bluuebunny/crossref_metadata_2025 huggingface dataset:
Probabilistic operability and greenhouse gas assessment during dynamic positioning operations
Authors: Fruzzetti Camilla , Donnarumma Silvia , Maggiani Francesca , Martelli Michele
Published: October 2023

A Dynamic Positioning system automatically maintains both the position and heading of a vessel by using its thrusters in the presence of external disturbances. This goal is ensured by a controller that compensates for the environmental disturbances and computes the proper set-points for each actuator. The core of such a system is composed of force and thrust allocation modules that tailor the required forces and moment over the available actuators. The propulsion systems used are often over-actuated and the thrust allocation algorithm implies an infinite number of solutions since it is impossible to solve analytically the problem. Over the years efforts from the research community dealt with the optimization in terms of accuracy, energy consumption, and maintenance with innovative allocation strategies were investigated. However, no publications or rules indicate the procedure for the evaluation of exhaust gas emission during dynamic positioning operations. For such a reason, the paper aims to develop an optimization procedure that includes an ad-hoc objective function with relative non-linear constraints for the thrust allocation logic that tends to minimize the actuators’ thrust. The procedure accounts for non-linear hydrodynamic effects on the thrust generation, including thruster-thruster and thruster-hull interactions, to obtain the most realistic results as possible. Moreover, following the IMO suggestions, the production of greenhouses gases emissions is evaluated in probabilistic terms. The proposed approach provides indicators in terms of yearly operability, fuel consumption, and environmental footprint during dynamic positioning operations that could be used for proper decisions in ship deployment.
Implementing a Prenatal Oral Health Program for Dental Students: Lessons Learned
Authors: Brame Jennifer L. , Quinonez Rocio B. , Ciszek Brittney P. , Weintraub Jane A.
Published: October 2023

The Prenatal Oral Health Program (pOHP) was developed to educate dental students on prenatal oral health and promote access to dental care for pregnant women. Program advancement has occurred in support of quality improvement. This mixed-methods design combined quantitative data from fourth-year dental students who participated the pOHP (N = 81) and qualitative data from a student-faculty-staff focus group discussion (N = 7). Different clinical structures, appropriate leveling in the curriculum, management with a patient care coordinator, and inclusion of interprofessional learning experiences (IPE) were compared. The survey response rate was 96.4% (N = 81). Trends were noted between students who provided clinical care for a pregnant patient (31%) versus those who did not. Results indicated that an integrated clinic was preferred, though students who had treated a pOHP patient showed greater support for a standalone clinic model. Survey and focus group data agreed that pOHP should occur during the third-year dental school training; however, students with patient experience favored second-year placement. Survey and focus group data emphasize the importance of a patient care coordinator for clinical management and IPE as an essential learning element. Innovating new clinical models requires a period of evolution to determine preferred and sustainable infrastructure. Results reveal the advantages and disadvantages of various program implementation models and demonstrate that student perceptions were influenced by their clinical experiences. Study findings will inform implementation and guide other programs as they create and modify existing curricula to enhance prenatal oral health.
Incidence of Distal Radial Artery Occlusion and its Influencing Factors After Cardiovascular Intervention Via the Distal Transradial Access
Authors: Chen Tao , Li Lamei , Yang Anni , Huang Hui , Shi Ganwei , Li Feng , Li Wenhua , Lu Wei , Xu Lingxia , Li Li , Cai Gaojun
Published: October 2023

Introduction:

One of the important advantages of the distal transradial access (dTRA) is the significant reduction in the incidence of radial artery occlusion (RAO). There are few reports on the influencing factors for distal radial artery occlusion (dRAO) after cardiovascular interventions via the dTRA.

Methods:

This retrospective analysis included the clinical data of patients who underwent a cardiovascular intervention via the dTRA. The dRAO was evaluated by ultrasound within 24 hours after the procedure. Multivariate logistic analysis was used to explore the influencing factors for dRAO.

Results:

The incidence of dRAO was 3.5% (28/805) at 24 hours follow-up after the procedure. In the comparison between the 2 groups, the preoperative distal radial artery (DRA) internal diameter in the dRAO group was significantly smaller than that in the non-dRAO group (p=0.001). The prevalence of DRA inner diameter/sheath outer diameter <1 was significantly higher in the dRAO group than in the non-dRAO group (p=0.013). The number of puncture attempts was significantly greater in the dRAO group than in the non-dRAO group (p=0.007). Multivariate logistic analysis showed that DRA inner diameter/sheath outer diameter <1 was an independent risk factor for dRAO (OR=4.827, 95% CI=1.087–21.441, p=0.039).

Conclusions:

The incidence of dRAO 24 hours after cardiovascular intervention via the dTRA was 3.5%, and a DRA inner diameter/sheath outer diameter <1 was an independent risk factor for dRAO. Preoperative ultrasound assessment of vessel inner diameter and selection of a sheath with a smaller outer diameter may reduce the risk of dRAO.

Clinical Impact

The incidence of distal radial artery occlusion after cardiovascular intervention was 3.5%. The distal radial artery inner diameter/sheath outer diameter <1 was an independent risk factor for distal radial artery occlusion. Preoperative ultrasound assessment of vessel inner diameter and selection of a sheath with a smaller outer diameter may reduce the risk of distal radial artery occlusion. The number of puncture attempts and compression time were not related to distal radial artery occlusion.
Ecocritical Agency in I Was a Teenage Exocolonist
Authors: Freye Sarah
Published: October 2023

In this article, I offer an ecocritical approach to video games that can help analyze how game designers can use choice-based game mechanics to offer audiences a way to confront humanity's role in the climate crisis. I Was a Teenage Exocolonist seamlessly integrates gameplay and narrative to help players cultivate new understandings about the anthropocene: “It takes little effort to render a planet inhospitable, but significant dedication to restore it” (Exocolonist, Age 13).
Evaluation of mechanical properties of biocomposites treated with date palm fiber
Authors: Benaniba Samir , Djendel Mokhtar , Kessal Oussama , Abderraouf Belkhadi A , Boubaaya Rabah , Dridi Meriem , Driss Zied
Published: October 2023

The utilization of environmentally friendly composite materials for building insulation offers a practical solution to reducing energy consumption. This study explores the application of novel biocomposites, comprising cement, sand, treated (DPFT) and raw (DPF) date palm fibers and their influence on the thermal and mechanical properties of mortars. The samples were prepared with varying weight percentages of date palm fibers (0%− 20%), treated with NaOH, and possessing a fiber length of 7 mm. Water absorption, density, resistance to bending and compression, thermal conductivity and diffusivity were encompassed. The results indicate that incorporating treated fibers has a beneficial effect on the thermal and mechanical properties of the composite when compared to using raw fibers. Additionally, higher proportions of DPF lead to decreased thermal conductivity, diffusivity, and resistance to bending and compression, highlighting the positive impact of DPFT on the composite’s thermal and mechanical attributes. Notably, the treated fiber composite significantly enhances the insulation capacity of the mortar.
What influences trust in and understanding of clinical trials? An analysis of information and communication technology use and online health behavior from the Health Information National Trends Survey
Authors: Occa Aurora , Merritt Allison S , Leip Allison , Stapleton Jerod L
Published: October 2023

Background

Using information and communication technologies to seek, discuss, and share health-related information influences people’s trust and knowledge of several health practices. However, we know little about the associations between individuals’ information and communication technology use and their perceptions of trust and knowledge of clinical trials. Examining these associations may lead to the identification of target audiences and channels for developing effective educational interventions and campaigns about clinical trials.

Methods

In this study, we analyzed Health Information National Trends Survey data to document perceptions of clinical trial-related knowledge and trust that were recently added as questions in this annual national survey of US adults. We also examined correlates of these clinical trial perceptions that included sociodemographic factors and individuals’ use of information and communication technologies to seek health information, discuss such information with their healthcare providers, and share the information in their network.

Results

More than 90% of participants had no or limited perceived knowledge about clinical trials. Knowledge was higher among those who seek or discuss health-related information online. Differences in perceived knowledge and trust emerged for some racial/ethnic subgroups and other demographic factors. Providers were considered the most trusted source of information (73.6%), followed by health organizations (19.4%) and social support (7.1%). Trust in health organizations compared to health providers was higher among those who used online resources to share health information online with others. Trust in social support was significantly higher among those who used information and communication technologies to communicate about health.

Conclusion

Based on these findings, we recommend developing online resources about clinical trials to be distributed through social media. These resources should facilitate a dialogue and be targeted to several groups considering their information and communication technologies’ use.
Portal hypertension increases the risk of hepatic decompensation after 90Yttrium radioembolization in patients with hepatocellular carcinoma: a cohort study
Authors: Carrión Laura , Clemente-Sánchez Ana , Márquez-Pérez Laura , Orcajo-Rincón Javier , Rotger Amanda , Ramón-Botella Enrique , González-Leyte Manuel , Echenagusía-Boyra Miguel , Luis Colón Arturo , Reguera-Berenguer Laura , Bañares Rafael , Rincón Diego , Matilla-Peña Ana
Published: October 2023

Background:

Transarterial radioembolization (TARE) is increasingly used in patients with hepatocellular carcinoma (HCC). This treatment can induce or impair portal hypertension, leading to hepatic decompensation. TARE also promotes changes in liver and spleen volumes that may modify therapeutic decisions and outcomes after therapy.

Objectives:

We aimed to investigate the impact of TARE on the incidence of decompensation events and its predictive factors.

Design:

In all, 63 consecutive patients treated with TARE between February 2012 and December 2018 were retrospectively included.

Methods:

We assessed clinical (including Barcelona Clinic Liver Cancer stage, portal hypertension assessment, and liver decompensation), laboratory parameters, and liver and spleen volumes before and 6 and 12 weeks after treatment. A multivariate analysis was performed.

Results:

In total, 18 out of 63 (28.6%) patients had liver decompensation (ascites, variceal bleeding, jaundice, or encephalopathy) within the first 3 months after therapy, not associated with tumor progression. Clinically significant portal hypertension (CSPH) and bilobar treatment independently predicted the development of liver decompensation after TARE. A significant volume increase in the non-treated hemi-liver was observed only in patients with unilobar treatment (median volume increase of 20.2% in patients with right lobe TARE; p = 0.007), especially in those without CSPH. Spleen volume also increased after TARE (median volume increase of 16.1%; p = 0.0001) and was associated with worsening liver function scores and decreased platelet count.

Conclusion:

Bilobar TARE and CSPH may be associated with an increased risk of liver decompensation in patients with intermediate or advanced HCC. A careful assessment considering these variables before therapy may optimize candidate selection and improve treatment planning.
Treatment of acute ischemic stroke in patients with active malignancy: insight from a comprehensive stroke center
Authors: Chae Woon Hyung , Vössing Annika , Li Yan , Deuschl Cornelius , Milles Lennart Steffen , Kühne Escolà Jordi , Hüsing Anika , Darkwah Oppong Marvin , Dammann Philipp , Glas Martin , Forsting Michael , Kleinschnitz Christoph , Köhrmann Martin , Frank Benedikt
Published: October 2023

Background:

Despite the high incidence of acute ischemic stroke (AIS) in cancer patients, there is still no consensus about the safety of recanalization therapies in this cohort.

Objectives:

In this observational study, our aim was to investigate the bleeding risk after acute recanalization therapy in AIS patients with active malignancy.

Methods and Study Design:

We retrospectively analyzed observational data of 1016 AIS patients who received intravenous thrombolysis with rtPA (IVT) and/or endovascular therapy (EVT) between January 2017 and December 2020 with a focus on patients with active malignancy. The primary safety endpoint was the occurrence of stroke treatment-related major bleeding events, that is, symptomatic intracranial hemorrhage (SICH) and/or relevant systemic bleeding. The primary efficacy endpoint was neurological improvement during hospital stay (NI).

Results:

None of the 79 AIS patients with active malignancy suffered from stroke treatment-related systemic bleeding. The increased rate (7.6% versus 4.7%) of SICH after therapy compared to the control group was explained by confounding factors. A total of nine patients with cerebral tumor manifestation received acute stroke therapy, two of them suffered from stroke treatment-related intracranial hemorrhage remote from the tumor, both asymptomatic. The group of patients with active malignancy and the control group showed comparable rates of NI.

Conclusion:

Recanalization therapy in AIS patients with active malignancy was not associated with a higher risk for stroke treatment-related systemic or intracranial bleeding. IVT and/or EVT can be regarded as a safe therapy option for AIS patients with active malignancy.
A Simple and Efficient UPLC-ESI-Q-TOF-MS Method for Determining the Chemical Composition in Rhizomes of Multiple Stems Paris polyphylla var. yunnanensis
Authors: He Xue , Jin Lin , Wang Qicui , Peng Anzhong , Li Haifeng
Published: October 2023

Due to the clinical significance of steroidal saponins, multiple stems Paris polyphylla var. yunnanensis (MPPY) has attracted much interest and played a crucial role in drug development. However, developing a simple and efficient method to analyze the chemical composition of MPPY remains a pronounced challenge. Herein, we report for the first time the component analysis of MPPY rhizomes using the chromatographic fingerprint combined with ultra-high performance liquid chromatography coupled with electrospray ionization quadrupole time-of-flight mass spectrometry (UPLC-ESI-Q-TOF-MS) method. Nineteen compositions of MPPY were qualitatively investigated by such strategy and confirmed as steroidal saponins. Among these compositions, 17 steroidal saponins were detected in 10 different batches of MPPY. Thirteen common peaks appeared in chromatographic fingerprint, of which 11 common peaks can be attributed by LC–MS data. The experimental facts demonstrate that the method established is simple, rapid, and reliable to evaluate the quality of MPPY. Besides, the correlation and difference of steroidal saponins in the rhizomes of MPPY from different places were also studied.
Aureobasidols A and B: New C11-Polyketides From an Endophytic Aureobasidium pullulans Isolate
Authors: Morehouse Nicholas J. , Johnson John A. , Gray Christopher A.
Published: October 2023

Objective: The aim of this research was the isolation, structure elucidation and evaluation of the bioactivity of natural products produced by an Aureobasidium pullulans fungal endophyte of the medicinal plant Thuja occidentalis. Methods: The natural products were isolated from an extract of A. pullulans culture broth by reversed-phase chromatography and their structures were elucidated based on analysis of HRESIMS and 1D/2D NMR data. The absolute configurations of the compounds were assigned by comparison of their electronic circular dichroism (ECD) and optical rotatory dispersion (ORD) data with values obtained for Boltzmann-weighted conformer ensembles calculated by density functional theory. Results/Conclusion: Two new C11-polyketides, aureobasidol A (1) and B (2), were isolated from the A. pullulans extract. Both polyketides showed selective but weak inhibitory activity against Mycobacterium tuberculosis in vitro.
What the future ocean has in common with an asthma attack
Authors: Aloisi Giovanni
Published: October 2023

Ocean acidification and ocean deoxygenation are consequences of anthropogenic CO2 emissions that remain largely unknown to the general public. Mostly, because lay audiences are not familiar with the complex chain of physical and chemical processes that drive these phenomena. This demands that communicators find clear, simple and psychologically effective language to frame ocean health issues in familiar terms. From antiquity to the Renaissance, and independently across multiple cultures, premodern thinkers have conceptualized the Earth in terms of the human body. This is not surprising given that metaphor lies at the core of human understanding. Building on this premodern tradition, I found a system of mathematical equations that calculates the chemical composition of the human body or the ocean, when forced by human physiological or oceanographic parameters, respectively. Based on this result, I build an extended analogy that introduces the basic functioning of the oceanic CO2 and O2 cycles to the general public. The analogy incorporates ocean acidification and deoxygenation, that have parallels in the acidification and deoxygenation of the human body caused by an asthma attack, providing ocean health communicators with a tool that promotes interest in, and explains the origin of, declining ocean heath. Extending the analogy to the continental domain allows to see the Earth as a superorganism, a perspective that may help promote an environmentally healthier relationship between humanity and the Earth.
Effect of menstrual status on lipid profile: A cross-sectional study in a tertiary care hospital in Nepal
Authors: Adhikaree Jasper , Shrestha Ruyusha , Bomjan Prabina , Shrestha Ashmita , Pokharel Shreya , Acharya Rashila , Siwakoti Anusha , Pokhrel Ritesh , Marzo Roy Rillera , Rajbhandari Prachand Man Singh , Acharya Swosti
Published: October 2023

Background: The ovarian follicular cell's degradation and subsequent decrease in the synthesis of estrogen results in the decreased cardiovascular protection. As a result, the incidence of cardiovascular disease (CVD) increases in postmenopausal women and is characterized by change in lipid profile. This study sought to ascertain the extent of the impact that menstrual status might have on lipid profiles among premenopausal and postmenopausal women. Methods: A cross-sectional study was conducted with 260 premenopausal and postmenopausal women (1: 1) and serum lipid component concentrations (high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), and total cholesterol (TC)) were measured. A comparison between two groups was made between premenopausal and postmenopausal women, and regression was carried out to estimate the effect of menstrual status on lipid components. Results: Compared with premenopausal women, the concentrations of the lipid components (HDL-C, LDL-C, TG, and TC) were found to be significantly higher in postmenopausal women. Using the linear regression, menstruation status was able to predict 11.7%–13.3% of the lipid components (TG and TC) when age and weight were adjusted. Conclusion: The difference in lipid components between premenopausal women and postmenopausal women exists, with menstrual status explaining 11.7%–13.3% variance for the observed lipid level. The factors influencing the lipid profile beside the menstrual status should also be explored. External intervention such as estrogen replacement therapy is also recommended in case of deviation of lipid profile from the suggested normal clinical range.
Using a Physical Computing Project to Prepare Preservice Primary Teachers for Teaching Programing
Authors: Tsai Fu-Hsing
Published: October 2023

The cultivation of computational thinking and programing education have gained prominence in K-12 education worldwide. Primary school teachers should be proficient in visual programing and using microcontrollers to teach programing courses. To cope with these trends, a learning activity was developed and implemented in Taiwan’s primary teacher education curriculum. The activity aimed to help preservice primary teachers learn about Scratch visual programing and micro:bit microcontroller boards by engaging in a physical computing project involving the design of an educational motion sensor game about energy. The results of the preliminary study found that the preservice primary teachers who participated in the activity were able to collaborate and develop motion sensor games suitable for primary school students. They also demonstrated significant improvements in their computational thinking concepts ( t(10) = 3.13, p < .05) and energy knowledge test scores ( t(10) = 2.74, p < .05). Furthermore, most participants expressed satisfaction with the activity, implying the activity’s feasibility for teacher education.
Collective Adaptive Responses Through Coping and Sensemaking Under Stress
Authors: Kim Jungsu , Lee Sukjun
Published: October 2023

This study explores adaptive response mechanisms as an appraisal of confronted stress through people’s activities of sending and receiving tweets with other Twitter users to share their thoughts, opinions or information on responses to a man-made disaster. We propose a model with a theoretical integration that represents the varying relations between stress and individuals’ responses over time. Using Twitter data from April 16, 2014, on the Sewol ferry disaster in Korea, our study found that the development of the collective response was characterized by individuals’ recurrent attempts to make sense of the causes and outcomes of an unexpected event in terms of time-dependent flows during the occurrence of the event. Collective sensemaking recurred when people could not make sense of the causes and results of unexpected events to facilitate the coping process. Our model provides insights into when and how a trigger event such as a disaster influences the development of shared collective response patterns.
The Development of the Trust in Self-Driving Vehicles Scale (TSDV)
Authors: Robertson Ian W. T. , Kortum Philip , Acemyan Claudia Ziegler , Oswald Frederick L.
Published: October 2023

Self-driving vehicles (SDVs) are an emerging technology in which consumers have low levels of trust. Researchers/designers can understand and improve consumer trust through research and iterative design, but doing so effectively requires reliable measures. Although general trust-in-automation measures exist, a measure tailored to SDVs may provide a more accurate tool. This study presents work undertaken to create a domain specific trust measure for SDVs. Candidate items were given to 400 participants who rated their trust in an SDV portrayed in a narrative describing a ride in said vehicle. The Trust in Self-driving Vehicles Scale (TSDV) was created by analyzing participants’ responses using psychometric methods. Four factors were extracted from participants’ responses. Five items were retained for each factor to create the TSDV. Initial evidence of the validity of the instrument is presented through the TSDV’s ability to discriminate between a trustworthy and non-trustworthy vehicle, as portrayed in use scenarios.
Biodynamic Modeling and Analysis of Human-Exoskeleton Interactions During Assisted Manual Handling
Authors: Chen Yinong , Yin Wei , Zheng Liying , Mehta Ranjana , Zhang Xudong
Published: October 2023

The objective of this study was to investigate the effects of a back exoskeleton on joint kinematics and kinetics during assisted manual handling tasks using subject-specific musculoskeletal biodynamic models and model-based analyses. We constructed these musculoskeletal models using OpenSim (Delp et al., 2007), incorporating optical motion capture, ground reaction forces (GRFs) measurements, and humanexoskeleton interactive force input. Our long-term goal is to enable digital modeling and simulation that can aid in the design and development of more effective exoskeletons and safer manual handling practices.
Comparison of Naïve Decision Aides for Time-Pressured Degraded Environments
Authors: Sealy William I.N. , Feigh Karen M.
Published: October 2023

Decision accuracy often suffers when missing information and time-pressure are introduced, and there is little consensus on how best to support decision making in these conditions. In this study we compare two naïve decision aides which aim to improve decision accuracy in two environments biasing towards Take-the-Best and Weighted Additive decision strategies. The first support aide slowly acquires missing information for the participants and the second aide provides option suggestions based on estimates of missing information. We found that while both decision aides were able to significantly improve decision accuracy, the aide which provided option suggestions outperformed the decision aide which acquired missing information. We also find that both decision aides have unique mediating effects on the presence of information imbalance.
Who Are We Without Land? Repeasantization and Caste in a Village of South India
Authors: Philip Jessy K.
Published: October 2023

The article explores the motivation for the reclamation of land-based livelihoods in a village in South India. In contrast to studies reporting a change in class position of small cultivators to wage workers due to pressures of depeasantization, this article argues for an agency-driven view of agrarian change. However, the article contends that such motivated acts of peasants to retain their autonomy are not solely derived from their interaction with economic processes. Fears of decline in status provide an extra-economic impetus to repeasantization. The loss of land-based livelihood implies social death for those castes with historical land occupation. A comparative perspective of the social framework of agriculture is essential to ground agency in social relations and comprehend the radical potential of peasant actions.
Conceptualization of Agile Leadership Characteristics and Outcomes from NASA Agile Teams as a Path to the Development of an Agile Leadership Theory
Authors: Silva-Martinez Jackelynne
Published: October 2023

The purpose of this study was to develop an agile leadership theory, which involved the identification of leadership characteristics and outcomes from agile teams as they incorporated agile principles to increase value to their customers. Although outputs of agile teams and how job satisfaction of employees affect customer satisfaction are well known, existing research does not fully cover the outcomes that agile teams generate. This makes it hard for risk-averse organizations to adopt agile transformations and efficiently equip their employees with agile leadership skills. A general inductive approach with strategies from constructivist grounded theory was used to collect and analyse data. Participants for this study were selected from agile teams at National Aeronautics and Space Administration using theoretical sampling and performing a constant comparative analysis driven by the data, aiming to draw out recurring patterns and most notable categories. Those resulted in four agile leadership characteristics and four outcomes from agile teams, and a proposed agile leadership model emerged as a path to developing a theory. Organizations can use these findings to support workforce development planning and measure their agile transformation efforts.
Religious Conversion and Emancipation of Untouchables: Gandhi’s View, Ambedkar’s Action and Beyond
Authors: Sonowal C. J.
Published: October 2023

Dr B.R. Ambedkar led the mass conversion of the Mahar population from Hinduism to Navayana Buddhism in the year 1956, aiming at the emancipation of the Mahar community, who were treated as untouchables. Dr Ambedkar believed that since untouchability was a part of Hindu tradition, Mahars could not be freed from it until they remained within the Hindu tradition. Contrarily, M.K. Gandhi maintained religious conversion as the purification and change of heart and attaining a higher level of spirituality. Every great religion has the capability for reform within it. He believed that a change of heart being within own religious tradition might eradicate social evils like untouchability, and for that, one should not change his religion. The article thus discusses the various perspectives of religious conversions and analyses the views of these two great thinkers of modern India, situating the Mahar conversion as the primary focus. Based on secondary literature sources, the author tries to situate the views of Gandhi and Ambedkar in the broader discourse on religious conversion and show that the Mahar conversion had a socio-political necessity and Gandhi’s views and appeal for eradication of untouchability did not have a practical value given the socio-religious context in India.
Significant Systemic Insulin Resistance is Associated With Unique Glioblastoma Multiforme Phenotype
Authors: Laviv Yosef , Sapirstein Eilat , Kanner Andrew A , Berkowitz Shani , Fichman Suzana , Benouaich-Amiel Alexandra , Yust-Katz Shlomit , Kasper Ekkehard E , Siegal Tali
Published: October 2023

Background:

Some glioblastoma multiforme (GBM) are characterized by the presence of gemistocytes (GCs), a unique phenotype of reactive astrocytes. Certain GCs can be identified as neoplastic cells but these cells were also found to be associated with diabetes in non-neoplastic lesions of the central nervous system. Our aim was to find a correlation between insulin - resistance metabolic features and the presence of GCs in patients with newly diagnosed GBM.

Methods:

Medical records from histologically confirmed GBM patients were retrospectively extracted for different systemic metabolic variables. A statistic-based comparison was made between GBM, diabetic patients with and without GC. Patients with poorly controlled diabetes (ie, hemoglobin A1C ⩾ 8.0) were also compared between the 2 groups.

Results:

A total of 220 newly diagnosed GBM patients were included in our study. 58 (26.3%) patients had a history of diabetes mellitus type 2 (DM2) at the time of admission. The rate of poorly-controlled DM2 was nearly as twice in the GC-GBM group than in the non-GC GBM group (18.75% vs 9.5%; P = .130). In the DM2 cohort, the subgroup of GC-GBM was significantly associated with demographic and metabolic features related to insulin resistance such as male gender predominance (89% vs 50%, P = .073) and morbid obesity (weight ⩾85 kg: OR 6.16; P = .0019 and mean BMI: 34.1 ± 11.42 vs 28.7 ± 5.44; P = .034 for group with and without GCs, respectively). In the poorly-controlled DM2 group, none of the GC-GBM patients were using insulin prior to diagnosis, compared to 61.1% in the non-GC GBM patients (OR = 0.04, P = .045).

Conclusion:

Systemic metabolic factors related to marked insulin resistance (DM2, morbid obesity, male gender) are associated with a unique histologic phenotype of GBM, characterized by the presence of GCs. This feature is prominent in poorly-controlled DM2 GBM patients who are not using synthetic insulin. This novel finding may add to the growing data on the relevance of glucose metabolism in astrocytes and in astrocytes associated with high-grade gliomas. In GBM patients, a correlation between patients’ metabolic status, tumor’s histologic phenotype, tumor’s molecular changes, use of anti-diabetic drugs and the respective impact of these factor on survival warrants further investigation.
Revision ACL-R With Contralateral BTB Autograft and Iliotibial Band Lateral Extra-Articular Tenodesis With Interference Screw Fixation: A Technique Video
Authors: Forsythe Brian , Gamsarian Vahram , Pan Amanda , Mirle Vikranth , Forlenza Enrico , Allahabadi Sachin
Published: October 2023

Background:

Lateral extra-articular tenodesis (LET) is a reproducible and reliable technique to assist in control of rotational stability of the knee and decrease forces across an anterior cruciate ligament (ACL) graft in the setting of ACL reconstruction. Bone-tendon-bone (BTB) autograft is a common graft choice in revision ACL reconstruction. We present a technique for combining contralateral BTB autograft with LET in revision ACL reconstruction.

Indications:

This technique is indicated in patients undergoing ACL reconstruction who are at increased risk of graft failure, including revision cases, high-grade rotational instability, return to pivoting/cutting sports, ligamentous laxity, young age, meniscal deficiency, and hyperextension/recurvatum.

Technique Description:

The contralateral BTB autograft is harvested through standard fashion. We begin with the LET dissection prior to fluid infiltration in the soft tissues. A 1-cm strip of iliotibial (IT) band is harvested and whipstitched. The IT band strip is passed from anterior to posterior deep to the lateral collateral ligament (LCL). The LET socket is aimed 10° proximal and 10° anterior to limit tunnel convergence with the ACL. The LET is fixed with a tenodesis screw with the knee in neutral rotation and 30° of flexion. The ACL femoral socket is then placed, and care is taken to avoid convergence. A 10-mm tibial tunnel is drilled near the level of the posterior margin of the anterior horn of the lateral meniscus. The ACL is subsequently fixed with standard techniques.

Results:

The addition of LET to revision ACL has been shown to improve failure rate and outcomes. The use of contralateral patella tendon graft reduces morbidity on the operated leg. Notably, the position of the femoral LET tunnel is less important than the ACL tunnel position on the femur. If the LET is passed under the LCL, then the fixation point on femur becomes less relevant. The technique presented is a time-efficient way for combining tenodesis with revision ACL.

Discussion/Conclusion:

Performing a revision ACL reconstruction utilizing contralateral donor tissue with the addition of LET is a viable and reliable option for competitive athletes.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form.
Swimming exercise ameliorates insulin resistance and nonalcoholic fatty liver by negatively regulating PPARγ transcriptional network in mice fed high fat diet
Authors: Zhang Yong , Xu Jie , Zhou Di , Ye Tingting , Zhou Puqing , Liu Zuofeng , Liu Xinyuan , Wang Zinan , Hua Tianmiao , Zhang Zhenghao , Sun Qingyan
Published: October 2023

Background

Recent findings elucidated hepatic PPARγ functions as a steatogenic-inducer gene that activates de novo lipogenesis, and is involved in regulation of glucose homeostasis, lipid accumulation, and inflammation response. This study delved into a comprehensive analysis of how PPARγ signaling affects the exercise-induced improvement of insulin resistance (IR) and non-alcoholic fatty liver disease (NAFLD), along with its underlying mechanism.

Methods

Chronic and acute swimming exercise intervention were conducted in each group mice. IR status was assessed by GTT and ITT assays. Serum inflammatory cytokines were detected by Elisa assays. PPARγ and its target genes expression were detected by qPCR assay. Relative protein levels were quantified via Western blotting. ChIP-qPCR assays were used to detect the enrichment of PPARγ on its target genes promoter.

Results

Through an exploration of a high-fat diet (HFD)-induced IR and NAFLD model, both chronic and acute swimming exercise training led to significant reductions in body weight and visceral fat mass, as well as hepatic lipid accumulation. The exercise interventions also demonstrated a significant amelioration in IR and the inflammatory response. Meanwhile, swimming exercise significantly inhibited PPARγ and its target genes expression induced by HFD, containing CD36, SCD1 and PLIN2. Furthermore, swimming exercise presented significant modulation on regulatory factors of PPARγ expression and transcriptional activity.

Conclusion

The findings suggest that swimming exercise can improve lipid metabolism in IR and NAFLD, possibly through PPARγ signaling in the liver of mice.
Prediction and Verification of Forming Limit Diagrams Based on a Modified Shear Failure Criterion
Authors: Wang Haibo , Wang Zipeng , Yan Yu , Xu Yuanhui
Published: October 2023

The forming limit diagram plays an important role in predicting the forming limit of sheet metals. Previous studies have shown that, the method to construct the forming limit diagram based on instability theory of the original shear failure criterion is effective and simple. The original shear instability criterion can accurately predict the left area of the forming limit diagram but not the right area. In this study, in order to improve the accuracy of the original shear failure criterion, a modified shear failure criterion was proposed based on in-depth analysis of the original shear failure criterion. The detailed improvement strategies of the shear failure criterion and the complete calculation process are given. Based on the modified shear failure criterion and different constitutive equations, the theoretical forming limit of TRIP780 steel and 5754O aluminum alloy sheet metals are calculated. By comparing the theoretical and experimental results, it is shown that proposed modified shear failure criterion can predict the right area of forming limit more reasonably than the original shear failure criterion. The effect of the pre-strain and constitutive equation on the forming limits are also analyzed in depth. The modified shear failure criterion proposed in this study provides an alternative and reliable method to predict forming limit of sheet metals.
Cytokine levels reflect tic symptoms more prominently during mild phases
Authors: Chi SuHyuk , Mok Young Eun , Kang June , Gim Jeong-An , Han Changsu , Lee Moon-Soo
Published: October 2023

Tic disorder is a neuropsychiatric condition that affects 3% of all children and can have a significant impact on their quality of life. Cytokines, interferons, interleukins, lymphokines, and tumor necrosis factors are involved in the neuroinflammatory circuitry of tic disorders. This study aimed to identify the cytokines involved in the pathogenesis of tic disorders. We enrolled 44 patients with tic disorder and 38 healthy controls. Patients were free of psychotropic medications for at least 3 weeks. Whole blood samples were analyzed using a Luminex® human cytokine multiplex assay kit. Patients were divided into groups with “mild tics” and “above moderate tics” based on Yale Global Tic Severity Scale (YGTSS) scores for comparison. The final analysis included 35 patients (28 male and 7 female) and 31 controls (20 male and 11 female). In the mild tic group, interleukin (IL)-12 p70 negatively correlated with motor tic scores. Granulocyte-macrophage colony-stimulating factor, IL-4, IL-8, and tumor necrosis factor (TNF)-α were positively correlated to phonic tic scores. IL-12 p40 and TNF-α were positively correlated to total tic scores. IL-12 p70 and IL-17a negatively correlated to impairment scores and total YGTSS scores. Tic disorder patients and healthy controls exhibit different cytokine profiles. Only patients with mild symptoms exhibit significant correlations, suggesting that the correlations between cytokine levels and tic symptoms are more relevant during the mild or remission phases. Our results present the importance of IL-1β and TNF-α, among others, but the identification of key cytokines are still necessary.
Induction of pre-hospital emergency anaesthesia i-PHEA: a national survey of UK HEMS practice
Authors: Hodkinson Mark , Poole Kurtis
Published: October 2023

Background

Pre-hospital emergency anaesthesia is a critical intervention undertaken by helicopter emergency medical teams. Previous studies informed current practice for induction regimes, using a standardized approach of fentanyl, ketamine and rocuronium. There may be a trend towards post-induction hypotension attributed to the induction regime used. Several new combinations of fentanyl, ketamine and rocuronium are emerging in clinical practice. There is currently no consensus on what induction regimes should be used.

Methods

A semi-structured survey was distributed to the medical leads of all UK air ambulance organisations between December 2022 and February 2023. Responses that were returned within the study period were included. Exclusions included missing data, declined participation and failure to return the survey within the data collection period. The survey sought to establish provision of pre-hospital emergency anaesthesia and current induction regimes for stable, unstable and post-cardiac arrest patients. Data was extracted from Microsoft Forms into Excel. Descriptive statistics were used to analyse survey response rate, provision of PHEA and induction regimes. The survey was endorsed by the National HEMS Research and Audit Forum.

Results

19 air ambulance organisations responded (response rate 86%). The majority of organisations provide over 100 pre-hospital emergency anaesthetics per annum (79%, n = 15/19). A standard combination of fentanyl, ketamine and rocuronium is used as a primary induction regime in haemodynamically stable patients by 52% of services (n = 10/19). In haemodynamically compromised patients, fentanyl was omitted or pracititioner choice emphasized by 79% of services (n = 15/19). There was variability in the dose of rocuronium from 1 mg/kg to 2 mg/kg throughout services.

Conclusion

There is variability in the approach to pre-hospital emergency anaesthesia. There is a growing dataset that would enable development of a registry to better understand induction regimes and the impact on patient physiology. Organisations are increasingly adopting a patient centered, practitioner choice model towards induction of anaesthesia.
Regular use of low-dose of opioids after gastrointestinal surgery may lead to postoperative gastrointestinal tract dysfunction in children: a Chinese national regional health center experience sharing
Authors: Dai Fangyu , Zhang Rensen , Deng Ruyu , Wang Guoyong , Guo Hongjie , Guo Chunbao
Published: October 2023

Background

The need for pain management is increasing in pediatrics, but the side effects of overuse or abuse of analgesics can be harmful to children’s health and even life-threatening in severe cases.

Methods

Patients who underwent resection of Meckel’s diverticulum at the Children’s Hospital of Chongqing Medical University from July 1, 2019, to July 1, 2022, were included in this study. Opioids were administered through patient-controlled analgesia (PCA). Based on the preoperative choices made by the legal guardians, patients were stratified into two groups: PCA Group (PCAG) and Non-PCA Group (NPCAG). Data pertaining to the clinical characteristics and prognoses of these patients were subsequently collected and analyzed to assess the impact of opioid administration.

Results

In the study, a total of 126 patients were enrolled, with 72 allocated to the Patient-Controlled Analgesia Group (PCAG) and 54 to the Non-Patient-Controlled Analgesia Group (NPCAG). When compared to the NPCAG, the PCAG exhibited a longer duration of postoperative fasting (median 72 vs. 62 h, p = 0.044) and increased utilization of laxatives (12[16.7%] vs. 2[3.7%], p = 0.022). However, the PCAG also experienced higher incidences of intestinal stasis and abnormal intestinal dilation (13[18.1%] vs. 3[5.6%], p = 0.037). No statistically significant differences were observed in pain assessments at the conclusion of the surgical procedure (0 vs. 1[1.9%], p = 0.429) or within the first 24 h postoperatively (16[22.2%] vs. 18[33.3%], p = 0.164). Additionally, NPCAG patients did not necessitate increased administration of rescue analgesics (2[2.8%] vs. 4[7.4%], p = 0.432).

Conclusions

The administration of opioids did not demonstrably ameliorate postoperative pain but was associated with a heightened incidence of postoperative gastrointestinal tract dysfunction. The retrospective nature of the current research should be considered and should be clarified further.
Prokinetics for the treatment of functional dyspepsia: an updated systematic review and network meta-analysis
Authors: Qi Qingqing , Wang Nana , Liu Han , Li Yanqing
Published: October 2023

Background

Since the previous network meta-analysis assessing the efficacy of prokinetics for functional dyspepsia (FD), there have been a number of new studies and cinitapride is a new prokinetic agent for FD. This updated meta-analysis aimed to explore the efficacy and safety of prokinetics for FD.

Methods

An updated study search in Pubmed, EMBASE, Cochrane Library and Web of Science was conducted in literatures published from July 2015 to March 2023. Randomized controlled trials investigating the use of prokinetics in adult FD patients were included. The primary outcome was the total efficacy rate and the secondary outcome was adverse events. A Bayesian network meta-analysis was performed using R software.

Results

A total of 28 studies were included. Network meta-analysis showed that metoclopramide had a higher total efficacy rate than mosapride (OR: 3.53, 95%CI: 1.70–7.47), domperidone (OR: 2.29, 95%CI: 1.16–4.63), itopride(OR: 2.77, 95%CI: 1.41–5.59), acotiamide(OR: 2.63, OR: 1.33–5.36), and placebo(OR: 5.68, 95%CI: 2.98–11.10), however similar to cinitapride (OR: 1.62, 95%CI: 0.75–3.53). Cinitapride had a higher total efficacy rate than mosapride (OR: 2.18, 95%CI: 1.16–4.14) and placebo (OR: 3.52, 95%CI: 2.01–6.24). Cinitapride had lower risk of total adverse events than domperidone. There was no difference in the risk of drug-related adverse events between the prokinetics.

Conclusions

Metoclopramide and cinitapride may have a better efficacy than other prokinetics in the treatment of FD, and cinitapride may have a lower risk of total adverse events. Further studies using uniform definitions or validated tools to measure the total efficacy rate are needed.