bluuebunny/crossref_metadata_2025 huggingface dataset:
Perioperative Risk Factors Predicting Hardware Exposure after Mandibulectomy and Reconstruction
Authors: Spencer Mychael T. , Jones Alexander J. , Mantravadi Avinash V.
Published: January 2024

Background and Hypothesis:Mandibulectomy is often required in the management of tumors, infection, or trauma of the head and neck. Reconstruction of the defect is accomplished via osteocutaneous free flaps and the use of titanium plates for fixation of the bone segments. Postoperative exposure of the mandibular hardware is an unfortunate outcome which results in significant quality of life detriment and often requires substantial revision surgery and reconstruction. We hypothesize that individuals with vasculopathic conditions and other circumstances that contribute to poor wound healing are more likely to experience hardware plate exposure following mandibular reconstruction.
Methods:A single-institution, retrospective cohort study was performed on all adults undergoing mandibulectomy and osteocutaneous free flap reconstruction from 2010-2020. Demographics, patient history, surgical parameters, and follow-up data were collected. Comparisons and logistic regression were used to determine factors associated with postoperative hardware exposure.
Results:The cohort consisted of 134 predominantly white (92.5%) male (65.7%) patients with mean age 58.4±13.0 years, 32 (23.9%) of whom had postoperative plate exposure. Between patients with and without exposure, there were no differences observed in demographics, substance use, surgical indications, or reconstructive techniques, neoadjuvant or adjuvant chemoradiation, nor 30-day major surgical site infection. The comorbidities of peripheral vascular disease, hypothyroidism, and immunosuppression were significantly more common in the plate exposure group. In multivariate logistic regression, peripheral vascular disease (OR [95%CI] = 18.8 [1.8-196.3]), hypothyroidism (OR [95%CI] – 3.5 [1.1-10.6]), and immunosuppression (OR [95%CI] =11.3 [2.4-54.1]) remained significant predictors of post-mandibulectomy hardware exposure.
Conclusion and Potential Impact:Patients with pre-existing peripheral vascular disease, hypothyroidism, and/or immunosuppression have an increased risk of post-mandibulectomy hardware exposure. Understanding these risk factors can improve shared patient-surgeon decision making and counseling, as well as guide practitioners to focus on mitigating these comorbidities prior to surgery.
Electronic Health Record-based Surveillance of Hypertension Prevalence
Authors: Stiles Justin , Dixon Brian E.
Published: January 2024

Background:Public health officials require timely, accurate data to guide decision-making. The Behavioral Risk Factor Surveillance System (BRFSS), a nationwide telephone survey of U.S. adults conducted by the CDC, serves as a primary source for chronic disease prevalence data. However, limitations like small sample sizes and publication delays exist. A promising alternative is Electronic Health Record-based (EHR) surveillance. Under the CDC-funded Multi-state Electronic Health Record-based Network for Disease Surveillance (MENDS) project, the Regenstrief Institute utilizes EHR data from the Indiana Network for Patient Care database to detect hypertension using algorithms based on a combination of blood pressure measurements, diagnostic codes, and antihypertensive prescriptions.
Methods:We compared hypertension prevalence estimates between BRFSS and MENDS using 2015 data from Indiana residents. BRFSS included individuals who positively reported a diagnosis of hypertension or antihypertensive medication use. MENDS included individuals based on clinical diagnosis, abnormal blood pressure readings, and medication history. Gestational hypertension and end-stage renal disease cases were excluded. Equivalence was empirically tested using the two one-sided t-tests (TOST) statistical method.
Results:TOST analysis revealed the two methods were not equivalent overall (p < 0.0001) or in any strata measured. The EHR-based model produced a lower estimate of 18.7% (95% CI ± 7.1 x 10-6, n=10,800,076), while BRFSS produced a higher estimate of 28.4% (95% CI ± 3.8, n=934).
Conclusion:BRFSS might overestimate (i.e., too sensitive) hypertension prevalence due to survey methodology, while the EHR-based model might underestimate (i.e., too specific) due to its more complex hypertension-detection algorithm. Nevertheless, the EHR-based model provides a reliable and more timely method for estimating hypertension prevalence.
Implications:MENDS provides estimates for other chronic disease risk measures such as diabetes, smoking, and obesity. Participating health departments receive updated data each month and can monitor trends. By providing reliable and timely data, public health officials can make well-informed decisions to serve their communities.
Geographic location as a variable to Home Gardening Interventions in Rural Indiana
Authors: Sutton Maggie , Witty Lynn , Meador Catherine , Finch W. Holmes
Published: January 2024

Background/Objective: The purpose of this study was to evaluate attitudes of a wide variety of persons towards barriers to home gardening and desired interventions for home gardening in multiple locations in the Muncie, Indiana area. The health benefits of gardening are well known, but little research has been done evaluating the ability or interest in home gardening in areas with significant populations of minorities or those with low socioeconomic status. Taste enhancing herbs or fresh and nutritious vegetables in food insecure areas could be invaluable. This study evaluates which interventions were preferred and needed based on geographic location in Muncie. Our hypothesis was that respondents from a garden fair in Muncie would be more likely to want more information than respondents from other locations.
Methods: A survey designed for a research study focusing on barriers to home gardening was deemed to be appropriate to use for analysis for this study, because it included several questions about desired and needed interventions. The survey asked respondents to write contact information if follow-up interventions or classes were desired. Cross tabulation was used to analyze the relationship between multiple variables in the survey.
Results: There is a statistically significant relationship between where the person was surveyed and whether they wanted to sign up for more information. 68.8% of respondents at the Minnetrista Garden Fair desired more information, compared to 0% of respondents at the Yorktown Farmer’s Market.
Conclusion: There was in fact a relationship between location surveyed and desire for more information, but this relationship isn’t as simple as location. The type of event and number of people attending the event also likely impacted results. Scientific/Clinical/Policy Impact and Implications: Results from this study will be used in further work to develop gardening related information and programs for those surveyed who wish to participate.
A Comparison of the Effectiveness Between Trabeculectomy and Minimally Invasive Glaucoma Surgeries
Authors: Syed Esa , Cantor Louis
Published: January 2024

Background and Hypothesis: Glaucoma affects 3 million Americans and is the second most common cause of blindness globally, after cataracts. It involves the degeneration of the optic nerve, often associated with increased eye pressure, leading to vision loss. Trabeculectomy was traditionally the standard surgical approach for managing glaucoma progression once medication and laser had failed. Recently, minimally invasive glaucoma surgeries (MIGS) have gained FDA approval for mild and moderate cases and are being implemented in practice. We hypothesize that MIGS procedures are just as effective as trabeculectomy in mild, moderate, and severe cases of glaucoma.
Experimental Design or Project Methods: Using data from IU Health, patients that underwent either a MIGS procedure or a trabeculectomy for open-angle glaucoma at least a year ago were identified. Visual field data was used to stage their glaucoma. Any future glaucoma surgery was noted. Using this information, three separate Kaplan-Meier curves at 95% confidence intervals were created corresponding to each stage of glaucoma with a second surgery defined as a failure and a survival analysis was done to visualize the difference between these surgical approaches.
Results: The sample included 119 patients and 179 eyes with a mean age of 80 and 57% females. The study had 80% power at a two-sided 5% significance level. Based on the survival analysis, there were no significant differences between trabeculectomy and MIGS in mild and moderate glaucoma (p=0.69 and 0.97 respectively). In severe glaucoma, MIGS had a lower failure rate compared to trabeculectomy (p=0.026).
Conclusion and Potential Impact: The research comparing trabeculectomy to MIGS is still relatively new and this study shows the safety and efficacy of MIGS procedures. If confirmed, this study could potentially change the standard of care to MIGS for all stages of open-angle glaucoma.
Validation of Blunting of Inflammatory Markers in LPS Induced Tissue with SPM Treatment
Authors: Delgado Cristina , Robinson Peyton , Khan Khalid , Ramakrishnan Vijay
Published: January 2024

Background and Hypothesis: Chronic rhinosinusitis (CRS) is defined as persistent inflammation of the mucosa of the nose and paranasal sinuses, either with or without nasal polyps. The pathophysiology of CRS is thought to occur due to a dysfunction of the immune response leading to prolonged NF-kB signaling. Many chronic diseases like CRS have been shown to have chronic NF-kB dysregulation. One hypothesis for the persistent inflammation seen in CRS patients is that they have a less robust pro-resolution response that aids in termination of the NF-kB pathway. In this study, we sought to validate our previous results from nasal polyp tissue using qPCR for key inflammatory mediators, CXCL1, CSF3, and myd88.
Methods: Human CRS nasal polyp tissue was collected during functional endoscopic sinus surgery to be grown in cell culture. The nasal polyp tissue was grown in 10 ug/ml of LPS to mimic gram-negative conditions commonly seen in CRS. Tissue cDNA was extracted and frozen at – 80° C. Tissue cDNA for control, RvD2, LPS, and LPS+RvD2 was thawed and used to run qPCR for myd88, CXCL1, and CSF3.
Results: qPCR data was normalized using GAPDH and B-actin. When normalized with GAPDH and B-actin, CSF3 was found to be downregulated with RvD2 exposure, while both myd88 and CXCL1 showed inconsistent results. Downregulation of CSF3 with RvD2 exposure, is consistentwith our hypothesis that RvD2 plays a role in NF-kB resolution.
Conclusion: Downregulation of the NF-kB pathway can play an important role in reducing the chronic inflammation seen in CRS. CSF3 was one gene target of the NF-kB pathway that was continuously found to be downregulated when nasal polyp tissue was treated with RvD2. Ourfindings demonstrate that when nasal polyp tissue is treated with pro-resolving mediators such as RvD2, at least one or more of the NF-kB-associated genes are downregulated.
Health-Related Quality of Life Correlates with Bladder and Bowel Dysfunction: the Need for a New Patient-Centered Questionnaire
Authors: Dillon Hannah , Whittam Benjamin , Rink Richard , Kaefer Martin , Meldrum Kirstan , Roth Joshua , Dangle Pankaj , Meng Yifan , Koehlinger Jeremy , Misseri Rosalia , Szymanski Konrad
Published: January 2024

Background and Hypothesis: Children with voiding dysfunction (VD), such as incontinence or urinary frequency, may report lower quality of life (QOL) compared to their peers. QOL questionnaires which could be used in this population have several limitations. PinQ is a bladder-specific, health-related QOL questionnaire, but it was developed without stakeholder input and fails to separate symptoms from QOL. Kidscreen-10 is a generic QOL questionnaire. We aimed to understand how QOL captured using existing instruments correlates with VD severity in a cross-sectional study. We hypothesized that large differences in symptoms would correspond with large differences in bladder-specific QOL but small differences in generic QOL.
Methods: We recruited children 8-18 years old with VD at a pediatric urology clinic (June-July 2023). VD included daytime incontinence, enuresis, frequency, urgency, and dysuria. We excluded children with severe developmental delay, anatomical urological abnormalities, or history ofurologic surgery. We captured demographics, symptoms (Vancouver Dysfunction Voiding Symptom Score, DVSS), and QOL (PinQ and Kidscreen-10). Questionnaire scores were compared to weighted means from previous studies. We calculated Spearman correlations and QOL differences corresponding with the reported 20-point range of DVSS scores.
Results: Twenty children (11 girls) at a median age of 10 years old participated (Table 1). Mean DVSS score was 14, similar to previous studies (weighted mean: 15). PinQ scores had a moderate positive correlation with DVSS scores (r = 0.37) with a 20-point DVSS difference  corresponding to a 24% difference in PinQ scores (Figure 1). Kidscreen-10 scores had a moderate negative correlation with DVSS scores (r = -0.33) with a 20-point DVSS difference corresponding to a 12% difference in Kidscreen-10 scores (Figure 2).
Conclusions: Previously published QOL questionnaires have significant limitations, limiting their clinical use in the care of patients with VD. A new, patient-centered, highly specific, and sensitive healthrelated QOL questionnaire is needed.
Sex-Based Differences in LPS-induced Rapid Myocardial Dysfunction
Authors: Yoniles Arris , Anjorin Olufisayo , Bhaskara Meghana , Wang Meijing
Published: January 2024

Background: Previous studies have indicated better myocardial responses with preserved cardiac function in female animals compared to males after LPS challenge; however, the mechanisms remain incompletely understood. Our published studies have revealed that TNFa substantially increased in heart tissue and serum following LPS. Females experienced less cardiac dysfunction than males during equivalent dose of TNFa infusion. Therefore, sex-related disparities in myocardial impairment could be due to an indirect/secondary outcome from LPS-induced inflammatory cytokines, like TNFa. To dissect the potential mechanism underlying myocardial reactions between males and females, we aim to determine any sex differences in LPS-caused direct effects on cardiac function using coronary infusion of LPS.
 
Methods: Isolated hearts from aged-matched adult male and female mice were subjected to LPS infusion via Langendorff after >20-min equilibration (Eq), with left ventricular developed pressure (LVDP) continuously recorded. Dose responsive experiments with LPS at 2.5, 5.0, and 7.5 mg/kg of body weight were performed in male hearts. Significant depression of LVDP (>20% drop) after LPS infusion was considered rapid response to LPS. Female estrous cycle was determined via vaginal smear.
 
Results: Male hearts infused with 5.0 and 7.5 mg/kg of LPS demonstrated significant depression of LV function. Males also experienced worse outcomes of LV function than females following 5.0 mg/kg of LPS infusion. A trend of earlier response to LPS occurred in male hearts compared to females. However, there were no significant differences in cardiac function between female groups in different estrous phases.
 
Conclusion and Potential Impact: Our data demonstrates that male hearts exhibit higher sensitivity to LPS-induced rapid cardiac dysfunction compared to females, but estrogen may have little influence on LPS-induced rapid functional depression. The insight from our data can be used to better understand the differences between male and female outcomes to cardiac pathologies and insult.
Clinical Utility of Dupilumab for the Treatment of Eosinophilic Esophagitis in Pediatric Patients
Authors: Becker Alexa , Bose Paroma
Published: January 2024

Background:Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus characterized by symptoms of esophageal dysfunction and 15 or more eosinophils per high-powered field (HPF) on esophageal biopsy. Treatment options for EoE include proton pump inhibitors (PPIs), topical corticosteroids (TCS), dietary elimination, and dupilumab. Dupilumab is monoclonal antibody against IL-4 and IL-13 administered subcutaneously and was granted FDA approval for EoE in adults and adolescents recently in 2022. Outcomes of real-world, clinical use of dupilumab for EoE remains unknown.
Objectives:To observe outcomes in pediatric patients with EoE treated with dupilumab.
Methods:A retrospective cohort study of pediatric patients prescribed dupilumab for EoE was conducted. Medical records were reviewed for demographic and clinical information as well as endoscopic and histologic findings before and after dupilumab treatment.
Results:A total of 28 patients were included (mean age 15y, 71.4% male). Mean baseline maximum eosinophils/HPF was 48 ± 41. 75% of patients were treated with combination therapy of EoE with diet elimination, PPIs, or TCS prior to being prescribed dupilumab. Prior authorization for dupilumab was required in 85.7% of cases. Ten patients had follow-up endoscopy with biopsy after starting dupilumab, and among these patients the mean maximum eosinophils/HPF with dupilumab significantly improved from 44 ± 37 to 13 ± 15 (p=0.027). Among 12 patients who had follow up clinic visits, two patients reported pain or swelling at injection sites, but no otheradverse events were reported
Conclusions:Dupilumab significantly improves histologic findings of EoE and is well tolerated among pediatric patients. We hope for continued monitoring of these patients to understand the clinical utility of dupilumab for EoE over time.
Prevalence of Positive Urine Drug Screen for Fentanyl and its Analogs in Indianapolis
Authors: Beckman Jennifer , Mast Elizabeth , Shepherd David , Zimmerman Michelle K. , Dahal Rejwi
Published: January 2024

Background and Hypothesis: IU Health Pathology Laboratory (IUHPL) recently added qualitative fentanyl screening to its test menu. However, fentanyl screening is not currently part of the urine drugs of abuse (DAU) panel which includes amphetamine, barbiturates,benzodiazepines, buprenorphine, cannabinoids, methadone, cocaine, opiates, oxycodone, and phencyclidine. Since fentanyl screen is a standalone test, we were interested in determining how often specimens had this ordered in conjunction with the DAU, as we suspected not all of them did. Our hypothesis was that positive urine drug screens may also be positive for fentanyl/fentanyl analogs.
Project Methods: Urine specimens sent for routine drug screens at IU Health Arnett, Ball, Bloomington, and IUHPL between June and mid-July 2023 were subjected to fentanyl screening. Specimen that screened positive were confirmed by LC-MS/MS for presence offentanyl and norfentanyl. Additionally, specimens were tested for 4ANPP (fentanyl precursor) and xylazine; if they were positive for either, they were sent to an outside laboratory to ascertain if other fentanyl analogs or designer opioids were present.
Results: Of the 1,893 DAU specimens received, 51.2% were positive for at least one drug class. Only 28 had an associated fentanyl screen order. Cannabinoids represented the most prevalent drug class with a 26.7% positivity rate. Only 1,724 samples were available to screen for fentanyl as part of this study. Of these, 214 specimens were positive for fentanyl, with a positivity screen rate of 12.4%. Confirmatory testing by LC-MS/MS indicated 206 of the 214 were true positives.
Conclusion and Impact: These results highlight the need for fentanyl testing and continued clinician education to increase awareness about the inability of standard urine drug screens to detect fentanyl. Dialogue between patients and clinicians would potentially decrease overdoses and/or result in more treatment referrals. Additionally, integrating fentanyl screening into the DAU panel will facilitate qualitative fentanyl testing.
Comparison of Visual Field Fluctuation Between Myopic and Emmetropic Glaucoma Patients
Authors: Barten Molly , Cantor Louis
Published: January 2024

Background: Conflicting epidemiologic studies suggest that myopia may both increase and decrease the risk of glaucomatous visual field loss. To provide appropriate treatment to glaucoma patients, it is important to detect meaningful changes in the visual field, which requires distinguishing between visual field fluctuation and progression. Visual field fluctuation is defined as the variability between two visual field tests performed on separate days or months on the same eye that cannot be attributed to a pathologic change. We hypothesize that glaucoma patients with myopia will demonstrate more visual field fluctuation compared to emmetropic patients.
Methods: Four or more 24-2 or 30-2 Humphrey visual field tests over several visits will be analyzed per patient. Data including the VFI plot, mean deviation, and threshold sensitivity on the glaucoma progression analysis will be collected to measure fluctuation. The sample is divided into two groups: 1. emmetropic glaucoma patients with a spherical equivalent refraction between +2 to -2 diopters and 2. high myopic glaucoma patients with a spherical equivalent refraction over -5 diopters. Bland-Altman plots, Mann-Whitney U tests, Root Mean Square Error (RMSE), intraclass correlation coefficients, and generalized estimating equation models for ordinal data will be used to analyze the collected data.
Results: Thus far, 2,979 charts have been reviewed with data collected from 27 emmetropes and myopes who met the inclusion criteria. The recruitment goal is 78 per group and 156 total. Preliminary results for RMSE found a statistically significant p-value for mean deviation (0.0320), and no statistically significant difference for threshold sensitivity (0.5179) and VFI (0.0904).
Conclusion and Potential Impact: This ongoing study will help establish if glaucoma patients with high myopia demonstrate greater visual field fluctuation. It is important for clinicians to have this information so that these patients can be examined carefully to prevent misdiagnoses or delayed glaucoma treatment.
Student Perceptions of Two Preclinical Medical School Exam Feedback Approaches
Authors: Gasaway Elsie , O’Loughlin Valerie
Published: January 2024

Background: In medical school, where learning an abundance of information in a short period of time is required, it is necessary that learners receive valuable feedback after summative assessments (i.e., unit exams). First-year medical students at Indiana University School of Medicine (IUSM) begin their education with a course titled Human Structure (HS), followed by Molecules to Cells and Tissues (MCT). Both courses provided different formats for exam feedback, resulting in anecdotal comments about preference and utility of feedback. This study uses qualitative research methods to examine IUSM-Bloomington students’ perceptions of exam feedback formats with respect to their utility and applicability.
Methods: Five, second-year IUSM-Bloomington medical students participated in a focus group to discuss their utilization and perceived usefulness of HS and MCT exam feedback. A thematic analysis was used to interpret data from the focus group. This study was deemed exempt by the IU-IRB (19409).
Results: The thematic analysis revealed that students’ discussions fell into three categories: logistics, utilization, and mentality. These categories were further broken into themes and subthemes, revealing 13 unique codes. Students spent a substantial amount of time discussing logistics of exam feedback. Barriers to utilization of exam feedback included a lack of information provided at the feedback sessions and a lack of time in the schedule available for feedback sessions. Students preferred MCT approach to exam feedback, however they recognized HS course logistics may prevent similar adoption. Students had small suggestions on how to improve feedback in both courses.
Conclusions/Implications: The data suggest students would benefit from small changes in how first-year medical school courses at IUSM provide exam feedback. Improvements could include extending the time of exam review sessions, incorporating a discussion on commonly missed exam concepts, providing answer explanations for incorrect and correct answers, and transitioning statewide reviews to be campus led.
Development of Assistive Devices for Eye Drop Administration in Patients with Cerebral Palsy
Authors: Kluemper Anthony , Hape Kristi , Chlebowski Arthur L.
Published: January 2024

Background:Cerebral Palsy is a non-progressive neurological disorder that affects movement, posture, and muscle coordination, caused by damage to the developing brain. It is one of the most common motor disabilities in childhood, with significant implications for an individual's physical and functional abilities. The severe impact on fine motor control in Cerebral Palsy patients is often most evident when performing actions where precision and accuracy are needed such as applying eye drops. This work addresses the design, development, and deployment of assistive devices for fine motor control of objects.
Methods:Using 3D modeling and printing, three prototypes were created and assessed for their efficacy in assisting patients with eye drop administration based on the needs and abilities of the individual, considering factors such as ease of use, affordability, and adaptability to different environments. After evaluation, changes were made to each prototype in order to better adapt the design according to the feedback received.
Results:Three final products were presented for patient review. Two of these addressed deficiencies of eye drop accuracy and the other fine motor control and bottle manipulation. Patients noted in their final evaluation of the assistive devices improvement in ability to manipulate eye drop bottles as well as better ability to aim the eye dropper for application in comparison to previous methods of application.
Conclusion and Impact:By understanding the challenges faced by the individual and evaluating the need for assistive devices, the fine motor challenges associated with eye drop administration due to cerebral palsy were addressed and three valuable products were created that improved patient autonomy and quality of life. Additionally, these devices could be useful for patients with a variety of motor limitations, enabling self-sufficiency while improving ease and accuracy of administration and minimizing waste.
Mental Health Assessments in Emergency Department Patients: Assessing Longitudinal Follow-up and Retest Reliability (MCAT-2) [Provisional Baseline Analysis]
Authors: Alarcon Andres , Satsangi Naman , Musey Paul
Published: January 2024

Background/Objective:The prevalence of anxiety and depression in adults in the United States is high with many experiencing ≥1 episode of anxiety or depression over a given year. Despite this, diagnoses of anxiety and depression in patients presenting to the ED for somatic complaints are seldom, relative to the population prevalence. Current fixed-item anxiety and depression screening tools have variable specificity and sensitivity, but adaptive screening tools such as the Computerized Adaptive Testing-Mental Health tool (CAT-MH) are thought to provide improved diagnostic characteristics and precision over fixed item tools. Our objective is to establish the reliability ofits depression and anxiety severity assessments in patients initially screened in an ED setting and reassessed over 30 days.
Methods:We are conducting a longitudinal observational study among adult ED patients presenting with somatic, non-mental health complaints. The CAT-MH, Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-8 (PHQ-8), are administered to randomly selected patients meeting enrollment criteria after informed consent. Participants are reassessed at 1-, 2-, and 4 weeks after ED discharge and analyzed for longitudinal test-retest reliability and sensitivity to change in score severity over time.
Results:In this ongoing study, we present baseline anxiety and depression severity assessments for the first 49 enrolled patients (Mean age of 37, 73% female, 49% white, 47% black). Fixed item tools (GAD-7 and PHQ-8) categorized 16% and 6% of patients as moderate and severe anxiety respectively vs 19% and 15% as moderate, and moderately-severe/severe depression. In comparison, CAT-MH categorized 8% and 10% as moderate and severe anxiety.10% and 6% were categorized as moderate and severe depression.
Conclusion:In this longitudinal observational study, we present baseline data for the first 49 out of 100 planned patients. Upon completion of the study, we hope to find that the severity assessments from CAT-MH remain stable over 30 days.
Assessing the Severity of Portal Hypertension: Is Liver or Spleen Stiffness Measurement an Alternative to the Gold Standard, Hepatic Vein or Porto-Systemic Pressure Gradient?
Authors: Ali Yasmin A. , Haste Paul M. , Vuppalanchi Raj
Published: January 2024

Introduction: Liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) are increased in patients with cirrhosis and portal hypertension (PH). However, increased SSM values are associated with presence of esophageal varices. Currently, the gold standard for risk stratification in patients with compensated advanced chronic liver disease (cACLD) is by measurement of portal pressure through assessment of hepatic vein or porto-systemic pressure gradient (HVPG and PSPG). However, these procedures are invasive, and either LSM or SSM may be a non-invasive alternative.
Aim: We aimed to investigate the relationship between LSM or SSM and HVPG/PSPG and examined the diagnostic accuracy for identification of clinically significant PH (≥10 mm Hg) or severe PH (≥12 mm Hg).
Methods: A retrospective study (IRB Protocol #19230) allowed us to identify patients who had who undergone portal pressure measurements (HVPG or PSPG). A total of 36 patients also had SSM values. Of these, 29 patients carried a hepatic cause of PH, while the remaining had pre-hepatic (n=4) and post-hepatic (n=3) etiology.
Results: The median age was 58 years (range: 25-71) with 52% male and 83% with cirrhosis. The median LSM and SSM were 35.7 kPa (range:7.4-75.0, normal ≤7.0 kPa) and 43.8 kPa (range: 20.7-100, normal ≤ 21.0 kPa). Both LSM (r = 0.42, P-value = 0.02) and SSM (r = 0.45, P-value: 0.01) correlated significantly with HVPG/PSPG. The diagnostic accuracy for both LSM and SSM for clinically significant PH was good for LSM (AUROC 0.76, 95% CI:0.58-0.94) and excellent for SSM (AUROC: 0.81, 95% CI:0.65-0.98). The diagnostic accuracy of LSM and SSM was lower for severe PH [AUROC 0.71 (P-value = 0.06) and 0.67 (P-value = 0.1) for LSM and SSM, respectively].
Conclusion: Both LSM and SSM correlate with portal pressure measurements and provide diagnostic accuracy to identify patients with clinically significant, but not severe, PH.
Evaluation of the Relationship Between Collagen Matrix Damage and Proteoglycan Activity Following Submaximal Fatigue Loading
Authors: Estes Peyton , Bice Caroline , Loflin Ben , Ahn Taeyong , Hanna Roufael , Schlecht Stephen
Published: January 2024

Background and Hypothesis:Previous research indicated that fatigue loading of the anterior cruciate ligament (ACL) leads to disruption and unraveling of the collagen triple helix structure. Using a novel in vivo murine model, we have spectroscopically shown that collagen unraveling at the molecular level is associated with an increase in proteoglycan activity. Moreover, we found an increase in tissue compliance within these damaged tissue domains. We hypothesize that the increase in proteoglycan activity is largely responsible for this mechanical change. To investigate this, we first need to identify the proteoglycan(s) responsible for our biochemical spectra that indicatedan elevation in activity associated with unraveled collagen domains. For this pilot project, we histomorphometrically investigated the proteoglycan activity of two potential protein candidates (decorin, versican) following sub-maximal ACL fatigue loading.
Experimental Design or Project Methods:The right knees of 20 mice underwent 5,000 cycles of moderate or strenuous fatigue loading. Left knees served as a control. Samples were collected 1 and 72 hours after loading. Immunohistochemistry was performed to detect decorin and versican activity in the ACLs.
Results:A greater area of the ACL was stained with decorin relative to versican in ACLs that underwent moderate fatiguing after 1-hour rest (p = 0.02) and 72-hour rest (p < 0.01). Similar differences were found in ACLs after strenuous fatiguing and 72-hour rest (p < 0.01). No significant temporal differences were found in versican (p = 0.76) or decorin (p = 0.53) activity in fatigued ACLs relative to controls.
Conclusion and Potential Impact:These preliminary findings suggest that versican nor decorin are the proteoglycans colocalizing with unraveled collagen. We are currently investigating aggrecan, lumican, and biglycan as other potential proteoglycan candidates to explain our spectroscopic data.
Factors Affecting Patient Reported Outcomes Following Tibial Plateau Fracture
Authors: Haag Luke , McCoy Erin , Patel Sohum , Slaven James , Lopas Luke , Natoli Roman
Published: January 2024

Background/Objective: 
Tibial Plateau Fractures (TPFs) account for ~1% of all fractures and ~8% of all fractures in the elderly. Despite the frequency and severity of TPFs there is a paucity of data evaluating factors that affect patient recovery after injury and surgical fixation. We hypothesized that patient reported outcomes are modulated by several variables including patient demographics, comorbidities, injury characteristics, and Social Determinants of Health (SDH).  
Methods: 
In this retrospective cohort study, we collected the interval patient reported outcome scores (PROs) of patients with TPFs treated with open reduction internal fixation occurring between February 2013 and November 2020. PROs included 1) Visual Analog Scale (VAS) pain scores, 2) Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) scores, and 3) Physical Function (PF) survey scores. Patient demographics, comorbidities, fracture characteristics, insurance status, and area deprivation index (ADI) of the patient’s residence were collected via electronic medical record review. Bivariate analyses of PRO scores to the aforementioned factors were performed using generalized estimating equations to account for participant repeated measures, with p<0.05 being considered significant. 
Results: 
196 patients were evaluated with >1 year follow-up. It was determined that patients’ insurance status affected their VAS (p0<.001), PI (p<0.001), and PF (p<0.001) scores. Patient ADI affected VAS (p<0.001) and PI (p=0.0026), with increased ADI scores resulting in worse PROs. Diabetes and depression were found to negatively impact VAS (p=0.010 & 0.008 respectively) and PI (p=0.0044 & 0.0048, respectively). Additionally, age and sex both influence VAS (p=0.0006 & 0.0033, respectively), and compartment syndrome was associated with decreased PF (p=0.0206).  
Conclusion and Potential Impact: 
To our knowledge, this is the first investigation to evaluate the effect of SDH on patient recovery following surgical fixation of TPFs—suggesting that insurance status and residence ADI scores are associated with worsened PROs. Further investigation is necessary to identify if these factors are independent of other covariates.
Maternal IVIG Administration in Rhesus Alloimmunized Pregnancies: A Systematic Review
Authors: Flood Anna , Sambatur Enaja , Mustafa Hiba
Published: January 2024

Background: Rhesus (Rh) alloimmunization occurs when an Rh negative mother is exposed to red blood cells (RBC) from an Rh positive fetus. The mother develops antibodies in the current pregnancy that attack Rh positive fetus in subsequent pregnancy, causing hemolytic disease of the fetus and newborn (HDFN). RhD is the most common antigen to result in fetal anemia requiring intrauterine transfusions (IUT). Although the traditional method of management and highly effective, IUTs carry significant risk particularly when performed early in gestation, potentially resulting in procedure-related fetal deaths. Intravenous immunoglobulin (IVIG) therapy may postpone or even replace invasive intrauterine treatment in fetuses of mothers with severe alloimmunization in previous pregnancies.
Objective: To evaluate whether maternal administration of IVIG in high-risk Rhesus alloimmunized pregnancies is effective in delaying the need for IUTs as well as delaying the onset of severe fetal anemia and thus in diminishing its clinical consequences.
Study design: A systematic literature search was conducted for maternal intravenous immunoglobulin administration in pregnancies with Rh isoimmunization in the following databases: Medline, Embase and Cochrane Library from 1946 to 2 February 2023. Inclusion criteria was studies done during pregnancy in which IVIG was administered to the mother in Rh alloimmunized pregnancies/fetal anemia. All non-english papers, animal papers, systematic reviews, editorials and studies in which IVIG was administered to non-pregnant patients were excluded. Data was extracted from these full texts and analyzed for inclusion based on the quantity of usable data and patient information. Extracted data included maternal antibody type and titer, number of maternal IVIG administrations, number of IUTs, and fetal Hb levels prior to first IUT and at delivery. Time interval (weeks) between IVIG and first IUT was also included in the extracted data along with gestational age at delivery. Individual patient data extraction was done for studies that provided data.
Results: 16 studies were included in data analysis. Analysis of extracted data is ongoing.
Celiac Disease in Medical Curriculum
Authors: Kerns Elizabeth , Husmann, PhD Polly R.
Published: January 2024

Introduction:  Celiac disease is a common autoimmune illness precipitated by the ingestion of gluten, a protein contained in grains (e.g., wheat, barley, and rye).  Celiac disease can present with a wide variety of manifestations across nearly any body system, but most individuals with celiac disease present with subclinical symptoms.  Despite relatively inexpensive testing and an effective treatment (i.e., a gluten free diet), most individuals with celiac disease remain undiagnosed, leading to significant disease burden.  Research suggests that physicians have poor knowledge of celiac disease, likely contributing to the high rates of missed diagnoses.  This study sought to assess the information encountered by students in pre-clinical medical education regarding celiac disease.
Methods:  Information was drawn from recent literature to create a rubric to evaluate the presentation of celiac disease in curricular and educational resources for pre-clinical medical students.  Categories evaluated included prevalence, morbidity/mortality, manifestations, comorbidities, and testing recommendations.  This rubric was used to assess the curriculum from a large US medical school and First Aid for the USMLE Step 1, a popular commercial resource used by medical students.
Results:  The medical school curriculum scored higher overall than First Aid (31/48 and 12/48, respectively).  The curriculum also scored higher in all categories except morbidity/mortality.  The curriculum showed deficits predominantly in morbidity/mortality and testing recommendations.  First Aid showed deficits in all categories.
Discussion:  Results showed that the medical school curriculum provided more complete information about several aspects of celiac disease.  First Aid did not thoroughly address any of the categories evaluated with the rubric.  While First Aid may be an effective consolidation of Step 1 material, it seems likely that it is focused on “teaching to the test” rather than providing thorough medical education for future physicians.  The medical curriculum is a more complete resource for students to learn about celiac disease.
Pemanfatan Temu Mangga dan Sambiloto untuk Imunitas Tubuh
Authors: Pujimulyani Dwiyati , Suryani Chatarina Lilis , Astuti Devi Fitri , Saputra Jumadil
Published: January 2024

Indonesia is located on the equator with a rich potential of local spices, for example, white turmeric of Curcuma Mangga (Curcuma mangga Val.) and Sambiloto leaves (Andrographis paniculata). These two food ingredients are only sold in fresh form because some people do not know how to process them properly and practically. Curcuma mangga can be processed into instant, ready-to-drink powder that is easy to consume. Not only that but curcuma mangga and sambiloto leaves also contain antioxidants such as polyphenols, which can be useful for increasing immune power. The purpose of this service is for partners to understand the benefits of Curcuma Mangga and Sambiloto leaves. The outreach activity was held on November 23, 2022, and was attended by 21 Himatepa-HMPPI UMBY administrators and 54 NREC Universiti Malaysia Terengganu. This activity includes counseling and training about the benefits of Curcuma Mangga and Sambiloto leaves and how to market them. The counseling also discussed how to process instant powder and Sambiloto. This service program resulted in partners understanding the benefits of Curcuma Mangga and Sambiloto leaves to increase immunity and its marketing strategies. The panelists liked the overall instant mango powder product with a score of 3.95. Partners can also increase their entrepreneurial abilities by producing instant powder from Curcuma Mangga and Sambiloto.
Pendekatan Klinis Perawatan Indirect Pulp Capping bagi Pelajar
Authors: Sofiani Erma , Nurhasanah Maulida , Orienty Fauzia Nilam
Published: January 2024

Cavities or caries are diseases of the hard tissue of the teeth. The presence of caries must not be ignored and must be treated because carious lesions can spread and result in pain, tooth loss, and infection of the tissues supporting the teeth. This community service activity aims to increase public awareness of dental and oral health through curative efforts and evaluation of the clinical picture after indirect pulp capping treatment at the State Agricultural Development Vocational School, Ikurkoto Health Center Area, Padang City. The method used in this service begins with patient screening, pulp capping treatment, and evaluation in the form of subjective and objective examinations 1 week after treatment. Participants in the activity were 403 patients who came from around the Ikurkoto Community Health Center area. This activity found that cavities were more common in the back (posterior) teeth, especially the lower molars, as much as 80%, compared to the front (anterior) teeth, as much as 20%. The material used is a bioactive material, namely Glass Ionomer Cement (SIK) type 2 with different brands, namely Fuji II LC (type II aesthetic) 70% and Fuji IX (type II reinforced) 30%. The evaluation results after treatment showed that as many as 71% of dental patients were asymptomatic and responded well to pulp capping treatment.
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Authors: Berdikari Admin
Published: January 2024

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Una Mirada Inicial a la Teoría de Nudos y a la Homología de Khovanov
Authors: Montoya-Vega Gabriel
Published: January 2024

La teoría matemática de nudos estudia las incrustaciones de círculos en el espacio R^3. La introducción de teorías de homología produce estructuras matemáticas complejas generando nuevas oportunidades de investigación. En este artículo brindamos una primera mirada a la homología de Khovanov, a la sucesión larga de Khovanov y se presenta un resumen de los orígenes históricos de la teoría. Además usamos esta sucesión para calcular la homología de los nudos toroidales T(2, n). Uno de los objetivos principales de esta publicación es fomentar el estudio de la teoría de nudos y la homología de Khovanov en Colombia y Latinoamérica en general.
Использование и применение средств физического воспитания в формировании морально-волевых качеств старшеклассников
Authors: Нюняев И.В , Ильиных С.Н
Published: January 2024

Важнейшей приоритетной задачей общеобразовательной школы является — разностороннее физическое воспитание учащихся. Особенно большие требования предъявляются к физической подготовленности юношей-старшеклассников, которым вскоре предстоит не только включиться в созидательную трудовую деятельность, но и выполнять нелегкие воинские обязанности во время службы в рядах Вооруженных Сил России. На уроках в старших классах остро стоит в вопрос воспитании у юношей морально-волевых качеств, способности действовать точно и целенаправленно в режиме физического и психологического напряжения.
Атлетическая гимнастика как вид самостоятельных занятий физической культурой
Authors: Айвазова Е.С. , Бабатова А.А.
Published: January 2024

В данной статье рассматривается содержание и значение атлетической гимнастики. Определяется роль атлетической гимнастики в процессе самостоятельных занятий физической культурой. Авторами выявляются наиболее значимые категории упражнений, которые входят в состав атлетической гимнастики.
Бизнес-процессы нефтегазовой отрасли как неотъемлемая часть хозяйственной деятельности компаний
Authors: Ларионова О.А , Плис С.А. , Идигова Л.М
Published: January 2024

В статье авторами исследуются актуальные вопросы управления бизнес-процессами нефтегазовой отрасли как неотъемлемой частью хозяйственной деятельности производственных компаний. Недостаточная изученность, актуальность, теоретическая и практическая значимость проблемы использования процессного подхода при организации учета добычных работ нефтегазовых компаний в условиях цифровой экономики, определили выбор темы данного исследования. Научной новизной в данной статье является процесс совершенствования теоретических положений и разработка прикладных рекомендаций, связанных с анализом и управлением эффективным развитием и конкретно бизнес-процессами производственно-технической деятельностью предприятий нефтегазовой промышленности и их структурных подразделений с учетом отраслевой специфики с конкретным элементом
Обращение прокурора в суд в целях защиты прав, свобод, законных интересов граждан, неопределенного круга лиц или интересов Российской Федерации, субъектов РФ, муниципальных образований
Authors: Воронов . Е.И
Published: January 2024

Научное исследование посвящено исследованию такого важного аспекта деятельности прокурора в России, как его право и обязанность обращения в суд в целях защиты прав, свобод и законных интересов граждан, неопределенного круга лиц, а также интересов Российской Федерации, субъектов РФ и муниципальных образований. Статья анализирует нормы законодательства, регулирующие вышеуказанный процесс, и освещает роль прокурора в судебном процессе, а также обсуждает критерии, определяющие возможность обращения прокурора в суд. В свою очередь, тема исследования представляется актуальной на современном этапе
Технология производства сухой стерильной бессывороточной питательной среды ВекторВак-ПС2 и оценка ее ростовых свойств на клеточных культур MDCK и Vero
Authors: Сумкина Т.П , Нечаева Е.А. , Думченко Н.Б.
Published: January 2024

Разработаны оптимальные условия для приготовления питательной среды бессывороточной ВекторВак-ПС2 сухой стерильной. Это позволит получать высококачественные результаты при культивировании клеток MDCK и Vero и удешевит стоимость питательной среды в отличие от жидкой. Разработка такой сухой стерильной питательной среды является одной из важнейших задач в биотехнологии, поскольку имеет ряд преимуществ: жидкая питательная среда требует специального хранения и транспортировки, а сухая питательная среда представляет собой порошок, который очень легко хранить и транспортировать. Целью настоящей работы является конструирование сухой стерильной питательной среды бессывороточной ВекторВак-ПС2 и оценка возможности ее применения для культивирования клеток MDCK и Vero.