bluuebunny/crossref_metadata_2025 huggingface dataset:
A review of research on design theory and engineering practice of high-speed railway turnout
Authors: Wang Ping , Xu Jingmang , Wang Shuguo , Qian Yao , Chen Rong , Yang Fei , Fang Jiasheng
Published: June 2022

This paper systematically reviews the research progress, problems, specific countermeasures, and development trends of dynamic design theory as applied to high-speed railway turnouts. This includes wheel–rail contact solving, high-speed vehicle–turnout dynamic interaction simulation, analysis of long-term turnout performance deterioration, safety assessment of trains passing through the turnout, and the maintenance and management of turnout serviceability. High-speed turnouts still face severe technical challenges with regard to their acclimation to the future development of rail transit technology. Some of these challenges include the suitability of next-generation higher-speed turnouts to a complex environment, lifecycle design, optimization of wheel–rail matching and vehicle–turnout dynamic performance, real-time status capture and performance assessment, health management and damage prediction. It is now necessary to deepen the basic theoretical study of high-speed railway turnouts, and integrate cutting-edge techniques, such as advanced materials and manufacturing, intelligence and automation, big data and cloud computing, in an effort to enhance China’s capabilities for original innovation in high-speed railway turnout technology. By analysing the present situation in a problem-orientated manner, this paper aims to provide a new perspective, as well as some basic data for academic research into technological innovations for railway engineering.
Making and Unmaking a “Bactericidal” Organism: Sterile Surgical Maggots and Organic Antiseptics in Inter-War America
Authors: Quick Tom
Published: June 2022

This article charts the popularization of and eventual disengagement with an approach to wound infection control centered on the medical efficacy of living beings (maggots) in 1920s and 1930s America. Baltimore surgeon William Stevenson Baer successfully drew on his wartime experience to promote the use of sterile or “surgical” maggots in the treatment for deep-seated bone infection at this time. This article situates the practices he promoted in the context of President Herbert Hoover's contemporary establishment of the “associative state,” thereby drawing out the relevance of the latter to medical governance. In so doing, it conveys an image of the development of early twentieth-century infection control that contrasts with narratives centered on medically productive aspects of biomedical industrialization and specialization. The incorporation of surgical maggot research and evaluation within the United States Department of Agriculture played a critical role in the subsequent abandonment of the use of maggots as medical aides. Hoover's orientation of this institution towards the support of large-scale private enterprise helped motivate efforts to synthetically replicate (and thereby displace) maggots' medical efficacy. Ultimately, maggot-based therapeutics proved incompatible with conditions created by the orientation of American governmental institutions towards corporate subsidy rather than the support of individuals.
Duplicate appendix complicated by low-grade appendiceal mucinous neoplasm: a rare case report and review of the literature
Authors: Suzuki Kensuke , Shimizu Yasuhito , Hirota Mihono , Fujino Masafumi , Nobumoto Daigo , Kubosawa Hitoshi , Oda Kenji , Ohtsuka Masayuki
Published: June 2022

Low-grade appendiceal mucinous neoplasms (LAMNs) have been a very controversial tumor, and there is a lack of standardization for the optimal surgical procedure due to the infrequency of this disease. This is the first case report of duplicate appendix complicated by LAMN. The preoperative imaging examinations revealed that the mucinous tumor was shrinking spontaneously, allowing for safe laparoscopic resection. The histopathological findings indicated a dilated common base of the duplicated appendix, suggesting that the mucinous content drained spontaneously to the cecum. Further studies of the various complications of LAMNs are needed to establish the optimal surgical approach for LAMNs.
Treatment of a recurrent ischial ulcer with injected exosomes
Authors: Messa Genevieve E , Tiongco Rafael P , Lau Frank H
Published: June 2022

Pressure ulcers (PUs) affect 2.5 million patients per year. Even after successful reconstruction, 50% of PUs recur. Patients with multiply recurrent PUs eventually consume all locoregional donor sites. This underscores the need for novel, less invasive approaches in PU reconstruction. Here, we report the first successful use of mesenchymal stem cell exosomes in PU reconstruction. The patient presented with a right ischial ulcer that persisted despite 9 months of wound care and appropriate antibiotic therapy. After six subcutaneous ExoFlo exosome injections over 8 weeks, the PU was completely healed. Additional studies of this promising technology should be performed.
The long-term survival and functional maturation of human iNPC-derived neurons in the basal forebrain of cynomolgus monkeys
Authors: Feng Su , Zhang Ting , Ke Wei , Xiao Yujie , Guo Zhong , Lu Chunling , Li Shuntang , Guo Zhongxin , Liu Yuanyuan , Tan Guohe , Chen Yingying , Yue Feng , Shu Yousheng , Yue Chunmei , Jing Naihe
Published: June 2022

Human induced neural stem/progenitor cells (iNPCs) are a promising source of cells for stem cell-based therapy. The therapeutic potential of human iNPCs has been extensively tested in animal models, including both mouse and monkey models. However, the comprehensive characterization of grafted iNPCs in the brain of non-human primates has been lagged behind. In this study, we transplanted human iNPCs into the basal forebrain of adult cynomolgus monkeys. We found that grafted iNPCs predominantly differentiated into neurons that displayed long-term survival up to 12 months. Additionally, iNPC-derived human neurons gradually matured in term of morphology and subtype differentiation. More excitingly, we observed that human neurons displayed electrophysiological activities resembling those of mature neurons, indicating the acquisition of functional membrane properties. Collectively, this study systematically characterized human iNPCs in the brain of non-human primates, and will provide invaluable clues for developing safe and effective stem cell-based therapies for different brain disorders.
Vasovagal Electrophysiology on 12-Lead ECG After Venipuncture
Authors: Redondo Jose , Conte Lisa M , Seda Gilbert
Published: June 2022

Vasovagal syncope is the most common form of syncope seen in young and otherwise healthy active duty service members. Although self-limiting, syncopal events often produce a significant drain of medical resources because of their sudden and often dramatic presentation, which can be associated with traumatic injuries secondary to loss in postural tone. Malignant differential pathologies associated with syncopal presentation need to be ruled out, which in turn further diminishes resources, especially in a deployed environment that is often in austere, remote locations with a lack of readily available medical supplies. We present a case of vasovagal syncope experienced by a 20-year-old sailor shortly after venipuncture and the 12-lead electrocardiogram captured shortly after presentation. This case highlights the unique electrophysiology during a vasovagal episode and the impact a relatively benign condition has on medical operations in the operational setting.
Neofunctionalization of a Noncoding Portion of a DNA Transposon in the Coding Region of the Chimerical Sex-Determining Gene dm-W in Xenopus Frogs
Authors: Hayashi Shun , Suda Kosuke , Fujimura Fuga , Fujikawa Makoto , Tamura Kei , Tsukamoto Daisuke , Evans Ben J , Takamatsu Nobuhiko , Ito Michihiko
Published: June 2022

Most vertebrate sex-determining genes (SDGs) emerge as neofunctionalized genes through duplication and/or mutation of ancestral genes that are involved with sexual differentiation. We previously demonstrated dm-W to be the SDG in the African clawed frog Xenopus laevis and found that a portion of this gene emerged from the masculinization gene dmrt1 after allotetraploidization by interspecific hybridization between two ancestral species around 17–18 Ma. dm-W has four exons consisting of a noncoding exon 1, dmrt1-derived exons 2 and 3, and an orphan exon 4 (Ex4) of unknown origin that includes coding sequence (CDS). In this study, we searched for the origin of Ex4 and investigated the function of the CDS of this exon. We found that the Ex4-CDS is derived from a noncoding portion of the hAT-10 family of DNA transposon. Evolutionary analysis of transposons and determination of the Ex4 sequences from three other species indicated that Ex4 was generated before the diversification of most or all extant allotetraploid species in subgenus Xenopus, during which time we hypothesize that transposase activity of this hAT superfamily was active. Using DNA–protein binding and transfection assays, we further demonstrate that the Ex4-encoded amino acid sequence increases the DNA-binding ability and transrepression activity of DM-W. These findings suggest that the conversion of the noncoding transposon sequence to the CDS of dm-W contributed to neofunctionalization of a new chimeric SDG in the ancestor of the allotetraploid Xenopus species, offering new insights into de novo origin and functional evolution of chimerical genes.
Recovery from the damage of cranial radiation modulated by memantine, an NMDA receptor antagonist, combined with hyperbaric oxygen therapy
Authors: Hokama Yohei , Nishimura Masahiko , Usugi Ryoichi , Fujiwara Kyoko , Katagiri Chiaki , Takagi Hiroshi , Ishiuchi Shogo
Published: June 2022

Background

Radiotherapy is an important treatment option for central nervous system malignancies. However, cranial radiation induces hippocampal dysfunction and white matter injury; this leads to cognitive dysfunction, and results in a reduced quality of life in patients. Excitatory glutamate signaling through N-methyl-d-aspartate receptors (NMDARs) plays a central role both in hippocampal neurogenesis and in the myelination of oligodendrocytes in the cerebrum.

Methods

We provide a method for quantifying neurogenesis in human subjects in live brain during cancer therapy. Neuroimaging using originally created behavioral tasks was employed to examine human hippocampal memory pathway in patients with brain disorders.

Results

Treatment with memantine, a non-competitive NMDAR antagonist, reversed impairment in hippocampal pattern separation networks as detected by functional magnetic resonance imaging. Hyperbaric preconditioning of the patients just before radiotherapy with memantine mostly reversed white matter injury as detected by whole brain analysis with Tract-Based Spatial Statics. Neuromodulation combined with the administration of hyperbaric oxygen therapy and memantine during radiotherapy facilitated the restoration of hippocampal function and white matter integrity, and improved higher cognitive function in patients receiving cranial radiation.

Conclusions

The method described herein, for diagnosis of hippocampal dysfunction, and therapeutic intervention can be utilized to restore some of the cognitive decline experienced by patients who have received cranial radiation. The underlying mechanism of restoration is the production of new neurons, which enhances functionality in pattern separation networks in the hippocampi, resulting in an increase in cognitive score, and restoration of microstructural integrity of white matter tracts revealed by Tract-Based Spatial Statics Analysis.
Trends in Socio-economic Inequality in Smoking Among Middle-aged and Older Adults in China: Evidence From the 2011 and 2018 China Health and Retirement Longitudinal Study
Authors: Liu Tai-Yi , Qiu De-Chao , Song Fujian , Chen Ting
Published: June 2022

Introduction

Socio-economic inequalities in smoking and related health problems are a public health concern worldwide. To support the development of effective tobacco control policies, this study examines trends in smoking rates according to socio-economic status (SES) in China.

Aims and Methods

We analyzed data from repeated cross-sectional China Health and Retirement Longitudinal Study (CHARLS) on adults aged ≥45 years for the years 2011 and 2018, which involved 16 471 participants in 2011 and 19 367 in 2018. We then estimated the SES of individuals based on four types of wealth-related variables, namely, education, occupation, household characteristics, and durable consumer goods. Principal-component analysis was conducted to measure SES, and the Erreygers normalised concentration index (ECI) was used to calculate socio-economic inequality in current smoking by gender, age, and region.

Results

The overall ECI (95% confidence interval) for women was −0.042 (−0.054 to −0.031) and −0.038 (−0.047 to −0.029) for 2011 and 2018, respectively. The ECI (95% confidence interval) for men was −0.077 (−0.101 to −0.050) and −0.019 (−0.042 to 0.005) for 2011 and 2018, respectively. The inequality in smoking by SES for adults aged < 60 years in the Northeast region increased during 2011–2018, from −0.069 (−0.144 to 0.006) to −0.119 (−0.199 to −0.038) for women and from 0.009 (−0.115 to 0.132) to −0.164 (−0.296 to −0.032) for men.

Conclusions

smoking inequality by socio-economic among adults aged ≥45 years declined in recent years in China. However, smoking inequality by SES increased in other population groups.

Implications

Our research indicated that socio-economic inequality of current smoking among residents aged 45 years and older declined in 2018 when compared with 2011 numbers, particularly for men aged ≥ 60 years. Women in the Northeast region displayed more significant smoking inequality by SES than women in other regions did. During the study period, there was an increase in inequality in smoking by SES for adults aged < 60 years in the Northeast region. Thus, tobacco control policies and interventions should be targeted at high-risk subpopulations with lower SES, particularly in Northeast China.
Long-term follow-up of young denim sandblasters in Turkey
Authors: Albez F S , Araz Ö , Yılmazel Uçar E , Alper F , Karaman A , Sağlam L , Akgün M
Published: June 2022

Background

Denim sandblasting-induced silicosis is a recently identified occupational disease.

Aims

In this study, we aimed to evaluate pulmonary and radiological changes in the long-term follow-up of former denim sandblasters.

Methods

Ninety former denim sandblasters were followed from 2007 to 2018. Chest X-rays were evaluated according to the International Labour Organization (ILO) classification. Baseline and final data were compared. Silicosis prevalence, radiological progression and pulmonary dysfunction were evaluated.

Results

All of the sandblasters were men. Their mean age was 34 ± 5 years, mean follow-up time was 9 ± 2 years (mean time since initial exposure: 17 ± 2 years) and mean duration of exposure was 34 ± 25 months. Rates of radiological progression and decline in pulmonary during follow-up were 63% and 39%, respectively. During follow-up, all patients were diagnosed with silicosis. All workers who were ILO category 0 at baseline (n = 26, 29%) progressed to higher categories. The number of patients in Category 2 doubled and the number of patients in Category 3 increased by 2.5-fold. Eleven patients developed new large opacities and the number of patients with category C opacity increased from 4 to 13. Exposure time was an independent determinant of radiological progression (OR: 1.0, P = 0.036) and decline in pulmonary function (OR: 1.3, P = 0.019).

Conclusions

The prevalence of silicosis in denim sandblasters increases steadily even after exposure is discontinued. Radiological progression was observed in a higher proportion of workers than a decline in lung function. Duration of exposure was the major determinant of disease progression in our study.
Using Patient-Reported Outcomes in Dose-Finding Oncology Trials: Surveys of Key Stakeholders and the National Cancer Research Institute Consumer Forum
Authors: Lai-Kwon Julia , Vanderbeek Alyssa M , Minchom Anna , Lee Aiyegbusi Olalekan , Ogunleye Della , Stephens Richard , Calvert Melanie , Yap Christina
Published: June 2022

Background

Patient-reported adverse events may be a useful adjunct for assessing a drug’s tolerability in dose-finding oncology trials (DFOT). We conducted surveys of international stakeholders and the National Cancer Research Institute (NCRI) Consumer Forum to understand attitudes about patient-reported outcome (PRO) use in DFOT.

Methods

A 35-question survey of clinicians, trial managers, statisticians, funders, and regulators of DFOT was distributed via professional bodies examining experience using PROs, benefits/barriers, and their potential role in defining tolerable doses. An 8-question survey of the NCRI Consumer Forum explored similar themes.

Results

International survey: 112 responses from 15 September–30 November 2020; 103 trialists [48 clinicians (42.9%), 38 statisticians (34.0%), 17 trial managers (15.2%)], 7 regulators (6.3%), 2 funders (1.8%)]. Most trialists had no experience designing (73, 70.9%), conducting (52, 50.5%), or reporting (88, 85.4%) PROs in DFOT. Most agreed that PROs could identify new toxicities (75, 67.0%) and provide data on the frequency (86, 76.8%) and duration (81, 72.3%) of toxicities. The top 3 barriers were lack of guidance regarding PRO selection (73/103, 70.9%), missing PRO data (71/103, 68.9%), and overburdening staff (68/103, 66.0%). NCRI survey: 57 responses on 21 March 2021. A total of 28 (49.1%) were willing to spend <15 min/day completing PROs. Most (55, 96.5%) preferred to complete PROs online. 61 (54.5%) trialists and 57 (100%) consumers agreed that patient-reported adverse events should be used to inform dose-escalation decisions.

Conclusion

Stakeholders reported minimal experience using PROs in DFOT but broadly supported their use. Guidelines are needed to standardize PRO selection, analysis, and reporting in DFOT.
De Novo Domestication in the Multi-Omics Era
Authors: Jian Liumei , Yan Jianbing , Liu Jie
Published: June 2022

Most cereal crops were domesticated within the last 12,000 years and subsequently spread around the world. These crops have been nourishing the world by supplying a primary energy and nutrient source, thereby playing a critical role in determining the status of human health and sustaining the global population. Here, we review the major challenges of future agriculture and emphasize the utilization of wild germplasm. De novo domestication is one of the most straightforward strategies to manipulate domestication-related and/or other genes with known function, and thereby introduce desired traits into wild plants. We also summarize known causal variations and their corresponding pathways in order to better understand the genetic basis of crop evolution, and how this knowledge could facilitate de novo domestication. Indeed knowledge-driven de novo domestication has great potential for the development of new sustainable crops that have climate-resilient high yield with low resource input and meet individual nutrient needs. Finally, we discuss current opportunities for and barriers to knowledge-driven de novo domestication.
cifB-transcript levels largely explain cytoplasmic incompatibility variation across divergentWolbachia
Authors: Shropshire J Dylan , Hamant Emily , Conner William R , Cooper Brandon S
Published: June 2022

Divergent hosts often associate with intracellular microbes that influence their fitness. Maternally transmitted Wolbachia bacteria are the most common of these endosymbionts, due largely to cytoplasmic incompatibility (CI) that kills uninfected embryos fertilized by Wolbachia-infected males. Closely related infections in females rescue CI, providing a relative fitness advantage that drives Wolbachia to high frequencies. One prophage-associated gene (cifA) governs rescue, and two contribute to CI (cifA and cifB), but CI strength ranges from very strong to very weak for unknown reasons. Here, we investigate CI-strength variation and its mechanistic underpinnings in a phylogenetic context across 20 million years (MY) of Wolbachia evolution in Drosophila hosts diverged up to 50 MY. These Wolbachia encode diverse Cif proteins (100% to 7.4% pairwise similarity), and AlphaFold structural analyses suggest that CifB sequence similarities do not predict structural similarities. We demonstrate that cifB-transcript levels in testes explain CI strength across all but two focal systems. Despite phylogenetic discordance among cifs and the bulk of the Wolbachia genome, closely related Wolbachia tend to cause similar CI strengths and transcribe cifB at similar levels. This indicates that other non-cif regions of the Wolbachia genome modulate cif-transcript levels. CI strength also increases with the length of the host’s larval life stage, presumably due to prolonged cif action. Our findings reveal that cifB-transcript levels largely explain CI strength, while highlighting other covariates. Elucidating CI’s mechanism contributes to our understanding of Wolbachia spread in natural systems and to improving the efficacy of CI-based biocontrol of arboviruses and agricultural pests globally.
Point-of-care ultrasound leads to a rare incidental diagnosis in a patient with acute kidney injury
Authors: Quinn Jesse H. , Sviggum Erik B. , La Nou Abigail T. , Burkhamer Kyle J.
Published: June 2022

Cardiac amyloidosis is a rare disorder with a poor long-term prognosis. Presenting features often mirror those of more commonly encountered diseases, making diagnosis challenging. Clinicians should suspect amyloidosis in patients presenting with symptoms of heart failure and preserved ejection fraction. Diagnostic testing assesses for characteristic ECG, echocardiogram, and cardiovascular MRI findings. Confirmatory testing traditionally is performed with endomyocardial biopsy, but safer, less-invasive options exist. Although overall prognosis is unfavorable, contemporary advances in treatment options have improved short-term patient survival.
Glenohumeral joint effusion assessment with point-of-care ultrasound
Authors: Ahern Brian J. , Falconi Audrey E.
Published: June 2022

Ultrasound has favorable diagnostic accuracy for detecting glenohumeral joint effusions. This article describes an easy-to-learn and interpret limited glenohumeral joint ultrasound examination that can help guide further evaluation and treatment. We report on a patient ultimately diagnosed with septic arthritis of the glenohumeral joint, the associated joint effusion having been detected on bedside ultrasound. This ultrasound examination is applicable to generalist PAs and those working in orthopedics and acute care settings.
Prevalence and associated factors of obstructive sleep apnea in refractory hypertension
Authors: Chedier Bernardo , Roderjan Christian N. , Cavalcanti Aline H. , de Souza Fabio , Muxfeldt Elizabeth S.
Published: June 2022

Background:

Refractory hypertension (RfHT) and obstructive sleep apnea (OSA) share common pathophysiological mechanisms and probably are intrinsically associated, but their prevalence, clinical profile, and polysomnography (PSG) pattern remain misunderstood.

Objective:

To describe OSA prevalence and PSG pattern of patients with RfHT in a large cohort of resistant hypertension (RHT).

Methods:

This is a cross-sectional study involving 418 RHT patients (30.9% male; mean age of 62.5 ± 9.9 years) who were submitted to full-night PSG. RfHT was defined as uncontrolled ambulatory blood pressure monitoring using five or more antihypertensive drugs, including spironolactone. Bivariate analysis compared RHT and RfHT and multivariate analysis was performed to assess the independent correlates of OSA.

Results:

A total of 90 patients (21.5%) were diagnosed with RfHT (26.7% male; mean age of 58.5 ± 8.3 years). In comparison with resistant ones, RfHT patients were younger, with higher smoking and previous cardiovascular diseases prevalence, especially stroke. There was no difference regarding anthropometric measures. OSA prevalence (80.0 vs. 82.9%) and moderate/severe OSA (51.1 vs. 57.0%) were similar in both groups as well as apnea–hypopnea index. In its turn, refractory hypertensive patients presented better sleep efficiency (78 vs. 71%), with higher total sleep time (315 vs. 281 min) and lower sleep latency (11 vs. 17 min). There was no difference regarding rapid eye movement sleep, oxygen saturation, microarousals index, and periodic limb movement.

Conclusion:

In this large RHT cohort, resistant and refractory hypertensive patients have similar OSA prevalence, although refractory ones, which by definition use spironolactone, are younger and apparently have a better sleep pattern.
Measures Against Antimicrobial Resistance in Children in Japan: Current Status and Future Prospects
Authors: Kusama Yoshiki , Ishiwada Naruhiko
Published: June 2022

Antimicrobial resistance (AMR) is a major problem in public health. Japan is addressing this problem with various measures based on the National Action Plan on AMR, published in 2016. In Japan, the fight against AMR is hindered by issues with the health care system, including the lack of a general practitioner registration system, an abundance of private clinics and health care for infants and toddlers being essentially free of charge. As measures against AMR in inpatient care, thorough infection prevention and the Japanese government’s incentivization of collaboration in infection prevention among hospitals and regions have helped to improve infection prevention. As measures against AMR in outpatient care, the creation of official Japanese government guidelines on antimicrobial stewardship has facilitated the implementation of antimicrobial stewardship in clinics. Another unique measure taken in Japan is incentivizing the nonprescription of antimicrobials for respiratory tract infections and diarrhea. Although Asia is a hot spot for AMR bacteria, the fight against AMR is affected by various factors, including insufficient precautions against nosocomial infections and the absence of surveillance systems. To combat these problems, Japan must take a strong leadership role. AMR is a problem not only at the level of individual countries but on a global scale and should, therefore, be addressed through joint action among nations.
Current Aspects of Pediatric Pharmacokinetics and Pharmacodynamics of Antimicrobials in Japan: Importance of the Promotion of Population PK/PD Analysis
Authors: Shoji Kensuke , Saito Jumpei , Nakamura Hidefumi , Matsumoto Kazuaki , Oda Kazutaka , Takesue Yoshio , Miyairi Isao
Published: June 2022

Pharmacologic knowledge is important for pediatricians conducting feasible pharmacokinetic or pharmacodynamic (PK/PD) studies or applying effective antimicrobial therapies in children. Because of the difficulties in conducting PK/PD studies in children, antimicrobial PK/PD data in children are still limited. To fill in the lack of knowledge, promotion of population PK/PD analysis, which allows us to handle sparse sampling data from individual patients, is important because it is considered a suitable methodology to conduct PK/PD studies in children with limited blood drug concentration data for PK/PD analysis. Population PK/PD analysis is also useful in the clinical setting to provide individualized optimal dosage for each patient with various conditions. Here we summarized the current aspects of pediatric PK/PD studies of antimicrobials in Japan from clinical and research perspectives, specifically focusing on the importance of population PK/PD analysis.
Effects of grade, academic performance, and sex on spatial working memory and attention in primary school children: a cross-sectional observational study
Authors: Zhan Nengpeng , Fan Xuelian , Shen Fengtao , Song Lulu , Zhou Chenhuan , Xiao Jiayi , Wu Xun , Li Leonardo Jiahao , Xi Jiayao , Jiayi Li Sophia , Zeng Suhua , Li Can , Wang Lihui , Li Weidong
Published: June 2022

Objective:

Only a few studies have investigated the development trends in spatial working memory and attention among a large sample of primary school students over a wide range of ages, while the efficiency of learning and memory processes is fundamental to academic performance, particularly for children, who are in a key developmental stage when their life opportunities can be altered. We aimed to explore how the spatial working memory and attention of primary school children are affected by grade, academic performance, and sex.

Methods:

In this cross-sectional observational study, students (144 boys, 139 girls, 6-13 years old) were recruited from Experimental Primary School Affiliated to Shanghai Jiao Tong University in Shanghai, China in 2018. The study protocol was reviewed and approved by the Bio-Ethics Board of the Bio-X Institutes, Shanghai Jiao Tong University. Based on a simple Spatial Working Memory and Attention Test on Paired Symbols test, we evaluate 283 participants’ working memory and attention ability.

Results:

Attention and working memory performance were enhanced as a positive function of grade in primary school children, and students who showed better academic achievement also performed better on the working memory task. However, attention and working memory performance were not affected by sex.

Conclusion:

Attention and working memory performance of primary school students develop with grade and corresponds to Better academic performance. Attention and working memory ability do not differ significantly between boys and girls.
Factors Associated With Poor Response to Clozapine in Schizophrenia
Authors: Grover Sandeep , Naskar Chandrima , Chakrabarti Subho
Published: June 2022

Purpose/Background

Limited numbers of studies have assessed the predictors of clozapine nonresponse. This study aimed to assess the demographic and clinical factors associated with an inadequate response to clozapine in patients with treatment-resistant schizophrenia (TRS).

Methods/Procedures

Two hundred eighty-seven outpatients with TRS receiving clozapine for more than 1 year were divided into 2 groups based on the need for a second antipsychotic medication and/or electroconvulsive therapy after receiving clozapine in the maximum tolerable dose for at least 3 months.

Results/Findings

One hundred two patients (35.4%) were considered to be clozapine nonresponders. Compared with responders, clozapine nonresponders were more often unemployed at the time of starting clozapine (P = 0.04), had a longer duration of untreated psychosis (P = 0.007), had received significantly higher number of adequate antipsychotic trials in the past (P = 0.02), had received antipsychotic polypharmacy in the past (P = 0.01), had experienced adverse effects with first- (P < 0.001) and second-generation antipsychotics (P = 0.01), and had more medical comorbidities (P = 0.03). The nonresponders more frequently had visual hallucinations (P = 0.001), and feelings/acts or impulses attributed to some external source (P = 0.03) in the lifetime, and had a significantly higher Clinical Global Impression severity score at the time of starting of clozapine (P < 0.001). While on clozapine, nonresponders received significantly higher dose of clozapine (P = 0.001) and higher proportion of them experienced constipation (P = 0.04), hypersalivation (P = 0.002), and obsessive-compulsive symptoms (P = 0.05) as adverse effects of clozapine.

Conclusions/Implications

The present study shows that approximately one-third of patients with TRS do not respond to clozapine. However, clozapine nonresponders, although broadly similar in sociodemographic profile to clozapine responders, differ from clozapine responders on past treatment profile.
Topographic Anatomy of the Medial Labyrinthine Wall: Implications for the Transcanal Endoscopic Approach to the Internal Auditory Canal
Authors: Yacoub Abraam , Molinari Giulia , Mostafa Badr Eldin , El Fiky Lobna , Mansour Ossama , Presutti Livio , Caversaccio Marco , Anschuetz Lukas
Published: June 2022

Hypothesis

To characterize transcanal endoscopic landmarks of the medial labyrinthine wall and correlate these with anatomical features of the fundus of the internal auditory canal (IAC).

Background

The transcanal transpromontorial approach (TTA) enables minimally invasive access to the IAC. The establishment of a landmark-based dissection technique for the approach is crucial to avoid injury to the facial nerve.

Methods

Twenty temporal bones were dissected endoscopically through the TTA. Furthermore, high-resolution computed tomography (CT) scans from ten adult normal temporal bones were analyzed and three-dimensionally reconstructed.

Results

A stepwise dissection technique for the TTA was demonstrated depending on a newly described landmark used in the identification of the facial nerve. The proposed landmark, which was named the intervestibulocochlear crest (IVCC), is an integrated part of the otic capsule. It can be differentiated after the excision of the lateral labyrinthine wall as a laterally based bony pyramid between the cochlea and the vestibule. Its medially directed apex blends with the central part of the falcifrom crest and points to the distal part of the meatal facial nerve. The IVCC is best detected on axial CT images at the level of the tympanic facial nerve. The union between the IVCC and the falciform crest appears radiologically as a short stem or mini-martini glass.

Conclusion

The proposed IVCC is a novel landmark with a consistent relationship to the IAC fundus and the facial nerve. It may be utilized in conjunction with the falciform crest to identify the facial nerve during minimally invasive transcanal surgeries.
Computed-Tomography Estimates of Interaural Mismatch in Insertion Depth and Scalar Location in Bilateral Cochlear-Implant Users
Authors: Goupell Matthew J. , Noble Jack H. , Phatak Sandeep A. , Kolberg Elizabeth , Cleary Miranda , Stakhovskaya Olga A. , Jensen Kenneth K. , Hoa Michael , Kim Hung Jeffrey , Bernstein Joshua G. W.
Published: June 2022

Hypothesis

Bilateral cochlear-implant (BI-CI) users will have a range of interaural insertion-depth mismatch because of different array placement or characteristics. Mismatch will be larger for electrodes located near the apex or outside scala tympani, or for arrays that are a mix of precurved and straight types.

Background

Brainstem superior olivary-complex neurons are exquisitely sensitive to interaural-difference cues for sound localization. Because these neurons rely on interaurally place-of-stimulation-matched inputs, interaural insertion-depth or scalar-location differences for BI-CI users could cause interaural place-of-stimulation mismatch that impairs binaural abilities.

Methods

Insertion depths and scalar locations were calculated from temporal-bone computed-tomography scans for 107 BI-CI users (27 Advanced Bionics, 62 Cochlear, 18 MED-EL).

Results

Median interaural insertion-depth mismatch was 23.4 degrees or 1.3 mm. Mismatch in the estimated clinically relevant range expected to impair binaural processing (>75 degrees or 3 mm) occurred for 13 to 19% of electrode pairs overall, and for at least three electrode pairs for 23 to 37% of subjects. There was a significant three-way interaction between insertion depth, scalar location, and array type. Interaural insertion-depth mismatch was largest for apical electrodes, for electrode pairs in two different scala, and for arrays that were both-precurved.

Conclusion

Average BI-CI interaural insertion-depth mismatch was small; however, large interaural insertion-depth mismatch—with the potential to degrade spatial hearing—occurred frequently enough to warrant attention. For new BICI users, improved surgical techniques to avoid interaural insertion-depth and scalar mismatch are recommended. For existing BI-CI users with interaural insertion-depth mismatch, interaural alignment of clinical frequency tables might reduce negative spatial-hearing consequences.
Long-Term Outcomes of Round Window Reinforcement for Superior Semicircular Canal Dehiscence Syndrome
Authors: Bunne Marie , Andersson Helene , Myhrum Marte
Published: June 2022

Objective

To report long-term patient reported outcome measures (PROMs) after standardized round window rein-forcement (RWR) with thin cartilage and perichondrium for superior semicircular canal dehiscence syndrome (SSCDS).

Methods

Cross-sectional survey in 2020 and retrospective longitudinal study of outcomes at 3 months, 1 year, and last follow-up after 28 consecutive RWRs. Endpoints were the last follow-up for PROMs and 1 year postoperatively for audiometry and cVEMP.

Results

At the last follow-up (mean 2.4 years postoperatively), improvement was reported for 19/28 ears (68%) in symptoms overall; for 17/27 ears (63%) in auditory symptoms, and for 12/24 (50%) in vestibular symptoms. Nine ears (32%) required further surgery. No major complications occurred. On the group level, postoperative improvement at 3 months declined significantly for auditory and vestibular symptoms over time, and stayed stable beyond 1 year. Improved ears had on average 2.9 years follow-up. Improvement correlated significantly with SSCD length, and was associated with contralateral dehiscence. Thirteen ears (46%) had another potential cause of vestibular symptoms. This group showed significantly less improvement. Audiometric test results did not predict PROMs.

Conclusions

Since long-term outcomes do not compare with those reported for plugging and repair, RWR is not suggested as a first line intervention for SSCDS. Considering the stable rates of improvement on average 2.9 years postoperatively and the absence of major complications, RWR may be an alternative to plugging or repair in fragile patients who do not accept the risk of complications with more invasive surgery, and who accept that results may deteriorate over time.
Progression of Hearing Loss in Observed Non-Growing Vestibular Schwannoma
Authors: Luryi Alexander L. , Babu Seilesh , Bojrab Dennis I. , Kveton John F. , Schutt Christopher A.
Published: June 2022

Objective

To assess hearing outcomes in observed vestibular schwannoma (VS) with focus on non-growing tumors.

Study Design

Retrospective review.

Setting

Two tertiary neurotology centers.

Patients and Interventions

Patients with sporadic VS undergoing at least 3 years’ observation.

Main Outcome Measures

Changes in pure tone averages (PTA) and word recognition scores (WRS) normalized to the contralateral ear.

Results

During the study period, 39 of 105 included patients (37.1%) had tumor growth. Patients with tumor growth had a mean normalized increase in PTA of 8.0 dB HL (p = 0.008) corresponding to a normalized average worsening of their PTA of 1.8 dB per year. Patients with non-growing tumors less than 5 mm in maximal dimension did not have significant ongoing normalized hearing loss (p > 0.05). Patients with non-growing tumors more than or equal to 5 mm had a mean normalized increase in PTA of 7.4 dB HL (p = 0.001) corresponding to an average of 2.0 dB HL per year, which was similar to the loss observed in growing tumors regardless of size (p > 0.05). Normalized decline in PTA of at least 5 dB HL was seen in 72% of patients with growing tumors, 53% of patients with nongrowing tumors more than or equal to 5 mm, and 38% of patients with non-growing tumors less than 5 mm.

Conclusions

A long-term analysis of hearing outcomes in observed vestibular schwannoma is presented. With observation, VS more than or equal to 5 mm is associated with continued hearing loss even without tumor growth, while non-growing tumors less than 5 mm are not associated with continuing hearing loss. These data inform expectations for observed VS for providers and patients.
A Systematic Review of Cases with Bezold’s Abscess
Authors: Young Kurtis , Ilustre Joshua , Tang Dennis M. , Wu Arthur W. , Wong Yu-Tung
Published: June 2022

Objective

The objective for this systematic review is to characterize clinical presentations of Bezold’s abscesses to improve awareness and promote earlier diagnoses and prompt intervention in this increasingly rare otologic infection.

Data sources

Pubmed/Medline, CINAHL (EBSCOhost), and Web of Science articles in all languages were searched.

Study selection

Inclusion criteria were that the article was either a case report, case series, or retrospective review with individual case data available. Non-English articles were excluded if they lacked an English language abstract and if that abstract lacked information on baseline demographics, clinical presentation, and management.

Data extraction

Included studies were evaluated using fulltext review and demographics, etiology, microbiology, antibiotic usage, and surgical variables were collected.

Data synthesis

Data were qualitatively synthesized, with means and averages obtained for all continuous variables.

Conclusions

Bezold’s abscess remains a rare otologic infection, but they are relatively commonly associated with serious neurologic and systemic complications. Delay in diagnosis was a frequent commonality and diagnostic vigilance is tantamount in avoiding this sequelae. Aggressive surgical extirpation and long-term antibiotic treatment is recommended.
Omega-3 fatty acids and metabolic partitioning of fatty acids within the liver in the context of nonalcoholic fatty liver disease
Authors: Calder Philip C.
Published: June 2022

Purpose of review

Nonalcoholic fatty liver disease (NAFLD) is now the most prevalent form of liver disease globally, affecting about 25% of the world's adult population. It is more common in those living with obesity, where it may affect as many as 80% of individuals. The aim of this article is to describe recent human studies evaluating the influence of omega-3 fatty acids on de novo lipogenesis (DNL) and hepatic fatty acid partitioning between incorporation into triacylglycerols (TAGs) and β-oxidation, to discuss the relevance of these effects in the context of NAFLD, and to provide an overview of the mechanisms that might be involved.

Recent findings

The omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) decrease hepatic DNL and partition fatty acids away from TAG synthesis and toward β-oxidation. EPA and DHA affect multiple hepatic transcription factors resulting in down-regulation of the DNL pathway and upregulation of β-oxidation. The net result is decreased accumulation of hepatic TAG and lowering of circulating TAG concentrations. Human trials demonstrate that EPA and DHA can decrease liver fat in patients with NAFLD.

Increased intake of EPA and DHA may reduce the likelihood of hepatic TAG accumulation and could be used to reduce liver fat in patients with NAFLD.
Neoadjuvant treatment combined with planned endoscopic surgery in locally advanced sphenoid sinus basaloid squamous cell carcinoma
Authors: Zhang Yinghong , Tian Suqing , Du Yali , Zuo Qiang , Zhu Li , Ma Furong
Published: June 2022

Introduction:

Basaloid squamous cell carcinoma (BSCC) is a rare and aggressive variant of SCC. It often diagnosed at a late clinical stage and is associated with a poor survival rate, and the optimal sequence of treatment modalities remains unclear.

Patient concerns:

A 45-years-old male patient presented with 3 months history of left side nasal obstruction without rhinorrhea, olfaction loss, epistaxis, loss of visual acuity, and negative for family history of sinonasal carcinoma.

Diagnosis:

A transnasal biopsy was performed under general anesthesia. The Hematoxylin-eosin staining of the pathological slice and immunohistochemistry findings were consistent with the diagnosis of BSCC.

Interventions:

The patient was treated with planned endoscopic surgery after preoperative neoadjuvant cisplatin with concurrent radiation therapy. After neoadjuvant therapy, the tumor volume was reduced, facilitating transnasal radical resection. The endoscopic surgery was followed by radiation therapy.

Outcome:

Follow-up at 24 months post-surgery did not reveal any recurrence of the tumor.

Conclusion:

Neoadjuvant therapy consisting of radiation and cisplatin is a potentially effective therapeutic option in the treatment of locally advanced BSCC prior to surgical resection. This treatment and concurrent radiation followed by planned surgical resection results in significantly improved survival of the patients.
How provocative tests in addition to wet swallows during high-resolution manometry can direct clinical management
Authors: Sanagapalli Santosh , Sweis Rami , Fox Mark
Published: June 2022

Purpose of review

Provocative tests have been advocated to address limitations of high-resolution manometry (HRM) with wet swallows. We describe the commonly used provocative manometric manoeuvres [rapid drink challenge (RDC), multiple rapid swallows (MRS), solid swallows and the solid test meal (STM)], compare their diagnostic yield and accuracy to wet swallows, and outline their role in directing clinical management.

Recent findings

Provocative testing with RDC and STM identifies a proportion of achalasia cases missed by standard testing, and RDC can play a similar role to radiology in the evaluation of treatment response. In EGJOO, provocative testing with RDC and STM not only increase the diagnostic yield, but can also help differentiate between spurious cases and those representing true outflow obstruction likely to respond to achalasia-type therapies. MRS and STM can help determine the clinical relevance (or otherwise) of ineffective oesophageal motility, and in this setting, MRS may predict the likelihood of postfundoplication dysphagia. RDC and STM can help identify cases of postfundoplication dysphagia more likely to respond to dilatation.

Provocative testing has been shown to increase diagnostic yield of HRM, clarify inconclusive diagnoses, allows corroboration of dysmotility with patient symptoms and helps direct clinical management.
Diet as a treatment for inflammatory bowel disease: is it ready for prime time?
Authors: Cusimano Frank A. , Damas Oriana M.
Published: June 2022

Purpose of review

Diet remains an important topic for patients with inflammatory bowel disease (IBD), yet few guidelines for dietary recommendations exist. There is a growing interest in the use of diet as treatment or adjuvant therapy for both ulcerative colitis and Crohn's disease. Here, we highlight the latest evidence on the use of diet for treatment of symptoms, active disease and maintenance of remission in ulcerative colitis and Crohn's disease.

Recent findings

The Crohn's Disease Exclusion Diet (CDED) and the Specific Carbohydrate Diet (SCD) are studied diets that have gained popularity, but there is growing interest in the use and efficacy of less restrictive diets such as the Mediterranean diet. Recent data suggest healthful dietary patterns alone, with an emphasis on whole foods that are high in vegetable fibre and that promote less consumption of ultra-processed foods may also help achieve remission in patients with ulcerative colitis and Crohn's disease.

In this review, we summarize the literature on diet as treatment for IBD. We highlight the latest clinical dietary studies, randomized clinical trials, as well as new and emerging diets for the treatment of IBD.