bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical Therapy and Outcome of Descending Necrotizing Mediastinitis in a Single- Center Series
Authors: Zhao Zhewei , Ma Dongjie , Xu Yuan , Guo Chao , Li Shanqing , Wang Jian , Wang Mu , Qin Yingzhi , Hongsheng Liu
Published: October 2023

Background Descending Necrotizing Mediastinitis (DNM) is an acute and often fatal infection that affects the neck and mediastinum. DNM treatment consists of broad-spectrum antibiotics, early diagnosis, and surgical debridement with multidisciplinary cooperation. However, owing to the rarity and complexity of this disease, the mortality rate is high. This retrospective study analyzed a single-center experience of managing DNM over the last ten years.Methods A single-center, retrospective, observational, and descriptive study was conducted on 31 patients with DNM at Peking Union Medical College Hospital from 2012 to 2022. Case report forms were used to collect data which were then analyzed with a focus on surgical management and outcomes.Results This study examined the outcomes of 31 patients diagnosed with DNM at our hospital. The most common comorbidities on admission were hypertension (48%) and diabetes mellitus (42%). The degree of diffusion of DNM according to Endo’s classification was classified as follows: type I in 7 patients (22.6%), type IIA in 5 (16.1%), and type IIB in 19 patients (61.3%). Among these patients, 13 (41.9%) were found to have a single microbial infection, while 16 (51.6%) were found to have polymicrobial infections. In all cases, neck drainage was performed via cervicotomy, with multiple drains (64.5%) and vacuum sealing drainage (VSD) (35.5%). Mediastinal drainage was performed via a cervical mediastinotomy (51.6%), video-assisted thoracic surgery (VATS) (41.9%), or thoracotomy (6.5%). The 30-day mortality rate was 25.8% and 24.0 days of the average length of hospital stay.Conclusions Early accurate diagnosis and timely intervention have been shown to be correlated with a positive prognosis. Cervicothoracic CT (computed tomography) is essential for the diagnosis, staging, and evaluation of the optimal surgical treatment. Cervicotomy and video-assisted thoracoscopic surgery with percutaneous drainage is effective, even in advanced cases. Additionally, the application of VSD in cervical incision did not improve prognosis but may shorten the length of ICU (intensive care unit) and hospital stays.
Cancer driver genes and opportunities for precision oncology revealed by whole genome sequencing 10,478 cancers
Authors: Houlston Richard , Kinnersley Ben , Sud Amit , Everall Andrew , Cornish Alex , Chubb Daniel , Culliford Richard , Gruber Andreas , Lärkeryd Adrian , Mitsopoulos Costas , Consortium GEL Genomics England Research , Wedge David
Published: October 2023

Identifying cancer driver genes is key for delivering the vision of precision oncology. The falling cost of whole genome sequencing (WGS) potentially makes WGS an attractive single all-encompassing test to identify cancer drivers in a patient, which may not be captured by standard panel testing but are targetable by small molecules. We analysed WGS data on 10,478 patients spanning 35 cancer types recruited to the UK 100,000 Genomes Project. We identified 330 driver genes, including 74 which are novel to any cancer. Across all cancer types 16% of the patients would be eligible for a currently approved therapy. Computational chemogenomic analysis of cancer mutations identified 96 additional targets of compounds that are potentially active and represent candidates for future clinical trials, expanding opportunities for improved patient care.
Exhaustive Variant Interaction Analysis using Multifactor Dimensionality Reduction
Authors: Gómez-Sánchez Gonzalo , Alonso Lorena , Pérez Miguel Ángel , Morán Ignasi , Torrents David , Berral Josep Lluis
Published: October 2023

One of the main goals of human genetics is to understand the connections between genomic variation and the predisposition to develop a complex disorder. These disease-variant associations are usually studied in a single independent manner, disregarding the possible effect derived from the interaction between genomic variants. In particular, in a background of complex diseases, these interactions can be directly linked to the disorder and may play an important role in disease development. Although their study has been suggested to help to complete the understanding of the genetic bases of complex diseases, this still represents a big challenge due to large computing demands. Here, we have taken advantage of High-Performance Computing technologies to tackle this problem using a combination of machine learning methods and statistical approaches. As a result, we have created a containerized framework that uses Multifactor Dimensionality Reduction to detect pairs of variants associated with Type 2 Diabetes (T2D). This methodology has been tested in the Northwestern University NUgene project cohort using a dataset of 1,883,192 variant pairs with a certain degree of association with T2D.Out of the pairs studied, we have identified 104 significant pairs, two of which exhibit a potential functional relationship with T2D.
Personalised Learning in Vocational Higher Education: A Model for Diverse Learners
Authors: Fariani Rida , Junus Kasiyah , Santoso Harry
Published: October 2023

Implementing blended learning in vocational higher education (VHE) is more effective considering the characteristics of the VHE curriculum, which is predominantly focused on practical learning and emphasises mastery of specific competencies. Due to the diversity of students in VHE, a 'one size fits all' blended learning design can be developed to be more adaptive and personalised. However, personalised blended learning (p-BL) design still needs to be improved, especially in VHE in Indonesia. Therefore, this paper offers a p-BL model that can be applied in VHE. Through an exploratory sequential mixed methods research design involving a literature review, seven interviews and a survey of 53 VHE lecturers and instructors, we identified the student model, knowledge model and personalisation model as the components of the p-BL model. The student model categorises students based on their knowledge levels and learning styles. The knowledge model annotates learning objects based on the level of difficulty and learning style dimensions. The personalisation model comprises learning objects and assessment recommendations; it also has a suggestion system that provides recommendations for assessment items for students who have failed, and it is recursive until the student passes the assessment. This suggestion system ensures that students master the competencies according to the characteristics of VHE learning in Indonesia. The personalisation process is integrated into blended learning using a station rotation and flexible model. The proposed p-BL model can be a reference for VHE institutions implementing personalised learning in their teaching and learning practices.
The effects of postoperative Trimetazidine treatment on ishaemia-reperfusion injury after isolated surgical myocardial revascularisation
Authors: Stanev Kamen , Rahman Hristo , Darbokliev Svetoslav , Gonovski Todor , Dobreva-Yatseva Bistra , Nachev Gencho
Published: October 2023

Background: The gold standard in managing patients with multi-vessel coronary artery disease (CAD) remains the surgical myocardial revascularization or coronary artery bypass grafting (CABG). Well-known, and described in details, is the pathophysiological process of free radical release in circulation, as a result of increased oxidative stress during the ischemia-reperfusion time and post surgical revascularization procedures. This process could reversibly or irreversibly cause marked myocardial damage.
The focus of the present trial, which is prospective single-blinded, controlled and randomised, is on detecting and analysing the trimetazidine drug effect on decreasing postoperative ischaemia-reperfusion myocardial damage. The aim is the evaluation of trimetazidine effects on reactive oxygen species (ROS), which may appear after myocardial ischemia-reperfusion period or systemic inflammatory response after on-pump surgical revascularization.
Methods: The present study included 90 elective surgery patients, operated through a time frame from March 2018 till October 2018. The studied population was further divided into two subgroups of comparison. The patients of the first subgroup received regular therapy of trimetazidine 35 mg b.d., immediately after tracheal extuba+tion. The rest of the prescribed medical therapy was standard and identical to all the participants of the studied patient population. Pre-and postoperative levels of specific blood biomarkers such as: high-sensitivity troponin T (hs-TnT), creatinine kinase-MB fraction (CK-MB) and malondialdehyde (MDA) were evaluated. The data was analysed and classified at the time of sample collection.
Results: The retrieved data information analysis concluded that regular drug therapy with trimetazidine leads to less malondialdehyde (MDA) release, consequently reduction in oxidative stress and improved cardiomyocyte protection by augmentation of the antioxidant status. The follow-up period was extended and conducted up to 6 months after the surgical revascularization. Excellent results were documented by conducting the Quality of life assessment by Minnesota Living with Heart Failure Questionnaire.
Conclusions: Improvement of myocardial cell metabolism and decreasing the level of postoperative ischemia-reperfusion damage is alleviated by postoperative regular trimetazidine drug therapy.
NKG2D ligand MICA regulates macrophage phenotype through PPAR/EHHADH pathway altering fatty acid oxidation (FAO) in hepatocellular carcinoma (HCC)
Authors: Huang Jingquan , Wu Qiulin , Yang Yan , Du Qiang , Yan Peng , Li Xicai , Yao Ming , Li Jianjun , Huang Yubin , Cai Xiaoyong , Geller David A , Yan Yihe
Published: October 2023

Background Tumor-associated macrophages (TAMs) play a crucial role in the tumor microenvironment (TME), and the metabolic activities of both tumor cells and TAMs have an impact on the TME. Moreover, the expression of MICA in tumor cells is closely associated with immune cells in hepatocellular carcinoma (HCC). However, it remains unclear whether MICA expression correlates with TAMs and influences the switch in macrophage phenotype by mediating metabolic alterations.
Methods Various biostatistical tools, qPCR, and IHC staining experiments were utilized to analyze data from The Cancer Genome Atlas (TCGA) and collected HCC tumor tissues. Single-cell RNA sequencing (scRNA-seq) analyses and a co-culture model of HCC cells with macrophages were performed to validate the findings from the biostatistical analyses.
Results Through the intersection of differentially expressed genes (DEGs), metabolism-related genes (MRGs), and co-expression genes (CEGs) with MICA in HCC, the EHHADH gene was identified. Gene set enrichment analyses were conducted to further confirm the role of EHHADH. EHHADH expression is decreased in HCC tumors and can serve as a prognostic biomarker for HCC. Expressions of MICA and EHHADH exhibited significant correlations with various phenotypic macrophages and exerted opposing effects on M1-like and M2-like macrophages infiltrating HCC. The underlying metabolic and molecular mechanisms revealed that MICA in tumor cells induced M2-like polarization through the PPAR/EHHADH pathway, which regulates fatty acid oxidation (FAO) in both tumor cells and macrophages.
Conclusions The metabolic gene EHHADH, which is associated with MICA, led to alterations in M2-like macrophages by promoting heightened fatty acid uptake and augmenting levels of FAO within macrophages.
Characterization of the interactions between Xanthan Gum and Trypsin with Spectroscopic and Molecular Docking technology
Authors: sun jisheng , wang xiaoxia , nie zhihua , ma litong , sai huazheng , cheng jianguo , liu yunying , duan jianguo
Published: October 2023

The interaction between xanthan gum and trypsin was studied using fluorescence spectroscopy, UV-vis absorption spectroscopy, circular dichroism chromatography, synchronous fluorescence spectroscopy, and molecular docking simulation. The quenching constant (KSV) and dynamic fluorescence quenching rate constant (Kq) were calculated in the study of fluorescence spectra, confirming that trypsin on xanthan gum exhibits static quenching. The interaction distance between xanthan gum and trypsin (r = 2.350 nm) is calculated using Förster theory, indicating non-radiative energy transfer occurs between them. Based on the formula, ΔH, ΔS, ΔG (298K, 303K, 308K) are all negative. Therefore, it can be concluded that the interaction force between xanthan gum and trypsin mainly consists of hydrogen bonds and van der Waals forces. The UV-vis absorption spectra were used to investigate the interaction between the two compounds. It was observed that the absorption peak of trypsin shifted towards longer wavelengths, indicating a change in its conformation. The addition of xanthan gum altered the environment and conformation of tryptophan residues in trypsin molecules, as shown by synchronous fluorescence spectra. The molecular docking simulation method shows that the main forces of xanthan gum and TRY are hydrogen bond and van der Waals force. The findings align with the thermodynamic parameters, suggesting that xanthan gum alters the secondary structure of trypsin. In the three-dimensional fluorescence spectrum, a redshift is observed in the maximum emission wavelengths of PEAK 1 and PEAK 2, indicating structural changes in trypsin upon binding with xanthan gum. Circular dichroic chromatography results demonstrate a significant decrease in β-fold content, implying an effect of xanthan gum on trypsin's structure.
CDH1 methylation analysis in invasive lobular breast carcinomas with and without gene mutation
Authors: González-Martínez Silvia , Kajabova Viera Horvathova , Pérez-Mies Belén , Carretero-Barrio Irene , Sarrió David , Moreno-Bueno Gema , Gión María , Perez-García José , Cortés Javier , Smolkova Bozena , Palacios José
Published: October 2023

The proposed role of CDH1 (E-cadherin gene) methylation as a mechanism of gene inactivation in Invasive Lobular Carcinoma (ILC) remains inconclusive. Using pyrosequencing, we analyzed CDH1 hypermethylation in E-cadherin deficient ILC cases with varied CDH1mutation status and Invasive Breast Carcinomas Non-Special Type (IBC-NSTs), finding no hypermethylation in any group of ILCs. In addition, CDH1 methylation correlated with the presence of Tumor-Infiltrating Lymphocytes (TILs). These findings challenge CDH1 methylation as a CDH1 inactivation mechanism in ILC and highlight TILs as a potential confounding factor in the gene methylation.
A customizable multiplex protein microarray for antibody testing and its application for tick-borne and other infectious diseases.
Authors: Krishnamurthy Hari , Jayaraman Vasanth , Krishna Karthik , Wang Tianhao , Bei Kang , Suresh Chithra , Matilda Shiny , Rai Alex , Welc-Falęciak Renata , Pawełczyk Agnieszka , Blanton Lucas , Chrdle  Aleš , Fořtová Andrea , Růžek Daniel , Nasrallah Gheyath , Abu-Raddadi Laith , Al-Sadeq Duaa , Abdallah Marah , Lilleri Daniele , Fornara Chiara , D'Angelo Piera , Furione Milena , Söderlund-Venerm Maria , Hedman Klaus , Chochlakis Dimosthenis , Psaroulaki Anna , Makridaki Eirini , Ntoula Artemis , Rajasekaran John
Published: October 2023

Tick-borne infections are the most common vector-borne diseases in the USA. Ticks harbor and spread several infections with Lyme disease being the most common tickborne infection in the US and Europe. Lack of awareness about tick populations, specific diagnostic tests, and overlapping symptoms of tick-borne infections can often lead to misdiagnosis affecting treatment and the prevalence data reported especially for non-Lyme tick-borne infections. The diagnostic tests currently available for tick-borne diseases are severely limited in their ability to provide accurate results and cannot detect multiple pathogens in a single run. The multiplex protein microarray developed at Vibrant was designed to detect multiple serological antibodies thereby detecting exposure to multiple pathogens simultaneously. Our microarray in its present form can accommodate 400 antigens and can multiplex across antigen types, whole cell sonicates, recombinant proteins, and peptides. A designed array containing multiple antigens of several microbes including Borrelia burgdorferi, the Lyme disease spirochete, was manufactured and evaluated. The immunoglobulin M (IgM) and G (IgG) responses against several tick-borne microbes and other infectious agents were analyzed for analytical and clinical performance. The microarray improved IgM and IgG sensitivities and specificities of individual microbes when compared with the respective gold standards. The testing was also performed in a single run in comparison to multiple runs needed for comparable testing standards. In summary, our study presents a flexible multiplex microarray platform that can provide quick results with high sensitivity and specificity for evaluating exposure to varied infectious agents especially tick-borne infections.
SAPHO syndrome treated with iguratimod combined with NSAIDs, and bisphosphonates: a prospective cohort study
Authors: Duan Hongji , Gao Shuang , Zhang Lihua , Song Le , Zhai Jiayu , Deng Xiaoli
Published: October 2023

Background
To evaluate the effectiveness of iguratimod combined with NSAIDs, and bisphosphonates treatment for rapid symptom relief in patients with SAPHO syndrome.
Methods
We recruited all patients seen in our unit from 2018 to 2023 diagnosed with SAPHO syndrome, who were treated with iguratimod combined with NSAIDs, and bisphosphonates, and were followed up for 12 weeks.
Results
A total of 19 patients were included. There were 14(73.7%) women and 5(26.3%) men. The average age was 49.5 years old (ranging from 26 to 67 years). During the follow-up period, a total of 5 patients terminated the experiment. 13/14(92.9%) patients responded favourably to the treatment of iguratimod combined with NSAIDs, and bisphosphonates. Younger patients might be better treated by iguratimod combined with NSAIDs, and bisphosphonates (p = 0.038)
Conclusion
Iguratimod combined with NSAIDs, and bisphosphonates seem to be a very effective mode of therapy in quickly relieving the symptoms of patients with SAPHO syndrome. Iguratimod may be a new choice for the treatment of SAPHO syndrome patients.
Design, Implement, and Evaluate the Educational Program based on Dimensions of Quality of Work Life among Emergency Medical Services Employees
Authors: Vasli Parvaneh , Panahi-Qoloub Ali , ZohariAnboohi Sima , Nasiri Malihe
Published: October 2023

Background
Quality of work life is a vital factor for health care providers. This study aimed to design, implement, and evaluate the educational program based on the dimensions of quality of work life among EMS employees.
Methods
The current interventional study was conducted on 100 emergency medical services employees in Tehran, Iran, who were chosen using a convenience sampling method (50 in the intervention group and 50 in the control group). The information was gathered using a Demographic questionnaire and a Walton quality of work life questionnaire with eight dimensions. The research was carried out in three stages: design, implementation, and evaluation of the educational program. During the design phase, the educational needs of the participants were determined in terms of the dimensions of the quality of work life and work and total living space. The educational program on work-life quality was implemented in four virtual group sessions, emphasizing the educational needs identified through uploading educational content to the WhatsApp application. The evaluation was conducted in two stages: before the educational program and three months after the program. With a significance level of 0.05, the data was analyzed using SPSS version 24 software.
Results
The results revealed that an education program on the quality of work life and its dimensions, emphasizing strategies to improve work and total living space, can improve the score of this dimension in the intra-group comparison of both the intervention and control groups (p = 0.046), as well as in the inter-group comparison, at the three-month post-intervention stage, there is a significant difference and a significant increase (p = 0.030), but it does not have a significant effect on the quality of work life and its other dimensions.
Conclusion
It is recommended that emergency medical services managers plan to improve the quality of working life of their employees, particularly in terms of work and total living space.
Early Cretaceous Equisetites from Slovakia
Authors: Kvaček Jiří , Čerňanský Andrej
Published: October 2023

A new find of terrestrial plant Equisetites cf. lyellii is reported from the Early Cretaceous of Slovakia. It comes from the Mráznica Formation of the Rajec Basin in Fatricum, Zbyňov locality, Rajecké Teplice (Žilina district). The presence of a 53 mm long horsetail axis, which cannot float a long distance, provides good evidence of terrestrial environments during sedimentation of the studied strata. According to our interpretation such a plant strongly indicates a moist to wet habitat (even swampy environments) on the presumed dryland from where it was transported. This dryland could represent an isolated unknown small island(s) in the vicinity or the Vindelician-Bohemian Massif that was active as a dryland for the entire period of time from the Triassic through the Late Cretaceous. Note, however, that the exact paleogeographic position of Fatricum during Mesozoic in relation to Vindelician Land is not entirely clear and such an interpretations need to be met with a caution.
Resolvent model for aeroacoustics of trailing-edge noise
Authors: Demange Simon , Yuan Zhenyang , Jekosch Simon , Hanifi Ardeshir , Cavalieri André V. G. , Sarradj Ennes , Kaiser Thomas L. , Oberleithner Kilian
Published: October 2023

This study presents a physics-based, low-order model for the trailing-edge (TE) noise generated by an airfoil at low angle of attack. The approach employs incompressible resolvent analysis of the mean flow to extract relevant spanwise-coherent structures in the transitional boundary layer and near wake. These structures are integrated into Curle's solution to Lighthill's acoustic analogy to obtain the scattered acoustic field. The model has the advantage of predicting surface pressure fluctuations from first principles, avoiding reliance on empirical models, but with a free amplitude set by simulation data.
The model is evaluated for the transitional flow (Re = 5e4) around a NACA0012 airfoil at 3 deg angle of attack, which features TE noise with multiple tones. The mean flow is obtained from a compressible large eddy simulation, and spectral proper orthogonal decomposition (SPOD) is employed to extract the main hydrodynamic and acoustic features of the flow.
Comparisons between resolvent and SPOD demonstrate that the physics-based model accurately captures the leading coherent structures at the main tones' frequencies, resulting in a good agreement of the reconstructed acoustic power with that of the SPOD (within 4 dB). Discrepancies are observed at high frequencies, likely linked to nonlinearities that are not considered in the resolvent analysis. The model's directivity aligns well with the data at low Helmoltz numbers, but it fails at high frequencies where the back-scattered pressure plays a significant role in directivity. This modeling approach opens the way for efficient optimization of airfoil shapes in combination with low-fidelity mean-flow solvers to reduce TE noise.
Evaluation of four ornamental plant extracts as insecticidal, antimicrobial, and antioxidant against the West Nile vector, Culex pipiens (Diptera: Culicidae) and metabolomics screening for potential therapeutics
Authors: Baz Mohamed M. , Mostafa Reham M. , Ebeed Heba Talat , Essawy Heba S. , Dawwam Ghada E. , Darwish Ahmed B. , El-Shourbagy Nancy M.
Published: October 2023

Mosquitoes, one of the deadliest animals on the planet, cause millions of fatalities each year by transmitting several human illnesses. Phytochemicals are possible biological agents for controlling pests that are harmful to both human and animal health as well as crops. Plants contain a wide range of potential phytochemicals that are target-specific, rapidly biodegradable, and eco-friendly. The potential of leaf extracts of Bougainvillea glabra, Delonix regia, Lantana camara, and Platycladus orientalis against Culex pipiens and microbial agents was evaluated. Acetone extracts had more toxic effects against Cx. pipiens larvae (99.0–100%, 72 h post-treatment), and the LC50 values were 142.8, 189.5, 95.4, and 71.1 for B. glabra, D. regia, L. camara, and P. orientalis, respectively. Plant extracts tested in this study showed high insecticidal and antimicrobial potential. L. camara acetone extract inhibited all the tested microbial isolates. D. regia showed higher antioxidant activity than other plant extracts in scavenging free radicals. GC-MS results showed the acetone extract had a higher number of chemical classes, with more terpene compounds. HPLC analysis showed the presence of flavonoids and phenolic compounds in L. camara and P. orientalis acetone extracts, and Sylimarine and Rutin were the most abundant. ADME analysis of elemene, caryophyllene oxide, caryophyllene, and copaene showed drug-likeness and revealed better gastrointestinal absorption and permeation of the blood-brain barrier by all the tested phytochemicals. Our results confirm that the diversity of phytochemicals found in ornamental plants has promising larvicidal activity and is a safe and effective alternative to chemical insecticides and biotechnology.
Diagnostic performance of muscular ultrasound in intensive care unit-acquired weakness: a systematic review and Meta-analysis
Authors: Gu Bin , Zhou Yu , Shi Rui , Miao Shumin , Pei Fei , Yuan Hao , Wang Luhao , Chen Minying , Liu Yongjun , Liu Zimeng , Nie Yao , Teboul Jean-Louis , Si Xiang , Guan Xiangdong , Wu Jianfeng
Published: October 2023

Background
The performance of muscular ultrasound in diagnosing intensive care unit (ICU)-acquired weakness (ICUAW) is debated. We conducted this systematic review and meta-analysis to assess the diagnostic efficacy of muscular ultrasound in ICUAW.
Methods
Three researchers independently searched PubMed, Web of Science, Embase, Cochrane library, CNKI, VIP and Wanfang databases for articles published before May 2023. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was employed to evaluate the methodological quality of the studies. A random-effects model was utilized to drive the summary estimates of sensitivity, specificity, and diagnostic odds ratio (DOR) with 95% confidence interval (CI), and summary receiver operating characteristic (SROC) curve was estimated. Additionally, a Fagan nomogram was constructed to calculate the post-test probabilities. Sources of heterogeneity were explored by subgroup analysis and meta-regression.
Results
This meta-analysis comprised nine prospective studies involving 485 participants, of whom 207 (42.68%) were diagnosed as ICUAW. Overall, the muscular ultrasound exhibited good performance for diagnosing ICUAW, with the area of SROC curve of 0.84 (95%CI 0.81–0.87), sensitivity of 0.76 (95%CI 0.70–0.82), specificity of 0.79 (95%CI 0.73–0.83), and DOR of 11.61 (95%CI 7.43–18.13). The included studies exhibited heterogeneity. Upon subgroup analysis, rectus femoris exhibited significantly superior discriminatory ability in identifying ICUAW when compared to the non-rectus femoris, with higher specificity (0.84 [95%CI 0.76–0.90] versus 0.71 [95%CI 0.64–0.77], p = 0.04) and SROC (0.89 [95%CI 0.86–0.91] versus 0.76 [95%CI 0.72–0.79], p < 0.01). Moreover, cross-sectional area was more effective than thickness, with higher specificity (0.84 [95%CI 0.77–0.89] versus 0.74 [95%CI 0.68–0.79], p = 0.02) and SROC (0.85 [95%CI 0.82–0.88] versus 0.76 [95%CI 0.72–0.80], p < 0.01). Furthermore, the integrated analysis of these two indicators revealed that the cross-sectional area of rectus femoris was statistically superior to the thickness of rectus femoris, with higher SROC (0.87 [95%CI 0.83–0.89] versus 0.80 [95%CI 0.76–0.83], p < 0.01).
Conclusion
Muscular ultrasound has potential to be a reliable tool for ICUAW diagnosis. Comparing to alternative indices, the cross-sectional area of the rectus femoris exhibits superior diagnostic efficacy and may be considered as a valuable parameter for clinical application.
WITHDRAWN: A reliability analysis method for industrial robots based on double hierarchy hesitant fuzzy linguistic term set and TODIM
Authors: Zheng Xiuli , Wang Hui , Dai Jinkun
Published: October 2023

Failure mode and effect analysis (FMEA) is the most commonly used method for quality and reliability analysis of industrial robots. FMEA is important for improving the quality and reliability of industrial robots by identifying potential failure modes and analyzing possible consequences. In order to enable FMEA method to solve relevant engineering problems in complex and uncertain working environment of industrial robots, this paper proposes a reliability analysis method based on double hierarchy hesitant fuzzy linguistic term set(DHHFLTS) and tomada de decisao interativa e multicritevio (TODIM). First, in complex and uncertain environments, we use a DHHFLTS for failure mode evaluation, which can truly portray people's hesitation in this particular environment. Then, the weights of each influencing factor are calculated according to the maximum deviation method of evaluation information. The maximum deviation method allows for capability gaps between evaluation members, i.e., it does not need to calculate the weight of evaluation members separately, which simplifies the calculation process of the method. Finally, the relative dominance and global dominance of failure modes are calculated by TODIM, and then the failure modes are ranked according to the global dominance. At the end of the paper, an example of failure mode analysis for a six-axis industrial robot is used to show the specific implementation process of this method and to prove the practicability and reliability of this method.
Supramolecular Catalyst with [FeCl4] Unit Boosting Photoelectrochemical Seawater Splitting via Water Nucleophilic Attack Pathway
Authors: Zhang Kan , Miao Jiaming , Lin Cheng , Yang Yan , Li Zhaosheng
Published: October 2023

Propelled by the structure of water oxidation co-catalysts in natural photosynthesis, molecular co-catalysts have been believed for a long time to possess the developable potential in artificial photosynthesis. However, the interfacial complexity between a light absorber and the molecular co-catalyst limits its structure stability against pH value and charge transfer efficiency. To overcome the challenge, a supramolecular scaffold with the catalytic unit instead of the molecular structure is, for the first time, reported. It is found that the [FeCl4] catalytic sites in the supramolecular matrix (polythiophene, polyaniline, or polypyrrole) undergo a water-nucleophilic attack defining the rate-limiting step of the water oxidation reaction, while the supramolecular matrix can be in situ grown on the surface of photoelectrode to enable a strongly coupled interface. A well-defined BiVO4 photoanode surface hybridized with [FeCl4] catalytic sites in polythiophene matrix reaches 4.72 mA cm− 2 at 1.23 V vs reversible hydrogen electrode under AM 1.5 G illumination, which also exhibits great stability for photoelectrochemical seawater splitting due to the restraint on chlorine evolution reaction by [FeCl4] unit, the anti-corrosion ability of polythiophene as well as the strongly coupled interface. This work provides a novel solution to the challenge of the interface charge transfer of molecular co-catalyst hybridized photoelectrode.
The Buffer Role of Emotions in International Conflict: Theoretical Evidence Supporting for Patriotic Education
Authors: Zhang Zhengping
Published: October 2023

Some scholars express concerns that patriotic education may increase the risk of international conflict by making people more emotional. However, their research may overlook other countries’ challenges to the status quo before international disputes. In this research, we use the behavioural economic paradigm and introduce four emotions into a two-stage bargaining model to study the role of emotions in forming and preventing international conflict. By comparing the subgame perfect Nash equilibria of the bargaining game, we draw the following conclusions: when the strength of two countries matches their initial resource shares, neither side has the incentive to initiate a conflict. However, one side is motivated to provoke a dispute when a mismatch occurs. The negative emotions arising from compromising with other countries and facing other countries’ resistance serve as a buffer to some extent. Patriotic education elicits national-dignity-related emotions among the populace, thereby reducing the occurrence of conflict to some extent. This research may contribute to the field of international relations through the lens of behavioural game theory and offer some game-theoretical insights into the impact of patriotic education and emotions on international conflict.
Evaluation of the efficacy and safety of preoperative intravitreal triamcinolone acetonide combined with internal limiting membrane peeling for the treatment of idiopathic macular epiretinal membrane
Authors: Wang Jie , Liu Yuyan , Chu Yanhua , Han Gouge , Han Quanhong
Published: October 2023

Purpose
To assess the efficacy and safety of preoperative intravitreal triamcinolone acetonide (IVTA) combined with internal limiting membrane (ILM) peeling for idiopathic epiretinal membrane (IMEM).
Methods
This was a retrospective study. Thirty-six phakic eyes of 35 patients were included in this study. IVTA was administered to 18 patients (18 eyes, Group IVTA) 7 days before vitrectomy, while the other 17 patients (18 eyes, Group no-IVTA) only underwent vitrectomy and ILM peeling. Patients were followed up for at least 6 months. Data on best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), inner retinal thickness (IRT), vascular parameters (measured by optical coherence tomography angiography, OCTA), mean macular sensitivity (MMS), 63% bivariate contour ellipse area (BCEA) and P1 (measured by macular integrity assessment, MAIA) were collected.
Results
There were significant differences in BCVA and IRT between the IVTA group and the no-IVTA group at 6 months after surgery (P = 0.000 and P = 0.010). The CMT and MMS of the two groups significantly changed from the preoperative values; however, there were no differences between the 2 groups during the entire study period (P = 0.242 and P = 0.849). The changes in vascular parameters, including foveal avascular zone (FAZ) area and vessel densities of superficial and deep capillary plexus (SCP VD and DCP VD), in the two groups were not statistically significant. There were no statistically significant differences in 63% BCEA and P1 either.
Conclusion
Macular morphology and macular integrity improved after vitrectomy combined with ILM peeling surgery. Compared with the no-IVTA group, preoperative intravitreal triamcinolone acetonide can improve best corrected visual acuity and accelerate the absorption of intraretinal fluid in terms of a significant reduction in IRT.
Thrombospondin-1 promotes liver fibrosis by enhancing TGF-β action in hepatic stellate cells
Authors: Imamori Makoto , Hosooka Tetsuya , Imi Yukiko , Hosokawa Yusei , Yamaguchi Kanji , Itoh Yoshito , Ogawa Wataru
Published: October 2023

Insulin resistance in adipose tissue is thought to be a key contributor to the pathogenesis of various metabolic disorders including metabolic dysfunction-associated steatotic liver disease /metabolic dysfunction-associated steatohepatitis (MASLD/MASH), but the mechanism underlying this contribution to MASLD/MASH has remained unknown. We previously showed that dysregulation of the PDK1-FoxO1 signaling axis in adipocytes plays a role in the development of MASLD/MASH by analysis of adipocyte-specific PDK1 knockout (A-PDK1KO) and adipocyte-specific PDK1/FoxO1 double-knockout (A-PDK1/FoxO1DKO) mice. We here focused on the role of the extracellular matrix protein thrombospondin-1 (TSP-1) as a secreted factor whose expression in adipose tissue is increased in A-PDK1KO mice and normalized in A-PDK1/FoxO1DKO mice. Genetic ablation of TSP-1 markedly ameliorated liver fibrosis in A-PDK1KO mice fed a high-fat diet. With regard to the potential mechanism of this effect, TSP-1 augmented the expression of fibrosis-related genes induced by transforming growth factor–β (TGF-β) in LX-2 human hepatic stellate cells. We also showed that TSP-1 expression and secretion were negatively regulated by insulin signaling via the PDK1-FoxO1 axis in cultured adipocytes. Our results thus indicate that TSP-1 plays a key role in the pathogenesis of liver fibrosis in MASH, and they implicate TSP-1 as an important adipokine linking adipose tissue insulin resistance to MASH.
The causal relationship between Emotions and Osteoarthritis: A Bidirectional Mendelian Randomization study
Authors: Pan Yu , Jin Xiaoliang , Zhou Qiujun , Jin Minwei
Published: October 2023

Background
Osteoarthritis is a global joint disease and its prevalence is still rising. At the same time, emotion disorder is also a huge problem in the whole world, previous studies suggested the relationship between emotion disorder and osteoarthritis. However, the causality effect is still unknown.
Method
A bidirectional Mendelian randomization study was designed to estimate the causality effect of emotion on osteoarthritis. The instrument single nucleotide polymorphisms were screened from open Genome-Wide Association Study summary (GWASs) datasets. The Inverse-Variance Weighted was deemed as the main effect, and the MR_Egger, Weighted Medium, Weighted mode, and Simple Mode were performed to complement the results.
Results
The emotions of depression, anxiousness, and feeling hurt were genetic effects of the development of osteoarthritis. Among them, the anxiousness was relegated to the risk of osteoarthritis (Odds Ratio [OR] 0.49, 95% Confidence Interval [CI] 0.26–0.91). The emotion of depression (OR 2.16, 95% CI 1.61–2.90) and hurt (OR 1.73, 95% CI 1.09–2.75) promoted the risk of osteoarthritis at the genetic level.
Conclusion
The emotion was genetic effect the risk of osteoarthritis, especially depression and feeling hurt.
Long time consequences after STARR procedure: report of 15 years experience and medico-legal perspective
Authors: Andreoli Remo , Zampieri Nicola , Orlandi Simone , Geccherle Andrea , Castellani Roberto L
Published: October 2023

Introduction
Stapled transanal rectal resection is the most surgical procedure used for obstructed defecation syndrome , rectal prolapse , rectocele and rectal intussusception worldwide.
The aim of this study is to report our experience and long time consequences and to offer a new medico-legal perspective.
Materials and methods
We retrospective review medical charts of patients treated between 2006 and 2021 by the same team directed by the same senior surgeon. We consider major complications and long time sequelaeses as main object for the discussion. Inclusion and exclusion criteria were created. IRB approved the study. After revision a medico-legal perspective was done based on major complications.
Results
During the study period 1726 patients, ages between 18 and 71 years old, were treated with 1280 STARR procedures and 446 “Longo”[was stopped on 2012]; all procedures were performed by the senior surgeon and visited by the team at the same control visit at 7days, 30 days and 12 and 18 months after surgery. All patients had 100% compliance at 30 days, while 85% had long time visit (more than 18 months). During the study period 6% (104subjects) of patients had minor complications while 1 patient (42 yrs female) reported total fecal incontinence after 18 months (0,05%). This patient had mental disorder treated with drugs unknown before surgery and long time mental disorder after surgery. We focused on this last case to discuss long time complications.
Conclusions
This survey reports some interesting clinical data; respect to standard complications minor complications such as pain, bleeding and anal discomfort represent less than 10% of procedures that is a good results in this perineal surgery. For those working with rectal mucosal prolapse, obstructed defecation syndrome, rectocele or rectal intussusception is essential to distinguish these diagnosis to have a good counselling with patient before surgery (at least 1 month before). It is essential to check these patients with a close follow-up especially after surgery, to avoid any other mental discomfort related to fecal incontinence; long time fecal incontinence, without anatomical disorders as our case, could be associated and related to drugs consumption or mental disorder, or perineal insensitivity due to surgical procedure. In conclusion it is essential to have good clinical practice to suggest STARR procedure, having idea about different diseases, different surgical approaches and different long time complications.
A rare case of congenital cardiac malformation: 3D imaging of the abnormal origin of the right coronary artery
Authors: Dikici Rumeysa , Avnioglu Seda , Oncel Ramazan Can
Published: October 2023

Objective: Coronary artery anomalies (CAAs) are one of the anomalies that are usually detected incidentally during coronary angiography. The abnormal origin of the right coroner artery (RCA) from the left coronary sinus of valsalva accounts for 0.02% to 0.2% of all abnormal coronary artery origins. In the presentation of this rare case, we aimed to examine the tomography images of the patient whose right coronary artery was determined to originate from the left coronary sinus of valsalva and to provide a better understanding by 3D modeling.
Case: A 39-year-old female patient was admitted to the cardiology clinic with complaints of chest pain that had been going on for 6 months and getting tired easily when exercising, going up and down stairs, and walking. Clinical examination and coronary computer tomography (CT) scans were performed, and it was determined that RCA originated from the left coronary sinus of valsalva. The right coronary artery follows an interatrial course between the aorta and the pulmonary artery, and it is thought that there is 70-90% stenosis in the right coronary artery. In addition, subcapsular lesions of 30x20 mm and 15x15 mm in size were observed in the sliced liver, showing contrast enhancement in the arterial phase. It was recommended that the patient be evaluated together with dynamic liver CT and MRI information.
Conclusion: Our patient is a rare case with abnormal origin of the RCA from the left sinus of Valsalva and possibly permanent asymptomatic tachycardia. Creating a 2D CT image of the case used in the clinic in 3D will help clinicians understand both the course of the RCA and how the RCA becomes compressed between the aorta and the pulmonary artery.
Effects of confounding and effect-modifying lifestyle, environmental and medical factors on risk of radiation-associated cardiovascular disease
Authors: Little Mark P , Boerma Marjan , Bernier Marie-Odile , Azizova Tamara V , Zablotska Lydia B , Einstein Andrew J , Hamada Nobuyuki
Published: October 2023

Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. It has been known for some considerable time that radiation is associated with excess risk of CVD. A recent systematic review of radiation and CVD highlighted substantial inter-study heterogeneity in effect, possibly a result of confounding or modifications of radiation effect by non-radiation factors, in particular by the major lifestyle/environmental/medical risk factors.
Methods: We assessed effects of confounding by lifestyle/environmental/medical risk factors on radiation-associated CVD and investigated evidence for modifying effects of these variables on CVD radiation dose-response, using data assembled for a recent systematic review.
Results: There are 42 epidemiologic studies which are informative on effects of adjustment for confounding or risk modifying factors on radiation-associated CVD. Of these 22 were studies of groups exposed to substantial doses of radiation for therapy or diagnosis. The remaining 20 studies were of groups exposed at much lower levels of dose and/or dose rate. Only four studies suggest substantial effects of adjustment for lifestyle/environmental/medical risk factors on radiation risk of CVD; however, there were also substantial uncertainties in the estimates in all of these studies. There are fewer suggestions of effects that modify the radiation dose response; only two studies, both at lower levels of dose, report the most serious level of modifying effect.
Conclusions: There are still large uncertainties about confounding factors or lifestyle/environmental/medical variables that may influence radiation-associated CVD, although indications are that there are not many studies in which there are substantial confounding effects of these risk factors.
Diagnosis (by p-RIFLE and KDIGO) and risk factors of acute kidney injury in pediatric diabetic ketoacidosis
Authors: Likhitha Siddarajaiah , Rameshkumar Ramachandran , Delhikumar Chinnaiah Govindhareddy , Selvan Tamil
Published: October 2023

Objective
To study the extent of agreement in diagnosis (by p-RIFLE and KDIGO serum creatinine criteria) and risk factors of acute kidney injury (AKI) in pediatric diabetic ketoacidosis (DKA).
Method
A retrospective cohort study involving children aged ≤ 15 with DKA was conducted between January 2014 and December 2022. Inborn errors of metabolism, septic shock, and urinary tract disease were excluded. The primary outcome was the extent of agreement in diagnosis by p-RIFLE and KDIGO. The secondary outcomes were staging agreement, risk factors, complications, time to resolution of DKA, and hospital stay, including PICU.
Results
161 patients' data were enrolled. Mean (SD) age was 8.6 (3.7) years. Good agreement between p-RIFLE and KDIGO criteria for diagnosis of AKI was noted at admission (Kappa = 0.71, p = < 0.001; sensitivity of 100% and specificity of 62%), at 24 hours (Kappa = 0.73, p = < 0.001; sensitivity of 100% and specificity of 72.2%) and at discharge (Kappa = 0.70, p = < 0.001; sensitivity of 100% and specificity of 77%) and also noted for the staging of AKI at admission (Kappa = 0.81, p = < 0.001), at 24 hours (Kappa = 0.73, p = < 0.001) and at discharge (Kappa = 0.70, p = < 0.001). On multivariate analysis, age (≤ 10-year: aOR = 3.28, 95%CI 1.51–7.10) and the severity of DKA (moderate: aOR = 4.18, 95%CI 1.18–14.79; severe: aOR = 4.93, 95%CI 1.29–18.80) were independent risk factors for AKI at 24-hour by KDIGO. Cerebral edema (n = 6, 3.7%), hypoglycemia (n = 66, 41%), and hypokalemia (n = 59, 36.6%) were noted. There was no difference in the resolution of DKA and hospital stay in AKI vs. no-AKI groups.
Conclusion
p-RIFLE and KDIGO serum criteria showed good agreement in diagnosing and staging AKI in pediatric DKA.