bluuebunny/crossref_metadata_2025 huggingface dataset:
Suppression of dc‐offset current in ac‐link of dual‐active‐bridge dc‐dc converter based on triple‐phase‐shift optimal control
Authors: Ren Qiang , Ai Sheng , Kang Wei , Jiang Yapeng
Published: April 2023

When dual‐active‐bridge dc‐dc converter (DAB) with energy storage load operates in a wide voltage range and high dynamic condition, the mismatch of primary and secondary side voltages will lead to high current stress and loss, and the dc‐offset current in the high‐frequency ac link will lead to magnetic saturation of magnetic components, which will damage the devices in serious cases. Therefore, aiming at the operation of DAB in a wide voltage range, a triple‐phase‐shift (TPS) optimal control strategy is adopted, and the phase shift angles of the bridges are adjusted according to the voltage ratio, so as to optimize the electrical stress and loss. What is more, the cause and mechanism of dc‐offset current in the ac‐link are analysed. Based on the TPS optimal strategy, the static dc‐offset current is suppressed with the low‐bandwidth detection of the offset current and the dynamic dc‐offset current is suppressed with the planning the current trajectory. A small‐power prototype is built, and the effectiveness of the TPS optimal control and the static and dynamic dc‐offset current suppression is verified.
A redshifted excess in the broad emission lines after the flare of the γ-ray narrow-line Seyfert 1 PKS 2004−447
Authors: Hon W. , Berton M. , Sani E. , Webster R. , Wolf C. , Rojas A. F. , Marziani P. , Kotilainen J. , Congiu E.
Published: April 2023

PKS 2004−447 is a narrow-line Seyfert 1 (NLS1) harbouring a relativistic jet with γ-ray emission. On 2019 October 25, the Fermi-Large Area Telescope captured a γ-ray flare from this source, offering a chance to study the broad-line region (BLR) and jet during such violent events. This can provide insights into the BLR structure and jet interactions, which are important for active galactic nuclei (AGN) and host galaxy co-evolution. We report X-shooter observations of enhancements in the broad line components of Balmer, Paschen, and He I lines seen only during the post-flare and vanishing 1.5 years after. These features are biased redwards up to ∼250 km s−1 and are narrower than the pre-existing broad line profiles. This indicates a connection between the relativistic jet and the BLR of a young AGN, and how γ-ray production can lead to localised addition of broad emission lines.
Dynamic and Polarimetric VLBI imaging with a multiscalar approach
Authors: Müller H. , Lobanov A. P.
Published: April 2023

Context. Due to the limited number of antennas and the limited observation time, an array of antennas in very long baseline interfer-ometry (VLBI) often samples the Fourier domain only very sparsely. Powerful deconvolution algorithms are needed to compute a final image. Multiscale imaging approaches such as DoG-HiT have recently been developed to solve the VLBI imaging problem and show promising performance: they are fast, accurate, unbiased, and automatic.

Aims. We extend the multiscalar imaging approach to polarimetric imaging, to reconstructions of dynamically evolving sources, and finally to dynamic polarimetric reconstructions.

Methods. These extensions (mr-support imaging) utilize a multiscalar approach. The time-averaged Stokes I image was decomposed by a wavelet transform into single subbands. We used the set of statistically significant wavelet coefficients, the multiresolution support (mr-support), computed by DoG-HiT as a prior in a constrained minimization manner; we fitted the single-frame (polarimetric) observables by only varying the coefficients in the multiresolution support.

Results. The Event Horizon Telescope (EHT) is a VLBI array imaging supermassive black holes. We demonstrate on synthetic data that mr-support imaging offers ample regularization and is able to recover simple geometric dynamics at the horizon scale in a typical EHT setup. The approach is relatively lightweight, fast, and largely automatic and data driven. The ngEHT is a planned extension of the EHT designed to recover movies at the event horizon scales of a supermassive black hole. We benchmark the performance of mr-support imaging for the denser ngEHT configuration demonstrating the major improvements the additional ngEHT antennas will bring to dynamic polarimetric reconstructions.

Conclusions. Current and upcoming instruments offer the observational possibility to do polarimetric imaging of dynamically evolving structural patterns with the highest spatial and temporal resolution. State-of-the-art dynamic reconstruction methods can capture this motion with a range of temporal regularizers and priors. With this work, we add an additional simpler regularizer to the list: constraining the reconstruction to the multiresolution support.
The rotation period distribution in the young open cluster NGC 6709
Authors: Cole-Kodikara E. M. , Barnes S. A. , Weingrill J. , Granzer T.
Published: April 2023

Open clusters serve as a useful tool for calibrating models of the relationship between mass, rotation, and age for stars with an outer convection zone due to the homogeneity of the stars within the cluster. Cluster-to-cluster comparisons are essential to determine whether the universality of spin-down relations holds. NGC 6709 is chosen as a more distant representative Pleiades-aged cluster for which no rotation periods of members have previously been obtained. This cluster is at a distance of over 1 kpc and has two red giant members. Isochrones place the age of the cluster at around 150 Myr, or approximately the same age as the Pleiades. Photometry is obtained over a multi-month observing season at the robotic observatory for STELLar Activity (STELLA). After basic processing, point-spread-function (PSF) photometry was derived using DAOPHOT II, and a suite of related software allowed us to create time series of relative magnitude changes for each star. Four time series analysis methods were then applied to these light curves to obtain rotation periods for members stars. We obtain, for the first time, rotation periods for 45 FGK cluster members of NGC 6709. We plot the Gaia DR3 colors of the member stars against their rotation periods and find a slow-rotating sequence with increasing rotation periods toward redder stars and a smaller clump of rapid rotators that have not yet joined this sequence. NGC 6709 has rotation periods very similar to those of another Pleiades-aged open cluster, NGC 2516.
Interaction of solar inertial modes with turbulent convection
Authors: Philidet J. , Gizon L.
Published: April 2023

Context. Inertial modes have been observed on the Sun at low longitudinal wavenumbers. These modes probe the dynamics and structure of the solar convective zone down to the tachocline. While linear analysis allows the complex eigenfrequencies and eigenfunctions of these modes to be computed, it gives no information about their excitation nor about their amplitudes.

Aims. We tested the hypothesis that solar inertial modes are stochastically excited by the turbulent motions entailed by convection. Unlike the acoustic modes, which are excited by vertical turbulent motions, the inertial modes are excited by the radial vorticity of the turbulent field.

Methods. We have developed a theoretical formalism where the turbulent velocity fluctuations provide the mechanical work necessary to excite the modes. The modes are described by means of a 2D linear wave equation with a source term, under the β plane approximation. This wave equation restrained to a spherical surface is relevant for the quasi-toroidal inertial modes that are observed on the Sun. Latitudinal differential rotation is included in the form of a parabolic profile that approximates the solar differential rotation at low and mid latitudes. The turbulent vorticity field underlying the source term is treated as an input to the model and is constrained by observations of the solar surface. The solution to the linear inhomogeneous wave equation is written in terms of a Green function, which is computed numerically.

Results. We obtain synthetic power spectra for the wave’s latitudinal velocity, longitudinal velocity, and radial vorticity, with azimuthal orders between 1 and 20. The synthetic power spectra contain the classical equatorial Rossby modes, as well as a rich spectrum of additional modes. The mode amplitudes are found to be of the same order of magnitude as observed on the Sun (∼1 m s−1). There is a qualitative transition between low and high azimuthal orders: the power spectra for m ≲ 5 show modes that are clearly resolved in frequency space, while the power spectra for m ≳ 5 display regions of excess power that consist of many overlapping modes.

Conclusions. The general agreement between the predicted and observed inertial mode amplitudes supports the assumption of stochastic excitation by turbulent convection. Our work shows that the power spectra are not easily separable into individual modes, thus complicating the interpretation of the observations.
Statistical study of type III bursts and associated HXR emissions
Authors: James Tomin , Vilmer Nicole
Published: April 2023

Context. Flare-accelerated electrons may produce closely temporarily related hard X-ray (HXR) emission while interacting with the dense solar atmosphere and radio type III bursts when propagating from the low corona to the interplanetary medium. The link between these emissions has been studied in previous studies. We present here new results on the correlation between the number and spectrum of HXR-producing electrons and the type III characteristics (flux, starting frequency).

Aims. The aim of this study is to extend the results from previous statistical studies of radio type III bursts and associated HXR emissions: in particular, to determine what kind of correlation, if any, exists between the HXR-emitting electron numbers and the radio flux, as well as whether any correlations between the electron numbers or energy spectra are deduced from associated HXR emissions and type III starting (stopping) frequencies.

Methods. This study is based on thirteen years of data between 2002 and 2014. We shortlisted ≃200 events with a close temporal association between HXR emissions and radio type III bursts in the 450–150 MHz range. We used X-ray flare observations from RHESSI and Fermi/GBM to calculate the number of electrons giving rise to the observed X-ray flux and observations from the Nançay Radioheliograph to calculate the peak radio flux at different frequencies in the 450–150 MHz range. Under the assumption of thick-target emissions, the number of HXR-producing electrons and their energy spectra were computed. The correlation between electron numbers, power-law indices, and the peak radio fluxes at different frequencies were analysed as well as potential correlations between the electron numbers and starting frequency of the radio burst. Bootstrap analysis for the correlation coefficients was performed to quantify the statistical significance of the fit.

Results. The correlation between the number of HXR electrons and the peak flux of the type III emission decreases with increasing frequency. This correlation is larger when considering the electron number above 20 keV rather than the electron number above 10 keV. A weak anti-correlation is also found between the absolute value of the electron spectral index and the peak radio flux at 228 MHz. A rough correlation is found between the HXR-producing electron number above 20 keV and the type III starting frequency. This correlation is smaller if the electron number above 10 keV is considered. All the results are discussed in the framework of results from previous studies and in the context of numerical simulations of bump-in-tail instabilities and subsequent radio emissions.
A possible dwarf galaxy satellite-of-satellite problem in ΛCDM
Authors: Müller Oliver , Heesters Nick , Jerjen Helmut , Anand Gagandeep , Revaz Yves
Published: April 2023

Dark matter clusters on all scales, and it is therefore expected that even substructure should host its own substructure. Using the Extragalactic Distance Database, we searched for dwarf-galaxy satellites of dwarf galaxies, that is, satellite-of-satellite galaxies, corresponding to these substructures of substructure. From investigation of Hubble Space Telescope data for 117 dwarf galaxies, we report the discovery of a previously unknown dwarf galaxy around the ultra-diffuse M96 companion M96-DF6 at 10.2 Mpc in the Leo-I group. We confirm its dwarf-galaxy nature as a stellar overdensity. Modeling its structural parameters with a growth-curve analysis, we find that it is an ultrafaint dwarf galaxy with a luminosity of 1.5 × 105 L⊙, which is 135 times fainter than its host. Based on its close projection to M96-DF6, it is unlikely that their association occurs simply by chance. We compare the luminosity ratio of this and three other known satellite-of-satellite systems with results from two different cosmological sets of ΛCDM simulations. For the observed stellar mass range of the central dwarf galaxies, the simulated dwarfs have a higher luminosity ratio between the central dwarf and its first satellite (≈10 000) than observed (≈100), excluding the Large and Small Magellanic Cloud (LMC/SMC) system. No simulated dwarf analog at these observed stellar masses has the observed luminosity ratio. This cannot be due to missing resolution, because it is the brightest subhalos that are missing. This may indicate that there is a satellite-of-satellite (SoS) problem for ΛCDM in the stellar-mass range between 106 and 108 M⊙, the regime of the classical dwarf galaxies. However, simulated dwarf models at both a lower (< 106 M⊙) and higher (> 108 M⊙) stellar mass have comparable luminosity ratios. For the higher-stellar-mass systems, the LMC/SMC system is reproduced by simulations; for the lower stellar masses, no observed satellite-of-satellite system has been observed to date. More observations and simulations of satellite-of-satellite systems are needed to assess whether the luminosity ratio is at odds with ΛCDM.
The computation of interstellar extinction in photoionized nebulae
Authors: Morisset Christophe , Corradi Romano L. M. , García-Rojas Jorge , Mampaso Antonio , Jones David , Kwitter Karen B. , Magrini Laura , Villaver Eva
Published: April 2023

Context. The proper plasma analysis practice (PPAP) method has been proposed to analyze spectroscopic data of ionized nebulae. The method is based on a coherent and simultaneous determination of the reddening correction and physical conditions in nebulae. The PPAP method’s creators reanalyzed the results of nine of the brightest planetary nebulae in M31. They claim that, if standard values of the physical conditions are used to compute the extinction instead of their proposed method, extinction correction is underestimated by more than 50%, and hence, ionic and elemental abundance determinations, especially the N/O ratio, are incorrect.

Aims. The discrepancies between the two methods are investigated.

Methods. Several tests were performed to assess the accuracy of the non-PPAP results when determining: (i) the interstellar extinction coefficient, (ii) the plasma electron temperature and density, and (iii) the ionic abundances, in particular of singly ionized nitrogen. In the last case, the ionic N+/H+ abundance was recalculated using both Hα and Hβ as the reference H I emissivity.

Results. The analysis shows that the errors introduced by adopting standard values of the plasma conditions are small, within the uncertainties. On the other hand, the interstellar extinction determined using the PPAP method (uncritically making use of all available Paschen and Balmer lines, without considering observational, random and/or systematic effects) is found to be overestimated for five of the nine nebulae considered. This has consequences for the subsequent analysis of the physical and chemical properties of the nebulae and their progenitors. The python notebook used to generate all the results presented in this Letter is publicly available at a GitHub repository.

Conclusions. The initial, non-PPAP results and conclusions are proven valid. Although the PPAP method is, in principle, a recommended practice, we insist that it is equally important to critically assess which H I lines are included in the determination of the interstellar extinction coefficient, and to make sure that physical results are obtained for the non-de-reddened line ratios.
Der Lichen planus des Ösophagus – Eine unterschätzte Erkrankung
Authors: Monasterio Carmen , Decker Annegrit , Schauer Franziska , Büttner Nico , Schmidt Arthur , Schmitt-Gräff Annette , Kreisel Wolfgang
Published: April 2023

Eine Beteiligung des Ösophagus bei der Hauterkrankung Lichen planus wurde erstmals 1982 beschrieben und fast 30 Jahre lang als eine Rarität angesehen. Untersuchungen der letzten 10 Jahre aber zeigen, dass diese Erkrankung weniger selten ist als angenommen. Es ist sogar anzunehmen, dass der ösophageale Lichen planus (Esophageal Lichen planus, ELP) häufiger ist als die Eosinophile Ösophagitis (EoE). Die Ösophagusbeteiligung betrifft meist Frauen im mittleren Alter. Das Hauptsymptom ist eine Dysphagie. Endoskopisch erkennt man in der Speiseröhre eine charakteristische Schleimhautablösung, eine Trachealisierung, und gelegentlich Hyperkeratosen und bei langem Bestehen auch Stenosen. Wegweisend ist die Histologie mit einer subepithelialen Ablösung sowie einem bandförmigen Infiltrat aus T-Lymphozyten, dem Nachweis von apoptotischen Keratinozyten (Civatte Bodies) und Dyskeratosen. Die direkte Immunfluoreszenz zeigt Fibrinogen-Ablagerungen entlang der Basalmembran. Eine etablierte Therapie gibt es bisher nicht. Die Behandlung mit topischen Steroiden ist in ⅔ der Fälle wirksam. Eine Therapie wie beim klassischen Lichen planus scheint unwirksam zu sein. Bei symptomatischen Stenosen kann eine Dilatation indiziert sein. Der ELP reiht sich in die Gruppe der „neuen“ immunologisch vermittelten Erkrankungen des Ösophagus ein.
Methodik und Zuordnungserfolg eines Linkage von Daten klinischer
Krebsregister mit Abrechnungsdaten gesetzlicher Krankenkassen
Authors: Bobeth Christoph , Tol Kees Kleihues-van , Rößler Martin , Bierbaum Veronika , Gerken Michael , Günster Christian , Dröge Patrik , Ruhnke Thomas , Klinkhammer-Schalke Monika , Schmitt Jochen , Schoffer Olaf
Published: April 2023

Hintergrund Das vom Innovationsfonds geförderte Projekt
„Wirksamkeit der Versorgung in onkologischen Zentren“ (WiZen)
ist ein breit angelegtes Projekt zur Erforschung der Wirksamkeit von
Zertifizierungen in der Onkologie. Im Rahmen des Projektes werden bundesweite
Daten der AOKen und Daten Klinischer Krebsregister aus verschiedenen
Bundesländern für die Jahre 2006–2017 verwendet. Zur
Kombination der Stärken beider Datenquellen werden diese für
acht verschiedene Krebsentitäten datenschutzkonform miteinander
verknüpft.

Methoden Das Datenlinkage erfolgte dabei anhand indirekter Identifikatoren
und wurde mittels der Krankenversichertennummer als direktem Identifikator und
Goldstandard validiert. Dies ermöglicht die Quantifizierung von
Potenzial und Qualität verschiedener Linkage-Varianten. Als Kriterien
zur Bewertung der Zuordnungen wurden Sensitivität und Spezifität
sowie Treffergenauigkeit und Treffergüte genutzt. Die durch das Linkage
resultierenden Verteilungen relevanter Variablen wurden anhand der
ursprünglichen Verteilungen in den Einzeldatensätzen
validiert.

Ergebnisse Je nach Kombination indirekter Identifikatoren ergab sich eine
Bandbreite von 22.125 bis 3.092.401 Linkage-Treffern. Eine nahezu perfekte
Verknüpfung der betrachteten Daten konnte durch die Kombination von
Informationen zu Entitätsart, Geburtsdatum, Geschlecht und Postleitzahl
der Personen erreicht werden. Insgesamt wurden mit den genannten Merkmalen
74.586 eineindeutige Verknüpfungen und für die verschiedenen
Entitäten eine mediane Treffergüte von mehr als 98%
erreicht. Die Alters- und Geschlechtsverteilungen der verschiedenen Datenquellen
sowie die verknüpften Sterbedaten wiesen zudem eine hohe
Übereinstimmung auf.

Diskussion und Schlussfolgerung GKV- und Krebsregisterdaten lassen sich
mit hoher interner und externer Validität auf Individualdatenebene
verknüpfen. Die stabile Verknüpfung ermöglicht durch den
simultanen Zugang zu Variablen beider Datensätze („das Beste aus
beiden Welten“) gänzlich neue Analysemöglichkeiten:
Für einzelne Personen stehen nun sowohl Informationen zum UICC-Stadium
der Erkrankung aus den Registern als auch Komorbiditäten aus den
GKV-Daten zur Verfügung. Durch die Verwendung gut verfügbarer
Linkagevariablen und den hohen Verknüpfungserfolg ist das Verfahren
vielversprechend für künftige Linkages in der
Versorgungsforschung.
„Therapeut*innen sind für dieses Handlungsfeld prädestiniert!“ – Betriebliche Gesundheitsförderung
Authors: Mischner Julia
Published: April 2023

Dorothea Bünemann-Geissler, MSc, berät seit Jahren überregional Unternehmen zu betrieblicher Gesundheitsförderung. Sie ist der Meinung, dass Heilmittelerbringende genau die Kompetenzen mitbringen, die dafür nötig sind, und plädiert für mehr Mut, sich dieses Handlungsfeld zu erschließen.
Polytrauma bei Kindern – die Versorgung kleiner Patienten gemeinsam meistern!
Authors: Bittner Sebastian
Published: April 2023

Der folgende Beitrag befasst sich mit der Polytraumaversorgung im Kindesalter und greift die S2k-Leitlinie auf, die Ende 2020 hierzu veröffentlicht wurde. Nach allgemeinen Zahlen und Ursachen zu verunfallten Kindern führt der Artikel kurz über die präklinische hin zur klinischen Versorgung.
„Es geht doch auch um uns als Familie …“ – pflegegeleitete Familieninterventionen im Intensivbereich
Authors: Naef Rahel , Weber Iris , Staudacher Diana , Massarotto Paola , Verweij Lotte
Published: April 2023

Der Intensivaufenthalt einer nahestehenden Person ist für Familien eine Ausnahmesituation. Unter dem Schock der Ereignisse erleben Angehörige Ungewissheit und Angst. Ihr Informationsbedürfnis ist hoch. Gezielte Unterstützung durch eine Family Nurse hat sich als entlastend erwiesen. Für Angehörige ist es eine Schlüsselerfahrung, dass eine Fachperson „ganz für sie da ist“. Auch die hohe fachliche Expertise der Family Nurse schätzen sie sehr.
Nachhaltigkeit im OP – korrelieren Sterilität, Sicherheit und Service auch mit einer ressourcenschonenden Verwendung von Medizinprodukten?
Authors: Egetemeyer Josef , Jacob Sven , Lehmann Ferdinand , Guba Markus , Werner Jens , Börner Nikolaus
Published: April 2023

In Zeiten einer nie da gewesenen Energiekriese gewinnt Nachhaltigkeit zunehmend an Bedeutung. Diese Entwicklung macht auch vor der Medizin und insbesondere vor dem OP nicht halt, da hier
eine wesentliche Menge an Treibhausgasen produziert wird. Aufgrund dieser Entwicklung stellt sich nun die Frage, ob sich Sterilität, Sicherheit und Service mit einer ressourcenschonenden
Verwendung von Medizinprodukten in Einklang zu bringen sind. Ein Ziel muss hierbei sein, Einwegartikel, die einen hohen Grad an Sterilität bieten, durch sicher wieder aufbereitbare
Mehrwegartikel zu ersetzen. Durch steigende Energiekosten sowie Lieferengpässe bietet die Wiederaufbereitung von Produkten für die Klinik zunehmende Unabhängigkeit. Weiterhin verbessert der
Weg hin zu erneuerbaren Energien bei Mehrwegprodukten den Carbon Footprint zusehends. Die gewonnene Unabhängigkeit der Kliniken bietet auch für die Patienten mehr Sicherheit, da die Gefahr
von nicht zur Verfügung stehenden Materialien verringert wird. Neben dem Ziel der zunehmenden Verwendung von Mehrwegartikeln wird auch das Recyceln von Einwegprodukten eine zunehmende Rolle
spielen. Life Cycle Assessments werden hierbei zunehmend die optimale Auswahl an Produkten steuern. Zusammenfassend bieten diese Optionen also die Möglichkeit, die zunehmende Notwendigkeit
von Nachhaltigkeit im OP umzusetzen.
Effect of different Intensity Electrotherapy on Functional Recovery
in Patients with Knee Osteoarthritis
Authors: Fan Zhijiao , Weiguang Gao , Yubao Ma , Shuyan Qie
Published: April 2023

Objective To explore the effects of different-intensity intermediate
frequency therapy on functional recovery of patients with knee
osteoarthritis.

Methods Three-band electromagnetic waves of constant amplitude
intermediate frequency electrotherapy group (Group A), interference
electrotherapy group (Group B) and modulated intermediate frequency
electrotherapy group (Group C) were used to treat knee osteoarthritis (KOA)
patients, 20 min/time, 1 time/day and 5
days/week for four weeks. Other rehabilitation items were performed the
same way. The rehabilitation therapy were evaluated by VAS score, Timed Up and
Go test and balance ability.

Results After 4 weeks of treatment, the treatment effects of the three
groups were all significant compared with the pre-treatment. Among the three
groups, the treatment effect of Group B was better than that of the other two
groups, and there was no significant difference in the treatment effect between
Group A and Group C.

Conclusion According to thee. g.results, it is possible that the
interference current is of a great action depth, and the
"endogenous" low-frequency modulated intermediate frequency
current possesses the advantages of both low and intermediate frequency, so with
the intermediate frequency current getting through the high resistance of skin,
the current effect of the low and intermediate frequency in the deep part of the
human body can be achieved.
LC-MS Analysis of Ginsenosides in Different Parts of Panax quinquefolius and Their Potential for Coronary Disease Improvement
Authors: Zhang Xuanming , Kong Can , Wang Xixin , Hou Hairong , Yu Hongxia , Wang Lizhen , Li Peihai , Li Xiaobin , Zhang Yun , Han Liwen , Liu Kechun
Published: April 2023

Seven main ginsenosides, including ginsenoside Re, ginsenoside Rb1, pseudoginsenoside F11, ginsenoside Rb2, ginsenoside Rb3, ginsenoside Rd, and
ginsenoside F2, were identified by LC-QTOF MS/MS from root, leaf and flower extracts of Panax quinquefolius. These extracts promoted intersegmental vessel growth in a
zebrafish model, indicating their potential cardiovascular health benefits. Network pharmacology analysis was then conducted to reveal the potential mechanisms of ginsenoside activity in the
treatment of coronary artery disease. GO and KEGG enrichment analyses elucidated that G protein-coupled receptors played a critical role in VEGF-mediated signal transduction and that the
molecular pathways associated with ginsenoside activity are involved in neuroactive ligand–receptor interaction, cholesterol metabolism, the cGMP–PKG signaling pathway, etc. Moreover, VEGF,
FGF2, and STAT3 were confirmed as the major targets inducing proliferation of endothelial cells and driving the pro-angiogenic process. Overall, ginsenosides could be potent nutraceutical
agents that act to reduce the risks of cardiovascular disease. Our findings will provide a basis to utilize the whole P. quinquefolius plant in drugs and functional foods.
Antiviral Effect of Natural and Semisynthetic Diterpenoids against Adenovirus Infection in vitro
Authors: Bidart Juan Esteban , Pertino Mariano Walter , Schmeda-Hirschmann Guillermo , Alché Laura Edith , Petrera Erina
Published: April 2023

The emergence and re-emergence of viruses has highlighted the need to develop new broad-spectrum antivirals to mitigate human infections. Pursuing our search for new bioactive plant-derived
molecules, we study several diterpene derivatives synthesized from jatropholones A and B and carnosic acid isolated from Jatropha isabellei and Rosmarinus officinalis,
respectively. Here, we investigate the antiviral effect of the diterpenes against human adenovirus (HAdV-5) that causes several infections for which there is no approved antiviral therapy
yet. Ten compounds are evaluated and none of them present cytotoxicity in A549 cells. Only compounds 2, 5 and 9 inhibit HAdV-5 replication in a concentration-dependent manner, without
virucidal activity, whereas the antiviral action takes place after virus internalization. The expression of viral proteins E1A and Hexon is strongly inhibited by compounds 2 and 5 and, in a
lesser degree, by compound 9. Since compounds 2, 5 and 9 prevent ERK activation, they might exert their antiviral action by interfering in the host cell functions required for virus
replication. Besides, the compounds have an anti-inflammatory profile since they significantly inhibit the levels of IL-6 and IL-8 produced by THP-1 cells infected with HAdV-5 or with an
adenoviral vector. In conclusion, diterpenes 2, 5 and 9 not only exert antiviral activity against adenovirus but also are able to restrain pro-inflammatory cytokines induced by the
virus.
The Feasibility and Impact of a Postresuscitation Care Protocol in the Well Baby Nursery
Authors: Reyes Santos Andy J. , Basta Caroline , Ramones Kristen Allyson , Lozy Tara , Spillane Nicole T.
Published: April 2023

Objective The objective of this study is to determine if a postresuscitation care (PRC) protocol in the well baby nursery (WBN) would improve identification of infants requiring neonatal intensive care unit (NICU) admission.

Study Design This is a retrospective and prospective cohort study of a PRC protocol in 765 WBN admissions after delivery room (DR) resuscitation with continuous positive airway pressure and/or positive pressure ventilation.

Results After protocol initiation, NICU transfers during the birth hospitalization increased significantly (11.17 vs. 16.08%, p < 0.05). There was no difference in incidence of NICU transfer (5.99 vs. 7.29%, pre-PRC vs. PRC, p = 0.47) during the first 4 hours of life during protocol administration. Respiratory distress was the most common indication for NICU transfer in both cohorts (7.90 vs. 11.81%, p = 0.09, pre-PRC vs. PRC). Noninvasive positive pressure and/or high-flow nasal cannula (5.72 vs. 9.55%, p = 0.06, pre-PRC vs. PRC) were routinely administered in the NICU to transferred infants.

Conclusion After apparent recovery from DR resuscitation, WBN admissions experience significant risk of complications requiring NICU transfer, supporting Neonatal Resuscitation Program recommendation for enhanced monitoring. In our study, we demonstrated the feasibility of standardized PRC protocol in the WBN. NICU transfers increased after initiation of a PRC protocol; however, further studies are needed to confirm possible benefits of this PRC protocol in improving identification of infants requiring a higher level of care.

Key Points
Anticoagulant Management and Outcomes in Nontraumatic Intracranial Hemorrhage Complicated by Venous Thromboembolism: A Retrospective Chart Review
Authors: Gorman Johnathon , Candeloro Matteo , Schulman Sam
Published: April 2023

Background There are limited data on anticoagulant management of acute venous thromboembolism (VTE) after spontaneous intracranial hemorrhage (ICH).

Methods We reviewed retrospectively all cases diagnosed with VTE during hospitalization for spontaneous ICH at our center during 15 years. Anticoagulation management outcomes were (1) timing after ICH of anticoagulant initiation for VTE treatment, (2) use of immediate therapeutic dosing or stepwise dose escalation, and (3) the proportion achieving therapeutic dose. Primary clinical effectiveness outcome was recurrent VTE. Primary safety outcome was expanding ICH.

Results We analyzed 103 cases with VTE after 11 days (median; interquartile range [IQR]: 7–22) from the diagnosis of ICH. Forty patients (39%) achieved therapeutic anticoagulation 21.5 days (median; IQR: 14–34 days) from the ICH. Of those, 14 (35%; 14% of total) received immediately therapeutic dose and 26 (65%; 25% of total) had stepwise escalation. Anticoagulation was more aggressive in patients with VTE >14 days after admission versus those with earlier VTE diagnosis. Twenty-two patients (21%) experienced recurrent/progressive VTE—less frequently among patients with treatment escalation within 7 days or with no escalation than with escalation >7 days from the VTE. There were 19 deaths 6 days (median; IQR: 3.5–15) after the index VTE, with significantly higher in-hospital mortality rate among patients without escalation in anticoagulation.

Conclusion Prompt therapeutic anticoagulation for acute VTE seems safe when occurring more than 14 days after spontaneous ICH. For VTE occurring earlier, it might also be safe with therapeutic anticoagulation, but stepwise dose escalation to therapeutic within a 7-day period might be preferable.
Pseudorandomized Testing of a Discharge Medication Alert to Reduce Free-Text Prescribing
Authors: Rabbani Naveed , Ho Milan , Dash Debadutta , Calway Tyler , Morse Keith , Chadwick Whitney
Published: April 2023

Background Pseudorandomized testing can be applied to perform rigorous yet practical evaluations of clinical decision support tools. We apply this methodology to an interruptive alert aimed at reducing free-text prescriptions. Using free-text instead of structured computerized provider order entry elements can cause medication errors and inequity in care by bypassing medication-based clinical decision support tools and hindering automated translation of prescription instructions.

Objective The objective of this study is to evaluate the effectiveness of an interruptive alert at reducing free-text prescriptions via pseudorandomized testing using native electronic health records (EHR) functionality.

Methods Two versions of an EHR alert triggered when a provider attempted to sign a discharge free-text prescription. The visible version displayed an interruptive alert to the user, and a silent version triggered in the background, serving as a control. Providers were assigned to the visible and silent arms based on even/odd EHR provider IDs. The proportion of encounters with a free-text prescription was calculated across the groups. Alert trigger rates were compared in process control charts. Free-text prescriptions were analyzed to identify prescribing patterns.

Results Over the 28-week study period, 143 providers triggered 695 alerts (345 visible and 350 silent). The proportions of encounters with free-text prescriptions were 83% (266/320) and 90% (273/303) in the intervention and control groups, respectively (p = 0.01). For the active alert, median time to action was 31 seconds. Alert trigger rates between groups were similar over time. Ibuprofen, oxycodone, steroid tapers, and oncology-related prescriptions accounted for most free-text prescriptions. A majority of these prescriptions originated from user preference lists.

Conclusion An interruptive alert was associated with a modest reduction in free-text prescriptions. Furthermore, the majority of these prescriptions could have been reproduced using structured order entry fields. Targeting user preference lists shows promise for future intervention.
Synthesis of Natural Products, Carbocycles, and Heterocycles by Hauser–Kraus Annulation
Authors: Namboothiri Irishi N. N. , Sankara Chenikkayala Siva , Gaikwad Shweta Prakash
Published: April 2023

In this Account, we summarize recent developments in Hauser–Kraus (H–K) annulation with respect to syntheses of natural products and other functionalized, fused, or spiro carbocycles and heterocycles. Although the classical H–K annulation occurs between a 1,4-dipolar synthon (a 3-nucleophilic phthalide), and a 1,2-dipolar synthon (a Michael acceptor), alternative modes of annulation, such as [4+4] and [4+1], as well as other reactivities of 3-nucleophilic phthalides that have been reported in recent years, are also covered in this account.

1 Introduction

2 Hauser–Kraus Annulation in Total Syntheses

3 Hauser–Kraus Annulation Methodologies

3.1 [4+2] Annulation

3.2 [4+4] Annulation Followed by Rearrangement

3.3 Michael Addition Followed by E2 Elimination

4 Miscellaneous Reactions

5 Conclusions
“Clinicoradiological Score – Valuable Tool to Assess the Risk of Strangulated Small Bowel Obstruction in Tertiary Care Center”
Authors: Monisha Gunasekaran , Manikanta K. S. , Ranganath Harindranath H.
Published: April 2023

Objectives

Small bowel obstruction accounts for about 3% of the emergency laparotomies, hence there is a need for early recognition of the risk associated with strangulated small bowel obstruction. However, there is no single reliable tool for evaluating the bowel strangulation risk precisely and quickly, hence we sought to assess the specificity and sensitivity of a scoring system named “Clinicoradiological score” as a tool to assess the risk of strangulated small bowel obstruction in tertiary care center for early intervention.

Material and Methods

The study was an observational study conducted on 50 patients with clinical symptoms of small intestinal obstruction, diagnosed by CT and admitted in-patient basis at the general surgery department in the hospitals attached to Bangalore Medical College and Research Institute, Bengaluru from November 2017 to May 2019. In this scoring system, one point was given to each factor which includes pain duration (4 or more days), guarding, leucocyte count at least 10 ×109/L, C-reactive protein 75 mg/L or more, free fluid at least 500 mL (CT criteria), reduced wall contrast enhancement (CT criteria) leading to a maximum score of 6.

Based on standard treatment outcome, patients were grouped into three categories (conservative management, laparotomy without resection and anastomosis, and laparotomy with resection and anastomosis). Data was analyzed by descriptive statistics. The risk factors were compared between three patient groups and Chi-square test used for hypothesis testing. Sensitivity and specificity were evaluated for accuracy of score.

Results

Out of the six factors of Clinicoradiological score, five factors were found to be predictors (p-value <0.01), while history of pain more than 3 days did not have a significant p-value. In our study all 18 patients with score more than 3 had gangrenous changes and underwent resection. The p-value of the score was found to be significant.

Conclusion

Clinicoradiological score has been proved to be a valuable tool in predicting the risk of strangulated small bowel obstruction and ascertained the need for subsequent intestinal resection.
Outcome of Laparostomy as a Treatment Measure for Abdominal Compartment Syndrome: A Retrospective Study
Authors: Kumar Eva Sherin Saravana , Singh Scott Arockia , Sagar Bala Vidhya , Chithambaram Nithila , Jeyasekharan Sabu , Jeyasekharan Devaprasath
Published: April 2023

Objectives

Abdominal compartment syndrome is a life-threatening condition that affects critically ill patients. When pressures inside a fixed cavity of the body increases, ischemia, muscle injury, and organ failure can result.

To assess the benefits and outcomes of laparostomy for abdominal compartment syndrome.

Material and Methods

This retrospective study included patients who underwent a laparostomy procedure as a treatment measure for abdominal compartment syndrome, secondary to different etiologies such as sepsis and major abdominal visceral trauma.

Results

Although there are a few complications such as incisional hernia in the future following a laparostomy, the mortality rate following the procedure is less than < 10%, thus ensuring a good prognosis for patients who present with acute surgical emergencies. It could also be further noted that an early closure by 7 to 14 days had definite beneficial outcomes as compared with delayed closure of more than 14 days. It prevented most long-term complications such as entero-atmospheric fistula formation or granuloma formation, the outcomes of which were further aided by the use of a transparent custom-made polypropylene mesh.

Conclusion

Laparostomy is the gold standard treatment for abdominal compartment syndrome. The use of a custom-made polypropylene mesh has proven to have the least complications in the follow-up period. Incisional hernias are the most common complications documented, followed by entero-atmospheric fistula.
Adalimumab-Induced Isolated Peritoneal Tuberculosis
Authors: Saad Melissa Kyriakos , Ghandour Fatme , Saikaly Elias
Published: April 2023

The therapeutic approach to immune-mediated diseases including Crohn’s disease has dramatically improved with the introduction of immunomodulators such as anti-tumor necrosis factor (TNF). However, its use is not complication-free, and since its introduction, a growing number of opportunistic infections is being reported in patients under treatment despite all preventive measures taken. Herein, we report a case of adalimumab-induced isolated peritoneal tuberculosis.
An Observational Analysis of Mesh Fixation with Minimum Sutures and Its Postoperative Outcomes
Authors: Saini Abhay , Mishra Navneet , Kushwah Priya , Toseef Mohammad , Huda Tanweer
Published: April 2023

Objectives

The history of hernia repair is the history of the surgery itself. The surgical management of inguinal hernia has continuously evolved for 200 years.

This article determines the incidence of recurrence, chronic pain, and complications following open, tension-free Lichtenstein hernioplasty using a minimal stitch approach.

Material and Methods

This was a single-center, hospital-based, prospective observational study. A total of 197 participants with uncomplicated hernias were enrolled. All participants were operated following open, tension-free, minimal stitch Lichtenstein hernioplasty. The duration of follow-up was 6 months.

Results

Thirty-one (15.7%) participants were lost to follow-up, and 154 (78.2%) participants completed the follow-up. Making total of 166 cases (of which 142 were unilateral and 12 were bilateral, counted as 24 individually). Overall, right-sided direct inguinal hernia (30%) was the most common type, followed by right-sided indirect hernia (26%). Most participants (85%) were given three sutures to fix the mesh during open tension-free hernioplasty. The incidence of postoperative complications, including wound infection, hematoma, and seroma, was zero among participants in each group. The incidence of chronic pain and recurrence at 3 and 6 months after the surgery was zero among all participants.

Conclusion

Most patients in this study required three stitches to fix the mesh during hernioplasty. There were zero incidences of chronic pain, recurrence of the hernia, or any postoperative complication among participants. Thus, hernioplasty can be safely and effectively performed with minimal sutures among male patients with either unilateral or bilateral uncomplicated hernia.
Epidemiology and Treatment Outcome of Blast Injuries to the Hand at a Tertiary Hospital of Kashmir Valley, India
Authors: Khurshid Junaid , Bashir Sheikh Adil , Rasool Altaf , Kulkarni Onkar Santosh Kumar
Published: April 2023

Objectives

Blast injuries to hand can have disastrous consequences on account of loss of critical hand functions. This study was conducted to study the epidemiology and outcome of hand blast injuries reporting to emergency department of a tertiary care hospital.

Material and Methods

All the blast injuries to hand admitted at our center between 2016 and 2020 were assessed at the time of injury and at 6 weeks after completion of primary management. The severity of injury and functional outcome was assessed using modified hand injury severity score (HISS) and quick disabilities of the arm, shoulder and hand (QuickDASH) scale, respectively. Descriptive statistics was calculated and correlation between HISS and DASH was assessed using Pearson's correlation coefficient.

Results

A total of 26 cases with a mean age of 23.12 ± 9.1 years were included. The subjects included 25 males and 22 subjects had injury to their dominant hand. The grade of injury was severe in 12 (46.15%) cases followed by moderate in 5 (19.2%) cases and major in 5 (19.2%) cases. The mean HISS score at injury was 67.46 ± 37.6. The mean QuickDASH score at follow-up was 37.24 ± 29.7. QuickDASH score at follow-up had a significant correlation with HISS score at baseline with a Pearson's correlation coefficient of (r = 0.67, p = 0.0012)

Conclusion

Blast injuries to hands are primarily seen in young males with low-grade explosives being the primary source of injury. Dominant hand is most commonly involved with many cases needing revascularization procedures. Higher severity of blast injuries to hand is associated with poor outcome at follow-up.
Extracorporeal Membrane Oxygenation in Intoxication and Overdoses: A Systematic Review
Authors: Maier Sven , Rösner Lisa , Saemann Lars , Sogl Jonas , Beyersdorf Friedhelm , Trummer Georg , Czerny Martin , Benk Christoph
Published: April 2023

Extracorporeal membrane oxygenation (ECMO) has been increasingly applied over recent decades to treat severe cardiogenic shock and acute lung failure and cardiac arrest of various causes. Acute intoxication with therapeutic substances or other chemical substances can cause severe cardiogenic shock or even cardiac arrest. The purpose of this study was to conduct a qualitative systematic review of ECMO use in intoxication and poisoning. We searched the PubMed, Medline, and Web of Science databases from January 1971 to December 2021 and selected appropriate studies according to our inclusion and exclusion criteria to evaluate the role of ECMO in intoxication and poisoning systematically. Survival at hospital discharge was examined to describe the outcome. The search resulted in 365 publications after removing duplicates. In total, 190 full-text articles were assessed for eligibility. A total of 145 articles from 1985 to 2021 were examined in our final qualitative analysis. A total of 539 (100%) patients were included (mean age: 30.9 ± 16.6 years), with a distribution of n = 64 (11.9%) cases with venovenous (vv) ECMO, n = 218 (40.4%) cases with venoarterial (va) ECMO, and n = 257 (47.7%) cases with cardiac arrest and extracorporeal cardiopulmonary resuscitation. Survival at hospital discharge was 61.0% for all patients, 68.8% for vaECMO, 75% for vvECMO, and 50.9% for extracorporeal cardiopulmonary resuscitation. When used and reported, ECMO seems to be a valid tool for adult and pediatric patients suffering intoxication from various pharmaceutical and nonpharmaceutical substances due to a high survival rate at hospital discharge.
MicroRNA-375-3p Alleviates Salicylate-Induced Neuronal Injury by Targeting ELAVL4 in Tinnitus
Authors: Zhu Jingjing , Chen Zhen , Yu Bo , Zhang Lan , Ai Fen
Published: April 2023

Purpose Tinnitus is a phantom perception of sound in the absence of acoustic source. Previous evidence has indicated that miR-375-3p is downregulated in rats with tinnitus in comparison to the controls. Nevertheless, its molecular mechanism underlying tinnitus pathogenesis is unclarified.

Methods SH-SY5Y cells were differentiated into neuronlike cells and stimulated with salicylate to mimic tinnitus in vitro. Immunofluorescence staining was utilized for measuring expression of NR2B (glutamate ionotropic receptor NMDA type subunit 2B). Intracellular reactive oxygen species (ROS) level was determined using DCFH-DA assay kit. Real-time quantitative polymerase chain reaction as well as western blotting was utilized for examining RNA and protein levels. Luciferase reporter assay was implemented for verifying the interaction between miR-375-3p and ELAVL4 (ELAV-like RNA-binding protein 4).

Results Salicylate treatment enhanced levels of NR2B and the early immediate gene ARC as well as ROS production. miR-375-3p was downregulated in salicylate-treated group. Overexpressing miR-375-3p attenuated the effects induced by salicylate in SH-SY5Y cells. miR-375-3p targeted ELAVL4 and upregulating ELAVL4 reversed miR-375-3p upregulation–triggered effects on SH-SY5Y cells under salicylate treatment.

Conclusion miR-375-3p mitigates salicylate-triggered neuronal injury in SH-SY5Y cells by regulating ELAVL4 expression.