survival rates. The cosmetic outcome was subjectively assessed by the Harris scale. Results: The median follow-up period was 53 months. The 3- and 5-years distant metastasis-free survival rates were 92.9% and 82.2%, respectively. One patient developed regional recurrence, and 6 patients developed distant metastasis. Eighty percentage of patients were admitted to have good to excellent cosmetic outcome. Conclusion: This Sudanese experience showed that oncoplastic BCS is oncologically safe and aesthetically satisfactory in patients with LABC who demonstrated good clinical response to NACT in a setting with enhanced levels of resources for breast cancer care.
Atherosclerosis and Epigenetic Modifications in Chronic Kidney Disease
Authors: Piko Nejc , Bevc Sebastjan , Hojs Radovan , Ekart Robert
Published: July 2023

Chronic kidney disease (CKD) is one of the most common chronic diseases worldwide, with prevalence currently projected at 10% and rising. Cardiovascular disease is the leading cause of morbidity and mortality in CKD patients and is integrally linked with atherogenesis and vascular stiffness. Estimated glomerular filtration rate and the level of proteinuria are not only markers of kidney function but of cardiovascular risk, as well. Despite the efforts, CKD patients still experience excessive cardiovascular burden. MicroRNAs (miRNAs) are small (18–24 nucleotides), single-stranded non-coding RNAs that regulate gene expression by blocking messenger RNA (mRNA) translation and initiating degradation of mRNA. Studies have confirmed the imperative role of miRNA dysregulation in the pathophysiology of several diseases, including atherosclerosis and CKD. This article summarizes what is currently known about the role of miRNAs in CKD patients.
Dimple of Venus Is Associated with the Increased Pelvic Incidence Angle and More Sagittally Oriented Facet Joint
Authors: Aytekin Kürşad , Balta Orhan
Published: July 2023

Objectives: The present study aims to investigate whether the dimple of Venus affects the anatomy of spinopelvic junction. Subjects and Methods: Inclusion criteria were having a lumbar MRI examination in the last 1 year, being older than 18 years of age and being able to radiologically evaluate the whole vertebral colon and pelvic girdle. Exclusion criteria were having congenital diseases of the pelvic girdle/hip/vertebral column and history of fracture or previous surgery in the same anatomic regions. The patients’ demographic data and low back pain were noted. At radiological examination, the pelvic incidence angle was measured by lateral lumbar X-ray. The facet joint angle, tropism, facet joint degeneration, intervertebral disc degeneration, and intervertebral disc herniation at the level of L5-S1 were examined on lumbar MRIs. Results: We included 134 male and 236 female patients with a mean age of 47.86 ± 14.50 years and 48.49 ± 13.49 years, respectively. We found that the patients with the dimple of Venus had higher pelvic incidence angle (p < 0.001) and more sagittally oriented facet joint (right facet joint p = 0.017, left facet joint p = 0.001) compared to those without the dimple of Venus. There was no statistically significant relationship between low back pain and the presence of the dimple of Venus. Conclusions: The dimple of Venus affects the anatomy of the spinopelvic junction and is associated with an increased pelvic incidence angle and a more sagittally oriented facet joint angle.
Dietary Iron Restriction Protects against Aneurysm Rupture in a Mouse Model of Intracranial Aneurysm
Authors: Kawakatsu Toru , Kamio Yoshinobu , Makino Hiroshi , Hokamura Kazuya , Imai Ryo , Sugimura Sho , Kimura Tetsuro , Hiramatsu Hisaya , Umemura Kazuo , Hashimoto Tomoki , Kurozumi Kazuhiko
Published: July 2023

Introduction: Iron accumulation in vessel walls induces oxidative stress and inflammation, which can cause cerebrovascular damage, vascular wall degeneration, and intracranial aneurysmal formation, growth, and rupture. Subarachnoid hemorrhage from intracranial aneurysm rupture results in significant morbidity and mortality. This study used a mouse model of intracranial aneurysm to evaluate the effect of dietary iron restriction on aneurysm formation and rupture. Methods: Intracranial aneurysms were induced using deoxycorticosterone acetate-salt-induced hypertension and a single injection of elastase into the cerebrospinal fluid of the basal cistern. Mice were fed an iron-restricted diet (n = 23) or a normal diet (n = 25). Aneurysm rupture was detected by neurological symptoms, while the presence of intracranial aneurysm with subarachnoid hemorrhage was confirmed by post-mortem examination. Results: The aneurysmal rupture rate was significantly lower in iron-restricted diet mice (37%) compared with normal diet mice (76%; p < 0.05). Serum oxidative stress, iron accumulation, macrophage infiltration, and 8-hydroxy-2′-deoxyguanosine in the vascular wall were lower in iron-restricted diet mice (p < 0.01). The areas of iron positivity were similar to the areas of CD68 positivity and 8-hydroxy-2′-deoxyguanosine in both normal diet and iron-restricted diet mouse aneurysms. Conclusions: These findings suggest that iron is involved in intracranial aneurysm rupture via vascular inflammation and oxidative stress. Dietary iron restriction may have a promising role in preventing intracranial aneurysm rupture.
Viral Glomerulopathy
Authors: Deoliveira Margaret , Sikri Hridyesh , Yu Samuel Mon-Wei , He John Cijiang
Published: July 2023

Background: The association between viral infections and glomerular diseases, commonly known as “viral glomerulopathies,” has been described in various clinical scenarios for decades. Despite advancements in diagnostic tools, it remains challenging to establish a causative link fully. Summary: Data from mouse models have substantiated clinical observations and implicate direct viral infection in the pathogenesis of viral glomerulopathy, particularly in human immunodeficiency virus-associated nephropathy. In addition to the traditional concept of direct viral effects on kidneys, other factors such as APOL1 risk alleles can further modify the clinical outcomes or presentations of different viral glomerulopathies. Newly developed antiviral drugs are now applicable to a wider range of patients with lower kidney function and fewer side effects. Key Message: Efforts focusing on vaccines and antiviral treatments have significantly reduced the incidence of viral glomerulopathies. However, the most recent pandemic caused by severe acute respiratory syndrome coronavirus 2 infection complicated by COVID-associated nephropathy illustrates our susceptibility to novel viruses. Ongoing research is pivotal to deciphering the mechanisms behind viral glomerulopathies and discovering therapeutics in a collaborative approach.
Transient Coma and Signs of Encephalopathy Related to 5-Fluorouracil and Carboplatin: A Case Report
Authors: Zupancic Mark , Farrajota Neves da Silva Pedro , Kas Elyas Karam , Friesland Signe , Ellingsen Cederö Thomasine , Gerling Marco
Published: July 2023

Chemotherapy-related encephalopathy is a rare but severe side effect of cancer therapy. Few reports exist on the course of encephalopathy due to 5-fluorouracil (5FU)/carboplatin treatment. Here, we report on a patient in his 70s, who received first-line palliative treatment with carboplatin followed by continuous infusion of 5FU against a metastasized cancer of the base of the tongue. During the first 5FU infusion, the patient developed a coma with sudden onset. In contrast to earlier reports of 5FU-induced encephalopathy, serum ammonium levels were near-normal, despite a slightly increased bilirubin. The electroencephalogram showed signs of general encephalopathy, for which no other probable cause than chemotherapy could be identified. Based on historical reports, the patient’s encephalopathy was likely due to 5FU treatment rather than carboplatin. While initially in a coma with a Glasgow Coma Scale score of three, the patient regained consciousness within 3 days of supportive therapy. This case highlights the potentially benign clinical course of 5FU-induced encephalopathy, characterized by fulminant clinical deterioration and quick recovery. Such a rapid deterioration in a palliative setting can pose a clinical dilemma, where invasive treatments such as intubation must be weighed against a limited prognosis, for which this case may provide guidance.
Unveiling the Burden of Miscoding and Misclassification in Stroke Mortality: Analysis of Multiple Cause-of-Death Data in Mexico
Authors: Cahuana-Hurtado Lucero , Gómez-Dantés Héctor , De la Cruz-Góngora Vanessa , Chiquete Erwin , Cantú-Brito Carlos
Published: July 2023

Background: The prevalence of risk factors for cerebrovascular diseases in Mexico is increasing although stroke mortality declined from 1990 to 2010, without meaningful changes afterward. While improving access to adequate prevention and care could explain this trend, miscoding and misclassification in death certificates need to be assessed to unveil the true burden of stroke in Mexico. Practices in death certification along with the presence of multi-morbidity could contribute to this distortion. Analyses of multiple causes of death could reveal ill-defined stroke deaths, providing a glimpse of this bias. Methods: Cause-of-death information from 4,262,666 death certificates in Mexico from 2009 to 2015, was examined to determine the extent of miscoding and misclassification on the true burden of stroke. Age-standardized mortality rates per 100,000 inhabitants (ASMR) were calculated for stroke as underlying and multiple causes of death, by sex and state. Deaths were classified following international standards as ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and unspecified, which were kept as an independent category to measure miscoding. To approximate misclassification, we compared ASMR under three misclassification scenarios: (1) current (the status quo); (2) moderate, which includes deaths from selected causes mentioning stroke; and (3) high which includes all deaths mentioning stroke. National and subnational data were analyzed to search for geographical patterns. Results: The burden of stroke in Mexico is underreported due to miscoding and misclassification. Miscoding is an important issue since almost 60% of all stroke deaths are registered as unspecified. Multiple cause analysis indicates that stroke ASMR could increase 39.9%–52.9% of the current ASMR under moderate and high misclassification scenarios, respectively. Both problems indicate the need to improve death codification procedures and cause-of-death classification. Conclusions: Miscoding and misclassification lead to underestimation of the burden of stroke in Mexico. Stroke deaths are underreported when other important causes coexist, being diabetes the most frequent.
Role of Vagus Nerve Stimulation in the Treatment of Chronic Pain
Authors: Shao Peiqi , Li Huili , Jiang Jia , Guan Yun , Chen Xueming , Wang Yun
Published: July 2023

Vagus nerve stimulation (VNS) can modulate vagal activity and neuro-immune communication. Human and animal studies have provided growing evidence that VNS can produce analgesic effects in addition to alleviating refractory epilepsy and depression. The vagus nerve (VN) projects to many brain regions related to pain processing, which can be affected by VNS. In addition to neural regulation, the anti-inflammatory property of VNS may also contribute to its pain-inhibitory effects. To date, both invasive and noninvasive VNS devices have been developed, with noninvasive devices including transcutaneous stimulation of auricular VN or carotid VN that are undergoing many clinical trials for chronic pain treatment. This review aimed to provide an update on both preclinical and clinical studies of VNS in the management for chronic pain, including fibromyalgia, abdominal pain, and headaches. We further discuss potential underlying mechanisms for VNS to inhibit chronic pain.
Tandem Triplication 11p15.5-ICR1 (H19/IGF2) Detected by Microarray and Optical Genome Mapping in a Prenatal Beckwith-Wiedemann Case
Authors: Lloveras Elisabet , Pérez Cristina , Mendez Begoña , Martin Susana , Alves Claudia , Reis-Lima Margarida
Published: July 2023

Optical genome mapping (OGM) appears as a new tool for matching standard cytogenetic methods (karyotype and microarray) into a single assay. The chromosomal region 11p15.5 harbours two differentially methylated regions, the imprinting centre regions 1 and 2 (ICR1, ICR2). Disturbances in both regions alter human growth and are associated with two imprinting disorders, Beckwith-Wiedemann (BWS) and Silver-Russell syndromes. Herein, we present a prenatal case with a triplication in 11p15.5, including the H19/IGF2 imprinted region, detected by microarray and OGM. A 30‐year‐old pregnant woman of 17 weeks of gestation was referred for prenatal karyotype and microarray study because of increased nuchal translucency, short femur, megabladder, hyperechogenic bowel, and renal ectasia. Microarray, OGM, and MS-MLPA were performed, and a tandem cis-triplication in 11p15.5 and hypermethylation of the ICR1 region, compatible with BWS was detected. OGM, with its power to detect all classes of structural variants, including copy number variants, at a higher resolution than traditional cytogenetic methods can play a significant role in prenatal care and management as a next-generation cytogenomic tool. This study further supports the hypotheses that the amplification/duplication-triplication of the H19/IGF2 region could be related to BWS if it is of paternal origin.
Research roundup
Authors: Allen Ultan
Published: July 2023

A brief overview of recently published articles on hepatology
Prolonged hypothermic storage of oocytes of the European common frog Rana temporaria in a gas mixture of oxygen and carbon monoxide
Authors: Gagarinskiy Evgeniy , Uteshev Viktor , Fesenko Eugeny
Published: July 2023

The maximum hypothermic storage time of amphibian oocytes is several hours, which is due to the peculiarities of the structure of the cell envelope. The authors of this paper have already demonstrated the possibility of increasing the storage period of unfertilized oocytes of the common frog (Rana temporaria) up to 5–7 days. The aim of the current study was to determine the possibility of using a 6.5 atm gaseous mixture of carbon monoxide and oxygen, for prolonged hypothermic preservation of unfertilized oocytes for 4 to 12 days. After four days, oocytes stored under CO+O2 conditions exhibited fertilization and hatching rates that were 1.6 and 2.2-fold higher than control, respectively. While no oocytes in the control group survived to day twelve, oocytes held under CO +O2 gas exhibited a 39±14% (38 out of 99 oocytes in total) fertilization rate, however only 1±2% (1/99) of those hatched. This approach is promising for the storage of genetic material from female amphibians, particularly in respect to managing and restoring endangered species, but may also be applicable to oocytes of other classes of vertebrates.
Dendrogram of transparent feature importance machine learning statistics to classify associations for heart failure: A reanalysis of a retrospective cohort study of the Medical Information Mart for Intensive Care III (MIMIC-III) database
Authors: Huang Alexander A. , Huang Samuel Y.
Published: July 2023

Background

There is a continual push for developing accurate predictors for Intensive Care Unit (ICU) admitted heart failure (HF) patients and in-hospital mortality.

Objective

The study aimed to utilize transparent machine learning and create hierarchical clustering of key predictors based off of model importance statistics gain, cover, and frequency.

Methods

Inclusion criteria of complete patient information for in-hospital mortality in the ICU with HF from the MIMIC-III database were randomly divided into a training (n = 941, 80%) and test (n = 235, 20%). A grid search was set to find hyperparameters. Machine Learning with XGBoost were used to predict mortality followed by feature importance with Shapely Additive Explanations (SHAP) and hierarchical clustering of model metrics with a dendrogram and heat map.

Results

Of the 1,176 heart failure ICU patients that met inclusion criteria for the study, 558 (47.5%) were males. The mean age was 74.05 (SD = 12.85). XGBoost model had an area under the receiver operator curve of 0.662. The highest overall SHAP explanations were urine output, leukocytes, bicarbonate, and platelets. Average urine output was 1899.28 (SD = 1272.36) mL/day with the hospital mortality group having 1345.97 (SD = 1136.58) mL/day and the group without hospital mortality having 1986.91 (SD = 1271.16) mL/day. The average leukocyte count in the cohort was 10.72 (SD = 5.23) cells per microliter. For the hospital mortality group the leukocyte count was 13.47 (SD = 7.42) cells per microliter and for the group without hospital mortality the leukocyte count was 10.28 (SD = 4.66) cells per microliter. The average bicarbonate value was 26.91 (SD = 5.17) mEq/L. Amongst the group with hospital mortality the average bicarbonate value was 24.00 (SD = 5.42) mEq/L. Amongst the group without hospital mortality the average bicarbonate value was 27.37 (SD = 4.98) mEq/L. The average platelet value was 241.52 platelets per microliter. For the group with hospital mortality the average platelet value was 216.21 platelets per microliter. For the group without hospital mortality the average platelet value was 245.47 platelets per microliter. Cluster 1 of the dendrogram grouped the temperature, platelets, urine output, Saturation of partial pressure of Oxygen (SPO2), Leukocyte count, lymphocyte count, bicarbonate, anion gap, respiratory rate, PCO2, BMI, and age as most similar in having the highest aggregate gain, cover, and frequency metrics.

Conclusion

Machine Learning models that incorporate dendrograms and heat maps can offer additional summaries of model statistics in differentiating factors between in patient ICU mortality in heart failure patients.
Responsiveness to endurance training can be partly explained by the number of favorable single nucleotide polymorphisms an individual possesses
Authors: Chung Henry C. , Keiller Don R. , Swain Patrick M. , Chapman Shaun L. , Roberts Justin D. , Gordon Dan A.
Published: July 2023

Cardiorespiratory fitness is a key component of health-related fitness. It is a necessary focus of improvement, especially for those that have poor fitness and are classed as untrained. However, much research has shown individuals respond differentially to identical training programs, suggesting the involvement of a genetic component in individual exercise responses. Previous research has focused predominantly on a relatively low number of candidate genes and their overall influence on exercise responsiveness. However, examination of gene-specific alleles may provide a greater level of understanding. Accordingly, this study aimed to investigate the associations between cardiorespiratory fitness and an individual’s genotype following a field-based endurance program within a previously untrained population. Participants (age: 29 ± 7 years, height: 175 ± 9 cm, mass: 79 ± 21 kg, body mass index: 26 ± 7 kg/m2) were randomly assigned to either a training (n = 21) or control group (n = 24). The training group completed a periodized running program for 8-weeks (duration: 20-30-minutes per session, intensity: 6–7 Borg Category-Ratio-10 scale rating, frequency: 3 sessions per week). Both groups completed a Cooper 12-minute run test to estimate cardiorespiratory fitness at baseline, mid-study, and post-study. One thousand single nucleotide polymorphisms (SNPs) were assessed via saliva sample collections. Cooper run distance showed a significant improvement (0.23 ± 0.17 km [11.51 ± 9.09%], p < 0.001, ES = 0.48 [95%CI: 0.16–0.32]), following the 8-week program, whilst controls displayed no significant changes (0.03 ± 0.15 km [1.55 ± 6.98%], p = 0.346, ES = 0.08, [95%CI: -0.35–0.95]). A significant portion of the inter-individual variation in Cooper scores could be explained by the number of positive alleles a participant possessed (r = 0.92, R2 = 0.85, p < 0.001). These findings demonstrate the relative influence of key allele variants on an individual’s responsiveness to endurance training.
The place and challenges of Human Rights Impact Assessments in Latin American internet regulatory futures
Authors: Ugarte Ramiro Álvarez
Published: July 2023

Human Rights Impact Assessments (HRIA) have become an important tool of corporate governance in the field of business and human rights and, thus, have been embraced by companies in the ICT sector. This was to an extent predictable: for quite some time now, internet companies have been accused of violating human rights through action or omission. In this context, HRIAs appear as a procedural mechanism that may help them make better decisions and, at least, curb criticism. This article seeks to contribute to inquiries into this development by highlighting the regulatory context in which HRIAs emerged within the ICT sector, the institutional history of the tool, its ambiguous genealogy and the challenges and opportunities for its usage in Latin America.