bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and validation of a machine learning model to predict prognosis in HIV-negative cryptococcal meningitis patients: A multicentre retrospective study
Authors: Liu Junyu , Lu Yaxin , Liu Jia , Liang Jiayin , Zhang Qilong , Li Hua , Zhong Xiufeng , Bu Hui , Wang Zhanhang , Fan Liuxu , Liang Panpan , Xie Jia , Wang Yuan , Gong Jiayin , Chen Haiying , Dai Yangyang , Yang Lu , Su Xiaohong , Wang Anni , Xiong Lei , Xia Han , jiang ying , Liu Zifeng , Peng Fuhua
Published: November 2022

Background: An increasing number of HIV-negative cryptococcal meningitis (CM) patients have been reported with fatality approaching 30%.At present, HIV-negative CM patients are stratified according to clinical guidelines and clinical experience for individualized treatment, but the effect seems to be not ideal in clinical practice. Therefore, an accurate model that predict the prognosis for HIV-negative CM patients is needed to provide reference for precision treatment.
Methods: This retrospective study involved 490 HIV-negative CM patients diagnosed between January 1, 1998, and March 31, 2022, by neurologists from 3 tertiary Chinese centres. Prognosis was evaluated at 10 weeks after the initiation of antifungal therapy. We used least absolute shrinkage and selection operator (LASSO) for feature filtering and developed a machine learning (ML) model to predict the prognosis in HIV-negative CM patients. Fifty-six patients from 2 other hospitals were analysed for external validation. An artificial intelligence (AI)-based detection model was also developed to automate the rapid counting of microscopic cryptococcal counts.
Results:The final prediction model for HIV-negative CM patients comprised 8 variables: CSF cryptococcal count, CSF white blood cell (WBC), altered mental status, hearing impairment, CSF chloride levels, CSF opening pressure (OP), aspartate aminotransferase levels at admission and decreased rate of CSF cryptococcal count within 2 weeks after admission. The areas under the curve (AUCs) in the internal and external validation sets were 0.87 (95% CI 0.794-0.944) and 0.86 (95% CI 0.744-0.975), respectively. An AI model was trained to detect and count cryptococci, and the mean average precision (mAP) was 0.993. Additionally, an online and freely available platform for predicting prognosis and detecting and counting cryptococci in HIV-negative CM patients was established.
Conclusions:A ML model for predicting prognosis in HIV-negative CM patients was built and validated, and the model might provide a reference for personalized treatment of HIV-negative CM patients. The change in the CSF cryptococcal count in the early phase of HIV-negative CM treatment can reflect the prognosis of the disease. In addition, utilizing AI to detect and count CSF cryptococci in HIV-negative CM patients can eliminate the interference of human factors in detecting cryptococci in CSF samples and reduce the workload of the examiner.
Structure and Hirshfeld surface analysis of two piperazine guest supramolecular inclusion complexes
Authors: Jin Zesen , Liu E , Jian Fang Fang
Published: November 2022

Two piperazine guest supramolecular inclusion complexes, (1) [MePa][Zn(H2PO4)2] (MePa = methylpiperazine, C5H12N2) and (2) [Pa][PHBA]·H2O (Pa = piperazine, C4H10N2; PHBA = p-hydroxybenzoic acid, C7H5O3) has been investigated structurally in the solid state. The host [Zn(H2PO4)2]n in (1) forms a rigid grommet to wrap the guest [MePa] in the grommet channel. The host PHBA in (2) with water molecules form rectangular building blocks from four directions, leaving cylindrical channels to the guest Pa. The guest piperazine molecules in two complexes are all stabilized and orderly arranged by supramolecular acting force which displays high symmetry. This kind of inclusion without changing the guest molecular structure is helpful for the study of drug sustained-release agents. Hirshfeld surface analysis showed that there were strong intermolecular forces on the surface of the two supramolecular inclusion crystals, which made the crystal structure very stable. Thermogravimetric analysis showed that complexes (1) and (2) had better thermal stability.
Sharing space at the research table: exploring public and patient involvement in a methodology priority setting partnership
Authors: Burke Nikita N , Stewart Derek , Tierney Theresa , Worrall Andrew , Smith Maureen , Elliott Jim , Beecher Claire , Devane Declan , Biesty Linda
Published: November 2022

Background: Public and patient involvement aims to improve research quality, relevance, and appropriateness. Despite an increasing evidence base on the influence of public involvement in health research, the role of involvement in methodology research, i.e., how we plan, do, and share research, is less clear. Using a qualitative case study, we explored public involvement in a research priority-setting partnership in rapid review methodology (Priority III) to support public involvement in future methodology research.
Methods: Participant observation, documentary analysis, interviews and focus groups were used to explore the processes of Priority III and identify the views and experiences of the participants of a steering group (n=26) regarding public involvement in a methodology priority-setting partnership. We used a single intrinsic case study research design and conducted two focus groups with five public partners, one focus group with four researches; and seven 1:1 interviews with researchers/methodologists and public partners. Nine episodes of participant observation were conducted. All data were analysed using template analysis.
Results: The findings of this study present three main themes and six subthemes:
Theme 1: We all bring unique qualities to the table
Subtheme 1.1 - Coming from different perspectives towards shared-decision making;
Subtheme 1.2 - Public partners bring pragmatism and grounding in reality;
Theme 2: We need support and space at the table
Subtheme 2.1 – Define and develop support needed for meaningful involvement;
Subtheme 2.2 - Creating safe space to listen, challenge and learn;
Theme 3: We all benefit from working together
Subtheme 3.1 - Reciprocity in mutual learning and capacity building;
Subtheme 3.2 - Relationships as partners in research, with a feeling of togetherness.
Conclusions: Despite initial uncertainty due to working outside of their comfort zones, public partners contributed meaningfully to a methodology priority-setting partnership when supported to address the challenges around an abstract topic to which all brought different perspectives. Our findings provide insight into factors that facilitated public involvement in this research context. Communication and trust underpin the findings. We also provide examples of practical actions and considerations for future research and research teams.
Sequencing strategies with ramucirumab and docetaxel following prior treatments for advanced non-small cell lung cancer: a multicenter retrospective cohort study
Authors: Tanizaki Satoshi , Matsumoto Kinnosuke , Tamiya Akihiro , Taniguchi Yoshihiko , Matsuda Yoshinobu , Uchida Junji , Ueno Kiyonobu , Kawachi Hayato , Tamiya Motohiro , Yanase Takafumi , Suzuki Hidekazu , Okishio Kyoichi
Published: November 2022

Objectives
Ramucirumab (RAM) and docetaxel (DOC) are commonly used after first-line therapy for advanced non-small-cell lung cancer (NSCLC). Therefore, we aimed to elucidate sequencing strategies of RAM and DOC following prior treatments, including immune checkpoint inhibitor (ICI), cytotoxic agent (CTx) alone, bevacizumab (BEV), and tyrosine kinase inhibitor (TKI).
Methods
We recruited patients with NSCLC who received RAM and DOC and compared the groups with and without prior ICI, CTx alone, BEV, and TKI, respectively. By tumor response to such treatments, the patients were further classified into “complete response (CR) + partial response (PR),” “stable disease,” and “progressive disease” groups, respectively. We compared RAM and DOC efficacy among these groups.
Results
In total, 237 patients were registered. In the group with prior ICI, the objective response rate and disease control rate were significantly higher than those without prior ICI (p = 0.012 and 0.028, respectively), and the median progression-free survival (PFS) was also significantly longer (p = 0.027). There were no significant differences in PFS between the groups with and without CTx alone, BEV, and TKI. Multivariate analysis revealed that prior ICI was an independent factor associated with better PFS. Furthermore, the prior ICI group with CR + PR significantly prolonged PFS compared to the group without prior ICI (p = 0.013).
Conclusion
RAM and DOC may be preferably administered after ICI, rather than after CTx alone, BEV, or TKI, and furthermore, enhanced if the prior ICI has a favorable tumor response.
How environmental factors condition natural regeneration in the altitudinal gradient of a montane rainforest
Authors: Duarte Victor Braga Rodrigues , Abreu Vítor Souza , Dias Henrique Machado , Kunz Sustanis Horn , Berg Eduardo van den
Published: November 2022

The variation of abiotic factors, and the plant species response to it, influence the regeneration capacity and, consequently, the structure of the forest community. The aim of this study is to describe the structure of the regenerating stratum and investigate its relationship with environmental and spatial variables along an altitudinal gradient. This study was carried out in the Santa Marta valley, state of Espírito Santo, Brazil. Data on height and diameter at soil height of regenerating individuals and environmental variables were collected in seven altitudinal quotas; and spatial variables (Moran’s Eigenvector Maps) were created based on geographic coordinates. Phytosociological parameters were calculated by species and the floristic similarity between the altitudinal quota were determined, as well as the species that characterize each group. Redundancy Analysis (RDA) was performed, and generalized linear models were adjusted to verify the influence of environmental and spatial factors on regenerating vegetation. The speciePalicourea sessilispresented the highest Importance Value. The formation of two floristic groups was verified, with 11 species indicative of the higher quota group (1,420 to 1,550 m) and only one of the second group (1,112 to 1,391 m). The first two axes of the RDA explained 51.02% of the variation in the floristic composition. The natural regeneration demonstrated environmental preferences, being influenced by luminosity, abundance in adult components, contents of calcium and sodium, plant litter accumulation, altitude, and spatial structure of the environment. The altitude did not seem to influence a pattern in abundance or richness of regenerating species.
Pulsatile paraarterial flow by peristalsis, pressure and directional resistance
Authors: Sharp M. Keith
Published: November 2022

The mechanism driving flow through the glymphatic system is unclear. The pulsatile flow measured in the space surrounding the middle cerebral artery (MCA) suggests that peristalsis created by intravascular blood pressure pulses is a candidate. However, peristalsis is ineffective in driving significant mean flow when the amplitude of channel wall motion is small, as has been observed in the MCA paraarterial space. In this paper, peristalsis in combination with two additional mechanisms, a longitudinal pressure gradient and directional flow resistance, is evaluated to match the measured MCA paraarterial flow. Two analytical models are used that simplify the paraarterial branched network to a long continuous channel with a traveling wave in order to maximize the potential effect of peristalsis on the mean flow. For these models, the measured arterial wall motion is too large to cause the measured oscillatory velocity, indicating that the glial wall must also move. At a combined motion matching the measured oscillatory velocity, peristalsis is incapable of driving enough mean flow. Directional flow resistance elements augment the mean flow, but not enough to provide a match. With a steady longitudinal pressure gradient, both oscillatory and mean flows can be matched to the measurements.
A Novel Burst Event Detection Model Based on Cross Social Media Influence
Authors: Ban Aiying , Zhang Zhiyong , Gao Dongjun , Zhou Ying , Gupta Brij B.
Published: November 2022

With the frequent occurrence of public emergencies around the world today, how to effectively use big data and artificial intelligence technologies to accurately and efficiently detect and identify burst events of the Internet has become a hot issue. These existing burst event detection methods lack of comprehensively considering multi-data source of social media and their influences, which leads to a lower accuracy. This paper proposes a novel burst event detection model based on cross social media influence and unsupervised clustering. In this article, we, explain the basic framework of burst event detection, along with characteristics of social media influence, and the word frequency features and growth rate features. In our proposed approach, according to the time information in the data stream, social media network data were sliced and the burst word features in each time window were calculated. Then, the three burst features were fused to compute the burst degree of words; after that the words larger than the threshold were selected to form the burst word set. Finally, the agglomerative hierarchical clustering method is introduced to cluster the burst word set and extracts the burst event from it. The results of the experiment on a real-world social media dataset show that the detection method has significantly improved in Precision and F1-score value compared with the latest four burst event detection methods and prove the effectiveness of the proposed method.
sexual function and its associated factors in Iranians with and without a recent history of COVID-19 infection
Authors: Haghparast Zeinab , Taghizadeh Ziba , Bagheri Azam
Published: November 2022

This study was designed to investigate the sexual function and its associated factors in Iranian women and men with and without a recent history of contracting COVID-19. This cross-sectional study was conducted with 384 individuals from August 1 to December 25, 2021, in Iran. The respondents were asked to fill out the International Index of Erectile Function (IIEF) questionnaire, the Female Sexual Function Index (FSFI) questionnaire, the Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI-II), and Haj-Yahia’s questionnaire of violence against women. The results showed that mean FSFI score of female respondents was 20.39 ± 4.15. Women with a recent history of COVID-19 infection had significantly lower scores in the orgasm (P = 0.012) and satisfaction (P = 0.030) dimensions of FSFI. The mean IIEF score of male respondents was 17.79 ± 4.31. There was a significant difference between groups with and without a recent history of COVID-19 in terms of mean IIEF score and also mean scores of each dimension of IIEF (p = 0.004). Multivariate regression showed that women’s sexual function was associated with age and BDI-II score, whereas men’s sexual function was associated with the history of recent COVID-19 infection and the education level. In addition, the results suggest an increase in the prevalence of sexual dysfunction during the COVID-19 pandemic in both women and men. These results can help the country’s health policymakers to devise appropriate measures for mitigating the adverse impacts of the COVID-19 pandemic on the well-being of communities, families, and individuals.
Prayer Time Indicator Based on Internet of Things
Authors: Ganie Sadam Hussain , Rashid Hanan , Mubashir Mohammad , Shah Syed Zubair Ahmad
Published: November 2022

The authors have requested that this preprint be removed from Research Square.
Proving Collatz Conjecture by finding cycles and diverging seeds
Authors: Ali Morad
Published: November 2022

The Collatz conjecture can be formulated in this question: Do we guarantee reaching one after applying function f (Hereinafter called Collatz function) multiple times? f(x) = (3x+1, x|2) ∨ (x|2, x ∤ 2) In this paper, we discuss an approach to analyze Collatz conjecture nature for all qx + 1, q ∈ {1,3,5,7,..}. this approach builds a method to know the number of potential cycles for q x + 1, q ∈ {1,3,5,7,..}, x < Mx, Mx ∈ ℂ. Multiple non-trivial cycles (numbers that form a cycle and does not reach one) were previously found where q ∈ {5, 181}. This paper will introduce equations that find non-trivial cycles, and therefore proving or disproving Collatz conjecture for any q.
Messaging Strategies of Ukraine and Russia on Telegram during the 2022 Russian invasion of Ukraine
Authors: Ghasiya Piyush , Sasahara Kazutoshi
Published: November 2022

The popularity of the instant messaging app Telegram in Ukraine and Russia was strong even before the still-ongoing Russian invasion of Ukraine. However, since 24 February 2022 (when the Russian invasion began), it has seen huge increases in subscribers and even become the primary communication and news source in Ukraine. In this exploratory research, we analyzed Telegram channels from both Ukraine (@UkraineNow — the official channel of the Ukrainian government, and @V_Zelenskiy_official — the official channel of Volodymyr Zelenskyy) and Russia (@rt_russian — the official channel of the news network RT) to discern the content of posts during this invasion. Our analysis of 37,172 posts in total showed that while @UkraineNow is particularly being used to communicate invasion-related news, @rt_russian is working as merely an extension of RT, which is part of the pro-Kremlin propaganda and disinformation ecosystem. However, Zelenskyy has opted for a completely different approach: he has used his Telegram channel to encourage Ukrainians and garner support from the world. The present conflict is at a critical juncture, and our timely research seeks to determine how both countries’ governments are utilizing Telegram as a weapon in the information war and what impact this has on ground.
Hepatoprotective effect of Pinostrobin against Thioacetamide-induced liver cirrhosis in rat
Authors: shareef Suhayla Hamad , Al-Medhtiy Morteta H. , Jabbar Ahmed Aj. , Aziz Peshawa Yunis , Abdulla Mahmood A.
Published: November 2022

Pinostrobin was used in traditional medication for management of numerous syndromes. In the current study, histology, immunohistochemistry, and hepatoprotection effects of Pinostrobin were assessed against thioacetamide (TAA) hepatotoxicity in rats. Thirty rats were arbitrarily separated into five groups. Group 1 was intraperitoneally (i.p) injected with distilled water 3 times/week and fed (po) daily with 10% Tween 20 for 2 months. Group 2–5 were i.p. injected with 200 mg/kg TAA thrice weekly for 8 weeks and fed with 10% Tween 20, 50 mg/kg silymarin, 30 and 60 mg/kg of Pinostrobin daily for 8 weeks, respectively. Experimental groups fed groups showed that Pinostrobin significant reduction in liver index and hepatocyte proliferation with much lesser cell injury. These groups were significantly down-regulated the PCNA and α-SMA. The liver homogenate exhibited increased antioxidant enzymes (SOD and CAT) activities accompanied with decline in malondialdehyde (MDA) level. The serum level of bilirubin, total protein, albumin and liver enzymes (ALP, ALT, and AST) were restored to normal and were comparable to that normal control and silymarin with TAA treated groups. The hepatotoxic group showed a significant rise in serum liver biochemical markers together with a considerable decrease in protein and albumin level compared to the normal group. The hepatotoxic group displayed decreased catalase and superoxide dismutase activities while increased lipid peroxidation. Pinostrobin decreased level of TNF-a, IL-6 and increased the level of IL-10. Acute toxicity with a higher dose of 500 mg/kg Pinostrobin did not manifest any toxicological signs in rats. Macroscopy of hepatotoxic liver exhibited irregular, rough surface with micro and macro nodule. Histopathology stained by Hematoxylin and Eosin, and Masson Trichrome showed there was inflammation and infiltration of lymphocytes, focal necrosis, fibrosis, and bile duct propagation. Pinostrobin fed group had expressively reduced TAA toxicity in gross and histology as designated by fewer disturbances of hepatic tissue, slight fibrosis, and low-grade cells infiltration. Immunohistochemical staining designated that pinostrobin significantly down-regulated the expression of proliferation cellular nucleus antigen (PCNA) and alpha-smooth muscle actin (α-SMA) in the liver. Thus, the findings of this study presented that the hepatoprotective effect of this plant may be due to a reduction in toxicity, inhibition of hepatocytes proliferation, down-regulation of PCNA and α-SMA, decreased enzyme markersand increased protein and albumin increased endogenous enzymes and reduced lipid peroxidation level.
The largest fully protected marine area in North America does not harm industrial fishing
Authors: Favoretto Fabio , López-Sagastegui Catalina , Sala Enric , Aburto-Oropeza Octavio
Published: November 2022

Marine protected areas (MPAs) that ban fishing restore marine life within their boundaries and can also replenish nearby fisheries. However, some argue that after large MPAs are established, fishing effort is displaced to unprotected areas and economic loss is incurred by the fishing industry. We tested these assumptions by assessing the behavior and productivity of the Mexican industrial fishing fleet before and after the implementation of the largest fully protected MPA in North America (the 147,000 km2 Revillagigedo National Park). We found no significant decrease in catches and no causal link between the variation of the spatial footprint of the industrial fleet and the implementation of the MPA. Our findings add to growing evidence that well-designed MPAs benefit marine ecosystems and, in the long term, can also benefit the fisheries they support.
A Phenome-Wide Association Study (Phewas) Of Late Onset Alzheimer Disease Genetic Risk in Children of European Ancestry at Middle Childhood: Results From the ABCD Study
Authors: Gorelik Aaron , Paul Sarah , Karcher Nicole , Johnson Emma , Nagella Isha , Blaydon Lauren , Modi Hailey , Hansen Isabella , Colbert Sarah , Baranger David , Norton Sara , Spears Isaiah , Gordon Brian , Zhang Wei , Hill Patrick , Oltmanns Thomas , Bjisterbosch Janine , Agrawal Arpana , Hatoum Alexander , Bogdan Ryan
Published: November 2022

Genetic risk for Late Onset Alzheimer disease (AD) has been associated with lower cognition and smaller hippocampal volume in healthy young adults. However, it remains unclear whether these and other associations are present during childhood. Using data from 5,556 genomically-confirmed European ancestry youth who completed the baseline session of the ongoing the Adolescent Brain Cognitive Development StudySM (ABCD Study®), our phenome-wide association study estimating associations between indices of genetic risk for late-onset AD (n = 4; AD polygenic risk scores (PRS), APOE rs429358 genotype, AD PRS with the APOE region removed (ADPRS−APOE), and an interaction between ADPRS−APOE and APOE genotype) and 1,687 psychosocial, behavioral, and neural phenotypes revealed no significant associations after correction for multiple testing (all ps > 0.0002; all pfdr>0.07). These data suggest that AD genetic risk may not phenotypically manifest during middle-childhood or that effects are smaller than this sample is powered to detect.
Effect of vacuum level on udder aspect and milking in the Sicilo-Sarde ewes
Authors: Mohamed Chniter , Taboubi Iheb , Dhaoui Amel , Darej Cyrine , Naceur M’Hamdi , Moujahed Nizar
Published: November 2022

The aim of this study was thus to investigate the effect vacuum level on udder traits, milking time, milk yield and components in Tunisian Sicilo-Srade ewes. Trial was carried out at the UCPA farm of Gnadil-Béja (Tunisia) among 3 periods of late lactation where 3 vacuum levels (40, 50 and 60 kPa) were applied for each one. Udder traits were measured before each milking, and milking time and milk amount were recorded. Milk total solids (TS), fat, solids not fat (SNF), protein, lactose, milk urea nitrogen (MUN) and somatic cell counts (SCC) were determined. Significant effects of lactation day were observed on udder traits with the exception of teats length. Machine milking time and milk yield were the highest at the beginning of the experiment. Excepting somatic cell counts and milk urea nitrogen, the highest values of milk components were observed at the intermediate period of experiment. Significant effects of vacuum level on machine milking time and milk yield were observed, where values are the highest with the low (40 kPa) and the intermediate (50 kPa) vacuum levels, respectively. Similarly, milk solids not fat content was higher in the groups of 40 and 50 kPa than that of 60 kPa. Contrarily to protein content, milk fat obtained with 50 kPa was higher than those of 40 and 60 kPa. In conclusion, the use of a medium vacuum level of 50 kPa seems to be the suitable choice at late lactation in the dairy Sicilo-Sarde ewe with more efficient of milking performances and any detrimental effects on udder health.
Relationships Between Processes and Profit: A Work-Based Assessment of Processes Within South East Queensland-Based Financial Planning Firms
Authors: Neilson Ben
Published: November 2022

This research explores the relationships between process and profit. It leverages data collected from 134 financial planning firms in South East Queensland as a sample size. It introduces a complete process framework designed using Kotter’s change framework and measures the effects on relationships. The results suggest that firms’ process is positively associated with profit, and that both process and profit are further correlated to decreasing effects of firms’ agency theory. Process development often mediates the relationships between process and profit when introduced with a specific framework design as a result.
An online serious game improves aspects of clinical reasoning skills in dietetic students
Authors: Wright Hattie H. , Tweedie Judith , Ashford Theresa
Published: November 2022

Virtual learning environments, including computer-assisted instruction and game-based learning, have become increasingly popular as educational tools. The present study sought to evaluate the potential of an online serious game to improve the clinical reasoning ability of pre-placement dietetic students during nutrition care planning (NCP). A pre-post-test study design investigated lower- and higher-level clinical reasoning skills in 43 pre-placement dietetics students, as well as perceptions on learning experiences, self-confidence, and views of NCP. Students’ ability to discriminate information, prioritise, and develop an appropriate nutrition intervention plan improved. Serious online games have potential to improve clinical reasoning skills in NCP.
Higgs decays to two leptons and a photon beyond leading order in the SMEFT
Authors: Corbett Tyler , Rasmussen Thor
Published: November 2022

We present the three-body decay of the Higgs boson into two leptons
and a photon to dimension-eight in the Standard Model Effective Field
Theory (SMEFT). In order to obtain this result we interfere the full
one-loop Standard Model result with the tree-level result in the SMEFT.
This is the first calculation of the partial width of the Higgs boson
into two leptons and a photon in the SMEFT to incorporate the full
one-loop dependence for the Standard Model as well as the full tree
level dimension-eight dependence in the SMEFT. We find that this channel
can aid in distinguishing strongly interacting and weakly interacting UV
completions of the SMEFT under standard assumptions. We also find that
this channel presents the opportunity to distinguish different operator
Classes within the SMEFT, potentially including contact
H\bar\ell\ell\gammaHℓ‾ℓγ
operators which are first generated only at dimension-eight in the
SMEFT.
Rationale and effectiveness of combination therapy of chronic anal fissures and hemorrhoids
Authors: Knorring G. Yu.
Published: November 2022

Hemorrhoids and anal fissures are a serious medical problem at the intersection of specialties. The disease has a progressive course, there are several stages. In the 3rd and 4th stages, surgical intervention is required, but in the 1st and 2nd stages, i.e. in more than 90% of all cases of the disease, it is enough to correct the lifestyle, physical activity, diet and nature of the diet, as well as conservative drug treatment. The complexity and multifactorial nature of the pathogenesis of hemorrhoidal disease dictate the need for the impact of therapy on the key mechanisms of the development of the disease. This can be achieved by combining agents with different effects and routes of administration to provide potentiation. Treatment of acute and chronic hemorrhoids includes general and local use of painkillers, antiinflammatory, phlebotonic, hemostatic and complex preparations. Among systemic drugs, the leading place belongs to phlebotonic agents of the flavonoid series of plant origin. Their effectiveness is associated with the effect both on the state of the vascular wall with a decrease in venous stasis and improvement of lymphatic outflow, and with an effect on the rheological properties of the blood. There is also a local anti-inflammatory effect of the combination “diosmin + hesperidin”, and in general, a palette of positive properties predetermines the use of these drugs for hemorrhoids. The combination of systemic flavonoids with local agents that provide repair of damaged tissues and have hemostatic effects contributes to an increase in the effectiveness of treatment. The combined use of systemic phlebotonic preparations and local reparative agents, which together provide a complex effect on various pathogenetic mechanisms and symptoms of hemorrhoids and anal fissures, accelerates the achievement of a positive result of treatment and the prevention of recurrence of the disease.
Chronic vein insufficiency correction in patients with lower extremities varicosity and knee osteoarthritis
Authors: Shcheglov E. A. , Alontseva N. N.
Published: November 2022

Introduction. Chronic vein diseases in general and varicose veins of the lower extremities in particular represent a serious medical and social problem.

The aim was to study the influence of the therapy of venous outflow disorders on the treatment results of osteoarthritis of the knee joints in patients with varicose veins in combination with osteoarthritis of the knee joints.

Materials and methods. The study included 105 patients with varicose veins combined with knee osteoarthritis who had previously received treatment for osteoarthritis of the knee joints but had not received or had received extremely irregular therapy for varicose veins. The follow-up period for the patients was 12 months. The patients underwent the first course of phlebotropic drugs for 2 months from the start of the study. Then this course was repeated twice at 3-month intervals. The standard phlebotropic drug was a micronized purified flavonoid fraction. Compression knitwear was recommended in all patients. Class 2 stockings or tights with an ankle pressure of 23–32 mmHg were used in the vast majority of cases. Treatment of osteoarthritis included the use of nonsteroidal anti-inflammatory drugs, disease-modifying agents (chondroitin sulfate, glucosamine sulfate), and physical therapy.

Results. The VCSS scale reduced the degree of chronic venous insufficiency in the clinical group. At inclusion in the study, the average score in the clinical group was 7.1 ± 1.9, after 6 months the result was 6.1 ± 1.5, and after 12 months – 6.0 ± 1.2 points. In the control group, where patients did not receive therapy for varicose veins, there were no dynamics. The results of joint syndrome against the background of correction of venous outflow disturbances – decrease of Leken and WOMAC index values, decrease of pain syndrome according to the visual analogue scale. All this led to a decrease in the patients' need for taking analgesics.

Conclusions. Out of 100 patients with joint pathology, 68 patients were diagnosed with varicose veins. These diseases aggravate each other, but we can assume that the venous pathology is primary. A vicious circle is set in motion – progression of osteoarthritis due to the disturbances of venous outflow, and varicosity due to the deterioration of muscular-venous pump functioning.
Successful pregnancy with primary infertility as a result of simultaneous bariatric intervention and laparoscopic oophorectomy in women with large cystic ovarian teratoma and morbid obesity
Authors: Samoylov V. S. , Stepanenko A. V. , Popov V. V.
Published: November 2022

The article presents a clinical observation of a patient with primary infertility on the background of morbid obesity (BMI – 64.6 kg/sq.m.) and large cystic teratoma of the right ovary, who underwent bariatric surgery – laparoscopic minigastric bypass and simultaneous laparoscopic right-sided oophorectomy. Along with the true gynecological causes of female infertility, which include, among others, benign formations of the uterine appendages, obesity is a proven significant factor in its development. The use of various infertility treatment options in obese women is ineffective, and pregnancy outcomes are often disappointing. The only proven effective treatment for morbid obesity is bariatric surgery. The implementation of bariatric intervention, and, as a result, a significant decrease in body weight, directly positively affects fertility rates. However, the polyetiological nature of primary infertility in women dictates the need for an integrated approach to treatment. A feature of the presented case is the simultaneous elimination of both etiological factors of infertility – gynecological and endocrine after one surgical intervention. The goal was achieved – after 10 months, the patient was diagnosed with a progressive uterine pregnancy for a period of 11 weeks, with a decrease in body weight by 49.9% of overweight. The course of pregnancy was uneventful. Childbirth independent, newborn full-term boy without deviations. After the birth of the child, the patient continued to reduce body weight and, 29 months after surgery, she achieved a loss of 67% of her excess weight. The presented case clearly demonstrates the advantages of simultaneous elimination of the most likely causes of primary infertility. However, the implementation of such interventions by laparoscopic access requires extensive surgical experience, technical equipment and comprehensive readiness of the medical institution.
Risk of sarcopenia after bariatric surgery in patients with type 2 diabetes mellitus
Authors: Khitaryan A. G. , Abovyan A. A. , Mezhunts A. V. , Orekhov A. A. , Melnikov D. A. , Sarkisyan А. V. , Adizov S. A. , Rogut A. A. , Ziegler G. J. , Amegninou C. M.J.
Published: November 2022

Introduction. Despite the great popularity of Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy in the treatment of morbid obesity, the problem of the development and progression of sarcopenia in patients with type 2 diabetes mellitus in the postoperative period remains insufficiently studied.

Aim. To study the prevalence and dynamics of sarcopenia in patients with type 2 diabetes mellitus after Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy in the long term.

Materials and methods. Our prospective study included 257 bariatric patients (170 Roux-en-Y gastric bypass and 87 laparoscopic sleeve gastrectomy) with type 2 diabetes mellitus. All patients underwent a standard set of preoperative examination with obligatory determination of the skeletal muscle mass index using the bioelectrical impedance analysis. After 6, 12, 18 and 24 months, control examinations were carried out.

Results. At the preoperative stage, 28 patients (16.5%) with signs of moderate sarcopenia were identified in the Roux-en-Y gastric bypass group and 15 patients (17.2%) in the laparoscopic sleeve gastrectomy group. According to the bioelectrical impedance analysis, 24 months after the operation, 37 patients (25.9%) with signs of moderate sarcopenia and 2 patients (1.4%) with severe sarcopenia were identified in the first group. 24 months after surgery in the second group there was no statistical difference in the number of patients with signs of sarcopenia in comparison with the preoperative period.

Conclusion. The frequency of development and progression of signs of sarcopenia after Roux-en-Y gastric bypass is statistically higher than after laparoscopic sleeve gastrectomy. In this regard, in our opinion, when choosing a method of surgical treatment of morbid obesity with concomitant type 2 diabetes mellitus, a detailed assessment of the state of protein metabolism by the bioelectrical impedance analysis is necessary.
The significance of minimally invasive treatment methods in the single-stage elimination of varicose vein disease of the great and small saphenous veins of the lower limbs and their branches
Authors: Alukhanyan O. A. , Gabibullaev R. E. , Alukhanyan A. O. , Kurganskiy O. V. , Aristov D. S.
Published: November 2022

Introduction. This article presents a clinical case of successful and single-stage endovenous laser coagulation combined with miniphlebectomy in a patient with extensive and combined varicose lesion of all major subcutaneous veins of the lower limbs with significant symptoms of chronic venous insufficiency.

Aim. To determine the possibilities of simultaneous elimination of all main subcutaneous veins and their varicose tributaries on both lower limbs using minimally invasive methods.

Materials and methods. A 44-year-old female patient complained of gastrocnemius muscle cramps, swollen shins, feeling of heaviness at the end of the working day and the presence of varicose veins in both lower extremities. The severity of the chronic vein disease before the intervention according to the VCSS (Venous clinical Severity Score) was 8. As a result, patency of deep veins and condition of their valve apparatus, insufficiency of valves of the sapheno-femoral and sapheno-popliteal annexes on both sides with reflux through large and small saphenous veins and anterior accessory large saphenous vein on the right, insufficiency of perforating veins of both tibias were determined. Endovenous laser coagulation of the great and small saphenous veins on both sides and the right anterior accessory great saphenous vein, miniphlebectomy of dilated tributaries within both lower limbs was performed. The symptoms of chronic venous insufficiency decreased markedly. Swelling of the lower legs and cramps in the gastrocnemiu muscles have almost completely disappeared, and the feeling of heaviness in the legs after static loads has significantly decreased.

Conclusion. Endovenous laser coagulation with miniphlebectomy should be given preference in varicose vein disease with combined affection of all great saphenous veins of both lower limbs. Their application provides an opportunity to eliminate simultaneously incompetence of all target veins and to remove varicose dilated tributaries, providing good therapeutic and cosmetic effect without hospitalization and detachment of the patient from his or her work activity.
Prevention of relapses of varicose veins in patients with true doubling of the great saphenous vein
Authors: Chernookov A. I. , Kuznetsov M. R. , Kandyba S. I. , Dolgov S. I. , Atayan A. A. , Ramazanov А. A.
Published: November 2022

Introduction. True doubling of great saphenous vein is observed in 1.6–2.1% of patients with varicose veins and may be one of the reasons for the development of postoperative relapse of the disease. Performing endovasal laser coagulation (EVLC) of both great saphenous vein trunks makes it possible to increase the radicality of the intervention and reduce the likelihood of a recurrence of varicose veins.

Aim. Based on the study of immediate and long-term results, to substantiate the expediency of using EVLC of the main and true additional stem of great saphenous vein in patients with varicose veins.

Materials and methods. From 2014 to 2020, 24 patients with a true doubling of great saphenous vein were treated. Among the applicants there were 12 women and 12 men aged 23 to 62 years with clinical class C2–C4 according to the CEAP (Clinical, Etiologic, Anatomic, Pathophysiologic) classification. All patients under tumescent anesthesia underwent simultaneous EVLC of the main and accessory trunk of the BPV, followed by miniflebectomy or sclerobliteration of varicose tributaries.

Results and discussion. The use of simultaneous coagulation of both trunks was performed by all patients, thus the technical success of the operation was observed in 100% of cases. There were no intraoperative complications. The use of such a volume of intervention is accompanied by an increase in the duration of the operation by 29.3%. Hyperpigmentation in the projection of the coagulated trunk was observed in 2 (8.3%) patients, neurological disorders – in 1 (4.2%) patient. During the examination of patients 1–2 years after the operation, no relapses of the disease were detected, and the cosmetic result of the intervention on a ten-point scale, patients on average estimated at 7.6 points.

Conclusions. True doubling of the great saphenous vein is rare and may increase the likelihood of relapses of the disease. EVLC of the main and additional BPV trunks is accompanied by an increase in the duration of surgery by an average of 29.3%, and the number of patients with hyperpigmentation by 1.5 times. Simultaneous EVLC of both tables with true duplication of BPV makes it possible to reliably block a potential source of varicose disease recurrence and reduce the likelihood of recurrent veins.
Outpatient management of patients after surgical operations for acute aortic dissection of type A
Authors: Kamaltdinov R. R. , Akhmetzianov R. V. , Bredikhin R. A. , Dzhordzhikiya R. K.
Published: November 2022

Acute aortic dissection of type A is still one of the most difficult diseases faced by doctors of all specialties. The current review is based on an analysis of current literature data and clinical guidelines. It covers various aspects of outpatient patient management and focuses on conservative therapy. The lack of an adequate diagnostic algorithm often leads to complications and, ultimately, death. The dynamic nature of the disease, the variability of clinical manifestations and the course of the pathological process require special attention. Both short-term and long-term survival of the patient depends on careful observation. Postoperative management of patients with acute aortic dissection of type A is entirely entrusted to the outpatient unit, which, due to the absence of the main aspects of the strategy in modern clinical recommendations, is not always prepared for the curation of this complex cohort of patients. The lack of experience in managing this pathology by outpatient hospital doctors causes significant difficulties in interpreting instrumental diagnostic methods, which leads to further erroneous tactics with the development of long-term complications. Due to the lack of a unified scheme of drug therapy, the question of prescribing drugs in these patients, who often receive a fairly large range of medications for concomitant pathology, remains open. These factors contribute to polyprogmasia or vice versa – insufficient volume of drug therapy, which further leads to the progression of the disease. As a result of insufficient emphasis on the basics of outpatient management of this cohort of patients, a whole complex of problems arises, leading to unsatisfactory treatment results and increased healthcare costs for their subsequent solution. The purpose of the review is to highlight the main problems of this issue from the point of view of evidence-based medicine.
Modern approach to the choice of laxative agent in surgical interventions in outpatient coloproctology
Authors: Belik B. M. , Kovalev A. N.
Published: November 2022

Introduction. Elimination of manifestations of functional constipation and normalization of the stool to date remain a complex and finally unresolved problem during typical surgical interventions in outpatient coloproctology.

Aim. To evaluate the clinical efficacy of the laxative agent sodium picosulfate in the surgical treatment of non-tumor diseases of the anal canal and rectum in outpatient settings.

Materials and methods. The results of surgical treatment of 566 patients with non-tumor diseases of the anal canal and rectum, which were divided into two groups, were analyzed. In 275 patients (group 1), laxative agents were not used during treatment or were used indiscriminately. In 291 patients (group 2), the laxative agent sodium picosulfate was used to normalize colon emptying and soften stools during treatment. Comparison criteria: level of pain syndrome after surgery, degree of inflammatory manifestations in the field of surgical intervention, shape, and nature of fecal masses (based on the Bristol scale), frequency of wound inflammatory complications and recovery time for patients.

Results. In the early stages after surgery, the stool had a softened consistency (type 5 and 6) in a much larger number of group 2 patients (89.7 ± 4.1 – 94.2 ± 5.1%) compared with group 1 patients (67.3 ± 4.8 – 76.7 ± 4.9%). At the same time, in group 2 patients, pain syndrome was less pronounced, inflammatory manifestations in the area of surgical intervention regressed faster, incidence of wound inflammatory complications decreased 2.8 times (from 16.4 to 5.8%) and work capacity was recovered earlier than in group 1 patients.

Conclusion. The use of the laxative agent sodium picosulfate in coloproctological patients when performing typical surgical interventions on the rectum and anal canal on an outpatient basis eliminates the manifestations of symptomatic constipation, ensures the formation of a softened stool in perioperative periods, reduces mechanical injury to the mucous membrane of the rectum by feces, reduces the level of pain syndrome, which improves the results of surgical treatment by reducing the number of wound inflammatory complications.
Rectangular top-hinged plate as portable flow measuring device
Authors: Gorgin Faraz , Vatankhah Ali R.
Published: November 2022

Most previous studies have focused on adjustable complex flap gates and little research has been carried out on simple inline top-hinged plates for flow measurement. The present study investigates discharge measurement by top-hinged plates located along channels under free flow condition. The proposed simple device is a portable one. Two discharge models are proposed based on Buckingham's theorem of dimensional analysis. The first model (Model I) considers deflection angle as an independent variable while the second model (Model II) considers it as a dependent variable. A series of laboratory experiments (687 runs) were performed to calibrate the proposed models. The results showed that when the slope of the channel increases, the accuracy of the proposed model slightly decreases. The first model has an average error of 2.32%, while the second model has an average error of 3.19%, thus flow discharge through the rectangular channels with longitudinal slopes in range of [0, 0.005] can be accurately estimated using the proposed discharge models. Based on this experimental study, the plate length enhances the performance of the second model when the mass plate is unknown. The proposed device offers a simple and reliable discharge measurement approach for both horizontal and sloping rectangular channels.