bluuebunny/crossref_metadata_2025 huggingface dataset:
Early Versus Late Administration of Long-Acting Insulin in Adult Diabetic Ketoacidosis
Authors: Do Michael M. , Fleury Jacklyn A. , Morgan Grant P. , Hall Zimmerman Lisa , Hanni Claudia M. , Sulaiman Hiba , Lutz Mark F.
Published: September 2024

Background:

Evidence is inconclusive if early administration of subcutaneous (SQ) long-acting insulin (LAI) in management of diabetic ketoacidosis (DKA) improves outcomes.

Objective:

This study compares early versus late administration of SQ LAI in time to DKA resolution.

Methods:

This single-center, retrospective study included patients with DKA who received ≥12 hours of continuous intravenous insulin (CIVI) with LAI overlap. Patients were compared based on LAI administration time to CIVI initiation: Early (<12 hours) versus Late (≥12 hours). The DKA resolution is defined as blood glucose < 200 mg/dL and 2 of the following: anion gap < 12 mEq/L, pH > 7.35, or serum carbon dioxide >15 mEq/L. Outcomes included time to DKA resolution, length of stay (LOS), CIVI duration, and adverse events.

Results:

A total of 27 patients were included in each group. Baseline characteristics were similar between both groups. There was no difference in time to DKA resolution, Early = 17.6 (13.9-26.8) hours versus Late = 19.2 (17.1-32.1) hours, P = 0.16. The Early group had shorter CIVI duration (Early = 19.5 ± 10.3 hours vs Late = 25.6 ± 8.4 hours, P = 0.02) and received less intravenous (IV) fluids in the first 36 hours (Early = 4.04 ± 2.12 L vs Late = 5.85 ± 2.24 L, P = 0.004). No differences were identified with adverse events, including hypoglycemia, or LOS.

Conclusion and Relevance:

Administration of SQ LAI < 12 hours did not decrease time to DKA resolution or LOS. Patients in the Early group had received a lower dose of LAI, shorter duration of CIVI infusion, and required less IV fluids within 36 hours of admission. This study supports the need for further research to determine the potential benefits of administering SQ insulin early in managing DKA.
Catechesis and Christian Recitation: Teaching the Old Testament in a Digital Age
Authors: Parker Jonathan Deane
Published: September 2024

Old Testament catechesis is too varied and too dependent on the story of the Old Testament (as we remember it) to be spiritually formative. Especially given the way the current secularized, “modern moral order” (Taylor) pressures Christians toward neo-Marcionism, the Christian church ought to take more seriously the way the Old Testament has been shaped by the Holy Spirit and the way it encourages catechesis to be done, that is, through memorization and recitation of the very words of the Old Testament, recovering Old Testament as Miqra. Such a practice is not only more in keeping with the Spirit's work in forming the Old Testament, but reciters will be able (a) to appreciate better its non-narrative sections (incl. law and poetry), (b) to pay attention to self-correcting features in its most difficult and violent passages, and (c) to have their imaginations and metaphors reshaped by its poetry. Such catechesis by recitation is not antithetical to classic “question-and-answer” catechisms, and it is easily recovered by beginning with reciting in households and/or reciting the Ten Commandments (as in the catechism of the Book of Common Prayer). In the end, this ancient, religious reading of the Old Testament is not too antiquated but timely and needed, given the postliterate nature of our current digital culture.
Eye, Heart, the Brain: The Psychophysiology of Trust in AVs
Authors: Zhang Yinsu , Mehta Ranjana K. , McDonald Anthony D.
Published: September 2024

Automation misuse and acceptance, influenced by trust, environmental conditions, and confidence, have hindered drivers from fully benefiting from partially automated vehicles. This study investigates how driver trust changes with AV reliance, differences in mental and physiological states, and continuous measures’ effectiveness. The takeover drivers reported lower trust than the non-takeover drivers in all scenarios. Nontakeover drivers’ elevated DLPFC activation aligns with trust networks and emotion regulation. The groups also differed in neural activation preand during scenarios with the takeover group showed more PFC, V2V3, and IFC engagement pre-scenario. Gaze revealed the takeover group fixated more on the AV button or dashboard, indicating readiness to take over, while non-takeover drivers focused on the rearview mirror, reflecting situational awareness. HRV responses showed higher physiological arousal in the takeover group pre-scenario. In summary, our multimodal approach reveals takeover behavior is associated with lower trust, cognitive unloading, increased stress, and anticipatory visual attention.
Design of adaptive barrier function-based backstepping finite time guidance control for interceptor-target systems
Authors: Mokhtare Zahra , Sepestanki Mohammadreza A. , Mobayen Saleh , Najafi Amin , Assawinchaichote Wudhichai , Jalilvand Abolfazl , Fekih Afef
Published: September 2024

This study introduces an optimal finite-time backstepping sliding mode guidance law, leveraging an adaptive continuous barrier function to examine the interceptor-target system’s motion in cylindrical coordinates. The integration of sliding mode and backstepping controllers enhances the robustness and performance of the proposed guidance method amidst external disturbances and model uncertainties. This combination also improves transient response, reduces chattering, and lowers control efforts. The adaptive continuous barrier function employed in this method eliminates the need for prior knowledge of the upper bounds of uncertainties and disturbances. Additionally, it ensures that adaptation gains are not overestimated, leading to more accurate performance and complete elimination of chattering. The Lyapunov stability theory is used to prove the finite-time convergence of the state trajectories of the interceptor-target system to a predefined neighborhood around the origin, despite external disturbances and uncertainties. A genetic optimization algorithm is utilized to optimally select the parameters of the guidance method. The efficacy of the proposed technique is validated through simulation results and real-time experiments on the Baseline Speedgoat Real-Time Target Machine platform. The method’s effectiveness and performance are further demonstrated through analysis and simulation in the MATLAB/Simulink environment.
Incidence of Acute Mountain Sickness in Adolescents Backpacking at Philmont Scout Ranch
Authors: Sharp Courtney LL , Ditmars Hayley , Stoltzfus Ky , Filardi Tanya , Mullan Aidan F. , Hyde Robert J.
Published: September 2024

Introduction

Individuals ascending to elevations above 2500 m are at risk of developing altitude illness. We sought to establish the incidence and to determine what risk factors, if any, increased the likelihood of developing acute mountain sickness (AMS) in adolescents at Philmont Scout Ranch (PSR) in Cimarron, New Mexico. PSR, with elevations ranging from 2011 to 3792 m, attracts thousands of adolescent participants each year, many of whom arrive from lower elevations with little or no experience ascending to high altitude.

Methods

We conducted a prospective observational study of adolescent participants aged 14 to 19 years who ascended to a minimum of 3000 m while trekking from June to July 2021. Prior to the start of each participant's trek, pretrek survey data were obtained at PSR's basecamp (2011 m). During the trek at 3048 m, the Lake Louise AMS score was used to diagnose AMS.

Results

The incidence of AMS in our study was 13.7%. Participants reporting a history of daily headaches had more than four times the risk of developing AMS. A history of gastrointestinal problems carried three times the risk of developing AMS, and a prior history of AMS increased the risk of developing AMS by 44%.

Conclusions

Our findings enhance our understanding of AMS risk in adolescents and may provide guidance to youth for developing AMS. For individuals with a history of headaches or gastrointestinal problems or a prior history of AMS, there may be an opportunity to reduce the risk of developing AMS.
A Novel TEK::GAB2 Gene Fusion in Pediatric Angiosarcoma of Pelvic soft Tissue: A Case Report and Literature Review
Authors: Sandoval Zachary Emmanuel , Schmidt Ryan J. , Bhutada Jessica Sheth , Shillingford Nick , Zhou Shengmei
Published: September 2024

Pediatric angiosarcoma of soft tissue, an extremely rare entity, remains poorly understood from a genetic standpoint. Herein, we present the case of a previously healthy 17-year-old girl with acute left hip pain. Subsequent magnetic resonance imaging revealed a 21.8 cm left pelvic sidewall mass with heterogeneous enhancement and multiple lung nodules. Biopsy of the tumor showed an infiltrative, hemorrhagic neoplasm composed primarily of atypical spindle to epithelioid cells. Focal vasoformative architecture was appreciated. Immunohistochemically, the tumor cells were strongly positive for CD31, ERG, and FLI-1, supporting the diagnosis of angiosarcoma. Genetic analysis identified a novel TEK::GAB2 gene fusion. TEK belongs to the angiopoietin receptor family, and its fusion with GAB2 is predicted to mediate tumorigenesis. This report expands the current knowledge on the spectrum of gene rearrangements of angiosarcoma.
A down-to-earth visual representation of contemporary China: analysing the video game Chinese Parents
Authors: Tan Xiyuan , Austin Hailey J
Published: September 2024

The award-winning indie video game Chinese Parents, developed by a mainland China-based studio, has gained significant popularity among both Chinese and Western players owing to its unique narrative and representation of contemporary mainland China. Some of these in-game representations include the strict parenting style, academic pressure on Chinese children, unique Chinese school culture and popular Chinese internet memes. This article applies compositional interpretation, as well as the framework of iconology in visual culture to analyse the representation of contemporary mainland China from a video-game-context graphic communication perspective. Examples of character portraits, background scene illustrations, biaoqingbao meme application and supporting visual elements are selected and analysed to demonstrate how the game incorporates contemporary Chinese culture into the visuals, while also challenging and playing into existing clichés of Chinese culture.
The digital divide research in sub-Saharan education: Representations, localisation of elements, and theoretical implications
Authors: Constancio Felippe
Published: September 2024

Research on the digital divide in sub-Saharan education needs an overview of its conceptual developments and practices since the studies in the field of the digital divide emerged and were established around the mid-1990s. The present systematic literature review fills such a gap by using mixed methods to analyse three aspects of research on the theme and context. Considering a sample of 54 studies, the selected aspects to analyse were key representations (of regions, areas of education, and focused groups), general elements to influence the exclusion of digital education, and adopted research designs. Results led discussions concerning significant imbalanced representations of subjects, localisation of characteristics of the elements across regions, and hidden spots and limitations of research impact, potentially motivated by theory-ladenness. The present study intends to contribute to the development of digital divide studies contextualising sub-Saharan regions with comments based on thorough examinations of attainments and failures of previous endeavours, contributing to more successful future research as a consequence.
Preliminary Exploration of Al18F-NOTA-FAPI-04 PET/CT in the Management of Ankylosing Spondylitis: A Prospective Clinical Study
Authors: Guo Shibo , Lyu Zhehao , Duan Chunyu , Wang Hui , Xu Peng , Han Wei , Fu Peng
Published: September 2024

Background

Ankylosing spondylitis (AS) is characterized by inflammation and osteoblastic changes in the sacroiliac joint. As a potential imaging method for the early assessment of AS, positron emission tomography (PET) can quantify systemic disease activity, which is conducive to monitoring the progression of disease activity and assisting in evaluating the efficacy of the treatment.

Objective

The study was to evaluate the diagnostic value of aluminium-[18F]fuoride(Al18F)-labelled fibroblast activation protein inhibitor (FAPI) PET/computed tomography (CT) in AS and to investigate its ability to assess disease activity during the development of AS.

Material and Methods

Twenty AS participants who met the Assessment of SpondyloArthritis international Society criteria and were in an active disease stage were included in this study from May 2022 to April 2023. Sixteen healthy controls were also inrolled. All participants underwent Al18F-NOTA-FAPI-04 PET/CT imaging after collecting clinical assessment and laboratory results. The correlation between positive joint count (PJC) and systemic joint standard uptake value ratio (SUVR, the mean SUVmax of the 5 highest joints/SUVmax of the uninvolved sacrum) on PET and clinical disease activity assessment and various laboratory tests were analyzed.

Results

A total of 2820 joints were observed in 20 participants (median age 34.5,[21-61]range, 15 men), with a PJC of 1300 (46.7%), and 39 positive uptakes were found in 40 sacroiliac joints (97.5%). PET/CT images revealed FAPI-04 uptake in both sacroiliac joints in 2 participants without radiographic sacroiliitis in the early stages of AS and varying degrees of uptake in the sacroiliac joints and spinal joints in the remaining participants. PJC and SUVR were positively correlated with most clinical assessments and laboratory findings ( P < .05), and SUVR of the sacroiliac joint was positively correlated with C-reactive protein (CRP) (mg/L; r = 0.498, P = .026).

Conclusion

Al18F-NOTA-FAPI-04 PET/CT was highly sensitive to systemic arthritic changes in AS participants and correlated with clinical disease activity and laboratory tests.
Variable viscosity characteristics of two-layered isothermal calendering phenomena with non-Newtonian fluids
Authors: Naeem Ayesha , Abbas Zaheer , Khaliq Sabeeh
Published: September 2024

Two-layer calendering using non-Newtonian fluids is used frequently in different industries to improve the working and the quality of the products. In this article, two-layer calendering of incompressible non-Newtonian fluids, that is, couple stress fluid and viscoplastic fluid in the upper and lower layer respectively is investigated. For the simplified governing equations, Lubrication approximation theory is applied. By the use of no-slip condition and non-dimensional variables, the exact solution for pressure gradient, pressure, and velocity profiles for both layers of fluid is calculated. The parameters are important from an engineering point of view like roll separating force, power delivered by rollers, torque acting by each roller, and adiabatic temperature are also calculated analytically. Additionally, the results of a couple stress parameter, viscoplastic Casson parameter, and viscosity ratios on all the parameters are also discussed and investigated in detail. Moreover, all the effects investigated are also verified with the literature results of single-layer calendering of non-Newtonian fluids by using large numeric values for the couple stress parameter and viscoplastic Casson parameter.
Multimodal treatment of attention-deficit/hyperactivity disorder and comorbid symptoms in an ultra football fan: A case report from Switzerland
Authors: Smith Alexander , Liebrenz Michael , Brechbühl Alain , Buadze Anna
Published: September 2024

This case report describes the therapeutic trajectory of a 47-year-old male ultra football fan from Switzerland, who was diagnosed and treated for attention-deficit/hyperactivity disorder, together with comorbid alcohol misuse and insomnia. Prior to this episode of care, the patient exhibited symptoms of impulsivity and inattention and persistent patterns of harmful alcohol consumption, recurrently participating in football-related violence. A multimodal approach involving psychotherapy and psychopharmacology yielded notable improvements in symptom management. To date, the patient has shown improved psychosocial functioning, reporting a significant reduction in alcohol use and the cessation of all aggressive acts. Consequently, this case provides insights into the relationship between attention-deficit/hyperactivity disorder and football-related violence, underlining the potential for tailored mental health interventions to enhance overall quality of life.
Women’s Education: Curriculum and Content in the Nineteenth and  Early Twentieth  Centuries India
Authors: Kumari Sangeeta
Published: September 2024

The initiation and expansion of women’s formal instruction in India in the pre-Independence time is the legacy of both colonialism and the nineteenth-century reform movement among Indians. The latter, to an extent, was a response to the Westernisation embedded in the colonial processes. In pre-colonial India, institutional and formal education was a rarity for womenfolk, and until the mid-nineteenth century, zenana education or instruction imparted at home was the accepted norm. Several scholars have noted that the nineteenth century saw an intense debate on women’s schooling, especially in relation to the wisdom of educating women, the form it should take, and the purpose it should serve. Historically, women’s education was viewed by most communities as meaningless. Large sections of the population of both Hindu and Muslim communities were content with extending conventional approaches of learning to women and were vehemently opposed to changing it in favour of a modern education either in government schools or missionary schools. At home, women were taught to read religious scriptures and to read and write the vernacular language, although the focus was on learning home crafts and subjects of domestic and practical utility.
Returning from Prison to a Changed City: How Does Gentrification Shape the Employment and Housing Opportunities of Returning Citizens?
Authors: Golash-Boza Tanya , Aquino Michael David , Ceciliano-Navarro Yajaira
Published: September 2024

Studies of returning citizens have found they benefit from living in well-resourced neighborhoods, yet they face obstacles to securing housing in these communities. Insofar as gentrification involves investing more public and private resources into communities, this raises the question of how this investment affects returning citizens whose former homes are in gentrifying neighborhoods—a common circumstance in Washington, DC. Based on 37 in-depth interviews with returning citizens from Washington DC, this study explores the impact of gentrification. We find that the increased housing prices associated with gentrification make it difficult for returning citizens to move to gentrified areas; that gentrification exacerbates the barriers they face to accessing employment opportunities; and that gentrifiers often make returning citizens feel unwelcome in the communities where they were raised. In sum, we find that returning citizens, like other long-term residents of gentrifying neighborhoods, face structural barriers both to living in gentrified neighborhoods and to accessing available resources.
Patient Experience in Neoplastic Disease in Light of the Statements of Doctors Who Are Oncological Patients
Authors: Chmielewska-Ignatowicz Tomira , Religioni Urszula , Borowska Mariola , Pawlikowski Jakub , Białoszewski Artur , Neumann-Podczaska Agnieszka , Merks Piotr
Published: September 2024

This study aimed to explore oncological doctor-patients experiences concerning the neoplastic disease. The study involved 20 Polish doctors with cancer. Respondents answered open questions related to cancer management and opinions about themselves as oncological patients. The results of the study indicate that doctor-patients deny their susceptibility to illness, which leads to prophylaxis ignorance. Many doctors diagnosed themselves with the disease, but they needed a clear verbal confirmation of the diagnosis by another physician. Respondents well assessed professional skills of doctor-colleagues. However, communication competencies of their doctors were assessed critically. Medical narratives may become an incentive to deepen the discourse on the quality of the relationship between a doctor and a doctor-oncological patient. They may also lead to further research on the anthropological, psychological, and sociological understanding of disease.
Parent and Young Adult Perspectives About the Transition to College During the COVID-19 Pandemic
Authors: Ness Michelle M.
Published: September 2024

Purpose

The purpose of this study was to describe the influence of COVID-19 on parents and their young adults with type 1 diabetes as they navigated the college environment during the COVID-19 pandemic.

Participants

A sample of 9 college students with type 1 diabetes and their parents were recruited to participate in interviews via purposive sampling methodology.

Methods

A descriptive, qualitative study was conducted using semi-structured questions via recorded video conferencing interviews.

Results

Three themes related to navigating type 1 diabetes at college during the pandemic emerged: (1) isolation and mental health: COVID-19-related isolation and loneliness; (2) risk and exposure to COVID-19: balancing risk of COVID-19 with type 1 diabetes; and (3) management of type 1 diabetes on campus during the pandemic: academics, university policies, and their impact on type 1 diabetes.

Conclusions

Students with type 1 diabetes and their parents had to navigate a complex set of concerns that extended beyond the usual challenges of diabetes management during the COVID-19 pandemic. Providers must provide additional support and incorporate education about type 1 diabetes management strategies to families affected by large-scale health crises.
A Quality Approach to Blinatumomab Delivery in Pediatric Oncology: A Children's Oncology Group Study
Authors: Montgomery Kathleen E. , Zupanec Sue , Yun Christine , Okada Maki , Kubaney Holly , Feehily Erin , Withycombe Janice S.
Published: September 2024

Background: Blinatumomab is a promising immunotherapy agent that has been shown to improve survival outcomes in children diagnosed with relapsed B-lineage acute lymphoblastic leukemia. Expanded use of blinatumomab in the treatment of childhood cancer is expected; however, clinician perspectives regarding administering this agent in healthcare and home settings have not been explored. Method: Semistructured interviews were conducted with clinicians ( N = 13) from pediatric institutions across the United States and Canada. Qualitative data were analyzed using a constant comparative analysis three-stage method. Results: Participants were primarily nurses (92%), female (77%), and had greater than 10 years of pediatric oncology experience. The selective code and overarching theme identified was “A quality approach to blinatumomab delivery in pediatric oncology.” Clinicians described detailed processes that were created and implemented to promote a common goal of safe blinatumomab administration across the continuum of care. Clinicians shared how they engaged in planning activities and considered a variety of factors prior to and during blinatumomab administration. Clinicians also expressed a need to reflect and evaluate on previous patient experiences to create new or revise existing processes and workflows. Communication was also central to clinicians’ work. Clinicians provided recommendations to assist others with blinatumomab administration and offered suggestions for items that could help with implementing future clinical trials containing similar agents. Discussion: Findings suggest nurses are pivotal to establishing processes which support safe administration of immunotherapies, such as blinatumomab, while also considering patient-specific needs and promoting quality of life.
Effect of polishing process on torque loss ratio and microgap of selective laser melting abutment: an in vitro study
Authors: Zhong Peixing , Deng Limei , Xu Sheng , Cao Yong
Published: September 2024

Background

The purpose of this in vitro study was to investigate the effect of polishing post-treatment process on the torque loss ratio and microgap of Selective Laser Melting (SLM) abutments before and after mechanical cycling test through improving the surface roughness of the implant-abutment interface.

Materials and methods

Forty SLM abutments were fabricated, with 20 underwent minor back-cutting, designated as polishing, in the implant-abutment interface. The abutments were divided into three groups: SLM abutments (group A), original abutments (group B), and polished SLM abutments (group C), each containing 20 abutments. Surface roughness was evaluated using a laser microscope. Implant-abutment specimens were subjected to mechanical cycling test, and disassembly torque values were measured before and after. Scanning electron microscope (SEM) was used to measure microgap after longitudinal sectioning of specimens. Correlation between surface roughness, torque loss ratio, and microgap were evaluated. LSD’s test and Tamhane’s T2 comparison were used to analyze the data (α = 0.05).

Results

The Sz value of polished SLM abutments (6.86 ± 0.64 μm) demonstrated a significant reduction compared to SLM abutments (26.52 ± 7.12 μm). The torque loss ratio of polished SLM abutments (24.16%) was significantly lower than SLM abutments (58.26%), while no statistically significant difference that original abutments (18.23%). The implant-abutment microgap of polished SLM abutments (2.38 ± 1.39 μm) was significantly lower than SLM abutments (8.69 ± 5.30 μm), and this difference was not statistically significant with original abutments (1.87 ± 0.81 μm). A significant positive correlation was identified between Sz values and the ratio of torque loss after cycling test (r = 0.903, P < 0.01), as well as Sz values and the microgap for all specimens in SLM abutments and polished SLM abutments (r = 0.800, P < 0.01).

Conclusion

The findings of this study indicated that the polishing step of minor back-cutting can lead to a notable improvement in the roughness of SLM abutments interface, which subsequently optimized the implant-abutment fit. It can be seen that the application of minor back-cutting method has advanced the clinical use of SLM abutments.
Immersive medical training: a comprehensive longitudinal study of extended reality in emergency scenarios for large student groups
Authors: Einloft Jonas , Meyer Hendrik L , Bedenbender Simon , Morgenschweis Muriel L , Ganser Andre , Russ Philipp , Hirsch Martin C , Grgic Ivica
Published: September 2024

Young healthcare professionals and medical graduates often fall short in the practical experience necessary for handling medical emergencies. This can not only lead to strained feelings of inadequacy and insecurity among future physicians and less experienced healthcare providers in general, but also to detrimental outcomes for patients as emergency medicine demands rapid decision-making with low tolerance for errors. New didactic modalities and approaches may be needed to effectively address this shortcoming. Immersive technologies are powerful novel educational tools with untapped potential in medical training, and may be particularly suitable for simulation trainings in the high-stakes field of emergency medicine.

Herein, we systematically explored the educational potential of extended reality (XR) technology, particularly virtual reality (VR), in the management of patients presenting as medical emergencies, combining the use of the STEP-VR application with an untethered hardware setup.

Importantly, we aimed at studying multiple, large cohorts of senior medical students involving a total of 529 participants and collecting data over a period of two years. We assessed students’ acceptance of the training through a modified questionnaire measuring device handling, content complexity, degree of immersion, learning success, and seminar design.

Our results show high, sustained acceptance and ease of use across different student cohorts and subgroups, with most students finding XR/VR engaging and beneficial for acquiring emergency medicine skills. Importantly, the prevalence of simulation sickness was minimal. Moreover, no major effect of the head-mounted displays (HMDs) price range was noted with regard to the learning experience. The results underscore the potential of XR/VR capabilities in effectively enhancing medical education, particularly in areas of high-stakes clinical scenarios and emergency care, by providing realistic and reproducible immersive training environments.

In summary, our findings suggest that XR/VR-based training approaches could significantly contribute to preparing future physicians for the complexities of emergency medical care, encouraging the integration of such technologies into medical curricula. However, careful consideration must be given to its suitability for all students and the practical challenges of its implementation, highlighting the need for further research to harness its full potential for medical education.
The polymorphism analysis and therapy vaccine target epitopes screening of HPV-35 E6 E7 among the threaten α-9 HPV in Sichuan area
Authors: He Jiaoyu , Li Tianjun , Cheng Chunlan , Li Ning , Gao Peng , Lei Dan , Liang Rong , Ding Xianping
Published: September 2024

High-risk human papilloma virus (HR-HPV) persistent infection is closely associated with the development of cervical cancer and squamous intraepithelial lesion (SIL).The α-9 HPVs, which is predominantly composed of HR-HPV types, account for 75% of HR-HPV infection in Sichuan. The oncoproteins E6 and E7 of HPV play a crucial role in tumor initiation and progression. Notably, HPV-35 is the only HR-HPV type within the α-9 genus that is not included in the nine-valent HPV prophylactic vaccine. Cervical cell samples obtained from Sichuan were collected for HPV detection and genotyping. Among the 406 HPV-positive samples, 31 HPV-35 were detected, 24 HPV-35 E6 and 26 E7 were successfully amplified and sequenced, five nucleotide mutations in E6 and three in E7 were detected, T232C, T434G of E6 (W78R, I145R) and C67T, G84T of E7 (H23Y, L28F) were non-synonymy mutation. PAML 4.8 server was used to detect positive selection sites of HPV-35 E6, E7, and E6 is W78R. Phyre2 were used to predict and analyze protein structures, W78R made influences on protein structure. IEDB were used to screen epitopes vaccine target for HPV-35 affection therapy, and 5 HPV-35 E6 and 3 HPV-35 E7 most potential epitopes were obtained, the most potential peptides for therapy vaccine design were 79-91YRYSVYGETLEKQ, 45-60FACYDLCIVREGQPY, 124-135RFHNIGGRWTGR of E6; 3-19GEITTLQDYVLDLEPEA, 38-47TIDGPAGQAK, 70-88VQSTHIDIRKLEDLLMGTF of E7 and W78R mainly decreased the epitopes affinity.

Conclusions Amino acid substitution in the positive selection sites of HPV-35 E6 and E7 genes have been found to influence protein structure and to decrease the overall affinity of antigen epitopes. This observation aligns with the evolutionary significance of positive selection site, which may confer advantages to the virus by making infected cells more challenging for the immune system to detect, thereby enhancing HPV’s adaptability to the host environment. The polymorphism analysis of HPV-35 E6, E7 contributes to the enrichment of α-9 HPV data in Sichuan China, which is instrumental in improving the effectiveness of clinical detection. Furthermore, these findings provide a relevant theoretical foundation for the prevention and treatment of HPV-related diseases.
Effect of cephalexin on chlorophyll and carotenoid content of Chlorella pyrenoidosa-2378 and its biodegradation in BG-11 medium
Authors: Kumar Sachin , Chanana Ishita , Utkarsh Kumar , Khan Ahmed Reza , Upadhyay Navneet Kumar , Khan Azhar , Kulshrestha Saurabh , Kumar Pradeep
Published: September 2024

Cephalexin (CFX), a β-lactam antibiotic which is identified for the treatment of different disease infections, has been reported as a micropollutant in wastewater released from sewage, hospital, or pharmaceutical industries. Chlorella pyrenoidosa-2378, a green microalgal strain, is recognized for its degradation ability against wastewater pollutants and the potential of the biomass it produces. In this present study, the cultivation process of Chlorella pyrenoidosa-2378 strain with CFX concentration of 50 mg/L, 100 mg/L, 150 mg/L, and 200 mg/L added to its culture medium labeled as test I, test II, test III, and test IV, respectively, is the process being observed for evaluation of its degradation ability and as sustainable approach for antibiotic degradation. chlorophyll a in test IV, chlorophyll b in test III, and carotenoid content in test I were observed to be higher in amount than control by 0.775 mg/L, .069 mg/L, and 0.356 mg/L, respectively. Using the HPLC method, the total removal efficiency was observed to be 79.09%, 86.26%, 89.62%, and 88.03% against 50, 100, 150, and 200 mg/L concentrations of CFX, respectively. The observations that C. pyrenoidosa-2378 remained stable while being used as an alternative bioremediation method, provide an alibi for its novelty and potentiality to be used commercially for biomass production and at industrial scale for degradation.

Graphical Abstract
Hereditary Angioedema in Pregnancy: A Case Report and Review of Obstetric Anesthesia Management
Authors: de Valle Micah K. , Stevenson Cooper , Adkison Michael , Delaune Christy , Defilippis Nicholas , Murugan Shobana
Published: September 2024

Hereditary angioedema (HAE) is a rare disorder due to C1 esterase inhibitor deficiency, causing recurrent swelling. Pregnancy can exacerbate HAE due to estrogen fluctuations alongside peripartum stress and trauma. We present a pregnant patient with HAE who underwent induction of labor and vaginal delivery with neuraxial anesthesia. Management included C1-inhibitor prophylaxis, 48 hours of postpartum monitoring, and a self-treatment plan at discharge. Angioedema prevention involves timely anesthesia consultation, accessible emergency airway equipment, early neuraxial anesthesia, planned vaginal delivery, and 48 to 72 hours of close postpartum monitoring. Readily available C1-inhibitor and a multidisciplinary approach with these recommendations are crucial for peripartum management.
A Case Series of Deep Subgluteal Block: A New Block Targeting the Missed Portion of the Hip for Analgesia After Total Hip Replacement
Authors: Atalay Yunus Oktay , Ciftci Bahadir , Tekin Bahar , Ansen Gamze , Sakul Bayram Ufuk , Cacan Mehmet Akif , Azboy Ibrahim , Yilmaz Bilge , Alici Haci Ahmet
Published: September 2024

The study aimed to evaluate the effectiveness of deep subgluteal block (DSGB) for pain relief after posterolateral-approached total hip replacement. The cadaver study and observational case series assessed the spread and outcomes of ultrasound-guided DSGB. Results showed low postoperative pain scores, minimal opioid requirements, and no complications related to DSGB. Anatomical dissection revealed effective spread of the injected substance. These findings suggest that DSGB could be a promising regional analgesic technique for postoperative pain management after posterolateral-approached total hip replacement.
Learning to Lead
Authors: Nájera Jennifer R.
Published: September 2024

In Learning to Lead, Jennifer R. Nájera explores the intersections of education and activism among undocumented students at the University of California, Riverside. Taking an expansive view of education, Nájera shows how students’ experiences in college—both in and out of the classroom—can affect their activism and advocacy work. Students learn from their families, communities, peers, and student and political organizations. In these different spaces, they learn how to navigate community and college life as undocumented people. Students are able to engage campus organizations where they can cultivate their leadership skills and—importantly—learn that they are not alone. These students embody and mobilize their education through both large and small political actions such as protests, workshops for financial aid applications, and Know Your Rights events. As students create community with each other, they come to understand that their individual experiences of illegality are part of a larger structure of legal violence. This type of education empowers students to make their way to and through college, change their communities, and ultimately assert their humanity.
Vertebrobasilar Artery Occlusion Treatment Outcomes Within 24 hours of Estimated Occlusion Time
Authors: Xu Yingjie , Zhang Pan , Hu Miaomiao , Sun Wen , Xu Guoqiang , Dai Chunyan
Published: September 2024

BACKGROUND AND OBJECTIVES:

The aim of this study was to investigate the efficacy and safety of endovascular treatment (EVT) in patients with acute vertebrobasilar artery occlusion (VBAO) within 24 hours of estimated occlusion time (EOT) and to evaluate the effect of early and late time window in a cohort of patients with VBAO treated with EVT.

METHODS:

Retrospective analysis was conducted on patients within 24 hours of the EOT in 65 stroke centers in China. Favorable outcome was defined as modified Rankin Scale ≤3 at 90 days. Patients were divided into the medical management (MM) group and the EVT group. Times were dichotomized into early (EOT ≤6 hours) and late (>6 hours) time windows. Multivariate logical regression models were used to evaluate the efficacy and safety of EVT and the effect of time windows on outcomes in EVT patients.

RESULTS:

Among 4124 patients, 2473 and 1651 patients were included in the early and late windows, respectively. 1702 patients received MM and 2422 were treated with EVT. EVT was associated with a higher rate of a favorable outcome at 90 days both in early (odds ratio [OR] 2.16, 95% CI 1.94-2.41) and late (OR 1.89, 95% CI 1.65-2.17) time windows. No differences were found regarding favorable outcome (OR 0.95, 95% CI 0.87-1.03) between VBAO patients treated with EVT within and beyond 6 hours.

CONCLUSION:

Patients with acute VBAO who received EVT within 24 hours were associated with improved favorable outcome compared with patients who received MM. EVT beyond 6 hours is feasible and safe with no increase in symptomatic intracranial hemorrhage.
Brachialis to Anterior Interosseous Nerve Transfer: Comprehensive Anatomic Rationale
Authors: Politikou Olga , Harnoncourt Leopold , Fritsch Fabian , Maierhofer Udo , Tereshenko Vlad , Laengle Gregor , Festin Christopher , Luft Matthias , Gstoettner Clemens , Hirtler Lena , Aszmann Oskar C.
Published: September 2024

BACKGROUND AND OBJECTIVES:

Distal nerve transfers for muscle reinnervation and restoration of function after upper and lower motor neuron lesions are a well-established surgical approach. The brachialis to anterior interosseous nerve (BrAIN) transfer is performed for prehension reanimation in lower brachial plexus and traumatic cervical spinal cord injuries. The aim of the study is to shed light on the inconsistent results observed in patients who undergo the BrAIN transfer.

METHODS:

An anatomic dissection was conducted on 30 fresh upper limb specimens to examine the intraneural topography of the median nerve (MN) in the upper arm at the level of the BrAIN transfer and the presence of intraneural fascicular interconnections distally.

RESULTS:

Fascicular interconnections between the AIN and other MN branches were consistently found in the distal third of the upper arm. The first interconnection was at 3.85 ± 1.82 cm proximal to the interepicondylar line, and the second one, after further proximal neurolysis, was at 9.45 ± 1.16 cm from the interepicondylar line. Intraneural topography of the AIN at the transfer level varied, with dorsomedial, dorsolateral, and purely dorsal locations observed.

CONCLUSION:

Consistent fascicular interconnections between the AIN and MN branches and intraneural topography variability of the MN may lead to aberrant reinnervation.
Efficacy of butylphthalide in the treatment of patients with stroke attributed to intracranial arterial stenosis
Authors: Lu Xudong , Qian Shuxia , Wang Yanping , Zhang Xiaoling , Jin Yuhua , Yu Bo
Published: September 2024

Objective: To explore the clinical efficacy of butylphthalide in treating patients with stroke attributed to intracranial artery stenosis (ICAS).
Methods: In this retrospective study, records of 163 patients with stroke attributed to ICAS admitted to Jiaxing Second Hospital from January 2021 to January 2023 were retrospectively analyzed. Patients were divided into two groups based on the treatment received: control group (patients received routine treatment, n=55) and observation group (patients treated with butylphthalide on a routine basis, n=58). Changes in levels of cerebrovascular reactivity (CVR), breath-holding index (BHI), pulsatility index (PI), and middle cerebral artery mean flow velocity (Vm) between the two groups before and after treatment were compared. In addition, cognitive function, neurological function, and living ability were compared between the two groups before and after treatment, as well as the overall clinical efficacy of the treatment.
Results: The baseline data was comparable between the two groups (P>0.05). After the treatment, CVR, BHI, and Vm indicators in the observation group were significantly higher than those in the control group, while the levels of PI indexes were significantly lower than those in the control group (P<0.05). Montreal Cognitive Assessment (MoCA) and Barthel scale scores of the observation group were significantly higher compared to the control group, while the scores of National Institutes of Health Stroke Scale (NIHSS) were significantly lower (P<0.05).
Conclusions: Butylphthalide in addition to routine treatment can effectively improve cerebrovascular reserve function, promote neurological and cognitive dysfunction recovery, and enhance daily living ability of patients with stroke caused by ICAS.
doi: https://doi.org/10.12669/pjms.40.9.10100
How to cite this: Lu X, Qian S, Wang Y, Zhang X, Jin Y, Yu B. Efficacy of butylphthalide in the treatment of patients with stroke attributed to intracranial arterial stenosis. Pak J Med Sci. 2024;40(9):---------. doi: https://doi.org/10.12669/pjms.40.9.10100
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Effect of high-flow nasal oxygen therapy combined with ipratropium bromide on Th1/Th2 balance and inflammation in patients with chronic obstructive pulmonary disease and respiratory failure
Authors: Li Ting , Xu Xuefen
Published: September 2024

Objective: To investigate the effect of a combination of high-flow nasal oxygen therapy (HFNO) and ipratropium bromide (IB) on Th1/Th2 balance and inflammation in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure (RF).
Methods: A retrospective analysis was conducted on the clinical data of patients with COPD and RF admitted to the Affiliated Nanjing Brain Hospital of Nanjing Medical University from June 2021 to March 2023. A total of 162 patients were included, with 79 patients received respiratory support using HFNO (HFNO group) and 83 patients who were treated using combined HFNO/IB (combined group). Treatment effect, lung function, levels of Th1/Th2, and inflammatory state were compared before and after the treatment.
Results: Total effeicacy of patients in the combined group was significantly higher than that of the HFNO group (P<0.05). After the treatment, pulmonary function levels of the two groups was higher than that before the treatment, and was significantly better in the combined group compared to the HFNO group (P<0.05). The treatment was associated with a significant increase in the levels of Th1/Th2 in both groups. Post-treatment levels of these indexes in the combined group were markedly higher compared to the HFNO group (P<0.05). After the treatment, the inflammatory response of the two groups decreased, and was lower in the combined group that in the HFNO group (P<0.05).
Conclusions: In COPD patients with RF, HFNO combined with IB is efficient in alleviating the inflammatory state of patients, restoring Th1/Th2 balance, and improving lung function compared to HFNO alone.
doi: https://doi.org/10.12669/pjms.40.9.10221
How to cite this: Li T, Xu X. Effect of high-flow nasal oxygen therapy combined with ipratropium bromide on Th1/Th2 balance and inflammation in patients with chronic obstructive pulmonary disease and respiratory failure. Pak J Med Sci. 2024;40(9):---------.  doi: https://doi.org/10.12669/pjms.40.9.10221
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Clinical application of 3D-printed fusion cage implantation in treating cervical spondylotic myelopathy
Authors: Ma Yue , Zhang De-bao , Li Fan , Song Yang
Published: September 2024

Objective: To investigate the clinical efficacy of 3D-printed fusion cage implantation in treating cervical spondylotic myelopathy.
Methods: A retrospective analysis was performed on 52 patients with single-segment cervical spondylotic myelopathy who received anterior cervical discectomy and fusion in Affiliated Hospital of Beihua University from July 2019 to July 2022. They were divided into the 3D group and the control group. Afterward, the perioperative indicators were compared between the two groups. Meanwhile, the Japanese Orthopaedic Association (JOA) scores, Visual analogue scale (VAS) and neck disability index (NDI) were recorded pre-operation and one-year post-operation. Evaluate the fusion rate of two group of intervertebral fusion cages.
Results: The JOA score and NDI of the two groups of patients were significantly improved compared to pre-operation (P<0.05), and the JOA score, JOA score improvement rate, and NDI of the 3D group were better than the control group (P<0.05), the VAS scores were significantly improved compared to pre-operation(P<0.05), but there was no statistically significant difference between the groups (P>0.05). The intervertebral height, angle, and cervical Cobb angle of the two groups of patients were significantly improved compared to pre-operation (P<0.05), and the improvement of intervertebral height, angle, and cervical Cobb angle in the 3D group was better than the control group (P<0.05).
Conclusion: The clinical efficacy of 3D printed intervertebral fusion cage placement in the treatment of cervical spondylotic myelopathy may be reliable, and it would be better than traditional intervertebral fusion cages in maintaining the height, angle, cervical Cobb angle, and fusion rate of the intervertebral space.
doi: https://doi.org/10.12669/pjms.40.9.9125
How to cite this: Ma Y, Zhang D, Li F, Song Y. Clinical application of 3D-printed fusion cage implantation in treating cervical spondylotic myelopathy. Pak J Med Sci. 2024;40(9):---------. doi: https://doi.org/10.12669/pjms.40.9.9125
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.