bluuebunny/crossref_metadata_2025 huggingface dataset:
Forward Roll Coating of a Williamson’s Material onto a Moving Web: A Theoretical Study
Authors: Zahid M. , Siddique I. , Saleem S. , Al-Zubaidi A. , Rana M. A. , Zafar M.
Published: August 2021

This paper presents a mathematical model for the thin film roll coating process of an incompressible Williamson material, passing through a closed passage between a rotating roll and a web. In light of lubrication approximation theory, the flow equations are nondimensionalized. The regular perturbation approach is used to provide solutions for the velocity profile, pressure gradient, flow rate per unit width, and shear stress at the roll surface. Important engineering quantities such as coating thickness, maximum pressure, separation point, roll/sheet separating force, and roll-transmitted power to the fluid are also obtained. The effects of several factors are graphically projected. The study shows that the material factors that are involved determine the operating variables. Coating thickness and separation point are controlled by Weissenberg’s number, therefore acting as a controlling parameter for the rate of flow, thickness in coating, power contribution, pressure, roll separating force, and separation point. In comparison to the existing results in the literature, the current results are broader and zero-order results are more accurate.
Self-Reported Academic Misconduct among Medical Students: Perception and Prevalence
Authors: Dar Umar F. , Khan Yusuf S.
Published: August 2021

Academic integrity is the basis of an education system and must be taught as an ethical behavior during academic training. Students who reflect honesty and truthfulness during the academic years are more likely to follow this path, develop professional integrity, and thus become responsible and dependable professionals. Here, we determine the prevalence of academic lapses among medical students by a cross-sectional descriptive survey based on a self-assessment questionnaire. Students’ perception of 37 behaviors comprising five domains, plagiarism, indolence, cheating, disruptive behavior, and falsifying data, were explored. A high percentage of students (83%) indicated that all 37 behaviors constitute misconduct. Approximately 65% of students thought that their fellow students were involved in dishonest behaviors, and 34% answered that they were indulged in some form of misconduct. Content analysis identified some prevalent behaviors such as doing work for another student (82.5%), getting information from the students who already took the exam (82.5%), copying the answer from neighbors (79%), and marking attendance for absent friends (74.5%). Multiple regression analysis points out that future indulgence in a behavior is significantly (p≤0.5) correlated with understanding a behavior as wrong, perceiving that others do it and whether one has already indulged in it. This study can serve as a diagnostic tool to analyze the prevalence of misconduct and a foothold to develop the medical school system’s ethical guidelines.
Research on Interest Rate Risk of Housing Mortgage Loan Based on Computer Simulation
Authors: Tang Enlin
Published: August 2021

In recent years, with the rapid increase of the business volume of housing mortgage loans of commercial banks, the risk of prepayment is increasingly exposed. Prepayment will have a great impact on the duration and convexity of housing mortgage loans of commercial banks and then bring difficulties to the asset liability management of banks. Therefore, empirical research on the changes of duration and convexity of housing mortgage loans caused by prepayment when the market interest rate changes is of great significance for commercial banks to manage interest rate risk exposure. Based on the analysis of the option characteristics of prepayable housing mortgage loan, the CIR model with GARCH(1, 1) is selected to describe the interest rate change path, and the computer simulation method is used to calculate OAS and then calculate the effective duration and effective convexity of housing mortgage loan under different prepayment rates, so as to understand the interest rate risk of housing mortgage loan in the presence of embedded option.
Robustness of the Storage in Cloud Data Centers Based on Simple Swarm Optimization Algorithm
Authors: Chamkoori Alireza , Katebi Serajdean
Published: August 2021

Storing extensive data in cloud environments affects service quality, transmission speed, and access to information in systems, which is becoming a growing challenge. In storage improvement, reducing various costs and reducing the shortest path in the storage of distributed cloud data centers are among the important issues in the field of cloud computing. In this paper, particle swarm optimization (PSO) algorithm and learning automaton (LA) are used to minimize the cost of a data center, which includes communication, data transfer, and storage and optimization of communication between data centers. To improve storage in distributed data centers, a new model called LAPSO is proposed by combining LA and PSO, in which LA improves particle control by searching for particle speed and position. In this method, LA moves each particle in the direction where it has the best individual and group experiences. In multipeak problems, it does not fall into local optimums. Results of the experiments are shown on the dataset of spatial information and cadastre of country lands, which includes 13 data centers. The proposed method evaluates and improves the optimal position parameters, minimum route cost, distance, data transfer cost, storage cost, data communication cost, load balance, and access performance better than other methods.
Comparative Analysis of the Effect of Low-Frequency Repeated Transcranial Magnetic Stimulation and Extracorporeal Shock Wave on Improving the Spasm of Flexor after Stroke
Authors: Xu Dandan , Cao Haiyan , Fan Yingjie , Yan Dongmei , Su Min
Published: August 2021

Poststroke spasticity (PSS) patients with muscle spasticity are effectively relieved by low-frequency repetitive transcranial magnetic stimulation (rTMS) or extracorporeal shock wave treatment (ESWT). However, there are relatively few reports about the difference in the efficacy of rTMS and ESWT for PSS. In this study, we examined and recorded the levels of UE motor section of the Fugl–Meyer Motor Assessment Scale (FMA-UE), myoelectric signal time-domain range integral values (iEMG), Modified Ashworth Scale (MAS), and Modified Barthel Index (MBI) before and after treatment to observe the differences in treatment effects between rTMS and ESWT in patients with PSS. 66 patients with PSS were enrolled in the study and signed an informed consent form, and the study was approved by the Ethics Committee of the First Hospital of Soochow University (2019008). The patients were divided into rTMS group, ESWT group, and regular group according to the random number table method, and there were 22 patients in each group. The rTMS group and ESWT group were treated with rTMS and ESWT on the basis of conventional treatment in the regular group, 5 times a week, and the total treatment time was 4 weeks. The results of the study showed that iEMG, MAS, FMA-UE, and MBI scores in the rTMS, ESWT, and regular groups were significantly ameliorated after treatment compared with those before treatment. The efficacy of the ESWT group was significantly better than in the regular group and slightly better than in the rTMS group, as shown by the iEMG, MAS, FMA-UE, and MBI scores, and the iEMG score of the ESWT group was significantly better than the rTMS group, while there were no significant differences in other indexes. The FMA-UE and MBI scores in the rTMS group were significantly better than those in the regular group after treatment in the rTMS group; however, the comparison between iEMG and MAS scores was not statistically significant. It can be seen that both rTMS and ESWT can alleviate upper limb flexor spasm, improve upper limb motor function, and improve activities of daily living in patients with PSS. Among them, ESWT has better antispasmodic effect and better short-term treatment effect.
Medical Image Enhancement Algorithm for B-Mode Ultrasound Image Analysis of Neonatal Respiratory Distress Syndrome
Authors: Liu Weina , Ma Jing , Qiao Yanxia , Ge Haiyan , Shen Cuncun , Li Junran , Qin Yaya , Qiu Jingjing
Published: August 2021

The aim of this paper was to explore the imaging characteristics of lung B-ultrasound images under image enhancement algorithm for neonatal respiratory distress syndrome (NRDS) and the therapeutic effect of vitamin A (VA) on NDRS. 30 newborn babies with NRDS in hospital were selected as the experimental group and 30 healthy newborn babies were selected as the control group. All of them received the lung B-ultrasound based on the image enhancement algorithm under the partial differential equation (PDE). The subjects of the control group were given formula milk every day. On the basis of formula milk, the subjects of the experimental group took VA soft capsule orally once a day at noon. Oxidative stress indexes, blood gas indexes, and mechanical ventilation parameters were recorded in the subjects of the two groups. The results of 30 newborn babies with NRDS in the experimental group indicated that the images of 12 cases presented the disappearance of line A and dense or discontinuous distribution of line B; the abnormal pleural line was found in the images of 8 cases; there was lung consolidation under the pleural line, patchy hypoecho, and point-strip hyperecho in the images of 5 cases; the images of 2 cases showed alveolar edema and alveolar interstitial syndrome. Compared with before treatment, the arterial partial pressure of oxygen (PaO2) of subjects in the experimental group (87.61 ± 5.79) increased dramatically, but their arterial partial pressure of carbon dioxide (PaCO2) decreased sharply after treatment (40.07 ± 6.12), with statistically huge differences (

P
<
0.05

). The respiratory rate (RR) and positive end expiratory pressure (PEEP) after treatment were greatly less than those before treatment of subjects in the experimental group (

P
<
0.05

), and the difference was statistically obvious (

P
<
0.05

). By comparing with before treatment, malondialdehyde (MDA) of subjects in the experimental group decreased after treatment while superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) increased considerably, with statistically marked differences (

P
<
0.05

). In conclusion, lung B-ultrasound based on partial image enhancement algorithm could clearly display the imaging characteristics of NRDS, such as pleural abnormalities and alveolar stroma. Besides, VA could effectively improve the neonatal shortness of breath, which had a good clinical effect.
Efficacy and Safety of Rivaroxaban Compared with Other Therapies Used in Patients with Peripheral Artery Disease Undergoing Peripheral Revascularization: A Systematic Literature Review and Network Meta-Analysis
Authors: Bauersachs Rupert , Wu Olivia , Hawkins Neil , Bowrin Kevin , Wojciechowski Piotr , Clay Emilie , Huelsebeck Maria
Published: August 2021

Background. The guidelines on antithrombotic treatment in patients with symptomatic peripheral artery disease (PAD) undergoing peripheral revascularization of the lower extremities were developed based on heterogeneous trials, assessing various dose regimens and recruiting patients who were subjected to different revascularization procedures. Objective. To compare efficacy and safety of treatments used in patients with PAD undergoing peripheral revascularization accounting for between-trial heterogeneity and large dispersion of the quality of evidence. Methods. A systematic literature review of randomised controlled trials (RCTs) recruiting adult patients with PAD receiving antithrombotics was conducted until January 2020. Hazard ratios (HR) were pooled using Bayesian network meta-analysis. The estimated between-treatment effects were presented as HR together with 95% credible intervals. The base case analysis included studies recruiting patients following recent peripheral revascularization, who received treatment regimens administered within the recommended therapeutic window, while a sensitivity scenario included all identified trials. Results. Thirteen RCTs were identified (8 RCTs enrolled patients following peripheral revascularization and 5 RCTs regardless of the previous revascularization). Five trials, recruiting an overall of 8349 patients, were considered for the base case analysis. Of those, 6564 patients were recruited in the VOYAGER PAD trial comparing rivaroxaban plus aspirin (RIV plus ASA) versus ASA. RIV plus ASA was associated with a lower risk of repeated peripheral revascularization versus ASA monotherapy (

HR
=
0.88

[0.79, 0.99]), however having a trend towards an increased rate of major bleeding (

HR
=
1.43

[0.98, 2.11]). There was no evidence for differences between RIV plus ASA and dual antiplatelet therapy and vitamin K antagonists plus ASA. Similar results were observed in sensitivity analyses. Conclusions. RIV plus ASA is associated with reduced risk of revascularization compared with ASA monotherapy, but the evidence for other comparators, in particular antiplatelet regimens, was insufficient to guide treatment decisions and highlights the challenge in establishing the magnitude of comparative efficacy using existing RCTs.
Deep Learning-Based Image Automatic Assessment and Nursing of Upper Limb Motor Function in Stroke Patients
Authors: Chen Xue , Shi Yuanyuan , Wang Yanjun , Cheng Yuanjuan
Published: August 2021

This paper mainly introduces the relevant contents of automatic assessment of upper limb mobility after stroke, including the relevant knowledge of clinical assessment of upper limb mobility, Kinect sensor to realize spatial location tracking of upper limb bone points, and GCRNN model construction process. Through the detailed analysis of all FMA evaluation items, a unique experimental data acquisition environment and evaluation tasks were set up, and the results of FMA prediction using bone point data of each evaluation task were obtained. Through different number and combination of tasks, the best coefficient of determination was achieved when task 1, task 2, and task 5 were simultaneously used as input for FMA prediction. At the same time, in order to verify the superior performance of the proposed method, a comparative experiment was set with LSTM, CNN, and other deep learning algorithms widely used. Conclusion. GCRNN was able to extract the motion features of the upper limb during the process of movement from the two dimensions of space and time and finally reached the best prediction performance with a coefficient of determination of 0.89.
Detection, Integration, and Optimization of Acoustic Field Simulation in the Closed Space
Authors: Meng Siming , Lin Ge , Liang Xiaoyan
Published: August 2021

Noise pollution in the closed space such as railway carriage is an important problem because the noise pollution seriously affects comfort and health of people in the closed space. We propose the method to detection, integration, and optimization of acoustic field simulation in the closed space. First, we analyze the acoustic ﬁeld distribution in the virtual 3D close space. We use harmonic sound wave propagation in the closed space and present the distribution according to geometric analysis. Second, we introduce Delaunay triangulation and k-means clustering into visualization to form the quiet zone and show it in 3D perspective. Our method used acoustic simulation to develop the sound barrier system. The simulation results show that our method can improve the analysis of the noise problem in the closed space.
Cornel Iridoid Glycoside Ameliorated Alzheimer’s Disease-Like Pathologies and Necroptosis through RIPK1/MLKL Pathway in Young and Aged SAMP8 Mice
Authors: Ma Denglei , Li Yanzheng , Zhu Yanqiu , Wei Weipeng , Zhang Li , Li Yali , Li Lin , Zhang Lan
Published: August 2021

Background. Aging is an important risk factor for sporadic Alzheimer’s disease (AD) and other neurodegenerative diseases. Senescence-accelerated mouse-prone 8 (SAMP8) is used as an animal model for brain aging and sporadic AD research studies. The aim of the current study was to investigate the pharmacological effects of cornel iridoid glycoside (CIG), an active ingredient of Cornus officinalis, on AD-type pathological changes in young and aged SAMP8 mice. Methods. Locomotor activity test was used to detect the aging process of SAMP8 mice. Nissl staining and immunohistochemical staining were applied to detect neurons and myelin basic protein-labelled myelin sheath. Western blotting was used to detect the expression levels of related proteins of synapse, APP processing, and necroptosis. Results. The results showed that SAMP8 mice at the age of 6 and 14 months exhibited lower locomotor activity, age-related neuronal loss, demyelination, synaptic damage, and APP amyloidogenic processing. In addition, the increased levels of receptor-interacting protein kinase-1 (RIPK1), mixed lineage kinase domain-like protein (MLKL), and p-MLKL indicating necroptosis were found in the brain of SAMP8 mice. Intragastric administration of CIG for 2 months improved locomotor activity; alleviated neuronal loss and demyelination; increased the expression of synaptophysin, postsynaptic density protein 95, and AMPA receptor subunit 1; elevated the levels of soluble APPα fragment and disintegrin and metalloproteinase 10 (ADAM10); and decreased the levels of RIPK1, p-MLKL, and MLKL in the brain of young and aged SAMP8 mice. Conclusion. This study denoted that CIG might be a potential drug for aging-related neurodegenerative diseases such as AD.
Fixed Point Results for Multivalued Mappings with Applications
Authors: Khan Arshad , Sarwar Muhammad , Khan Farhan , Alsamir Habes , Hammad Hasanen A.
Published: August 2021

In this manuscript, using the concept of multivalued contractions, some new Banach- and Caristi-type fixed point results are established in the context of metric spaces. For the reliability of the presented results, some examples and applications to Volterra integral type inclusion are also studied. The established results unify and generalize some existing results from the literature.
Vaccination with Polyclonal Antibody Stimulator (PAS) Prevents Pancreatic Carcinogenesis in the KRAS Mouse Model
Authors: Smith Jill P. , Cao Hong , Chen Wenqiang , Kallakury Bhaskar , Phillips Teresa , Sutton Lynda , Cato Allen
Published: August 2021

The incidence of pancreatic cancer is increasing significantly and will soon become the second leading cause of cancer-related deaths in the United States. We have previously shown that the gastrointestinal peptide gastrin, which is only expressed in the fetal pancreas and not in the adult pancreas, is activated during pancreatic carcinogenesis where it stimulates growth in an autocrine fashion. In this investigation, we used transgenic LSL-KrasG12D/+; P48-Cre mice that develop precancerous pancreatic intraepithelial neoplasia (PanIN) lesions and pancreatic cancer over time. Starting at 3 months of age, mice were either left untreated (control) or were treated with a gastrin-targeted vaccine, polyclonal antibody stimulator (PAS 250 μg) followed by a monthly booster until the mice reached 8 months of age when pancreata were excised, and analyzed by histology for PanIN grade in a blinded fashion. High-grade PanIN-3 lesions were significantly less in PAS-treated mice (P = 0.0077), and cancers developed in 33% of the control mice but only in 10% of the PAS-treated mice. Compared with the control mice, fibrosis was reduced by >50%, arginase positive M2 macrophages were reduced by 74%, and CD8+ T cells were increased by 73% in the pancreas extracellular matrix in PAS-treated mice.

Prevention Relevance:

PAS vaccination significantly decreased high-grade PanIN lesions and altered the pancreas microenvironment, rendering it less carcinogenic.
Laparoscopic Lavage in Complicated Diverticulitis with Colonic Perforation, Always Be Closing?
Authors: Sijberden Jasper , Snijders Heleen , van Aalten Susanna
Published: August 2021

Laparoscopic lavage is seen as an acceptable alternative to colonic resection in selected patients with acute diverticulitis with purulent peritonitis. There is no consensus on what surgical technique should be used when performing this procedure. This case series describes the disease course of 3 patients with acute diverticulitis with purulent peritonitis treated with laparoscopic lavage and direct suturing of a colonic perforation. All patients (38- and 71-year-old males and a 44-year-old female) were seen in the emergency department due to acute lower abdominal pain. Clinical examination and laboratory and imaging studies were suggestive of perforated diverticular disease. Laparoscopic lavage with placement of drain(s) and direct suturing of a colonic perforation was performed. Postoperative treatment with intravenous antibiotics was continued for a variable term. Postoperative courses were uneventful. Patients were discharged on postoperative days 5, 5, and 7. At almost 1-year follow-up, all patients are in good clinical condition and have not had a recurrent episode of diverticulitis. Therefore, this case series shows promising results of laparoscopic lavage with direct suturing of colonic perforation in patients with diverticulitis with perforation and purulent peritonitis.
Comparing Vascular Brain Injury and Stroke by Cranial Magnetic Resonance Imaging, Physician-Adjudication, and Self-Report: Data from the Strong Heart Study
Authors: Suchy-Dicey Astrid , Muller Clemma , Shibata Dean , Howard Barbara V. , Cole Shelley A. , Longstreth Jr. W.T. , Devereux Richard B. , Buchwald Dedra
Published: August 2021

Background: Epidemiologic studies often use self-report as proxy for clinical history. However, whether self-report correctly identifies prevalence in minority populations with health disparities and poor health-care access is unknown. Furthermore, overlap of clinical vascular events with covert vascular brain injury (VBI), detected by imaging, is largely unexamined. Methods: The Strong Heart Study recruited American Indians from 3 regions, with surveillance and adjudication of stroke events from 1989 to 2013. In 2010–2013, all 817 survivors, aged 65–95 years, underwent brain imaging, neurological history interview, and cognitive testing. VBI was defined as imaged infarct or hemorrhage. Results: Adjudicated stroke was prevalent in 4% of participants and separately collected, self-reported stroke in 8%. Imaging-defined VBI was detected in 51% and not associated with any stroke event in 47%. Compared with adjudication, self-report had 76% sensitivity and 95% specificity. Participants with adjudicated or self-reported stroke had the poorest performance on cognitive testing; those with imaging-only (covert) VBI had intermediate performance. Conclusion: In this community-based cohort, self-report for prior stroke had good performance metrics. A majority of participants with VBI did not have overt, clinically recognized events but did have neurological or cognitive symptoms. Data collection methodology for studies in a resource-limited setting must balance practical limitations in costs, accuracy, feasibility, and research goals.
The Prognostic Impact of Tumor Differentiation on Recurrence and Survival after Resection of Hepatocellular Carcinoma Is Dependent on Tumor Size
Authors: Shinkawa Hiroji , Tanaka Shogo , Kabata Daijiro , Takemura Shigekazu , Amano Ryosuke , Kimura Kenjiro , Kinoshita Masahiko , Kubo Shoji
Published: August 2021

Introduction: The present study aimed to evaluate the effect of poor differentiation and tumor size on survival outcome after hepatic resection of hepatocellular carcinoma (HCC). Methods: A total of 1,107 patients who underwent initial and curative hepatic resection for HCC without macroscopic vascular invasion participated in the study. Using the multivariable Cox proportional hazards regression model, we evaluated changes in hazard ratios (HRs) for the association between tumor differentiation and survival based on tumor size. Results: In patients with poorly (Por) differentiated HCCs, the adjusted HRs of reduced overall survival (OS), recurrence-free survival (RFS), early RFS, and early extrahepatic RFS were 1.31 (95% confidence interval [CI]; 1.07–1.59), 1.07 (95% CI 0.89–1.28), 1.31 (95% CI 1.06–1.62), and 1.81 (95% CI 1.03–3.17), respectively. Moreover, based on an analysis of the effect modification of tumor differentiation according to tumor size, Por HCC was found to be associated with a reduced OS (p = 0.033). The HRs of Por HCCs sharply increased in patients with tumors measuring up to 5 cm. The adjusted HRs of reduced OS in patients with Por HCCs measuring <2, ≥2 and <5, and ≥5 cm were 1.22 (95% CI 0.69–2.14), 1.33 (95% CI 1.02–1.73), and 1.58 (95% CI 1.04–2.42), respectively. The corresponding adjusted HRs of reduced early RFS were 0.85 (95% CI 0.46–1.57), 1.34 (95% CI 1.01–1.8), and 1.57 (95% CI 1.03–2.39), respectively. The adjusted HRs of reduced early extrahepatic RFS were 1.89 (95% CI 0.83–4.3) in patients with tumors measuring ≥2 and <5 cm and 2.33 (95% CI 0.98–5.54) in those with tumors measuring ≥5 cm. Conclusions: Por HCC measuring ≥2 cm was associated with early recurrence. Hence, it had negative effects on OS. After surgery, patients with Por HCC measuring ≥5 cm should be cautiously monitored for early extrahepatic recurrence. These findings will help physicians devise treatment strategies for patients with HCC.
Posterior Approach in Management of Phacomorphic Angle Closure
Authors: Ichsan Andi Muhammad , Tombe Geraldi Ayub Fujiwan , Launardo Anastasia Vanny , Jaury Junely Vimala , Pratiwi Andi , Nislawati Ririn , Sumara Nurul Magfirah Rusli , Islam Itzar Chaidir
Published: August 2021

This article presents a case of posterior lensectomy through 3-port pars plana vitrectomy for the management of phacomorphic angle closure. A 67-year-old man presented to the outpatient department with headache and decreased vision in his left eye for the past 3 days. Visual acuity 2/60, intraocular pressure (IOP) >60 mm Hg, and the anterior chamber (AC) depth Van Herick grade 1. A complete ophthalmologic examination revealed a phacomorphic angle closure. Serial management was performed consisting of mannitol 20% intravenously, laser peripheral iridotomy, and trabeculectomy. However, the depth of the AC became more shallow, and the IOP remained high. Lens extraction as definitive therapy could not be performed because of the adhesion of the iris and anterior lens capsule to the corneal endothelium; thus, posterior lensectomy using 3-port pars plana vitrectomy, and phacofragmatome was performed. Once the corneal thickness was returned to normal, and the AC depth was sufficient, the patient underwent secondary intraocular lens implantation. A significant improvement in visual acuity, normal IOP, and AC depth were achieved after the management of the posterior approach. Thus, this posterior approach should be considered a good option of management technique in cases with phacomorphic angle closure with very shallow AC depth and a fragile cornea.
Subarachnoid Hemorrhage in Bacterial Meningitis Patients
Authors: Deliran Shahrzad S. , Brouwer Matthijs C. , van de Beek Diederik
Published: August 2021

Introduction: Subarachnoid hemorrhage (SAH) has been described as an uncommon complication of community-acquired bacterial meningitis. However, the incidence, clinical course, and outcome are unclear. Methods: We assessed the clinical characteristics, incidence, and clinical outcome of patients with SAH complicating bacterial meningitis in a prospective nationwide cohort study from 2006 to 2018 in the Netherlands. Patients were identified through the Netherlands Reference Laboratory for Bacterial Meningitis, which receives around 90% of CSF isolates of all Dutch patients with bacterial meningitis, or after direct report by the treating physician. Results: SAH was diagnosed in 22 of 2,306 episodes (0.9%), of which 7 (32%) were diagnosed upon admission and 15 (68%) during admission. All patients showed clinical deterioration before SAH was diagnosed: altered mental status in 18 of 22 patients (82%), focal neurological symptoms in 2 (9%) and, new-onset fever with severe tachycardia in 1 (5%). Acute onset of headache was not reported in any of the patients. Distribution of blood was diffuse in the subarachnoid space in 7 patients (32%), multifocal in 8 patients (36%), and focal in 7 patients (32%) of 22 patients. In 6 patients (27%), CT angiography, MR angiography, or digital subtraction angiography was performed, showing a mycotic aneurysm in 1 patient (5%) and vasculitis in 1 patient (5%). Presence of SAH in bacterial meningitis patients was associated with a poor prognosis assessed at discharge: 12 of 22 patients with SAH died (54%) compared to 361 of 2,257 (16%, p < 0.001) without SAH, and 19 of 22 had an unfavorable outcome (86%) compared to 831 of 2,257 (37%, p < 0.001). Conclusion: SAH is an uncommon complication in bacterial meningitis and is associated with high case fatality and morbidity.
Characterization of Helicobacter pylori tlyA and Its Association with Bacterial Density
Authors: Prakosa Adi Wasis , Miftahussurur Muhammad , Juniastuti Juniastuti , Waskito Langgeng Agung , Doohan Dalla , Fauzia Kartika Afrida , Rezkitha Yudith Annisa Ayu , Sugihartono Titong , Syam Ari Fahrial , Uchida Tomohisa , Yamaoka Yoshio
Published: August 2021

Background: In the recent studies, a less virulent Helicobacter pylori variant could still colonize the human stomach and induce gastric inflammation, suggesting the involvement of other virulence factors, such as TlyA hemolysin. Nevertheless, the association of TlyA in the pathogenesis of H. pylori infection remains unclear. We investigated the tlyA profile and determined its relationship with gastritis severity. Methods: An observational study was conducted using DNA stocks and secondary data from previous studies. The tlyA variant was examined by NGS and confirmed with polymerase chain reaction. Gastritis severity was categorized by the Updated Sydney System. The relationship between a variant of tlyA and gastritis severity was determined, in which discrete variables were tested using the χ2 test or Fisher exact test. Results: Two H. pylori tlyA variants were observed and characterized as tlyA1 and tlyA2. We noted a unique variant in the amino acid sequence 32–35 that is exclusively detected among H. pylori isolated from the Papua island. In addition, we observed that the tlyA variant had a significant association with the H. pylori density in the antral (p = 0.002). Histological analyses revealed that TlyA1 was associated with higher H. pylori density than TlyA2. However, we did not observe any significant association of tlyA with the infiltration of inflammation cells. Conclusions: We observed 2 tlyA variants (tlyA1 and tlyA2). A significant association of tlyA with bacterial density suggested that tlyA plays a more significant role in the colonization process than its influence on the severity of inflammation in gastric mucosa.
Early-Life Patterns of Sugar Consumption and Dental Caries in the Permanent Teeth: A Birth Cohort Study
Authors: Feldens Carlos Alberto , dos Santos Igor Fonseca , Kramer Paulo Floriani , Vítolo Márcia Regina , Braga Vanessa Simas , Chaffee Benjamin W.
Published: August 2021

Early-life family conditions may presage caries development in childhood. The aim of this study was to evaluate associations between patterns of sugar consumption in early childhood and permanent dentition caries at age 6 years. A cohort enrolled women accessing prenatal care at public health clinics in Porto Alegre, Brazil. Sociodemographic, anthropometric, and dietary data were collected during pregnancy and 6-month, 12-month, and 3-year follow-ups. Calibrated dental examinations occurred at ages 3 and 6 years. Multivariable logistic regression analysis was performed in series to quantify associations between early-life variables and permanent dentition caries. At age 6 years, 7.9% of children (21/266) had ≥1 caries lesion on permanent teeth (first molars). In unadjusted models, gestational weight gain, sweet food introduction (age 6 months), household sugar purchases (age 3 years), and caries (age 3 years) were positively associated with permanent dentition caries (age 6 years). In multivariable models, each 1-kg increase in gestational weight gain (odds ratio [OR]: 1.08; 95% confidence interval [CI]: 1.01, 1.16) and each 1-item increase in sweet food consumption at age 6 months (OR: 1.27; 95% CI: 1.02, 1.59) remained statistically significantly associated with permanent molar caries. Findings from this cohort study suggest family and child factors that long predate the permanent dentition, including sugar-related behaviors, predict future dental status, and may inform prevention strategies.
Refraktäres/rezidiviertes Multiples Myelom: CAR-T-Zell-Therapie zeigt beträchtliche Wirksamkeit
Authors: Holderried Tobias
Published: August 2021

KarMMa ist eine offene, einarmige, multizentrische, multinationale Phase-II-Studie zur Bewertung der Wirksamkeit und Sicherheit von Idecabtagen Vicleucel (ide-cel) bei erwachsenen Patienten mit rezidiviertem und refraktärem Multiplem Myelom (RRMM) in Nordamerika und Europa. Der primäre Endpunkt der Studie ist die Gesamtansprechrate (Overall Response Rate, ORR), die von einem unabhängigen Prüfungsausschuss (IRC) gemäß den Kriterien der International Myeloma Working Group (IMWG) bewertet wird. Ein wichtiger sekundärer Endpunkt ist ein komplettes Ansprechen (complete Response, CR) oder besser. Bei ide-cel handelt es sich um eine BCMA-gerichtete, genetisch modifizierte autologe CAR-T-Zell-Immuntherapie. Ide-cel besteht aus einem murinen extrazellulären einkettigen variablen Fragment (single-chain variable fragment, scFv), das spezifisch für die Erkennung von BCMA ist und an eine humane CD8-α-Gelenk- und Transmembrandomäne gebunden ist. Diese ist im Tandem mit den zytoplasmatischen T-Zell-Signaldomänen CD137 4–1BB und CD3-ζ-Kette fusioniert. Ide-cel erkennt und bindet an BCMA auf der Oberfläche von multiplen Myelom-Zellen, was zur Proliferation von CAR-T-Zellen, zur Ausschüttung von Zytokinen und zur anschließenden zytolytischen Abtötung von BCMA-exprimierenden Zellen führt. Ide-cel führte bei der Mehrheit der stark vorbehandelten Patienten mit refraktärem und rezidivierendem Myelom zu einem Ansprechen; ein MRD-negativer Status wurde bei 26% der behandelten Patienten erreicht. Bei fast allen Patienten traten toxische Wirkungen des Grades 3 oder 4 auf, am häufigsten hämatologische toxische Wirkungen und Zytokin-Freisetzungssyndrome (Cytokine-release syndrome, CRS). (ClinicalTrials.gov Identifier: NCT03361748)
Transnational by Default: Online Child Sexual Abuse Respects No Borders
Authors: Witting Sabine K.
Published: August 2021

Combatting child sexual abuse on the internet requires a high level of harmonisation of both substantive and procedural laws, as online child sexual abuse is transnational by default: while the transnational nature of child sexual abuse material used to be the exception before the advent of the internet, it is now the rule. In order to prosecute and investigate online child sexual abuse across country borders, states rely heavily on extraterritorial jurisdiction clauses as well as informal and formal law enforcement collaboration channels. This paper analyses existing channels in the opsc, Budapest Convention and Lanzarote Convention, particularly against the background of the recently published crc Committee Guidelines regarding the implementation of the Optional Protocol to the Convention on the Rights of the Child on the sale of children, child prostitution and child pornography (crc/c/156), and provides for concrete guidance on how to ensure that the best interests of the child in the prosecution and investigation of transnational crimes such as online child sexual abuse is the primary consideration.
Serapias ausoniae (Orchidaceae; Orchideae): a new species from southern Italy confirmed by morphological, cytological and molecular analyses
Authors: GENNAIO ROBERTO , PELLEGRINO GIUSEPPE
Published: August 2021

Serapias ausoniae, here described as a new species, is known only from the southern part of the Apulia, Italy. The new taxon is morphologically similar to S. parviflora but is larger than sympatric S. parviflora specimens. Serapias ausoniae is characterized by larger floral elements, in particular, the bract is longer (~ 5.0 cm) and wider (~ 1.5 cm) and the dimensions of epichile, hypochile, petals and sepals are on average 40–50% larger than S. parviflora. Karyological analyses showed that the new taxon is a tetraploid (2n = 72), whereas sympatric and allopatric S. parviflora specimens are diploids (2n = 36). Moreover, genetic analyses suggest that the new taxon is of autopolyploid origin.
Appropriateness and Cost-Effectiveness of Echocardiograms Ordered by Pediatric Cardiologists and Primary Care Providers for Syncope
Authors: Thompson Tracey M. , Hasselman Ty E. , Wang Yanzhi , Jantzen David W.
Published: August 2021

The pediatric appropriate use criteria (AUC) were applied to transthoracic echocardiograms (TTE) ordered by primary care providers (PCPs) and pediatric cardiologists for the diagnosis of syncope to compare appropriateness ratings and cost-effectiveness. Included were patients ≤18 years of age from October 2016 to October 2018 with syncope who underwent initial outpatient pediatric TTE ordered by a PCP or were seen in Pediatric Cardiology clinic. Ordering rate of TTE by pediatric cardiologists, AUC classification, and TTE findings were obtained. PCPs ordered significantly more TTEs than pediatric cardiologists for “rarely appropriate” indications (61.5% vs 7.5%, P < .001). Cardiologists ordered TTEs at 17.2% of visits. Using appropriateness as a marker of effect, with the incremental cost-effectiveness ratio, it was more cost-effective ($543.33 per patient) to refer to a pediatric cardiologist than to order the TTE alone. This suggests that improved PCP education of the AUC and appropriate indications of TTEs for syncope may improve cost-effectiveness when using order appropriateness as a marker of effectiveness.
Does Racism Discriminate? Racial and Ethnic Discrimination Among Nigerians and Jamaicans in Houston Texas
Authors: Jones-Obeng Caralee
Published: August 2021

As a result of more racially inclusive immigration policies in the U.S., the African and Caribbean population has increased. Thus far, scholarly inquiry on Black immigrants have focused on their incorporation into the racial hierarchy, their experiences with racism, and their relationships with African Americans. While beneficial, these studies overlook the impact of ethnic discrimination for Black immigrants. Although all individuals of African descent share similar racialized experiences in the U.S., I hypothesize that diverse Black immigrant groups endure unique discriminatory experiences because of their ethnic identities. Thus, through in-depth interviews with 27 Nigerian and 20 Jamaican respondents, this paper explores Black immigrants’ experiences with racial and ethnic discrimination. I found that, regardless of ethnic background, 80% of my Nigerian and Jamaican respondents encountered racism. In contrast, ethnic discrimination varied between my Nigerian and Jamaican respondents. My Nigerian respondents were more likely to report their encounters with ethnic discrimination. These experiences ranged from being accused of internet scamming to being mocked for having an accent. On the other hand, not only were my Jamaican respondents less likely to report ethnic discrimination, but they were also more likely to see their ethnicity as an advantage.
Characterization of piercing damage in CFRP cross-ply laminates after punch shear machining via impact loading
Authors: Matsuda Shinya , Mabe Kohei , Ogi Keiji , Yashiro Shigeki , Kakudo Yoshifumi
Published: August 2021

In industrial processes, piercing and trimming are essential because composite structures are usually manufactured in a near-net shape to reduce machining operations. Punching and shear cutting using out-of-plane shear loading are expected to increase productivity. Nevertheless, little is known about the effects of such operations on polymer-matrix composites. This study presents on the characterization of piercing damage in typical carbon fiber reinforced plastic (CFRP) cross-ply laminates [0°2/90°2]s after punching using quasi-static (QS) and drop-weight impact (DWI) loadings. During QS punching, the upper and lower ply interfaces delaminate due to the high shear stress to cut fibers and gradual shear deformation in the middle ply; however, during DWI punching at a low impact velocity, delamination of the lower ply interface can be reduced due to the localization of shear deformation, as compared to that in QS punching. Finally, the damage accumulation process during DWI punching is discussed.
Fatigue behavior of graphene nanoplatelets reinforced and unreinforced basalt/epoxy composite pressure vessels subjected to low-velocity impact under internal pressure
Authors: Sepetcioglu Harun , Tarakcioglu Necmettin
Published: August 2021

In this study, the fatigue behavior of 0.25 wt.% graphene nanoplatelets (GnPs) reinforced and unreinforced impact damaged basalt/epoxy composite pressure vessels (CPVs) was investigated. The CPVs were subjected to low-velocity impact (LVI) of 2.5 J, 5 J, 7.5 J, 10 J, 15 J, 20 J, and 25 J under internal pressure of 50 bar (hoop/axial prestresses: 98/49 MPa). Then, to detect fatigue life changes, fatigue tests were performed at load rates of 30% of ultimate hoop stress (σHS), where sweat damage occurred in the basalt/epoxy CPVs under alternating internal pressure. Considering the remaining fatigue life and formation of the damages in the CPVs for all impact energies, to investigate the fatigue behavior and GnPs effects of CPVs subjected to low-velocity impact, an impact value of 5 J was preferred. The 5 J impact damaged CPVs were subjected to fatigue cyclic following ASTM D 2992 at load rates of 20%, 25%, 30%, 35%, and 40% of the σHS. The fatigue life of damaged CPVs was compared by that of undamaged over S-N curves. As the impact energy increased, the impact damage area increased. The increased size of damage reduced the fatigue life of basalt/epoxy CPVs. At the fatigue load rates mentioned above, the GnPs improved the fatigue life of damaged basalt/epoxy CPVs by about 3.5, 3.2, 11.3, 2.4, and 5 times, respectively.
Hybrid processing of TiC/TiCu/C composites with tailored hardness
Authors: Rambo Carlos R , Travitzky Nahum
Published: August 2021

This work reports the effect of TiC volume fractions on hardness of TiC/TiCu/C composites synthesized through in situ reactive infiltration of Ti-Cu alloy into porous carbon preforms prepared by 3 D-printing. Reactive melt infiltration of the alloy at 1100 °C under argon into C-preforms with different porosities resulted in materials composed of TiC, Cu-rich intermetallic matrix (Ti3Cu4) and residual carbon. The microstructure consists of TiC grains distributed along the Cu-Ti/C boundary. The hardness of TiC/Ti3Cu4/C composites could be tailored by the TiC volume fraction and the distribution in the composites, which are determined by the processing parameters and the initial porosity of the carbon templates in 3 D-printing stage. The hardness of the produced composites ranges from 350 HV to 570 HV and could be tailored by the TiC volume fraction and distribution in the composites, which are determined by the processing parameters and the initial porosity of the carbon-preforms.
Co-cured manufacturing of multi-cell composite box beam using vacuum assisted resin transfer molding
Authors: Akin Mert , Oztan Cagri , Akin Rahmi , Coverstone Victoria , Zhou Xiangyang
Published: August 2021

Co-curing holds great promise to minimize assembly weight, time, and cost for stiffened aerospace structures, which are conventionally fabricated separately and then integrated either through mechanical fastening or adhesive bonding—also known as secondary bonding. This study presented a low-cost co-curing process using VARTM to fabricate stiffened shells, particularly composite box beams. The experimental investigation was performed and the co-curing process was improved by scrutinizing the critical process parameters, such as foam strength and coating, and curing cycle. This work was also intended to present the demonstration of the proposed co-curing method and its comparison with the conventional secondary bonding technique for three-cell carbon fiber-reinforced polymer (CFRP) composite box beams. Fiber volume fraction measurements were carried out to the specimens extracted from the various section of the co-cured part, namely top skin, web, and bottom skin and as a result, around 60% of fiber volume fraction was measured, which was in good agreement with the results obtained from optical microscopy-based image analysis. Structural-level four-point bending test results showed that the weight normalized maximum and the ultimate load of the part increased by 44% and 45% with the use of the co-curing process, respectively. The improved mechanical properties indicated that stronger structural integration can be achieved by integrally curing structures. SEM micrographs revealed a favorable fiber-matrix interface, bolstering the superior integration of the co-cured part. These findings suggest that the low-cost co-curing process can be a potential candidate for the fabrication of stiffened aerospace structures, such as composite box beams.
Impact of Internet Pornography on Chinese Teens: The Third-Person Effect and Attitudes Toward Censorship
Authors: Zhou Shuhuan , Zhang Zhian
Published: August 2021

Based on the third-person effect hypothesis–people’s belief that the media influences others more than it influences themselves–we administered a questionnaire to Chinese teens ( N = 1,538) to discover the impacts of exposure to internet pornography on perceptions of pornography and attitudes toward censorship of pornography. The results validated the third-person effect hypothesis and showed that teens’ subjective perceptions of what constitutes internet pornography and their exposure to it are critical variables for predicting perceptions of negative impacts of pornography on self and others and affirmative attitudes toward censorship. The study also found that the impact on self is the best variable for predicting attitudes toward censorship. The discussion is framed in the context of Chinese collective culture and conservative attitudes toward sex.
Clinical yield of screening colonoscopies in Jamaica
Authors: Cawich Shamir O , Mahabir Avidesh H , Arthurs Milton
Published: August 2021

There is still no organised national screening programme for colorectal cancer in Jamaica. We sought to evaluate the detection of colorectal cancer precursor lesions in patients who underwent opportunistic screening over three years. Patients with colorectal polyps were selected for further study. In 431 procedures, there were 84 (19.5%) patients with colorectal polyps identified at screening colonoscopy, which gave a 19.5% sensitivity to identify patients with polyps at risk of developing colorectal cancer, 9.5% being <50 years of age. At the time of examination, 16.7% had already developed invasive adenocarcinoma. We conclude that it is time for policy makers to develop a national colorectal cancer screening programme to diagnose patients early and improve their therapeutic outcomes.
CT Findings of Firework Injuries to the Head and Neck
Authors: Yi Yangtian , Ginat Daniel Thomas
Published: August 2021

Objectives:

The purpose of this study is to review the CT imaging findings of injuries in the head and neck caused by fireworks through a case series.

Methods:

The imaging database from the University of Chicago Medicine was searched with “fireworks,” “firecrackers,” and “mortar” as keywords and CT as the imaging modality. Cases without acute CT findings or initial CT scans were excluded.

Results:

Eighteen cases with acute CT findings of head and neck firework injuries were identified and included. The associated injuries included skull fractures (5, 28%), ocular injuries (7, 39%), soft tissue trauma (18, 100%), retained foreign bodies (8, 44%), and intracranial trauma (2, 11%).

Conclusions:

Fireworks can cause injuries of varying severity in the head and neck, including blunt and penetrating trauma, that warrant CT evaluation.