bluuebunny/crossref_metadata_2025 huggingface dataset:
Socio-hygienic and clinical-microbiological features of the formation of reproductive health disorders in adolescent girls
Authors:   N. A. Semashko National Research Institute of Public Health, Zhelezova P. V. , Nepomnyashchaya G. G. ,   N. A. Semashko National Research Institute of Public Health, Mingazova E. N. ,   N. A. Semashko National Research Institute of Public Health,   Kazan State Medical University.
Published: February 2023

Studies show that inflammatory diseases of the small pelvis and inflammatory diseases of the external genital organs are risk factors for the formation of reproductive health disorders in adolescent girls, the reason for seeking advice and treatment in outpatient and inpatient medical organizations. It is generally believed that pelvic inflammatory disease, as a consequence of the activity of a polymicrobial infection, usually occurs in sexually active women and is rare in young women and adolescent girls who are not sexually active. However, worldwide the prevalence of pelvic inflammatory disease remains quite high among children and adolescent girls of prepubertal and sexually inactive age. In contrast, inflammatory gynecological diseases of the external genital organs are considered a common pathology in girls of early and prepubertal age, however, studies show that they are common among adolescent girls due to the high prevalence of risk factors. Early diagnosis and treatment of pelvic inflammatory disease (PID) in adolescent girls is essential to ensure fertility and reproductive health in this population.
Surgical Treatment of Single-Level Lumbar Stenosis Is Associated with Lower 2-Year Mortality and Total Cost Compared with Nonsurgical Treatment
Authors: Hwang Raymond W. , Briggs Catherine M. , Greenwald Scott D. , Manberg Paul J. , Chamoun Nassib G. , Tromanhauser Scott G.
Published: February 2023

Background:

Spine surgery has demonstrated cost-effectiveness in reducing pain and restoring function, but the impact of spine surgery relative to nonsurgical care on longer-term outcomes has been less well described. Our objective was to compare single-level surgical treatment for lumbar stenosis, with or without spondylolisthesis, and nonsurgical treatment with respect to patient mortality, resource utilization, and health-care payments over the first 2 years following initial treatment.

Methods:

A retrospective review of the Medicare National Database Fee for Service Files from 2011 to 2017 was performed. A 2-year prediction of mortality risk (risk stratification index, RSI) was used as a measure of patient baseline health. Patients (88%) were matched by RSI and demographics. Mortality, spine-related health-care utilization, and 2-year total Medicare payments for patients undergoing surgical treatment were compared with matched patients undergoing nonsurgical treatment.

Results:

We identified 61,534 patients with stenosis alone and 83,813 with stenosis and spondylolisthesis. Surgical treatment was associated with 28% lower 2-year mortality compared with matched patients undergoing nonsurgical treatment. Total Medicare payments were significantly lower for patients with stenosis alone undergoing laminectomy alone and for patients with stenosis and spondylolisthesis undergoing laminectomy with or without fusion compared with patients undergoing nonsurgical treatment. There was no significant difference in mortality when fusion or laminectomy was compared with combined fusion and laminectomy. However, laminectomy alone was associated with significantly lower 2-year payments when treating stenosis with or without spondylolisthesis.

Conclusions:

Surgical treatment for stenosis with or without spondylolisthesis within the Medicare population was associated with significantly lower mortality and total medical payments at 2 years compared with nonsurgical treatment, although residual confounding could have contributed to these findings.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Orthostatic Intolerance-Type Events Following Hip and Knee Arthroplasty
Authors: de Campos Tarcisio F. , Vertzyas Nick , Wolden Mitch , Hewawasam Deshitha , Douglas Ben , McIllhatton Christopher , Hili Jessica , Molnar Chloe , Solomon Michael I. , Gass Gregory C. , Mungovan Sean F.
Published: February 2023

Background:

Orthostatic intolerance (OI)-type events following hip and knee arthroplasty increase the risk of falls, hospital length of stay, and health-care costs. There is a limited understanding of the incidence of and risk factors for OI-type events in patients during the acute hospital stay. Our aim was to systematically review the incidence of and risk factors for OI-type events during the acute hospital stay following hip and knee arthroplasty.

Methods:

A systematic review and meta-analysis of studies that investigated the incidence of and risk factors for OI-type events was undertaken. A comprehensive search was performed in MEDLINE, Embase, and CINAHL from their inception to October 2021. The methodological quality of identified studies was assessed using the modified version of the Quality in Prognosis Studies (QUIPS) tool.

Results:

Twenty-one studies (14,055 patients) were included. The incidence was 2% to 52% for an OI event, 1% to 46% for orthostatic hypotension, and 0% to 18% for syncope/vasovagal events. Two studies reported female sex, high peak pain levels (>5 out of 10) during mobilization, postoperative use of gabapentin, and the absence of postoperative intravenous dexamethasone as risk factors. There was no consensus on the definition and assessment of an OI-type event.

Conclusions:

OI-type events are common during the acute hospital stay following hip and knee arthroplasty, and 4 risk factors have been reported for OI-type events. High-quality prospective cohort studies are required to systematically and reliably determine the incidence of and risk factors for OI-type events.

Level of Evidence:

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
A Different Take on Lumbar Stenosis
Authors: Tobert Daniel G.
Published: February 2023

Update

This article was updated on February 23, 2023, because of a previous error. In the subtitle on page e12, the name that had read “Robert W. Hwang” now reads “Raymond W. Hwang.”

An erratum has been published: J Bone Joint Surg Am. 2023 Apr 5;105(7):e22.
Iatrogenic Nerve Injuries of the Upper Extremity
Authors: Crowe Christopher S. , Shin Alexander Y. , Pulos Nicholas
Published: February 2023

» Iatrogenic nerve injuries may occur after any intervention of the upper extremity.

» Causes of iatrogenic nerve lesions include direct sharp or thermal injury, retraction, compression from implants or compartment syndrome, injection, patient positioning, radiation, and cast/splint application, among others.

» Optimal treatment of iatrogenic peripheral nerve lesions relies on early and accurate diagnosis.

» Advanced imaging modalities (e.g., ultrasound and magnetic resonance imaging) and electrodiagnostic studies aid and assist in preoperative planning.

» Optimal treatment of iatrogenic injuries is situation-dependent and depends on the feasibility of direct repair, grafting, and functional transfers.
Team Approach: Management of Pathologic Fractures
Authors: Hammad Aws , Ahmed Osman , Connell Philip P. , Olson Daniel , Balach Tessa
Published: February 2023

» Optimal care for pathologic fractures centers on the use of a multidisciplinary team; thus, whenever there is a concern for pathologic fracture and proper workup is unable to be performed, prompt referral to a center equipped to manage these injuries should occur.

» Fixation strategies for pathologic fractures must take into account patient characteristics, cancer subtypes, and overall goals of treatment.

» As the treatments of cancers improve, patient life expectancy with disease will improve as well. This will lead to an increase in the incidence of impending or completed pathologic fractures. The broader subspecialties of orthopaedics must be aware of general principles in the diagnosis and management of these injuries.
Complications and Outcomes After Surgical Intervention in Clavicular Nonunion
Authors: Yetter Thomas , Harper Jacob , Weatherby Paul J. , Somerson Jeremy S.
Published: February 2023

Background:

Surgical repair of clavicle fractures is being employed more frequently, although most fractures are still treated conservatively. Both can result in nonunion. Current treatments for clavicle nonunion include open reduction with internal fixation (ORIF) plating without bone graft, ORIF plating with bone graft, and intramedullary pin fixation.

Methods:

We performed a systematic review and meta-analysis of studies reporting outcome, complication, and reoperation rates following surgical treatment for clavicle nonunion. Subgroup analysis was undertaken for outcome and complication rates between single plating and intramedullary pin fixation, bone graft use, and nonunion time length definition.

Results:

Fifty-three studies met inclusion criteria (1,258 clavicle nonunions). Mean clinical follow-up was 2.6 years. Seventy-two percent of nonunions were of the middle third, 1% were proximal third, 12% were distal third, and 15% were not reported. Forty-eight percent of nonunions were atrophic or oligotrophic and 17% were hypertrophic (35% not reported). Mean time to union was 13.6 weeks. Ninety-five percent of patients achieved union after the primary nonunion surgery. Overall complication rate was 17%. Single-plating fixation had significantly faster union time (15.2 vs. 19.8 weeks), lower reoperation rate (23% vs. 37%), and hardware removal rate (20% vs. 34%) than intramedullary pin fixation. Bone graft had significantly lower rates of delayed union (0.6% vs. 3.6%) but higher complication (15% vs. 8%) and reoperation rates (29% vs. 14%) than the other groups. Studies that defined nonunion after 3 months had significantly faster union times than the 6-month studies (13 vs. 16 weeks). The 3-month group had a significantly lower overall complication rate (12% vs. 25%) and hardware/fixation failure rate (3% vs. 5.5%) than the 6-month group.

Conclusions:

This systematic review is the largest report of complications, reoperations, and patient outcomes of clavicle nonunions after surgical intervention in the current literature. Plating showed faster time to union and lower reoperation rates than intramedullary pin fixation. Bone graft use showed lower rates of delayed union but substantially higher rates of complications and reoperations. Reports with a definition of nonunion at 3 months showed faster union times and lower complication rates compared to reports with a definition of nonunion that was 6 months or greater. Surgery could be considered at 3 months post-injury in cases of symptomatic non-united clavicle fracture, and plating results in reliable outcomes. Adjuvant bone grafting requires further study to determine its value and risk/benefit ratio.

Level of Evidence:

Level IV, Systematic Review. See Instructions for Authors for a complete description of levels of evidence.
The Biomechanical Burden of Orthopaedic Procedures and Musculoskeletal Injuries Sustained by Orthopaedic Surgeons
Authors: Xu Amy L. , Covarrubias Oscar G. , Yakkanti Ramakanth R. , Sotsky Rachel B. , Aiyer Amiethab A.
Published: February 2023

Background:

Orthopaedic surgeons are at high risk for experiencing work-related musculoskeletal (MSK) injuries and chronic pain due to repetitive large magnitude forces, altered posture from lead vests, and prolonged irregular body positions. We sought to synthesize available evidence regarding (1) the biomechanics of orthopaedic surgery and (2) MSK injuries sustained by orthopaedic surgeons with subsequent treatment and consequences.

Methods:

To conduct this systematic review, we queried 4 databases (PubMed, Embase, MEDLINE, and Web of Science) for original research studies presenting on the biomechanics of orthopaedic surgery or MSK injuries sustained by orthopaedic surgeons. Studies were excluded if they were not original research (i.e., reviews) or reported on non-MSK injuries and injuries in patients or nonorthopaedic specialists. The literature search yielded 3,202 publications, 34 of which were included in the final analysis.

Results:

Eight studies reported on the biomechanics of orthopaedic surgery. Surgeons spent an average 41.6% of operating time slouched. Head and whole spine angles were closest to natural standing position when using a microscope for visualization and with higher surgical field heights. Use of lead aprons resulted in a shifted weight distribution on the forefoot, gain in thoracic kyphosis, and increase in lateral deviation from postural loading. Twenty-six studies reported on MSK symptoms and injuries experienced by orthopaedic surgeons, with an overall prevalence from 44% to 97%. The most common body regions involved were lower back (15.2%-89.5%), hip/thigh (5.0%-86.6%), neck (2.4%-74%), hand/wrist (10.5%-54%), shoulder (7.1%-48.5%), elbow (3.1%-28.3%), knee/lower leg (7.9%-27.4%), and foot/ankle (7%-25.7%). Of surgeons with any reported MSK symptom or injury, 27% to 65.7% required nonoperative treatment, 3.2% to 34.3% surgery, and 4.5% to 31% time off work. Up to 59.3% of surgeons reported that their injuries would negatively influence their ability to perform surgical procedures in the future.

Conclusions:

The orthopaedic surgeon population experiences a high prevalence of MSK symptoms and injuries, likely secondary to the biomechanical burdens of tasks required of them during strenuous operations.

Level of Evidence:

Level III. See Instructions for Authors for a complete description of levels of evidence.
Chemical and Physical Characteristics of Twenty One Sweet Potato Genotypes Collected from Malaysia
Authors: Utomo Joko Susilo , Ginting Erliana
Published: February 2023

The chemical and physical characteristics of sweet potatoes are essential in terms of quality and preference of the products. Breeding of sweet potatoes has resulted in a large number of genotypes which generates variation in chemical composition and physical properties. Therefore, such characteristics of 17 sweet potato germplasm accessions and four commercial cultivars originated from Malaysia were evaluated to be able to select them for breeding and food purposes. The starch contents were significantly different (p<0.05) that ranged from 10.67 to 25.40% fresh weight basis (fwb). The purple-fleshed group showed a higher amylose content than those of the orange, white, and yellow-fleshed groups. A variation in sugar contents was also noted and the highest amount of fructose was observed in the yellow-fleshed group, followed by the orange, white, and purple-fleshed groups. However, glucose, sucrose, and maltose could not be grouped according to their tuber flesh colors. The textural properties of steamed tubers considerably varied between sweet potato genotypes. The white-fleshed sweet potato showed the lowest hardness value, followed by the orange, yellow and purple-fleshed genotypes. Moisture, starch, and amylose contents significantly correlated with hardness of the steamed tuber with r = -0.83**, 0.60**, and 0.61**, respectively, while adhesiveness was affected by moisture and amylose contents with r =0.54** and -0.37**, respectively. Springiness had a positive correlation with adhesiveness and chewiness exhibited a negative correlation with moisture content, however, it positively correlated with hardness. Sweet potatoes with low hardness and chewiness are suitable to be used as raw material for juice and jam, while those with medium hardness and chewiness are suitable for products made from mashed tubers. Sweet potatoes with firm texture are tailored for flour preparation, which can be further used for flour-based products. This study reflects a great variation in chemical and physical characteristics of sweet potato genotypes that can be further used for the breeding of improved varieties with desired criteria as well as suitability for particular food products.
FOREIGN AND PRIVATE DOMESTIC INVESTMENTS IN INDONESIA: CROWDING-IN OR CROWDING-OUT?
Authors: Setiyanto Aris
Published: February 2023

This study aims to investigate the empirical relationship between Foreign Direct Investment (FDI) to Private Domestic Investment (PDI) in Indonesia by using quarterly data from 1990Q2 to 2020Q2. It tests the crowding-in effect (which suggests complementarity between FDI and PDI) and crowding out effect (which indicates asubstitution effect between FDI and PDI) at the sectoral level. Our results imply the prevalence of the crowding-in effect in the primary and secondary sectors, with the tertiary sector exhibiting a neutral relationship. No rational reason was observed for the restriction of foreign investment. Therefore, it is suggested that Indonesia’s government needs to actively engage in FDI to increase the growth of new investments in the primary and secondary sectors of the domestic economy.
MACRO-FINANCIAL DETERMINANTS OF DEFAULT PROBABILITY USING COPULA: A CASE STUDY OF INDONESIAN BANKS
Authors: Muhajir Maulana Harris , SIX Pierre , Ahn Jung-Hyun
Published: February 2023

We investigate the default probability of Indonesian banks using the copula approach and analyze the macro-financial factors that drive them. We use quarterly data comprised of 80 banks from 2005 to 2019. We find empirical evidence that Common Equity Tier 1 (CET 1) ratio, inefficiency ratio, and deposit ratio have negativelyimpacted the bank’s default probability. We also find that macroeconomic variables such as policy rate, real exchange, economic growth, and unemployment reduce the default probability. Our study suggests that regulators should focus on capital and deposit management policies to reduce bank risk-taking behaviour. Additionally, the policy rate effectively anticipated the banks’ default risk.
La realidad de la informalidad en el Perú previo a su bicentenario
Authors: Kamichi Miyashiro Manuel José
Published: February 2023

El presente ensayo tiene como objetivo central mostrar las principales características del empleo informal en el Perú antes del bicentenario. A partir de la revisión de diversos estudios al respecto, se puede concluir que los trabajadores informales en el país se caracterizan por poseer pocos ingresos, poca productividad y bajo nivel educativo. Todo apuntaría a que la informalidad en el Perú es estructural, por lo que reformas como disminuir los impuestos, los costos y trámites de la formalización solamente tendrían efectos marginales. La solución estaría centrada principalmente en diversificar la producción, estimular la demanda y lograr que se aumente la productividad en las unidades productivas de menor tamaño, que es donde se concentran la mayoría de los informales.
Manual de procedimientos para la bioprospección de esponjas marinas del Perú
Authors: Cóndor Luján Báslavi Marisbel , Francia Quiroz Juan Carlos , Pons Casellas María Jesús , Reategui Arévalo Oscar , Indacochea Mejía Aldo Gonzalo
Published: February 2023

El presente Manual de procedimientos para la bioprospección de esponjas marinas del Perú, elaborado por el equipo técnico del subproyecto «Bioprospección de esponjas marinas de la costas central y sur del Perú para la obtención de principios activos», en colaboración con las Organizaciones Sociales de Pescadores Artesanales (OSPAS), la Cooperativa de Trabajadores Pesqueros Artesanales Algas Marinas (COTRAPALMAR) de San Andrés (Pisco, Ica) y la Asociación de Maricultores El Arca de Noé de Marcona (Marcona, Ica), y con el cofinanciamiento del Programa Nacional de Innovación en Pesca y Acuicultura (PNIPA), tiene como objetivo divulgar los protocolos empleados durante el estudio de las esponjas marinas (Phylum Porifera) como fuente de nuevas sustancias antimicrobianas, con el fin de promover la exploración de la biodiversidad marina del Perú para generar productos con valor económico actual o potencial dentro de un marco de sostenibilidad, buscando el beneficio y desarrollo social de las comunidades locales.
Tweeting the World a Better Place
Authors: Lietz Roman , Lenehan Fergal
Published: February 2023

While the reputation of the platform Twitter was severely dented during the presidency of President Donald Trump, who often retweeted far-right content, this article engages from the argumentative assumption that Twitter is an inherently cosmopolitan online space, both in terms of statements found there and of the lived experience of users on the platform itself. Cosmopolitanism is understood as a normative concept and as a descriptive term for increasing cultural interconnectedness. Twitter users may engage in pursuing liberal aims by taking responsibility for or identifying with all humanity, and thus enact the more conceptual ideas of cosmopolitanism into pragmatic and viral utterances. They may also be deemed cosmopolitan influencers. Based on qualitative interviews with ten purposely selected Twitter users, it is argued that the motivation behind such online political engagement is chiefly societal and activist, and stems from a desire to change society and, indeed, to “give back to society”. Tweeters are guided by an array of values, such as authenticity, solidarity, justice and equality, and freedom of expression. These socially-engaged Twitter users also often see themselves as exceptional, and able to view social developments others cannot see. The data shows that positive reinforcing as well as negative discouraging feedback plays a crucial role and gives hints for the promotion of Cosmopolitan Twitter.
Data-Driven Reduced-Order Models for Volve Field Using Reservoir Simulation and Physics-Informed Machine Learning Techniques
Authors: Behl M. V. , Tyagi M.
Published: February 2023

Reservoir simulation is the industry standard for prediction and characterization of processes in the subsurface. However, large gridblock counts simulation is computationally expensive and time-consuming. This study explores data-driven reduced-order models (ROMs) as an alternative to detailed physics-based simulations. ROMs that use neural networks (NNs) effectively capture nonlinear dependencies and only require available operational data as inputs. NNs are usually labeled black-box tools that are difficult to interpret. On the other hand, physics-informed NNs (PINNs) provide a potential solution to these shortcomings, but they have not yet been applied extensively in petroleum engineering.

In this study, a black-oil reservoir simulation model from Volve public data release was used to generate training data for an ROM leveraging long short-term memory (LSTM) NNs’ temporal modeling capacity. Network configurations were explored for their optimal configuration. Monthly oil production was forecast at the individual wells and full-field levels, and then validated against real field data for production history to compare its predictive accuracy against the simulation results. The governing equations for a capacitance resistance model (CRM) were then added to the reservoir-scale NN model as a physics-based constraint and to analyze parameter solutions for efficacy in characterization of the flow field.

Data-driven ROM results indicated that a stateless LSTM, with single time lag as input, generated the most accurate predictions. Using a walk-forward validation strategy, the single well ROM increased prediction accuracy by about 95% average when compared with the reservoir simulation and did so with much less computational resources in short time duration. Physical realism of reservoir-scale predictions was improved by the addition of CRM constraint, demonstrated by the removal of negative flow rates. Parameter solutions to the governing equation showed good agreement with the field-scale streamline plots and demonstrated the ROM ability to detect spatial irregularities. These results clearly demonstrate the ease with which ROMs can be built and used to meet or exceed the predictive capabilities of certain time-history production data using the reservoir simulation.
Physics-Based and Data-Driven Polymer Rheology Model
Authors: AlAbdullah M. B. , Delshad M. , Sepehrnoori K. , Balhoff M. T. , Foster J. T. , Al-Murayri M. T.
Published: February 2023

Polymer flooding is a common enhanced oil recovery (EOR) method used to increase aqueous phase sweep efficiency by increasing viscosity. Estimating polymer viscosity for given reservoir conditions (i.e., oil viscosity, temperature, and brine composition) requires intensive laboratory work. There are existing empirical models to estimate polymer bulk rheology without prior laboratory work; however, they have many coefficients, simple brine composition, and lack physics-based regression boundaries. This study benchmarks the existing polymer empirical and machine learning (ML) models against a new data-driven model with some physics basis for common synthetic polymers. We cover a broad range of polymer concentrations, temperature, salinity, and hardness with an upper limit of 5,000 ppm, 120℃, 290,000 ppm, and 33,000 ppm, respectively. The data were preprocessed through data analytics techniques, and a model was developed with some physics basis by fitting Martin’s equation for Carreau model coefficients. Our regression boundaries obey flexible polymers’ physical and laboratory behavior. We benchmarked the bulk rheological model with existing models in the literature. We used the published models’ coefficients and then tuned their coefficients for our data set for a fair comparison. We then investigated ML as a predictive tool without compromising overfitting the data using the simplest ML model (linear regression) all the way to artificial neural network (ANN) and hybrid ML models. This is the first study that comprehensively benchmarks polymer rheology models and proposes a simple, least number of coefficients, and tunable polymer-rheology model. We provide a predictive bulk rheology model that enables the user to accurately predict polymer viscosity without laboratory measurements and for a wide range of temperatures and brine compositions. Moreover, our study includes the recently common polymer SAV-10 that was not previously studied. We present a simple water viscosity model for a broad brine salinity and temperature range. Our study shows that ML techniques might provide deceptively high accuracy for small data sets, unless due diligence is done to avoid a high-variance model.
Unstable EBV latency drives inflammation in multiple sclerosis patient derived spontaneous B cells
Authors: Soldan Samantha , Su Chenhe , Monaco Maria Chiara , Brown Natalie , Clauze Annaliese , Andrada Frances , Feder Andries , Planet Paul , Kossenkov Andrew , Schäffer Daniel , Ohayon Joan , Auslander Noam , Jacobson Steve , Lieberman Paul
Published: February 2023

Epidemiological studies have demonstrated that Epstein-Barr virus (EBV) is a known etiologic risk factor, and perhaps prerequisite, for the development of MS. EBV establishes life-long latent infection in a subpopulation of memory B cells. Although the role of memory B cells in the pathobiology of MS is well established, studies characterizing EBV-associated mechanisms of B cell inflammation and disease pathogenesis in EBV (+) B cells from MS patients are limited. Accordingly, we analyzed spontaneous lymphoblastoid cell lines (SLCLs) from multiple sclerosis patients and healthy controls to study host-virus interactions in B cells, in the context of an individual’s endogenous EBV. We identify differences in EBV gene expression and regulation of both viral and cellular genes in SLCLs. Our data suggest that EBV latency is dysregulated in MS SLCLs with increased lytic gene expression observed in MS patient B cells, especially those generated from samples obtained during “active” disease. Moreover, we show increased inflammatory gene expression and cytokine production in MS patient SLCLs and demonstrate that tenofovir alafenamide, an antiviral that targets EBV replication, decreases EBV viral loads, EBV lytic gene expression, and EBV-mediated inflammation in both SLCLs and in a mixed lymphocyte assay. Collectively, these data suggest that dysregulation of EBV latency in MS drives a pro-inflammatory, pathogenic phenotype in memory B cells and that this response can be attenuated by suppressing EBV lytic activation. This study provides further support for the development of antiviral agents that target EBV-infection for use in MS.
A Spaced Learning, Small–Group Course in Electrocardiogram Interpretation: A Peer–Led Pilot Study in Graduate Internal Medicine Education
Authors: Pillai Balakrishnan , Reejhsinghani Risheen
Published: February 2023

Background
Electrocardiogram (ECG) interpretation remains a perennial challenge for trainees, however a superior method of instruction for ECG analysis has yet to be determined. Many physicians struggle with a lack of confidence in ECG analysis, leading to medical errors. A body of current literature supports the benefits of small-group sessions, spaced learning, and peer-led endeavors in medical education. The authors’ aim was to develop a pilot ECG interpretation course, utilizing peer-led teaching in a spaced learning format, that was deliverable in the graduate medical education context.
Methods
As the trend of the “resident as teacher” model continues to blossom, the authors implemented a resident–led, small–group, spaced learning course in ECG interpretation. The course was conducted with participation of first–year Internal Medicine residents during busy inpatient rotations at a major academic medical center in February 2022, and used surveys to gauge learner confidence, competence, and subjective experience.
Results
This course was designed and conducted by residents, for residents, and increased learner competence and comfort in interpreting ischemic ECG patterns, conduction system pathology, supraventricular arrhythmias and ventricular rhythms. Scores reflecting confidence in ECG interpretation showed a trend towards improvement following this course, trainees preferred this course to traditional ECG didactic courses, and participants indicated that they would recommend it to others at their training level.
Conclusions
Given the feasibility and scalability of this intervention, the authors’ next steps will be to incorporate this course into the annual incoming resident orientation, and directly compare the perceived and measurable learning outcomes against traditional didactic methods on a larger scale.
Applying Deep learning in Recognizing the Properties of Vitreous Opacity on Ophthalmic Ultrasound Images
Authors: feng li , Zhang Yanzhu , Wei Wei , Qiu Hui , Shi Mingyu
Published: February 2023

BACKGROUND: To explore the feasibility of artificial intelligence technology based on deep learning to automatically recognize the properties of vitreous opacities in ophthalmic ultrasound images.
METHODS: The normal and three typical vitreous opacities confirmed as physiological vitreous opacity (VO), asteroid hyalosis (AH) and vitreous hemorrhage (VH)，were selected and marked from 2000 gray scale Color Doppler ultrasound images for each lesion. Five residual networks (ResNet) and two GoogLeNet models were trained to recognize the vitreous lesions. 75% images were randomly selected as the training set, the remaining 25% as a test set. The accuracy and parameters were recorded and compared among these seven different deep learning (DL) models. The precision, recall, FI score and the area under the receiver operating characteristic curves (AUC) values of recognizing the vitreous lesions were calculated with the most accurate DL model.
RESULTS: There were significant statistical differences in the accuracy and parameters among these seven DL models. GoogleNet inception V1 achieved the highest accuracy (95.5%) and the least parameters (10315580) in recognizing the vitreous lesions. GoogleNet inception V1 achieved 0.94, 0.94, 0.96, and 0.96 precision；0.94, 0.93, 0.97and 0.98 recall ；0.94, 0.93, 0.96 and 0.97 F1Score in recognizing normal, VO, AH, and VH. The AUC values of these four vitreous lesions were 0.99, 1.0, 0.99 and 0.99, respectively.
CONCLUSIONS: GoogLeNet inception V1 has shown promising results in recognizing the ophthalmic ultrasound image. With more and more ultrasound image data, a wide variety of hidden information in the eye diseases can be clearly detected automatically by the artificial intelligence technology based on deep learning.
Shengxian decoction protects against chronic heart failure in a rat model via energy regulation mechanisms
Authors: Yang Ze-Qi , Han Yang-Yang , Gao Fan , Tian Jia-Ye , Bai Ran , Guo Qiu-Hong , Liu Xing-Chao
Published: February 2023

Background
Energy metabolism imbalance plays an important role in the pathological process of chronic heart failure (CHF). Improving myocardial energy metabolism is a new strategy for the treatment of CHF. Shengxian decoction (SXT), a well-known traditional Chinese medicine (TCM) formula, has good therapeutic effects on the cardiovascular system. However, the mechanism of the therapeutic effects of SXT in treating CHF remains largely unclear.
Methods
SD rats were randomly assigned into 6 groups: sham, model, positive control (trimetazidine) and high-, middle-, and low-dose SXT groups. Echocardiography was used to evaluate cardiac function. H&E, Masson and TUNEL staining were performed to examine myocardial structure and myocardial apoptosis. Western blotting was used to examine the expression of related proteins. Colorimetry was used to determine myocardial ATP levels in experimental rats. Transmission electron microscopy was used to observe the ultrastructure of myocardial mitochondria. ELISA was used to estimate CK, cTnI, and NT-proBNP levels, and LA、FFA、MDA、SOD levels.
Results
Treatment with SXT improved cardiac function and ventricular remodelling and inhibited cardiomyocyte apoptosis and oxidative stress levels induced by CHF. Moreover, CHF caused decrease ATP synthesis, which was accompanied by a reduction in ATP 5D protein levels, damage to mitochondrial structure, abnormal glucose and lipid metabolism, and changes in the expression of PGC-1α related signal pathway proteins, all of which were significantly alleviated by treatment with SXT.
Conclusion
SXT reverses CHF-induced cardiac dysfunction and maintains the integrity of myocardial structure by regulating energy metabolism. The beneficial effect of SXT on energy metabolism may be related to regulating the expression of the PGC-1α signalling pathway.
Neighborhoods and COVID-19 Fatalities: Evidence from a full population study in Sweden
Authors: Wixe Sofia , Lobo Jose , Mellander Charlotta , Bettencourt Luis
Published: February 2023

The COVID-19 pandemic has highlighted a debate about whether marginalized communities suffered the disproportionate brunt of the pandemic’s mortality. Empirical studies addressing this question typically suffer from statistical uncertainties and potential biases associated with uneven and incomplete reporting. We use geo-coded micro-level data for the entire population of Sweden to analyze how local neighborhood characteristics affect the likelihood of dying from COVID-19. We control for several individual and neighborhood characteristics to compare the results in specific communities to overall death patterns in Sweden during 2020. We find that individuals residing in socioeconomically disadvantaged neighborhoods were not more likely to die with COVID-19. We also find that the individuals show a generally higher probability of death from any cause in these neighborhoods. Nevertheless, ethnicity is an important explanatory factor for COVID-19 deaths for foreign-born individuals, especially from East Africa, who are more likely to pass away regardless of the residential neighborhood.
Synthesis and Characterization of Co-Ru@NC- MOF, Co-Ru@ ZSM-5 and Co-Ru@ ɤ- Al 2 O 3 , Composite Catalysts – An Applications in Fischer-Tropsch Synthesis
Authors: Shokouhi Mohamad , Haghtalab Ali , Zamani Yahya , Mohajeri Ali
Published: February 2023

In this work, we synthesized the metal-organic framework ZIF-67 (MOF) by the hydrothermal method. The XRD spectrum of this MOF was consistent with the spectrum given in the literature, which indicated the successful synthesis of ZIF-67. Following the calcination process of the MOF, ruthenium metal was added to the catalyst as a promoter by impregnation method to synthesize Co-Ru@NC composite catalyst. In addition, we synthesized the Co-Ru@ZSM-5 and Co-Ru@ɤ-Al2O3 catalysts by the impregnation method. We performed the characterization tests such as atomic absorption, EDX, ESEM, TEM, BET, XRD, and H2-TPR to find out the surface and volume of the catalysts, formed phase, reduction temperature, hydrogen consumption, and catalyst morphology. Moreover, we carried out Fischer-Tropsch Synthesis (FTS) to obtain the CO conversion, hydrocarbon product selectivity, hydrocarbon chain growth probability, and reaction yield using the synthesized catalysts. The results of using three catalysts showed that the CO conversion, and selectivity to methane and C2 − 4 hydrocarbons enhanced with increasing temperature from 210 to 230°C. On the other hand, the C5+ selectivity and hydrocarbon chain growth probability (α) were reduced by increasing temperature. By the use of the Co-Ru@NC catalyst, the maximum C5+ selectivity, and the minimum CH4, CO2, and C2 − 4 selectivity were 93.85%, 4.89%, 0.010%, and 1.25%, respectively. The probability of heavy hydrocarbon chain growth is higher for the Co-Ru@NC catalyst than for the other two catalysts. The maximum C5+ selectivity for Co-Ru@ZSM-5 and Co-Ru@ɤ-Al2O3 catalysts at 210°C are 80.27% and 80.50%, respectively. The maximum CO conversion values ​​for the Co-Ru@NC, Co-Ru@ZSM-5, and Co-Ru@ɤ-Al2O3 catalysts at 230°C are 85.62%, 78.35%, and 72.74%, respectively. The increasing order of Fischer-Tropsch reaction yield for the synthesized catalysts was Co-Ru@NC > Co-Ru@ZSM-5 > Co-Ru@ɤ-Al2O3.
Astrocyte reactivity influences the association of amyloid-β and tau biomarkers in preclinical Alzheimer’s disease
Authors: Pascoal Tharick , Bellaver Bruna , Povala Guilherme , Ferreira Pamela , Ferrari-Souza João Pedro , Leffa Douglas , Lussier Firoza , Benedet Andrea , Ashton Nicholas , Triana-Baltzerz Gallen , Kolbzh Hartmuth , Tissot Cécile , Therriault Joseph , Servaes Stijn , Stevenson Jenna , Rahmouni Nesrine , Lopez Oscar , Tudorascu Dana , Villemagne Victor , Ikonomovic Milos , Gauthier Serge , Zimmer Eduardo , Zetterberg Henrik , Blennow Kaj , Aizenstein Howard , Klunk William , Snitz Beth , Maki Pauline , Thurston Rebecca , Cohen Ann , Ganguli Mary , Karikari Thomas , Rosa-Neto Pedro
Published: February 2023

An unresolved question for the understanding of Alzheimer’s disease (AD) pathophysiology is why a significant percentage of amyloid β (Aβ)-positive cognitively unimpaired (CU) individuals do not develop detectable downstream tau pathology and, consequently, clinical deterioration.In vitroevidence suggests that reactive astrocytes are key to unleashing Aβ effects in pathological tau phosphorylation. In a large study (n=1,016) across three cohorts, we tested whether astrocyte reactivity modulates the association of Aβ with plasma tau phosphorylation in CU people. We found that Aβ pathology was associated with increased plasma phosphorylated tau levels only in individuals positive for astrocyte reactivity (Ast+). Cross-sectional and longitudinal tau-PET analysis revealed that tau tangles accumulated as a function of Aβ burden only in CU Ast+ individuals with a topographic distribution compatible with early AD. Our findings suggest that increased astrocyte reactivity is an important upstream event linking Aβ burden with initial tau pathology which might have implications for the biological definition of preclinical AD and for selecting individuals for early preventive clinical trials.
The Common polymorphisms in ­­P21/WAF1 and MDM2 genes as a risk factor for susceptibility and poor prognosis of non-small cell lung cancer in Iraqi population.
Authors: Al-Janabi Anwar Madlool , Al-Khafaji Salih Mahdi , Taher Maher Fenjan
Published: February 2023

Background: Cyclin-dependent kinase inhibitor (P21/WAFI) and murine double minute 2 (MDM2) genes regulate cell growth. In malignant tumors, altered expression of these gene products is associated with poor prognosis. Current study aimed to investigate P21-rs1801270 and MDM2-rs2279744 genes polymorphisms with lung cancer risk in Iraqi population.
Methods and Results: This study included 140 lung cancer patients (101 males and 39 females) diagnosed with non-small cell lung carcinoma, matched with 150 healthy individuals(105 males and 45 females). The study was done between 2018 to 2022. The genotyping of P21 and MDM2 were examined by using the PCR-RFLP technique.
Compared with the P21-98 C and MDM2-309T genotypes, we found that P21-98A and MDM2-309G variants were associated with a high risk of NSCLC in Iraqi patients (OR= 5.0, C.I= 3.2-14.2, P<0.0001) for AA and (OR= 6.7, C.I= 4.0-12.4, P<0.0001)for GG. Also, AA and GG genotypes were associated with poor prognosis and significant associations were observed with a stage (p= 0.02) and metastasis status (p =0.003) for P21 gene, (p= 0.01) and (p= 0.04) for MDM2 gene respectively of NSCLC in elderly and smokers. Our results obviously showed the multiplicative interaction of P21 AA and MDM2 GG genotypes in risk of developing lung cancer.
Conclusions: The presence of AA variant alleles for p21 and GG for MDM2 increased the risk of lung cancer in males mainly those smokers older than 45 years. For this reason, these gene mutations may have a role as markers for susceptibility to lung cancer in those groups of people.
Study of the effectiveness of Wavelet Genetic Programming model for Water Quality Analysis in the Uttar Pradesh region
Authors: Saxena Bhawna , Gaonkar Mansi , Singh Sandeep Kumar
Published: February 2023

Water constitutes an essential part of the Earth as it helps in making the environment greener, supporting people to survive and in transporting various nutrients and minerals. But all these factors are drastically impacted due to rising water pollution and its poor sanitation leading to poor water quality. In India, according to the latest survey, due to the excessive use of chemicals by the industries, fertilizers and pesticides by the farmers, various water bodies are getting contaminated, causing a lack of good quality water suitable for consumption. About 2 lakh people die every year due to various diseases caused by consumption of contaminated water. Not only the surface water, groundwater and river water are also getting contaminated. Hence, there is a need to analyze the quality of water in the existing water sources. In this work, a workflow is proposed for analyzing the water quality in selected regions of Uttar Pradesh state. The proposed work uses a hybrid Wavelet Genetic Programming model for analysis and visualization of 13 rivers of Uttar Pradesh region. Prediction of Dissolved Oxygen (DO) level is used as the determinant for water quality assessment. Continuous Wavelet Transform is utilized to decompose the DO dataset and the decomposed DO values are treated as input variables for the model using Morlet wavelet function. The results have proved that the proposed model is suitable for the accurate prediction of DO values.
Design and implementation of the teaching system of a "situational simulation hospital" on the mobile terminal
Authors: Li Dan , Zhou Donghui , Hu Weina , Zhou Xinyu , Li Li , Zhang Qiong , Wang Jie , Zou Mengqing , Li Xinyi , Wang Min , Guan Xu
Published: February 2023

This paper takes "situational simulation hospital practice and testing" as the teaching content, gamification as the innovative breakthrough point, and mobile learning as the goal, organically combines games and medicine, establishes a new student-centered learning model, and develops a mobile learning product in line with the development trend of "Internet + education." The mobile learning products conform to the development trend of "Internet+education," integrate game elements (such as problem situations, challenges, role-playing, instant evaluation, etc.) into teaching, provide learners with rewards, challenges, and success experiences that are lacking in the real world, create a variety of pleasant learning situations that are conducive to the input experience, make learners "learn in entertainment, learn in It is dedicated to serving medical students and medical workers, providing learners with an adaptive, fragmented and gamified mobile learning environment, realizing an innovative attempt to achieve student-centered and education 4.0, providing them with a new mode of hospital teaching experience by conducting "situational simulation of hospital practice and testing" on mobile terminals for teaching content, etc. The system is designed and finally implemented through the teaching content of "simulated hospital practice and test" on mobile terminals, which is a new attempt in the modern medical teaching field of gamified mobile learning.
Efficacy of a novel polyoxazoline based hemostatic patch in liver and spleen surgery
Authors: Roozen Edwin , Lomme Roger , Calon Nicole , Broek Richard ten , Goor Harry van
Published: February 2023

BACKGROUND:A new hemostatic sealant based on a N-hydroxy-succinimide polyoxazoline (NHS-POx) polymer was evaluated to determine hemostatic efficacy and long-term wound healing and adverse effects in a large animal model of parenchymal organ surgical bleeds.METHODS:Experiment 1 included 20 pigs that were treated with two NHS-POx patch prototypes (a gelatin fibrous carrier (GFC) with NHS-POx and an oxidized regenerated cellulose (ORC) with poly(lactic-co-glycolic acid)-NHS-POx:NU-POx (nucleophilically activated polyoxazoline)), a blank gelatin patch (GFC-Blank), TachoSil®, and Veriset™ to stop moderate liver and spleen punch bleedings. After various survival periods (1-6 weeks), pigs were re-operated to evaluate patch degradation and parenchymal healing. During the re-operation experiment 2 was performed; partial liver and spleen resections with severe bleeding, and hemostatic efficacy was evaluated under normal and heparinized conditions of the two previous prototypes and one additional NHS-POx patch. In the third experiment an improved NHS-POx patch (GATT-Patch; GFC-NHS-POx and added 20% as nucleophilically activated polyoxazoline; NU-POx) was compared with TachoSil®, Veriset™ and GFC-Blank on punch bleedings and partial liver and spleen resections for rapid (10 seconds) hemostatic efficacy.RESULTS:NHS-POx-based patches showed better (GFC-NHS-POx 83.1 %, ORC-PLGA-NHS-POx: NU-POx 98.3%) hemostatic efficacy compared to TachoSil® (25.0%) and GFC blank (43.3%), and comparable efficacy with Veriset™ (96.7%) on moderate standardized punch bleedings on liver and spleen. All patches demonstrated gradual degradation over 6 weeks with a reduced local inflammation rate and an improved wound healing. For severe bleedings under non-heparinized conditions, hemostasis was achieved in 100% for Veriset™, 40% for TachoSil, and 80-100% for the three NHS-POx prototypes; similar differences between patches remained for heparinized conditions. In experiment 3, GATT-Patch, Veriset™, TachoSil and GFC-Blank reached hemostasis after 10 seconds in 100%, 42.8%, 7.1% and 14.3% respectively, and at 3 minutes in 100%, 100%, 14.3% and 35.7% respectively, on all liver and spleen punctures and resections.CONCLUSIONS:NHS-POx-based patches, and particularly the GATT-Patch, are fast in achieving effective hemostatic sealing on standardized moderate and severe bleedings without apparent long term adverse events.